One of the most important parts of tactical/austere/emergency medicine that isn’t talked about much is the mindset and mental piece. Those that have been in the field for a long time understand this, but when learning the skills, it is never discussed enough. I don’t know if this is because it isn’t cool to talk about, if it is because it isn’t viewed as important by the academic crowd, or what the issue may be.
A problem that I noticed is that not all the trainers have done a lot of tactical trauma or remote rescues. All the theory they are teaching is correct, its just that once it is put in it play a lot of other minor or seemingly minor issues arise.
One of the guiding principles of TCCC is that fire superiority is the best medicine. In my experience I have found this to be 100% true. But what does this mean? To some that I have spoken with, they think that it means that everyone is expendable. I understand how that could be an immediate response to hearing that. But what fire superiority is, removing the threat, the thing that makes “is the scene safe?” the question that every EMT/medic is taught to look for at the beginning of every scenario. But its bigger/simpler than that. It is solving the most important problem first. If the threat isn’t removed than anyone that is going to save the casualty will likely get injured or killed as well (that is why we get them off of the X). The second reason that fire superiority is so vitally important is that the winning mentality is vitally important to a casualty’s survivability. They were able to scientifically prove that a casualty on the winning side will more often survive wounds that someone on the losing side will not.
If the casualty does not fight for themselves or have the will to fight for themselves then they will shut down quickly. Another issue that comes up is when the first responder says “I’m here its okay, you’re going to make it. What happens then is that casualty stops fighting for themselves and “lets the corpsman, medic, first responder save them, except their body stops fighting for itself as well.
So if you ever arrive to a casualty (whether or not they can speak) the thing that you need to keep telling them is that I’m here to help and you need to stay with me and fight for yourself. Keep fighting. And talk to them, it will calm both of you down. If you are hysterical it will panic them and make it worst. However, if you come to the casualty as a quiet professional that is composed and speaks to the casualty calmly than the entire scene will work. This air will transfer to everyone there and you can get down to the business of helping them.
People will be reassured if they know that someone is there to help them, they will get worst if they can see your panic and lack of composure. If someone is hysterical on the scene of an injury, then they need to be given a job or removed from the scene altogether. Typically, if someone gets close enough to be in the way it is one of these to issues. Occasionally someone with a camera shows up and gets in the way, even in military, they might have to be told to kick rocks. Sometimes a loved one is an issue, and if they can’t be given a job that is helpful than they need to go away. Everyone else that is there wants to help and sometimes giving them the task of managing the crowd is enough, looking for the ambulance or working on the evac plan are important as well.
If you have a radio system (the military didn’t seem to have this problem) there will be someone on the other end (usually in a supervisory position) that will start screaming and second guessing you. Their panic can be contagious and not helpful. Ignore them if you can or tell them that they can kick rocks. That person can’t oversee a medical scene that they aren’t at.
So how does someone practice so that they can approach a casualty with the right mindset? Like anything else it must be trained for, to develop the confidence in these types of situations. In addition to the actual training, you need to start running mental rehearsals so that your mind has practiced multiple scenarios repeatedly. Having a plan prevents panic in a big way. If you get stuck then you need to go back to the beginning of whichever assessment that you use and start over. Be it MARCH, trauma, and simple head to toe if you don’t what else.
-Joe
Outpost 95 