Page 188 - Journal of Special Operations Medicine - Winter 2015

patient and provide results to arriving emergency medi- armor protection, availability of resources, and finan-
cal services personnel. cial restrictions. Policy and operational experts must
approach the challenge of creating a successful FCP pro-
The high-profile Boston Marathon bombing focused the gram with a more nuanced and sophisticated mindset
attention of national policy makers on what many in the founded on the principles of high reliability organiza-
first response community have always known: bystand- tions (HRO)—in particular, a reluctance to simplify, a
ers will be present, bystanders will act, and by doing so, deference to expertise, and a commitment to resilience.
bystanders can effectively assist the emergency response
to these incidents to save lives. The keys to successfully Recommendations and Future Direction
transforming bystanders into effective FCPs are a com-
bination of community education and training, first re- There are four key requirements to the development and
sponder integration, and the development of standard implementation of a successful community FCP pro-
operating procedures that address scene security, com- gram: administrative leadership and operational policy
munication, education, and commitment to a tiered development, pre-positioning of public access trauma
whole of community response paradigm. 3 kits, first responder training, and training of FCPs.

The First Care Provider Administrative Leadership and
Operational Policy Development
The FCP represents the first link in the trauma chain
of survival from point of wounding through definitive Successful FCP integration requires grassroots initia-
care. An FCP-empowered system offers a univer- tives and national public policy leadership. Leaders
3,4
sal, flexible bystander-initiated trauma protocol. This must evolve past the complete reliance on traditional
shared language, based on the principles of TECC, em- 911 response and overcome the widespread reluctance
powers the FCP and the arriving medical/rescue assets to introduce policies that empower medical action in the
to integrate effectively and work off of the “same sheet broader population. Implementation of public policies
of music.” Like many of the recent advances in trauma that incentivize FCP program adoption and standard-
care, the FCP concept harkens back to a time of more ization encourages both government and private sector
robust civilian resilience. The impetus for more robust action. Nonmedical leadership is critical to creating an
FCP programs is born from the increasing frequency of effective whole of community system that reduces po-
incidents where geographic or operational barriers pre- tentially preventable trauma mortality. 7
vent timely professional first responder access to victims.
Public Access Trauma Kits
The successful transformation of bystanders into effec-
tive FCPs requires a commitment from national policy Many government buildings and public access busi-
makers, first response agencies, and local community nesses in the United States are grossly underprepared to
leaders to collectively provide opportunities for train- support FCP interventions for traumatic injuries during
ing and education. Several national organizations have targeted violence events. The deployment of public ac-
recently made recommendations regarding “bystander” cess trauma kits serves two critical roles. First, they pro-
interventions. Many of these efforts have contributed vide a visual cue to prompt FCPs to take action. Second,
to the national dialogue but have only provided limited if properly equipped, they can provide critical material
medical recommendations that focus solely on external to support lifesaving interventions for more than just
bleeding control. Anchoring on the military data from hemorrhage control. Public access to readily available
5
the past 15 years, these recent bystander initiatives pre- medical equipment should be part of a multipronged ap-
sume that the wounding, fatality, and population pat- proach to community safety. Civilian experts and medi-
terns in civilian active violence and mass casualty events cal evidence, rather than military recommendations,
are the same as combat operations. This flawed conclu- should guide equipment selection. Signage indicating
6
sion presumes that first responders should “just do what location of trauma equipment should be clear and easily
the military does.” Despite the increased use of military- understood, mirroring efforts currently undertaken for
style weapons and tactics in civilian events, the prin- fire control devices, automatic external defibrillators,
ciples of evidence-based medicine preclude the en bloc and emergency exit planning.
application of military TCCC to the civilian setting. At
its most basic, the military medical response paradigm First Responder Training
fails to account for simple differences in civilian mass
casualty incidents including civilian demographics, spe- The training of professional first responders currently
cial populations, wounding patterns (i.e., predominance focuses on unified command, operational coordination,
of gunshot wounds over explosives), lack of ballistic and direct life saving interventions. Additionally, this

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