Phases of care
PHASES OF A CRISIS
A crisis is no accident, even though it is often defined as either a chance event or an event caused by stress-response carelessness. When we are under extreme stress we think differently, act differently and create memories differently. Critical thinking skills become absent as our brains divert that energy into the fight, flight or freeze response. Most deaths and injuries due to a crisis are caused by stress-response carelessness and not a chance event and are thus preventable.
Traumatic incidents fall into two categories: intentional and unintentional. Intentional injury results from an act carried out on purpose with the goal of harming, injuring or killing.
Traumatic injury that occurs not as a result of a deliberate action, but rather as an unintended or accidental consequence, is considered unintentional.
Trauma care is divided into three phases: pre-event, event and post-event. Actions can be taken to minimize the impact of traumatic injury during any of the three phases of trauma care.
CARE UNDER FIRE
Care under fire is the care provided while under hostile fire. In this circumstance, medical equipment and supplies are limited. Attention to suppression of hostile fire may minimize the risk of injury to would be victims and teammates. There is little time available to provide care while under enemy fire and it may be more important to suppress enemy fire than stopping to care for casualties. The event will dictate how much care you are able to provide.
Where the event occurs is called the X spot. The X spot is ongoing chaos. Through effective engagement of the hostile force, we will add order to the chaos. The first thing to do is create Control Points. Specifically, Command and Control Point, Casualty Collection Points and Rapid Evacuation Control Points.
The common principles for bring order to chaos are:
- Security: Securing Designated Control Points
- Clear Delineation of what is Inside/Outside of the Control Points (i.e.: chemlights, color tape etc.)
- Create Effective Work Space for Field Care and Rapid Evacuation (big enough for the casualty(s) and medical supplies/equipment)
- Ensure that Command and Control is Integrated, is Mobile and Allows Command and Control to Make Fluid Decisions
- Rapid Evacuation Control Points should be thought of as locations that allow for and increased speed of movement (i.e.: area cleared of debris, litters, vehicles etc.) of casualties and responders away from a threat (i.e.: IED, new attack, spreading fire etc.)
Field Care
When effective hostile fire has ceased, care may be rendered to the casualties. Initial triage, then moving casualties to an area under cover called a Casualty Collection Point (CCP) to administer Field Care. While law enforcement officers, vets and citizens who care about their civic duty to protect surround the Casualty Collection Point (CCP), anticipating another attack. The upcoming homeland attack will come in waves. This requires a different approach to Care Under Fire, Field Care and Evacuation Care. Our efforts need to be coordinated and drilled.
Evacuation Care
Primary targets in the upcoming homeland attack are Level One Trauma Centers across the country. As such, local hospitals need to rethink their response. Transporting to a higher level of care may not be available as these Level One Trauma Centers will be diverting their patients due to an ongoing terror attack. Therefore, Evacuation Care should be considered from the Casualty Collection Points to the local hospital. Local hospitals should drill triage protocols with secure Mobile Care Zones across the hospital campus; while engaging in lock-down procedures and assigning Law Enforcement Officers, Vets and Patriotic Citizens protect the local hospital campus.