PART 1 Basic Trauma Response for SWAT Operators

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PART 1Basic Trauma Responsefor SWAT Operators
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Shots ring out

• On an approach to execute a warrant shots ring
  out. Two
• team members fall to the ground while others take
  cover.
• One operator was shot in the left elbow. He
  shouts that he
• has been hit and calls for medical aid. The
  second operator
• is hit in the head and is lying motionless with a
  small amount
• of bleeding from the head wound.
• Which of these patients requires immediate
  treatment and
• Transport under fire? You are the medicwhats
  your move?

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Scenario resolution

• Patient A (Elbow wound) This is a patrolling
  incident. A corpsman came to the aid of the
  patient and while evaluating his injuries the
  corpsman was shot in the head and killed. A
  second rescuer came to the aid of both parties
  and was shot in the chest and killed. The patient
  subsequently crawled about 50 meters to a more
  secure area and was evacuated.
• Patient B (Head wound) Another patrolling
  incident. Another member of the squad was
  applying a dressing to the head and he was shot
  in the right hand and left wrist. Another member
  came to their aid and he was shot in the forearm.
  Another came to help and was shot in the left
  shoulder. When yet another platoon member came to
  their aid, he was shot in the right side of the
  chest and right hip. A sixth platoon member was
  shot in the left posterior thorax when he tried
  to help. Finally, a seventh member was wounded in
  the right thigh when he came to help.

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Relevance or Course

• EACH YEAR OFFICERS ARE KILLED IN THE LINE OF
  DUTY.
• 1998 - 161 Killed in the line of duty
• 1999 - 134 Killed in the line of duty
• 2000- 150 Killed in the line of duty
• 1997 - 50K Injured via Assault
• 1998 - 60K Injured via Assault

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Relevance

• Hazardous Nature of SWAT
• Organized opposing forces
• Military type weapons
• Hostage taking
• Barricaded subjects
• Toxic hazards/clandestine drug labs
• TEMS Medic/TMOG
• Self-Aid/Buddy-Aid

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Relevance

• GOLDEN HOUR
• Term used to Quantify predicted outcome based on
  time to definitive care
• PLATINUM TEN MINUTES
• Care received within this interval is critical to
  survival

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Role of the Special Operator

• DO NO FURTHER HARM
• Basic Premise of Medicine
• DO NOT EXCEED TRAINING OR CAPABILITIES
• Tempting but legally dangerous

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Role of the Special Operator

• LIFE-SAVING INTERVENTION FOR LAW ENFORCEMENT
• You, Your partner
• OBTAINING MEDICAL CARE FOR SUSPECTS
• BYSTANDERS OR CIVILIANS

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Definitions

• TRAUMA - PHYSICAL INJURY CAUSED BY EXTERNAL
  FORCE
• COMMON TYPES
• ELECTRICAL SHOCK
• VEHICLE ACCIDENTS
• BURNS
• FALLS
• PENETRATING INJURY (GSW, KSW)
• BLUNT INJURY (GSW to Body Armor)

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Legal Issues

• CONSENT
• By law you must have consent before rendering
  treatment
• INFORMED CONSENT
• IMPLIED CONSENT
• Life-Threatening, Unresponsive, Mental
  Deterioration
• Dynamic, not static

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Legal

• DUTY TO ACT ON THE JOB
• LAW ENFORCEMENT OFFICER
• SUSPECT OR CUSTODY
• Flynn v. United States, 902 F.2nd 1524 10th
  Cir. 1990
• BYSTANDERS AND CIVILIANS

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Legal

• GOOD SAMARITAN LAWS
• Designed to protect you if you are acting in good
  faith and within your scope of training
• Limited to level of training to approved standards

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MINDSET OF TRAUMA RESPONSE

• BASICS RULE!
• EXSANGUINATION
• PRIMARY CAUSE OF DEATH
• MANY FATALITIES PREVENTABLE

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RAPID TRAUMA ASSESSMENT (RTA)

• BSI/BLOODBORNE PATHOGEN
• Always a Concern
• Universal Precautions
• PERSONAL COMFORT LEVEL
• Officer or Civilian?

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RTA

• OFFICER SAFETY
• PARAMOUNT IMPORTANCE
• LAW ENFORCEMENT FIRST!
• CONTINUED THREAT?
• SUSPECT SEARCHED/HANDCUFFED?

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RTA

• DETERMINE MECHANISM OF INJURY
• WHAT THE ? HAPPENED?
• HOW MANY VICTIMS?
• GET HELP
• HOW?
• WHO?

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RTA LIFE THREATENING TRAUMA

• IF YOU SEE IT, TREAT IT
• IF YOU DONT SEE IT, FIND IT

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RTA GROSS BLEEDING

• DIRECT PRESSURE
• ELEVATION
• PRESSURE BANDAGE
• IMPROVISE
• PRESSURE POINTS
• BRACHIAL
• FEMORAL
• TOURNIQUET

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RTA AIRWAY

• JAW THRUST
• OPEN AIRWAY
• CHECK FOR FOREIGN OBJECTS

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RTA BREATHING

• IS THERE ANY
• CHECK RATE
• 12-20
• ADEQUATE TO SUSTAIN LIFE?
• CPR MASK
• COMFORT LEVEL

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RTA CIRCULATION

• PULSE
• CHECK RATE
• 60-100 (OR BEYOND?)
• GENERAL IMPRESSION
• SKIN COLOR
• TEMPERATURE

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RTA DISABILITY

• LOOK FOR CAUSES
• TRUST YOUR INSTINCTS
• INVESTIGATE!!!!!

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RTA EXPOSE

• REMOVE GEAR/CLOTHING
• WEAPON RETENTION
• CONFIRM WHAT YOU BELIEVE
• FIND WHAT YOU CANT SEE
• HOW IMPORTANT IS MODESTY?
• MAINTAIN BODY TEMPERATURE!

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RTA LOAD AND GO DECISION

• MAKE THE DECISION!
• COMMON SENSE AND FACTS ON-HAND
• 90 of combat deaths occur on the battlefield
  before the casualty ever reaches a medical
  treatment facility
• TIME WASTED ON-SCENE INSTEAD OF GETTING CARE
• REMEMBER TO PROVIDE CARE EN-ROUTE
• CONTACT EMS/HOSPITAL (medical preplan)
• TASK TO SOMEONE
• Who, what, when, why, where, how and ETA

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RTA HEAD TO TOE CHECK

• WHY PERFORM?
• YOU HAVE UNKNOWNS
• YOU HAVE TIME
• CLOCK
• CONDITION
• YOU HAVE EXTRA PEOPLE
• GIVE THEM SOMETHING TO DO

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RTA HEAD TO TOE PROCESS

• SYSTEMATIC, THOROUGH AND ORDERLY
• TOP TO BOTTOM, FRONT TO BACK
• DESIGNED TO COVER ENTIRE BODY MUCH LIKE A GOOD
  SUSPECT SEARCH

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RTA HEAD TO TOE PROCESS

• HEAD
• NECK
• CHEST
• BACK/BUTTOCKS
• ABDOMEN
• PELVIS
• EXTREMITIES

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RTA SHOCK

• BODYS RESPONSE TO TRAUMA
• LOW BLOOD VOLUME
• UNABATED SHOCK EQUALS CERTAIN DEATH

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RTA SHOCK SIGNS AND SYMPTOMS

• MENTAL STATUS CHANGE
• PALE, COOL, MOIST SKIN
• IMPENDING DOOM
• RAPID, WEAK PULSE
• RAPID, SHALLOW RESPIRATION

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RTA SHOCK TREATMENT

• ADDRESS UNDERLYING CAUSE(S)
• COMPLETE ABCs
• KEEP WARM
• TLC
• DEFINITIVE MEDICAL CARE

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DRESSING AND BANDAGING

• DRESSING USED TO COVER WOUND
• STOPS BLEEDING
• PROTECT WOUND
• PREVENT FURTHER CONTAMINATION
• BANDAGE USED TO HOLD DRESSING IN PLACE

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TYPES OF INJURIES

• PENETRATION/PUNCTURE
• MAY BE LITTLE EXTERNAL BLEEDING
• INTERNAL BLEEDING MAY BE SEVERE, BUT UNSEEN
• CHECK FOR EXIT WOUND
• TREATMENT
• ABCs
• DRESSING AND BANDAGE

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TYPES OF INJURIES

• SUCKING CHEST WOUND
• PENETRATION OF LUNG CAVITY
• ALLOWS AIR TO ESCAPE
• TREATMENT
• USE OCCLUSIVE DRESSING
• BE PREPARED TO REMOVE DRESSING TO VENT LUNG CAVITY

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TYPES OF INJURIES

• BURNS
• FOCUS ON CARE INSTEAD OF EXACT DEGREE/THICKNESS
• TREATMENT
• STOP THE BURNING
• ABCs
• AIRWAY IS SUSCEPTABLE TO COMPROMISE
• COVER WITH DRY STERILE DRESSING
• PREVENT CONTAMINATION!

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TYPES OF INJURIES

• CHEMICAL BURNS
• BRUSH OFF DRY POWDER
• FLUSH WITH COPIOUS AMOUNTS OF WATER
• EYES
• ELECTRICAL BURNS
• OFTEN MORE SEVERE THAN OUTWARD APPEARANCES
• RESPIRATORY AND CARDIAC COMPROMISE

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TYPES OF INJURIES

• IMPALED OBJECTS
• ABCs
• DO NOT REMOVE OBJECT
• SECURE OBJECT
• DRESS WOUND

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TYPES OF INJURIES

• EVISCERATIONS
• ABCS
• COVER WITH THICK MOIST DRESSING
• TREAT FOR SHOCK
• DO NOT REPLACE ORGANS
• AMPUTATIONS
• ABCS
• PRESERVE AMPUTATED PART
• TREAT FOR SHOCK

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HEAT EMERGENCIES

• HEAT EXHAUSTION
• MOIST, PALE SKIN
• REMOVE FROM ENVIRONMENT
• HYDRATION AND COOLING
• HEAT STROKE
• TRUE EMERGENCY
• DRY, HOT SKIN
• RAPID TRANSPORT WITH COOLING PROCEDURES

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QUESTIONS?
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10 Minute Break