Page 172 - Journal of Special Operations Medicine - Winter 2015

Integrated Education of All Responders

Norman E. McSwain, MD, FACS,
Medical Director, Prehospital Trauma Life Support

he Hartford Consensus issued a call to action that for control of the scene, suppressing the perpetrator,
outlined specific activities that the public, law en- and preserving evidence, whereas EMS/fire/rescue has
Tforcement, emergency medical services (EMS)/fire/ the responsibility to preserve life and limb. To increase
rescue, and definitive care need to enact to increase survival from active shooter and intentional mass ca-
survival from active shooter and intentional mass ca- sualty events, it is important that hemorrhage control
sualty events. An acronym, THREAT, summarizes the be used as soon as possible and that first response law
recommendations: T is for threat suppression, H indi- enforcement officers have the training necessary to be
cates hemorrhage control, RE denotes rapid extrication proficient at hemorrhage control. External hemorrhage
to safety, A is for assessment by medical providers, and control also must be regarded as a core responsibility of
T indicates transport to definitive care. law enforcement. Officers must know how to use direct
pressure, hemostatic dressings, and tourniquets to stop
To answer this call to action, education of all responders bleeding. In addition, law enforcement officers need to
in THREAT is needed. The specific educational needs move the wounded as quickly as possible to areas where
of each responder group will be presented. However, they can be assessed and treated by responding medical
it should be noted that a major tenet of The Hartford providers. EMS/fire/rescue must be integrated into the
Consensus is that education should be multidisciplinary process as early as possible.*
and emphasize an integrated response. All responders
should consistently train and drill together.* EMS/Fire/Rescue Response
The U.S. Fire Administration of the Federal Emergency
Public Response Management Agency, U.S. Department of Homeland
As was demonstrated at the Boston Marathon bomb- Security, has issued Fire/Emergency Medical Services
ings, the uninjured or minimally injured members of Department Operational Considerations and Guide
the public will act as immediate responders. The pub- for Active Shooter and Mass Casualty Incidents. This
†
lic should be officially recognized as a resource in the document is a resource for response planning and prep-
response to mass casualty incidents and be included in aration for active shooter and mass casualty incidents.
planning and training for active shooter and intentional It calls for fire and EMS agencies to incorporate the
mass casualty incidents.* For details of training the THREAT principles into their standard operating proce-
public in bleeding control, please see the contribution dures while developing protocols together and engaging
by Richard Carmona, MD, MPH, FACS, the 17th Sur- in mutual education. A specific recommendation of the
geon General of the U.S., in this compendium regarding Hartford Consensus is that there be earlier integration
unique strategies to educate the public in the principles of EMS/fire/rescue in the response. EMS personnel must
of the Hartford Consensus. know to act as quickly as possible to assess and treat the
wounded. The use of casualty collection points and ac-
Law Enforcement Response cess corridors for EMS secured by police will compress
The Hartford Consensus recognized that law enforce- the time between the first response by law enforcement
ment and EMS/fire/rescue traditionally have had diverse and access to victims by EMS.* EMS personnel, includ-
responsibilities. Law enforcement has the responsibility ing 911 dispatchers, need to know how to use direct

*Jacobs LM, Wade DS, McSwain NE, et al. The Hartford Consensus: A call to action for THREAT, a medical disaster prepared-
ness concept. J Am Coll Surg. 2014;218(3):467-475 .
† U.S. Fire Administration, FEMA. Fire/Emergency Medical Services Department Operational Considerations and Guide for Ac-
tive Shooter and Mass Casualty Incidents. September 2013. Available at: https://www.usfa.fema.gov/downloads/pdf/publications
/active_shooter_guide.pdf. Accessed June 30, 2015.

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