Wisconsin Tactical Medicine Continuum of Care “Save” data

1. Wisconsin Tactical Medicine Continuum of Care “Save” data Wisconsin TEMS Initiative March 2014 Complied by: Officer Chad Stiles, RN/Paramedic

2. Dedication Wisconsin Department of Justice (DCI) Special Agent John “Jay” Balchunas, who was a former Milwaukee Police Officer and New Berlin Fire Department EMT/Fire Lieutenant and Deputy Jamison Kampmeyer of the Marathon County Sheriff’s Office, Tactical Medic for the Marathon County SWAT Team, and firefighter/EMT with Colby Fire/EMS. Both of these men were dedicated public servants in law enforcement, firefighting and EMS.

3. Milwaukee, WI. June 9th, 2009 2 officers shot Officer Norberg: 1STshot right shoulder, 2nd shot left jaw with exit right jaw area Officer Kunisch: 1st shot left hand 2nd shot left shoulder 3rd shot into neck which extended into jaw thru left eye with exit near top of head with brain matter exposed.

4. Tactical Medicine Continuum of Care Bystander care (i.e. school teacher, security, church usher) Police Officer/SWAT Operator Self-aid and Buddy aid ALS/BLS Tactical Medic and/or “warm zone” Rescue Task Force medic Transport Agency (Police Vehicle, ALS/BLS EMS, or Aeromedical Service) Trauma Center/Hospital

5. Wisconsin Training Initiative: >400 TEMS Trained Fire/EMS/LE Personnel (40hour) >1500 Awareness level trained officers (4hour) >250 Milwaukee PD police recruits TECC/TCCC trained (4-12hour) >375 TECC trained Officers/SWAT Operators (8hour) >300 TEMS Awareness Fire/EMS (WEMSA Conference) >500 Awareness level at other Conferences/Summits or trainings (1-8 hour) Total >3325 by end of 2013

6. Inclusion Criteria “Save” in the context for the inclusion of this data collection means: • the police officer or tactical medic’s actions were according to TECC guidelines • was essential to providing an improved patient outcome by: maintaining an airway, stabilizing breathing, and/or controlling bleeding • may have contributed to sustaining the life of a human being or improving patient outcome

7. HemConChitoGauze Use 12/12/2011 Lieutenant Patrick R. Esser Waukesha County Sheriff’s Dept.

8. Background • Attended FTO Conference in Fall of 2011 • Presentation was given by Chris Cook on Combat Casualty Care • Researched various products and purchased HemCon’s ChitoGauze

9. Motor Vehicle Crash • Call for MV accident came in at 0542 on 12/12/2011 • First squad and myself on scene at 0549 • Road conditions were extremely icy • First day back to patrol after 4 weeks of light duty

12. Motor Vehicle Crash DRIVER: • 35-year-old female • Disoriented • Sitting in caller’s vehicle upon squads arrival

13. Motor Vehicle Crash PASSENGER: • 38-year-old male, William Bodus • Was heard moaning in wooded area • Located approx. 15’ from vehicle

15. Response • First arriving deputy located Bodus and advised of severe neck laceration • Flight for Life put on standby • Laceration observed from trachea to back of neck, on right side

18. Use of ChitoGauze • Training consisted of watching video demo of Quikclot and reviewing directions for ChitoGauze • Applied gauze as directed • Turned over gauze wrapper to EMS

19. Use of ChitoGauze

20. EMS • EMS requested that the gauze be removed • Care for the wound was turned over to one specific person • Bodus was transported by ambulance to Froedtert

21. Follow-up • Phone call from Froedtert; first responder use was surprising • Severed carotid artery • Department purchased 50 go bags for patrol cars through asset forfeiture

22. Go-Bags • Tournequet • Occlusive dressing • Quik Clot Gauze • Trauma Sheers • Bandage • Gloves • Tape • Non-adherent dressing

23. Waukesha County Sheriff November 2013 - Deputy Brian Skaar – Put out fire with small fire extinguisher, called Flight for Life - provided CAT tourniquet to EMS that he purchased for his tactical medical kit on car vs semi accident likely saving the victim who had a partially amputated leg. (4 hour awareness training WCTC Inservice)

24. Contact Information: Lt. Patrick Esser Waukesha County Sheriff’s Dept. (w)262-896-8154 (c)262-424-9116 Pesser@waukeshacounty.gov

25. Tactical EMS in a Non Tactical Environment • Josh Finke-EMS Division Chief • Wausau Fire Department

26. Response • An ambulance was requested to respond to a call at 0324hrs • Rural area just northeast of the city • Report of a male party that had been stabbed • Advised to stage until LE is able to secure the scene

27. Staging • Ambulance staged approx 1/2 mile from the scene • Met by a large group of people walking down the road • Staged for a very short period of time

28. Scene • Upon arrival to scene paramedics were summoned by a LE officer to the patients side • Total response time of 11 minutes • Paramedics noted a large amount of blood in the snow outside of the house

29. Patient Info • Patient is a 21 year old male • Found inside the house supine in the kitchen with a friend at his side • Patient was laying in large pool of blood and had blood soaked clothing

30. Assessment • Patient was alert and oriented • A large stab/laceration was noted to the inferior portion of the left upper arm • Prior to arrival a tourniquet was applied using a belt, bleeding was slowed however, significant hemorrhage was still present

31. Treatment • A SOF-T Tourniquet was applied rapidly by a TEMS trained paramedic • Bleeding was well controlled within a matter of seconds • Initial vitals are stable BP-124/87 HR-100 RR-20 • Large bore IV with warmed NS bolus

32. Hospital Course • Patient was transported to Aspirus Hospital • Met by the trauma team • Tourniquet was briefly loosened by surgeon heavy arterial bleeding was encountered, the patient did develop hemorrhagic shock • The patient was then moved to a surgical suite

33. Treatment • Upon arrival to the surgical suite the patient underwent a procedure for a bypass of his brachial artery • The tourniquet was in place for approximately 95 minutes • The patient did also suffer an injury to his brachial plexus nerve

34. Recovery • In the first day post surgery the patient did experience a significant amount of weakness in his hand • This did continue to improve in the days post injury • This was mostly due to the injury to the brachial plexus nerve

35. Recovery • Several weeks post surgery in a follow up with his regular physician the patient was noted to have some residual numbness in his 5th digit • His strength was much improved • Expected to make a complete recovery

36. Elm Grove Elm Grove PD fully implemented TECC with a department wide training block and kits to every officer. Their officers are all EMT’s and paramedics, but they received the extra training to provide care TECC care as well.

37. Elm Grove Police Chief Jim Gage applied a tourniquet to a significant hand laceration, partial severed thumb caused by a rotary saw.  Homeowner tried to assist the construction worker victim by using a towel for a bandage and direct pressure and had tied a second towel around his forearm as a make-shift tourniquet. Bleeding was still excessive upon officer arrival with these measures in place.  Officers decided to deploy the tourniquet which successfully suspended the bleeding. (WCTC 40 hour TEMS and department 4 hour TECC in-service)

38. Elm Grove Police Chief Jim Gage and Patrol officer Phil Doney used Quik Clot for an uncontrolled femoral bleed (surgical plug released).  Bleeding was slowed significantly and patient was emergently transported to trauma center.  Surgeon stated that patient would have exsanguinatedif aggressive bleeding control would not have been applied in the field. (WCTC TEMS class and department 4 hour TECC in-service)

39. Elm Grove Police A tourniquet was applied when a DPW worker suffered a severe leg laceration from a chain saw accident.  Bleeding was moderate but uncontrolled prior to the application of the tourniquet. (WCTC 40 hour TEMS and entire department 4 hour TECC in-service)

40. Elm Grove Police Officers Phil Doney and Sandy Brown were some of the first officers on scene at Azana Spa shooting and help provide patient care prior to FD by moving victims off the “X” and begin treatment. GSW – Through the leg – Femur Fx GSW - Neck – bleeding controlled with towel (40 hour TEMS and entire department 4 hour TECC in-service)

41. Green Bay Police Department GBPD fully implemented TECC in summer 2013 for all patrol and SWAT officers, in cooperation with Prevea clinic who funded kits for every officer: Results: Four cases of cutting/stabbing victims September to November 2013 where police made life saving actions using hemostatic agent. (4 hour awareness level department in-service, 40 hour WCTC TEMS and two 8 hour WCTC courses)

42. Green Bay PD - Sept 2013Severe neck laceration with uncontrolled bleeding in field

43. Green Bay PD Oct 2013Severed jugular vein in necktreatment provided by officer in high threat environment under long gun cover by another officer

44. Green Bay PD Oct 2013post surgical close-up

45. Green Bay PD Oct 2013struck artery in heart – per MD, patient would have died without actions by officer

46. Green Bay PD November 2013Uncontrolled bleeding from neck in field

47. Milwaukee PD Officer Daniel Pierce - Milwaukee Police Department - Fall 2010 - Used Quik Clot Combat gauze on a severe occipital head bleed on a patient cut with a knife during an aggravated battery. The bleeding was so severe it was unable to be controlled by direct pressure, and patient had altered mental status. (awareness level training at recruit level and 8 hour course at Medicor/Milw PD )

48. Milwaukee PD Officer Keller - Milwaukee Police Department - Oct 2011 - Formed a chest seal out of a tissue purse pack wrapper to form an emergent chest seal on a stabbing victim involved in a DV with a sucking chest wound. (8 hour training at recruit level at Milw PD)

49. Milwaukee PD Officer Brock Cameron - Milwaukee Police Department - 2011 - Used a tourniquet to control bleeding on a lower extremity bleed of Officer Stachowiak who was shot in the leg. (8 hour officer training at Medicor/Milw PD)

50. US Marshals/Milwaukee PD A tourniquet was used by the US Marshals shooting in May 2012 on the south side of Milwaukee to control a severe lower extremity bleed on the suspect. MPD Officer Mike Kykendall said when they removed the tourniquet in the trauma room blood “hit the ceiling” and the tourniquet had to be re-applied until surgery. (training unknown)