In today’s world, terrorist attack or other social or natural disaster could create a medical scene comparable to a battlefield, and bystanders may be the first responders, write Steven J. Hatfill, M.D., and Jane M. Orient, M.D., in the winter 2013 issue of the Journal of American Physicians and Surgeons. The bombing at the finish line of the Boston Marathon provides an example.
The military has learned how to drastically reduce the number of preventable deaths from blast or gunshots, and these lessons are being adapted for civilian use by the Committee for Tactical Emergency Casualty Care (C-TECC).
Control of catastrophic hemorrhage is a first priority. Tourniquets are essential and are being incorporated into emergency kits. The old perception that tourniquets are a “last resort” is fortunately changing. Direct pressure and wound packing, preferably with gauze impregnated with hemostatic agents, can also be life-saving.
A person can bleed to death within 90 seconds from a femoral artery and vein, the authors state. The difference between life and death can be 500 cc of blood.
Other basic skills include securing the airway, sealing open chest wounds, recognizing and treating tension pneumothorax, and rapid assessment for other critical injuries.
Authors advocate teaching these skills to medical professionals, first responders, and lay people. “Blow-out kits” with needed supplies should be widely available, but responders may need to use materials available at the scene to improvise.
“The ability to control catastrophic hemorrhage and provide an airway should be a basic skill of every police officer on the street, but at this time, it is not part of their basic training,” the authors write.
