December 29, 2018
The world has changed drastically in the last 30 some years. Even our language has evolved. No longer do we use terms like; pay phones, rotary dials, transistor radios, beepers, cassette recorders. We also, no longer use that technology. We are now somewhere between self-driving cars and booking tickets to Mars.
Healthcare has also changed with the times, and some diseases once in circulation have been eradicated. Unfortunately though, new strains of 'not so good stuff' have come into the present.
EMS is trying its best to keep up. One of the things we have to look forward to is a discussion on whether or not to train EMT's in scenes of ASHE (active shooter/hostile event). If you are interested in this topic, EMSWORLD magazine (March 2017 / Vol. 46, NO. 3) has excellent articles on the subject. One is a roundtable discussion with 4 top experts and I strongly encourage you to find the publication and read the article.
One of the first questions they ask of these experts is whether or not EMS should be more proactive in assisting casualties in mass shootings? Some of the experts in this article say scene safety might be an illusion. The questions they bring up must cause us to think. No one can truly say that a scene is absolutely safe until you are far from it, in the safety of your ambulance, driving away. They will not be asking EMT's to go into the line of fire but all of them agree that the emergency system needs a solution.
Another question brought up in this article is weather it is feasible to expect the police to help with the medical stabilization of patients. E. Reed Smith, MD states, " the law enforcement officer who is no longer stopping the killing can very quickly switch over to stopping the dying." He goes on to say that the scope of practice for the police would be very much the same as a current lay-person's knowledge: bleeding control, tourniquet use, compression only CPR, public-access defibrillation, and maintaining body temperature.
What I found enlightening is that some of these experts are advocating for hemorrhage control kits to be displayed right beside AED's in public places. In fact there is a program out there called Stop the Bleed. The goal of the Stop the Bleed program is to make training in bleeding control as common as CPR training and Combat Application Tourniquets (C-A-T's) publicly available, with enough pressure bandages to treat 8 patients, mounted alongside your public-access AED. The article states, "The recommendation to train citizens and all first responders to stop bleeding came out of the Hartford Consensus." "This committee was formed in direct response to the 2012 mass shooting at Sandy Hook Elementary School in Newtown, CT, which left 20 children and 6 staff members dead."
Ed Racht, MD, sums it up and says that an important part of the strategy of responding to ASHE's is preparing law enforcement and other responders for aggressive hemorrhage control. "If law enforcement-which has the training and expertise to go deeper into the uncontrolled hot zone –can rapidly identify and control significant bleeding and bring patients to safety, they can have a significant impact on patient outcome and loss of life." The question is, will they want to?
A similar thing took place when many fire departments strongly encouraged the fire fighters to become CFR's (Certified First Responders), which is the level below EMT. A very large amount of fire fighters I have come across clearly stated to me that all they wanted to do was fight fires. Maybe this narrow tunnel thinking needs to change to a much broader vison and training in the present world of violence and terrorism. www.dhs.gov/stopthebleed