Page 118 - Journal of Special Operations Medicine - Spring 2016

needle/catheter or needle decom- 2. Efforts should be made to
pression thoracostomy kit. minimize heat loss.
d. C – Circulation f. E – Everything else
i. In general, healthy adult trauma i. Consider Mark I/DuoDote for
patients with a radial pulse and suspected organophosphate/nerve
normal mentation do not need agent exposure.
IV therapy in the Warm Zone. ii. Dependent upon resource avail-
ii. Patients with evidence of ability, burns, eye injuries, and
hypotension: acute pain should be managed
1. If the patient displays signs of per The Maryland Medical Pro-
a closed head injury, IV fluid tocols for EMS Providers.
therapy is indicated to main- g. D – Documentation
tain at least a radial pulse or i. Key findings and interventions
SBP of at least 90mmHg. should be conveyed to the next
2. Patients in hypovolemic shock phase of care.
should receive a one-time 4. Cold Zone: (Traditional Patient Care Protocols)
500mL bolus of IV fluid. Area surrounding the Warm Zone. Responders can
iii. Patients in traumatic cardiac operate without concern of danger or threat to per-
arrest should be considered de- sonal safety or health.
ceased and no CPR should be (a) Casualties are moved from the Warm Zone to the
performed in this zone. Cold Zone by way of an evacuation corridor(s).
e. H – Hypothermia (i) Evacuation Corridor: An area transition-
i. Hypothermia in trauma patients ing between the Warm and Cold Zone
has been associated with in- that is secured from immediate threat and
creased mortality. Hypothermia allows for a mitigated risk in transporting
is easier to prevent than treat. victims from the CCP to the triage/treat-
1. Patients should be moved to a ment area beyond the outer perimeter.
warmed location if possible. (b) Once in the Cold Zone, casualties will require
retriage, particularly assessing for the develop-
ment of a life-threatening condition and effects
of Warm Zone therapy.
Association of Police Officer (i) If massive hemorrhage has not been ad-
Paramedics of the United States dressed or has been ineffectively managed,
it should be immediately readdressed with
strategies mentioned above.
(c) Patients should be triaged and transported per
standard practices.
(d) Medical care in the Cold Zone should be dic-
tated by resource availability and, when possible,
equate to the general patient care standards in The
Maryland Medical Protocols for EMS Providers.
(e) CPR may have a larger role during the evacu-
ation phase especially for patients with elec-
trocution, hypothermia, nontraumatic arrest,
or near drowning; however, it is still casualty
count/resource dependent.
The mission of the APOPUS is to advocate for cross- Keywords: law enforcement; emergency medical services;
trained police officer EMT/paramedics across the emergency medical services, prehospital; active shooter
United States. Our advocacy exists in two broad
areas. The first is in securing discounted training and
education, travel, equipment and supplies, exhibitions,
competitions and certifications. The second is to foster Dr Levy is an associate professor of emergency medicine at
professional discourse and communication between Johns Hopkins University. He is the medical director for How-
our members by recommending pertinent professional ard County Department of Fire and Rescue Services.
journals and articles as well as high-quality initial and
sustainment training centers. In doing so, the APOPUS Sgt Straight is a State Trooper Paramedic and supervisor of
seeks ultimately to advance both the recognition and the Maryland State Police Tactical Medical Unit.
career opportunities of our members in the United
States and abroad. Battalion Chief Marino is the chief of special operations for
the Prince George’s County Fire and EMS Department.
www.apopus.com
Dr Alcorta is the State of Maryland EMS medical director.

102 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016