Page 94 - JSOM Summer 2024

continuous quality improvement initiatives, and 24/7 online majority of bags being at least 85% complete. Complete audit
medical direction. inventory findings are itemized in Table 1.
The ATF’s Approach to Tactical Medicine
The central principles of TCCC influenced the early develop- TABLE 1 All ATF Tactical Medic Bags (n=66) Containing Specific
Inventoried Items and Percentages of All Program Bags Deemed
ment of the Tactical Medic Program, as it did for many of its Complete for Each Item
civilian law enforcement counterparts. The ATF continues to No. of bags % of all bags
embrace the approach to casualty care driven by prioritized Item containing complete
responses to survivable injuries. Further, the agency appreci- Extremity hemorrhage
ates the fundamental differences between population cohorts
likely to be encountered in high-threat civilian incidents and Pressure bandage 66 100
those anticipated in combat settings. Wider disparities in age, Hemostatic dressing 66 100
body habitus, limb size, prevalence of comorbidities, impacts Limb tourniquet 66 100
of polypharmacy, and potential for toxidromes distinguish Tension pneumothorax
civilian casualties from those typically injured on the battle- Chest seal 66 100
7
field. As previously reported, a large proportion of ATF tac- Thoracostomy needle 66 100
tical medic encounters may be classified as involving minor Airway management
injuries or low-acuity medical complaints. 8
Bag valve mask 66 100
Nasopharyngeal airway 65 98
A unifying logistical aspect of operational medicine is the basic
need to organize, transport, and functionally deploy medical Supraglottic airway 65 98
supplies and equipment. At the individual medic level, this typ- Diagnostic equipment
ically translates to the maintenance of an operational medic Pulse oximeter 66 100
“bag” of varying configurations containing essential supplies, Stethoscope 64 96
equipment, and, potentially, medications. The Tactical Medic Glucometer 57 86
Program considers the aggregate completeness and appropri- Pharmacology
ateness of the contents of its medic bags a surrogate measure- Epinephrine 60 90
ment of overall programmatic operational readiness. For all
tiers of medical assessment and treatment, the Tactical Medic Naloxone 51 77
Program stipulates that all medic bag contents be approved Aspirin 50 75
by both the national program manager and medical director. Tranexamic acid 48 72
Diphenhydramine 46 70
Nitroglycerin 45 68
Methods
ATF = Bureau of Alcohol, Tobacco, Firearms and Explosives.
Between January and March of 2021, the ATF conducted an
audit and inventory of all Tactical Medic Program bags un- Nearly all bags examined were mission ready with equipment
der the auspices of an internal quality assurance initiative ap- needed to perform critical interventions for casualties with
proved by its Special Operations Division. During the audit traumatic injuries. For example, every medic bag contained
period, every ATF tactical medic was required to bring their pressure bandages, limb tourniquets, chest seals, and thoracos-
agency-issued medic bag to one of five scheduled annual medi- tomy needles. Only one bag audited did not contain a supra-
cal requalification training sessions. Medics were instructed to glottic airway, and one did not contain hemostatic dressings.
bring their medic bags configured as they would to support a Only 48 bags (72%) carried tranexamic acid for infusions.
standard enforcement operation, without further explanation
or preparatory information. For responses to medical incidents and resuscitations, the au-
dit findings were more variable. Every bag contained a bag
Each ATF medic bag was inspected by the national program valve mask device as well as nasopharyngeal airways. For
manager and contents inventoried using specific categories of inventoried medications, however, bags differed in complete-
supplies and equipment. The presence of life-saving procedural ness, in decreasing order, with regards to epinephrine (90%),
supplies, key diagnostic equipment, and select resuscitation naloxone (77%), aspirin (75%), diphenhydramine (70%), and
medications were inventoried. The intent of the audit was not nitroglycerin (68%). Lastly, of the three diagnostic adjuncts
to link findings with the individual medic to whom a bag was inventoried, 100% of medic bags contained a fingertip pulse
assigned. As such, names or other medic identifiers were nei- oximeter, 96% a stethoscope, and 86% a glucometer.
ther collected nor recorded. Bag content inventory data was
collected using paper forms and subsequently transferred to an Discussion
electronic spreadsheet for simple statistical analyses utilizing
™
Excel 365 (Microsoft Corp., 2022). The ATF Tactical Medic Program conducted an audit to in-
ventory all agency-issued medic bags as a surrogate assess-
ment of its overall preparedness to deliver life-saving care
Results in high-threat operational environments. Prior work in this
A total of 66 ATF tactical medic bags were inventoried during arena assessed the degree to which medical supplies recom-
the course of this audit. The presence or absence of 17 items of mended by TCCC were reflected in the actual contents of a
equipment, supplies, diagnostic equipment, and medications cohort of active-duty U.S. military combat medics’ aid bags.
was documented. The rate of medic bag completeness with re- That study found that most contents in those aid bags were
gards to specific items ranged from 68% to 100%, with the not TCCC-preferred items and that a subset of medics were

92 | JSOM Volume 24, Edition 2 / Summer 2024