Introduction Haemorrhage is the leading cause of preventable death in combat settings. Pre‑hospital practice guidelines for shock advocate for intravenous (IV) access to enable the rapid delivery of blood products and adjunct treatments. However, peripheral intravenous catheter (PIVC) insertion and securement is challenging in the austere setting, and catheter failure is common. This study investigated dressing and securement methods to prevent PIVC dislodgement within an Australian Defence Force (ADF) tactical combat casualty care (TCCC) training course.

Methods A pragmatic in vitro design was used to compare the proportion of dislodged PIVCs using three securement techniques – the ruggedised field IV method (Ranger), the S‑Wrap technique, and standard care (a Tegaderm^TM dressing). The study was undertaken from February to May 2022 at the Australian Army School of Health (ASH) in Victoria, Australia. Pull-out force was simulated using a purpose-designed pulley system and measured with a digital forge gauge. The null hypothesis of no difference in average force between products was tested using one-way analysis of variance, followed by a post‑hoc Bonferroni test. Statistical significance was determined at p≤0.05. This study is registered with the Australian New Zealand Clinical Trials Registry CTRN12621000314820.

Results Of the three methods of PIVC securement tested in this study (standard, Ranger, S‑Wrap), the S‑Wrap method demonstrated a significantly higher average pull-out force (66.1N; SD 7.1), and the lowest average pull-out force was associated with Tegaderm^TM (9.7N; SD 2.2). The securements provided greater resistance against the pull-out force at 0˚ compared to 30˚. The three Bonferroni-adjusted p values for the three null hypotheses between the three products were all <0.001.

Conclusion PIVC securement is challenging in the austere or combat setting, and failure is common. The S‑Wrap technique is an uncomplicated, feasible and safe PIVC securement dressing for use in high threat/austere pre‑hospital settings.

Firefighters, paramedics, police and rescue authorities can find themselves confronted with highly chaotic and stressful situations on arrival at vehicle collisions with casualties including those who are trapped. Cognitive overload can occur as first responders find themselves juggling the responsibility of scene safety alongside patient care. This paper introduces CrashMARCHE, a dual stream mnemonic built on an existing patient care mnemonic (MARCHE) developed in the tactical medicine sub-discipline. CrashMARCHE adds a scene safety stream, prompting users to undertake certain tasks to improve their safety and that of others on the scene. This model is scalable to individual training, skills and agency procedures and is encouraged to be used by all involved in this type of response. It intends to prompt first responders to undertake key life-saving actions whilst also establishing a safe work environment. It is hoped this model will be considered for inclusion as part of formal training and qualifications as well as organisational procedures.

This paper examines the history and current provision of medical care within public order (PO) situations in the United Kingdom (UK). In exploring the definitions and categories of disorder, it describes a high threat, non-permissive environment that can be compared to the threat of a firearms environment, an area in which high threat medicine, tactical medicine or tactical emergency medical support (TEMS) has been formally recognised. Although UK PO scenarios are only rarely associated with firearms discharges, after considering the unique challenges, characteristics, prevalence and injuries arising within this particular environment, the paper proposes that PO medicine should be recognised as an operational sub-speciality of UK high threat medicine in its own right. The obligations of those groups potentially providing care within PO has some bearing on the care that can be provided. This paper examines the UK legal powers, equipment, experience and training requirements to assist pre-hospital care providers in the recognition and development of this unique sub-speciality both in the UK and internationally.