DISSECTING THE CHAIN OF SURVIVAL

Elements of the Chain

The Point of Injury (POI) is where the chain starts – it is the location where a casualty
incurs any injury. This is also where the first link of the chain begins- initial
medical attention in the form of self aid/ buddy aid, or more recently, Tactical Combat
Casualty Care (TC3) provided by the Combat Lifesaver (CLS) via Care Under
Fire. Here, critical lifesaving medical attention is given which tried to address the
age-old problem of stopping the bleeding. Failure at this level of the chain to give the
expected medical care causes catastrophic consequences. The next form of medical
care which also falls under the aegis of TC3 is Tactical Field Care that is afforded at the
Casualty Collecting Point (CCP). So far, the both forms of medical care are Level 1
and 2 in the Echelons of Care. The next element of the chain is evacuation wherein
again, as the last triad of TC3, En Route Care, falls into. This is a very signifi cant
part of the chain of survival for the success and speed of evacuating a casualty signifi
cantly determines the outcome of the casualty. Failure to afford prompt and adequate
evacuation negates any and all gains obtained at the fi rst element of the chain
or in Level1 and 2. Upon arrival at the medical treatment facility (MTF), surgical
intervention, which must be timely, and appropriate, completes the chain of survival
that a casualty has to pass through. Here, Level 3 of the Echelon of Care is afforded.

The PMC Experience

Taken in context, one now must take a look where the PMC, in relation to the
chain of survival, has room for improvement or needs more attention. Knowing
that the PMC has been at the forefront of major battles against insurgents in the
Philippines since its inception in 1950, it is but easy to see that dissecting the chain
of survival in the PMC operational setting makes the article relevant. In the fi rst
link of the chain, the presence of the unit Corpsman and lately the Combat Lifesavers
(CLS) are the main providers of this form of care. The training these personnel
receive are focused more on fi eld medicine, along with the tools of the trade that
they take along with them in battle. However, a critical part of the fi rst chain, self
aid / buddy aid that the individual Marine can perform, is lacking or weak in terms
of knowledge, skills and training. Though the aforementioned unit healthcare providers
are present, having every Marine knowledgeable in self aid/ buddy aid and
consequently equipped to perform such task strengthens the foundation of the fi rst
link of the chain. The second link is a very weak link the PMC has in its relationship
to the chain. Inasmuch as land evacuation assets are limited, and the terrain the Marines
operate are some of the most difficult terrains our country has, the utter dependence
on air and maritime evacuation assets whose availability are dictated by
several factors makes this link practically the critical gap in the chain. As noted, the
dependency or absence of such evacuation assets negates the gains afforded
in the fi rst link. The last link, though, not among the capabilities of the PMC, has
to be given consideration, due to its role of keeping a battle casualty
alive. Though the PMC is dependent on General Headquarters controlled MTF’s
that provide such like the Armed Forces of the Philippines (AFP) Trauma Center in
Jolo and the Camp Navarro General Hospital in Zamboanga City both in the volatile
southern Philippines, the capability or lack of a capability of either MTF will dictate
the eventual outcome of our casualty.

Recommendations

Having dissected the chain, and identifying its relationship to the PMC, it is
evident that there are certain critical gaps that the PMC can address to solidify the
chain. The simplest is providing self aid/ buddy aid training to all Marines and adequately
equipping the individual Marine so as to enable him to be able to translate
the skills learned into good use. For the second link, providing the line units
with dedicated and capable land evacuation assets for starters will make the foundations
of this link sturdier. The Navy, as the mother unit of the PMC, may as well
invest in providing the PMC air and maritime evacuation assets that can be relied
on at a moments notice in most if not all kinds of scenarios. This also will strengthen
the Fleet Marine concept of operations wherein interoperability via appropriate
naval assets to support Marine evacuation requirements, shall be done. The last
link can be suitably modifi ed to meet the PMC’s needs and missions; providing a
mobile aid station deployable in conjunction with brigade level tactical command
posts during operations, with surgical resuscitative capability will improve chances
of survival and at the same time decrease the level of dependency of Marine combat
casualties to AFP fi xed MTF’s. Though that will entail much training and cost, investing
in such an endeavor with its expected outcome will make such worth its price.

Conclusion

Time and again, same problems with essentially same lessons learned recur.
Though the basic problem of stopping the bleeding has been partly addressed, this effort
can only be good to a certain period of time, in accordance with the prescribed
Golden Hour in trauma that the other links in the Chain of Survival supplement
to improve the a casualty’s chances of living in today’s battlefield.

Date: 01/25/2011

Source: MCIF 1/11