Page 128 - JSOM Fall 2021

An Ongoing Series

First Aid UCV (Green Cross) for
Prehospital Medicine in Social Commotion Situations

1
F. Chacón-Lozsán, MD *; F. Dávila, MD 2

ABSTRACT
Venezuela is living in a delicate social and political crisis that for prehospital medicine in combat situations and opened the
has taken thousands of lives. Beginning in March 2017, a se- door for a new kind of medical care.
ries of continuous and increasingly violent demonstrations has
taken place, with a high number of civilian casualties. These In the same way, members of First Aid UCV found themselves
demonstrations typically have been outside the range of ac- in a situation in which a great number of civilians, police, and
tion of the government prehospital services. In addition, the military personnel were being injured during the violent Ven-
number of casualties frequently overwhelmed the abilities of ezuelan demonstrations. For the UCV to prevail as a neutral
the available rescue services. Out of the need for a first aid first aid institution, its members carried no weapons of any
team that could operate in this violent scenario, First Aid UCV type while operating inside dangerous zones to provide the
(Central University of Venezuela) was created. A large number fastest response possible to any casualty.
of professionals with medical, rescue, and tactical medicine
experience integrated this new team, modifying their training With the help of some international institutions, the TCCC,
and practice to adapt to a scenario in which unarmed medi- Tactical Emergency Casualty Care (TECC), ATLS, PHTLS,
cal students and medical doctors performed extractions, pro- and North Atlantic Treaty Organization Interallied Confeder-
vided first aid, and managed the transport of demonstration ation of Medical Reserve Officers (NATO CIOMR) manuals
casualties, doing so even when team members were sometimes and courses have contributed to the organization Prehospital
targeted by the government police and military forces. This Medicine in Social Commotion Situations (PMSCS).
method has had successful results in all 60 operations con-
ducted to date, with a total of 5,000 casualties being extracted Differences Between the TCCC, TECC, PHTLS,
among civilians, the military, and the police force. Only one and the PMSCS
member of the team was injured during the operations, and no The PHTLS manual is the gold standard for prehospital
deaths were reported during the process. trauma care in urban environments, where the risk for both
the casualty and the operator is typically low. On the other
Keywords: prehospital medicine; tactical medicine; Venezuela; hand, the TCCC is a modified manual adapted to combat situ-
social commotion ations, in which the operator and the casualty usually are sol-
diers in a combat situation and both carry combat, protective,
and first aid equipment.
Theoretical Fundamentals
However, the environment of the PMSCS is a civil commotion,
Before the establishment of Tactical Combat Casualty Care in which violence surrounds the operators, sometimes making
(TCCC) standards, it was evident that trauma courses such them targets; however, as representatives of a neutral medical
as those of the Advanced Trauma Life Support (ATLS) and institution, the operators are unarmed, unable to answer a di-
the Prehospital Trauma Life Support (PHTLS) systems were rect offense, and must be prepared to extract and treat all the
not sufficient for combat situations. Realizing that it needed casualties in a hostile situation. The Tactical Emergency Casu-
a new method of extracting and treating casualties in combat alty Care (TECC) guidelines, designed for nonmilitary first re-
situations, the United States Army, after years of research, in sponders in a tactical scenario, nevertheless recommend threat
1996 published the first TCCC as a supplement to Military mitigation before attempting extraction or providing care. In
Medicine. This new treatment philosophy created the basis the situation faced by the authors, we as PMSCS providers
*Correspondence to Franciscojlk@hotmail.com
1 Dr F. Chacón-Lozsán is a critical care specialist, Central University of Venezuela (UCV); a National Association of Emergency Medical Techni-
2
cians Tactical Combat Casualty Care provider; and a First Aid UCV specialist instructor and operator. Dr F. Dávila is a medical doctor at UCV
and a First Aid UCV founder.
NOTE: All figures and images in this manual are from the First Aid UCV bank of pictures.

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