The Symbiotic Relationship Between Operational Military Medicine, Tactical Medicine, and Wilderness Medicine: A View Through a Personal Lens.

There are direct and indirect linkages and a form of symbiosis between operational military medicine from World War II and present wilderness medicine, from the beginnings to contemporary practice, and the more recently evolved field of tactical emergency medical support. Each of these relationships will be explored from the historical perspective of the Department of Military & Emergency Medicine, Uniformed Services University of the Health Sciences from 1982 to the present.

The Transition to the Committee on Tactical Combat Casualty Care.

The original Tactical Combat Casualty Care (TCCC) guidelines were published in a special supplement to Military Medicine in 1996 as the terminal deliverable of a 2-year development project funded by the United States Special Operations Command (USSOCOM). Two years later, the USSOCOM Biomedical Initiatives Steering Committee (BISC) promulgated its Task Statement 5-98, in which it called for the formation of a panel of subject matter experts to update the TCCC guidelines. This article discusses the formation of the Committee on Tactical Combat Casualty Care (CoTCCC) and the changes to the original guidelines that constituted the first update.

Tactical Combat Casualty Care: Beginnings.

Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. The origins of TCCC were nontraditional. The TCCC program began as a Naval Special Warfare biomedical research effort launched after the realization that extremity hemorrhage, a leading cause of preventable death on the battlefield, was not being treated with a readily available and highly effective intervention: the tourniquet. This insight prompted a systematic reevaluation of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by special operations medical personnel and the Uniformed Services University of the Health Sciences. The product of that 3-year research project was TCCC, the first-ever set of battlefield trauma care guidelines designed to combine good medicine with good small-unit tactics.

The role of the expedition doctor: lessons from 100 years ago.

This paper explores the role of the doctor on the expeditions of the heroic age of Antarctic exploration. The medical role includes medical screening of prospective expedition members, choosing medical equipment so as to maintain a balance between being able to cope with any eventuality and the cost and weight of equipment and drugs, health screening during an expedition, first aid training for field parties without a doctor, and, obviously, treatment of any injury or disease that occurs. If injury or illness occurs, the presence of a doctor is of great psychological benefit to the expedition. Although medical experience is important, it is probably more important that the doctor is a "team member," playing a full part in the expedition's aims, whether these are scientific, exploration, or reaching some goal. Most of the lessons learned during these expeditions a hundred years ago are just as relevant today.

The foundations of wilderness medicine: some historical features.

The surgeons of the navies of the early days of western civilization--Greece, Rome, and the Italian city-states--were most likely the first practitioners of recognizable wilderness medicine. The teachings of Hippocrates and Galen ruled over the practice of medicine in Europe for centuries, but the steady evolution of understanding of the nature and causes of disease was starting to provide a useful foundation upon which to build by the turn of the 19th century. By 1800, nonetheless, the gap between medical theory and knowledge and the real ability to provide effective therapy was still enormous. However, the discovery of anesthesia in the 1840s and Joseph Lister's elucidation and application of the principles of asepsis in 1865 were major steps forward in the history of medicine. Many other improvements in civilian medical care relevant to wilderness medicine, though, have come about as a direct result of military medicine having to determine how to best keep people alive and well, often in very trying combat-related circumstances. The advancement of wilderness medicine has been closely connected to military exploration/operations throughout history, and not surprisingly, this remains in many ways as true today as it was a thousand years ago.

Because it's there The education of George Mallory.

Initiative, creativity, and resolve represent both the pillars of the Wilderness Medical Society (WMS) and the story of George Mallory. His journey from humble beginnings to his rise to become one of history's most legendary mountaineers is a testament to the impact of great mentors as well as the development of Mallory as a mentor himself. In this light, the path of George Mallory in mountaineering and the role of WMS in wilderness medicine share a common theme. This essay is not only a tribute to George Mallory but also a testament to the importance of mentorship and the role of WMS in inspiring mentorship and education to future pioneers.

Raymond Greene: physician, mountaineer, and raconteur.

C. Raymond Greene (1901-1982) was a man of many talents. After graduating from medical school in 1927, he spent a decade in general practice. He subsequently became heavily involved in the emerging specialty of endocrinology and went on to gain considerable recognition in the treatment of thyroid disorders before eventually becoming involved in the world of medical publishing. Aside from Greene's mainstream vocational and intellectual pursuits, from boyhood he nurtured a passionate interest in mountaineering--first in his native Great Britain, and then the European Alps, and ultimately in the high Himalayas. His involvement in landmark climbs, such as the successful Kamet venture in 1931 and Everest attempt in 1933, earned him a place in the pantheon of Himalayan explorers and mountaineers and stimulated Green's interest in high altitude physiology and medicine. He made notable additions to the literature on this subject in publications such as Nature and Journal of Physiology. Apart from his remarkable life achievements in the areas of medicine, mountaineering, and publishing, Greene was perhaps best remembered by those close to him (and by contemporary readers who are devotees of his writing) as a peerless storyteller with a sardonic sense of irony.