Not all casualties on the battlefield are victims of blast or penetrating trauma. Cardiac arrest in the absence of blast or penetrating trauma may warrant consideration for initiation of CPR.

For example, in severe cases of hypothermia, a casualty can lose vital signs but regain them once they have been actively warmed; and if CPR is initiated, their outcome may be improved. Similarly, near-drowning victims may experience cardiac arrest. Another situation you could encounter is electrocution, in which a return of normal cardiac activity may be delayed, but occur even in the absence of defibrillation. These, and other non-traumatic instances of cardiac arrest, may lead you to consider initiating CPR.

However, the same potential drawbacks previously mentioned apply in these cases, as well. If the situation is not safe, the responders may be at risk of becoming casualties while performing CPR. The resources that need to be dedicated to proper CPR are significant, to include multiple people to do compressions and provide respirations, perhaps over a significant amount of time, depending on the evacuation and transfer options. Mission success should not be compromised, and the Combat Medic/Corpsman will need to weigh all of these issues when making a determination about initiation and cessation of CPR attempts.

Not covered in this discussion, but important to understand, is that the Tactical Evacuation Phase TCCC Guidelines state: “CPR may be attempted during this phase of care if the casualty does not have obviously fatal wounds and will be arriving at a facility with a surgical capability within a short period of time. CPR should not be done at the expense of compromising the mission or denying lifesaving care to other casualties.”