Arming the First Care Provider

The following is excerpted from Building Community Resilience to Dynamic Mass Casualty Incidents: A Multi-Agency White Paper in Support of the First Care Provider, authored by the Committee for Tactical Emergency Casualty Care, FirstCareProvider.org and the Koshka Foundation for Safe Schools. Find the whole document at https://www.firstcareprovider.com/#white-paper.

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Natural and manmade disasters are creating increasingly complex response challenges. The current U.S. emergency response model relies heavily upon the availability and expertise of highly trained public safety agencies. Too often this leads the public and our leaders to assume professional emergency medical care will be immediately available. Unfortunately there are often delays in first responders accessing victims, especially in complex high-threat events.

Initiatives such as the Rescue Task Force model and the 3-ECHO program are creating “warm zone/indirect threat care” operational paradigms for first responders and are an important first step in shortening the time from injury to first medical intervention. However, despite aggressive and expedient deployment of professional medical providers, there remains a time gap from point of injury to lifesaving intervention that only First Care Providers—empowered and trained community members—can address.¹

The First Care Provider represents the first link in the trauma chain of survival from point of wounding through definitive care.^3,4 A First Care Provider-empowered system offers a universal, flexible bystander-initiated trauma protocol. This shared language, based on the principles of Tactical Emergency Casualty Care, empowers the FCP and the arriving medical/rescue assets to integrate effectively and work off the “same sheet of music.”

There are four key requirements to the development and implementation of a successful community First Care Provider program:

1. Administrative leadership and operational policy development—Successful FCP integration requires grassroots initiatives and national public policy leadership. Leaders must evolve past the complete reliance on traditional 9-1-1 response and overcome the widespread reluctance to introduce policies that empower medical action in the broader population. Non-medical leadership is critical to creating an effective whole-of-community system that reduces potentially preventable trauma mortality.⁷

2. Public access trauma kits—Many government buildings and public businesses in the United States are grossly underprepared to support FCP interventions for traumatic injuries during targeted violence events. The deployment of public access trauma kits serves two critical roles. First, they provide a visual cue to prompt First Care Providers to action. Second, if properly equipped, they can provide critical material to support lifesaving interventions for more than just hemorrhage control. Public access to readily available medical equipment should be part of a multipronged approach to community safety.

3. First responder training—The training of professional first responders currently focuses on unified command, operational coordination and direct lifesaving interventions. This traditionally marginalizes the bystanders and uninjured persons on scene. This must change. First responders must be familiar with the capabilities of the FCP as well as have operational plans that incorporate these available providers as force multipliers in the response.

4. First Care Provider training—Data from across the globe demonstrates that training individuals empowers action and improves survival from medical and traumatic emergencies.^8–10 Trained First Care Providers demonstrate a willingness to operate independently, are able to recognize critical injuries and can properly allocate resources for maximal benefit.¹¹

External hemorrhage control is a critical skill for many traumatic type injuries; however, it is not a panacea. Recent events reveal that access to the wounded, recognition of significant injury and rapid evacuation to medical care are at least as important as immediate hemorrhage control. Education on all of the preventable causes of death¹² in penetrating and blast trauma should be the ultimate goal and can be accomplished with a limited time investment. In addition to reducing mortality through application of TECC, this training will improve resilience by empowering individuals to take action in times of crisis.