Both military literature and the popular media abound with accounts of the successful use of armored tactical vehicles (ATVs) in the setting of conflict as well as equally compelling tales of what happened in their absence. Recent documentaries depicting the failed Mogadishu Raid of 1993, the North Hollywood Shootout of 1997, and the Sadr City Uprising of 2004 highlight the potential value of ATVs in both military and law enforcement operations in urbanized terrain, as well as the consequences of their absence. In the current geopolitical climate, the growing threat of domestic terrorist activity, civil unrest, and easy access to illegally acquired military-specification ordnance compels all organizations involved in the homeland security mission to evaluate potential threats and to consider the use of ATVs as one of many tools to mitigate them. As a natural outgrowth of such planning, tactical medical planners and providers should be familiar with the practical application of ATVs to their mission.

Numerous historical references exist with regard to the use of armored conveyances in the ancient world, such as the Egyptian and Roman application of chariot warfare, Hannibal’s employment of war elephants, and armored knights and chargers of the medieval period. The first recorded use of motorized ATVs in combat was in the First World War by the British Expeditionary Forces during the Battle of the Somme, in 1916. By the end of that war, the concept of employing ATVs in the setting of conflict was firmly established. Further doctrinal development of ATV strategy and tactics by such historical figures as George Patton, Erwin Rommel, and Heinz Guderian served to integrate ATVs into combined arms operations. More recent experiences during the Arab-Israeli War of 1973 and Gulf Wars I and II have served to further cement the primacy of the ATV as a means of defeating both fixed fortifications and motorized threats and of delivering or extracting personnel in relative safety despite high-lethality environments. Thus, it is intuitive that ATVs were ripe for adaptation to civil sector use in tactical law enforcement and related homeland security operations.

While the development of armored ambulances has paralleled that of general purpose ATVs, the degree of progress and technical sophistication has been slower for the former. The subordinate nature of tactical medical support, lower funding priorities for medically related initiatives, and understandably higher emphasis on “tooth” versus “tail” innovation have contributed to the common practice of the adaptation of armored fighting vehicles into armored rescue vehicles, rather than de novo tactical medical vehicle designs.

The preponderance of ATV designs used in tactical medical operations arises from one of three categories: (i) retrofitted military armored fighting vehicles (tracked and wheeled armored personnel carriers); (ii) modified or otherwise up-armored civilian vehicles (armored cars,
limousines, sport-utility vehicle variants); or (iii) hybrid “ground-up”-designed urban tactical vehicles. Among these, the vast majority of tracked or otherwise heavily armored ATVs are acquired either on-loan or as property transfers to law enforcement organizations from the U.S. Department of Defense via various military surplus divesture programs. Wheeled vehicle types reflect greater variation, and their acquisition is largely a function of the respective organization’s program budget, terrain analysis, and mission requirements. Examples of ATVs used in tactical medical operations, and their respective performance characteristics, are given in Appendix 1.

Potential functional uses for ATVs in tactical medicine and related applications are numerous and, to some extent, limited only by the planner’s imagination. Common applications include (i) tactical team insertion, including medical elements; (ii) bystander/casualty rescue and tactical team extraction; (iii) use as a weapons platform (lethal or less-than-lethal); (iv) use as a communications platform for a hostage negotiator; (v) use as a CBRNE-hardened operational platform; (vi) use as a medical supply/logistical backhaul vehicle when returning from patient transport; (vii) use as a leader/medical officer reconnaissance platform; and (viii) use as the ultimate mobile incident command or mass casualty triage command post.

Given the myriad potential uses of ATVs and the likely finite resources available to the tactical commander, it is incumbent on the medical planner to integrate medical support or contingency plans requiring ATV usage into the overall mission planning process at the earliest possible point. Considerations during this planning phase include the anticipated number of medical operators to be transported; the type of mission to be executed, along with subordinate phases, if applicable; the anticipated most likely and worst-case casualty/patient transport requirements; the type of care that will be rendered; the evacuation destination and whether ambulance exchange points or helicopter landing zones will be employed; the estimated weight and volume requirements for medical and other rescue-related equipment to be employed by the medical team; and a plan for management and transport of CBRNE-contaminated casualties, if applicable.

Ideally, the medical element should be integrated into the full tactical team and well accustomed to the ATVs, equipment, and other crew members prior to an actual tactical mission. If this is not the case, it is strongly advised that the medical element utilize any available opportunity to become familiarized in the time prior to mission execution.

When first “saddling-up” in an ATV, the medical operator will likely form two immediate impressions: a sense of greater security and the relatively cramped quarters of the crew compartment. In all but the most spacious ATVs, this sensation will be amplified after taking into account the impact of the confined space on the ability to transport and provide en route medical treatment to casualties/patients.