How to save lives in the civilian battlespace

In “Saving Private Ryan” one of the more enduring scenes depicted in the movie is of combat medics during the invasion of Normandy risking life and limb on the battlefield to treat and save allied wounded.  The film depicts the medics moving from one severely wounded soldier to another, under a hale of bullets and artillery fire, offering life-saving aid, or, in cases where nothing can be done, providing pain relief and comfort.

This ideal of the battlefield medic is one that most of us probably envision when we think of Navy corpsmen embedded with the Marines, Air Force para-rescuemen (PJs), or Army medics.  It is an image forged through decades of care provided under fire, on battlefields from Flanders to Fallujah, and from Korea to Kunar.

It is also a model that we must now migrate to the streets of America.

Sadly, terrorist groups — both domestic and international — as well as a generation of deranged mass murderers, have occasionally turned our cities and towns into temporary war zones.  They have transformed movie theaters, schools, churches, bars, and city streets into combat zones populated with injuries usually only seen on far-away battlefields.  Through their planned attacks, they have forced on us all what can be labeled a “civilian battlespace,” a temporary transference of war zone conditions to a non-war zone population center.

Today’s civilian paramedics (at all levels, from EMT-Basic to Paramedic) can expect to see penetrating trauma, blast wounds, traumatic burns, blunt force trauma, traumatic amputations, and extremity hemorrhaging in the course of one of these attacks.  These injuries are often reserved for combat hospitals in theaters of war, or if they happen in a civilian setting, are usually limited to a few patients in a motor vehicle accident or other type of civilian emergency.

If they are fortunate, most medics will never have to deal with a mass shooting/mass casualty incident, where tens or hundreds of patients present with combat-style wounds.  However, such events have become far too common to ignore, from the point of view of medical/tactical standard operating procedures.  They have also become far too common for today’s civilian medics to face without more extensive preparation, beyond the basics of emergency pre-hospital medicine.

One aspect of that preparation is a change in mindset on the part of civilian medics, from standing back until a scene is declared “secure” by police units, to moving in sooner to offer critical care to victims of mass shootings or terror attacks.  This is a controversial change, as most EMS systems place the safety of their medics as the highest priority.

While the latter goal is laudable and necessary for the good of the profession, and to protect critical health care providers, it is also sometimes overly cautious, especially when a mass shooting event or mass casualty event occurs.  In a prescient column in the Washington Post on August 28, 2016, former paramedic Kevin Hazzard — who is the author of “A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back” — calls the previous approach of staging until a scene is secure “outdated.”

According to Hazzard, paramedics must be trained to respond in dangerous environments, should be given the tools they need to stay safe, and should not be kept on the sidelines until a scene is completely safe.  Hazzard argues for a new model that incorporates more coordinated training with law enforcement, and even perhaps the use of body armor and additional tools to keep medics safe.

Hazzard goes on to suggest that in today’s environment, paramedics in the civilian world must unfortunately be prepared to care for patients in harm’s way, in the “warm zone” near a potentially still-active shooter.  In fact, many departments have begun to go this way, incorporating the use of “rescue task forces,” to respond to shootings and terror events.  These would incorporate medics, firefighters, and police into a joint team to move into a warm zone and begin to treat critically wounded patients before a scene is fully secure.

It is this kind of innovative thinking, incorporating lessons learned from military battlefield medicine, that will help save lives on America’s streets.  It is a dangerous new world out there, after all, and one to which first responders must quickly adapt.

(Photo courtesy of NBCLA.com)