Page 146 - Journal of Special Operations Medicine - Fall 2014

training courses, is committed to instructing the student organizations that have requested the RTC training al-
in proper civilian application of the guidelines, as writ- ready provide training such as Prehospital Trauma Life
ten without alteration, in the appropriate high-threat Support, Advanced Cardiac Life Support, Basic Life
conditions. This policy applies mainly to the language Support, etc. This program offers local leaders the abil-
and intent of the guidelines and does not preclude ex- ity to expand their training offerings.
cluding parts of the guidelines that lay outside the scope
of practice or beyond the boundaries of the accepted Anderson County, South Carolina, through federal
medical protocols of the student. grant funds, requested the Train-the-Trainer course and
capability of expanding their training courses beyond
The C-TECC Principles of Guidelines Instruction is en- their regional first responders to community entities.
forced by the Committee through the Board of Direc- As with other agencies, C-TECC members have worked
tors. The Board of Directors will do everything possible with to develop similar capabilities. Anderson County
to fully investigate and resolve any complaints or notifi- EMS & Special Operations Division is now trained and
cations of instruction or alterations of the guidelines by prepared to stand up an all-inclusive public safety model
educational/training entities that fall outside this policy. (e.g., law enforcement, EMS, fire, hospital, and CERT)
and recognized TECC Training Center. Chief Stoller, An-
Only organizations that follow the Principles of Guide- derson County EMS, states, “Regionalization is impor-
lines Instruction set forth by the C-TECC are allowed tant to us. A common set of goals and protocols allows
to utilize the following language “in accordance with us to work together better, safer and more efficiently.”
the Principles of Guidelines Instruction set by the Com- According to Stoller, their goal is to share this training
mittee for Tactical Emergency Casualty Care” and the with all public safety personnel in and around Anderson
“C-TECC recognized training logo” on advertisements County as well as adapt the training to schools, indus-
and instructional materials. In the near future, those try, and other locations where this latest trauma training
companies that are recognized as in accordance with the may help save a life.
standards set by C-TECC will be listed on the C-TECC
website under training and educational resources.
Hot Topics
This past summer, some of the members of C-TECC as-
sisted in the development and implementation of a pro- CAT Tourniquet Application: Single or Double Loop?
totype TECC Recognized Training Center (RTC). The The C-TECC does not endorse any particular medical
TECC RTC is a new initiative, and the backend logisti- device or product. However, the Combat Application
cal assets to support this project are being finalized. The Tourniquet (CAT) is a widely tested and deployed de-
RTC initiative places the responsibility to provide ac- vice. Recently, a laboratory study by Clumpner et al.
curate TECC training where it belongs, in the hands of compared single-loop versus double--loop application
the first responders who are committed to serving and of the CAT. In regard to lower extremity application,
3
protecting their given community. the study found that by only routing through one loop,
the median time of application was 3.5 seconds faster.
The TECC RTC development program entailed a 2-day The study also found that blood loss was statistically
Train-the-Trainer program targeting first responder significantly lower: mean 93 ± 22.7mL versus 144 ±
agency training officers, agency leadership, and medi- 79mL. Median difference was 87 versus 114mL. While
cal directors. The session is collaborative with agency this provides interesting information regarding the CAT
leadership, providing tailored guidance based on lo- application, there are several critical limitations to this
cally identified threats and gap analysis. The Train- study relating to operational medicine. First, this was
the-Trainer session also provides strategies for tiered a lab trial on manikins. Second, extraction/casualty
TECC application based on the students that the RTC movement was not simulated; models remained static.
wishes to instruct and certify (i.e., fire personnel and Third, though single-loop application was 3.5 seconds
RTF, patrol officers, SWAT personnel, EMS, hospital faster, the mean was thrown off by the “maximum”
staff, emergency management, school staff, and commu- time outliers. Fourth, though blood loss difference was
nity emergency response team [CERT]). It is suggested “statistically” significant (27mL of blood), it is unlikely
but not mandated that the RTC pool their instructors to be clinically significant. Further, this difference in
for the Train-the-Trainer from as many first responder blood loss can be offset by proximal pressure to the
disciplines as possible to create an environment of in- vasculature while applying the CAT (for most opera-
teroperability for their future course students. This tional personnel, this is standard operating procedure).
technique has been shown to increase interoperability When determining your application technique, you must
across multiple first response agencies. The RTC then account for a variety of operational considerations in-
serves as the training certification body. In general, the cluding the casualty’s size, equipment that may impede

138 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014