The Tools--and The Mindset--For Surviving Traumatic · PDF fileTHE THREE PHASES OF SABA/ODMK 1. ... Get off the ‘X’—the best bandage in the world ... triangular hasp. Self Aid

Self Aid – Buddy Aid ©Copyright TTPOA 2009, All Rights Reserved

OFFICER DOWN MEDICAL KIT

The Tools--and The Mindset--For

Surviving Traumatic Injury, Preventing

Catastrophic Blood Loss and Reaching

Professional Medical Aid

TACTICAL MEDICAL TEAM

Dallas Police Department


PRODUCED IN ASSOCIATION WITH THE

TEXAS TACTICAL POLICE OFFICERS ASSOCIATION’S


DISCLAIMER

Several medical concepts and use of medical adjuncts will be

discussed within this block of instruction. Before utilization

of any of these concepts and/or adjuncts, it is recommended

that the user consult with their own Medical Director, EMS

Coordinator, Agency Attorney, or some other person in a

position to approve the use of those concepts taught here.

The fact that TTPOA may advocate one particular brand of

adjunct over another is based solely on current

recommendations of CoTCCC and neither TTPOA, the DPD

Tactical Medical Team, nor their representatives, have

received compensation from any of the manufacturers of the

products discussed within this block of instruction.


SABA/OFFICER DOWN MEDICAL KIT

LEARNING OBJECTIVES

• Define Self Aid. Buddy Aid (SABA)

• Understand the present need for SABA Training for Law Enforcement• Identify recent changes in Fire Department/Paramedic/EMS response policies in ‘Hot Zones’

• Understand the importance of blood loss management in the critical first seconds after injury

• Identify the MINDSET essential to SABA/use of the ODMK Tools• No Tactical Medical Aid until Safe

• Be prepared to be the only one who can save yourself (Self Aid)

• Be prepared to render aid to injured fellow Officer (Buddy Aid)

• Have a plan for Tactical Evacuation of injured Officer to Professional Medical Care (Medic Aid)

• Know how to use the TOOLS in the ODMK• Tourniquet

• Quik Clot Combat Gauze

• Pressure Dressing

• Know how to Locate a Wound

• Recognize and Implement Airway Recovery

K


SELF AID BUDDY AID

Law Enforcement Officers WILL be exposed to high-risk situations with a potential for traumatic injury to themselves, their fellow Officers, and/or the civilian population. The nature of First Response increases the likelihood that the location where the Officer is injured may REMAIN ‘hot’ after the injury/injuries are sustained. Professional Medical Care may not be willing or able to enter that hot combat zone—but the need for critical, immediate medical care remains.

Having the Tools and Mindset to successfully render medical aid to one’s self or to injured fellow Officers can dramatically increase the chances of a victim’s survival and positively impact the long-term effects of the injury.

Application of the SABA concept through the Officer Down Medical Kit tools can be the one thing that mitigates serious injury to, or even the death of, a fellow Officer.

Remember, the life you save may be your own.


WHY DO I NEED TO KNOW THIS?

• Civilian Emergency Medical Services personnel may have limited training working in high-risk, life-threatening environments—’hot’ or ‘combat’ zones.

• Further, EMS policies are moving toward prohibition of their personnel entering active ‘hot’ zones.

• Increasingly, chances are EMS will be staged blocks away from the incident until the scene is safe.

• However—life-threatening injuries still require immediate medical intervention. Every second delayed may reduce the likelihood of a favorable outcome.



DOES THE TRAINING I AM

RECEIVING WORK?

• Wichita, Kansas—June 1, 2008: Officer

Derek Purcell shot twice in hip by 9mm

– Tourniquet (improvised) applied at scene by fellow

Officer recently trained in SABA

– Officer Purcell’s life saved; EMS credits SABA training


WICHITA, KS PURCELL VIDEO

Click to Play Video


HOW HAS SABA AND THE ODMK BEEN

VALIDATED?

• Developed from battlefield-proven military Tactical Combat Casualty Care (TCCC or T3C)

• Military Combat Casualty Care models have evolved throughout the history of armed conflict, were codified as early as Napoleon, professionalized in US armed forces in the Civil War, and have evolved in every theater of armed conflict since

• Current SABA/TCCC extensively validated in overseas conflicts since 1990.


SABA DEFINED

SELF AID – The care one renders one’s self,

until help arrives. Priority given to self-rescue (finding cover or concealment) and hemorrhage (blood loss) control.

BUDDY AID – The care one renders to injured fellow Officers. Priority given to tactical evacuation (finding cover or concealment)—to include providing effective return fire to hostile threat if necessary and ultimately extraction to a perimeter, and Professional Medic Aid—and hemorrhage (blood loss) control.


MEDIC AID – Professional medical care, provided

by trained and equipped Fire/Rescue, EMTs and

Paramedics who have responded to a tactical or

combat situation, staged outside the ‘hot’ zone

beyond a secure perimeter.

We will get us to them, if they can no longer get themselves to us.

THE ULTIMATE GOAL OF SABA AND

THE ODMK:


PRIORITIES OF THE SABA MINDSET

Priority 1: No Medical Aid in an Active Gunfight

Address Hostile Threat

Get Off the ‘X’

Priority 2: Render Self Aid

Address Own Injury

Keep Calm and Watch Your Back

Priority 3: Render Buddy Aid

Get There With The Tools You Need to Succeed

Determine Injured Fellow Officer’s Mindset and your Response

Priority 4: Secure Medic Aid

Tactical Evacuation


TOOLS OF THE OFFICER DOWN

MEDICAL KIT

�Tourniquet

�Quik Clot Combat Gauze

�Pressure Dressing

No tool can help if it isn’t there where and when you need it.


YOUR TRAINING—MINDSET &

TOOLS—IN ACTION:

• Though Tactical Combat Casualty Care evolved over two centuries of armed conflict, it crystalized in its present form following research--and a culminating, landmark paper--which appeared in a 1996 issue of Military Medicine.

• This synthesized hard lessons learned over centuries of battlefield healthcare but particularly learned from then-recent history.

• The research drew heavily on experience at the “Battle of the Black Sea” which took place in Mogadishu, Somalia in October 1993. It reprioritized military guidelines for trauma management, which previously mirrored tactics used in the civilian sector. The result led to TCCC, and in turn our own SABA training and the issuance of ODMK gear.

• Watch both TOOLS and MINDSET at work in this dramatization:


THE MAIN GOAL OF SABA/ODMK

TOOLS & MINDSET:

Decrease Preventable Death at the critical time and place of wounding.



THE THREE PHASES OF SABA/ODMK

1. Care Under Fire (CUF) -- Mindset1. Get Off The ‘X’

Addressing Hostile

Seeking Cover or Concealment

2. Tactical Field Care (TFC) -- Tools1. SELF AID

2. BUDDY AID

3. Tactical Evacuation (TACEVAC) -- Plan


BASIC MINDSET FOR

CARE UNDER FIRE

1. Address hostile(s), returning fire if necessary and taking cover as

quickly as possible. Get off the ‘X’—the best bandage in the world

cannot help if the injured takes additional rounds.

2. With threat addressed and once in cover/off the ‘X,’ determine

casualty’s mental state of engagement--instruct casualty to remain

engaged as a combatant if appropriate and they are able, consider

whether disarming casualty is necessary if they are not. Remember the

injured fellow Officer you are rescuing has just been involved in as

extreme an encounter as they will ever experience, may be unconscious,

in shock or experiencing hysteria, *and are armed*--address that reality

before rendering BUDDY AID (which may cause them additional shock

and pain) to avert additional tragedy.


TACTICAL FIELD CARE

• Undertaken when threat may still be present but is not IMMEDIATE.

• Medical Tools available are limited to those carried in the field—and into the ‘hot’ zone—by law enforcement first responders.

• SELF AID must be rendered by injured Officers until assistance arrives—first to rescue should encourage injured Officer to render, or continue rendering, SELF AID.

• BUDDY AID may supplement or replace SELF AID as necessary.

• Know, practice with and keep on your person your ODMK Tools—skill using them is perishable and they do no good in a locker at the station, a warbag in the car or a closet at the house….


BASIC TOOLS FOR TACTICAL FIELD CARE

� Provided in Officer Down Medical Kit:

� Tourniquet

� Quik Clot Combat Gauze

� Pressure Bandage

� Consider obtaining, to supplement:

� Clean gloves

� Method of Carry

� Other


TOURNIQUET


TOURNIQUET APPLICATION


TOURNIQUET USE ESSENTIALS

• Apply ONLY TO INJURED EXTREMITIES (arms and legs).

• The head is not an extremity.

• Apply OVER THE CLOTHING/UNIFORM.

• Remember you may not be there when it is removed, and it must be seen by those rendering MEDIC AID.

• Apply HIGH & TIGHT:

• As far toward the torso as possible, between the wound and the heart.

• Tighten strap and wind windlass as tight ly as possible, lock end into triangular hasp.


QUIK CLOT COMBAT GAUZE

In instances of compressible

bleeding where a

tourniquet could not be

applied (not an extremity

wound, none available, etc)

use Combat Gauze as the

medical tool of choice.

--Hemostatic Agent

--Not same as

previous generation

• Combat Gauze™ causes rapid, localized coagulation, controlling bleeding faster than conventional dressing.

• Forms a rapid, stable blood clot in the wound.

• It does not absorb into the body and is safe to leave in the wound until MEDIC AID is available.

• This generation does not produce heat.

• This generation has removed shellfish as hemostatic agent but still be aware of possible allergies (look for Allergy warning bracelets or necklaces).

Combat Medical Systems, LLC, Tel: 910-426-0003, Fax: 910-426-0009, Website: www.combatgauze.com

HOW DOES QUIK CLOT WORK?

• Pack Combat Gauze™

tightly into wound and

directly onto bleeding

source

• More than one gauze may

be required to stem blood

flow

• Combat Gauze™ may have

to be re-packed into

wound to ensure proper

placement


QUIK CLOT APPLICATION

• Combat Gauze™ may

be left in place

• Dressing should be

wrapped secure

gauze in the wound


BANDAGING OVER QUIK CLOT

QUICK CLOT COMBAT GAUZE

INSTRUCTIONAL VIDEO

(OPTIONAL TO SUPPLEMENT HANDS-ON DEMO)

Click to Play Video


PRESSURE DRESSING

APPLICATION

• Insure Pressure Dressing is sterile (vacuum packaging uncompromised).

• Pressure Dressing may supplement hemostatic gauze for maximum blood loss control.

• Pressure Dressing may also be used for less severe injuries that do not require a tourniquet or hemostatic agent. It is ultimately a high-quality bandage—use it as such.

• Pressure Dressing may be the best—and only—Tool in ODMK for a Head Wound.


OLAES PRESSURE DRESSING

INSTRUCTIONAL VIDEO

(OPTIONAL TO SUPPLEMENT HANDS-ON DEMO)

Click to Play Video


THE PERSONAL MEDICAL TOOL

• Officers are familiar with the concept of always being armed, even if it is just with ‘personal weapons’—one’s hands, feet, elbows, etc; Officers should remember they likewise have ‘personal medical tools’ which can be effective in extremity.

• DIRECT PRESSURE-it works most of the time for external blood loss

• Use two hands if possible

• Press against the ground or other hard surface underneath the wound if possible

• Lean into it—if it hurts, the victim and possibly you, it is probably working

• Do not let up applied pressure to ‘check the wound’—you may undo all of the good you have done


LOCATING THE WOUNDUSING THE PERSONAL MEDICAL TOOL

• First Responders operate in low light, high contrast environments;

locating the source of blood loss on an injured Officer may be much

more difficult to do by sight than is imaginable, but time is still of the

essence.

• Blood can be almost impossible to see against dark uniforms especially

at night (and hard to feel in sterile gloves).

• Officers can still locate the wound by feel quickly using two touch

methods:

• Sweep

• Rake


WOUND SWEEP/RAKE INSTRUCTIONAL VIDEO(OPTIONAL TO SUPPLEMENT HANDS-ON DEMO)

Click to Play Video


NO TOURNIQUET WAS APPLIED-THE VICTIM DIEDTHIS IS A COMBAT WOUND-BUT HAVE WE ALL NOT SEEN MOTOR VEHICLE ACCIDENTS

PRODUCE SIMILAR CARNAGE?


TOURNIQUET(S) APPLIED-THE VICTIM

SURVIVED


MAKE-SHIFT TOURNIQUET (USING PERSONAL

MEDICAL TOOLS AND INGENUITY)


MULTIPLE TOURNIQUETS = A SAVED LIFE


� THE TOOLSYOU’VE BEEN PROVIDED IN

YOUR OFFICER DOWN MEDICAL KIT—

COMBINED WITH THE MINDSET TO USE

THEM—CAN SAVE LIVES.

�HAVE SAVED LIVES. LIVES OF

DALLAS POLICE OFFICERS.


METHODS OF CARRY

• You will have received basic familiarization with the Tools in your ODMK today.

• Proficiency with them is a perishable skill; practice to be ready under stress.

• Consider practicing with your ODMK Tools so you can utilize them with EITHER HAND, if necessary.

• Consider where you will carry your ODMK Tools, and let those closest to you know.

• If it sounds like your skills with your Tactical Medical Tools are a lot like your skills with your firearms, it should.


CARRY OPTIONS


CARRY OPTIONS


BASIC AIRWAY RESTORATION

The best blood loss control in the world

does not help if they aren’t still breathing.

Basic Airway Restoration Remedies:• If unconscious, open airway with head-tilt/chin lift

• Place casualty in the Recovery Position


HEAD TILT/CHIN LIFT


AIRWAY RESTORATION RECOVERY

POSITION


TACTICAL EVACUATION (TACEVAC)

• Remembering Priority 1 stresses no

rendering of Tactical Medical Care while still

exposed to potential continuing hostile

aggression, Officers should have a plan for

self-rescue (SELF AID) and have considered

options—and obstructions—to rescuing

injured fellow Officers (BUDDY AID).


CASUALTY EXTRACTION

• SELF AID—Push, Pull, Drag or Crawl to Cover

• BUDDY AID—Drags, Pulls and Carries

• There are easy ways and hard ways

(arguably under stress there are only hard ways)

• The bottom line is MISSION

SUCCESS--GET OFF THE “X”


DRAGS, PULLS & CARRIES TO CONSIDER

• ‘Firefighter’ carry

• Consider complications of duty gear

• Two person carry

• Immobilize wrists (grip forearms, not hands)

• One person drag

• Two person drag

• Blanket/Jacket/Poncho drag

• Consider ubiquitous DPD raid jacket


DRAGS, PULLS, CARRIES


DRAGS, PULLS, CARRIES


ADDITIONAL CONSIDERATIONS

• What Not To Do

• Overextend yourself

• Overreach what your know/have been trained to do

• What TO Do

• Wear your Ballistic Vest:

• These tools do not address torso wounds for multiple

reasons, including their likely complexity—but also

because you have this life-saving Tool already provided.

• Occlusive (three-way or ‘sucking chest wound) bandage in Dressing


PRACTICAL TRAINING: ODMK

Use the time, training versions of the ODMK Tools available and the team of TacMed Instructors today to get ‘hands-on’ time with the Tools provided in your Officer Down Medical Kit. The next time you go to use any of it, lives could be depending on you. Including yours.

Documents

The Tools--and The Mindset--For Surviving Traumatic · PDF fileTHE THREE PHASES OF SABA/ODMK 1. ... Get off the ‘X’—the best bandage in the world ... triangular hasp. Self Aid