Tactical_Medicine_Web_Brochure

Conference Description:
This conference will address those new and innovative interventions, products and techniques whose implementation at the point of wounding (POW) will allow for a more stable and viable patient upon arrival at the tertiary facility and, hence, improved longterm outcome. Though originally designed for the military theater, Tactical Combat
Casualty Care (TCCC) concepts are rapidly being adopted within the civilian medical and law enforcement communities as they are asked to respond to terror incidents at home. Columbine High School, Virginia Tech and terror incidents in Russia and India are only a few examples of the world in which we live. This conference is as relevant to
law enforcement (local and federal) and medical first responders as it is to the Soldiers and Marines on the battlefield. It is also relevant to physicians, nurses and other care providers, both civilian and military, who have a need for familiarity with current medical care techniques in the tactical environment.

The TCCC recommendation of Combat Gauze (TM) has clouded the issue of effectiveness with respect to other available agents. That is to say, there are others on the market that were just as effective in studies that were not chosen. Hopefully, the attached study summarizes the pros and cons of most available agents.

TCCC Hemostatics JRAMC 2010

“Four Hours of Tourniquet Time”

“26 y.o. male with foot traumatic amputation and
multiple frag wounds to the right leg with a high thigh
field tourniquet in place. Arrived to the CSH with SBP of
100 HR of 120. we had no report on duration of the
tourniquet. We took down the tourniquet and he promptly
coded. We put the tourniquet back up, intubated him and
gave him fluid and bicarb and he came back. We found
out later that the tourniquet had been in place for over 4
hours….”

The use of tourniquets – while rare in civilian trauma is
very common in combat injuries. Tourniquets are the
number 1 instrument that a medic can employ to lower the
KIA numbers. The use of tourniquet with application until
the absence of a distal pulse by default causes distal
ischemia. Release of a functioning tourniquet after several
hours can result in the release of acidic fluid and potassium.
The patient intubated and without a head injury can be
briefly hyperventilated. Before taking down a long
duration tourniquet make sure the patient is well hydrated,
resuscitated, adding an ampule of sodium bicarbonate or
THAM can prophylax against the release of “bad humors”,
lactic acid, and potassium. Also release the tourniquet
slowly – if the rare arrhythmia arises re–employ the
tourniquet and retry after further bicarb and fluid. If the leg
is necrotic remember “life before limb” and perform an
amputation.

Lessons Learned:
–Prolonged tourniquet times can result in the release
of acidotic fluid and hyperkalemia
–Perform 4 compartment fasciotomy with all lower
extremities with significant tourniquet times

Quick Points:

1. Improvised tourniquets are a bad idea
2. The most common reasons for not having a tourniquet are unsound
3. Learn the basics and you can improvise if forced

The above picture is an example of the difficulties in improvising a tourniquet when a wound is severe enough to require one. As the gentleman pictured noted in an email to us, “… [he] received life-threatening injuries to both upper legs as the result of another shooter’s accidental discharge of his weapon. The .30-06 bullet caused very serious injuries to both legs, but the most critical injury was the severing of my left popliteal artery (the largest artery behind the knee)…” To repeat, this injury is secondary to a weapon not being cleared on a range, not a battlefield wound nor a deliberate attempt on his life by a suspect. As you can see, initial attempts to stop the bleeding with a belt were unsuccessful, as illustrated by the ground saturated with blood. Luckily, the Range Master had a kit that contained a SOFTT, which was applied quickly and saved his life.

The point is this: if a manufactured device is available, then have one on-hand. Too many police officers dismiss carrying a tourniquet because “that is the medic’s job.” BULLSHIT! Or, and this is a common one, “I will improvise and use a belt or sling.” Really? Whether an LEO is serving a warrant or issuing a ticket he/she is responsible for his/her life for the time it takes medics to arrive and assist if the scene is safe.

The above-mentioned reasons for not carrying a tourniquet are unfathomable. First, that a team SOP, in the context of a SWAT team, for instance, would be for one to rely on a medic to save one’s life does not make sense. As has been belabored in tactical medicine circles, one can bleed-out in less than 4 min. Are you going to sit and wait for someone else to save your life? The military suffered from that mindset, but have since adopted the care guidelines of self-aid, buddy-aid, and medic-aid. Second, the improvised-when-needed reasoning is not sound. This would be analogous to waiting until you had a weapon pointing at your face, then proceeding to quickly constructing a Zip gun. I assume an LEO would not serve a warrant or stop a suspicious vehicle without having a pistol. Therefore, why would you do the same without a piece of kit that costs approximately the same as a box of 9mm ammunition and has been proven to save lives?

It is not our stance that one should not know how to improvise. In fact, we sponsered a contest to find the best ways to improvise using one piece of kit, of which a tourniquet was one. However, while one ought to have the knowledge to improvise when needed that only comes from learning the basics, choosing to not carry the correct equipment because one plans to improvise is not prudent.

Thank you all for your submissions. We will begin posting videos of them over the next few months. If you have any other ideas for contests, let us know.

Tac Med Team

Abstract
Introduction: Tension pneumothorax is the second leading cause of preventable combat death. Although relatively simple, the management of tension pneumothorax is considered an advanced life support skill set. The purpose of this study was to assess the ability of non-medical law enforcement personnel to learn this skill set and to determine long-term knowledge and skill retention.

Methods: After completing a pre-intervention questionnaire, a total of 22 tactical team operators completed a 90-minute-long training session in recognition and management of tension pneumothorax. Post-intervention testing was performed immediately post-training, and at one- and six-months post-training.

Results: Initial training resulted in a significant increase in knowledge (pre: 1.3 ±1.35, max score 7; post: 6.8 ±0.62, p < 0.0001). Knowledge retention persisted at one- and six-months post-training, without significant decrement.

Conclusions: Non-medical law enforcement personnel are capable of learning needle decompression, and retain this knowledge without significant deterioration
for at least six months.