Page 90 - Journal of Special Operations Medicine - Spring 2016

closer to the “X” when a crisis occurs. Further, they
The Hartford Consensus should be trained to think first like a Tactical Medic in
austere conditions and start basic care before contem-
Hemorrhage Control Beyond the plating more elegant approaches.
Traditional Audiences: Instructions for Authors
From my perspective, this training starts in the first
by Todd Fredricks, DO
year of medical school. Every first-year medical student
whom I teach at Ohio University Heritage College of
s a long-time member of SOMA and an educator Osteopathic Medicine is exposed to the absolute criti-
who works at one of the “soft-targets” described cality of tourniquet use in hemorrhage control. I bring
Aby Dr Fabbri, I was pleased to see the attention hemorrhage control devices and agents to class and
1
given to civilian threat response and Dr Butler’s com- demonstrate their application. This is very important
ments regarding the civilian sector in the latest issue of because it is well understood that when we “train as we
2
this journal. Unfortunately, these efforts are far from fight,” we develop critical muscle memory skills that al-
3
enough. Articles describing the lessons learned from and low us to rely on our hands and not our brains when we
techniques and value of prehospital hemorrhage control are under stress. Though I am a medical school educa-
must be published not just in surgical, emergency medi- tor, we should introduce hemorrhage control concepts
cine, and military journals but in civilian general medi- at the very beginning of all provider training to include
cal publications as well. nursing, veterinary, dental, and pharmacy programs. It
should be integral to Basic Life Support (BLS) training,
Because I work in a rural part of the country, I am regu- and it complements Dr Jacob’s call to incorporate bleed-
larly exposed to prehospital providers who do not have ing control bags next to automated external defibrilla-
the resourcing of major metropolitan centers. Often, tors (AEDs).
the prehospitalists and emergency medicine providers at
smaller hospitals are not equipped with tourniquets and I would also point out that while rural America is espe-
sometimes are not aware of advances that make survival cially vulnerable to active shooter incidents because of
from exsanguinating hemorrhage more likely in Kanda- the lack of resources and infrastructure that are found
har than in Appalachia. As an US Army officer, this has in urban centers, training for prehospital hemorrhage
been profoundly disturbing to me. Our essential mission control has implications far beyond such incidents. Ev-
is to protect and defend the nation. While this might en- ery year in my small community, we have automobile,
tail deep operations across oceans, by definition it must hunting, and agricultural accidents that result in severe
first mean that every American citizen in CONUS has hemorrhage. Thus, reporting on the value of prehospi-
the same chance of receiving advanced hemorrhage con- tal hemorrhage control is not isolated to kinetic tactical
trol that troops forward enjoy. events. The translation of value for any rural provider
faced with a traumatically amputated limb is clear and
A look at most JSOM references and a quick PubMed beneficial. Medical operators who seek to publish in ci-
search show that discussions of hemorrhage control in vilian journals should never underestimate the rejection
the civilian sector appear largely in the journals servic- response that many civilian providers experience when
ing emergency medicine and surgery. They appeal to a they hear anything that includes the words “tactical” or
group of individuals found mostly in hospitals and oper- “military.” My student evaluations always include a few
ating with the benefit of a foundational knowledge and comments along the lines of, “I do not see the relevance
the equipment to control hemorrhage. This is not the of discussing combat medicine to civilian practice.”
only audience that needs to hear this message.
The bottom line is that many of the most skilled civilian
Some time ago, LTC (P) Mabry and I had a discussion providers are as gentle as sheep and the idea of being in
about his often-quoted query, “Who owns battlefield an active shooter situation scares them deeply; enough
trauma care?” As part of that discussion, the concept to make them mentally shut down whenever the topic is
of “prehospital specialists” was introduced. The idea discussed. In other words, they do not know what they
of physicians who are intimately familiar with trauma do not know and are fearful of learning. Because of this,
care delivery before the operating room or emergency civilian journal reporting should include the aforemen-
department or before arrival of emergency medical ser- tioned nontactical examples to further condition the
vices (EMS) personnel is very intriguing from the per- civilian medical community that hemorrhage control is
spective of Homeland Defense. These people would not not a niche consideration unique to the military or the
be emergency medicine physicians or surgeons. Concep- active shooter event. Sensitivity to the reality of Ameri-
tually, they should be primary care physicians because can civilian atmospherics is critical for us to gain buy-in
they are disseminated into the community and thus are and for the message to be widely adopted.

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