Page 63 - Journal of Special Operations Medicine - Fall 2015

the Tucson police officers initially based their training and evacuation with significant variation, as based on
on TCCC and TECC guidance but then tailored the their individual training pathways as well as the pro-
equipment in their IFAKs upon local AVI response and tocols permitted by their current medical director. The
civilian data from officers wounded in the line of duty. basic concepts of hemorrhage control and, now more
In a novel civilian tactical emergency medical train- frequently, principles of DCR are slowly becoming the
ing program called the “First Five Minutes,” now all practice of BLS and ALS providers nationally. Still,
Tucson officers receive universal medical training from critical interventions such as tourniquets as an isolated
members of the Tactical EMS team, who emphasize a treatment remain inconsistently trained and used. A re-
mastery of tourniquet use, proficiency of hemorrhage cent study evaluating all EMS response to mass casualty
control, and familiarization with DCR concepts. In the incidents nationally recorded more than 14,000 obvious
first 9 months of this program, they reported more than injuries associated with the patient at the time of initial
20 prehospital tourniquet applications and more than dispatch. Of all casualties evaluated and treated, only
100 prehospital hemorrhage-control dressing applica- seven tourniquets were deployed. This highlights the
tions in the field setting of police officers caring for criti- concern that valuable lessons in trauma management
cally injured victims on scene. from the combat theater continue to be poorly imple-
mented in the civilian setting.
In Charlotte, the county medical director endorsed pre-
hospital trauma protocols that provide role-specific Professional medical first responders must demonstrate
TECC training to patrol, Special Weapons and Tactics mastery of TECC and high-threat response principles.
(SWAT), fire (BLS), and medic (ALS) personnel. Similar These prehospital experts must then develop their
to the RFR model, this standardization improves inter- tiered training and response protocols based upon lo-
operability, equipment procurement, and joint training cal resources. Similar to the RFR model, ALS provid-
sessions. Each first responder understands their role and ers should demonstrate mastery of hemorrhage control,
the other agency roles in the TECC Chain of Survival. As including tourniquets and alternative advanced tech-
a result of the Charlotte policy, over an 18-month period, niques, DCR, rapid casualty assessment and extraction,
patrol officers applied five tourniquets to injured civilians, and interagency warm-zone operations. BLS providers
four of which were life saving. All of the officers involved must be proficient in creating casualty access and extrac-
in these incidents underwent a TECC-based program that tion, providing rapid casualty assessment and executing
emphasized tourniquet mastery, hemorrhage-control pro- effective tourniquet applications. As the RFR program
ficiency, and DCR familiarization training similar to the also demonstrated, perhaps the most important role of
Tucson program. In all five scenarios, officers were on the medical first responder is to serve as the liaison and
scene prior to medical first responders. advocate between the operational and advanced medi-
cal care communities.
Examples such as the Tucson Police Department and the
independently trained LEOs in the Charlotte area illus- Physicians and Trauma Surgeons
trate the strategy and resultant benefit of establishing a
tiered AVI casualty response program, which have the The importance of physicians as community leaders
second-order effect of improving casualty response and cannot be emphasized enough. As in the RFR program,
survival during routine trauma calls. A standardized command ownership is a critical final link in reinforcing
training regimen, with universal training and language and supporting the development of other aspects of the
as well as high-level leadership support, similar to the Chain of Survival. In the military, command ownership
RFR program, has the potential to profoundly reduce rests with the line officers. In the civilian sector, how-
potentially preventable morbidity and mortality in AVI ever, leadership responsibility is more distributed. The
and other civilian prehospital trauma scenarios. first-responder agency leadership, medical directors,
emergency medicine physicians at first-receiving facili-
ties, and traumatologists all play critical roles in devel-
Medical First Responders
oping and supporting implementation of best-practice
Professional medical first-responder agencies are in- high-threat response guidelines. Civilian physicians
creasingly endorsing new paradigms for high-threat op- have more influence and authority in these decisions
erations largely based on the principles of TECC and than their military counterparts. Therefore, they have
“warm zone” operational models. However, unlike a responsibility to advocate for policies and procedures
cardiac arrest response, for which the AHA created a that will reduce mortality in AVIs, including the ex-
clearly defined standard of care, the response of prehos- panded scopes of practice and training of our law en-
pital medical providers in high-threat scenarios is still forcement personnel and our citizens. As demonstrated
maturing. Both BLS and ALS providers, even within the by the Ranger data, high-level expert support can help
same region, will approach casualty assessment, care, reduce mortality.

Community Approach to Reducing Mortality From AVIs 51