Page 173 - Journal of Special Operations Medicine - Winter 2015

The public should be officially Because local facilities may not be
recognized as a resource in the trauma centers, it is critical that all
response to mass casualty incidents
and be included in planning and hospitals be prepared to accept
training for active shooter and and treat severely injured patients.
intentional mass casualty incidents. Hospital providers must be skilled
at resuscitation and management
pressure, hemostatic dressings, and tourniquets to con- of injuries, including surgical and
trol hemorrhage. In the event of fire, firefighter leader-
ship must provide and identify safe zones as soon as it radiologic interventions. To be
is feasible. Also recommended is that law enforcement prepared, all hospitals should
and EMS/fire/rescue personnel know and use a common
language as they respond. In addition, a unified com- routinely practice the enactment of
mand structure should be used to direct all responders.* disaster plans.
Definitive Care
Because local facilities may not be trauma centers, it of the patient. It also teaches how to determine if a pa-
is critical that all hospitals be prepared to accept and tient should be transferred to a higher level of care and
treat severely injured patients. Hospital providers must how to optimize that process if necessary. More infor-
be skilled at resuscitation and management of injuries, mation about the course, which is designed for physi-
including surgical and radiologic interventions. To be cians in the hospital environment, is available at www.
prepared, all hospitals should routinely practice the en- facs.org/quality%20 programs/trauma/atls.
actment of disaster plans. Hospitals that are in proximity
®
to places where large groups of people gather, such as Advanced Trauma Operative Management
®
shopping malls, schools, sports arenas, and movie the- (ATOM )
aters, should practice community scenarios to rehearse Advanced Trauma Operative Management (ATOM) is
the rapid deployment of resources. Drills should test the designed to teach senior surgical residents, trauma fel-
emergency department and hospital-wide activation. This lows, military surgeons, and fully trained surgeons who
practice should include the management of unidentified infrequently operate on trauma victims the operative
patients, rapid internal hemorrhage control, mobilization management of penetrating injuries to the chest and ab-
of the blood bank, accessibility of computed tomography domen. Students are taught to identify injuries, develop
scanning, and the availability of surgical care with ex- a plan of care, and safely repair the injuries. ATOM is
peditious operating room activation. Plans also should offered by the ACS COT. More information is available
include methods for constant communication and coordi- at www.facs.org/quality-programs/trauma/education.
nation between the hospital and prehospital personnel.*

Conclusion The use of casualty collection points and
To support the principles of the Hartford Consensus, all access corridors for EMS secured by
responders in all disciplines and in all care environments police will compress the time between
should be properly trained in hemorrhage control. The the first response by law enforcement
following select educational programs are available to
teach trauma care and hemorrhage control to medical and access to victims by EMS.
and nonmedical individuals.

®
®
Advanced Trauma Life Support (ATLS ) Advanced Trauma Care for Nurses (ATCN)
Advanced Trauma Life Support (ATLS) was developed Advanced Trauma Care for Nurses (ATCN) is de-
by the American College of Surgeons (ACS) Commit- signed for registered nurses to increase their ability to
tee on Trauma (COT) to teach a systematic and concise manage the multitrauma patient. The course is taught
method of caring for a trauma patient. The course concurrently with the ATLS, with nurses auditing the
emphasizes assessment, resuscitation, and stabilization ATLS lectures and then participating in skill and testing

*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.

The Hartford Consensus 161