Challenging the Status Quo of Tactical Medicine
Dogma Detectives takes a critical look at widely held beliefs in medicine, examining the evidence, literature, and research that support—or challenge—current practices. The goal is to foster thoughtful discussion, promote ongoing learning within the Tac-Med community, and deepen understanding of the science that shapes modern medical decision-making.
Have a case for the Dogma Detectives? E-mail us at DogmaDetectives@gmail.com, and we may feature your case on the Tac Med Page!
Current Dogma Detective cases can be downloaded below
To Be Blunt, Should I Work This Arrest
Dogma Detectives Case #09-09-13-01 Case Summary:
This Dogma Detectives case examines whether patients in blunt trauma cardiac arrest should receive resuscitative efforts in the field. Traditional teachings suggest near-zero survival, but a review of global studies reveals a small subset of patients—particularly those with hypoxic, electrical, or reversible causes—may benefit from targeted intervention. The conclusion: the idea that survival is impossible is a myth, not a fact. Proper triage, rhythm assessment, and resource-aware care can identify rare but real opportunities for survival.
The Shock Was Palpable
Dogma Detectives Case #05-13-13-01 Case Summary:
This case investigates the long-held assumption that the presence or absence of certain pulses can reliably estimate systolic blood pressure—a concept rooted in outdated ATLS guidelines. Reviewing multiple small observational studies, Dogma Detectives finds limited support for this method, revealing frequent overestimations of BP based on pulse location alone. The conclusion? While pulse quality correlates with patient outcomes, clinicians should focus less on estimated numbers and more on signs of hypoperfusion and clinical context.
Tipping The Scale
Dogma Detectives Case #05-09-13-01 Case Summary:
This case examines the longstanding use of the Trendelenburg position in treating hypovolemic shock and cardiac arrest. Despite its persistence in emergency protocols, research consistently shows minimal to no hemodynamic benefit—and in some cases, potential harm, including impaired respiratory function and increased afterload. Dogma Detectives challenges the routine use of this position, highlighting the importance of evidence-based interventions like passive leg raises, which offer limited but more physiologically sound benefits.
To MONA with Love
Dogma Detectives Case #03-21-13-01 Case Summary:
This case revisits the classic MONA protocol—morphine, oxygen, nitrates, and aspirin—for treating acute coronary syndrome. While aspirin remains strongly supported by evidence, the utility of morphine, oxygen, and nitrates is far less clear. Recent studies reveal potential harm from morphine, no proven benefit from routine oxygen use, and limited clinical value from nitrates beyond symptom relief. Dogma Detectives highlights how evidence has evolved—and why treatment must follow suit.
Supraglottic Airway Roundtable
Dogma Detectives Case #03-17-13-01 Case Summary:
This case explores the evolving role of supraglottic airways (SGAs) in prehospital care and tactical environments. While faster and easier to place than endotracheal tubes, SGAs pose concerns around aspiration protection, cerebral blood flow, and complications during subsequent intubation. Drawing on current studies and device comparisons, Dogma Detectives highlights the trade-offs between convenience and definitive airway control—emphasizing that the best approach depends on provider training, patient presentation, and system capabilities.
Ringers vs. Saline
Dogma Detectives Case #03-13-13-01 Case Summary:
This case challenges the assumption that Normal Saline (NSS) and Lactated Ringer’s (LR) are physiologically interchangeable in resuscitation. Drawing from studies in surgical, trauma, and pediatric populations, Dogma Detectives reveals that large volumes of NSS can lead to hyperchloremic metabolic acidosis, coagulopathy, and increased bleeding—while LR more closely mirrors plasma chemistry and results in better outcomes in high-volume resuscitation. Though the difference is less critical in short EMS transports, prolonged care settings should reconsider defaulting to saline.
Arresting Alchemy
Dogma Detectives Case #03-07-13-01 Case Summary:
This case evaluates the role of epinephrine in cardiac arrest, asking whether its routine use actually improves meaningful survival. While multiple studies show increased rates of return of spontaneous circulation (ROSC), none demonstrate consistent improvements in neurologically intact survival or hospital discharge rates. Dogma Detectives highlights that, despite long-standing protocols, the evidence for epinephrine’s effectiveness remains inconclusive—and that high-quality CPR and early defibrillation continue to be the most critical interventions.
The Chest Seal Conundrum
Dogma Detectives Case #03-03-13-01 Case Summary:
This case challenges the long-held EMS practice of sealing all open chest wounds with occlusive dressings or chest seals. Dogma Detectives reviews the physiology of open vs. closed pneumothoraces and finds that sealing a wound may actually increase the risk of developing tension pneumothorax—especially in cases involving lung parenchyma injury. The conclusion: the evidence is inconclusive, and in some cases, maintaining an open pneumothorax may be the safer approach until definitive care is available. Chest seals should not be considered universally benign.
Backboards Breaking My Back
Dogma Detectives Case #02-21-13-01 Case Summary:
This case questions the routine use of backboards and collars in EMS, especially for blunt and penetrating trauma. While widely used, research reveals no clinical benefit for blunt trauma and clear evidence of harm in penetrating injuries—including a doubled mortality risk. Dogma Detectives highlights that immobilization can increase pain, imaging time, and length of stay without improving outcomes. Instead, providers are urged to follow evidence-based decision tools like the NEXUS criteria or Canadian C-Spine Rule and minimize unnecessary immobilization in the field.
Atrovent vs. Magnesium
Dogma Detectives Case #02-20-13-01 Case Summary:
This case compares Atrovent (ipratropium) and magnesium sulfate in managing acute exacerbations of reactive airway disease, particularly asthma and COPD. While both agents show modest benefit, magnesium appears more effective in severe asthma when used alongside beta-agonists, helping bridge the gap until steroids take effect. Atrovent demonstrates some value in moderate to severe asthma and long-term COPD management, though acute COPD benefits are less clear. With minimal side effects, both remain useful—but not interchangeable—tools when used with clinical discretion.
Red Lights Response
Dogma Detectives Case #02-18-13-01 Case Summary:
This case examines whether the routine use of lights and sirens (L+S) in ambulance responses actually improves patient outcomes. While L+S may save 45 seconds to 4 minutes of response time, studies show no significant benefit to survival or care quality—and a marked increase in crash risk, particularly at intersections. Dogma Detectives concludes that while L+S may feel urgent, good patient care matters more than speed, and minimizing unnecessary risk should take priority.
Angioedema Challenges
Dogma Detectives Case #02-17-13-02 Case Summary:
This case explores the critical differences between allergic, hereditary, and medication-induced angioedema—highlighting why standard treatments like epinephrine, steroids, and antihistamines are ineffective in non-allergic presentations. Bradykinin-mediated angioedema, often triggered by ACE inhibitors or calcium channel blockers, requires supportive care and airway management rather than traditional allergy protocols. Dogma Detectives emphasizes the importance of accurate diagnosis and timely intervention, especially when managing airway compromise in vulnerable patients.
Tourniquet Trouble
Dogma Detectives Case #02-17-13-01 Case Summary:
This case challenges outdated fears about tourniquet use by tracing their history from Civil War practices to modern tactical medicine. While once considered a last resort due to perceived risks like limb loss and acidosis, current evidence overwhelmingly supports early tourniquet application for severe bleeding. Dogma Detectives highlights how military experience and clinical research now recognize tourniquets as life-saving tools that should be standard in both civilian and combat settings, with minimal risk when used appropriately.