First Care Providers: Extending the Chain of Trauma Survival (Part 2 of 2)
Joshua Bobko, MD, FAAEM
Director, First Care Provider
Joshua Bobko, MD, FAAEM
Director, First Care Provider
Dr. Joshua Bobko is a Board Certified Emergency Physician and an Assistant Professor of Emergency Medicine at Loma Linda University. He completed a fellowship in Emergency Medical Services, and is the Medical Director for the Westminster (CA) Police department. His company, Valiant Research, provides operational medical support for FBI-LA SWAT.
Recognizing the gap in traditional Emergency Medical Services, he started the non-profit FirstCareProvider.org with the goal of improving community resilience by expanding trauma education into our communities. He is a national leader in the development and implementation of multi-jurisdictional medical responses to atypical emergencies, and is a voting member on the Committee for Tactical Emergency Casualty Care. He is a national authority on high-threat civilian medicine and authored the landmark papers on pediatric casualty care. His current research includes expanding operational medicine concepts to other non-traditional populations and redefining the planning assumptions for disaster preparedness.
Published January 28, 2016
In my previous post, I discussed how action by First Care Providers (FCPs, medical laypeople trained in basic trauma care) can greatly increase the odds of survival following an injury. The Army Rangers, who pioneered this concept, found that immediate "point of injury care" could virtually eliminate preventable combat deaths.
Today, many organizations train laypeople in CPR, AED and stroke recognition. We also do a wonderful job with fire evacuation plans. However, there are very few training programs dealing with trauma, the No. 1 killer of young people, and most emergency plans end with, “Call 911.”
As a veteran and an emergency medicine physician, I wanted to change that. So, along with some colleagues, I founded a nonprofit organization dedicated to training and certifying ordinary citizens as FCPs. In today's post, I'll share more about our program and its impact.
An Idea Takes Shape
I was inspired to start FirstCareProvider.Org while developing a trauma care curriculum for Orange County law enforcement officers.
To design the curriculum, I drew from the Tactical Emergency Casualty Care (TECC) guidelines. As I mentioned in my previous post, an interdisciplinary committee called C-TECC has adapted the military's "point of injury" care program for civilian use by law enforcement and emergency medical services (EMS). These TECC guidelines have been endorsed by professional organizations and government agencies, including the Federal Emergency Management Agency, the International Association of Fire Fighters, Department of Fire Administration and the Department of Homeland Security.
As I worked on the law enforcement curriculum, my mind kept wandering through ways to adapt TECC for ordinary citizens. I realized that such training might provide a sort of "herd immunity" for our communities. If a high percentage of citizens were empowered as FCPs, victims of vehicle accidents, falls, natural disasters and violence would be more likely to receive immediate care, even when uniformed response was delayed (such as in Hurricane Katrina or a “Polar Vortex").
To meet this gap in our response systems, my colleagues and I created FirstCareProvider.Org as a vehicle to extend TECC principles into the community.
What We Teach
"The most important concept is that there is power in the educational process. The more tools people have, the more people are willing to help. The more willing they are to help, the more lives we can save." — Joshua Bobko, MD, founder, First Care Provider
FirstCareProvider.Org trains and certifies citizens to recognize and respond to critical injuries. Instruction focuses on major causes of preventable death such as massive bleeding and breathing emergencies. Participants also learn to communicate with professional first responders and act as EMS "extenders."
To give you a taste of the teaching process, here's our framework for dealing with a violent intruder. We've augmented the U.S. government's "Run, Hide, Fight" program with the TECC guidelines to create a new acronym, ACT:
Act: Assess the scene and take action. Run, hide or fight the shooter (in that order).
Communicate: Make contact with victims, fellow bystanders and 911/professional first responders. Work together to increase safety, shorten response time and prevent duplicated efforts.
Treat: Use techniques to control massive bleeding (including tourniquets), open airways, treat breathing emergencies and get the injured to help.
Here's a poster that pulls it all together in easy-to-remember groups of three:
In our experience, these skills can be learned quickly. We've trained teachers, city hall employees, mall security guards, heavy equipment workers and high school students, to name a few.
Which raises an important question. How do we know it works?
FCPs in Action
To test the effectiveness of our FCP community curriculum, we conducted a mass casualty simulation. The scenario was a 6.8 earthquake. The setting was a local shopping mall. (In exchange for the space, our organization trained the mall security workers.)
During the scenario, we compared the performance of several groups:
People who had received FCP training six weeks earlier, grouped demographically (i.e., trained teachers, trained nurses, trained high school students, etc.).
The simulation was scripted and presented by actors. Participants (including the firefighters) had no access to medical equipment other than a basic, wall-mounted trauma kit and fire extinguisher.
The "victims" of the earthquake were represented by animatronic manikins donated by Innovative Tactical Training Solutions (ITTS). They're the same type used to train combat medics and quite lifelike. They breathe, gurgle and bleed. They also record data about the care they receive.
So what happened? First, the trained FCPs took action much quicker than the untrained control group. (34 seconds to first action versus 111). The following video illustrates the contrast between their approaches:
Overall, the trained FCPs were very effective. When it came to stopping massive bleeding and maintaining the airway in unconscious patients, they performed just a little more slowly than professional first responders. (This isn't to say they can or should replace professionals. But it does suggest they retained their training and performed effectively.)
A Growing Movement
As concern about terrorism and public violence grows, communities are embracing the FCP concept. First Care Provider is working with the city of Westminster, Calif., to train all city employees as FCPs. The town of Rancho Cucamonga, Calif. is hosting FCP training for the community at the public library. And the police chief of Huntington Beach, Calif. is championing a similar community program. We’ve also been approached by groups in Canada, Australia and the United Kingdom.
A final thought: in an emergency, FCP training benefits the bystander as well as the patient. It's traumatic to witness a life-threatening injury and not know how to help, especially when the victim is a friend or loved one. By contrast, taking action replaces feelings of helplessness and victimization with control and efficacy.
"When we empower people to not be victims of disasters, we build community resiliency." - Joshua Bobko, MD