Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX C n Trauma Care in Mass-Casualty, Austere, and Operational Environments
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What protective equipment is needed to
prevent hypothermia, eye injury, and ear/
hearing injury during transport?
Implementation of ATLS-OE
ATLS-OE is currently offered for all new military
medical officer accessions, through the Defense Medical
Readiness Training Institute and the Uniformed Service
University, and will soon be made available to all
military ATLS programs.
Improving Survival from
Active Shooter and
IntentioNAl Mass-cAsualty
Events
From 2000 to 2013, there were 160 active shooter
events with 1,043 casualties and 486 deaths in the
United States. Similarly, during the period from 1983
to 2002, there were more than 36,000 explosive
incidents in the United States with 6,000 injuries
and nearly 700 deaths. Most concerning is that the
incidence of active shooter events has risen in recent
years, and the extreme lethality of these events cannot
be ignored.
The Hartford Consensus
With these events in mind, in the aftermath of the
tragic shootings at Sandy Hook Elementary School
in Connecticut in 2012 and the Boston Marathon
bombing in 2013, the Joint Committee to Develop
a National Policy to Increase Survival from Active
Shooter and Intentional Mass Casualty Events was
established by the American College of Surgeons in
collaboration with leaders from the various federal
institutions including the National Security Council;
U.S. military and federal law enforcement agencies;
police, fire and emergency medical organizations; and
several key healthcare organizations. The committee’s
efforts have been a national call to action to address
survivability of these events and to train first responders
and the lay public in the control of hemorrhage.
The committee’s recommendations are referred to
as the Hartford Consensus, and currently consist of
four reports:
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Hartford Consensus I: Improving Survival from
Active Shooter Events (June 1, 2013)
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Hartford Consensus II: Active Shooter and
Intentional Mass-Casualty Events (September
1, 2013)
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The Hartford Consensus III: Implementation of
Bleeding Control (July 1, 2015)
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The Hartford Consensus IV: A Call for Increased
National Resilience March 1, 2016
Given the high volatility of an active shooter event,
the most important initial step is threat suppression by
law enforcement personnel. However, the immediate
priorities of rapid extremity hemorrhage control by
trained first responders and expeditious transport
of those with potentially noncompressible internal
hemorrhage must be considered.
Critical events in an integrated response to an active
shooter event are represented by the acronym THREAT:
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Threat suppression
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Hemorrhage control
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Rapid Extrication
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Assessment by medical providers
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Transport to definitive care
Using lessons learned from the military’s experience
with TCCC, early external hemorrhage control
must be the responsibility of the earliest person
on scene, and law enforcement personnel should
be trained and equipped to control bleeding with
tourniquets and hemostatic agents. Similarly, EMS
and fire personnel must shift operational tactics and
develop new paradigms of emergency management
coordination to push forward in support of rapid
casualty evacuation.
Stop the Bleed Campaign
In response to these recommendations, the White House
launched the “Stop the Bleed” initiative in October
2015, with the goal to provide bystanders of emergency
situations with the tools and knowledge to stop lifethreatening
bleeding. In a public health mandate
similar to the widespread teaching of cardiopulmonary
resuscitation (CPR) and the Heimlich maneuver, the lay
public should be trained in immediate bleeding control,
or “buddy aid.” Appropriate bleeding control equipment
(gloves, tourniquets, hemostatic dressings) should be
readily available to all emergency personnel and in
publicly accessible “hemorrhage control kits” that are
as readily accessible and as identifiable as automatic
external defibrillators. Lastly, the training alone is not
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