Tactical & Hunter First Aid Workshop

Transcription

1 Jackson Hole Gun Club Jackson, WY July 15, 2013 Tactical & Hunter First Aid Workshop LTC Will Smith MD, Paramedic

2 Disclaimers No financial conflicts to disclose Board of Advisors for Chinook Med Volunteer Position - evaluate products This presentation is NOT an official position or endorsement from the United States Department of Defense/ US Army or Department of Interior/ National Park Service

3 Objectives Briefly describe military tactical combat casualty care (TCCC) How to prepare for the worst in a tactical setting. What should be in a Tactical First Aid kit and how to use it.

4 Boston Marathon Bombing - April 15, Killed 282 Injured

5 My Experience EMT - Basic 1990 EMT- Intermediate 1992 EMT - Paramedic 1995 MD Emergency Medicine

6 My Experience Joined Army Reserve - Sept 27, 2001 Deployments Iraq - Dec 2005 to Mar 2006 Egypt - Oct 2007 to Nov 2007 Iraq - Oct 2008 to Jan 2009 El Salvador - Sept 2009 Panama - April 2010 Croatia - June 2011

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8 Before: Streets of EMS to Combat Now: Combat to Streets of EMS

9 TCCC Conventional civilian medicine was not appropriate for optimizing casualty care within the tactical environment. Butler, et. al. Military Medicine 2006 Tactical Combat Casualty Care CoTCCC - Committee on TCCC

10 Two Important Principles 1. To perform the correct intervention at the correct time in the continuum of Tactical Care. 2. A medically correct procedure performed at the wrong time may lead to further casualties.

11 TCCC American College of Surgeons (PHTLS) 7 th Ed May 2011

12 TCCC/TEMS Recognized DOD - All branches DOI - National Park Service Dept Homeland Security (Boarder Patrol) Civilian Law Enforcement/EMS National Tactical Officers Assn (NTOA) Others

13 Tactical Emergency Casualty Care (TECC) Bringing Combat Medicine to the Streets of EMS

14 Responding to Mass Violence Events Change in Protocols and Tactics

15 Levels of Combat Care Self Aid Buddy Aid IFAK - All Soldiers IFAK - Individual First Aid Kit

16 Levels of Combat Care Combat Life Saver EMR

17 Levels of Combat Care Combat Lifesaver Skills (CLS) Rapid casualty assessment (Triage) Control hemorrhage Treat penetrating chest trauma Maintain BLS airway Initiate saline lock and IVF (Removing?) Package casualty for transport

18 Levels of Combat Care Combat Medic 91 Whisky Special Forces Medic 18 Delta EMT or Paramedic

19 Levels of Combat Care Medical Treatment Facilities (MTF) Level 1 - BAS Level 5 - CONUS Rural Clinic to Trauma Center

20 TCCC 3 Phases Care under fire Direct Threat Care Tactical field care Indirect Threat Care Tactical Evacuation Care Evacuation Care Tactical EMS terms

21 Care Under Fire/Direct Threat Care Return fire Mitigate Threat Provide basic care Stop bleeding (TQ) Move patient to CCP (if safe) Scene Safety

22 Tactical Field Care Indirect Threat Care No longer under direct fire - MARCH-E Major Bleeding Airway Respiration (NDC/Chest Seals) Circulation Head/Hypothermia Everything Else - Head to toe/s;oint, etc

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24 3 Categories of patients in Tactical Environment 1. Patients who will live regardless 2. Patients who will die regardless 3. Patients who will die from preventable deaths unless proper lifesaving steps are taken immediately Goal of TCCC/TEMS #3

25 OIF$ $Opera*on$Iraqi$Freedom;$OEF$ $Opera*on$Enduring$Freedom$(Afghanistan)$ Most%Preventable% CNS$ $Central$Nervous$System$ MSOF$ $Mul*CSystem$Organ$Failure$ FST$ $Forward$Surgical$Team$ CSH$ $Combat$Support$Hospital$

26 Tactical Field Care Tourniquet First for extremity bleeding Use other methods as needed Direct pressure Pressure bandages Hemostatic agents Forget Pressure Points and Elevation! Last Resort or First Choice?

27 Tactical Field Care Chest injuries Cover sucking/open chest wounds Needle decompression

28 Needle Decompression At least 3 needle/catheter gu Chest Walls >2 Combat Life Saver level EMR (not ALS)

29 Chest Seals 3 vs. 4 Sides Vented (1-way valve) Multiple Products Expired AED pads are adequate

30 Tactical Field Care Splint obvious fractures Joint above and below Bone above and below Check Distal Circulation, Sensation, and Strength Reassess

31 Combat TACEVAC TACEVAC - Tactical Evacuation CASEVAC - Casualty Evacuation MEDEVAC - Medical Evacuation

32 Evacuation Determine if you can get yourself out Call for help Search and Rescue Risk vs. Benefit of immediate evacuation

33 Bleeding Control Old Algorithm Direct Pressure Elevation (above heart) Pressure Points Tourniquet (LAST RESORT)

34 Hemorrhage due to penetrating trauma is the leading cause of preventable death during military operations Butler, JEMS 2008

35 Tourniquets Risk vs. Benefit Appropriately applied Limited application time

36 Tourniquets C-A-T Tourniquet

37 What makes a good TQ? Width >1, Mechanical arm (cam) Easily application (<60 sec) Self-applied, adjustable, non-slip

38 Ideal Pneumatic Cuff Delphi Tourniquet

39 Compression Bandages Direct Pressure = Stop Bleeding

40 Compression Bandages

41 Combined Use

42 Hemostatic Agents

43 Hemostatic Agents Stop bleeding in areas where TQ don t work TCCC Top agent: Combat Guaze

44 Other Agents

45 Harmful effects of Granular Clotting Agents Kheirabadi, J Trauma 2009 Exothermic local effect of complete vessel occlusions (injured and surrounding) Embolic events (PE/Stroke)

46 Kheirabadi, J Trauma 2009

47 Hypothermia Prevention

48 Hypothermia Kills Even in Iraq, 18% of pts arrived T<36C (96.8F) Temps in critical trauma pts < 34C (93F) = near 100% mortality Arthurs 2006 Am J Surg

49 HPMK - Hypothermia Kit

50 Exposure to other things

51 Exposure to other things

52 Tactical First Aid Kit Bleeding Control Common Ailments (blisters, etc) Simple OTC meds (tylenol, ibuprofen) Splinting Rest, Ice, Elevation, Compression

53 Summary Tourniquet First for severe extremity bleeding Adapted protocols for EMS and Tactical Settings (TECC)

54 References The War on Trauma, Lessons Learned from a Decade of Conflict. Supplement to JEMS October 2008, sponsored by North American Rescue, Inc. Download at: War Surgery in Afghanistan and Iraq. A series of cases, Ed. Nessen, et. al Office of the Surgeon General.

55 References Combat Lifesaver Course: Student Self-Study Guide. Subcourse IS0871, Edition B. Army Institute for Professional Development. Ft. Sam Houston, TX.

56 Questions?