Page 108 - JSOM Summer 2020

FIGURE 1 The geographic layout of the event and ingress and egress
routes. Ambulances, decontamination zones, and rescue task forces
were strategically positioned to respond expeditiously.

FIGURE 3 Task forces with rescue
task force capabilities were staged to
FIGURE 2 Alachua County Fire Rescue ambulances were staged off- help locate victims and provide life-
site ready to transport patients to local area hospitals. sustaining treatments, if necessary.

TABLE 2 Tactical Combat Casualty Care vs Tactical Emergency
Casualty Care
Tactical Combat Tactical Emergency
Casualty Care Casualty Care
Military/SWAT Operators: Civilian population
Applicable healthy, athletic, at risk: variable
population prescreened individuals health issues
Support of team to Casualty care and
Goal of medical complete the mission, to evacuation of
providers neutralize the threat, and wounded individuals
end attack on civilians (typically civilians)
Young, healthy team Spectrum of ages
Casualties/ members wearing ballistic and health, not
Although the names sound similar, there are important con- patients protection, including wearing ballistic
ceptual differences between TECC and TCCC (Table 2). Both helmets protection
are based on lessons learned from combat injuries; however, Wounding May be limited to Entire body
extremities, because of
TECC guidelines are designed for treatment of civilian vic- patterns ballistic protection
tims, whereas TCCC focuses on SWAT and other operational THREAT: MARCH:
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responses. RTFs use TECC strategies to treat civilian victims, T: threat suppression M: massive
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who, compared with the population treated following TCCC H: hemorrhage control hemorrhage
guidelines, span a greater age range, often have preexisting Treatment RE: rapid extrication to A: airway control
comorbid conditions, and do not wear body armor. RTF mem- priorities safety R: respiratory
A: assessment by medical
support
algorithm
bers are under the command of the escorting law enforcement providers C: circulation
officers, who decide movement and evacuation decisions. In T: transport to medical H: hypothermia
contrast, the SWAT medical support team’s primary goal is care
to support the safety of SWAT Operators while neutralizing
lethal threats. They must often bypass injured civilians to decontamination (Figure 4). An EMS physician was embed-
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decrease the total number injured. Once the threat has been ded with the decontamination team to screen and triage vic-
neutralized, SWAT medics can provide care for the injured by tims who could be treated by the onsite medical facilities and
using TCCC strategies. decontamination areas versus those requiring higher level of
hospital care. Therefore, jail staff were involved in discussions
In anticipation of civil unrest and the possible use of lacri- regarding the level of injury and illness they felt comfortable
mators by law enforcement, a decontamination area was es- managing. With these efforts, we hoped to reduce unnecessary,
tablished. Additional information raised the possibility of multiple EMS transports, including to the hospital or subse-
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assailants using more hazardous substances, such as foreign quent EMS transports from the jail to the hospital.
military-grade agents obtained from the internet or improvised
agents such as butyric acid “stink bombs.” GFR placed sev- All pertinent local agencies prepared diligently for all possible
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eral decontamination teams in close to the event to assist with scenarios. One such consideration was the use of a vehicle as a

106 | JSOM Volume 20, Edition 2 / Summer 2020