Page 73 - Journal of Special Operations Medicine - Summer 2014

required for casualty evacuation and providing for a After action analysis of these incidents showed that a
more rapid medical response for the injured. Thus, the new prehospital medical approach was necessary to the
standard conventional civilian prehospital emergency active shooter/mass casualty incident.
care would not be suitable in the case of a riot. There
is a need for the emergency ambulance service to be In April 2013 at the Hartford Consensus Conference,
6,7
trained in tactical medicine and integrated in the opera- the American College of Surgeons and senior leaders
tions of the SPF. from medical, law enforcement, and the EMS communi-
ties developed a concept document based on the prin-
ciples of tactical medicine where stopping hemorrhage
Definition and Value of Tactical Medicine
becomes the first priority, instead of managing the airway
The mission of tactical medicine in operations can be as taught in conventional civilian prehospital emergency
divided into three principal considerations: care. The purpose of the Hartford Consensus Confer-
ence was to develop recommendations to increase the
1. To treat the casualty survivability in mass casualty shootings by integrating
2. To prevent more casualties the critical actions contained in the THREAT acronym:
3. To complete the mission
T Threat suppression
The concepts of Tactical Combat Casualty Care (TCCC) H Hemorrhage control
1
have been developed by the U.S. Military, and those RE Rapid Extraction to safety
principles have been adopted on a worldwide basis. In A Assessment by medical providers
addition, in the United States, the principles of TCCC T Transport to definitive care
have been adopted by numerous TEMS units operating
in conjunction with Special Operations law enforcement Just as the principles of tactical medicine apply in an ac-
teams (SWAT, Special Response Teams, etc.). These prin- tive shooter incident, they also apply in any mass casu-
ciples have evolved, improved and have an established alty incident which includes civil unrest and riots where
track record of decreasing battlefield casualties and im- casualties, both civilian and uniformed officers, need to
proving survival rates. be evacuated and managed in a tactically challenging
and fluid environment. Tactical medicine can be trans-
The National Tactical Officers Association, Interna- lated to anti-riot operations where multiple casualties
tional Association of Chiefs of Police (IACP), and In- with traumatic injuries have to be managed. The sever-
ternational Association of Fire Fighters (IAFF) have ity of the injuries will also depend on the different kinds
published position papers emphasizing the importance of armaments used by the rioter, ranging from rocks and
of having tactical medical teams attached to tactical law bricks, to pipe bombs, to Molotov cocktails.
enforcement units.
2–4
In developing the principles of TCCC, it must be recog- Dynamic Concepts of
nized that the military is dealing with a young healthy Tactical Medicine in Operational Support
population which is not representative of the nonmilitary Care in tactical medicine can be divided into three zones
civilian population. The civilians who could be involved which then dictate the level of medical care. The cor-
in an incident represent all age groups, ranging from rect medical intervention, at the wrong time or place, in-
infants to the elderly. In addition, the civilian popula- creases the probability of casualties and further injury to
tion is more likely to have significant medical illnesses the victim and rescuer. The guidelines of TECC provide
(e.g., cardiac, diabetes, etc.) than the military popula- for three phases of medical care in hostile environments.
tion. Due to the differences between the military and The direct threat phase occurs when the casualty is in a
civilian groups, the need for modification of the prin- situation that is immediately life threatening. This area
ciples of TCCC for the civilian sector was recognized. is not cleared, not secure, and a high potential exists for
The Committee on Tactical Emergency Casualty Care violent acts to occur. This could be an unstable building,
(CoTECC) has modified the TCCC guidelines for civil- a motor vehicle accident with leaking fuel, a burning
5
ian application, developing the TECC guidelines. The building, a riot, exposure to gunfire from a suspect, an
need for a change in the way that prehospital medical improvised explosive device (IED) or any similar situa-
care has traditionally been provided in situations of tion where there is an immediate threat to life. In law
mass casualty incidents was highlighted by the analysis enforcement terms, direct threat situations occur in the
of a number of situations that occurred in the United “hot zone.” indirect threat situations (second phase) oc-
States: the Aurora movie theater shooting, the Ft. Hood cur in those areas where a life threatening situation may
shooting, the Tucson shooting, the Sandy Hook shoot- develop, but does not currently exist. This exists in a
ing, and the Boston Marathon bombing, among others. cleared area in the hot zone. In law enforcement terms,

Little India Riot and Tactical Medicine Among Medics 63