PLANO, Jan. 15, 2019 – QinFlow, the manufacturer of the Warrior, a modular blood and IV fluid warming solution for the entire continuum of emergency care, is proud to announce that its Warrior solution was recently acknowledged for its superior performance in comparison to other battery-powered blood warmers in the Tactical Combat Casualty Care (TCCC) recent update of its Advanced Resuscitative Care (ARC) Guidelines.
Tactical Combat Casualty Care (TCCC) is the standard of care in Prehospital Battlefield Medicine. The TCCC Guidelines are routinely updated and published by the Committee on Tactical Combat Casualty Care, a component of the Joint Trauma System. The TCCC committee recently released Advanced Resuscitative Care Guidelines. Download the full Guidelines here (.pdf).
TCCC suggests that whole blood infusion and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) be used to address Noncompressible torso hemorrhage (NCTH), the last remaining major cause of preventable death on the battlefield, that often causes death within 30 minutes of wounding.
For blood warmers, the study states “whole blood should be warmed during transfusion” and that “a recent review of battery-powered blood warmers found that the Warrior device (QinFlow, Tel-Aviv, Israel) performed better than the Buddy Lite and the Thermal Angel“.
“We are very proud with the TCCC acknowledgment”, said Ariel Katz, CEO QinFlow Inc. “The Warrior’s superior performance is derived from its underlying state-of-the-art, highly efficient and patent protected warming technology, which allows it to safely warm near-freeze fluids and blood products to body temperature extremely fast, even at high flow rates, thus allowing first responders, critical care transport teams, and emergency care professionals within the hospitals to focus on what they do best – saving lives”, he added.
For more information on QinFlow and the Warrior modular system, visit www.QinFlow.com or submit a request for a free trial for your agency by filling out your information here.
About QinFlow Since 2009 QinFlow (short for Quality in Flow) has worked to develop and perfect a proprietary fluid warming technology (patented) that delivers unparalleled levels of warming efficiency. The company’s flagship product – the Warrior – provides front end rescue teams, first response teams, critical care transport teams, and emergency care professionals within various hospital settings with a high performance, reliable, simple to operate, and completely portable blood and IV fluid warming device that operates flawlessly in all environmental conditions in order to fight hypothermia and save lives. QinFlow is headquartered in Rosh Ha’ayin (Israel) and Plano TX (USA). TCCC acknowledgment refers to an independent study performed by Amit Lehavi, MD, et al, that was published by the Emergency Medical Journal (BMJ; Download the full study here). QinFlow is not affiliated with the companies mentioned in the study. For more information on QinFlow and the Warrior modular system, visit www.QinFlow.com or submit a request for a free trial for your agency by filling out your information here.
Lieutenant, crew lead, captain, senior medic – they’re all titles floating around the EMS community – but what do these titles really entail?
For some agencies, they’re exactly that; titles. For others, however, they signify accomplishment, accountability, responsibility and investment within the organization.
Those in the fire service, or military for that matter, are accustomed to rank and structure in their daily work life. One does not simply overstep his or her company officer to go straight to a chief officer unless there’s an emergent issue a superior needs to address. There’s a chain-of-command … a structure … a flow.
Quite honestly, many EMS agencies are lacking this chain of command (and it shows!).
Yes, there’s an EMS director or chief sitting at the top of the food chain in every organization (or at least I hope there is), but considering all of the many facets that compose running an EMS agency, all of these roles can’t simply sit in the hands of one individual. There needs to be delegation.
Organizations like the National EMS Management Association (NEMSMA) have recently introduced credentials that recognize the background and abilities of such supervisory, managing and executive paramedic officers, just like the National Fire Academy and many state fire service entities have done for fire officers. Some private training companies and thought-provokers within our industry have even developed courses and workshops to address this paradigm shift.
Implement EMS training for officers in these skills
Creating a certification or credential is one way to address this need within our industry, and so is building a training program to introduce and implement it as part of your agency’s culture.
Identifying a training need as an EMS company officer can be accomplished in many ways. Programs can reflect existing courses that focus on incident management, incorporate leadership development and can even slide-in some basic-level management curriculum. In order to build this type of program, however, we need to look at the roles of an EMS company officer (which can certainly differ slightly in each organization):
One of the strongest attributes of the fire service, and fire-based EMS for that matter, is their chain-of-command.
Now, having a command presence is by no means synonymous with micromanagement. In any working environment – especially an emergency scene – there needs to be a clear path for:
Overall EMS operations.
This is where the EMS company officer can step in.
EMS company officers don’t necessarily need to be in their own SUV hidden at an intersection down the street. They can be “ordinary” field providers. In any event, someone still needs to be in charge, someone needs to take command and someone still needs to provide daily oversight.
Your director, chief, field training officer, medical director or compliance officer can’t be on-duty or in the field every day, but an EMS company officer can. Acting in an oversight role provides continued direction for the agency when administrative staff can’t be present (or don’t need to be present). Company officers can resolve clinical issues immediately, or document them accordingly and notify the next person in line to handle these events; acting as a resource.
This isn’t to say that only older providers can be company officers, but it does imply that those filling this role should be a wealth of knowledge. Whether it’s knowing the agency’s historical perspective, having greater insight into the system as a whole or simply having more of a clinical background in the agency’s scope of practice, company officers should be seen as a resource – a “go-to person” that can either provide an answer, or knows where to find an answer. They can help to guide you, like a mentor.
Another component to the resource role is the drive to set up others for success. Being a mentor to an individual, a crew or an entire on-duty shift is a powerful responsibility. Having a command presence demands authority; being a mentor earns respect.
For instances where there’s an oversight issue, or a clinical clarification is needed, someone needs to close the communication loop to provide follow up, or advocacy, for the crews as a whole. Company officers need to act as a buffer – a middleman – when it comes to the relationship between line staff and administration. They need to act, at least in theory, like our elected representatives … our advocates.
At the end of the day, a company officer not only needs to be seen as a resource and mentor, but also as an equal; as a partner. They need to be clinically competent, skilled in their trade and cognizant of the agency’s operations. When push comes to shove, they need to be able to step in right next to you (not over you) to do the same job … to walk in your shoes right alongside you.
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By Christopher L. Wistrom, DO; James MacNeal, DO, MPH; Mike Blaser; Kevin Olin; and Ben Biddick
Jackie Joyner Kersee said, “It’s better to look ahead and prepare than to look back and regret.”
Responding to an active shooter incident at a school is one of the most trying and tremendous challenges for any public safety organization. Even in the best of circumstances, well-trained professionals will have difficulty assessing the situation, defusing the incident, treating the wounded, and moving through and beyond the terror.
As EMS and police prepare for these types of incidents, it is easy to overlook those that we are trying to protect. It is even easier to view them as a liability or in the way. After extensive planning and education, we propose that teachers are an often-overlooked and invaluable asset. After all, who is better positioned to be an immediate responder than those already within the situation?
By training those within the immediate emergency how to appropriately render medical aid, we greatly increase the potential survivability of the wounded. This makes the same classrooms, hallways and cafeterias where tragedy just transpired the ground zero for the healing process.
School employees are able to stop the dying if they are empowered to preplan a response, know the preventable causes of death in penetrating trauma, know how to treat the wounded, render emergency aid that stops life-threatening bleeding and how to direct the efforts of others.
These teachers then become vital partners who preserve life. An educated public turns a first response into an immediate response. The empowerment of the education is undeniable and, even if unused, serves to better the mental health of the teachers, students and parents alike. It prevents them from being helpless in their hallways.
A multidisciplinary cadre to address MCI response
This all looks great on paper, but how does reality play out? How does any community respond to the unthinkable?
In searching for that answer, our community engaged in a tabletop exercise. Grasping the full scope of the problem is no easy concept. However, it is clear that in traditional response models, it takes too long to get medical care to those who are injured.
We formed a multidisciplinary cadre to address this gap in care. Ideally, we hoped to find a plug and play education model that could be instituted. After much research, discussion and brainstorming, we found no such plug and play program, and thus developed our own.
The intent from the onset was to empower these untrained immediate responders with the tools necessary to save a life. We hoped this would encourage teachers and staff in the school district to render immediate and immensely valuable casualty care to school staff or students who may have sustained injuries in a large-scale act of violence.
We also desired to make the training universal, so that another community that was struggling with this issue could build on the work we had done and use our program as a cornerstone.
Casualty Care in the Classroom™ was born. This program places pressure dressings and tourniquets in the hands of teachers. It is based on the principles of trauma combat casualty care.
CCC was intentionally designed in a train-the-trainer format. This allows the model to be taught by local law enforcement and EMS with local health professionals to local schools. By using local resources, there is a greater personal interest in the training, as these are the schools our own children attend.
Training teachers to stop the bleed
The training was met with resounding success. Teachers no longer have to wait for public safety personnel to reach them in order to receive aid. They are empowered to render the aid themselves and stop severe bleeding until police, fire and EMS personnel could reach them.
It was shocking just how aware and concerned our teachers were when it came to the daily headlines and reports of large-scale acts of violence. Of 160 active-shooter incidents since 2000, 24.4 percent were at educational facilities, with 117 killed and 1,230 wounded .
Providing the teachers with training on how to open an airway, pack a wound, apply a pressure dressing and apply a tourniquet empowered them to take action and participate in the response instead of waiting helplessly for rescue. The teachers were hungry for the education, and since have become an essential element in our response.
We learned in these 45-minute educational sessions that the teachers had questions about what law enforcement officers may look like as they respond, when to call 911, how to avoid overwhelming dispatch, liability, self-aid and improvised aid. All these questions have been adopted as part of the training.
Participants are also educated about the objectives of all the agencies during the response. They are taught that law enforcement is there to stop the killing in order to create an environment where CCC-trained staff and paramedics can stop the dying. When victims understand the necessary role of law enforcement, then they can have realistic expectations. Instructors explain that law enforcement may bypass injured victims during an active threat, but not because they are callous or do not care about the injured.
Empowering teachers to act as active shooter first responders
Although all involved hope this training will never have to be used in a real-world incident, it is essential for a rapid and empowerment-based response to very real dangers should they occur. This positive action seeks to rob the perpetrators of violence of the larger body counts and horrific headlines they seek.
To have teachers who possess an understanding of the public safety response processes, knowledge to provide medical care and empowerment to make practical application of that knowledge creates an environment where our children receive the most rapid and effective care possible in the event of a mass casualty incident. It is the display of a strong, united community and promises to save lives, speed healing and restore safety as rapidly as possible.
The return on this investment is a conscious mind satisfied that every resource available has been prepared and primed to respond to any large-scale act of violence and an unconscious mind ready to resort to its training, rising to the occasion.
This article, originally published October 4, 2017, has been updated
1. U.S. Department of Justice, Federal Bureau of Investigation. Study on Active Shooter Incidents between 2000-2013. Sept. 16, 2013
About the authors
Dr. Christopher Wistrom is a board-certified emergency medicine physician and practicing EMS field physician. He also serves as associate EMS medical director for Mercy Health in Janesville, Wis.; Lake Geneva, Wis. and Rockford, Ill.
Mike Blaser is a sergeant; and Kevin Olin and Ben Biddick are officers of the Janesville Wisc. Police Department.
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