Lessons Learned from a Decade of Conflict - Boekje Pienter

You check your rig and preparefor another shift fullof chest pain and dyspneacalls. But what you don’t know isthat terrorists have walked unabatedinto a middle school nearyour station, forced 1,800 studentsand teachers into the auditoriumand killed several hostages whoresisted their takeover.Minutes later, you get dispatchedto assist police at the scene. Onarrival, you see five dead childrenbeing thrown out school windowsand at least 48 others with gunshotwounds laying on or runningacross the school property.Then you watch in horror as sixpolice officers approach the schoolin a rescue attempt and terroristsopen fire with a hail of bullets from automaticassault rifles. As the officers return fire, the terroristsdetonate improvised explosive devices(IEDs) strategically placed at the front entranceof the school, severely injuring the approachingofficers and now causing them to have torescue their own.Suddenly, you’re tasked with performing initialtriage and managing the injuries of dozensof children and police officers struggling tostay alive. You’re not currently allowed to carryand use tourniquets for amputations, let aloneuse them to temporarily stem massive bleeding.You’re also not allowed to carry hemostaticdressings because your medical directorsees no need for them. And your protocols onlyallow you to perform pleural decompressionswhen there’s a confirmed tension pneumothoraxpresent.Many of these patients and the circumstancesconfronting you fall outside your normalthought and action processes, and way outsideyour EMS system’s protocols and procedures.So, what do you do?If you think this scenario can’t happen inyour community, put this special supplementto JEMS aside, go to a local elementary school,bury your head in playground sand and pretendthat no one hates you, your governmentand your way of life. Because such threats toyour community are real, the subsequentchallenges they present to your organizationmust be dealt with. It requires a lot of forwardthinking to prepare for what experts predictwill strike many EMS systems in the future.This supplement brings together experts inthe field of military and civilian medicine whopresent new concepts, techniques and productsthat have proven essential to military and tacticalenvironments. Their articles are wovenForward ThinkingRequiredAn Introduction by A.J. Heightman,MPA, EMT-P, Editor-in-Chief, JEMStogether to show why and how military and tacticalmedical advances should be applied to civilian EMS.In Terror in America’s Schools, John Giduck, authorof Terror at Beslan, focuses on al Qaeda’s promiseto attack America’s schools. He uses his extensiveknowledge of the Sept. 1, 2004, Beslan, Russia schoolmassacre to illustrate how easily a similar event couldoccur in the United States.Pointing out how soldiers, police officers and EMS/fire personnelwere fired on and killed while attempting to rescue the morethan 300 hostages in the school, Giduck stresses the need for EMS/fire responders to go into these battles with a tactical mindset andbe trained to use available weapons if/when they’re trapped andunable to escape terrorist gunfire.In The Origins of EMS in Military Medicine, Daved van Stralen,MD, discusses how advances in combat medicine have influencedcivilian EMS. Through this historical overview, van Stralenunderscores why and how EMS providers should look to militarymedicine for developments in trauma care, especially while thiscountry is at war.In From the Battlefield to Our Streets, Jeffrey Cain, MD, a WestPoint graduate who served with the 75th Ranger Regiment andas a battalion physician in Iraq, details how combat medicine isrevolutionizing civilian trauma care. He highlights the military’sTactical Combat Casualty Care guidelines and points out militarylessons learned in hemorrhage control, airway care, penetratingchest injury management, hypothermia prevention, pain managementand rapid patient evacuation.Peter Taillac, MD and Gerald Doyle, MD, present protocols forthe safe and effective use of tourniquets by civilian EMS personnelin Tourniquet First! They also venture into uncharted EMSwaters and illustrate how tourniquets can, and should, be used astemporary hemorrhage control devices when you’re overtaxed by aseriously injured patient or a host of patients at an MCI.Finally, in The Stress Paradox, Bruce Siddle explores how thehuman body responds (positively and negatively) to stress anddanger, specifically the sympathetic nervous system’s reactionto stress, and how this impacts precision skills, from complexmedical procedures to such basic tasks as opening our kits andfinding and deploying supplies.The military, by virtue of their experience treating large numbersof casualties in a relatively short time period, and under theworst circumstances, once again is leading the way in trauma careinnovations and saving lives we previously thought couldn’t besaved. Progressive EMS systems will not let such developments goignored. Only by studying the lessons being learned daily on thebattlefields of the war on terror can we ensure that our trauma careis state-of-the-art back home.Elsevier Public Safety War on Trauma 3