Ballistic First AidPre-First Response

James M. Berry, MDProfessor, Dept of Anesthesiology

Vanderbilt UniversityNashville Tennessee

Disclaimer

Co-founder and research director of Tactical Medicine, LLCNashville TN

The opinions expressed here do not reflect those of the US DOD or any other federal agency

Statement of ProblemPenetrating trauma is both common and deadly

30K fatal - 70K nonfatal (firearms only) annually

Some injuries are potentially lethal within minutes

Trained paramedical professionals are limited:In numbersIn trainingIn access

Both civilians and LE are vulnerable

Real-world Example

Active shooter, Newtown school

20 child, 6 adult fatalities154 rounds of .223 in ~5 min

LE entry at 14 min

EMS/medevac delayed for sweep/clearance

Penetrating Trauma

Knife

FirearmHandgunRifle

Immediate mortality highly variable

US Military Approach

Extensive experience in penetrating trauma

Tactical Combat Casualty Care (TCCC) – US SOCOM 1996

Significant reduction in preventable death

Injuries of ConcernExtremity bleeding

Chest injury

Abdominal injury

Airway obstruction

Critical Assumptions

Immediate response to injury

Individually-carried supplies (IFAK)

Medic available for additional (field) care

Medevac to definitive care within an hour

Individual First Aid Kit (IFAK)TourniquetPressure dressingHemostatic gauzeChest sealNasal airwayGloves

TCCC Phases

Care under fire (CUF)

Tactical field care (TFC)

Tactical evacuation care (TEC)

Care Under Fire - basics

•Take cover – self-assess•Win the fight•Observe for casualties•Encourage self-aid•Tourniquet high and tight if needed•Do NOT attempt rescue

One Essential ToolCombat Application Tourniquet (CAT)

orSOF Tourniquet

/Charles Krupa/AP

Military vs LE approach

•TCCC •TFA•Priority •Fire superiority •Low collateral

damage

•Tactics •Offensive •Defensive

•Supplies •Dedicated individual kit

•Shared

•Rescue under fire •No •Rare

NTOA – Fall 2013TEMS Position Statement

lDOYLESTOWN, Pa. — The National Tactical Officers Association (NTOA) is calling for basic Tactical Emergency Medical Support (TEMS) training for all police officers in light of recent incidents of mass violence.“Patrol officers are now trained and equipped to respond to active, violent incidents using tactics that were once reserved for special weapons and tactics (SWAT) teams. The time has come to also provide these officers with basic TEMS training and equipment in order to potentially save the lives of victims, bystanders, police officers and suspects in the event they are wounded.”

TnLEA Course OutlineFour-hour class

Introduction and DefinitionsHistory - SafetyWorking under StressPersonal ProtectionInitial AssessmentBleeding - Extremity InjuryAbdominal InjuryChest InjuryAirway CompromiseTriage – Documentation - Further TreatmentConclusion – Final Exam

Summary andRecommendations for 2014Every officer should have:

Basic training in CUF/TFCSuitable tourniquet carried on personIFAK equivalent in patrol unitBackup by SWAT medic or equivalant

Obstacles and Challenges

Acceptance of problem – Denial

LE excuses too busytoo much “responsibility” legal issues

Funding cost, logistics, time

Unfortunate Truth

When seconds count:

LE are minutes away, andEMS are even further….

•CPR •TFA•Priority •Circulation •Massive

hemorrhage

•Intervention •Chest compression •Tourniquet

•Critical time •3 minutes •1-5 minutes

•Incidence(per year)

•360,000 •80,000

Comparison of CPR and TFA

AdditionalRecommendations for 2014

Institute a nationwide program of civilian training inBasics of penetrating trauma

-Assessment and immediate responsesFocus on private security, hunters, teachersAvailable to all (like CPR/BLS)No prior medical

training needed

No child left behind…

OR

No child left to bleed

Questions or Comments?

James M. Berry, MDadmin@tacmedicine.net