Continuum of Care Save Data, 2014 TEMS Summit PowerPoint

Report
Wisconsin Tactical Medicine
Continuum of Care
“Save” data
Wisconsin TEMS Initiative
March 2014
Complied by:
Officer Chad Stiles, RN/Paramedic
Dedication
Wisconsin Department of Justice (DCI) Special Agent John “Jay” Balchunas, who was a
former Milwaukee Police Officer and New Berlin Fire Department EMT/Fire Lieutenant
and
Deputy Jamison Kampmeyer of the Marathon County Sheriff’s Office, Tactical Medic for
the Marathon County SWAT Team, and firefighter/EMT with Colby Fire/EMS.
Both of these men were dedicated public servants in law enforcement, firefighting and
EMS.
Milwaukee, WI. June 9th, 2009
2 officers shot
•Officer Norberg: 1ST
shot right shoulder,
2nd shot left jaw with
exit right jaw area
•Officer Kunisch: 1st
shot left hand 2nd shot
left shoulder 3rd shot
into neck which
extended into jaw thru
left eye with exit near
top of head with brain
matter exposed.
Tactical Medicine Continuum of Care
Bystander care (i.e. school teacher, security, church usher)
Police Officer/SWAT Operator Self-aid and Buddy aid
ALS/BLS Tactical Medic
and/or “warm zone” Rescue Task Force medic
Transport Agency (Police Vehicle, ALS/BLS EMS, or
Aeromedical Service)
Trauma Center/Hospital
Wisconsin Training Initiative:
>400 TEMS Trained Fire/EMS/LE Personnel (40hour)
>1500 Awareness level trained officers (4hour)
>250 Milwaukee PD police recruits TECC/TCCC trained (4-12hour)
>375 TECC trained Officers/SWAT Operators (8hour)
>300 TEMS Awareness Fire/EMS (WEMSA Conference)
>500 Awareness level at other Conferences/Summits or trainings
(1-8 hour)
Total >3325 by end of 2013
Inclusion Criteria
“Save” in the context for the inclusion of this
data collection means:
– the police officer or tactical medic’s actions were
according to TECC guidelines
– was essential to providing an improved patient
outcome by: maintaining an airway, stabilizing
breathing, and/or controlling bleeding
– may have contributed to sustaining the life of a
human being or improving patient outcome
Lieutenant Patrick R. Esser
Waukesha County Sheriff’s
Dept.
Background
 Attended FTO Conference in Fall of 2011
 Presentation was given by Chris Cook on Combat
Casualty Care
 Researched various products and purchased
HemCon’s ChitoGauze
Motor Vehicle Crash
 Call for MV accident came in at 0542 on 12/12/2011
 First squad and myself on scene at 0549
 Road conditions were extremely icy
 First day back to patrol after 4 weeks of light duty
Motor Vehicle Crash
DRIVER:
35-year-old female
Disoriented
Sitting in caller’s vehicle upon squads arrival
Motor Vehicle Crash
PASSENGER:
38-year-old male, William Bodus
Was heard moaning in wooded area
Located approx. 15’ from vehicle
Response
 First arriving deputy located Bodus and advised of
severe neck laceration
 Flight for Life put on standby
 Laceration observed from trachea to back of neck, on
right side
Use of ChitoGauze
 Training consisted of watching video demo of
Quikclot and reviewing directions for ChitoGauze
 Applied gauze as directed
 Turned over gauze wrapper to EMS
Use of ChitoGauze
EMS
 EMS requested that the gauze be removed
 Care for the wound was turned over to one specific
person
 Bodus was transported by ambulance to Froedtert
Follow-up
 Phone call from Froedtert; first responder use was
surprising
 Severed carotid artery
 Department purchased 50 go bags for patrol cars
through asset forfeiture
Go-Bags
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


Tournequet
Occlusive dressing
Quik Clot Gauze
Trauma Sheers
Bandage
Gloves
Tape
Non-adherent dressing
Waukesha County Sheriff
November 2013 - Deputy Brian Skaar – Put
out fire with small fire extinguisher, called
Flight for Life - provided CAT tourniquet to
EMS that he purchased for his tactical medical
kit on car vs semi accident likely saving the
victim who had a partially amputated leg.
(4 hour awareness training WCTC Inservice)
Contact Information:
Lt. Patrick Esser
Waukesha County Sheriff’s Dept.
(w)262-896-8154
(c)262-424-9116
[email protected]
Tactical EMS in a Non Tactical
Environment
• Josh Finke-EMS Division Chief
• Wausau Fire Department
Response
• An ambulance was requested to respond to
a call at 0324hrs
• Rural area just northeast of the city
• Report of a male party that had been
stabbed
• Advised to stage until LE is able to secure the
scene
Staging
• Ambulance staged approx 1/2 mile from the
scene
• Met by a large group of people walking
down the road
• Staged for a very short period of time
Scene
• Upon arrival to scene paramedics were
summoned by a LE officer to the patients
side
• Total response time of 11 minutes
• Paramedics noted a large amount of blood in
the snow outside of the house
Patient Info
• Patient is a 21 year old male
• Found inside the house supine in the kitchen
with a friend at his side
• Patient was laying in large pool of blood and
had blood soaked clothing
Assessment
• Patient was alert and oriented
• A large stab/laceration was noted to the
inferior portion of the left upper arm
• Prior to arrival a tourniquet was applied
using a belt, bleeding was slowed however,
significant hemorrhage was still present
Treatment
• A SOF-T Tourniquet was applied rapidly by a
TEMS trained paramedic
• Bleeding was well controlled within a matter
of seconds
• Initial vitals are stable BP-124/87 HR-100 RR20
• Large bore IV with warmed NS bolus
Hospital Course
• Patient was transported to Aspirus Hospital
• Met by the trauma team
• Tourniquet was briefly loosened by surgeon
heavy arterial bleeding was encountered,
the patient did develop hemorrhagic shock
• The patient was then moved to a surgical
suite
Treatment
• Upon arrival to the surgical suite the patient
underwent a procedure for a bypass of his
brachial artery
• The tourniquet was in place for
approximately 95 minutes
• The patient did also suffer an injury to his
brachial plexus nerve
Recovery
• In the first day post surgery the patient did
experience a significant amount of weakness
in his hand
• This did continue to improve in the days post
injury
• This was mostly due to the injury to the
brachial plexus nerve
Recovery
• Several weeks post surgery in a follow up
with his regular physician the patient was
noted to have some residual numbness in
his 5th digit
• His strength was much improved
• Expected to make a complete recovery
Elm Grove
Elm Grove PD fully implemented TECC with a
department wide training block and kits to
every officer.
Their officers are all EMT’s and paramedics, but
they received the extra training to provide
care TECC care as well.
Elm Grove Police
Chief Jim Gage applied a tourniquet to a significant
hand laceration, partial severed thumb caused by
a rotary saw. Homeowner tried to assist the
construction worker victim by using a towel for a
bandage and direct pressure and had tied a
second towel around his forearm as a make-shift
tourniquet.
Bleeding was still excessive upon officer arrival with
these measures in place. Officers decided to
deploy the tourniquet which successfully
suspended the bleeding.
(WCTC 40 hour TEMS and department 4 hour TECC in-service)
Elm Grove Police
Chief Jim Gage and Patrol officer Phil Doney used Quik
Clot for an uncontrolled femoral bleed (surgical plug
released). Bleeding was slowed significantly and
patient was emergently transported to trauma
center. Surgeon stated that patient would have
exsanguinated if aggressive bleeding control would not
have been applied in the field.
(WCTC TEMS class and department 4 hour TECC in-service)
Elm Grove Police
A tourniquet was applied when a DPW worker
suffered a severe leg laceration from a chain
saw accident. Bleeding was moderate but
uncontrolled prior to the application of the
tourniquet.
(WCTC 40 hour TEMS and entire department 4 hour TECC in-service)
Elm Grove Police
Officers Phil Doney and Sandy Brown were
some of the first officers on scene at Azana
Spa shooting and help provide patient care
prior to FD by moving victims off the “X” and
begin treatment.
GSW – Through the leg – Femur Fx
GSW - Neck – bleeding controlled with towel
(40 hour TEMS and entire department 4 hour TECC in-service)
Green Bay Police Department
GBPD fully implemented TECC in summer 2013
for all patrol and SWAT officers, in cooperation
with Prevea clinic who funded kits for every
officer:
Results:
Four cases of cutting/stabbing victims September
to November 2013 where police made life saving
actions using hemostatic agent.
(4 hour awareness level department in-service, 40 hour WCTC TEMS and two 8
hour WCTC courses)
Green Bay PD - Sept 2013
Severe neck laceration with uncontrolled bleeding in field
Green Bay PD Oct 2013
Severed jugular vein in neck
treatment provided by officer in high threat
environment under long gun cover by another officer
Green Bay PD Oct 2013
post surgical close-up
Green Bay PD Oct 2013
struck artery in heart – per MD, patient would have died without
actions by officer
Green Bay PD November 2013
Uncontrolled bleeding from neck in field
Milwaukee PD
Officer Daniel Pierce - Milwaukee Police
Department - Fall 2010 - Used Quik Clot
Combat gauze on a severe occipital head
bleed on a patient cut with a knife during an
aggravated battery. The bleeding was so
severe it was unable to be controlled by direct
pressure, and patient had altered mental
status.
(awareness level training at recruit level and 8 hour course at Medicor/Milw
PD )
Milwaukee PD
Officer Keller - Milwaukee Police Department Oct 2011 - Formed a chest seal out of a tissue
purse pack wrapper to form an emergent
chest seal on a stabbing victim involved in a
DV with a sucking chest wound.
(8 hour training at recruit level at Milw PD)
Milwaukee PD
Officer Brock Cameron - Milwaukee Police
Department - 2011 - Used a tourniquet to
control bleeding on a lower extremity bleed of
Officer Stachowiak who was shot in the leg.
(8 hour officer training at Medicor/Milw PD)
US Marshals/Milwaukee PD
A tourniquet was used by the US Marshals
shooting in May 2012 on the south side of
Milwaukee to control a severe lower extremity
bleed on the suspect. MPD Officer Mike
Kykendall said when they removed the
tourniquet in the trauma room blood “hit the
ceiling” and the tourniquet had to be reapplied until surgery.
(training unknown)
Milwaukee PD
Officer Dan Pierce of Milwaukee Police
Department District 7, Responded to for a double
shooting in the fall of 2012. One victim was PNB
and the other had multiple GSW wounds
including the upper right arm and a leg. Both
wounds were severely bleeding. Officer Pierce
packed the wounds with Quik Clot Combat Gauze
to control bleeding prior to the fire department
arrival.
(awareness level training at recruit level and 8 hour course at
Medicor/Milw PD)
Milwaukee PD
Jan 2013 – MPD District 5 recruit Kurt Drestke
applies a tourniquet to a subject’s arm after
he was shot. Blood was pouring out of wound
“like a faucet” according to Sgt. Greg Durran,
who was attempting to hold direct pressure
with two hands until bleeding was controlled
by the recruit's personal tourniquet.
(8 hour recruit level TECC training at Milwaukee PD)
Milwaukee PD
2013 – Officer Miles Kowalik – District 3 applies tourniquet to GSW victim’s leg to stop
spurting bleed from a severed femoral artery.
(40 hour WCTC TEMS class)
Milwaukee PD
2013 – Officer Miles Kowalik – District 3 applies tourniquet to victim’s severely
bleeding partially amputated leg from a MVA
(40 hour WCTC TEMS class)
Milwaukee PD
January 2014 - Armed Robbery/Shooting Suspect had victim at gunpoint to his head,
when the victim attempted to push the
suspect away, the suspect shot the victim in
the left leg, striking the femoral artery.
Suspects fled the scene and their location was
unknown. Sgt. Rena Rokus arrived and applied
a tourniquet, which Milwaukee FD stated was
lifesaving.
(40 hour WCTC TEMS class)
Milwaukee PD
January 2014 - Armed Robbery/Shooting Suspect had victim at gunpoint to his head,
when the victim attempted to push the
suspect away, the suspect shot the victim in
the left leg, striking the femoral artery.
Suspects fled the scene and their location was
unknown. Sgt. Rena Rokus arrived and applied
a tourniquet, which Milwaukee FD stated was
lifesaving.
(40 hour WCTC TEMS class)
Madison Police Department
June 2014
Madison Police Officer Alexandria Nieves-Reyes applied
CAT tourniquet to 20 y/o male severe laceration of arm after punching restautrant
window
"The first officer on scene was patrolling on foot in the same block," MPD Department
spokesman Joel DeSpain said. "He heard the sound of breaking glass and looked to
see the man's arm inside of the restaurant.“
Per Medics (one with 20 years experience) state that the actions clearly saved the
gentleman's life...he described it as one of the most amazing bleeds he had seen.
The trauma team took extended (several hours) time in the OR trying to stop the
bleed when the tourniquet was removed.
(Training was from Madison PD SWAT Scout Matt Kenney – unknown duration)
Waukesha Memorial Hospital ER
February 2014 – 77 y/o male with a ruptured
fistula – severely hypotensive after normal
hemorrhage control management failed to
control the bleed.
SOFTT-W tourniquet applied and immediately
controlled bleeding.
Tactical Emergency Casualty Care
http://c-tecc.org/
Wisconsin TEMS Yahoo
Group
http://groups.yahoo.com/groups/WI_TEMS

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