Page 161 - Journal of Special Operations Medicine - Fall 2015

Guideline Evolution (Leads: Sean McKay, EMT-P; and matters is the performance requirement of placing a
Mark Anderson, EMT-P) tourniquet effectively (even if it is improvised) and ac-
complishing the outcome of cessation of hemorrhage.
The C-TECC works continuously to update the content
and format of the guidelines. At the last C-TECC meet- The second advantage of the standardized NFPA for-
ing, the decision was made to evaluate different formats mat is that it allows the organization to tailor the level
to facilitate adaption of the guidelines. One initiative of training and operations to accommodate a variety of
involves translation of the current guidelines into a end users. NFPA uses a tiered-knowledge approach (i.e.,
National Fire Protection Association (NFPA) job per- Awareness, Operations, and Technician) with escalating
formance requirements (JPRs) format. This additional expectations and requirements. The terms Awareness,
formatting option does not affect TECC Guideline con- Operations, and Technician will not only allow speci-
tent. However, a separate NFPA JPR version would also ficity for skill sets ranging from the bystander through
be available for training organizations that commonly the first receiving facility but also facilitate the second-
integrate JPRs into their program of instruction and order effect of interoperability within various agencies
evaluation forms. responding to a dynamic incident. As an example, when
looking at JPRs pertaining to tourniquet application
The development of a JPR includes six components: and/or casualty collection point acquisition and man-
Job Task Analysis, Complete Job Inventory, Using Task agement, the patrol officer or rescue task force (RTF)
Analysis Worksheets, Use Action Verbs to State Task, member would obviously need to be at the Technician
Identify Task Standard, and JPRs. Using this compo- level, while the command staff may only need to be at
nent/technique approach has proven to provide consis- the Awareness or Operations level. When looking at
tency and readability within the formatted document. RTF-specific performance requirements, such as pack-
The NFPA JPRs focus on requisite knowledge and skills aging and evacuation, the firefighter would need to be
rather than mandating specific equipment or training at a Technician level, while the patrol officer may need
modalities. The definitions that follow offer sample for- to be at an Operations level depending on the agency.
matting related to operational rope rescue: Because of the potential critical task of breaching for ac-
cess into a fortified building (e.g., Virginia Tech), patrol
1. Requisite Knowledge. Determination of incident needs officers should be Technicians, while emergency medical
as related to choosing compound rope systems, the services (EMS) personnel should still have an Awareness
elements of efficient design for compound rope sys- level of the requirement.
tems, knot selection, methods for reducing excessive
force to system components, evaluation of incident A third benefit of using the NFPA format is the concept
operations as related to interference concerns and set- of “authority having jurisdiction” (AHJ). The NFPA
up, rope commands, rigging principles, system safety acknowledges that all agencies and jurisdictions have
check procedures, and methods of evaluating system different threats, resources, political environments, bud-
components for compromised integrity. gets, and operational constraints. Therefore, the NFPA
2. Requisite Skills. The ability to determine incident JPRs outline requisite knowledge and skills, but the AHJ
needs as related to choosing compound rope systems, determines the specific piece of equipment or the tech-
select effective knots, calculate expected loads, eval- nique to accomplish the JPR. Individual departments,
uate incident operations as related to interference municipalities, and/or counties determine the relevant
concerns and set-up, perform a system safety check, AHJ to fulfill the JPR.
and evaluate system components for compromised
integrity. In addition to the NFPA JPR formatting, the C-TECC
has established a working group to begin tailoring the
Per the NFPA, the goal of this format is “to describe the online guidelines to create a mechanism for agencies to
methodology for developing [JPRs] so individuals can more easily create tailored guidelines for nonmedical
identify the specific format and are able to revise text that first responders, basic life support, advanced life sup-
is used to evaluate the knowledge, skills, and abilities of port, and special operations teams.
a person qualifying for a national recognized standard
level or position as they perform essential job tasks.” TECC First Care Provider (Leads: Dr Josh Bobko; Mark
Anderson EMT-P; and Dr Rich Kamin)
There are many advantages to incorporating the NFPA
format into the TECC Guidelines. First, the format does Guidelines Committee member Dr Joshua Bobko dis-
not dictate a specific technique or specific equipment. cussed the First Care Provider initiative that began in
So whether the end user selects one particular commer- 2012. The term First Care Provider (FCP), coined by Dr
cial tourniquet over another, it does not matter. What Bobko and Board of Advisers member Todd Baldridge,

C-TECC Fall Update 149