Increasing the Ability to Survive in Critical Trauma Incidents. Richard M. Smith President, Con10gency Consulting, LLC

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1 Increasing the Ability to Survive in Critical Trauma Incidents Richard M. Smith President, Con10gency Consulting, LLC

In 2017-346 Reported Mass Shooting Source:

2 In Reported Mass Shooting Source: Gun Violence Archive gunviolencearchive.org

As of June 2018-154 Reported Mass Shooting Map depicts incidents

3 As of June Reported Mass Shooting Map depicts incidents through May, 2018 Source: Gun Violence Archive gunviolencearchive.org

4 Location of Attacks by Percentages Source: Texas State University ALERRT Center

5 Connection to Victims

6 Average Police Response Time 3 Minutes

7 First Responders: Priority of Actions Stop the Killing Stop the Dying Rapid Evacuation of the Injured

8 Immediate Responders : Priority of Actions Survive The Event Survive the Injury Provide First Aid

9 PREP: The Key for Survival Prepare Mentally & administratively Respond Effectively & survive the incident Equip Workplace with lifesaving tools & knowledge Provide First aid & survive the injury

10 Prepare Mentally The #1 Killer in an Active Shooter Event! Was that firecrackers? I wonder what that was? I thought it was part of the show! What's that popping noise? Then I heard balloons popping! Denial and then I realized someone was shooting people!

Prepare Administratively Planning Emergency Action Plans & Standard Operating Procedures Identify SAFE rooms Training Seek appropriate active shooter

11 Prepare Administratively Planning Emergency Action Plans & Standard Operating Procedures Identify SAFE rooms Training Seek appropriate active shooter training for all staff and security team members Re-enforce mental preparation; prevent denial Testing Routinely test response plans and evaluate performance

Respond Effectively Survive the Incident Hot Zone RUN or FIGHT Rounds are inbound and they can or have hit you Armed security teams should attempt to eliminate the threat Warm Zone RUN or HIDE Still

12 Respond Effectively Survive the Incident Hot Zone RUN or FIGHT Rounds are inbound and they can or have hit you Armed security teams should attempt to eliminate the threat Warm Zone RUN or HIDE Still a High Threat environment Think S-I-M (Security, Immediate Action Plan, and Medical) Can turn HOT at anytime Cold Zone RUN Threat has been eliminated Outside of the active threat area Generally thought to be safe

13 Equip Workplace with Lifesaving Equipment Public Access Bleeding Control Stations Mass Casualty Active Shooter Response Bags Personal Individual First Aid Kits (IFAK)

14 Provide First Aid Surviving the Injury Seconds Count! A victim who is bleeding from an artery can die in as little as 3 minutes. Serious bleeding from an extremity is the most frequent cause of preventable death from injury. Life-threatening bleeding warrants immediate intervention.

History of Tactical First Aid 1993 Military formed a Committee on Tactical Combat Causality Care (Co-TCCC) & investigated battlefield deaths Investigated

15 History of Tactical First Aid 1993 Military formed a Committee on Tactical Combat Causality Care (Co-TCCC) & investigated battlefield deaths Investigated what it would take to prevent the death process Published findings of Point of Injury Care in 1996 Based on findings, mandated training of all service members

16 Co-TCCC Study Findings 6% Preventable Combat Deaths 33% 60% Extremity Hemorrhage Tension Pneumothorax Airway Obstruction Hypothermia

Golden Hour VS Platinum A Race Against Time Golden Hour

victims of an active shooter is 45 min What does this

17 Golden Hour VS Platinum A Race Against Time Golden Hour What is it? Platinum A New Standard! National EMS response time: 8 to 10 minutes (metropolitan areas) Average EMS treatment times for victims of an active shooter is 45 min What does this mean for us? Initial Responders MUST be trained and equipped to provide immediate lifesaving care

18 Let s Put the Pieces Together Ensure your own safety Identify the injury(ies) Stop the bleeding Keep the victim(s) warm Seek professional medical help

If at any time your safety is threatened, attempt to remove yourself from the danger and find a safe

19 Ensure Your Own Safety Before you offer any help, you must ensure your own safety! Only initiate care if the scene is safe for you to do so. If at any time your safety is threatened, attempt to remove yourself from the danger and find a safe location Good medicine can be bad tactics The right medical intervention at the wrong time can cause catastrophic results Ensure your staff knows when they should provide care

20 Identify the Injury(ies) MARCH Trauma Assessment Rapid Systematic Head-to-toe trauma assessment Assessment of exclusion Designed for: Hostile environments To treat what will kill you first!!

Stop the Bleeding (Extremities) Bleeding from wounds to

tourniquet is a device that stops the flow of blood to

arterial blood flow into the extremity and to the wound

21 Stop the Bleeding (Extremities) Bleeding from wounds to the arms and legs can be controlled by a tourniquet A tourniquet is a device that stops the flow of blood to an extremity If applied correctly, the tourniquet stops arterial blood flow into the extremity and to the wound Limiting blood loss may prevent the patient from going into shock

Pack with hemostatic dressing or plain gauze roll This

22 Stop the Bleeding (Junctional) Groin, shoulders/armpits, or neck Cannot use a tourniquet Apply direct pressure Pack with hemostatic dressing or plain gauze roll This technique can control bleeding that might otherwise prove fatal

6 Body temperature below 91 causes the body to go into shock Hypothermia

23 Keep the Victim(s) Warm Hypothermia is defined as a low body temperature Normal temperature is 98.6 Body temperature below 91 causes the body to go into shock Hypothermia won t allow blood to clot (internal bleeding concern) Prevention is the best remedy Keep victim(s) warm even in warm environments

Seek Professional Medical Help Immediate Responder care the first link in the chain of survival Once care is provided, goals should shift to emergency service

24 Seek Professional Medical Help Immediate Responder care the first link in the chain of survival Once care is provided, goals should shift to emergency service intervention Call 911 and report location & injuries If safe, assist with patient evacuations Pre-plan with your local first responder agencies for an improved response strategy

Increasing the Ability to Survive in Critical Trauma Incidents Relies On: Preparing because it CAN happen to you Responding effectively; your actions matter Equipping

25 Increasing the Ability to Survive in Critical Trauma Incidents Relies On: Preparing because it CAN happen to you Responding effectively; your actions matter Equipping the workplace with the necessary lifesaving tools Providing Lifesaving medical care Surviving a critical trauma incident relies on EVERYONE to be an Immediate Responder!

26 Questions? Richard M. Smith +1 (210)

Bleeding Control (B-Con) Basic

Bleeding Control (B-Con) Basic Bleeding Control (BCon): Course Content and Becoming and Instructor Phillip J. Prest, DO, FACOS, FACS Assistant Professor, Clinical Surgery The University of South Carolina School of Medicine Palmetto