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Rehearsals integrate medical evacuation with tactical operations. Practicing casualty movement, CCP setup, HLZ marking, and communication procedures reduces delays and confusion during real missions. It does not replace medical training or CCPs. Mission orders remain essential. Rehearsals under realistic conditions expose weaknesses and allow refinement, increasing survivability and mission effectiveness.

Four-person litter teams balance speed, endurance, and casualty stability, allowing rotation of carriers and preserving strength over long distances. Security elements provide overwatch during movement, ensuring survivability. Two-person carries exhaust operators quickly, risking drops or delays. Assigning medics to all litters prevents them from performing medical oversight. Moving without rest reduces effectiveness and increases exposure. Pre-rehearsed rotations, strap systems, and bounding with security ensure safe casualty evacuation across challenging terrain while maintaining mission integrity.

The 9-Line communicates location, security, patient precedence, and logistics to launch evacuation. MIST adds clinical detail vital for receiving teams: mechanism (blast, GSW), injuries (anatomic), signs/symptoms (vitals, mental status), and treatments provided (tourniquets, TXA, decompression, blood). Used together, they streamline preparation of appropriate teams and equipment, accelerating definitive care. MIST is not post-mission paperwork nor hospital-only. Delivering clear, standardized MIST reduces handoff errors, ensures continuity of care, and supports efficient triage at the next echelon. Include times of key interventions and any changes since initial report.

Secondary brain injury is prevented by maintaining oxygenation and cerebral perfusion. Field guidelines emphasize avoiding hypotension (SBP <90) and hypoxia (SpO₂ <90). Permissive hypotension is contraindicated in TBI. Hyperventilation is reserved only for herniation, not routine care. Steroids have no role in acute TBI and worsen outcomes. SBP ≥100–110 and SpO₂ ≥90% represent critical targets. This approach preserves perfusion pressure, supports autoregulation, and minimizes risk of secondary ischemia until neurosurgical care is available.

Hypothermia is part of the lethal triad (acidosis, coagulopathy, hypothermia) and accelerates death in trauma. After hemorrhage control, apply hypothermia prevention kits: insulated blankets, active warming devices, and vapor barriers. Passive only measures are insufficient. Waiting until evacuation loses critical time. Warm fluids alone cannot offset environmental losses. Early, aggressive prevention—insulation from ground, layered coverings, and warmed IV/blood when possible—preserves clotting, reduces acidosis, and improves survival, even in hot climates where trauma-induced hypothermia is still common.