september 2019 newsletter - strategic operations · patient simulations, and concludes with a final...

September 2019 Newsletter

In this Edition:

• Update to the Tactical Emergency Casualty Care (TECC) Course

• The Next Nine Minutes

• Featured Product: Multi-Junctional Bleed Trainer

(continued on next page)

Update to the Tactical Emergency Casualty Care (TECC) Course

Strategic Operations (STOPS) recently taught the newly released 2nd edition of the National Associations Emergency

Medical Technicians (NAEMT) Tactical Emergency Casualty Care (TECC) course. This edition teaches EMS practitioners on all

levels how to respond to and care for patients in a civilian tactical environment. The new course was released on June 25th

of this year and includes new lessons concentrating on the MARCH assessment (Massive hemorrhaging, Airway,

Respiration, Circulation and Hypothermia), immediate action drills for tourniquet application, also features eight all-new

patient simulations, and concludes with a final mass casualty, active shooter simulation.

TECC is a set of best practice treatment guidelines for trauma care in high-threat prehospital environments. The guidelines

are built from lessons learned by the U.S. and allied military

forces during Operation Iraqi Freedom and Operation Enduring

Freedom and were brought to the civilian sector via the

Committee on Tactical Combat Casualty Care (Co-TCCC). This

course provides appropriately modified guidelines to address

the specific needs of civilian populations in hazardous

situations.

There have been recent mass-casualty events that required a

significant EMS response such as shootings at the Route 91

Harvest country music festival in Las Vegas, Pulse Nightclub in

Orlando, and the bombings at the 2013 Boston Marathon

which demonstrated the gap that exists between the capability

of prehospital trauma care and casualty needs during these

horrible events. This course is designed to provide first

responders the best practices when operating in adverse

conditions involving multiple casualties.

The goals of TECC from C-TECC:

• To balance the threat, civilian scope of practice, differences in the civilian population, medical equipment limits, and

variable resources for response to atypical emergencies

• To establish a framework that balances risk / benefit ratio for all civilian operational medical response To guide medical

management of preventable deaths at or near the point of wounding

• To minimize provider risk while maximizing patient benefit

First Training Class of New TEEC Course, with

Instructors and Staff at Strategic Operations

Strategic Operations Inc. 4705 Ruffin Road San Diego, CA 92123 (858) 244-0559 www.strategic-operations.com

Update to the Tactical Emergency Casualty Care (TECC) Course (continued)

The application of the TECC guidelines for civilian Fire/EMS medical operations is essential, and sometimes outside traditional

application in tactical and law enforcement operations. The medical response to almost any civilian scenario involving high

risk to responders, austere environments, or unintentional trauma will benefit from the new guidelines. This also includes

active shooter response, and terrorism-related events, mass casualty, wilderness scenarios, technical rescue efforts, and even

traditional trauma response.

This class is open to EMTs, paramedics, nurses, physician assistants, and physicians. To be eligible, students must carry a li-

cense or active provider certification.

According to NAEMT, a new 1-day course geared toward Law Enforcement officers called TECC-LEO will be released Fall 2019.

Check our website for updates.

Upon completion, participants receive 16 hours of CAPCE-approved credit and a 4-year NAEMT TECC 2nd edition Provider

certification.

By Wyatt Sabo, BS, Medical Subject Matter Expert, Strategic Operations

References:

Feldman, R. (2019). Committee for Tactical Emergency Casualty Care. Retrieved from http://www.c- tecc.org/about/overview

Tactical emergency casualty care (TECC): Course manual (2nd ed.). (2020). Burlington, MA: Jones & Bartlett Learning.

The Next Nine Minutes

Active threat and mass casualty incidents (MCI) tragically have increased in frequency and complexity throughout the United

States. Local law enforcement (LE) and medical emergency response teams have struggled to manage actual events. A

significant contributor to this failure is the way in which first responders train for these incidents.

Put simply, training is not done in a realistic[1] environment resembling actual scene conditions and performed using critical

skills with heightened stress reactions of providers. First responders more likely default to tabletop scenarios and sandbox style

trainings based on simplicity of logistics or ease of

scheduling with limited number of entities

participating rather than full immersive, multi-agency

drills that promote best practices.

In one of the most ambitious efforts in the U.S. to

reverse these deficiencies, the 18th Judicial District

of Colorado agreed on a uniform regional standard

operational guideline for active threat resolution.

Two years of preparation by Denver South Metro

Fire Rescue culminated in a month- long Active

Threat Response Training called “The Next Nine

Minutes,” in November of 2018.

(continued on next page)


The Next Nine Minutes (continued)

Three different churches and three hospitals provided support for eighteen training sessions and active shooter scenarios with

dozens of role players, many of whom wore human worn surgical simulators (Cut Suits), others were amputees, and all were

made up with medical moulage. Rocky Vista University Medical school provided volunteers, doctors and equipment.

Ambulances took the injured to hospitals where they were admitted to the emergency department. Surgeons performed

complex trauma surgeries on the Cut Suit in the operating rooms with STOPS supplied Advanced Surgical Skills Packages (ASSP).

SWAT Paramedics were integrated with LE in the “hot

zone,” while having a rescue task force (RTF) comprised

of fire/EMS and LE quickly behind in the “warm zone,”

for rescue of known victims reported by interior teams.

It is well documented over many MCI events that

victims have been dying due to the lack of simple

bleeding control measures and rapid access of first

responders into the building. This was the lead finding

of the Hartford Consensus.

The training was named “The Next Nine Minutes”

because the goal was to have the first unit arrive on

scene, establish an RTF and produce the first, most

critical, patient for transport in under nine minutes. It

also directly correlates to the average length of time in

real events that a shooter engages his/her targets prior

to shooting ceasing.

Each day of training in November, hours of video and time stamps for tactical benchmarks were tracked and reviewed. Very few

times, out of the 18 training sessions, did first responders exceed the benchmark of producing a patient in under nine minutes

after their arrival. This was one of the two most significant lessons learned reported in the post training after-action document

and through subsequent follow-up training sessions

recapping the shortfalls of the drill. The other top

lesson learned was failure to immediately start unified

command with LE and fire/EMS.

In the next newsletter we will review the lessons

learned and how they were applied five months later

at the STEM school shooting in Highlands Ranch, with

encouraging positive results by some of the South

Metro first responders who participated in “The Next

Nine Minutes.”

* * *

By Kit Lavell, Executive Vice President; Training Captain Chris

Wells, South Metro Fire Rescue; Lieutenant Paramedic/Fire

Fighter Ryan Shelton, South Metro Fire Rescue.

[1] Strategic Operations (STOPS) calls this type of training Hyper-Realistic® and defines it as “the achievement of such a high degree of fidelity in the simulation

of real world conditions in a training environment that participants willing suspend disbelief so as to emotionally become totally immersed and eventually stress

inoculated in a way that can be measured physiologically.” Recent medical studies corroborate anecdotal evidence that Hyper-Realistic® immersion training

produces a stress inoculation effect and that repetitive training in controlled, stressful situations enables people to lower their stress levels from the

detrimental range to a more beneficial one, in a measurable way.


Featured Product: Multi-Junctional Bleed Trainer

July 2019 Drawing Winner

In July, a drawing was held for a Hyper-Realistic® Moulage Kit (HRMK) (featured product of our event 8th Annual Intensive

Surgical and Trauma Skills Course (ISTSC)).

Congratulations to Dr. Kim Lim of Austin Health, Victoria, Australia.

Uncontrolled hemorrhaging is the number one concern for patient

survivability at the point of injury. The most arduous of wounds are

those in junctional areas – the groin and the axilla – where tourniquets

can’t be used.

The bleeding in these locations is often deeper and maintaining

adequate external pressure can be difficult to impossible. Wound

packing can be used in concert with tourniquet use; however,

tourniquets cannot be applied at a junction; wound packing is a key

skill to control massive hemorrhage.

The Multi- Junctional Bleed Trainer is the perfect training tool to

perfect these life saving techniques. The Multi-Junctional Bleed

Trainer (MJBT) can be used in conjunction with the Blood Pumping

System (BPS) in Hyper-Realistic® scenarios.


The Multi-Junctional Bleed Trainer is a Hyper-Realistic® medical training

device designed to allow users to safely simulate hemorrhaging in some

of the most challenging anatomical locations such as the carotid artery,

the axillary artery and the inguinal artery.

september 2019 newsletter - strategic operations · patient simulations, and concludes with a final...

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