Page 146 - Journal of Special Operations Medicine - Winter 2015

The good news is that one aspect of this unfortunate retired Army COL John F. Kragh Jr and other military
circumstance is about to change. Through the aggressive authors and shaped into best-practice battlefield trauma
efforts of Dr Lenworth Jacobs, Director of the Trauma care guidelines by the Committee on TCCC. 13–16 While
Institute at Hartford Hospital in Hartford, Connecti- some civilian communities have implemented these
cut, and a Regent of the American College of Surgeons guidelines into their police, fire, and EMS sectors very
(ACS), the use of extremity tourniquets and hemostatic successfully, 17,18 many have not and much remains to be
dressings now has strong advocacy in the civilian sector. done. There are now a number of courses sponsored by
the National Association of Emergency Medical Techni-
The Hartford Consensus working group—formally cians that teach the current US military recommenda-
named the “Joint Committee to Create a National Pol- tions regarding tourniquet and hemostatic dressing use,
icy to Enhance Survivability from Active Shooter and to include Bleeding Control, Law Enforcement First Re-
Intentional Mass Casualty Events” was chartered by the sponder, Tactical Emergency Casualty Care, and Tacti-
ACS to identify measures that would improve survival cal Combat Casualty Care.
for the victims of these horrific acts of violence that are
becoming increasingly common in our country. Dr Ja- The imperative to translate military advances in trauma
cobs began this effort after the leadership in the state care to the civilian sector, especially for victims of gun-
of Connecticut asked him to review the tragic deaths shot wounds and explosions, was described by Elster
in the Sandy Hook shooting incident and to provide and his co-authors. This is especially true in the pre-
19
advice about what more could be done for the victims hospital phase of care, where most preventable deaths in
of such events. The leaders of the ACS subsequently trauma victims occur. 20,21
responded to his strong appeal that the College take
a leadership role in improving survival for the victims The nation owes Dr Jacobs, the Harford Consensus
of these incidents. With the approval and endorsement Working Group, and the ACS a great debt for their
of the college, Dr Jacobs convened the Hartford Con- leadership in this area. Their work was highlighted at a
sensus Group, which held a series of three meetings in ceremony held at the White House on 6 October 2015,
2013–2015. This group included representatives from as part of a ceremony announcing the start of a national
the White House, the Department of Defense, the De- “Stop the Bleed” campaign that includes the prehospital
partment of Homeland Security, and the ACS. Among measures recommended by the JTS and TCCC to con-
the participants were prominent trauma surgeons such trol external hemorrhage. If widely implemented, these
as Dr Jacobs, the late Dr Norman McSwain (trauma di- recommendations will undoubtedly improve prehospi-
rector at the Spirit of Charity Hospital in New Orleans), tal care and survival for trauma victims in the United
Dr Richard Carmona (former Surgeon General of the States—both those injured in active shooter or mass
United States), Dr John Holcomb (the architect of many casualty events and those who are injured in the mo-
of the Department of Defense’s advances in trauma care tor vehicle accidents and acts of violence that occur
during the recent conflicts), and Dr Ronnie Stewart throughout our country every day.
(chair of the ACS Committee on Trauma). The group
also included a number of other medical leaders as well References
as representatives from the law enforcement and fire-
fighter communities. The Hartford Consensus Group 1. Mabry RL, DeLorenzo R. Challenges to improving combat ca-
sualty survival on the battlefield. Milit Med. 2014;179:477–482.
developed three published advisory statements, which 2. Kotwal RS, Butler FK, Edgar EP, et al. Saving lives on the bat-
have been compiled into the Hartford Consensus Com- tlefield: a Joint Trauma System Review of Prehospital Trauma
pendium. This compendium has now been released as Care in Combined Joint Operating Area—Afghanistan. J Spec
12
a Special Communication from the ACS. The articles Oper Med. 2013;13:77–80.
that follow this introduction are excerpts from the Hart- 3. Sauer SW, Robinson JB, Smith MP, et al. Saving lives on the
battlefield (Part II—one year later. A Joint Theater Trauma Sys-
ford Consensus Compendium and are republished with tem & Joint Trauma System Review of Pre-Hospital Trauma
Dr Jacobs’ generous permission. Care in Combined Joint Operating Area—Afghanistan (CJOA-
A). USCENTCOM Report 2014.
As noted in the article that discusses the military ex- 4. Eastridge BJ, Mabry R, Seguin P, et al. Prehospital death on the
perience with tourniquets and hemostatic dressings, the battlefield: implications for the future of combat casualty care.
J Trauma Acute Care Surg. 2012;73:S431–S437.
Hartford Consensus Working Group has endorsed these 5. Kotwal RS, Howard JT, Orman JA. The effect of a golden hour
two TCCC recommendations for external hemorrhage policy on the morbidity and mortality of combat casualties.
control for use by first responders in the civilian sector. JAMA Surg. 2015. Epub ahead of print; 30 Sept 2015.
The article by Holcomb et al. on how to most effec- 6. Maughon JS. An inquiry into the nature of wounds resulting in
killed in action in Vietnam. Milit Med. 1970.
tively employ these devices is based on the experience 7. Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminating
gained gained by the US Military during 14 years of preventable death on the battlefield. Arch Surg. 2011;146:
conflict. This experience has been well documented by 1350–1358.

134 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015