The Marriage of Civilian & Military Medicine
The video clip of the bomb going off at the finish line of the Boston Marathon graphically served to illustrate what occurs when a normal life event is transformed into cultural chaos.
It was a blink-of-the-eye moment caught by the camera and memorialized forever, with one of the most powerful learning moments being the grim reality that it is impossible to make “everyday life” safe.
Given the reality that 100% prevention is unobtainable, our focus must shift to improving our management strategies.
Logistically, what happened at the Boston Marathon was a small, contained event that could be easily handled by local EMS resources. Is this as bad as it is going to get out there in EMS land? Not even close.
I serve on a civilian/military committee that received a briefing from a high-level military logistician who projected our travel environment will be at the current orange level of security for the next 40 years. We are a nation of 300 million people and protecting cabs, trains and buses represents mathematical impossibilities. The challenge of protecting air travelers offers nothing close to a 100% guarantee of safe travel. The secondary message that briefing delivered was crystal clear—the asymmetrical platform of terrorism offers no quick or easy military solution.
Assuming the logistician was spot on, the challenge ahead is no small one. In the world of EMS, we are charged with the care of both our citizens and visitors to our country in the prehospital setting. At some point, we will take a much larger hit than local EMS resources will be able to manage and military assets will need to be deployed to co-manage the event.
To better prepare for what I and many others believe to be an inevitable terrorist event, we need to do everything possible to integrate the military model of trauma care into civilian medicine as part of our preparations.
Our colleagues in the military are experts when it comes to the management of trauma. Some of the really impressive work is being done by the Special Operations warriors, with excellent research on topic areas such as the field use of tourniquets, clotting compounds, resuscitation fluids and resuscitation strategy, and managing the triad of death—hypothermia, acidosis and coagulopathies.
The lessons learned in the battlefield need to be integrated into the civilian learning curve so that our interventions improve.
I had an opportunity to hear a conference presentation from an Israeli paramedic who shared that the most important lifesaving event the Israelis discovered was welding the bus windows open a couple of inches. With the windows closed, an IED can kill everyone on the bus. With the windows open, the pressure wave vents and fatalities may be limited to just four or five instead of 30 or 40.
Another outstanding continuing education opportunity is the Tactical Combat Casualty Care course (TC3 course). This course is the military model of Prehospital Trauma Life Support (PHTLS) and offers an excellent opportunity for civilian medics to be exposed to the principles and practices of tactical medicine, covering topics like how to provide care under fire and field evacuation strategies.
One of the downstream benefits of giving civilian medics exposure to military medicine is the investment in our collective futures. If a large-scale terrorist event occurs, and military assets are brought in to support the civilian response, how can we expect to perform up to the standard of care that our patients deserve and expect if we have never actually trained with our military counterparts or worked any type of field exercises? If civilian EMS providers don’t have a rudimentary understanding of what a military support response would look like and, specifically, how command/communications would function in this setting, the chances of a cohesive, organized, effective response are unlikely.
I think making TC3 a required element of every paramedic program is an excellent investment in the future of EMS. In addition, pursuing increased opportunities for joint military/civilian exercises will take your performance to the next level.
Sadly, the 9/11 terrorist attack changed our lives and our world forever, but we need to remain focused on our mission, which has not changed—the care and well being of our citizens and visitors to our country.
Until next month…
Mike Smith, BS, MICP, is director of clinical education and lead instructor for the EMS program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.
