Page 167 - JSOM Spring 2018

working group and new equipment working group. A research the importance of the TECC Chain of Survival and need for
and development working group was proposed and will be coordinated efforts by first care providers, law enforcement,
voted on at the May 2018 annual meeting. fire/EMS, and first receivers.

In response to end-user feedback, C-TECC has developed Significant point of wounding care was performed by first care
abridged guideline documents for each specific scope of pro- providers and law enforcement personnel. Many victims had
vider of the chain of survival. These abridged guidelines attempt multiple penetrating injuries given the number of rounds fired
to take into account the specific scope of practice, nomencla- and fragmentation that occurred from the projectiles. Atypi-
ture, standard of care, equipment availability, training, and cal transport platforms, including ride-sharing apps and taxis,
other issues for each of the provider levels. These scope spe- were used to expedite transport of patients to definitive care.
cific guidelines do not differ from the existing set of full TECC Additional research must be conducted to determine wound-
guidelines; instead, each set of provider guideline focuses the ing patterns, efficacy of interventions, and future impact on
TECC guidance to the appropriate skill level and scope of the TECC guidelines and high threat operational response.
specific end user. Currently, the scope-specific guidelines for
first care providers are available on the C-TECC website. Also of note was that initially, first responders considered
that this incident may have been a complex coordinated at-
The specific guidelines for medical first receivers were dis- tack (CCA) since multiple other casinos were calling in active
cussed at the meeting. Further discussion on them will take shooter incidents when injured victims presented at outlying
place at the 2018 May annual meeting. casinos away from the Route 91 festival. This was de-con-
flicted but presented a challenge for first responders already
dealing with a significant and difficult initial incident scene.
Program Updates
The need for integrated and coordinated response operations
The George Washington University School of Medicine and and especially unified command was used in this case to re-
Health Sciences has continued with the development of a se- spond and mitigate appropriately for incident resolution.
ries of TECC training courses funded by a FEMA Continuing
Training Grant (CTG). The courses are currently undergoing National Activities
final review and approvals, and should be available for wide-
spread delivery by the end of January 2018. The first course in Members of C-TECC continue to support federal activities
the series, Introduction to Tactical Emergency Casualty Care such as the Joint Counter Terrorism Awareness Workshop
(TECC) (AWR-359-W), is web-based, has received final ap- Series and Integrated Emergency Management Course for
proval, and is currently available at http://tecc.inquisiqr4.com/. Complex Coordinated Response. In November, key leadership
of C-TECC participated as stakeholders in a meeting of the
The other courses in the series are PER-356: TECC for First White House National Security Council Resilience Director-
Care Providers, PER-357: TECC for Law Enforcement, PER- ate Working Group to address preparedness, response and
358: TECC for Fire/EMS, PER-359: TECC for First Receivers, community resilience in active shooter incidents. In January
PER-360: TECC for First Responder Integration for Active 2018, C-TECC leadership and advisors will attend an “Active
Shooter/Active Killing Incidents-Rescue Task Force (RTF), Shooter Listening Session” co-hosted by the Department of
and PER-361: TECC Active Shooter/Active Killing Incident Homeland Security Office of Health Affairs and the Federal
Command. Interested agencies and jurisdictions can request Emergency Management Agency.
the training from their State Administrative Agency (SAA).
The SAA contact list can be found at https://www.fema.gov The National Fire Protection Agency (NFPA) has released its
/media-library/assets/documents/28689. latest draft of the NFPA 3000: Standard for Preparedness and
Response to Active Shooter and/or Hostile Events. The pur-
Specific issues currently being studied by the committee, either pose of NFPA 3000 is to “identify the minimum program ele-
in working groups or as a whole, include use of chest seals, ments necessary for organizing, managing, and sustaining an
integration of additional WMD/CBRN considerations, and active shooter and/or hostile event response program and to
whole blood and blood product use in the field. Guidelines reduce or eliminate the risks, effect, and impact on an organi-
and/or language changes related to these areas will be consid- zation or community affected by these events.” The draft stan-
ered at the annual meeting in conjunction with SOMSA. dard is currently open for review and public comment. TECC
is included as the standard guideline for point of wounding
care during such incidents and as a listed competency for
Case Study
both law enforcement and medical providers. The standard
Pete Carlo, PA-C (C-TECC Board of Advisors), described his can be accessed at https://www.nfpa.org/codes-and-stan-
experience on the evening of 1 October 2017 following the dards/all-codes-and-standards/list-of-codes-and-standards/
shootings that occurred during the Route 91 Harvest Festival detail?code=3000
concert. The incident resulted in 489 individuals being injured
by a single assailant occupying the high ground of a hotel Acknowledgments
across from the outdoor concert venue. Fifty-eight people C-TECC acknowledges and thanks the Rancho Cucamonga
died from their injuries. Mr Carlo provided an explanation of Fire Department for its support of the committee’s work
the overall response and focused on specific events involving and generosity in hosting the 2017 Mid-Year Full Commit-
him at his hospital. Mr Carlo described how reporting to his tee Meeting. Additionally, the C-TECC Executive Committee
trauma center as opposed to responding to the scene, despite thanks Guidelines Committee member Mr Ofer Lichtman for
his being a tactical medic with SWAT, had a positive impact his invaluable assistance in scheduling and coordinating travel
on operations at the hospital. Anecdotal evidence reinforces logistics for the meeting.

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