After Aurora: Tactical Combat Casualty Care in the Aftermath of an Active Shooter

Transcription

1 After Aurra: Tactical Cmbat Casualty Care in the Aftermath f an Active Shter Presented t Energy Facilities Cntractrs Grup, March 12, 2014 Jseph Thill Directr, Office f Security & Emergency Preparedness NREL is a natinal labratry f the U.S. Department f Energy, Office f Energy Efficiency and Renewable Energy, perated by the Alliance fr Sustainable Energy, LLC.

2 Dn t Dubt That This is Cmbat! The Threat/Adversary: Vilence with an intended utcme Weapns f war: High pwered firearms, Imprvised Explsive Devices (IED) that cause the same chas and hrrific wunds (physical and mental) that exist n the battlefield T defeat, requires unity f effrt, maneuver, speed, and directed vilence t neutralize the threat The recvery and respnse that is used n the battlefield (Stabilize, Transprt, Triage, Treat) 2

3 Dn t Dubt That This is Cmbat! Perpetrated by individuals Perpetrated by grups Ptential t evlve t a crdinated effrt t disrupt, terrrize and engage the US n ur wn sil It has and will happen in: Our Schls Our Malls Our Gvernment Facilities Our seats f Natinal Pwer (Ecnmic, Military, Infrastructure) 3

4 Agenda Overview f the Aurra Theater Shting Excerpt frm After Aurra by 9News Denver Intrductin t Tactical Cmbat Casualty Care (TCCC) and the Rle it Can Play in Preparing Fr and Respnding T the Active Shter/Crdinated Assault Pretending it wn t happen des a disservice t thse wh have suffered in the past and thse wh may in the future. 4

5 July 20 th, 2012 Aurra, Clrad 12:40am at the Century Theater 16 inside Theater 9 James Hlmes the alleged shter pens fire after thrwing gas canisters; AR-15, shtgun and Glcks: FBI finds 238 bullet hles and impact marks 12 Killed (including a 6 year ld girl) 58 wunded 8 minutes after 911 call, suspect in custdy 11 minutes after 911, first wunded persn is transprted 5

6 July 20 th, 2012 Aurra, Clrad Unprecedented evacuatin f wunded Changes t hw we will respnd t these events in the future Changes t Tactics, Techniques and Prcedures Changes t Plice Training 6

7 AFTER AURORA 7

8 Tactical Cmbat Casualty Care (TCCC) The fate f the wunded rests with the ne wh applies the first dressing. -Nichlas Senn, M.D.,

9 Tactical Cmbat Casualty Care (TCCC) Rted in a 1996 Study f Military Emergency Medicine Fcus n treatment at the pint f wunding t treat survivable wunds Three distinct envirnments: Care Under Fire Tactical Field Care Tactical Evaluatin Care Three Gals: Identify the causes f preventable death n the battlefield Address them aggressively Cmbine gd medicine with gd tactics 9

10 (Data based n the Wund Data Munitins Effectiveness Team (WDMET) during the Vietnam War between 1967 and 1969) 10

11 Tactical Cmbat Casualty Care (TCCC) Wrld War II Vietnam OIF/OEF CFR 19.1% 15.8% 9.4% Nte: CFR is the Case Fatality Rate the percent f thse wunded wh die frm wunds Gd Tactics are gd medicine Right treatment at the right place at the right time Training all service members in the treatment f preventative techniques Cmbat Applicatin Turniquet (CAT) Israeli Pressure Dressing Cmbat Gauze/ Quick Clt Nasal Pharyngeal Airway Saline Lck and IV Infusin All Service Members trained in TCCC (aka Cmbat Lifesaver Curse) prir t entering theater 11

12 Tactical Cmbat Casualty Care (TCCC) Turniquet as an immediate treatment fr extremity wunds Up t the mid-1990s, medics were training nt t use turniquets Highly effective fr: Hemrrhage frm extremity wunds Junctinal hemrrhage (where an arm r leg jins the trs, such as in the grin area after a high traumatic amputatin) Study f turniquet use shwed n detrimental effects tied t use (2001-present) We believe that the strap-and-buckle turniquet in cmmn use is ineffective in mst instances under field cnditins it rarely cntrls bleeding n matter hw tightly applied. AMMED Jurnal 1945 Over 2500 deaths ccurred in Vietnam secndary t hemrrhage frm extremity wunds. These casualties had n ther injuries. 12

13 Tactical Cmbat Casualty Care (TCCC) Cmbat Applicatin Turniquet (CAT) Pressure Dressing (Israeli Bandage) 13

14 It Wrks! TCCC has helped U.S. cmbat frces t achieve the highest casualty survival rate in histry A recent U.S. Army Training and Dctrine Cmmand survey f Sldiers in cmbat units fund that TCCC is the secnd mst valued element f their training, exceeded nly by training in the use f their individual weapn. COL Karen O Brien, TRADOC Surgen CTCCC Meeting April 2010 The new cncept f Tactical Cmbat Casualty Care has revlutinized the management f cmbat casualties in the prehspital tactical setting. -Critical Care Medicine July 2008 I am writing t ffer my cngratulatins fr the recent dramatic advances in pre-hspital trauma care delivered by the U.S. military. Multiple recent publicatins have shwn that Tactical Cmbat Casualty Care is saving lives n the battlefield. Dr. Jeff Salmne American Cllege f Surgens Cmmittee n Trauma Chairman f Prehspital Trauma Subcmmittee Letter t ASD Health Affairs 10 June

15 Tactical Cmbat Casualty Care (TCCC) TCCC is being adpted by EMS and Law Enfrcement acrss the cuntry Why? Key cmpnent f Advanced Law Enfrcement Rapid Respnse Training (ALERRT) fr Active Shter Aurra Plice Department, Clrad trained all fficers in ne and tw day iteratins at Denver Health Highly effective and easy t train Applicable during Active Shter and Mass Casualty (Bstn Marathn) During an Active Shter r Mass Casualty Event: EMS will be verwhelmed Security situatin may prevent fast evacuatin t treatment facilities Hspitals/Trauma Centers, especially thse clsest t the event, will be verwhelmed The gal is t intervene at the right time t prevent death due t bleeding while awaiting transprt t extended care! 15

16 Questins? 16