Category Archives: TECC

Tac Tool Tuesday! IFAK!

This week let’s take a look at IFAKs.  What do you carry on your belt?   What’s going to be immediately at hand when something catastrophic happens?

DSC_1103

A tourniquet? Where is it?  Can you get to it with your dumb hand? When was the last time you drilled with your preferred model?

You see pictures of combat medics festooned with tourniquets, and that’s a good place to start.  At least one easily accessible TK rigged for application to yourself with one hand.

Anything else?  Here’s the thing about an IFAK.  It’s all about you!  There’s a reason it’s an “Individual” First Aid Kit.  YOU use it on YOURSELF under bad conditions.  Worst case, someone else uses it on you because you’re so immobilized you can’t even get a TK on your own arm.

There are some great products on the market, some innovative designs that fit in a plate carrier or a hydration pocket on a small pack, a cargo pocket on your pants, or the slash pocket on a duty vest. It needs to be small enough that you’ll carry it everywhere.  Don’t keep it in a jacket pocket, you probably leave your jacket in your car some days.

Or you can build your own.  Must haves? Think of it like your ten essentials for a backcountry trip.  What must I be able to do? What would I like to be able to do? How much can I carry? How much can I spend?

About 60% of combat fatalities come from extremity bleeding.  Some come from tension pneumothorax.  Few come from airway obstruction.

What do you need to do with your IFAK? You need to stop bleeding.  Tourniquets. Pressure dressings. Wound packing. Hemostatic agents. You need to open an airway. A size 28 NPA is a good device for that. Needling a chest would be great.  14g x 3.5″ needle.

There are lots of kits on the market.  North American Rescue makes their Individual Patrol Officer Kit available with chitosan, combat gauze, or celox hemostatics to customize your kit for your needs based on your best assessment. It only comes with one tourniquet, but hang a second on your belt if you’ve got space and you’re good to go in that department.

As importantly or more, you and your peers, the guy on your left and the woman on your right flank need to know what to do with it.

 

 

Tac Tool Tuesday! Junctional Compression!

The AAT is now the AAJT! This device has been shown to reduce hemorrhage in junctional trauma with lower tissue pressures than other devices.

AAJT

Exciting emerging applications for this device include it’s prospective use in pelvic fractures! Rather than worry about stopping multiple fracture sources of blood loss, just stop blood flow to the affected area altogether until timely surgical repair or embolization.

Here’s a link to the abstract from the research at Madigan Army Medical Centre

Tac TechniqueTuesday! Casualty Movement

We’ve looked at airways, we’ve looked at hemcon.  Let’s take a look at casualty movement skills & decision making for this week Tac Technique Tuesday.

There are a number of ways to drag and or carry a casualty and to determine which one is the most effective for any given situation you need to start with a task assessment.

A two person drag can be sustained for distance and can cover even clear ground quickly.

A two person drag can be sustained for distance and can cover even clear ground quickly.

Answer the following questions about the situation:

How far am I moving him?
How quickly do I need to move him?
Have we won the firefight or mitigated the threat?
Is there cover and/or concealment where I can stage on route?
From where can I be observed? Are those spots covered by friendlies?
From where can I be engaged? Are those spots covered by friendlies?
Do I have a device to assist with this task?

Now that you appreciate the task at hand, think about the options open to you.  Are you on your own with your partner down in the open?  Do you have an ERT poised to take the target building? Can you quickly get a set of eyes on that vital ground? Do you have air assets, drones, or other means in play?

4 moves you need to know!Cradle Drop Drag

Self evacuation via the leopard crawl
2 Person Drag
1 Person Drag
Hawes Carry

Tac Technique Tuesday!

We’ve recently looked at wound packing as one of the more effective methods to control hemorrhage.  This week let’s look at surgical crichoidthyrotomy as an airway option in tactical environments.

Surgical airways are recommended by both C-TECC and CoTCCC relatively early in the airway management flowchart, below NPA and positioning and above placement of an ET tube.  Unlike the civilian setting where equipment is readily available and one monitor/patient is the norm, the Tactical Field Care (TCCC) and Indirect Threat Care (TECC) phase recommendations recognize that time and equipment constraints may not allow us to use tools like ETCO2 waveform capnography to confirm tube placement, or even Direct Laryngoscopy or Video Laryngoscopy to place a tube.  In those settings, a scalpel-bougie crich may be your best bet for definitive tactical airway management.Crich

Watch this video of Dr Dennis Kim demonstrating a very deliberate surgical method on a cadaver, and think about doing this in a dust-storm in Iraq (or a blizzard in the BC Alpine), or in the pitch black with IR illumination and NVG’s while balancing the equipment on the cleanest surface you can find, your jumpkit or your lap.

https://www.youtube.com/watch?v=Kg14kdIycDE

If they are done quickly and smoothly out of prepared stripped-down kits they are significantly easier and safer than ETT placement.  There is no technology to depend upon.  No Laryngoscope, no waveform capnography to confirm placement.

Equipment is simple: A scalpel, a bougie, and a cut down #6 ETT with 10 ml syringe attached.

If necessary, make a vertical incision to mark your midline.  Cut the skin laterally across the neck to expose the crichoid membrane.  Pierce the membrane, extend the incision and do not remove the scalpel.  Insert the bougie over top of the scalpel blade into the tracheal lumen. Remove the scalpel and pass the tube over the bougie.

The technique starts at 2:30 in this video!

https://www.youtube.com/watch?v=BT7KsQN6ANc

If you compare the two techniques, you’ll see that the scalpel-bougie Crich is the easier, safer method.  By keeping the surgical tract open continuously, via scalpel, then bougie, then tube, there is a major reduction in the chance of losing the tract.  Losing the tract in the dark, in the dust, in the snow, isn’t an option. This is your last ditch airway procedure.  It must work!

 

Our TECC Venue

We’ve got it.  We’ve booked one of British Columbia’s premier tactical training facilities for our March TECC Course!  The Vancouver Police Department Tactical Training Center will be hosting us on the 14th and 15th of March for our inaugural Tactical Emergency Casualty Care for Law Enforcement & EMS course.  What this means is access to simulation rooms and equipment through the full use of force spectrum.

We’re firm believers in the principle of “train as you fight”.

The facility motto is “train as you work”, clearly someone in City Hall didn’t like the violent overtones of the original statement, but considering the facility includes multiple firearms ranges, redman suits and training batons, firearms and OC Spray, we’ll stick with original intention of the statement.

Train as you fight.  We’re good with that.

One Step Closer to our Tactical Emergency Casualty Care Course

For the past several days I’ve been working the phone lines and email tree trying to nail down a venue for our next course offering, and I think we’ve found it.  I’ll be stopping by tomorrow to ensure that it meets our needs and is cost effective for our clientele.

Our Tactical Emergency Casualty Care Course is open to paramedics, law enforcement, and Canadian Armed Forces members.  TCCC and TECC teach the same material, but to different target audiences, in a slightly different format.  While sending the 9-Liner CasEvacReq is an essential skill for a deployed soldier, there isn’t much need to teach it to a street level paramedic or police member.

What each of them does have to know is how to handle themselves if they’re injured; how to apply a tourniquet to themselves, their patient, or their partner quickly and efficiently and get back to the job at hand.  How to control hemorrhage with wound packing, direct pressure, and with a variety of bandages.  How to place an airway, on the floor, in the dark, by touch. How to move someone by themselves over smooth terrain, over rough terrain.

Tomorrow, at 1300, I find out if we’ve got our venue!