Emergency Casualty Research Articles

Highlights From the 2023 Revision of Pediatric Tactical Emergency Casualty Care Guidelines.

In 2023 the Committee for Tactical Emergency Casualty Care (C-TECC) issued updated Pediatric Tactical Emergency Casualty Care (TECC) Guidelines (Guidelines) that focus on the delivery of stabilizing care of children who are the victims of high-threat incidents such as an active shooter event. The Guidelines provide evidence-based and best practice recommendations to those individuals and departments that specifically provide operational medical support to law enforcement agencies caring for children in this uniquely dangerous environment where traditional resources may not be available. This article highlights key takeaway points from the Guidelines, including several updates since the first version was released in 2013.The evidence base for the care of children in this environment is lacking, and medical care delivered in the high-threat environment is inconsistent and often not optimized for the care of infants and children. The Guidelines are supported from the existing literature base where possible, and where it is not, by consensus as to the current best practices as determined by iterative deliberations among the diverse and experienced group of stakeholders who are members of C-TECC. The Guidelines provide patient assessment and management information specific to the care of children in the following 3 dynamic phases of the high-threat environment: Direct Threat, Indirect Threat, and Evacuation. The phases represent a continuum of risk to the patient and the responder ranging from extreme (such as ongoing gunfire) to minimal (during movement toward definitive medical care).The high-threat environment is dynamic and there is competing safety, tactical/operational, and patient care priorities for responders when infants and children are injured. The Guidelines provide recommendations on the type of medical and psychological care that should be considered under each phase of threat and establishes the context for how and why to deliver (or potentially defer) certain interventions under some circumstances in order the maximize the opportunity for a good outcome for an injured pediatric patient. The Guidelines also emphasize the importance of synergizing hospital-based pediatric trauma care with those law enforcement and fire/emergency medical services that may provide field care to children under high-threat circumstances.

Enhanced Manual Ventilation with a Handheld Audiovisual Device - BENGI - Insights from a Pilot Study in Special Operations Medicine.

In emergency casualty and evacuation situations, manual ventilation using self-inflating bags remains a critical skill; however, significant challenges exist in ensuring safety and effectiveness, since inaccurate manual ventilation is associated with life-threatening risks (e.g., gastric insufflation with aspiration, barotrauma, and reduced venous return). This study assessed the impact of audiovisual feedback from the bag-valve-mask (BVM) emergency narration guided instrument (BENGI), a handheld manual ventilation guidance device, on improving performance and safety, immediately and 2 weeks after, with no additional manual ventilation training. In a crossover manikin simulation study with 20 participants, BENGI immediately and significantly improved tidal volume and respiratory rate accuracy. Intraand inter-participant variations were lower with BENGI, with Poincaré plot analysis showing improved performance that remained for at least 2 weeks following BENGI training. BENGI's audiovisual feedback improves manual immediately and persistently, making it invaluable for training and clinical use in diverse scenarios, from battlespace to civilian emergencies.

Physical Fitness Determinants of a Military Casualty Evacuation Test.

Casualty evacuation has been identified as a typical and essential single military task which every soldier should be able to perform rapidly during combat. Previous studies suggest that casualty evacuation is typically conducted by dragging and demands e.g., lean body mass and anaerobic performance. Association of physical fitness with casualty evacuation by dragging has been studied widely but previous studies lack comprehensive assessment of all physical fitness determinants. The purpose of the present study was to examine comprehensively how casualty emergency evacuation (CEE) performance associates with physical fitness and body composition. A total of 25 conscripts (20 men, 5 women) volunteered for measurements of height, weight, waist circumference, body composition, 1-min sit-ups and push-ups, grip strength, isometric bench and leg press, standing long jump, 30-s cycle ergometer test, and 12-min run test. Subjects performed a CEE test in which evacuation time (ET), heart rate, blood lactate concentration, and rate of perceived exertion were measured. In the CEE test, subjects wore combat gear (11.7 ± 1.6 kg) and dragged a doll wearing combat gear (80.2 kg) 28 m while crawling (go round two cones, Z-pattern) and 20 m upright (straightforward). Correlations and backward regression analysis were used for statistical analyses. The level of significance was set to P ≤ .05. Evacuation time lasted on average 87 ± 32 s with a peak heart rate of 184 ± 6 bpm, lactate concentration of 9.4 ± 2.7 mmol/l, and RPE of 17 ± 1. Evacuation time correlated inversely and strongly with anaerobic capacity and power (r = -0.72-0.78, P ≤ .001), but not with aerobic fitness. Inverse and strong correlations were observed between ET and maximal strength variables (r = -0.58-0.69, P ≤ .01), whereas muscular endurance and ET revealed non-significant correlations. Evacuation time correlated moderate to strongly with body fat percentage (r = 0.48, P ≤ .05) and inversely with lean body mass (r = -0.74, P ≤ .001) and body height (r = -0.53, P ≤ .01). The backward regression analysis showed that anaerobic capacity (standardized β = -0.52, P ≤ .001), fat percentage (standardized β = 0.40, P ≤ .001), and isometric leg press (standardized β = -0.25, P ≤ .1) together explained the variance of ET significantly (adjusted R2 = 0.84, P ≤ .001). This study examined thoroughly how different physical fitness dimensions and body composition relate to a CEE test performed by a combination of dragging while crawling and in upright position. Casualty emergency evacuation was discovered as a high-intensity military task, which demands most importantly high anaerobic performance, lean body mass, and maximal strength capabilities. Improving these dimensions of physical fitness should be considered highly important as CEE is essential and possibly one of the most demanding military tasks which every soldier should be able to conduct in combat. From operational perspective, it is relevant that soldiers are able to perform CEE during operations; therefore, further research is needed on how acute operational stress changes the nature of CEE and its physical determinants.

Effect of early administration of tetracosactide on mortality and host response in critically ill patients requiring rescue surgery: a sensitivity analysis of the STOPSHOCK phase 3 randomized controlled trial

BackgroundUndifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction. This was a sensitivity analysis of a drug (tetracosactide; TCS10) targeting melanocortin receptors (MCRs) in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.MethodsSensitivity analysis was based on a randomized, two-arm, multicenter, double-blind, controlled trial. The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs-outputs in 100 consecutive cases (from August to September 2013 from Emilia Romagna region, Italy). Patients included an agent-based TCS10 group (10 mg, single intravenous bolus before surgery; n = 56) and control group (n = 44) and the association with cytokines, lactate, and bleeding-blood transfusion episodes with the prior-risk log-odds for mortality rate in time-to-event was analyzed.ResultsThirty-day mortality was significantly improved in the TCS10 group vs. control group (0 vs. 8 deaths, P < 0.0001). Baseline levels of interleukin (IL)-6, IL-10, and lactate were associated with bleeding episodes, independent of TCS10 treatment [odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.39–2.79; OR = 1.53, 95%CI 1.17–2.12; and OR = 2.92, 95%CI 1.40–6.66, respectively], while baseline level of Fms-like tyrosine kinase 3 ligand (Flt3L) was associated with lower bleeding rates in TCS10-treated patients (OR = 0.31, 95%CI 0.11–0.90, P = 0.03). For every 8 TCS10-treated patients, 1 bleeding case was avoided. Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group (OR = 0.32, 95%CI 0.14–0.73, P = 0.01). For every 4 TCS10-treated patients, 1 transfusion case was avoided.ConclusionsSensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care. To introduce the technology readiness level in real-life critically ill patients, further large-scale studies are required.Trial registrationEuropean Union Drug Regulating Authorities Clinical Trials Database (EudraCT Number: 2007-006445-41).

Incidence of Polytrauma in the Casualty Emergency Department of a Tertiary Care Hospital in Dhaka City

Background: Polytrauma is a public health problem in every country. Objective: The purpose of the present study was to assess the incidence of Polytrauma in the Casualty Emergency Department of a tertiary care hospital in Dhaka city. Methodology: This cross-sectional study was carried out in the casualty of Emergency Department of Dhaka Medical College Hospital, Dhaka, Bangladesh. The patients who were admitted from January 2014 to December 2014 were included in this study. This study includes all the patients with polytrauma, most of whom underwent laparotomy or other types of surgery like suprapubic cystostomy, amputation, surgical toileting, chest drainage, but a small number was managed with non-operative approach. Immediately after admission, the patients were subjected to resuscitation, primary survey and history taking including pre-hospital retrieval. A tabulated sheet of questionnaire was given to all the patients and answer was taken by conversation and examination. Results: A total number of 100 patients were recruited for this study. The mean age with SD of the study population was 33.5±12.5 with the range of 3 to 67 years. The male female ratio is 7.33:1. The victims of polytrauma sustained their injury from different kinds of trauma. Out of hundred cases with polytrauma, road traffic accidents was the most common cause which included motor vehicle accident, pedestrian and motor cycle accident and resulted in a total of 63 casualty occupying 63% of the entire series. Polytrauma resulted fall from height occurred in 10 (10%) cases. Stab injury caused polytrauma in 5 (5%) cases. Conclusion: In conclusion majority of the study population is young adult with the predominance of male presented with road traffic accident. Journal of Current and Advance Medical Research, July 2023;10(2):60-64

Audit and Inventory of Federal Law Enforcement Agency Tactical Medic Bags.

Separate evidence-based, best practice guidelines and recommendations exist for the prehospital management of traumatic injuries sustained in combat settings and those encountered during high-threat civilian operational incidents. The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) Tactical Medic Program is a mature operational medicine asset supporting high-threat federal law enforcement operations. The ATF conducted an audit of its agency-issued tactical medic bags with regards to completeness, as defined by authorized medical protocols, which are aligned with current Tactical Combat Casualty Care and Tactical Emergency Casualty Care guidelines.

Emergency Medical Services in Taiwan: Past, Present, and Future.

This review assessed the development of Taiwan's emergency medical services (EMS) and focused on the optimizing initiatives of the EMS systems, the current state of Taiwan's EMS system, EMS benchmarks in different regions of Taiwan, EMS response during the coronavirus disease 2019 (COVID-19) pandemic, and future design. In the past decade, there has been a noticeable increase in prehospital services, numerous optimizing initiatives to improve patient prognosis, and the medical oversight model. Taiwan's current EMS system, including the dispatch system, out-of-hospital cardiac arrest (OHCA) patient management, time-sensitive critical illness in prehospital settings, and disaster response, has undergone significant improvements. These improvements have been demonstrated to have a measurable impact on patient outcomes, as supported by medical literature. Each region in Taiwan has developed a unique EMS system with local characteristics, such as the implementation of the Global Resuscitation Alliance 10 steps for OHCA-related quality control, hearing automated external defibrillator program, a five-level prehospital triage system, an island-hopping strategy for patients with major trauma, dispatcher-assisted teamwork for OHCA resuscitation, and optimized prehospital care for acute coronary syndrome patients. In response to the COVID-19 pandemic from 2019 to 2023, Taiwan's EMS implemented measures to combat the outbreak such as interagency collaboration to obtain patient's personal information, to optimize prehospital management initiatives, and to provide financial compensation and personal insurance for emergency medical technicians. The areas that need focus include integrating prehospital and in-hospital information to build a national-level database (One-Stop Emergency Management), increasing public awareness of first responders and emergency casualty care, and evolving the EMS system by incorporating private EMS system, initiating school-based education of paramedicine, and legally recognizing paramedics as medical and health care personnel. By improving these areas, we can better prepare for the future and ensure that Taiwan's EMS system continues to provide high-quality care to those in need.

Triage and Evaluation of Blast-injured Patients in Wenling Liquefied Petroleum Gas Tanker Explosion.

On June 13, 2020, a liquefied petroleum gas tanker exploded in Wenling. Here, we describe the mass casualty emergency response to the explosion. We collected the medical records of 176 inpatients at 8 hospitals from Taizhou and Hangzhou. The 176 inpatients with blast injuries comprised 70 females and 106 males, with an average age of 45.48 ± 19.96 years, and more than half of the patients were farmers. They were transported to 6 hospitals distributed around the explosion site in Taizhou in the initial rescue period and were grouped according to their new injury severity score as having mild, moderate, severe, or extremely severe injuries. Most patients with severe and extremely severe injuries were admitted to a superior hospital post-secondary triage. 44 patients experienced primary blast injuries, 137 experienced secondary blast injuries, 37 experienced tertiary blast injuries, and 40 patients experienced quaternary blast injuries. Multiple blast injuries were suffered by 62 patients. Most patients (95.45%) suffered external injuries, with the chest, extremities, and face as the main affected areas. Burns were diagnosed in 26 adults, of which 15.38%, 19.23%, 7.70%, and 57.69% suffered mild, moderate, severe, and extremely severe cases. 16 burn patients suffered from burn-blast injuries. Upper limbs and the head/face/neck area, as exposed areas, were more likely to experience a burn injury. Inhalation was the main accompanying injury. Of the 8 patients who died in the prehospital session, 7 had burn injuries. This report on the accident and injury characteristics of an open-air LPG-related explosion will facilitate responses to subsequent catastrophes.

IBERO Protocol: A Multi-agency Coordination Framework for the Tactical Emergency Casualty Care Spanish System

Introduction:Despite Spanish experience in counterterrorism, jihadism means new modus operandi, based on active mass casualty incidents, involving new injury patterns as mass bleeding ones. Therefore, the environment is completely different to first responders' structure. This change forced the revision of the tactical response model, led by the Spanish Association for Emergency Medicine's Tactical Care Secretary, who provides a discussion forum to its members, reaching a joint framework document, IBERO, adapted to Spanish tactical emergency capabilities.Method:Methodology was based on three parameters: 1)Literature revision, selecting three sources: Books and academic papers, TCCC and TECC guidelines, and Hartford Consensus, and AARs from the main active incidents with similarities to jihadist ones.2)Formation of discussion groups: Threat definition, tactile response, and prehospital care, triage and evacuation systems.3)A final group formed by representatives of each discussion group wrote the final document.Results:The protocol defines a staged plan of action, adapted to Spanish legislation and institutions, following the acronym IBERO: 1)Information: threat intelligence and information transmitted to responders from the incident location and dispatchers.2)Block the threat by perimeter, zonification and suppression of the threat.3)Escalation of resources. Definition of areas of action according to direct threat, indirect threat and safe areas of action.4)Response and Rescue. Extrication to safe areas, including different stages of triage and protection against secondary attacks.5)Order and evacuation. Access to other emergency services, and psychological first aid.Conclusion:The document proves the need for a coordinating framework of the Spanish emergency system to be fully adapted to these new threats. The discussion groups have identified the need for regular training on threat identification, zonification setting, mass bleeding control, extrication, and evacuation techniques during hostile situations. To achieve this goal, realistic training is mandatory.

Proceedings of the 2023 Spring/Summer Meeting of the Committee for Tactical Emergency Casualty Care (C-TECC) and Committee Updates.

Proceedings of the 2023 Spring/Summer Meeting of the Committee for Tactical Emergency Casualty Care (C-TECC) and Committee Updates.

Acute Hypokalemic Paralysis Secondary to Distal Renal Tubular Acidosis Presenting as Guillain Barre Syndrome

A 52 year old female patient presented to emergency casualty with Acute onset quadriparesis with respiratory muscle involvement in. During initial work up Serum electrolytes showed severe hypokalemia. Arterial blood gas showed normal anionic gap metabolic acidosis with positive urine anion gap and urine examination showed alkaline PH in the presence of systemic acidosis. All these findings suggest Distal Tubular Acidosis. Further evaluation revealed strongly positive Anti nuclear antibodies with SS-A also being positive suggesting Sjogren’s Syndrome.

Supporting discovery and development of medical countermeasures for chemical injury to eye and skin

Vesicants, from vesica (Latin for blister), can cause local and systemic toxicity. They include the chemotherapy drug nitrogen mustard and chemical warfare agents sulfur mustard, Lewisite, and phosgene oxime. These agents are commonly released in vapor form and consequently, eyes and skin are the most vulnerable. The ocular and cutaneous injuries can be acute, subacute, or chronic, and can predispose casualties to secondary deleterious effects. Underlying these broad organ responses are shared and tissue-specific cellular and molecular biological cascades that attempt to counteract such chemical injuries. Depending on the severity of the chemical insult, biological responses often lead to inadequate wound healing and result in long-term pathology instead. Exposure to other toxic industrial chemicals such as acrolein, chloropicrin, and hydrogen fluoride, can also cause prominent eye and skin damage. There are currently no FDA-approved drugs to counteract these injuries. Hence, the possibility of a mass casualty emergency involving these chemicals is a major public health concern. Recognizing this critical challenge, the United States Department of Health and Human Services (HHS) is committed to the development of medical countermeasures to advance national health and medical preparedness against these highly toxic chemicals. Here, we provide an overview of various HHS funding and scientific opportunities available in this space, emphasizing parallels between eye and skin response to chemical injury. We also discuss a main limitation of existing data and suggest ways to overcome it.

Police prehospital trauma care and hemorrhage control training as an indicator for elevated performance: A systematic review of literature

The global escalation of terrorist and felonious assaults in the civilian environment along with the Emergency Medical Services lack of training in tactical emergency casualty care lead the police forces to look for new training strategies regarding penetrating trauma management from Law Enforcement Personnel. USA police agencies approached the military committee for guidelines due to similarities presented between civilian incidents and warfare. Therefore, modified Tactical Emergency Casualty Care programs were developed. These programs were also adapted by the Hellenic Police Force, along with German, Italian, French and British Police. The aim was to elevate Law Enforcement Officers medical knowledge and practical skills in bleeding control, tension pneumothorax and airway management using hemostatic dressings, tourniquets, decompression needles and nasopharyngeal tubes respectively, in an ongoing situation. It is evident that LEOs training nowadays is more demanding as far as it concerns severe and life-threatening injury management, resulting to increased self-confidence and medical skill development. On the other hand, such training should be accessible and cost-efficient to the majority of field-operating personnel.

Tactical Emergency Casualty Care and the Art of Practicing Nonmaleficence in Harm's Way.

This exploration of the author's training and experience as a tactical physician underscores the benefits of physicians' work with law enforcement personnel in field-based operations that are ethically complex. The article points in particular to physicians' roles in assessing potential risks and benefits-especially of use of force-to promote community safety.

Концепція надання екстреної медичної допомоги при масовому ураженні

У статті наведено основні проблемні питання організації і надання екстреної медичної допомоги у масових випадках та намічено шляхи їх вирішення.

PERITONEAL CLOSURE VERSUS NON-CLOSURE IN OPEN APPENDICECTOMIES

Acute Appendicitis is a common surgical emergency and Open Appendicectomy is widely performed. This study aims to analyze the difference of outcome in peritoneal closure versus Non closure in open appendicectomy. Adult patients (18- 65 years) admitted and operated for Acute appendicitis were studied prospectively from July 2019 to July 2020 at King George Hospital, Visakhapatnam. The intra operative time, post-operative pain, wound infection and duration of hospital stay were analyzed. Between July 2019 and July 2020 there were 86 patients with diagnosis of Acute appendicitis to the emergency casualty of KGH, Visakhapatnam and underwent Open appendicectomy. They were divided into two groups randomly, Group A: Open appendicectomy with peritoneal closure (39) and Group B: Open appendicectomy with non-closure of peritoneum (47). There was found to be a reduction in the duration of surgery, less post operative pain and shorter duration of hospital stay in patients who underwent non-closure of peritoneum compared to patients who underwent peritoneal closure. There was no difference in incidence of post-operative wound infection when compared to closure of peritoneum. Non closure of peritoneum is associated with shorter operative time, reduced requirement of post-operative analgesia and shorter duration of hospital stay and hence can be safely recommended.

Immediate Paramedic Tactical Response Unit in a Civilian Emergency Medical Service: The First Year Experience.

An immediate paramedic tactical response unit was implemented into a civilian emergency medical services (EMS) system. This was compared with the preexisting traditional tactical EMS support (TEMS). The primary aim of the study was to evaluate the effect on tasking frequencies. The secondary aims of the study were to assess mission timings and the effect on patient encounters. Paramedics with tactical emergency medical training provided immediate response on a 24/7 basis. They responded to support police in high-risk TEMS scenarios and incidents in a Tactical Emergency Casualty Care (TECC) role. Tasking frequencies, timings, and clinical input were compared between the first year of immediate response and 3 preceding years of TEMS. The number of TEMS dispatches increased from an average of 5 to 54 annually. The median time from dispatch to scene arrival decreased from a median of 54 minutes (interquartile range [IQR] 39-65) to 17 minutes (IQR 11-26) (p < .0001). The overall mission duration decreased from a median of 3 hr 13 min (IQR 2 h 29 min to 4 h 40 min) to 1 h 12 min (IQR 34 min-1 h 18 min) (p < .0001). The number of treated patients increased from one minor injury annually to 13 severe and six minor injuries annually. Implementing immediate tactical paramedic response significantly decreases response time and mission duration and increases the number of activations and resultant number of treated patients.

A faster and easier biodosimetry method based on calyculin A-induced premature chromosome condensation (PCC) by scoring excess objects

Dicentric analysis and the ring PCC assay as established biodosimetry methods both have limitations in the estimation of absorbed doses in suspected overexposure cases between 5 and 10 Gy. The proposed method based on calyculin A-induced PCC overcomes these limitations by scoring excess objects as the endpoint. This new scoring method can potentially serve as a faster and up-scalable approach that complements the existing methods with higher accuracy at different dose ranges. It can also potentially be performed by less skilled workers when no automated system is available in mass casualty emergency cases to assist with the triage of patients. Additionally, it offers the possibility to further reduce the sample size and PCC induction time. In this pilot study, a calibration curve for excess objects was constructed using the new scoring method for the first time and a blind validation test composed of three unknown doses was carried out. Almost all the dose estimates were within the 95% confidence limits of the actual test doses by scoring only 50–100 PCC spreads. This method was found to be more accurate than ring PCC for doses below 10 Gy.

Allocating Medical Resources During a Mass Casualty Emergency: Sometimes It Is OK to Wait

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2 or COVID-19) pandemic has overwhelmed health care systems the world over, turning the situation into a “mass casualty emergency” (MCE) in some locations. Ideally, medical resources—material and human—would be unlimited. However, as the current pandemic has made evident, such thinking is utopian—shortages and rationing are here.1 As such, health care providers must be prepared to make critical allocation choices with life-and-death consequences.

How to Stop the Bleed: First Care Provider Model for Developing Public Trauma Response Beyond Basic Hemorrhage Control.

IntroductionSince 2013, the First Care Provider (FCP) model has successfully educated the non-medical population on how to recognize life-threatening injuries and perform interventions recommended by the Committee for Tactical Emergency Casualty Care (C-TECC) and the Hartford Consensus in the disaster setting. Recent programs, such as the federal “Stop The Bleed” campaign, have placed the emphasis of public training on hemorrhage control. However, recent attacks demonstrate that access to wounded, recognition of injury, and rapid evacuation are equally as important as hemorrhage control in minimizing mortality. To date, no training programs have produced a validated study with regard to training a community population in these necessary principles of disaster response.MethodsIn our study, we created a reproducible community training model for implementation into prehospital systems. Two matched demographic groups were chosen and divided into “trained” and “untrained” groups. The trained group was taught the FCP curriculum, which the Department of Homeland Security recognizes as a Stop the Bleed program, while the untrained group received no instruction. Both groups then participated in a simulated mass casualty event, which required evaluation of multiple victims with varying degree of injury, particularly a patient with an arterial bleed and a patient with an airway obstruction.ResultsThe objective measures in comparing the two groups were the time elapse until their first action was taken (T1A) and time to their solution of the simulation (TtS). We compared their times using one-sided t-test to demonstrate their responses were not due to chance alone. At the arterial bleed simulation, the T1A for the trained and untrained groups, respectively, were 34.75 seconds and 111 seconds (p-value = .1064), while the TtS were 3 minutes and 33 seconds in the trained group and eight minutes in the untrained groups (physiologic cutoff) (p-value = .0014). At the airway obstruction simulation, the T1A for the trained and untrained groups, respectively, were 20.5 seconds and 43 seconds (p-value = .1064), while the TtS were 32.6 seconds in the trained group and 7 minutes and 3 seconds in the untrained group (p-value = .0087). Simulation values for recently graduated nursing students and a local fire department engine company (emergency medical services [EMS]) were also given for reference. The trained group’s results mirrored times of EMS.ConclusionThis study demonstrates an effective training model to civilian trauma response, while adhering to established recommendations. We offer our model as a potential solution for accomplishing the Stop The Bleed mission while advancing the potential of public disaster response.