The Board of Directors would like to thank you all for a very successful 2014 as well as an incredibly productive winter 2014 full committee meeting!
To recap for those of you who could not attend, the meeting at SOMA this year was extremely well attended, both by our members as well as many conference attendees. The support from SOMA this year was fantastic as always, as demonstrated by how easy it was to expand our room for 325 seats to 150 seats. Thank you again to the administration and directors for the SOMA scientific assembly.
Our day started as always with the Pledge of Allegiance and welcome to all in attendance and on-line. The Board of Directors presented a brief update regarding the finances of the committee as well as a thank you to Brent Bronson and North American Rescue Products for their continued support of the committee. The next BOD will be in January and will discuss the addition of at least one new member to the Guidelines Committee.
Guideline Committee members Dr. David Tan and Robert Wylie gave us a fantastic impromptu debrief on the tactical response to the Ferguson, MO riots over the past few months - several learning points were passed:
- The need to prepare for extended mobile operations -- most TAC operations are static on location in one place. In Ferguson, they moved constantly for over 10 hours based on crowd movements. With the significant heat and humidity at the time, members of their team suffered from dermatitis and heat rashes, especially in the groin. As a stop-gap, they used wet wipes to provide hygiene and drying in the areas affected.
- Resupply issues and basic logistics during large-scale crowd movement. Their designated cold zones often became compromised or isolated based on the dynamic crowd movements, making supply of food and water for operational teams difficult. Planning should be done to allow for individual Go Bags to limit the need for intact supply lines during mobile operations.
- Counter-insurgency operations and effective use of social media was used by the crowds. It is well worth the time to become more familiar with these tactics as well as develop social media monitoring programs for your agency.
Guidelines Committee member Dr. Joshua Bobko presented on the First Care Provider initiative. The term First Care Provider, coined by Dr. Bobko and BOA member Todd Baldridge, is meant to denote those people who are involved in a high threat disaster or mass casualty scenario by proximity but are uninjured. Formerly referred to as 'bystanders,' these people represent medical force multipliers for traditional first responders and should be leveraged to initiate needed medical care to the wounded. Dr. Bobko spoke on the program he has developed in the Los Angeles region as well as the work of the Committee in this area. First Care providers are the first link in the TECC chain of survival and will be a focus for the Committee in 2015.
We then heard about the TECC roll out in the United Kingdom and Europe by Stewart Thomas, the proprietor of Line 9 Medic. Stewart has developed TECC training programs for British first responders. Call Hostile Environmental Medical Skills And Tactics (HEMSAT), the course is based on the tenets of TECC and has been taught to a variety of emergency response personnel over the past several years. We are happy to bring Stewart onto the Committee on the Board of Advisors as an international asset to provide guidance to the Committee on how to increase the spread of TECC outside of the United States.
Guidelines Committee member John Delaney briefed the Committee on the activities of the InterAgency Board (www.iab.gov) and the TECC work that is being done within the IAB. The InterAgency Board is a voluntary collaborative panel of emergency preparedness and response practitioners from a wide array of professional disciplines that represent all levels of government and the voluntary sector. The IAB provides a structured forum for the exchange of ideas among operational, technical, and support organizations to improve national preparedness and promote interoperability and compatibility among local, state, and federal response communities. Based on direct field experience, IAB members advocate for and assist the development and implementation of performance criteria, standards, test protocols, and technical, operating, and training requirements for all-hazards incident response equipment with a special emphasis on Chemical, Biological, Radiological, Nuclear, and Explosive issues. The IAB also informs broader emergency preparedness and response policy, doctrine, and practice. Several members of C-TECC currently serve on the IAB as well. Over the past three years, the Health and Medical Responder safety subgroup has been discussing and developing recommendations to the first responder community for the incorporation of TECC into high risk operations. Most notably, all TECC equipment (e.g. tourniquets, pressure bandages, hemostatic agents) has been incorporated into the federal standardized equipment list, TECC has been added as a project item to the HMRS working list, and a white paper on the need for TECC training for Law Enforcement officers is in final review.
As part of the on-going mission to keep all C-TECC members up to date on the most current equipment and supplies for high threat response, John Steinbaugh presented on the new hemostatic X-Stat that is now being fielded. As with all vendor presentations to the Committee, the inclusion of X-Stat on the agenda does not imply endorsement by the Committee, but is for information sharing only.
The final presentation of the day was an interesting discussion led by Dr. Mel Harris on evidence regarding intra-osseous infusion and the possible limitations of its use. Presenting data to show that the true functionality of IO infusion is limited, Dr. Harris sparked debate among the members. This topic will be discussed again in the future as members of the Committee now will begin the evidentiary review that could potentially lead to guidelines changes.
After allowing for public comment that yielded good input on the need for increased use of social media by the Committee, we moved into Committee business. Dr. Rich Kamin, Psych mitigation working group leader, and Board of Advisors member Dr. Matt Wentzel spoke on the progress of the working group that included distribution of the IAB white paper on psychological mitigation for first responders. We expect incorporation of new language on psychological mitigation into the guidelines at the Spring 2015 meeting.
Co-Chairman Dr. Smith then re-introduced the issue of inclusion of Hot, Warm, and Cold Zone into the names for the TECC phases of care. This issue had been brought to the Guidelines Committee on-line after the last meeting, but was tabled by the Executive Committee in order to allow for open discussion in front of the entire Committee. After much discussion among the members and guests, mainly hinging around ensuring all disciplines understood the common meaning of the terms, the Guidelines Committee voted to include the terms. A second motion and vote was also carried to include language in the guidelines to clearly explain the meaning of each phase of care. The TECC phases will now be referred to as Direct Threat/Hot Zone, Indirect Threat/Warm Zone, and Evacuation Care/Cold Zone.
Two other important projects came out of the meeting. First, Committee guest Dr. Lee Palmer, DVM volunteered to help the Committee create a TECC for working canines. Unanimously approved by the Committee, the working group will be lead by Board of Advisor’s member Dr. Allen Yee along with Dr. Palmer. This is a fantastic extension of TECC and is much needed for our working canine partners in all areas of first response, not only law enforcement. The other project was the formation of a working group to examine the need for additions to the Evacuation Care/Cold Zone guidelines for extended care operations, such as post-Katrina or post-earthquake missions.
Finally, the Committee approved the development a standard slide deck to teach TECC for first responders. This is not meant to be the only method for teaching TECC but is to be a resource for agencies and personnel who have not been able to develop their own training. It is still, and will remain, the position of the Committee that incorporation and training of TECC should be developed in-house in an agency-specific manner as opposed to rigid cookie-cutter methods. TECC is intended to be adaptable to each agency’s culture, scope of practice, providers, risk appetite, etc and ideally would be operationalized in a manner that is unique to each agency. However, the Committee feels that full development of training may be beyond the capability of resource-limited agencies and thus the standard generic TECC training slide deck will serve as a much-needed resource. These slides should be developed and approved by the Spring 2015 meeting and will be provided to the public at no cost.
The Chairmen and Board of Directors of the Committee for Tactical Emergency Casualty Care would like to thank all of its members, as well as the stakeholders in first response who have spent much of time and effort in development of the TECC guidelines. Almost all of this work is unsupported and thus is a true labor of love.
We are saving lives, and are proud to continue in our endeavors into 2015. Have a happy and safe New Year. We will see you in spring of 2015 in Chicago (exact dates TBA.)