walking wounded and who is a bystander. A simple command of “All involved in the accident that can walk to me, do so now”. Have them walk to a safe location to be further evaluated by incoming resources. This act will unclutter your scene and allow for a rapid triage of patients that are in need of life saving interventions. Triage should be a continuous process as patients can deteriorate after the initial assessment due to compensated shock or other unforeseen injuries (Kastros, 2014). Even though more studies are needed to prove the efficacy of S.T.A.R.T in the
PERSPECTIVES OF MASS CASUALTY INCIDENTS 5 trauma department (Gebbart, Pence 2007), it has proven itself on the emergency ground to assist in organizing chaos. EMS has implemented training and techniques from the military due to the increased hostile events across the U.S. We are now seeing battleground wounds in our streets from bombings, gunshot wounds, and blunt force trauma. Tactical Combat Casualty Care (TCCC) is being taught to first responders to apply basic life saving techniques in bleeding control, sucking chest wounds and rapid evacuation in hostile events. Application of tourniquets has fallen back into favor and has been proven to be beneficial in bleeding control with minimal complications from use. A recent study of prehospital reports from 2005 to 2012 found ninety-eight instances in which tourniquets were used successfully. None of the patients died or lost limbs due to tourniquet application and two patients possibly suffered nerve injury and vascular complication (Temin 2015). Along with tourniquets, hemostatic agents, compression bandages, and gauze is also used to pack wounds and control bleeding. Chest seals are used for penetrating trauma that has created a sucking chest wound. This first aid equipment is carried in smaller, more mobile bags that are equipped with the essentials, unlike the first out bags that would be used on routine medical calls. Along with the first aid gear being modified, so is the personal protective equipment (PPE) that is donned when entering a hostile event environment. The use of ballistic PPE is routinely being issued to EMS personnel to provide another layer of safety. Ballistic PPE consists of a Kevlar flak jacket with rifle plates inserted in the front and back. A helmet and protective eye wear is also included. This added PPE is out of the norm for EMS and Firefighter to work in and creates a new element in providing patient care. Scenario based training is a must to understand the limitations generated through the bulky and added weight of the PPE.
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