The modern transition to tactical medical care occurred in the Special Operations section of the U.S. military in the late 1990s.

U.S. Navy Captain Frank Butler created a course for SEAL team commanders in the management of casualties on the modern battlefield. It was not to make them into medics but to expose commanders to the issues they would face if there were casualties in the unit. The focus was on treatment of potentially preventable deaths due primarily to blood loss. Tourniquets, which had not been used extensively in the U.S. military since the Civil War, were reintroduced and refined. There was also an emphasis on the small unit tactics used to safely conduct a rescue under fire. The Army Rangers was the other group to originally embrace this concept. The Rangers got command-level support for having well-defined protocols and extensive training and now have the best survival rate within the entire U.S. Department of Defense. There is now continuous quality improvement to identify and implement needed changes.