Conn. First Responders Discuss Benefits of Tactical Care Training

Aug. 20—Gunfire! Hear it?

Visiting with friends at a local junior high school, I hear a staccato response to the initial shots ... with more gunfire.

My neck bulges as blood pulses. Adrenaline, endorphins and body temperature immediately spike.

A police officer comes around the hallway, gun drawn and yells for someone to call 911.

Controlled chaos begins in this tactical exercise designed to mirror a mass shooting.

The cop tells us the hallway and classrooms are clear of threats and tells us to enter the classroom and begin caring for gunshot victims.

As a team, we begin a race against life and death. We enter a hellish scene. Teens and a teacher litter the floor.

Precious seconds tick away as rivulets of blood ebb from children. A teacher lies motionless on the floor behind her desk with a gunshot wound to the chest. I turn to scan the room. I open the door to a closet and I see a student in hiding, bloody but breathing, with a gunshot wound to the hand.

Purposely ill-prepared, without tourniquets, blood clotting gauze, chest seals or any other medical gear, we look for anything available in the classroom that can stop death until more help arrives.

My classmate, an off-duty Waterbury police officer, with some of the other Tactical Combat Casualty Care providers, begins critical care on the teacher behind the desk, who is struggling with her breathing.

A voice of reason and authority shouts at me, then yells, again: "Move. Be the difference."

I look around the room for objects that can by used in saving lives: duct tape, a candy bar wrapper, any fabric, rope.

It was my third and final day of East Coast Tactical Medicine's intensive Tactical Combat Casualty Care course, which engages trainees in mass casualty exercises that replicate traumatic 21st century news events. Trainees learn to perform immediate medical care to victims while keeping themselves and patients from getting killed.

My friends and I have just been certified as TCCC providers through ECTM of Waterbury.

"Move, think, look," repeats Stuart Hirsch, 52, a TCCC instructor and director of operations for emergency services at the St. Mary's Hospital Level II Trauma Center in Waterbury. Hirsch is the hospital's liaison with ECTM, and has a background in helicopter medevac and rescue operations.

As an aviator for charitable nonprofit foundations, he delivers disaster relief to developing countries and helps provide rescue training while building emergency medical services infrastructure.

"St. Mary's Hospital is making an organizational commitment to promote this training because we realize that the tide of violence is increasing from both domestic sources and terrorist sources," Hirsch says. "We felt that it was compelling to be proactive in this training, giving our staff and the community the skills to be prepared to respond rather than being victims of aggression."

"We train people to be empowered rather than being hapless victims."

Danny Devlin, 31, an Army Special Forces veteran, co-founded East Coast Tactical Medicine in 2017 with partner Dr. Scott Whyte, 58, an emergency room physician at St. Mary's Hospital of Waterbury.

"Our motto, 'Be The Difference,' is a subtle reminder that just one person, with the right training, can make a world of difference in the most trying of times," says Devlin.

Whyte, Devlin's partner in ECTM's founding, also is a SWAT physician with a local law enforcement agency.

"Some people have a life attitude of, 'That will never happen to me,'" Whyte says. "But we read about tragedy in the news every day. Anybody with reasonable sense should know that similar tragedies are going to happen again. At East Coast Tactical Medicine, we teach many skills that are combat-proven to be effective in treating penetrating and explosive injuries like the Boston Marathon bombing and mass casualty shooting incidents like Las Vegas."

Devlin and Whyte created East Coast Tactical Medicine to give the community an opportunity to be lifesavers in traumatic environments. "We educate first responders, physicians and medical providers, and others who want to be the difference, to step up and take action," Whyte says. "The injuries you might be treating can be caused by many things besides a gun. Trauma happens with a motorcycle hitting the guard rail or an IED (improvised explosive device). I know of a police officer who was almost killed recently by lacerating his arm on broken glass during an entry."

The goal for ECTM is to provide a bomb-proof Tactical Combat Casualty Care certification course available to the general community. The course is recognized by the National Association of Emergency Medical Technicians. ECTM is partnered with St. Mary's Hospital of Waterbury and supported by the St. Mary's Hospital Foundation.

Because of Devlin, ECTM has an unofficial but dynamic relationship with other members of the military Special Operations community that helps the training be "incredibly compelling and robust in its scope," says Hirsch.

"I have a reasonable amount of experience in U.S. military Special Operations, managing controlled chaos. Between Dr. Whyte and myself, we pretty much cover the gambit on medical tactical expertise as it relates to Tactical Combat and Tactical Emergency Casualty Care," says Devlin.

Devlin, a military professional with humanitarian instincts, looks to Whyte as the experienced medical leader of ECTM. "Dr. Whyte brings the unpredictable nature of the hospital Emergency Department and the medical expertise of a tactically trained SWAT physician. He has the mind and the instincts and the real-world experience necessary to produce the best possible outcome in a life and death situation," says Devlin.

The respect goes both ways.

Devlin "is a Green Beret," Whyte says. "He's been there and done that. He has taught TCCC many times. He plays it close to the vest and doesn't talk much about his military experiences."

With all scenario safety precautions in place, Whyte and Devlin lead a cadre of committed ECTM instructors to recreate an environment that challenges the brain by applying pressure with sensory overload tricks as trainees face critical incidents in a mock schoolroom, a corporate office environment, and an open-air mass casualty event, among other scenarios.

A professional theatrical make-up artist applies realistic injuries to the role players acting as victims. The "victims" scream, yell and resist treatment. Aggressive music pulsates, simulated blood oozes, machine-made smoke and darkness obscure vision—and that all merges with the sound of authentic firearms modified to fire non-lethal projectiles.

"You obviously can't recreate the actual experience of a mass-casualty trauma, but the scenarios get you ramped up, so that when the real thing happens you don't freeze," says TCCC classmate Jed Morrissey, a Guilford firefighter and paramedic who has trained with SWAT teams and patrol officers.

In the class, Morrissey learned, under significant duress, how to assess and recognize significant bleeding and then apply a tourniquet. He appreciated the ability to personally engage in the fight-or-flight environment created by ECTM.

Back on the job, Morrissey had to use a tourniquet recently in an emotional life-or-death trauma. "Freezing is not good for anybody," he quips.

The first two days of ECTM'S TCCC classes are taught at St. Mary's Hospital using a "crawl, walk, run" philosophy, says Devlin, who recently returned from a combat zone deployment. The teaching evolutions in critical care include multimedia classroom presentations, lectures, hands-on learning with medical equipment and case study analyses. Approximately $40,000 of medical gear and equipment is used in the training. That expense does not include many ancillary expenses such as maintenance of Simunition firearms that are realistic and fire nonlethal projectiles during force-on-force training; safety equipment; facility costs; and insurance.

The TCCC class moves seamlessly into intensive evolutions of tourniquet application, hemorrhage control, pressure and hemostatic dressings, airway management, intubation, needle decompression, treatment of open chest wounds, hypothermia prevention, pain management, splinting, treatment of ocular injuries, carry techniques, medical evacuation, care under fire and improvised medicine.

During the first two days of lecture and hands-on training, I watched TCCC classmate James Nealy, 59, Quinnipiac University assistant chief of public safety, perform various exercises in the class. I was impressed with his quiet but professional demeanor. When I learned he was from Quinnipiac University, it gave me a clue that Neely and the Hamden-based university clearly are proactive in providing campus security with TCCC skills.

"I took the class because I thought I needed advanced, on-the-ground critical injury response training because of the high likelihood of facing serious injuries that might occur in an active shooter scenario or an accident that can be treated immediately, with my officers or anybody on campus," says Nealy, a retired Connecticut State Police trooper and former Bridgeport Public Schools director of public safety who now runs the day-to-day activities of Quinnipiac University campus safety and critical incident training on campus.

"It could be a kid falling, someone with a knife or a bat or a car accident, not just an active shooter. There are many things that can happen today and we have to have people that are capable of responding to those incidents," says Nealy.

My TCCC classmates, an eclectic, mixed-gender group, also included a physician's assistant going to Baghdad's Green Zone as a contractor; a registered nurse; a police officer; a newly minted pistol permit holder; a paramedic; a firefighter; two emergency medical technicians; a young man entering military service; a U.S. Marine veteran who is planning to become a military contractor;—and myself, a photojournalist, among others.

Devlin, asked how Tactical Combat Casualty Care, in the wake of current events, could be implemented domestically, recommends to "train the trainer."

"If every school, police department, business, church and organization that catered to large masses of people sent one or two people to become a certified TCCC Provider, they could return to their respective organizations as subject matter experts among their staff or faculty and train others on the life-saving skills they learned," he says. "This would be the most cost-effective approach for organizations on a limited budget, and a highly effective means of educating the masses, which enhances preparedness. Hopefully, we are teaching future teachers that can pass along this valuable, life-saving information," says Whyte.

ECTM's pool of instructors runs the gamut, including "ER physicians, nurse practitioners and tactical EMTs to Navy corpsmen who served as combat medics for U.S. Marines and the U.S. Special Operations community and the St. Mary's Hospital Emergency Department," according to Devlin.

"We have new guest instructors for every class, but we also have a core group of instructors," he says. "Each instructor brings a different perspective to the students. We are firm believers that there isn't one right way to do anything. We give students the tools, the data points and the forum to make calculated decisions and find creative solutions to problems."

Many use what they learn in the course in their daily work.

"Shortly after the class, I had to use a tourniquet," says ECTM course graduate DePalma, an emergency medical technician who works and lives in New Haven. "Even though I knew how to use a tourniquet from EMT school, TCCC took it to the next level, going into all the nuances of using them. ... I am really glad I took the class for both the mindset and the physical skills."

DePalma says his recent hands-on training was invaluable. "The simulated wounds were realistic. The training was eye-opening as you try to adapt and overcome obstacles. I feel like the mental preparation is huge. I have absolutely been in that situation on the job. I am glad I went through it on real live actors. I fell back on that training instead of wasting time working through the problem in my mind. You can get rattled if you are not ready for it. If you are not trained first, you might be that deer in the headlights."

Extraction techniques are taught and used in the TCCC training.

"How many people know the right way of carrying or dragging someone without hurting them?" DePalma says. "If people were just trained in extraction, to safely, effectively and quickly extracting people from a bad situation, making a difference in saving people to get treatment, especially in a stampede, knowing how to carry someone out when they are shot in the leg, it could make a difference in the survivability of the person. That is a big deal, to fall back on the training."

DePalma says that while a professional responder may not be on scene for minutes, a bystander is there immediately and can make a huge difference in preventing death before first responders arrive. A lot of the course, he said, is simple enough that you can teach others basic techniques that increase the odds of survival.

Guilford paramedic Morrissey agrees. "It's the mindset of flight or flight. The class teaches you that the average person and the professional first responder can work side-by-side."

"Sadly, the world we live in has more catastrophic events than ever," Morrissey says. "The TCCC training gives you the confidence to recognize these events and then how to help. It is huge to know how to stabilize a victim and move on to the next casualty, taking critical care to the next patient and making them stable, as well. That is huge."

"The most important takeaway are immediate things I can do to help a person's survivability in the event of a critical incident injury that most people might think is not survivable," says Nealy, who also is a member of Quinnipiac University's emergency management team. "The training allows me a way to take a look at the information I learned and transfer that information to our university support staff, teaching them to be the initial responders that help stabilize victims until secondary medical care is available. I can quickly assess what is going on and direct people to treat injuries and treatment during a rapid triage."

Ultimately, Devlin says, the training is about survival.

"Be a force multiplier and project positive influence," Devlin says. "Catastrophe strikes when you least expect it. Do what you can to prepare yourself, if not for you then for those around you. At the end of the day, it comes down to the people who count on you when they can't count on themselves."

For information on East Coast Tactical Medicine Tactical Combat Casualty Care classes, or to register for TCCC classes scheduled for June 6-8, visit www.eastcoasttacmed.com or call 203-500-4369. You can also find East Coast Tactical Medicine on Facebook.