Page 163 - Journal of Special Operations Medicine - Summer 2016

Management Agency/Federal Bureau of Investigation/ remote damage control resuscitation and prehospital
National Counterterrorism Center Joint Counter Ter- whole-blood transfusion was presented by Dr Geir
rorism Awareness Workshop Series (JCTAWS) and In- Strandenes and Marc DePasquale, 18D.
tegrated Emergency Management Course for Complex • Prehospital application of resuscitative endovascular
Coordinated Attacks (IEMC-CCA). JCTAWS has re- balloon occlusion of the aorta (REBOA) was pre-
cently been conducted in San Diego, California; Dallas, sented by Dr Peter Fischer.
Texas; St. Louis, Missouri; and Tampa, Florida. Future • Intramuscular delivery of tranexamic acid in trauma
workshops are scheduled for San Francisco, California; was presented by Dr Eric Vu.
Phoenix, Arizona; and New Orleans, Louisiana. An
IEMC-CCA was recently conducted for Durham, North The TECC principles are framed around the concepts
Carolina, at the Emergency Management Institute in of damage control resuscitation. As emerging science
Emmitsburg, Maryland, and future courses will be held and technology offer new solutions, the C-TECC will
for Bellevue, Washington; Ada County, Idaho; and Salt continue to review, analyze, and integrate cutting-edge
Lake City, Utah. Interested communities may contact advances into its guidelines.
C-TECC to seek additional information on how to re-
quest either JCTAWS or IEMC-CCA. Program Updates
Key program updates on the Hartford Consensus were
Scientific Advances presented by Dr Matt Levy and an overview of Counter
Effective response to civilian mass-shooting incidents Narcotics and Terrorism Operational Medical Support
remains of critical concern to public safety entities was given by Greg Smith.
worldwide. Data-driven practices from the battlefield
experiences of the US Military have led to widespread Case Study
endorsement of public access hemorrhage control as a A major meeting highlight included an in-depth presen-
key element of survivability. A new study published in tation of the 2 December 2015 complex terrorism attack
the Journal of Trauma, “The profile of wounding in ci- in San Bernardino, California. The presentation was by
vilian public mass shooting fatalities,” was presented Ryan Starling, a paramedic/police officer with the San
1
by coauthor Geoff Shapiro, C-TECC Executive Com- Bernardino Police Department Special Weapons and
mittee member. The purpose was to gain a greater un- Tactics. Mr Sterling was operational during the event
derstanding of the fatality patterns after civilian public and was the first medical provider to access the initial
mass shootings, using similar design and methods to the scene, triage casualties, render point-of-wounding care,
military combat autopsy studies that drove the develop- and coordinate evacuation of patients. This case study
ment and priorities for TCCC. Study data demonstrated highlighted the complexities of response to such coordi-
not only that fatalities following civilian public mass nated attacks and accentuated the ongoing need to dis-
shootings differ from combat fatalities in the mechanism seminate the tenets of TECC and operationalizing new
of injury, overall wounding pattern, fatal wounding pat- integrated response models.
tern, and the percentage of potentially survivable inju-
ries but also simple hemorrhage control measures alone Technology
may not have the same positive effect on survivability A panel of industry representatives presented updates
in civilian public mass shootings as they do in combat. on research and development of hemostatic agents. John
Steinbaugh of RevMedx, Simon McCarthy of Tricol
Tourniquets and external hemorrhage control should be Biomedical (formerly HemCon), Corey Russ of Com-
part of, but not be the sole focus of, public medical edu- bat Medical Systems, and Ricardo Flores of Z-Medica
cation and first responder capabilities. Further, the dif- provided clinical information regarding current agents
ficulties encountered by study investigators in obtaining as well as new products under development or review.
clinical injury and forensic information demonstrated the Mr Flores provided a reminder that end users should
ongoing need to develop enhanced accessibility to quality review all available research and clinical data regarding
civilian casualty data. The study conclusion emphasizes hemostatic agent selection. End users should consider
that although hemorrhage control remains a critical com- the study type, scope, and patient population when de-
ponent of point-of-wounding care, the entirety of TECC termining its usefulness. Like other similar committees,
training and procedures implemented in a provider scope- the C-TECC does not have a mandate to endorse any
appropriate manner as a system along the chain of sur- product or manufacturer. Rather, C-TECC emphasizes
vival is crucial to improving survivability when planning the need for medical directors and program managers
and preparing for high-threat incident mitigation. to review existing literature and to correlate with the
needs and demographics of their patients to make data-
• An introduction to the Trauma Hemostasis and Oxy- driven decisions before selecting any product for field
genation Research (THOR) project and discussion of use.

C-TECC Spring/Summer Meeting Proceedings 149