Futuristic Utilization of Tactical Night Vision Goggles in Darkness by Combat Medics

In   Issue Volume 25 No. 2 .

Sedat BILGE M.D.
Emergency Physician Specialist (sedatotuz@gmail.com), Gulhane Research and Training Hospital, Department of Emergency Medicine, Etlik, Ankara, Turkey, 06010
Attila AYDIN M.D.
Emergency Physician Specialist (drattilaaydin@gmail.com), Gulhane Research and Training Hospital, Department of Emergency Medicine, Etlik, Ankara, Turkey, 06010
Cemile AYDIN M.D.
Internal Medicine Specialist (drcemileaydin@gmail.com), Etimesgut State Hospital, Department of Internal Medicine, Etimesgut, Ankara, Turkey, 06010
Meltem BILGE M.D.
Anesthesia and Resuscitation Specialist (doktormeltem@hotmail.com), Diskapi Reearch and Training Hospital, Clinic of Anesthesia and Resuscitation, Diskapi, Ulus, Ankara, Turkey, 06010
Associate Professor of Surgery General Surgeon & War (mehmeteryilmaz@hotmail.com), Gulhane Research and Training Hospital, Department of Emergency Medicine, Etlik, Ankara, Turkey, 06010

Nowadays, the laws of war and rules of engagement are often disregarded by enemy combatants, and it is common to encounter practices in direct violation of these principles. To perform life-saving interventions and treatment on the battlefield, combat medics need special equipment, including light-emitting devices such as laryngoscopes and finger lights. However, the use of such devices in prehospital critical settings can potentially turn combat medics into targets for the enemy. Using this equipment in the field without taking tactical precautions can significantly increase the risk of enemy fire for combat medics. Night-time operations have also shown that insufficient light can significantly affect the success rate of these skills and procedures. When facing limitations at night or in limited light conditions, soldiers generally resort to the tactical solution of using night vision goggles (NVG). 1 Using light-emitting devices at night-time is associated with the risk of being spotted and killed by the enemy. An Israeli physician was shot by a sniper while performing endotracheal intubation (ETI) at night. 2 There have been a few studies on NVG use in medical interventions, including on an ETI application with NVGs undertaken by anaesthetists1; on emergency cricothyroidotomy with NVGs 3; and on ETI and intravenous line insertion (IVI) with NVGs undertaken by emergency physicians and paramedics. 4 However, considering the nature of military operations, it is well-known that the most frequently encountered types of injuries on the field are injuries to chest, head, abdomen and extremities. We have noted that there are currently no NVG studies on these types of battlefield injuries. 5

There is consequently a need for NVG studies on life-saving medical procedures. At the clinics of the Gulhane Military Medical Academy Department of Emergency Medicine- Turkey, we are continuing to conduct medical studies on this subject. Our ongoing studies have revealed that combatant medical staff are able to apply chest tube and needle thoracostomy successfully by using the NVG. (Figure-1-2) Military paramedics/medics not only perform patient intervention on the field of combat, but they also have to observe their environment without taking their NVGs off during battle.

The study of Butler et al. 2 is a tragic illustration of the harm and damage that can be caused when an extra light source other than the NVG we recommend is used by paramedics/medics in the field of combat. Medical interventions performed with NVG in the dark should be a part of basic training provided in tactical emergency medicine.

In the future, NVG it can be expanded to other lifesaving interventions like vascular access, in the darkness and in unsafe circumstances, and can provide safety both for the providers of first aid and for the wounded individuals. More studies can be conducted with NVG to enhance the safety of interventions undertaken in unsafe areas.

The authors state that they have no conflict of interest

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References 1- Gellerfors M, Svensén C, Linde J, et al. Endotracheal Intubation With and Without Night Vision Goggles in a Helicopter and Emergency Room Setting: A Manikin Study. Mil Med. 2015; 180:1006-10. 2- Butler FK Jr, Holcomb JB, Giebner SD et al. Tactical combat casualty care 2007: evolving concepts and battlefield experience. Mil Med. 2007; 172:1-19. 3- MacIntyre A, Markarian MK, Carrison D et al. Three-step emergency cricothyroidotomy. Mil Med. 2007 ;172 :1228-30. 4- Brummer S, Dickinson ET, Shofer FS et al. Effect of night vision goggles on performance of advanced life support skills by emergency personnel. Mil Med. 2006; 171:280-2. 5- Dawes R, Thomas GOR: Battlefield resuscitation. Curr Opin Crit Care 2009; 15: 527–35.


Acknowledgement Dedicated in memory of Lt. Col. Ihsan EJDAR