EMS World

MAR 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 28 of 59

28 MARCH 2018 | EMSWORLD.com COVER REPORT: MCI TRAINING As active-shooter incidents increasingly afflict the public at large, first responders are working to improve tactical responses to further reduce the number of casualties. Stop the Bleed is a national campaign aiming to teach bystanders and first responders practical measures to prevent fatal blood loss in victims suffering traumatic wounds. Stop the Bleed holds training courses across the nation, and while civilians can teach them, who's better fit to lead the lessons than the first responders themselves? Detective Andrew Bershad, NREMT-P, CIC of the New York Police Department, and Sgt. Scott Harding, BS, NREMT-P, CIC of the Greenburgh Police Department in New York, taught one of these classes together in November 2017 in Paterson, N.J. "If we're not embracing [active-shooter incidents] as the new norm, then we're training to fail," says Harding (pictured), an instructor for the National Association of EMTs and American College of Surgeons. Harding believes planning and practicing are key elements to successful outcomes in active-shooter scenarios. It's important to keep safety at the front of the mind so everyone can make it home at the end of the day, he says, stressing that the mind-set should be, "If I work this intelligently and rehearse this frequently, this will likely end successfully." Bershad, a tactical medic and rescue specialist for the NYPD's Emergency Service Unit, stresses the importance of scene safety and teamwork. "Our safety is paramount as first responders. You have to be aware and rely on each other," says Bershad. "There's a certain risk we know we take on when we enter this profession." When it comes to MCIs, the mantra used in Harding's and Bershad's class is "It's not if, it's when." The frequency of mass shootings confirms this unfortunate truth, but preparation can help mitigate these incidents. "If we embrace the thought that it may happen, and we plan and work with our counterparts in law enforcement, the fire service, EMS, and incorporate civilians, we have a much better opportunity at winning these events," Harding says. Some of this planning includes learning how to save as many lives as possible. Many preventable deaths in MCIs are caused by blood loss. Stop the Bleed focuses heavily on tourniquet use due to its high success rates in controlling extremity bleeding. When Harding and Bershad began their initial training in the mid 1980s, tourniquets were frowned upon. Lessons learned from the global war on terror have enabled EMS providers and law enforcement to better understand the benefits of tourniquets, says Harding. It's vital to apply a tourniquet to a patient suffering severe blood loss within the first three minutes before they go into shock, as their chances of survival will then start declining rapidly. Considering this small window of survival time, EMS providers are entering the warm zone in MCIs more than ever. While it risks the safety of providers, timelier treatment saves more lives. "If we don't use them and use them aggressively, the potential for someone dying is obvious," says Harding. High-quality training is essential for preparing EMS personnel for working on scenes with active threats. "If we train and equip our EMS people properly, their involvement is an absolute necessity," says Harding. "But it requires training and commitment. If we put our heads together and work well together, the opportunity for success is just that obvious. The problem is, if we respond to a dynamic situation without preparation, quite frankly, we always don't do well." Interagency collaboration and heightened awareness is crucial— EMS personnel shouldn't rely solely on force protection to provide their safety. Bershad says every first responder must act as a safety officer with the understanding that they're entering an austere environment. "Force protection is just one leg of the safety layer you put down," says Bershad. "Ballistic protection and situational awareness through training is tremendous—good training becomes muscle memory so they're not thinking, 'Uh-oh, I have to be extra diligent of my safety.'" Bershad emphasizes the necessity of assessing scene safety during hostile events when providers may have to enter the warm zone. "I think the awareness has to be increased, especially for nontactical providers," he says. "We try to stress it more in our training—to be diligent of possible secondary devices or attacks." Harding suggests it's time for a change of perspective. Just as EMS personnel have access to personal protective equipment (PPE) for blood and body fluids, they should now have access to PPE for a "different type of threat," he says. "Allowing them to have a ballistic helmet, good protection for their eyes, and a ballistic vest empowers them to be safer and smarter." It's important for providers to be skilled in wearing PPE, as it can affect the way they operate if they aren't accustomed to it, Harding says. Since police officers are the most comfortable wearing ballistic gear, agencies should work with local law enforcement to receive training on operating with such PPE. Overall, though, emergency personnel should always be continuing their education in MCI-related patient care. "Uniformed responders should continue to aggressively seek out bleeding-control training. It's going to protect them as well as the people they're directed to," Bershad says. "Something as simple as that could make a difference for a victim surviving an incident." When it comes to extending urgent care training to civilians through Stop the Bleed, Harding believes it's an absolute necessity. "What I notice is that, as Americans, when we are pushed up against the wall, we see a lot more people willing to step up for their communities," Harding says. "The civilians who get involved absolutely make a difference." —Val Amato PLAN AND PRACTICE: The Keys to an Active-Shooter Response

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