Environmental hazards have an unrecognized and unmet influence on operations. The mistranslation of vertical access and rescue customs and practices, to an environment with uncertain and unrecognizable hazards, can lead to catastrophic failure. Application of these customs and practices to meet the complex operational constraints and environmental hazards central to high-hazard mission sets, has persisted and confused operational vertical rescue teams. Improvised approaches, using minimal but readily available equipment, can close gaps between theory and practice and between discrete concepts in a continuously evolving environment. This paper addresses existing gaps in operational vertical response utilizing a context-specific approach similar to the authors of the original Tactical Combat Casualty Care (TCCC) project published in the 1996 supplement of Military Medicine (Butler FK, 1996).
 
 A pragmatic framework is introduced, which has been evolving for the past 10 years within USSOCOM, Federal special operations teams, and municipal special response elements termed Operational Vertical Mobility (OVM). Operational Vertical Mobility (OVM) creates an adaptable model within high-hazard vertical response in the same manner that TCCC disrupted prehospital tactical medicine (Butler FK Jr, 2007). Since normative traditional civilian vertical practices do not translate well into the context of a Volatile, Uncertain, Complex, Ambiguous, Threat containing, and Time-compressed (VUCA-T2) environment, OVM reframes vertical response key performance parameters (KPP’s) in opposition to traditional design principles. OVM promotes creating theories out of practice rather than forcing theories into practice. In order to appraise the key performance parameters of verticality within a VUCA-T2 environment, a panel of practitioners with expertise across multiple vertical disciplines and specialized units analyzed relevant guidelines, principles, industry recommendations, nonlinear sciences, and high reliability organizational characteristics for successful operational application.