Introduction: This abstract analyzes new challenges in combat medicine (TCCC) in the conflict scenarios of the Ukrainian front, the October 7th attack, and the Gaza War, and the Hizbullah-Israel escalation, between 2022 and 2024, and what lessons learned can be integrated in a civilian environment, according to TECC guidelines and algorithms. Methods: Methodology is based on bibliographical revision, providing a framework for TCCC’s emerging patterns. Afterwards, an analysis based on the TECC guidelines and Hartford Consensus algorithms is conducted to infer the main lessons to integrate into civilian tactical care situations. Results: 1. Ukrainian front. The use of conventional artillery and drones as guided projectiles in swarm or isolated configurations, and lately as flame-throwers, adds to mass hemorrhage injury patterns as fractures from collapsed structures and burns. 2. Gaza front. October 7th combined a high lethality from multiple locations, active shootings, hostage taking, and the use of grenades and fire in close quarters. Operations in Gaza feature underground warfare and massive use of artillery and IEDs, coexisting with stabbing attacks and car rammings in the West Bank. Mass bleeding injury patterns add collapsed structure, crush traumatic injuries, and non-lethal mental issues. 3. Lebanese front. Hizbullah increased the use of rockets and drone attacks, causing mass casualty incidents, looking for the collapse of the regional hospital network. Israeli tampering with Hizbullah’s pagers as IEDs leveraged the device ergonomics to maximize lethality and injury patterns. Casuistry doesn’t reveal new injury patterns, but rather the multiplication of the number of victims. Conclusion: TECC-related algorithms remain valid. Lessons learned must include a) management of a massive number of simultaneous casualties; b) capabilities for tactical rescue and care in underground or collapsed structures; c) a high number of casualties with primary, secondary, and tertiary blast injuries due to explosions and different severity burnings because of the use of fire in open and confined environments.
Beatriz Alegre Gutiérrez (Sun,) studied this question.