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YOUR MUNICIPALITY POLICE DEPARTMENT
STANDARD OPERATING PROCEDURE
XXX – TACTICAL EMERGENCY CASUALTY CARE
WHEPP TEMS TOOLKIT DRAFT 01/29/2013
GENERAL ORDER:
2013-XX
ISSUED Month XX, 2013
ACTION: Creates Standard Operating Procedure XXX
EFFECTIVE Month XX, 2013
Author: PO Chad Stiles, RN/Paramedic
Medical Director Approval:
XXX.00 PURPOSE
This policy has been established specifically for members of the Department
trained in Tactical Emergency Casualty Care, Tactical Combat Casualty Care,
Tactical Emergency Medical Support (TEMS) and members who are also licensed
EMS or medical providers in the State of Wisconsin, including EMT through
paramedic level.
The purpose of this policy is to establish clear guidelines on providing medical
care, including self-aid and buddy-aid, in high threat tactical environments,
establish uniform and approved medical equipment, and standardized carrying
configurations for members of the department.
Members should attempt to utilize the EMS system for providing emergency
medical care, however, the department recognizes that certain situations members
are expected to handle occur in high threat environments, where normal means of
emergency medical care (including EMS care by YOUR MUNICIPALITY Fire
Department, YOUR MUNICIPALITY EMS, and/or Private Ambulance Services)
are not immediately available due to the scene being unsafe by actions of a hostile
actor or actors (i.e. active shooters, barricaded subjects and riot situations), remote
physical location (i.e. water patrol), events of terrorism, or natural or man-made
disasters, or mass casualty events where normal medical resources are
overwhelmed and/or not available in a timely manner due to uncontrollable
circumstances.
This policy is intended as a guideline for members to provide triage and
emergency medical treatment including point of wounding care to themselves,
fellow members, or civilians while under direct or indirect threats and during
tactical extrication and evacuation, until ultimate delivery to definitive emergency
medical care (EMS and/or hospital). These life-saving treatments can occur in
hostile and austere environments and situations, or while awaiting normal EMS
response. This care is above and beyond the level of what is trained and required
in 520 hour recruit training program of the State of Wisconsin Law Enforcement
Training and Standards Board for First Aid/CPR manual.
Realizing the dynamic nature of high threat and austere environments, this policy
is not meant to be a rigid protocol, but a guideline of best practices to be applied
by the member at the scene of an emergency and prior to definitive care by an
agency licensed by the Wisconsin Department of Health (including YOUR
MUNICIPALITY Fire Department, YOUR MUNICIPALITY EMS, or other
EMS service), or hospital facility, as the tactical or emergency situation dictates.
XXX.05 HISTORY
Tactical Combat Casualty Care (TCCC) is an evidence based medical care
concept that was developed and implemented by the US Military during the
Global War on Terror. TCCC currently serves as the current standard of care to
treat preventable battlefield deaths of military personnel for all deploying
combatants and medical personnel of the US Military. TCCC focuses on
providing care in three phases: care under fire, tactical field care, and tactical
evacuation care. These treatments focus on the three major causes of
‘preventable’ battlefield death: uncontrolled hemorrhage, tension pneumothorax,
and airway obstruction. It has been hypothesized by experts in law enforcement
and emergency medicine that these causes of preventable death would be similar
for police officers involved in violent confrontations. In 2011, TCCC guidelines
were adapted for domestic law enforcement use by the Committee on Tactical
Emergency Casualty Care (TECC). These TECC recommendations and protocols
have been published in the Journal of Special Operations Medicine (volume 11,
edition 3) and are offered as a nationally recommended standard of care, as a set
of principles of trauma management for high-threat pre-hospital environments.
XXX.10 DEFINTIONS AND STATUTE REFERENCES
A. MEDICAL LICENSE – WI Chapter 448.03(1)(a) states that no person may
practice medicine and surgery, or attempt to do so or make a representation as
authorized to do so, without a license granted by the board.
B. PRACTICE OF MEDICNE AND SURGERY – WI Chapter
448.01(9)(a) states "Practice of medicine and surgery" means: (a) To examine
into the fact, condition or cause of human health or disease, or to treat,
operate, prescribe or advise for the same, by any means or instrumentality.
448.01(9)(c) also includes in the definition to penetrate, pierce or sever the
tissues of a human being. This definition would include needle
decompression and wound packing.
C. MEDICAL LICENSE EXEMPTION – WI Chapter 448.03(2) gives the
following exception: nothing in this subchapter shall be construed either to
prohibit, or to require, a license or certificate under this subchapter for any of
the following: (i) any person furnishing medical assistance or first aid at the
scene of an emergency.
D. SCENE OF AN EMERGENCY – WI Chapter 448.01(9s) defines the “scene
of an emergency" means:
an area not within the confines of a hospital or other institution which has
hospital facilities, or the office of a person licensed, certified or holding a
limited permit under this chapter.
“Scene of Emergency” Case Law Definition also includes WI Supreme Court
Case Mueller v. McMillian the scene of any emergency or accident should:
"…follow the person in peril and in need of emergency care. It covers the
farmer that answers the door to find the victim of an automobile accident
who was able to make it to his door or the driver finding a hunter who,
after falling from his deer stand, crawls out to a highway with his broken
leg. The fact that the site of the accident is some distance away does not
reduce an injured person's need for assistance."
E. DIRECT THREAT CARE (CARE UNDER FIRE) – Describes actions
taken in response to a casualty where the external, on-going threat to life is
dangerous, or more dangerous than injury sustained.
F. INDIRECT THEAT CARE (TACTICAL FIELD CARE) – Articulates a
set of trauma care priorities during high-risk operations during a period when
the casualty and the provider are in an area of relative safety, protected by
cover and/or concealment, but have the possibility of engaging a threat.
G. TACTICAL EVACUATION CARE (TACEVAC) – Describe actions taken
to provide appropriate trauma care during transport to definitive medical care
when there is generally reduced threat to the patient and medical provider.
H. CASUALTY COLLECTION POINT – Staging area for casualties in an
area of relative safety, under cover and concealment, where triage and
treatment occur while awaiting tactical evacuation to or transport by an EMS
service.
I. PACE METHODOLOGY – (Primary, Alternative, Contingency, and
Emergency) Planning for emergency situations containing at least four
methods for mitigating a problem.
J. EMS PROVIDER – An emergency medical technician at any level that is
credentialed with an emergency medical service provider, which is licensed
by the State of Wisconsin Division of Health (DHS) - EMS Section, under
DHS 110 of the Wisconsin Administrative Code.
K. TEMS – Tactical Emergency Medical Support
L. TCCC – Tactical Combat Casualty Care - an evidence based medical care
concept, developed and implemented by the US Military during the Global
War on Terror, which serves as the current standard of care to treat
preventable battlefield deaths of military personnel.
M. TECC – Tactical Emergency Casualty Care - a nationally recommended
standard of care including principals of trauma management for high-threat
pre-hospital environments.
N. IFAK – Individual First Aid Kit
O. MCI – Mass Casualty Incident
XXX.15 LEVELS OF CARE PROVIDED BY MEMBERS
Department members will be classified by the level of standardized tactical
medical care training they have received in approved TCCC, TECC or TEMS training
courses provided by approved instructors at YOUR MUNICIPALITY Police Department
Training Division, or an approved Wisconsin Technical College System or Wisconsin
DHS training center.
Department members who are military active duty, reserves, or recent honorable
discharge, and have received military medical training including TCCC, Combat
Lifesaver, Combat Medic (68W), or Hospital Corpsman during the course of their
military service training within the last two years, may provide a copy of their course
completion certificate or provide a letter from their unit commander or NCO, confirming
successful completion of training, to the department to receive credit for their training.
These members may then provide pre-hospital care to the level of their training in
emergency situations until delivery of the patient to the EMS system in accordance with
this SOP and current TECC protocols, but are encouraged to take an updated tactical
medicine course for law enforcement as soon as practical.
Provider Designation
LEO Awareness
TECC (or TCCC equivalent)
TEMS Medic
EMR
EMT
Advanced EMT
Paramedic
Provider Level
LESB 520 + Awareness Trained
LESB 520 + Operator Level
LESB 520 or below EMS levels + TEMS Medic
Emergency Medical Responder
Emergency Medical Technician
Advanced Emergency Medical Technician
Paramedic
Lineup
Designation
N/A
(TECC)
(TEMS)
(EMS)
(EMS)
(EMS)
(EMS)
Training Time
4 hour minimum
8 hour minimum
40 hour minimum
DHS defined
DHS Defined
DHS defined
DHS defined
Tourniquets
X
X
X
X
X
X
X
Pressure Bandage
w/packing
X
X
X
X
X
X
X
Hemostatic Tourniquet
Agent
De-escalation
X
X
X
X
X
X
X
X
X
Chest
Seal
X
X
X
X
X
X
X
Limited needle
decompression NPA
X
X*
X
X*
X
X
X
X
X*
X
* With additional training and certification
Note: Any member holding a WI EMS license may only practice within the scope of practice as defined by DHS.
Other EMS/medical related skills listed in protocol such as patient assessment, splinting
and hypothermia management should be considered standard for all levels of providers.
All members who are also licensed EMS providers by Wisconsin Department Health
Services EMS Section must maintain current WI EMS licensure and credentialing
requirements per DHS EMS section to practice. Members holding a DHS license, must
provide a copy of license to the designated service director every two years. Members
will follow designated protocols for their provider level as outlined in the department’s
EMS operational plan.
Members should balance the medical necessity verses the tactical situation to determine
proper patient care. Care may not be able to be rendered immediately due to an unsafe
scene. Members should consider activating the EMS system early and pre-staging
medical personnel in a safe area outside of the scene of high-risk incidents as to decrease
EMS response time if needed.
XXX.20 LOCATION AND CARRYNG OF TACTICAL MEDICAL EQUIPMENT
Members who have taken an approved TCCC, TECC, or TEMS course, are
authorized to carry the following equipment in one of the approved carrying
configurations, in order to provide for a standardized location on the member to carry
medical supplies. Equipment may be department issued or be personally purchased items.
Carrying methods:
A. Patrol (concealed)
a. Within the trauma plate pouch, or attached to their concealable body
armor Velcro carrier or within interior pocket of outer vest carrier
B. Black leg-rig IFAK (Individual First Aid Kit)
C. Black over-the-shoulder Active Shooter Pack
D. Additional medical supplies may also be carried on duty belt in a single black
pouch or ankle devices as approved by department quartermaster.
E. Specialty unit commanders may also elect to approve an alternate carrying
configuration for medical supplies based on unit need, as long as the
equipment is carried in a standardized location and method by all unit
members.
Additional Locations of Tactical Medical Equipment
A. Training Division
As accidents can occur during training, Training Division staff will maintain a
fully stocked tactical medical kit and ensure a TECC trained member present at
all training events involving firearms. The Training Division will also
maintain:
1. One complete TECC kit in each range bay
2. Deployable TECC kits for remote shoots
3. Training Division Office by AED/First Aid Kit
B. SWAT
1. Bearcat/Armored Vehicle
2. SWAT Equipment Van/Command Post
C. Water Patrol
1. All boats
D. Major Incident Response Team
1. Equipment Van
2. Deployable TECC Medical Kits
E. Sub-Stations
1. By AED/First Aid kit
F. Locations where firearms are handled and stored
1. Crime Scene/Evidence Processing Area
2. Evidence/Property Section
G. Hazardous Devices Unit (Bomb Squad)
Equipment: (Authorized medical equipment is inclusive only of member’s skill level):
A. Co-TECC or Co-TCCC Approved Tourniquets, currently:
a. Combat Action Tourniquet (CAT) or
b. Special Operations Forces Tactical Tourniquet (SOFTT-W)
B. Airway devices
a. 28F Nasal Pharyngeal airway and/or
b. Appropriately sized NPA measured to member
C. Breathing devices
a. CPR mask with one way valve
b. Chest Seals
i. Valved
ii. Fully Occlusive
c. Needle decompression system
i. 14g, 3.25” Angiocath
1. Mojodart
2. Air Release System (ARS)
D. Bleeding Control
a. 4”-6”Trauma Bandages/Dressings
b. Sterile gauze suitable for wound packing
c. Co-TECC or Co-TCCC approved Hemostatic Agent
E. Additional Medical Equipment
a. Medical gloves
b. Casualty Care Card(s)
c. Operator/Officer Medical Care Information (carried in vest carrier)
d. Trauma shears
e. Additional equipment as determined by skill level and approved
protocol
XXX.25 MEDICAL STANDARD OPERATING GUIDELINES FOR PREHOSPITAL TRAUMA CARE IN A HIGH THEAT ENVIRONMENT
As adapted for Wisconsin and YOUR MUNICIPALITY from http://c-tecc.org/
DIRECT THREAT CARE/CARE UNDER FIRE (DT/CUF)
Goals:
1. Accomplish the mission with minimal casualties
2. Prevent the casualty from sustaining additional injuries
3. Keep response team maximally engaged in neutralizing the existing threat (e.g.
active shooter, unstable building, confined space HAZMAT, etc.)
4. Minimize public harm
Principles:
1. Establish tactical supremacy and defer in depth medical interventions if
engaged in ongoing direct threat (e.g., active fire fight, unstable building
collapse, dynamic explosive scenario, etc.).
2. Threat mitigation techniques will minimize risk to casualty and to provider.
3. Minimal trauma interventions are warranted.
4. Consider hemorrhage control
a. Tourniquet application is the primary medical intervention to be
considered in CUF/ Direct Threat Care.
b. Consider instructing casualty to apply direct pressure to the wound if no
tourniquet available or application is not tactically feasible.
5. Consider quickly placing or directing casualty to be placed in position to
protect airway.
Guidelines:
1. Mitigate the threat and take cover (e.g. return fire, utilize less lethal technology,
assume an overwhelming force posture, extraction from immediate structural
collapse, etc.).
2. Direct the casualty to stay engaged in operation if appropriate.
3. Direct the casualty to move to cover and apply self aid if able.
4. Casualty Extraction
a. If a casualty can move to safety, they should be instructed to do so.
b. If a casualty is unresponsive, the scene commander, supervisor or senior
officer on scene should weigh the risks and benefits of an immediate
rescue attempt in terms of manpower and likelihood of success. Remote
medical assessment techniques should be considered.
c. If the casualty is responsive but cannot move, a tactically feasible rescue
plan should be devised.
d. Recognize that threats are dynamic and may be ongoing, requiring
continuous threat assessments.
5. Stop life threatening external hemorrhage if tactically feasible:
a. Direct casualty to apply effective tourniquet if able
b. Apply the tourniquet over the clothing as proximal—high on the limb—
as possible.
c. Tighten until cessation of bleeding and move to safety. Consider
moving to safety prior to application of the tourniquet if the situation
warrants.
d. Tourniquet should be readily available and accessible with either hand
e. Consider instructing casualty to apply direct pressure to the wound if no
tourniquet available or application is not tactically feasible
f. Consider quickly placing casualty, or directing the casualty to be placed,
in position to protect airway if tactically feasible
g. If tourniquet is applied to strong-side shooting hand, strongly consider
firearm transition to unaffected side in the event of palsy which could
affect weapon control.
Skill sets:
1. Tourniquet application - consider PACE methodology (Primary, Alternative,
Contingency, Emergency)
a. Commercially available tourniquets
b. Secondary commercial available tourniquet
c. Hemostatic agent/trauma dressing, or direct pressure depending on tactical
situation
c. Field expedient (improvised) tourniquets
2. Tactical casualty extraction
3. Rapid placement in recovery position
INDIRECT THREAT CARE/TACTICAL FIELD CARE (ITC/TFC)
Goals:
1. Goals 1-4 as with DT/CUF care
2. Stabilize the casualty as required to permit safe extraction to dedicated
treatment sector or medical evacuation assets.
Principles:
1. Maintain tactical supremacy and complete the overall mission.
2. As applicable, ensure safety of both first responders and casualties by rendering
weapons safe and/or rendering any adjunct tactical gear safe for handling (flash
bangs, gas canisters, ECDs etc).
3. Conduct dedicated patient assessment and initiate appropriate life-saving
interventions as outlined in the ITC/TFC guidelines. DO NOT DELAY
casualty extraction/evacuation for non-lifesaving interventions.
4. Consider establishing a casualty collection point(s) if multiple casualties are
encountered.
5. Establish communication with the tactical and/or command element and
request or verify initiation of casualty extraction/evacuation.
6. Prepare casualties for extraction.
Guidelines:
1. Law Enforcement casualties should have weapons made safe once the threat is
neutralized or if their mental status is altered.
2. Bleeding:
a. Assess for unrecognized hemorrhage and control all sources of major
bleeding:
1. If not already done, use a tourniquet or an appropriate pressure
dressing with deep wound packing to control life-threatening
external hemorrhage that is anatomically amenable to such
treatment.
2. Apply the tourniquet over the clothing as proximal— high on
the limb— as possible, or if able to fully expose and evaluate
the wound, apply directly to the skin 2-3 inches above wound.
3. For any traumatic total or partial amputation, a tourniquet should
be applied regardless of bleeding.
b. For compressible hemorrhage not amenable to tourniquet use, or as an
adjunct to tourniquet removal (if evacuation time is anticipated to be
longer than two hours), apply a hemostatic agent in accordance with
the directions for its use and an appropriate pressure bandage.
c. Reassess all tourniquets that were applied during previous phases of
care. If ineffective in controlling hemorrhage or if there is any potential
delay in evacuation to care, expose the wound fully, identify an
appropriate location 2-3 inches above the injury, and apply a new
tourniquet directly to the skin.
d. Expose and clearly mark all tourniquet sites with the time of tourniquet
application.
3. Airway Management:
a. Unconscious casualty without airway obstruction:
i. Chin lift or jaw thrust maneuver
ii. Nasopharyngeal airway
iii. Place casualty in the recovery position
b. Casualty with airway obstruction or impending airway obstruction:
i. Chin lift or jaw thrust maneuver
ii. Nasopharyngeal airway
iii. Allow casualty to assume position that best protects the airwayincluding sitting up
iv. Place unconscious casualty in the recovery position
4. Breathing:
a. All open and/or sucking chest wounds should be treated by immediately
applying an occlusive material to cover the defect when the patient has
exhaled and secure it in place. Monitor the casualty for the potential
development of a subsequent tension pneumothorax.
b. In a casualty with progressive respiratory distress and known or
suspected torso trauma, consider a tension pneumothorax and
decompress the chest on the side of the injury with a 14-gauge, 3.25
inch needle/catheter unit inserted:
i. In the second intercostal space at the midclavicular line. Ensure
that the needle entry into the chest is lateral to the nipple line and
is not directed towards the heart.
ii. If properly trained, consider a lateral decompression, inserting
the needle in the 4th or 5th intercostal space, in the mid- axillary
line on the injured side.
5. Prevention of hypothermia:
a. Minimize casualty’s exposure to the elements. Keep protective gear on
or with the casualty if feasible.
b. Replace wet clothing with dry if possible. Place the casualty onto an
insulated surface as soon as possible.
c. Cover the casualty with commercial warming device, dry blankets,
poncho liners, sleeping bags, or anything that will retain heat and keep
the casualty dry.
6. Penetrating Eye Trauma: If a penetrating eye injury is noted or suspected:
a. Perform a rapid field test of visual acuity (Can they see or not see?).
b. Cover the eye with a rigid eye shield (NOT a pressure patch). If a
commercial eye shield is not available, use casualty’s eye protection
device or anything that will prevent external pressure from being
applied to the injured eye.
7. Reassess casualty:
a. Complete secondary survey checking for additional injuries. Inspect and
dress known wounds that were previously deferred.
b. Consider splinting known/suspected fracture
8. Provide analgesia as necessary.
a. Able to continue mission:
i. Consider oral non-narcotic medications such as acetomenophen
(Tylenol) 1000mg by mouth
9. Burns:
a. Stop the burning process
b. Facial burns, especially those that occur in closed spaces, may be
associated with inhalation injury. Aggressively monitor airway status
and oxygen breathing in such patients and consider early airway
management.
c. Cover the burn area with dry, sterile dressings and initiate measures to
prevent heat loss and hypothermia.
d. All previously described casualty care interventions (ABC’s) can be
performed on or through burned skin in a burn casualty.
e. Analgesia in accordance with TECC guidelines may be administered.
f. Aggressively act to prevent hypothermia for burns greater than 20% of
the body.
10. Prepare casualty for movement: Consider environmental factors for safe and
expeditious evacuation. Secure casualty to a movement assist device when
available. If vertical extraction required, ensure casualty secured within
appropriate harness, equipment assembled, and anchor points identified.
11. Communicate with the casualty if possible. Encourage, reassure and explain
care.
12. Cardiopulmonary resuscitation (CPR) within a tactical environment for
victims of blast or penetrating trauma who have no pulse, no ventilations, and
no other signs of life will not be successful and should not be attempted. In
certain circumstances, such as electrocution, drowning, atraumatic arrest, or
hypothermia, performing CPR may be of benefit and should be considered in
the context of the tactical situation.
Skill set:
1. Hemorrhage control:
a. Direct Pressure
b. Tourniquet
c. Pressure Dressing
d. Wound Packing
e. Hemostatic Agent
2. Airway:
a. Apply Manual Maneuvers (chin lift, jaw thrust, recovery position)
b. Insert Nasal pharyngeal airway
3. Breathing:
a. Application of effective temporary occlusive chest seal (gloved hand)
b. Apply commercially available occlusive dressing
c. Consider alternate occlusive material if no commercial seal is available
c. Perform needle chest decompression
4. Circulation:
a. Recheck interventions
5. Wound management:
a. Apply eye shield
b. Apply dressing for evisceration
c. Apply extremity splint
d. Initiate basic burn treatment
6. Prepare casualty for Evacuation:
a. Consider spinal immobilization
b. Move casualty (drags, carries, lifts)
c. Secure casualty to litter
d. Initiate hypothermia prevention
7. Other skills:
a. Perform hasty decontamination
b. Casualty monitoring
c. Establish casualty collection point(s)
d. Perform triage (SALT method)
i. Immediate (red) – unstable and requires immediate attention
ii. Urgent (yellow) – currently stable but requires urgent attention
iii. Delayed (green) – stable and care may be delayed (walking wounded)
iv. Dead/Expectant (black) – expected to die or dead
XXX.30 EVACUATION/TACTICAL EVACUATION CARE AND
TRANSPORTATION OF INJURED
Goals:
1. Maintain any life saving interventions conducted during DTC/CUF and
ITC/TFC phases
2. Provide rapid and secure extraction to a appropriate level of care
3. Avoid additional preventable causes of death
Principles:
1. Reassess the casualty or casualties
2. Utilize additional resources to maximize advanced care
3. Avoid hypothermia
4. Communication is critical, especially between tactical and non tactical EMS
teams.
Guidelines:
1. Reassess all interventions applied in previous phases of care. If multiple
wounded, perform primary triage.
2. Airway Management:
a. The principles of airway management in Evacuation Care are the same
as in
ITC/TFC
b. reassess for respiratory decline in patients with potential
pneumothoraces.
c. Consider the mechanism of injury and the need for spinal
immobilization. Spinal immobilization is not necessary for casualties
with penetrating trauma if the patient is neurologically intact. Maintain
high clinical suspicion for casualties over age of 65 y/o with blunt
mechanism. Additionally, patients may be clinically cleared from spinal
immobilization under a locally approved protocol if they have none of
the following:
- Neurologic impairment
- Altered mental status
- Distracting injury
- Intoxication
- Midline c-spine tenderness
- Pain free range of motion of head and neck
3. Breathing:
a. All open and/or sucking chest wounds should be treated by immediately
applying an occlusive material to cover the defect and securing it in
place. Monitor the casualty for the potential development of a
subsequent tension pneumothorax. Tension pneumothoraces should be
treated as described in ITC/TFC.
b. Reassess casualties who have had chest seals applied or had needle
decompression. If there are signs of continued or progressive respiratory
distress:
i. Consider repeating the needle decompression. If this results in
improved clinical status, the decompression can be repeated
multiple times.
4. Bleeding:
a. Fully expose wounds to reassess for unrecognized hemorrhage and
control all sources of major bleeding.
b. If not already done, use a tourniquet or an appropriate pressure\dressing
with deep wound packing to control life-threatening external
hemorrhage that is anatomically amenable to such treatment.
i. Apply the tourniquet directly to the skin 2-3 inches above
wound.
ii. For any traumatic total or partial amputation, a tourniquet
should be applied regardless of bleeding.
c. Reassess all tourniquets that were applied during previous phases of
care.
i. Tourniquets applied in prior phases that are determined to be
both necessary and effective in controlling hemorrhage should
remain in place if the casualty can be rapidly evacuated to
definitive medical care.
ii. If ineffective in controlling hemorrhage or if there is any
potential delay in evacuation to care, identify an appropriate
location 2-3 inches above the injury, and apply a new tourniquet
directly to the skin.
d. Expose and clearly mark all tourniquet sites with the time of tourniquet
application. Use an indelible marker.
5. Suspected or known Traumatic Brain Injury (TBI).
a. If suspected TBI and casualty not in shock, raise the casualty’s head to
30 degrees.
6. Prevention of hypothermia:
a. Minimize casualty’s exposure to the elements. Move into a medic unit,
vehicle, or warmed structure if possible. Keep protective gear on or
with the casualty if feasible.
b. Replace wet clothing with dry if possible. Place the casualty onto an
insulated surface as soon as possible.
c. Cover the casualty with commercial warming device, dry blankets,
poncho liners, sleeping bags, or anything that will retain heat and keep
the casualty dry.
7. Reassess casualty:
a. Complete secondary survey checking for additional injuries. Inspect and
dress known wounds that were previously deferred.
b. Splint known/suspected fractures.
8. Provide analgesia as necessary
a. Acetaminophen (Tylenol) 1000mg by mouth
9. Burns:
a. Burn care is consistent with the principles described in ITC/TFC.
b. Be cautious of off-gassing from patient in the evacuation vehicle if
there is suspected chemical exposure (e.g. cyanide) from the fire.
c. Consider early airway management if there is a prolonged evacuation
period and the patient has signs of significant airway thermal injury
(e.g. singed facial hair, oral edema, carbonaceous material in the
posterior pharynx and respiratory difficulty.)
10. Prepare casualty for movement: Consider environmental factors for safe and
expeditious evacuation. Secure casualty to a movement assist device when
available. If vertical extraction required, ensure casualty secured within
appropriate harness, equipment assembled, and anchor points identified.
11. Determine mode and destination for evacuation to definitive care.
a. If EMS response time for a transporting unit is significantly greater than
transport time to a trauma center due to availability of EMS resources
(i.e. MCI), weather, or time/distance, consider emergency transportation
by police vehicle, or EMS intercept.
b. Secure landing zone as soon as practical if utilizing aeromedical
transport service.
12. Communicate with the casualty if possible and with the accepting facility.
a. Encourage, reassure and explain care
b. If casualty is transported by police squad, attempt to notify receiving
hospital of pending arrival as soon as possible while enroute.
13. Cardiopulmonary resuscitation (CPR) may have a larger role during the
evacuation phase especially for patients with electrocution, hypothermia, non
traumatic arrest or near drowning.
XXX.35 DOCUMENTATION OF CARE
Documentation of Care: Initiate documentation of clinical assessments, treatments
rendered, and changes in the casualty’s status on the casualty care card. Forward this
information with the casualty to the next level of care.
File a sick and injured report in the YOUR MUNICIPALITY records system, outlining
assessment, treatment and patient outcome information.
XXX.40 REPLACEMENT OF MEDICAL SUPPLIES
Option 1:The department will replace any tactical medical equipment used through the
quartermaster or at the work location.
Option 2: The member will document TECC equipment used on the casualty care card,
and obtain a replacement kit through YOUR MUNICIPALITY Fire or EMS Department
when they respond to the scene to transport. YOUR MUNICIPALITY Fire/EMS will
then bill the patient or insurance carrier using their billing system already in place at a
premium rate to fund the logistics of the replacement program.