Page 162 - Journal of Special Operations Medicine - Fall 2015

is meant to denote those people who are involved in a high traffic public venues). In addition, C-TECC is lead-
high-threat disaster or mass casualty scenario by prox- ing a national effort to engage emergency medical dis-
imity but do not suffer life-threatening injuries. For- patch (EMD) providers to modify existing protocols on
merly referred to as bystanders, these people represent hemorrhage control. Two recent events have driven this
medical-force multipliers for traditional first responders effort. On 14 January 2015 in San Diego, California,
and should be leveraged to initiate needed medical care EMD gave instructions to a former Navy seaman to re-
to the wounded. move the tourniquet from a bleeding extremity wound of
a motorcycle accident victim. The victim subsequently
1
The Westminster Police Department (PD) in California died because of exsanguinating hemorrhage. On 14 June
has initiated one of the first whole-community TECC 2015, EMD at Oak Beach, North Carolina, told off-duty
programs to offer basic TECC training and equipment paramedic Marie Hildreth to not place a tourniquet on a
to schools, major retailers, and other city facilities with victim whose arm had been amputated in a shark attack.
2
the goal of building a community of FCPs. The C-TECC strongly encourages medical directors and
EMD leaders to revise and update their protocols to re-
The organizers took a multiphase approach to atypi- flect modern practice of hemorrhage control as recom-
cal disaster preparedness with the Westminster PD. The mended by the C-TECC and now the American College
initial phase consisted of Run, Hide, Fight and shelter- of Surgeons. This includes an earlier and more liberal
in-place education. The subsequent phase focused on application of prehospital tourniquets. 3–6
communication with 9-1-1 dispatch and first respond-
ers, operational planning for media relations, family Building First Responder Resiliency
reunification, and so on. The third phase educated par-
ticipants on the preventable causes of traumatic death C-TECC continues to work toward developing recom-
and provided equipment familiarization training. The mendations for best practice surrounding mitigating
effort concluded with a large-scale exercise using paired stress-induced mental health disorders in responders to
groups of various demographic components of the com- high-threat incidents. The importance and support for
munity evaluated in an earthquake scenario. The roles, building resiliency in first responder groups is growing
scenarios, and evaluation criteria were all standardized due to subject matter expert consensus and a grow-
to be shared through FCPs and the TECC committee. ing amount of research specific to the issue. As such,
multiple organizations (IAB, International Association
Measured data points were “time to first action” and of Chiefs of Police, National Fallen Firefighter Founda-
“time to solution.” First action was considered a sur- tion, and others) have issued documents that stress the
rogate for recognition of life threat, and was broadly importance of increasing awareness of the risk of and
defined to allow untrained subjects an equal chance resources dedicated to addressing the complications of
for success in the scenarios. Time to solution was also emotional and psychological stress. The importance of
broadly defined to account for the untrained demo- resources dedicated to support providers after an event
graphic. The study enabled trained laypeople to use and the understanding that building preresponse resil-
the various means of hemorrhage control. Subgroup iency will create a more robust and protected responder
analysis included time to tourniquet application and a have been described.
subjective evaluation of tightness using the hemorrhage-
control feature of ITTS mannequins (Innovative Tactical The Committee expects that as best practice is further
Training Solutions Inc.; http://www.tommanikin.com). developed and promulgated, the TECC Guidelines will
be modified to include specific recommendations to
The preliminary results were reported at the TECC meet- minimize fallout from psychological stress. Until specific
ing in June and showed a significant improvement in the guidelines can be developed, the Committee has com-
trained layperson’s ability to recognize life-threatening in- mitted to aggregating and helping distribute best prac-
jury and respond appropriately. Further study is required tice as it is created.
on a larger scale and a standardized, multi-community
model is being rolled out this summer across the nation. Ongoing Training
Through this and other ongoing efforts, the Committee is
acquiring data to support the hypothesis that education Members of the C-TECC continue to be actively in-
of laypeople can effectively reduce both time to recogni- volved in the Interagency Planning Group and delivery
tion and time to definitive hemorrhage control. of the Joint Counter Terrorism Awareness Workshop
Series (JCTAWS) sponsored by DHS and the Federal
The ongoing C-TECC FCP efforts are focused on the Emergency Management Agency (FEMA), the National
continued support of community-based hemorrhage- Counterterrorism Center, and the FBI. Jersey City, New
control training programs (e.g., schools, universities, Jersey, and San Antonio, Texas, were host cities in this

150 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015