When injuries occur in the Austere, Remote or Tactical (ART) environment, outcomes can be improved by swift medical intervention. This may be lifesaving critical care or giving analgesia for a field sprain. The resultant group awareness that the medical professional’s care is close at hand is good for morale and operational effectiveness.This manual presents a system for delivery of Acute Critical Care, with a focus on lifesaving interventions that reduce or eliminate preventable death.The manual draws from my personal civilian, expedition and military medical experience alongside the body of published evidence which forms the basis for Remote Damage Control Resuscitation (RDCR). The RDCR concept was an adaption of Advanced Trauma Life Support (ATLS) and Prehospital Trauma Life Support (PHTLS) for the military environment in the conflicts of Iraq and Afghanistan.This manual is also heavily influenced by the Trauma Hemostasias Oxygenation Research (THOR) Network, a multinational, multidisciplinary group of medical professionals who seek to improve outcomes in traumatic hemorrhagic shock. The THOR network was at the forefront of the reintroduction of Whole Blood as the optimum resuscitation fluid for patients with hemorrhagic shock from 2010.There are many systems and ways of approaching the critically injured casualty. The best is the one which works, and that the provider has practiced repeatedly to proficiency in scenarios, and even more importantly for real in the deployed setting.It is only in constantly striving for improvement, with careful reflection on our performance within a team, that we improve. We also require an awareness of the harm we might do, actively looking for and avoiding those harms. No person should perform an intervention unless they are aware of the risks, have a strategy to identify them and more importantly rectify these if encountered. There is a tendency in medicine towards iatrogenic blindness, it is the responsibility of all medical professionals to constantly seek to identify and strive to eliminate this.There is a special camaraderie between those who seek to help people and save life in the most difficult circumstances including the lives of their opponents. It is to these brave and honourable men and women that this manual is dedicated.“Delivering the BEST care we can in the WORST of situations”
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