Pro EMS Center for Medical Education, Development, Improvement and Clinical Simulation (MEDICS) in Cambridge, Mass., recently offered a two-day Tactical Combat Casualty Care (TCCC) class to 41 paramedics, bringing in an array of medical and tactical experts and incorporating state-of-the-art simulation technology for hands-on scenario training.
Lectures were presented by Cambridge Fire Department (CFD) Captain Greg Carter; Ali Raja, MD, and Brian Geyer, MD, from Brigham and Women’s Hospital; Kerry Davis from Dark Angel Medical Care; and Center for MEDICS TCCC instructor Jackson McWade. CFD Lieutenant Jeremy Walsh and TCCC instructor and Cambridge Police Department officer Matt Brown supervised the hands-on skills stations with other TCCC instructors.
The TCCC class trains paramedics on tactical strategies when entering an active scene. Approved by the National Association of EMTs (NAEMT), the class provides an opportunity to practice the skills most likely to be used in an active situation, including tourniquet application, airway management, IV and intraosseous (IO) placement and wound packing, and adds in challenging factors and obstacles.
Paramedics practiced airway management and IV/IO placement skills in low-light and no-light conditions. A Laerdal manikin was positioned upside-down and simulated a patient with a complicated airway problem. Tourniquets were applied on a Trauma FX manikin that kicks, bleeds and talks in a completely dark environment with a strobe light, fog machine and loud music blaring.
Students participated in three scenarios designed to incorporate situational awareness with a stressful situation and the application of appropriate medicine.
The realistic features of each manikin provided real-time feedback to students on the success of their interventions.
After the lectures and skills stations, students rotated among three scenario environments designed to incorporate situational awareness with a stressful situation and the application of appropriate medicine.
One scenario simulated a meth lab that just exploded, trapping law enforcement officers inside. The medics had to enter the scene, find the casualties (without knowing how many there were), and treat the patients if able. After finding one low-fidelity manikin simulating a person who died in the explosion, the medics continued to search the room, without knowing whether there was still an active threat. Eventually, they discovered the Trauma FX high-fidelity manikin, which was bleeding, kicking and screaming at them.
A second scenario captured the chaos of an active shooter scene. Actors depicted distraught and hysterical victims and witnesses to a mass casualty incident. The volunteers used Techline wearable wounds hooked up to a bleeding station to create realistic hemorrhaging.
In the final scenario, police and EMS on scene were told to enter a home when a typical domestic situation escalates—a mother and child are shot and need treatment. The concern for medics, as well as law enforcement, was whether the situation was still active or if the shooter has been disabled or inactivated.