When care under fire isn’t a metaphor, how do you adapt your medical response?
We recently sat down with Scott King, tactical medical educator and course lead for our upcoming Hostile Environment Medicine Course in Namibia, to unpack the foundational principles of hostile medicine. This conversation, now released as the first episode in a multi-part webinar series, is free to view and packed with insights that bridge military and civilian pre-hospital care.
Below are some key themes and takeaways from that session.
What is Hostile Medicine?
Scott defines hostile medicine as any medical response that must happen in a threat-rich or resource-poor environment. That could mean conflict zones, active shooting scenes, or even civilian scenarios involving gang violence or mass casualty incidents. More than just being armed, hostile medicine is about being situationally aware, decisive under pressure, and confident in adapting your training to suit the reality on the ground.
“You don’t need to be in uniform to learn from tactical medicine, we’re seeing lessons from combat care apply across civilian and paramedic roles every day.”
From C-ABCDE to MARCH: A Shift in Mindset
One of the most impactful topics covered was the evolution from the traditional C-ABCDE structure to MARCH, a NATO-standard approach increasingly adopted in both UK military and civilian trauma training.
Why the change? Because massive haemorrhage control is now understood to be the most urgent priority.
Waiting to assess bleeding further down the checklist can cost lives.
“If in doubt, apply the tourniquet. But what we’re teaching now is also about knowing when and how to revisit that decision. Conversion and de-escalation are just as vital.”
Prolonged Field Care is the New Reality
In environments like Ukraine and Gaza, the ‘golden hour’ is often unattainable.
Scott shares how field medics are now holding patients for up to 14-18 hours before they can be extracted to surgery.
This changes the resuscitation landscape entirely.
From whole blood use to telemedicine, and from pain relief protocols to temperature control, prolonged field care is about continuing effective care, often with minimal kit and under huge pressure.
“We’re seeing forward deployment of skills and blood products like never before. You need a system. You need realism in training. You need confidence in chaos.”
Why Communication is a Life-Saving Skill
Whether you’re working alongside NATO partners or briefing emergency services, clear, structured communication can change outcomes. Tools like MIST, NATO 9-liners, and even simple handovers based on the MARCH framework help ensure care is continuous, even in disruption.
Scott also touched on the importance of systems-based training:
- Start simple, then layer in environmental stress
- Build muscle memory for critical interventions like tourniquet application
- Use techniques like Five-for-Five (take 5 seconds to plan the next 5 minutes) to ground decision-making
Ready to Train in Namibia?
This blog only scratches the surface of the full conversation. If you’re serious about developing tactical medical skills in real-world conditions, and applying them to both clinical and non-clinical scenarios, the Hostile Environment Medicine Course is your next step.
When: 1st – 7th June 2025
Where: Namibia
Taught by Scott King & WEM faculty
Includes TCCC certification
And if you haven’t already, watch the full webinar episode now, it’s free to view and sets the stage for what’s to come.
→ Want to learn more? Check out part one of the series now.
→ Join Scott in Namibia this year!
→ Have you played our Hostile Horizons Game? Check it out now.
