Page 135 - JSOM Winter 2017

An Ongoing Series

“Evita Una Muerte, Está en Tus Manos” Program

Bystander First Aid Training for Terrorist Attacks

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J. J. Pajuelo Castro, RN *; J. C. Meneses Pardo, MD ; P. L. Salinas Casado ;
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P. Hernández Martín, EMT-B ; R. Montilla Canet, EMT-B ; J. L. del Campo Cuesta, RN ;
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G. Incera Bustio ; D. Martín Ayuso 8
ABSTRACT
Background: The latest terrorist attacks in Europe and in the the training when pre- and post-training test scores were com-
rest of the world, and the military experience in the most recent pared within the three groups. The greatest improvement was
conflicts leave us with several lessons learned. The most impor- seen in the citizens/first responders group
tant is that the fate of the wounded rests in the hands of the
one who applies the first dressing, because the victims usually Keywords: tourniquet; hemostatic; compression bandage;
die within the first 10 minutes, before professional care provid- terrorism; mass casualty incident
ers or police personnel arrive at the scene. A second lesson is
that the primary cause of preventable death in these types of
incidents involving explosives and firearms is massive hemor- Introduction
raghe. Objective: There is a need to develop a training oriented
to citizens so they can identify and use available resources to The latest terrorist attacks in the United States, Europe, and in
avoid preventable deaths that occur in this kind of incidents, the rest of the world, added to military experience in the most
especially massive hemorrhage. Methods: A 7-hour training recent conflicts, leave us several lessons learned. The most im-
intervention program was developed and conducted between portant is that “the fate of the wounded . . . rests in the hands
January and May 2017. Data were collected from participants’ of the one who applies the first dressing” (Nicholas Senn) at
answers on a multiple-choice test before and after undertaking the scene of the incident, because the wounded usually die
the training. Improved mean score for at least 75% of a group’s within the first 10 minutes of their injury, before health pro-
members on the posttraining test was considered reflective of fessionals or police personnel arrive at the scene. Analysis sof
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adequate knowledge. Results: A total of 173 participants (n = terroritist incidents indicates massive bleeding, as in combat,
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74 men [42.8%]; n = 99 women [57.2%]) attended the train- is the first cause of preventable death and that these incidents
ing. They were classified into three groups: a group of citizens/ are a growing and global phenomenon. According to a study
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first responders with no prior health training, a group of health by Eastridge et al., 90.9% of potentially preventable deaths
professionals, and a group of nursing students. Significant dif- in combat are due to bleeding, with 13.5% being located in
ferences (p < .05) between mean pre- and post-training test limbs and, therefore, appropriate for tourniquet application;
scores occurred in each of the three groups. Conclusion: There 7.9% are due to airway problems and another 1.1% are due
was a clear improvement in the knowledge of the students after to tension pneumothorax.
*Address correspondence to secretariamactac@gmail.com
1 Mr Pajuelo Castro is a registered nurse in University Hospital Fundación Jiménez Díaz Intensive Care Unit and clinical simulation instructor.
He is the coordinator of the “Evita una muerte, está en tus manos” program. He is National Association of Emergency Medical Technicians
(NAEMT) Tactical Combat Casualty Care (TCCC) coordinator in Spain and is currently collaborating with the CoTCCC, C-TECC, SOMA, and
the Journal of Special Operations Medicine as a publication translator of ATP-P supplement or TCCC and TECC teaching materials. Mr Castro
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also has SOF and deployment experience, and nongovernmental organization field experience. Dr Meneses Pardo is at Sevilla University with the
Thoracic Surgery Speciality. He also is a thoracic surgeon in University Hospital 12 de Octubre and University Hospital Torrejon. He is a member
of University Hospital 12 de Octubre Lung Transplant Unit and Universidad Complutense Surgery Department associate professor in Madrid,
and the coordinator of Medical Basis for Special Operations Combat Medics training. Mr Salinas Casado is the team leader of Equipo Táctico
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de Respuesta y Rescate (ETRR) in Grupo de Acción Rápida (GAR) of the Spanish Guardia Civil. He is a NATO shooting instructor, counter IED
instructor, and an NAEMT TCCC and Law Enforcement First Responder (LEFR) instructor, among other training programs like NRBQ-R. He
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has antiterrorist and SOF experience in Spain and in multiple deployments. Mr Hernández Martín is an EMT and team member of the ETRR
and NAEMT TCCC and an LEFR instructor. He has an antiterrorist experience in Spain and Africa. Mr Montilla Canet is an EMT and team
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member of the ETRR and NAEMT TCCC and is an LEFR instructor. He has an antiterrorist experience in Spain and a military background. Mr
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del Campo Cuesta is a registered nurse in Guadarrama 12 Brigade. He has multiple deployments in Medevac Assets in Iraq and Afghanistan. He
is an NAEMT TCCC and LEFR instructor. Mr Incera Bustio is a team member of the ETRR and NAEMT TCCC, and is an LEFR instructor. He
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has an antiterrorist experience in Spain and a military background. Mr Martín Ayuso is the shooter department headman in Pozuelo de Alarcón
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Local Police. He has experience in first aid and police tactics and procedures.
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