Hemorrhage Control by Law Enforcement Personnel: A Survey of Knowledge Translation From the Military Combat Experience
|
|
- Arthur Miller
- 5 years ago
- Views:
Transcription
1 MILITARY MEDICINE, 180, 6:615, 2015 Hemorrhage Control by Law Enforcement Personnel: A Survey of Knowledge Translation From the Military Combat Experience Sara J. Aberle, MD*; Andrew J. Dennis, DO, FACOS ; John M. Landry, PhD ; Matthew D. Sztajnkrycer, MD, PhD* ABSTRACT Background: Military data demonstrate that exsanguinating hemorrhage is the leading cause of potentially preventable combat death. The purpose of this study was to evaluate attitudes and approaches of civilian law enforcement personnel in the management of acute hemorrhagic trauma. Methods: Anonymous survey administered via an online distribution mechanism. Results: 1,317 U.S. law enforcement personnel began the survey. 370 respondents (30.4%) reported their agencies issued tourniquets, whereas 48.8% indicated their agencies had provided specific training in tourniquet application. Pressure dressings were provided to 43.6% of respondents while hemostatic agents were available to 29.8%. Tourniquets were considered the intervention most likely to save a life, but were also deemed most likely to possibly cause harm or injury if used inappropriately. 43 respondents (0.036%) stated they were aware of circumstances within the past year in which an officer in their agency sustained injuries where a tourniquet could have been used, but was not. Conclusions: Hemorrhage control supplies are being issued to less than half of the responding officers. When used, these interventions were generally thought to be effective. Further study is needed to delineate specific medical interventions, and therefore training and equipment, needed by law enforcement personnel. INTRODUCTION Despite improvements in training, tactics, and equipment, law enforcement remains a dangerous profession. Occupational fatality rates for law enforcement personnel are more than 400% higher than the national average. 1 In 2011, 169 officers died in the line of duty, of which 72 officers were feloniously killed. 2,3 An additional 54,774 were assaulted while on duty, with 26.6% of those assaults resulting in injuries. 2 Among individuals dying from combat-related trauma, exsanguinating hemorrhage is responsible for 35% of prehospital deaths and 33% to 40% of deaths within the first 24 hours from time of injury. 4,5 Military data suggested that nearly 24% of combat deaths were potentially survivable, with exsanguinating hemorrhage the predominant cause of potentially preventable death. 6 Introduction of Tactical Combat Casualty Care (TCCC) at the unit level resulted in dramatic decreases in case fatality rates and preventable combat deaths. 5,7 Knowledge translation refers to the dissemination of data and experience into novel arenas of clinical use, with the objective of improved health and safety. In the absence of law enforcement-specific medical training, U.S. law enforcement agencies have turned to their military counterparts in search of medical training guidelines during conditions of active or unknown threat, which may preclude the entry and assistance of conventional emergency medical services. The use of TCCC-based hemorrhage control guidelines have *Department of Emergency Medicine, Mayo Clinic, Rochester, MN Department of Trauma and Burn, JHS Cook County Hospital, Chicago, IL Hillsboro Beach Police Department, 1210 Hillsboro Mile, Hillsboro Beach, FL doi: /MILMED-D been emphasized by national law enforcement agencies and recommended as part of the response to active shooter events One outcome of this knowledge translation is the development of a civilian Committee on Tactical Emergency Casualty Care (TECC). 10 The purpose of this study is to characterize the penetration of current military hemorrhage control guidelines into U.S. law enforcement, including equipment available for use and training of law enforcement officers, in managing acute hemorrhagic trauma. A secondary objective of this study is to begin to define the utilization gap for hemorrhage control among law enforcement personnel, where military hemorrhage control interventions could have been performed but were not. METHODS This study was conducted using the online service SurveyMonkey (Portland, Oregon). The internet link to this survey was distributed through Force Science News (Force Science Research Center, Mankato, Minnesota), a law enforcement-related newsletter. Participation in the survey was entirely voluntary. The survey was administered over a 2-month period from May 1, 2012 to June 30, The study was reviewed by the Mayo Foundation Institutional Review Board and determined to be exempt. Survey Design An anonymous survey was administered via an online distribution mechanism. In addition to demographic and medical education data, specific information was collected regarding training and use of tourniquets, pressure dressings, and hemostatic agents. Responding law enforcement personnel had the opportunity to describe their opinions and experiences regarding hemorrhage control in comment sections. MILITARY MEDICINE, Vol. 180, June
2 FIGURE 1. Number of respondents per U.S. state. Statistical Analyses Survey responses were initially entered into a Microsoft Excel 2008 database (v12.3.6, Microsoft Corporation, Redmond, Washington, DC). Statistical analysis was performed using JMP statistical analysis software (JMP 9.0.3, SAS Institute, Cary, North Carolina), utilizing Pearson χ 2 tests and basic demographic calculations. According to convention, an α level of 0.05 defined statistical significance. RESULTS Of the 1,363 respondents beginning the survey, 1,317 were U.S. law enforcement personnel, representing all 50 states and the District of Columbia (Fig. 1). Agency type and populations served are described in Table I. TABLE I. Respondent Agency Type and Population Size Served Agency Type Respondents (%) City, Municipal, Population > 250, (15.0) City, Municipal, Population 100, , (8.8) City, Municipal, Population 50, , (12.1) City, Municipal, Population 25,000 50, (8.8) City, Municipal, Population 10,000 25, (7.6) City, Municipal, Population < 10, (8.2) Metropolitan County 127 (9.4) Nonmetropolitan County 118 (8.7) State Agency 139 (10.2) Federal Agency 101 (7.4) Others 52 (3.8) Equipment and Training Table II lists department issue rates for hemorrhage control equipment, as well as the rates at which officers are allowed to purchase intervention equipment on their own for use in the field, whereas Table III lists TCCC and hemorrhage control intervention training rates. Of 1,216 officers who answered the question, 370 (30.4%) reported their agencies issued commercial one-handed tourniquets. 602 respondents (48.8%) indicated their agencies had provided specific training in tourniquet application. Agencies issuing tourniquets were more likely to provide tourniquet-related medical training compared with those not issuing tourniquets (97.3% vs. 30.2%, p < ). Of officers who reported their agencies did not issue tourniquets, 134 (15.8%) further reported individual officers were not permitted by their agencies to purchase and field a tourniquet. 552 respondents (43.6%) reported being provided with pressure dressings by their agencies, whereas 642 respondents (52.9%) reported receiving training in the use of pressure dressings. Agencies issuing pressure dressings were more TABLE II. Equipment Access to Hemorrhage Control Equipment as Reported by Respondents Agency Issue Rate (%) Ability to Purchase (%) Commercial Tourniquet 396 (30.6) 964 (85.2) Hemostatic Agent 394 (29.2) 953 (81.5) Pressure Dressing 552 (43.6) 955 (88.3) 616 MILITARY MEDICINE, Vol. 180, June 2015
3 TABLE III. Medical Training Level and Prevalence of Tactical Medical Hemorrhage Control Training Reported by Respondents Respondent Reported Highest Level of Medical Training (%) American Red Cross First Aid/Basic CPR 502 (37.1) Department of Transportation First Responder 229 (16.9) Emergency Medical Technician Basic 228 (16.9) Emergency Medical Technician Intermediate 67 (4.9) Emergency Medical Technician Paramedic 97 (7.2) Tactical Combat Casualty Care/Combat Lifesaver 78 (5.8) Other 152 (11.2) Respondent Tactical Medical Hemorrhage Control Training (%) Tactical Combat Casualty Care/Combat Lifesaver Training 571 (42.1) Agency-Provided Commercial Tourniquet Training 602 (48.8) Agency-Provided Hemostatic Agent Training 408 (32.0) Agency-Provided Pressure Dressing Training 642 (52.9) likely to provide training (82.1% vs. 30.6%, p < ). 389 respondents (29.8%) reported their agencies issued hemostatic agents, and 408 (32.0%) respondents reported their agencies provided training in the use of hemostatic agents. Agencies issuing hemostatic agents were more likely to provide related training (73.2% vs. 15.5%, p < ). Experiences and Perceptions Commercial tourniquets were considered the intervention most likely to save a life in the case of life-threatening compressible hemorrhage, selected by 39.5% of the respondents (Fig. 2). Officers who were issued tourniquets, or had received TCCC or Combat Lifesaver training, were significantly more likely to identify this method of hemorrhage control as the most likely lifesaving intervention ( p < ). The majority of officers thought a basic pressure dressing or direct TABLE IV. Reported Cases of Hemorrhage Control Use and Perceived Efficacy in Managing Bleeding Intervention Officers Cases Perceived Efficacy (%) Commercial Tourniquet Hemostatic Agent Pressure Dressing manual compression were the hemostatic methods most likely to be used during their career (32.0% and 37.3%, respectively; Fig. 2). Direct manual pressure was thought to be the easiest method to employ with minimal training (39.0%; Fig. 2). 97 officers (0.079%) described a total of 123 actual incidents in which a tourniquet was used and reported them to be effective in 85.4% of the cases (Table IV). Being issued a tourniquet (p < ) or trained in their use (p <0.0001) increased the likelihood of officers reporting knowledge of an actual scenario in which one was employed. Officers who were aware of an incident in which an officer utilized a tourniquet in the field were more likely to trust a tourniquet as a lifesaving measure ( p < ). 43 respondents (0.036%) respondents stated they were aware of circumstances within the past year in which an officer in their agency sustained injuries where a commercially produced one-handed tourniquet could have been used, but was not. No significant differences in tourniquet issue or training rates were noted for these cases. The majority of responding law enforcement officers (70.6%) identified tourniquets as the most likely hemorrhage control method to possibly cause harm or injury if used inappropriately (Fig. 2). However, there were some groups of respondents who were significantly less likely than their peers to perceive tourniquets as being potentially harmful: those FIGURE 2. Respondent perceptions concerning hemorrhage control interventions. MILITARY MEDICINE, Vol. 180, June
4 who were issued tourniquets by their agency (p < ), trained in tourniquet use ( p < ), underwent TCCC training (p < ), were aware of an actual incident in which a tourniquet was employed ( p = ), or those who knew of a case where a tourniquet could have been used, but was not (p = 0.037). 214 officers reported 321 actual incidents in which pressure dressings were used in the field. These were felt to be the most successful hemorrhage control intervention, with a 92.5% perceived effectiveness rate (Table IV). Officers who were aware of an incident in which a pressure dressing was used were more likely to consider using a pressure dressing ( p = ). 92 respondents reported being aware of at least one incident in the past year in which an officer sustained injuries where a pressure dressing could have been used, but was not. There were no significant differences between pressure dressing training rates and missed opportunities. However, those who were not issued pressured dressings by their agency were significantly more likely to report knowledge of a case where a pressure dressing could have been used, but was not (9.12% vs. 5.44%, p = 0.016). 85 officers reported being aware of officers from their agency using hemostatic agents in the field. The hemostatic agent application was considered successful in 87.2% of applications (Table IV). 126 officers stated they were aware of incidents in the past year in which law enforcement personnel sustained injuries where they perceived that hemostatic agents could have been used, but were not. Those who were not trained in hemostatic agent use were significantly more likely to report a missed opportunity (11.52% vs. 7.52%, p = 0.029). Similarly, those not issued hemostatic agents were more likely to think a potential intervention was missed than those who were issued the supplies (11.43% vs. 7.18%, p = 0.023). Those officers trained in hemostatic agent use were more likely to use a technique other than direct manual pressure or a pressure dressing than those who had not received hemostatic agent training ( p = ). Officers who were issued hemostatic agents or tourniquets, or who had received TCCC training were less likely than their peers to report pressure dressings or direct manual pressure as the most likely interventions they would use in their career ( p < , <0.0001, and , respectively). Respondents provided a number of comments describing their experiences with hemostatic agents. Mechanisms of injury for which hemostatic agents were used included gunshot wounds, stabbings, complicated lacerations, and motor vehicle accidents. A few respondents specifically identified injuries sustained in noncompressible regions where hemostatic agents were used and considered to be helpful, or were not used but were thought to be potentially helpful. DISCUSSION On average, 53 law enforcement officers are murdered in the line of duty every year. 2 The majority of these events involve penetrating trauma. In addition, more than 50,000 are feloniously assaulted each year. In many of these events, situations are dynamic and rapidly evolving, and medical care is complicated by the presence of ongoing threats. 11 After the 1993 Battle of Mogadishu, Somalia, the U.S. military changed its approach to battlefield trauma care. Using evidence-based data and taking into account operational realities, a novel approach to trauma care was developed. This new approach, designated TCCC, is the current standard of care for prehospital combat trauma care in the U.S. military and many coalition forces. TCCC has proven to be remarkably effective and continues to save lives down range. 5,7,12,13 Units fully invested in TCCC demonstrated improved survival rates; the U.S. Army 75th Ranger Regiment reported no possibly preventable combat deaths after adopting TCCC. 5 Analysis of combat deaths over a 10-year period demonstrated nearly 1,000 deaths that might have been prevented by the widespread adoption of TCCC protocols. 4,14 Of these deaths, approximately 90% were because of hemorrhage. One key finding of these studies was the importance of awareness and support at the command level. In the absence of civilian guidelines for medical care under conditions of active threat, law enforcement agencies have turned to the experiences and successes of the U.S. military TCCC program. 8,9 Among the key differences between TCCC and traditional civilian advanced trauma life support is the prioritization of exsanguinating extremity hemorrhage over airway management, and emphasis on the early use of tourniquets and hemostatic agents. This change in focus was based upon military data, which demonstrated 9% of total deaths and 60% of possibly preventable deaths in combat were because of isolated extremity hemorrhage. 6 As part of this knowledge translation, recently developed civilian TECC guidelines emphasize extremity hemorrhage control as the principal element of medical care to be provided under circumstances of active threat. 10 In contrast to the military medicine environment, the use of tourniquets in the civilian sector remains controversial. The documented lifesaving potential of tourniquets has caused a reconsideration of tourniquet safety, and an increasingly permissive environment for use. Vocal calls for civilian use have appeared in both law enforcement professional journals and media reports. 15,16 Despite this, both the American Red Cross and the American Heart Association state that there is insufficient data for or against recommending their routine use in civilian first aid. 17 Tourniquet use, a foundational skill of TCCC and TECC, was therefore examined closely in this study and was perceptually identified as the most likely lifesaving hemorrhage control method by respondents. Tourniquets may provide a particular advantage to law enforcement officers as compared with other civilian first responders because once placed, tourniquets could permit continued hands-free hemorrhage management and therefore allow officers to better engage any ongoing threat, consistent with key TCCC concepts of 618 MILITARY MEDICINE, Vol. 180, June 2015
5 providing care under fire. The Israeli experience with tourniquets demonstrated that 69% were applied secondary to such situational constraints, with 34% applied because of care under fire. 13 In contrast to current U.S. military standards, in which almost every U.S. soldier is trained in tourniquet use and issued a commercial tourniquet when deployed, less than half of the responding officers reported receiving agencysponsored tourniquet training and less than one-third of respondents reported being issued tourniquets. Based on the comments from survey respondents, at least some resistance to tourniquet issuance and training appears linked to cost and time required to train personnel and provide the necessary supplies. Some officers also expressed concern for potential harm if those employing the tourniquets were not adequately trained. Previous review of lifesaving interventions and hemorrhage control performed in combat showed tourniquets were applied incorrectly less frequently than airway management, vascular access, and thoracic needle decompression. 12 A more recent study of military prehospital tourniquet placement demonstrated that 83% of tourniquets were inadequately tightened. 18 Pressure dressing application, the most frequently used combat trauma hemorrhage intervention, was also identified as the most commonly used intervention among our survey respondents (371, 37.0%). 12 Pressure dressings were the hemorrhage control supplies most frequently issued to respondents and were thought to be generally safe to employ. Respondents were significantly more likely to report a missed opportunity if they were not issued a pressure dressing, whereas lack of training in this methodology was not significant. The principal limitation for pressure dressing use appears to be lack of access rather than lack of training. Echoing combat experience, hemostatic agent use by law enforcement was the least frequently reported hemorrhage control intervention. 12 Respondents expressed concern for potential adverse effects of these agents. However, when used, they were thought to be effective in the vast majority of occurrences, even more so than tourniquet use. Hemostatic agents were also identified as the hemorrhage control modality most likely to manifest a utilization gap, in which they could have been used, but were not. A lack of training in or issuance of hemostatic agents was significantly linked to reported utilization gaps. Focused education and increased equipment access may be important factors with regard to this hemorrhage control modality. This study identified several interesting patterns in perceptions of hemorrhage control. Experience with, training in, or even secondary knowledge of actual use of various hemorrhage control methods altered perception of the intervention, biasing in favor of the intervention. These results also appear to demonstrate the presence of an affect heuristic toward the intervention, in which a positively viewed intervention is less likely to be associated with perception of potential negative consequences. It remains unclear whether these experientially based perceptions result in any significant consequences in the field. Lastly, a large number of survey respondents identified a need and desire for additional medical training in their comments, specifically as it pertains to the tactical setting. This is supported by other studies, which have shown more than 90% of their respondents were interested in law enforcement-specific medical training. 19,20 The goal of such education should not be limited to having training available but to ensure the skills taught could be executed successfully in the field, and that the skills are maintained over time. Limitations This study has a number of limitations, including those inherent in any survey-based study. Selection bias was introduced simply because of the increased motivation of those respondents receiving the weekly newsletter used to disseminate the survey. Study respondents also reported higher levels of medical training than departmental minimums. The questions queried perceptions in a survey setting, permitting response bias to potentially alter their answers when compared with decisions during actual events. The retrospective nature of some survey questions may have introduced recall bias, in that respondents were asked to remember something from the past in relationship to a potential perceived benefit. It is also important to note that the sample size of 1,317, while large, reflects less than 0.05% of all sworn law enforcement officers in the United States and thus provides only a small window into the law enforcement population. As a consequence, the results of this study reflect the experiences of a very small representation of the total U.S. law enforcement population and should be interpreted as such. TCCC is an evidence-based curriculum focusing on management of the leading causes of possibly preventable combat death. Previous studies have identified differences in military and law enforcement fatality patterns, 21 as well as the incidence of exsanguinating extremity trauma in the civilian sector. 22 Such differences may directly impact the knowledge translation of military TCCC data to the civilian law enforcement setting. Lastly, this study did not directly address certain practical issues, such as availability and oversight of medical direction, lack of national training standards, and subsequent concerns for litigation, after hemorrhage control application. CONCLUSIONS This study suggests that the importance of hemorrhage control has penetrated a large portion of the sample described in this study, either through formal TCCC courses, other agencysponsored training, and trade literature, or through media reports. Hemorrhage control supplies are currently being issued to less than half of the departments represented by the responding officers. When used, TCCC hemorrhage control interventions were generally thought to be effective. There appears to be some correlation between perceived MILITARY MEDICINE, Vol. 180, June
6 missed intervention (utilization gap) opportunities and a lack of supply availability and training. Many respondents expressed a desire for additional training. Further study is needed to identify the leading causes of possibly preventable death in the civilian sector and to further delineate the medical interventions, training, and equipment needed by civilian law enforcement personnel. REFERENCES 1. Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ: Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 2010; 34(1): U.S. Department of JusticeFederal Bureau of InvestigationCriminal Justice Information Services Division (CJIS): Uniform Crime Reports, Law Enforcement Officers Killed and Assaulted (LEOKA), Available at accessed March 7, Anonymous: Causes of Law Enforcement Deaths Over the Past Decade ( ). Facts and Figures. National Law Enforcement Officers Memorial Fund. Available at accessed March 9, Eastridge BJ, Mabry RL, Seguin P, et al: Death on the battlefield ( ): implications for the future of combat casualty care. J Trauma Acute Care Surg 2012; 73: S Kotwal RS, Montgomery HR, Kotwal BM, et al: Eliminating preventable death on the battlefield. Arch Surg 2011; 146: Bellamy RF: The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med 1984; 149: Tien HC, Jung V, Rizoli SB, Acharya SV, MacDonald JC: An evaluation of tactical combat casualty care interventions in a combat environment. J Spec Oper Med 2009; 9: Butler FK, Carmona R: Tactical combat casualty care: from the battlefields of Afghanistan and Iraq to the streets of America. Tactical Edge 2012; 27: Jacobs LM, Wade DS, McSwain NE, et al: The Hartford Consensus: THREAT, a medical disaster preparedness concept. J Am Coll Surg 2013; 217: Callaway DW, Smith ER, Cain J, et al: Tactical emergency casualty care (TECC): guidelines for the provision of prehospital trauma care in high threat environments. J Spec Oper Med 2011; 11: Schwartz RB, McManus JG, Croushorn J, et al: Tactical medicine competency-based guidelines. Prehosp Emerg Care 2011; 15: Lairet JR, Bebarta VS, Burns CJ, et al: Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2 Suppl 1): S Lakstein D, Blumenfeld A, Sokolov T, et al: Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma 2003; 54(5 Suppl): S Phillips MM: Are U.S. Soldiers Dying From Survivable Wounds. Wall Street Journal, September 19, Available at are-u-s-soldiers-dying-from-survivable-wounds ?mobile=y; accessed October 25, Doyle GS, Taillac PP: Tourniquet First! The War on Trauma. Law Officer Supplement, Available at tourniquet-first; accessed October 25, Lloyd J: Emergency tourniquets, war lessons saved lives in Boston. USA Today, April 17, Available at story/news/nation/2013/04/17/tourniquets-emergencyboston/ /; accessed October 25, Markenson D, Ferguson JD, Chameides L, et al: Part 13: first aid: 2010 American Heart Association and American Red Cross International Consensus on First Aid Science with treatment recommendations. Circulation 2010; 122(16 Suppl 2): S King DR, van der Wilden G, Kragh JFJr, Blackbourne LH: Forward assessment of 79 prehospital battlefield tourniquets used in the current war. J Spec Oper Med 2012; 12: Kleinman D, Kastre T: Beyond the tape. Law enforcement officers make major impact as initial care providers. JEMS 2012; 37: 38 40, Sztajnkrycer MD, Callaway DW, Baez AA: Police officer response to the injured officer: a survey-based analysis of medical care decisions. Prehosp Disaster Med 2007; 22: Sztajnkrycer MD: Tactical medical skill requirements for law enforcement officers: a 10-year analysis of line-of-duty deaths. Prehosp Disaster Med 2010; 25: Dorlac WC, DeBakey ME, Holcomb JB, et al: Mortality from isolated civilian penetrating extremity injury. J Trauma 2005; 59: MILITARY MEDICINE, Vol. 180, June 2015
Trauma remains the leading cause of death in adults
TCCC Standardization The Time Is Now Carl W. Goforth, PhD, RN, CCRN; David Antico, MSN, RN, FNP-BC Trauma remains the leading cause of death in adults worldwide, 1 and a significant portion of those deaths
More information1/7/2014. Dispatch for fire at Rosslyn, VA metro station Initial dispatch as Box Alarm
1 Dispatch for fire at Rosslyn, VA metro station Initial dispatch as Box Alarm 4 engines, 2 trucks, 1 rescue, 1 medic unit, 2 battalion chiefs, 1 EMS supervisor, 1 battalion aide First arriving units report
More informationTrauma and Injury Subcommittee: Battlefield Research, Development, Test and Evaluation Priorities. Norman McSwain, MD Subcommittee Member
Trauma and Injury Subcommittee: Battlefield Research, Development, Test and Evaluation Priorities Norman McSwain, MD Subcommittee Member Defense Health Board November 27, 2012 1 Trauma and Injury Subcommittee
More informationTactical Combat Casualty Care for All Combatants August (Based on TCCC-MP Guidelines ) Introduction to TCCC
Tactical Combat Casualty Care for All Combatants August 2017 (Based on TCCC-MP Guidelines 170131) Introduction to TCCC Pretest Pre-Test TCCC Web Link to Video What is TCCC and Why Do I Need to Learn About
More informationHigh Threat Mass Casualty 1/7/2014. Game changer..
Changing the Paradigm: Guidelines for High Risk Scenarios E. Reed Smith, MD, FACEP Committee for Tactical Emergency Casualty Care 1 Game changer.. 2 High Threat Mass Casualty What is the traditional teaching
More informationTactical Combat Casualty Care: Transitioning Battlefield Lessons Learned to other Austere Environments
Tactical Combat Casualty Care: Transitioning Battlefield Lessons Learned to other Austere Environments CAPT (Ret.) Brad Bennett PhD, NREMT-P, FAWM - Chair/Moderator COL Ian Wedmore MD - Co-Chair CAPT (Ret.)
More informationJOINT COMMITTEE TO CREATE A NATIONAL POLICY TO ENHANCE SURVIVABILITY FROM MASS CASUALTY SHOOTING EVENTS HARTFORD CONSENSUS II
July 11, 2013 JOINT COMMITTEE TO CREATE A NATIONAL POLICY TO ENHANCE SURVIVABILITY FROM MASS CASUALTY SHOOTING EVENTS HARTFORD CONSENSUS II Concept to Action On April 2, 2013, representatives from a select
More informationDEFENSE HEAL TH BOARD FIVE SKYLINE PLACE, SUITE LEESBURG PIKE FALLS CHURCH, VA
DEFENSE HEAL TH BOARD FIVE SKYLINE PLACE, SUITE 810 5111 LEESBURG PIKE FALLS CHURCH, VA 22041-3206 JUN 14 2011 FOR: JONATHAN WOODSON, M.D., ASSISTANT SECRETARY OF DEFENSE (HEALTH AFFAIRS) SUBJECT: Tactical
More informationUPMC Trauma Care System
A Western PA Initiative 1 UPMC Trauma Care System Altoona (Level II Adult) Children s Hospital (Level I Pediatric) Hamot (Level II Adult) 2 Mercy (Level I Adult, Burn Center) Presbyterian (Level I Adult)
More informationActive Violence and Mass Casualty Terrorist Incidents
Position Statement Active Violence and Mass Casualty Terrorist Incidents The threat of terrorism, specifically active shooter and complex coordinated attacks, is a concern for the fire and emergency service.
More informationTCCC for All Combatants 1708 Introduction to TCCC Instructor Guide 1
TCCC for All Combatants 1708 Introduction to TCCC Instructor Guide 1 1. Tactical Combat Casualty Care for All Combatants August 2017 Introduction to TCCC Tactical Combat Casualty Care is the standard of
More informationMedical Training for U.S. Armed Services Medical Personnel and All Other Combatants
Medical Training for U.S. Armed Services Medical Personnel and All Other Combatants Military Trauma Care s Learning Health System & its Translation to the Civilian Sector National Association of Emergency
More informationIntegration of Tactical Emergency Casualty Care Into the National Tactical Emergency Medical Support Competency Domains
Integration of Tactical Emergency Casualty Care Into the National Tactical Emergency Medical Support Competency Domains Andre M. Pennardt, MD, FACEP; David W. Callaway, MD, MPA, FACEP; Richard Kamin, MD,
More informationTactical & Hunter First Aid Workshop
Jackson Hole Gun Club Jackson, WY July 15, 2013 Tactical & Hunter First Aid Workshop LTC Will Smith MD, Paramedic www.wildernessdoc.com Disclaimers No financial conflicts to disclose Board of Advisors
More informationDeployment Medicine Operators Course (DMOC)
Deployment Medicine Operators Course (DMOC) The need has never been more critical to equip those who will first contact the battlefield casualty with lifesaving knowledge to improve survivability. Course
More informationamong TEMS providers:
The need for standardization among TEMS providers: Training, credentialing and roles By Scott Warner, MD, EMT Tactical teams which have integrated tactical medics and physicians into their law enforcement
More informationBringing Combat Medicine to the Streets of EMS. MAJ Will Smith MD, EMT-P US Army
Bringing Combat Medicine to the Streets of EMS MAJ Will Smith MD, EMT-P US Army Disclaimers No financial or other conflicts to disclose This presentation is NOT an official position or endorsement from
More informationSurgical Legacies of Modern Combat: Translating Battlefield Medical Practices into Civilian Trauma Care
American College of Surgeons 2017. All rights reserved Worldwide. Surgical Legacies of Modern Combat: Translating Battlefield Medical Practices into Civilian Trauma Care Achieving Zero Preventa bl e Deaths
More informationReview of the Defense Health Board s Combat Trauma Lessons Learned from Military Operations of Report. August 9, 2016
Review of the Defense Health Board s Combat Trauma Lessons Learned from Military Operations of 2001-2013 Report August 9, 2016 1 Problem Statement The survival rate of Service members injured in combat
More informationESCAMBIA COUNTY FIRE-RESCUE
Patrick T Grace, Fire Chief Page 1 of 7 PURPOSE: To create a standard of operation to which all members of Escambia County Public Safety will operate at the scene of incidents involving a mass shooting
More informationSTOP THE BLEED. InfoBrief. International Public Safety Association. March 2018
1 STOP THE BLEED InfoBrief International Public Safety Association March 2018 2 About This International Public Safety Association InfoBrief discusses how and why the Stop the Bleed program was developed
More informationphoto ChrisDownie istockphoto.com
photo ChrisDownie istockphoto.com 48 JEMS DECEMBER 2009 >> By E. Reed Smith, MD; Blake Iselin, FF/EMT-III; & W. Scott McKay Arlington County, Va., Rescue Task Force represents a new medical response model
More informationTrauma and Injury Subcommittee
Trauma and Injury Subcommittee Decision Brief: Combat Trauma Lessons Learned from Military Operations of 2001-2013 Col (Ret) Donald Jenkins, MD, FACS, DMCC Defense Health Board November 6, 2014 1 Overview
More informationNAVAL POSTGRADUATE SCHOOL THESIS
NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS TACTICAL MEDICAL TRAINING FOR POLICE OFFICERS: LESSONS FROM U.S. SPECIAL FORCES by Christopher D. Judge December 2012 Thesis Advisor: Second Reader:
More informationUNITED STATES MARINE CORPS FIELD MEDICAL TRAINING BATTALION Camp Lejeune, NC
UNITED STATES MARINE CORPS FIELD MEDICAL TRAINING BATTALION Camp Lejeune, NC 28542-0042 FMST 401 Introduction to Tactical Combat Casualty Care TERMINAL LEARNING OBJECTIVE 1. Given a casualty in a tactical
More informationComparison: ITLS Provider and Trauma Nursing Core Course (TNCC)
Overview International Trauma Life Support (ITLS) is a global organization dedicated to preventing death and disability from trauma through education and emergency care. ITLS educates emergency personnel
More informationINSTRUCTOR GUIDE FOR INTRODUCTION TO TCCC-MP
INSTRUCTOR GUIDE FOR INTRODUCTION TO TCCC-MP 160603 1 1. Introduction to Tactical Combat Casualty Care for Medical Personnel 03 June 2016 Tactical Combat Casualty Care is the new standard of care in prehospital
More informationFixing the Wounded or Keeping Lead in the Air Tactical Officers Views of Emergency Care on the Battlefield
MILITARY MEDICINE, 180, 2:224, 2015 Fixing the Wounded or Keeping Lead in the Air Tactical Officers Views of Emergency Care on the Battlefield CAPT Sten-Ove Andersson, NC SwMC* ; LT Col Lars Lundberg,
More informationMedical Provider Ballistic Protection at Active Shooter Events
Medical Provider Ballistic Protection at Active Shooter Events Jason P. Stopyra, MD; William P. Bozeman, MD; David W. Callaway, MD; James E. Winslow III, MD, MPH; Henderson D. McGinnis, MD; Justin Sempsrott,
More informationA RESIDENT PHYSICIAN EXPERIENCE
DEPARTMENTS / TEMS University of Cincinnati TEMS: A RESIDENT PHYSICIAN EXPERIENCE By David W. Strong, Justin L. Benoit and Dustin J. Calhoun The intense physical demands, as well as the dangerous nature
More informationAmerican College of Surgeons Bleeding Control Legislative Toolkit
American College of Surgeons Bleeding Control Legislative Toolkit This document is a resource for ACS Chapters, Fellows, and Committee on Trauma (COT) advocates to promote the Stop the Bleed program and
More informationORIGINAL ARTICLE. Eliminating Preventable Death on the Battlefield
ONLINE FIRST ORIGINAL ARTICLE Eliminating Preventable Death on the Battlefield Russ S. Kotwal, MD, MPH; Harold R. Montgomery, NREMT; Bari M. Kotwal, MS; Howard R. Champion, FRCS; Frank K. Butler Jr, MD;
More informationORIGINAL ARTICLE. Eliminating Preventable Death on the Battlefield
ONLINE FIRST ORIGINAL ARTICLE Eliminating Preventable Death on the Battlefield Russ S. Kotwal, MD, MPH; Harold R. Montgomery, NREMT; Bari M. Kotwal, MS; Howard R. Champion, FRCS; Frank K. Butler Jr, MD;
More informationContents. The Event 12/29/2016. The Event The Aftershock The Recovery Lessons Learned Discussion Summary
#OrlandoUnited: Coordinating the medical response to the Pulse nightclub shooting Christopher Hunter, M.D., Ph.D. Director, Orange County Health Services Department Associate Medical Director, Orange County
More informationPresentation to the Quality of Life Council Nova Southeastern University June 12, 2012
Armed Encounters between Police and Citizens In Broward County: Implications for Policy and Practice Presentation to the Quality of Life Council Nova Southeastern University June 12, 2012 Tammy Kushner,
More informationPHYSICIAN ASSISTANTS IN TACTICAL MEDICINE TRAINING PROGRAMS
Physician Assistants in Tactical Medicine Training Programs Chapter 21 PHYSICIAN ASSISTANTS IN TACTICAL MEDICINE TRAINING PROGRAMS Felipe Galvan, PA-C, MPAS; Todd P. Kielman, PA-C, MPAS; Robert M. Levesque,
More informationTrauma and Injury Subcommittee: Lessons Learned in Theater Trauma Care in Afghanistan & Iraq. Donald Jenkins, MD Norman McSwain, MD
Trauma and Injury Subcommittee: Lessons Learned in Theater Trauma Care in Afghanistan & Iraq Donald Jenkins, MD Norman McSwain, MD Defense Health Board November 27, 2012 1 Trauma and Injury Subcommittee
More informationD ebakey1 observed that, Had certain problems in World
SPECIAL REPORT Implementing and preserving the advances in combat casualty care from Iraq and Afghanistan throughout the US Military Frank K. Butler, MD, David J. Smith, MD, and Richard H. Carmona, MD,
More informationNEW TRAUMA CARE SYSTEM. DOD Should Fully Incorporate Leading Practices into Its Planning for Effective Implementation
United States Government Accountability Office Report to Congressional Committees March 2018 NEW TRAUMA CARE SYSTEM DOD Should Fully Incorporate Leading Practices into Its Planning for Effective Implementation
More informationINTRADEPARTMENTAL CORRESPONDENCE. The Honorable Board of Police Commissioners
INTRADEPARTMENTAL CORRESPONDENCE October 1, 2013 BPC #13-0348 1.0 TO: The Honorable Board of Police Commissioners FROM: Inspector General, Police Commission SUBJECT: POST REFRESHER TRAINING AUDIT RECOMMENDED
More informationSan Diego Operational Area. Policy # 9A Effective Date: 9/1/14 Pages 8. Active Shooter / MCI (AS/MCI) PURPOSE
PURPOSE The intent of this Policy is to provide direction for performance of the correct intervention, at the correct time, in order to stabilize and prevent death from readily treatable injuries in the
More informationTCCC for Medical Personnel Curriculum 1708
TCCC for Medical Personnel Curriculum 1708 TCCC-MP Guidelines TCCC Guidelines for Medical Personnel 170131 TCCC Quick Reference Guide Link to TCCC Quick Reference Guide PowerPoint Presentations Intro to
More informationLaw Enforcement and Public Safety. Medical Response to Trauma: The Hartford Consensus. This module uses information from: Objectives 9/25/2014
Law Enforcement and Public Safety Medical Response to Trauma: The Hartford Consensus This module uses information from: Improving Survival from Active Shooter Events: The Hartford Consensus Pre-Hospital
More informationLaw Enforcement and Public Safety. Medical Response to Trauma: The Hartford Consensus
Law Enforcement and Public Safety Medical Response to Trauma: The Hartford Consensus This module uses information from: Improving Survival from Active Shooter Events: The Hartford Consensus Pre-Hospital
More informationDefense Health Agency PROCEDURAL INSTRUCTION
Defense Health Agency PROCEDURAL INSTRUCTION SUBJECT: Implementation Guidance for the Utilization of DD Form 1380, Tactical Combat Casualty Care (TCCC) Card, June 2014 References: See Enclosure 1 NUMBER
More informationBest Medicine, Worst Places: Tactical Medicine in an Urban Environment
Best Medicine, Worst Places: Tactical Medicine in an Urban Environment Alexander Eastman, MD, MPH, FACS Interim Medical Director The Trauma Center at Parkland UW Medicine EMS & Trauma Conference September
More informationDear Chairman Alexander and Ranking Member Murray:
May 4, 2018 The Honorable Lamar Alexander Chairman Senate Committee on Health, Education, Labor and Pensions United States Senate 428 Dirksen Senate Office Building Washington, DC20510 The Honorable Patty
More informationWhenever wars are fought, children are caught in the crossfire.
ORIGINAL ARTICLE Ten years of military pediatric care in Afghanistan and Iraq Matthew Borgman, MD, Renée I. Matos, MD, Lorne H. Blackbourne, MD, and Philip C. Spinella, MD BACKGROUND: METHODS: RESULTS:
More informationThe Israeli Experience
E.M.S Response To Terrorism The Israeli Experience GUY CASPI Chief MCI Instructor and Director of Exercises and Operational Training MAGEN DAVID ADOM IN ISRAEL Israel National EMS and Blood Services guyc@mda.org.il
More informationBringing Medical Education, Training and Health Care Delivery into the Twenty-first Century
white paper Bringing Medical Education, Training and Health Care Delivery into the Twenty-first Century By Deborah N. Burgess, M.D., F.A.C.P, Senior Vice President Abstract The aviation industry has been
More informationSummary & Recommendations
Summary & Recommendations Since 2008, the US has dramatically increased its lethal targeting of alleged militants through the use of weaponized drones formally called unmanned aerial vehicles (UAV) or
More informationUnderstand the history of school shootings Understand the motivation and similarities regarding school shootings Improve understanding of the
April, 2015 Understand the history of school shootings Understand the motivation and similarities regarding school shootings Improve understanding of the planning, training, and equipment required to manage
More informationChapter 1. Learning Objectives. Learning Objectives 9/11/2012. Introduction to EMS Systems
Chapter 1 Introduction to EMS Systems Learning Objectives Define the attributes of emergency medical services (EMS) systems List 14 attributes of a functioning EMS system Differentiate the roles and responsibilities
More informationDepartment of Defense Trauma Registry
Appendix Appendix 3 Department of Defense Trauma Registry General Evidence-based medicine allows for identification of best practices and the timely formulation of clinical practice guidelines. Unfortunately,
More informationPreparation. Are We Ready? Preparing for the Unpredictable
Are We Ready? Preparing for the Unpredictable Eric Goralnick, MD, MS Medical Director, Emergency Preparedness Brigham and Women s Healthcare Preparation 2012 Prioritized Active Shooter in Hazard Vulnerability
More informationThe Journal of TRAUMA Injury, Infection, and Critical Care
Injury Severity and Causes of Death From Operation Iraqi Freedom and Operation Enduring Freedom: 2003 2004 Versus 2006 Joseph F. Kelly, MD, Amber E. Ritenour, MD, Daniel F. McLaughlin, MD, Karen A. Bagg,
More informationAMBULANCE diversion policies are created
36 AMBULANCE DIVERSION Scheulen et al. IMPACT OF AMBULANCE DIVERSION POLICIES Impact of Ambulance Diversion Policies in Urban, Suburban, and Rural Areas of Central Maryland JAMES J. SCHEULEN, PA-C, MBA,
More informationRunning head: COORDINATING AN EFFECTIVE POLICE AND FIRE RESPONSE 1
Running head: COORDINATING AN EFFECTIVE POLICE AND FIRE RESPONSE 1 Coordinating an Effective Police and Fire Response to Active Shooter Incidents for the Cities of Aberdeen, Cosmopolis, and Hoquiam Washington
More informationProgress Report: Effects from Combat Stress Upon Reintegration for Citizen Soldiers and on Psycholo gical
Progress Report: Effects from Combat Stress Upon Reintegration for Citizen Soldiers and on Psychological Profiles of Police Recruits with Prior Military Experiences Stephen Curran, Ph.D., ABPP Atlantic
More informationNew Hampshire Bureau of Emergency Medical Services. EMS in the Warm Zone Active Shooter Best Practice Guide. Version 1.
2015 New Hampshire Bureau of Emergency Medical Services EMS in the Warm Zone Active Shooter Best Practice Guide Version 1.0 02/05/2015 1 EMS in the Warm Zone Active shooter events can happen in any community
More informationOutcomes of Chest Pain ER versus Routine Care. Diagnosing a heart attack and deciding how to treat it is not an exact science
Outcomes of Chest Pain ER versus Routine Care Abstract: Diagnosing a heart attack and deciding how to treat it is not an exact science (Computer, 1999). In this capacity, there are generally two paths
More informationStudy Title: Optimal resuscitation in pediatric trauma an EAST multicenter study
Study Title: Optimal resuscitation in pediatric trauma an EAST multicenter study PI/senior researcher: Richard Falcone Jr. MD, MPH Co-primary investigator: Stephanie Polites MD, MPH; Juan Gurria MD My
More informationof Trauma Assembly 28 th Page 1
Eastern Association for the Surgery of Trauma 28 th Annual Scientific Assembly Sunrise Session 11 Preparing for the Next War: Pivotal Military Civilian Relationships January 16, 2015 Disney s Contemporary
More informationInfections Complicating the Care of Combat Casualties during Operations Iraqi Freedom and Enduring Freedom
2011 Military Health System Conference Infections Complicating the Care of Combat Casualties during Operations Iraqi Freedom and Enduring Freedom The Quadruple Aim: Working Together, Achieving Success
More information9/5/2017. Pulse Nightclub Tragedy. Pulse Nightclub Tragedy. Pulse Nightclub: Deadliest Mass Shooting In U.S. History
Pulse Nightclub: Deadliest Mass Shooting In U.S. History Joseph A. Ibrahim, MD FACS Michael L. Cheatham, MD FACS Pulse Nightclub Tragedy Pulse Nightclub Tragedy 1 Pulse Nightclub Tragedy Orlando Regional
More informationof Trauma Assembly 28 th Page 1
Eastern Association for the Surgery of Trauma 28 th Annual Scientific Assembly Sunrise Session 11 Preparing for the Next War: Pivotal Military Civilian Relationships January 16, 215 Disney s Contemporary
More informationIMPLEMENTATION OF A TACTICAL MEDICAL TRAINING PROGRAM TO ENHANCE THE SURVIVABILITY OF OFFICERS IN THE FARMINGTON POLICE DEPARTMENT
IMPLEMENTATION OF A TACTICAL MEDICAL TRAINING PROGRAM TO ENHANCE THE SURVIVABILITY OF OFFICERS IN THE FARMINGTON POLICE DEPARTMENT Tamara Smith Farmington Police Department Farmington, New Mexico A Staff
More informationSierra Sacramento Valley EMS Agency Program Policy. EMT Training Program Approval/Requirements
Sierra Sacramento Valley EMS Agency Program Policy EMT Training Program Approval/Requirements Effective: 07/01/2017 Next Review: As Needed 1002 Approval: Troy M. Falck, MD Medical Director Approval: Victoria
More informationUNITED STATES MARINE CORPS FIELD MEDICAL TRAINING BATTALION-EAST Camp Lejeune, NC CONDUCT TRIAGE
UNITED STATES MARINE CORPS FIELD MEDICAL TRAINING BATTALION-EAST Camp Lejeune, NC 28542-0042 FMSO 107 CONDUCT TRIAGE TERMINAL LEARNING OBJECTIVE (1) Given multiple simulated casualties in a simulated operational
More informationModel Policy. Active Shooter. Updated: April 2018 PURPOSE
Model Policy Active Shooter Updated: April 2018 I. PURPOSE Hot Zone: A geographic area, consisting of the immediate incident location, with a direct and immediate threat to personal safety or health. All
More informationEMS Medicine Live! Welcome. Seventh EMS Webinar
EMS Medicine Live! Welcome Seventh EMS Webinar EMS Medicine Live! EML s Mission Community & Academic EMS Physician Education Information Sharing Board Preparation Group involvement See and meet your peers
More informationPalm Beach County Fire Rescue Standard Operating Guideline
Palm Beach County Fire Rescue Standard Operating Guideline Operational Procedure for the Protective Element Medical Team Effective Date /DRAFT Revised Date DRAFT SCOPE: PURPOSE: AUTHORITY: This guideline
More informationPatterns of Injury in Hospitalized Terrorist Victims
Patterns of Injury in Hospitalized Terrorist Victims KOBI PELEG, PHD, MPH,* LIMOR AHARONSON-DANIEL, PHD,* MICHAEL MICHAEL, MD, S.C. SHAPIRA, MD, MPH, AND THE ISRAEL TRAUMA GROUP Acts of terror increase
More informationACTIONS COMMUNICATE TREAT. Survive Tomorrow. Today. All-in-one system to counter and survive Active Violence Events.
Survive Tomorrow. Today. All-in-one system to counter and survive Active Violence Events. Welcome to the The is an all-in-one system for when seconds count and help is minutes away. Originating from a
More informationThe Future of Emergency Care in the United States Health System. Regional Dissemination Workshop New Orleans, LA November 2, 2006
The Future of Emergency Care in the United States Health System Regional Dissemination Workshop New Orleans, LA November 2, 2006 Sponsors Josiah Macy, Jr. Foundation Agency for Healthcare Research and
More informationDayton MMRS. Metropolitan Medical Response System
Confidential - FOUO This presentation is CONFIDENTIAL (nonclassified) and For Official Use Only (FOUO). Presentation is a security record under Section 149.433 of the Ohio Revised Code. This is NOT a public
More informationNational Association of EMS Educators Pre-EMS Education and Instructor Development Accepted by the NAEMSE Board of Directors September 10, 2003
POSITION PAPER National Association of EMS Educators Pre-EMS Education and Instructor Development Accepted by the NAEMSE Board of Directors September 10, 2003 Introduction The National Association of EMS
More informationCOUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCY. PROGRAM DOCUMENT: Initial Date: 12/06/95 Emergency Medical Technician Training Program
COUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCY Document # 4510.13 PROGRAM DOCUMENT: Initial Date: 12/06/95 Emergency Medical Technician Training Program Last Approved Date: 07/01/17 Effective Date:
More informationJournal Club. Medical Education Interest Group. Format of Morbidity and Mortality Conference to Optimize Learning, Assessment and Patient Safety.
Journal Club Medical Education Interest Group Topic: Format of Morbidity and Mortality Conference to Optimize Learning, Assessment and Patient Safety. References: 1. Szostek JH, Wieland ML, Loertscher
More informationNorth Palm Beach Police Department
North Palm Beach Police Department 1 Average Response Time for all Emergency Calls 3 minutes:22 seconds 2 6:00 4:48 3:36 2:24 1:12 0:00 Emergency Non-Emergency 3 Jan 15 Dec 15 Jan 16 Dec 16 -/+ % Change
More informationAlbert Bahn. Alice Training Institute
Albert Bahn Alice Training Institute Proprietary Notice Much of the information in this presentation is proprietary property of Edu-Safe Associates and the Alice Training Institute. It may not be reproduced
More informationIMPACT OF SIMULATION EXPERIENCE ON STUDENT PERFORMANCE DURING RESCUE HIGH FIDELITY PATIENT SIMULATION
IMPACT OF SIMULATION EXPERIENCE ON STUDENT PERFORMANCE DURING RESCUE HIGH FIDELITY PATIENT SIMULATION Kayla Eddins, BSN Honors Student Submitted to the School of Nursing in partial fulfillment of the requirements
More informationBattlefield Trauma Systems
Battlefield Trauma Systems Chapter 35 Battlefield Trauma Systems Introduction A trauma system is an organized, coordinated effort in a defined geographic area that delivers the full range of care to all
More informationCost Effectiveness of Physician Anesthesia J.P. Abenstein, M.S.E.E., M.D. Mayo Clinic Rochester, MN
Mayo Clinic Rochester, MN Introduction The question of whether anesthesiologists are cost-effective providers of anesthesia services remains an open question in the minds of some of our medical colleagues,
More informationJoint Medical Readiness Oversight Committee Annual Report to Congress On the Health Status and Medical Readiness of Members of the Armed Forces May 2008 TABLE of CONTENTS Background... 1 Action 1, Ronald
More informationPulse Nightclub: Deadliest Mass Shooting In U.S. History William Havron III MD FACS General Surgery Program Director - ORMC
Pulse Nightclub: Deadliest Mass Shooting In U.S. History William Havron III MD FACS General Surgery Program Director - ORMC Pulse Nightclub Tragedy Pulse Nightclub Tragedy Pulse Nightclub Tragedy Orlando
More informationHistory of Trauma Surgery
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/focus-on-disaster-medicine-and-preparedness/history-of-traumasurgery/1500/
More informationA New Approach to Organization and Implementation of Military Medical Treatment in Response to Military Reform and Modern Warfare in the Chinese Army
MILITARY MEDICINE, 182, 11/12:e1819, 2017 A New Approach to Organization and Implementation of Military Medical Treatment in Response to Military Reform and Modern Warfare in the Chinese Army Yang Pei,
More informationPensacola Fire Department. FY 2016 Budget Workshop
Pensacola Fire Department FY 2016 Budget Workshop 1 Mission The primary mission of the Pensacola Fire Department is to provide a wide range of services and programs designed to protect lives and property
More informationReview of 54 Cases of Prolonged Field Care
Review of 54 Cases of Prolonged Field Care Erik DeSoucy, DO; Stacy Shackelford, MD; Joseph Dubose, MD; Seth Zweben, NREMT-P; Stephen C. Rush, MD; Russ S. Kotwal, MD, MPH; Harold R. Montgomery, SO-ATP;
More informationThe National Academy of Science, Education, and Medicine
SPECIAL REPORT Leadership lessons learned in Tactical Combat Casualty Care Frank K. Butler, MD, FAAO, FUHM, Pensacola,Florida The National Academy of Science, Education, and Medicine recently completed
More informationEMS S Y S T EM REPOR T
LOS ANGELES COUNTY EMS AGENCY INSIDE THIS ISSUE: EMERGENCY 2 DEPARTMENTS PATIENTS PER 2 TREATMENT BAY EMERGENCY 3 DEPARTMENT SATURATION EMS VOLUME 4 MOST PREVALENT 5 CHIEF COM- PLAINTS EMS PROVIDER 6 AGENCIES
More informationA Comparison of Job Responsibility and Activities between Registered Dietitians with a Bachelor's Degree and Those with a Master's Degree
Florida International University FIU Digital Commons FIU Electronic Theses and Dissertations University Graduate School 11-17-2010 A Comparison of Job Responsibility and Activities between Registered Dietitians
More informationOut-of-Hospital Combat Casualty Care in the Current War in Iraq
TRAUMA/ORIGINAL RESEARCH Out-of-Hospital Combat Casualty Care in the Current War in Iraq Robert T. Gerhardt, MD, MPH Robert A. De Lorenzo, MD, MSM Jeffrey Oliver, MPAS, EMPA-C John B. Holcomb, MD, FACS
More informationThis Annex describes the emergency medical service protocol to guide and coordinate actions during initial mass casualty medical response activities.
A N N E X C : M A S S C A S U A L T Y E M S P R O T O C O L This Annex describes the emergency medical service protocol to guide and coordinate actions during initial mass casualty medical response activities.
More informationVictim Rescue Drill: Lessons Learned
Victim Rescue Drill: Lessons Learned Tactical medics face the fire at the International Tactical EMS Association's fifth annual Medic Up competition By Matthew D. Sztajnkrycer, MD, PhD, Michael Meoli,
More informationSCOTSEM Annual Meeting Aug 24, 2016
NCTC/DHS/FEMA/FBI JOINT COUNTERTERRORISM AWARENESS WORKSHOP SERIES SCOTSEM Annual Meeting Aug 24, 2016 Preparing Communities for a Complex Terrorist Attack 1 Overview Background Workshop Objectives Structure
More informationPatient Satisfaction in Phlebotomy
PHLEBOTOMY JaneC. Dale, MD Peter J. Howanitz, MD Patient Satisfaction in Phlebotomy A College of American Pathologists' Q-Probes Study From the Department of Laboratory Medicine and Pathology, Mayo Clinic,
More informationEXPERIENTIAL EDUCATION Medication Therapy Management Services Provided by Student Pharmacists
EXPERIENTIAL EDUCATION Medication Therapy Management Services Provided by Student Pharmacists Micah Hata, PharmD, a Roger Klotz, BSPharm, a Rick Sylvies, PharmD, b Karl Hess, PharmD, a Emmanuelle Schwartzman,
More informationTactical Combat Casualty Care. CAPT Peter Rhee, MC, USN MD, MPH, DMCC, FACS, FCCM Professor of Surgery / Molecular Cellular Biology
Tactical Combat Casualty Care CAPT Peter Rhee, MC, USN MD, MPH, DMCC, FACS, FCCM Professor of Surgery / Molecular Cellular Biology Good medicine in bad places Tactical Care 24 man team raid Building
More information