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Evolution of hot zone care: MARA
  1. John Miles and
  2. C Crook
  1. Medical Support Unit, Hereford, UK
  1. Correspondence to John Miles, Medical Support Unit, Mailpoint 530, Hereford HR4 7DD, UK; john.miles446{at}


Modern conflict and terrorist events have moved from linear two-dimensional battlespaces into complex, continuously evolving three-dimensional environments. Contested spaces make traditional definitions of zones of response confusing and lead to delays in care. The presence of actual or perceived ongoing threats creates an environment in which the initiation of tactical field care (TFC) may be inappropriate, despite the absence of an immediate risk to life. This risks a ‘time and space gap’ between care under fire and TFC. Major haemorrhage, airway, respiration, analgesia is proposed as a rethought approach to care in such environments.

  • trauma management
  • accident & emergency medicine
  • protocols & guidelines

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  • Contributors JM and CC contributed equally in developing the concept and writing the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.