You check your rig and prepare for another shift full of chest pain and dyspnea calls. But what you don’t know is that terrorists have walked unabated into a middle school near your station, forced 1,800 students and teachers into the auditorium and killed several hostages who resisted their takeover.
Minutes later, you get dispatched to assist police at the scene. On arrival, you see five dead children being thrown out school windows and at least 48 others with gunshot wounds laying on or running across the school property.
Then you watch in horror as six police officers approach the school in a rescue attempt and terrorists open fire with a hail of bullets from automatic assault rifles. As the officers return fire, the terrorists detonate improvised explosive devices (IEDs) strategically placed at the front entrance of the school, severely injuring the approaching officers and now causing them to have to rescue their own.
Suddenly, you’re tasked with performing initial triage and managing the injuries of dozens of children and police officers struggling to stay alive. You’re not currently allowed to carry and use tourniquets for amputations, let alone use them to temporarily stem massive bleeding. You’re also not allowed to carry hemostatic dressings because your medical director sees no need for them. And your protocols only allow you to perform pleural decompressions when there’s a confirmed tension pneumothorax present.
Many of these patients and the circumstances confronting you fall outside your normal thought and action processes, and way outside your EMS system’s protocols and procedures.
So, what do you do?
If you think this scenario can’t happen in your community, put this special supplementt JEMS aside, go to a local elementary school, bury your head in playground sand and pretend that no one hates you, your government and your way of life. Because such threats to your community are real, the subsequent challenges they present to your organization must be dealt with. It requires a lot of forward thinking to prepare for what experts predict will strike many EMS systems in the future.This supplement brings together experts inthe field of military and civilian medicine who present new concepts, techniques and products that have proven essential to military and tactical environments. Their articles are woven together to show why and how military and tactical medical advances should be applied to civilian EMS.
In Terror in America’s Schools, John Giduck, author of Terror at Beslan, focuses on al Qaeda’s promise to attack America’s schools. He uses his extensive knowledge of the Sept. 1, 2004, Beslan, Russia school massacre to illustrate how easily a similar event could occur in the United States. Pointing out how soldiers, police officers and EMS/fire personnel were fired on and killed while attempting to rescue the more than 300 hostages in the school, Giduck stresses the need for EMS/fire responders to go into these battles with a tactical mindset and be trained to use available weapons if/when they’re trapped and unable to escape terrorist gunfire.
In The Origins of EMS in Military Medicine, Daved van Stralen, MD, discusses how advances in combat medicine have influenced civilian EMS. Through this historical overview, van Stralen underscores why and how EMS providers should look to military medicine for developments in trauma care, especially while this country is at war.
In From the Battlefield to Our Streets, Jeffrey Cain, MD, a West Point graduate who served with the 75th Ranger Regiment and as a battalion physician in Iraq, details how combat medicine is revolutionizing civilian trauma care. He highlights the military’s Tactical Combat Casualty Care guidelines and points out military lessons learned in hemorrhage control, airway care, penetrating chest injury management, hypothermia prevention, pain management and rapid patient evacuation.
Peter Taillac, MD and Gerald Doyle, MD, present protocols for the safe and effective use of tourniquets by civilian EMS personnel in Tourniquet First! They also venture into uncharted EMS waters and illustrate how tourniquets can, and should, be used as temporary hemorrhage control devices when you’re overtaxed by a seriously injured patient or a host of patients at an MCI.
Finally, in The Stress Paradox, Bruce Siddle explores how the human body responds (positively and negatively) to stress and danger, specifically the sympathetic nervous system’s reaction to stress, and how this impacts precision skills, from complexmedical procedures to such basic tasks as opening our kits and finding and deploying supplies.
The military, by virtue of their experience treating large numbers of casualties in a relatively short time period, and under the worst circumstances, once again is leading the way in trauma care innovations and saving lives we previously thought couldn’t be saved. Progressive EMS systems will not let such developments go ignored. Only by studying the lessons being learned daily on the battlefields of the war on terror can we ensure that our trauma care is state-of-the-art back home.