The First Responders of the Millennial Generation......Are they prepared?

In recent years, terrorist type acts seem to be at a new high. Attacks are more violent and frequently supported by access to global technology and advanced weaponry. We want to discuss why millennial first responders should have outcome-based training to effectively make important decisions in evaluating hazards and risks in today’s terroristic environment. It reasons how the military have statistically proven that training geared towards the millennial can minimize battle field deaths through customized medical training using informatics technology.  A systematic approach to modernized learning of appropriate tactical medical techniques, coordinated planning, and readily available up-to-date informatics technology will prepare first responders for today’s globally driven violent environment. 

Though widely appreciated within the military organizations of our allies and partners in the war on global terror, civilian EMS had been slow to embrace the military standards and changes to training methodology and the cost-benefit of incorporating them into civilian pre hospital care within the continental United States until recently. Our current EMS programs are lagging behind the criminal elements that are more technologically advanced. Of those EMS systems surveyed, the majority said their respective organizations had not made specific plans to accommodate the learning differences of the millennial team members, nor has the tactical medical training been updated to include advanced digital technology.

With availability of persuasive social networks coupled with the rapid advancement of mass communication, the risks and responsibility of EMS and other first responders will continue to grow exponentially here in the continental United States. Though widely appreciated within the military organizations of our allies and partners in the war on global terror, civilian EMS has not been advancing with technology and developing trends globally. The old philosophy of no-change-needed, compounded by the current significant budgetary constraints, has kept our antiquated emergency response system slow to react to modern times.  

As difficult as it was for the military to collect casualty data despite uniform standard operating procedures and relatively low casualty numbers in comparison to the civilian environment, its success far out reaches that of the civilian world in providing data analysis. Such information ultimately drives evidence based decision making and best practice development. Additionally, the Army has seen a cost savings through use of smart phones, tablets and applications to make information field available.

Is it time to make a change in our civilian system to offer these young first responders the best chance to save others and save themselves?

----Dr. Mark Cannon, Dr. Donna Wanser-----

Law Enforcement Lives Matter.

The year 2014 has come to a close with one hundred and eighteen United States law enforcement officers losing their lives while on duty.  Fifty-seven officers were murdered with forty-seven being shot and killed.  While it was not the deadliest year for law enforcement in the last decade, death by gunfire rose over fifty percent compared to 2013.  

Recent tragic events involving U.S. law enforcement has led to unparalleled community protests and anti police demonstrations which on several occasions have led to further violence against law enforcement officers. The recent murders of New York police officers has invoked its own social movement that proclaims law enforcement lives matter too. The men and women who protect and serve us are husbands, wives, parents, children, brothers and sisters like every other family in our society. They have taken on a very difficult career which requires split second decision making that can lead to life changing results. In 2013, 49,851 law enforcement officers were assaulted on duty. If our civilized society is to continue it must fully embrace that law enforcement lives matter.

Notably, the government is now proclaiming that the terrorist cells are moving forward with soft terrorist attacks worldwide, including the United States.  This further increases the risks of our U.S. law enforcement. The recent execution style murder of two police officers in Paris, France is just another example of how influential these terrorist are becoming. Our law enforcement teams are now faced with soft terrorist attacks and deadly domestic attacks.  How do we best prepare our local law enforcement teams for today’s environment?

Being shot and killed remains the number one cause of death for law enforcement officers and the numbers are growing. It is almost double that of car accidents. In addition to human deaths, seven law enforcement service dogs have been killed in 2014. Five being shot to death and two stabbed. Despite what appears to be a growing public perception that law enforcement officers can make "superman" like decisions in split seconds, and have adequate training to prepare them for all types of situations, the numbers are asserting otherwise. There is no acceptable rate of injury or death for those who protect and serve us making continuous learning necessary to keep up with today’s violence.

An important part of officer safety is training both the law enforcement officer and the first responders in civilian tactical medicine. The medical community is actively working on evidenced based pre hospital care that is designed and proven to be effective for civilian first responders. Currently, the military's Tactical Combat Casualty Care doctrine (“TCCC”) is the only proven type of training that has been shown with great success to be effective on the battlefield. Unfortunately, the mechanism of battlefield injury does not parallel the injuries seen predominately in civilian life. The tactical situations of the battlefield, though occasionally compared, have few similarities with majority of the situations encountered by law enforcement. Evacuation and transportation to tertiary care centers is typically fairly constant throughout the metropolitan areas of the United States, thus unlike the military, does not play a significant role in injury survival.

Catastrophic bleeding, similar to military findings, is the number one cause of civilian trauma death with survivable injuries. It is recognized that an arterial injury can lead to death in as little as three minutes with loss of consciousness occurring as fast as 90 seconds. The importance of bleeding control has made a significant push into first responder training in various regions of the country. There are, now, numerous case reports in the civilian literature regarding immediate blood loss control by first responders, including law enforcement officers, where the victim survived due to the care they received at the site of injury.

The introduction of the modern battle tourniquet has been the most significant contributor to civilian tactical medicine training and pre hospital bleeding control since the US Civil War. In 2006 after uniform distribution of tourniquets to all US combat forces, the US Army Institute of Research reported an 85% reduction in extremity bleeding deaths in Afghanistan and Iraq. On the civilian side, the aftermath of the Boston Marathon Bombing saw the largest use of tourniquets for bleeding control than in any other previous critical incident in the United States.

As specifics of civilian trauma death are further defined, more research is being performed to develop a TCCC like tactical medicine doctrine for civilian first responders. Definitions regarding the immediate tactical situation are being adapted from TCCC to give first responders guidelines on when medical care is appropriate and expected versus making the tactical circumstances the top priority.

 The creation of tactical zone language has helped define the priorities in high risk critical incidents where tactics and injury management are combined. The high risk zone or "Hot Zone” is defined as an area where an immediate threat is imminent and the top priority is threat management. Active shooters, structurally unstable buildings, bombings and natural disasters may all be considered hot zone situations where medical aid stands behind tactical considerations in regards to priority decisions. The "Warm Zone" is defined as the area close to an imminent threat that has some form of security and protection. In this location, tactical considerations remain top priority, but with adequate security, medical aid can be initiated following the medical BABC's (Bleeding, Airway, Breathing and Circulation). The warm zone may at any time convert back to a hot zone where the top priority converts back to threat management with the emphasis on tactics. The warm zone is mostly where the services of law enforcement, Fire and EMS will merge and work in union, each bringing their unique expertise. The "Cold Zone" is defined as where advanced medical aid is performed and transportation and evacuation are planned and executed.

The usage of the tactical zones is an example of how civilian tactical medical response can be performed in an effective and safe tactically forward manner. Additionally, continued civilian based research driving improvement to pre hospital care training, will provide first responders the knowledge, mindset and skill set to operate and survive in the increasingly violent environment that today’s millennial society is becoming. The one hundred eighteen US law enforcement officers who have died while on duty in 2014 are only a fraction of the first responders on duty deaths this year worldwide.