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Field Medicine for Terrorist Attacks
Written by: Greg Ellifritz
Aftermath of the Boston Bombing
Since Monday’s terrorist bombing in Boston, I have been besieged by emails asking for medical advice. Live video and graphic images on the internet are opening people’s eyes. They can see themselves witnessing a similar event and want to know how to properly help the injured. The standard Red Cross First Aid/CPR class won’t be enough when it comes to mass casualties, bomb injuries, and gunshot wounds.
The type of training that people need to effectively cope with battlefield injuries was developed by the military and is commonly called “Tactical Combat Casualty Care” or TCCC for short. I teach entire weekend classes on this subject. Some of my friends teach classes that go into even greater depth. You aren’t likely to become proficient by reading an article, but I can give you some TCCC pointers to help you survive a terrorist attack even if you don’t have any formal training. Here’s what you need to know:
1) Get the patient to safety. In an active shooting event or terrorist bombing, EMS may not be allowed to enter buildings or bomb sites until they are deemed “safe” by law enforcement personnel. That may mean a long wait for you or your patient. If you can get outside to safety, do so. If you can carry your patient to a safer place to wait for medical care, it would be a good idea.
Remember about secondary devices. You must get out of the immediate area of a bomb blast. The worst possible outcome is getting blown up again! Look for a casualty collection point in an open area, preferably behind hard cover. Clear that casualty collection point of any potential secondary explosive devices before you start bringing the injured there for treatment.
Some may worry about causing additional injury to a patient by moving him. That may occur, but the risks are minimal. Penetrating battlefield trauma injuries are not likely to be worsened by moving the patient. Get yourself and your patient to a relatively safe area first!
2) Stop the bleeding. The number one cause of preventable battlefield death is uncontrolled bleeding from an extremity. You have to stop the leaks!
Direct pressure is the standby solution. It works well and will stop bleeding in about 95% of battlefield injuries. For it to work however, direct pressure must be hard and sustained. That limits the rescuer to treating only one casualty at a time. It also may be difficult to perform while exhausted or while you are carrying your casualty to safety.
The solution to that problem is a Pressure Dressing. These dressings are merely a way to hold pressure on a wound with a bandage rather than directly from the rescuer. There are lots of good bandages on the market. I like the Cinch Tight, Emergency Bandage (also called the Israeli dressing), or Oleas bandage the best. All will work fine. Pick one and buy a few extra to practice with before throwing them in your kit.
Israeli Bandage
Even if you are carrying your medical kit, you will not likely have enough bandages for a mass casualty event like the Boston bombing. Practice improvising pressure dressings by using gauze pads combined with roller gauze, duct tape, or ace bandages.
3) Use a tourniquet. For some wounds, a pressure dressing won’t be enough to stop the bleeding. That’s where the tourniquet comes in. Several lives were saved in the recent bombing when a soldier trained in TCCC applied at least five tourniquets to patients who were blown up near the finish line of the marathon.
Improvised tourniquet placed on wounded spectator’s leg after the Boston Marathon bombing
Tourniquets were once demonized and treated as a “last resort”. Recent military experience in Iraq and Afghanistan has changed medical thinking on this previously controversial practice. The military is now teaching aggressive tourniquet use and cites it as the single most successful battlefield medical intervention to prevent death from combat trauma. Not a single soldier in our war on terror has lost a limb from a properly placed tourniquet.
Use a tourniquet in these three instances:
- When bleeding can’t be stopped with direct pressure or a pressure dressing
- As a first line whenever you see spurting arterial blood from an extremity
- On any traumatic amputation
Place the tourniquet as high on the limb as possible and crank it down until the bleeding stops. In approximately 20% of cases, a second tourniquet may be needed to stop bleeding. Place it directly below the first tourniquet and crank it down. Do not loosen or remove it. There are protocols for removing tourniquets or converting them to other dressings, but these are outside the scope of this article. It is likely that your casualty will reach definitive medical treatment in less than two hours here in the USA. If that is the case, let the doctors remove the tourniquet.
The military uses the CAT Tourniquet, SOF-T Tourniquet, and TK-4 Tourniquet. Of these, I like the SOF-T (especially the SOF-T Wide) the best.
SOF-T Tourniquet
Also learn how to improvise a tourniquet using a triangular bandage and a windlass. Don’t use a shoestring or zip ties. Make sure your improvised tourniquet is 1-2″ wide for optimal effectiveness and to reduce the chance of injury to your patient. Watch this short video by my late friend Paul Gomez about making a simple improvised tourniquet using a keyring and caribiner.
If you don’t have the keyring or carabiner, use whatever you can find as a windlass and hold or tape it in place.
4) Use a hemostatic agent. What if the bleeding is from a location where a tourniquet can’t be placed? If the wound is on the shoulder, the neck, or the groin, you may not be able to use a tourniquet. In that case, you will need a hemostatic agent. These are basically chemical blood stoppers. There have been several generations of them over the years, but the current crop stops bleeding well and does not produce the extreme heat that earlier varieties did.
While several options are likely to be effective, I would limit my selection to Quick Clot Combat Gauze or Celox Trauma Gauze. These two are the best products currently on the market. Here is a brief training video on how to use the hemostatic gauze. Caution for those with weak stomachs:
If you don’t have hemostatic gauze, pack the wound in the same way with roller gauze (Kerlix) or gauze pads.
There are other techniques to learn, but these four steps will get you through most situations reasonably well. I urge you to seek additional training. My company provides regular classes in the Ohio area. I would also recommend the training classes taught by TDI, Lone Star Medics, Dark Angel Medical and Tactical Development Group. Get some training!
If you can’t get in-person training classes, check out the online TCCC References and the Combat Lifesaver Home Study Course. Both are free.
If you don’t want to purchase these items from the amazon links above, you can get most of them at the following locations:
Please ask any questions in the comments below and I will try to help you out.
2013-04-18 04:55:07
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