Tactical paramedics the new war-zone developed gear.

Tactical paramedics might be found wherever there’s danger — stabbings, shootings, explosions, police raids, suspicious packages, hazmat calls.
And some of the medical techniques and products they’ll use at these scenes are coming straight from the battlefields of Afghanistan and Iraq.

“We’ve learned a bit from the battlefields,” says Craig MacInnes, acting commander of special operations with the Ottawa Paramedic Service.
The first tactical paramedic unit in Canada was introduced in Toronto in 1996. Ottawa launched its own in 2003.
Today, almost every major city in Canada has a similar unit, but Ottawa’s has the widest scope, mostly because this is the capital, and first responders have to be prepared for myriad potential risks because of the presence of the federal government and embassies. There are also more training opportunities in Ottawa, including working with the military, police and RCMP.
When the Canadian Forces went to Afghanistan, it was the first time Canadians had been deployed in a combat role since the Korean War, about 50 years earlier.
They brought with them a trauma treatment protocol called Tactical Combat Casualty Care, known as TCCC — or “T-Triple-C” — which had been introduced in 1996 for U.S. Special Operations Forces as the result of a review of data from the Vietnam War.

The physicians who conducted the review concluded that about a quarter of deaths could have been prevented. That prompted a re-thinking of how casualties were managed on the field of battle.
Canadian Special Operations Forces adopted TCCC in 1999, and it was identified for conventional forces in 2002, before the Canadian Forces were deployed to Kandahar.
The Vietnam War review turned a long-accepted idea on its ear. In Vietnam, the leading cause of potentially preventable deaths had been bleeding from wounds in the extremities. At the time, tourniquets were frowned upon by civilian authorities (“an instrument of the devil that sometimes saves a life,” said one critic), and the military followed this line.
But on the battlefield, stopping hemorrhaging through the use of tourniquets, dressings and pressure became became the first priority, said Lt. Col. Colleen Forestier, a physician who is director of health services operations in the Canadian Armed Forces.
“It was undeniable that we were saving lives with the use of tourniquets,” said Forestier, who served for seven months in Afghanistan. “If you kept the blood in, then the patient survived. It was a complete change in thinking.”
The practice filtered from the military to tactical paramedics, and now to general practice. There are now two tourniquets on every ambulance in Ottawa, and tactical paramedics carry multiple tourniquets.
Meanwhile, other products and protocols used by army medics have also trickled into paramedic use, first by tactical teams, then by all paramedics. The war in Afghanistan introduced hemostatic dressings such as gauze impregnated with an agent that aids in the coagulation of blood, as well as intraosseous IV, the process of injecting medication or fluid directly into the bone marrow, usually in the shinbone, if intravenous access is not possible.
Battlefield lessons quickly translated into civilian use. It took only a few years for what is called “pre-hospital trauma life support” to be endorsed by the American College of Surgeons, said Forestier, who works occasionally in the emergency room at the Queensway-Carleton Hospital.

For military medics, the other piece of the puzzle was the tactical piece — how to do quick interventions in the field without anyone else getting injured, Forestier said.
“The first priority was making sure that no one else got hurt.”
Tactical paramedics have to be prepared to use their training and personal protective equipment to work in a environments where there is a high level of threat, such as active crime scenes and unstable situations, McInnes said.
They must follow the commands of their police partners, and have a high level of awareness of the situation they’re working in, including direct and indirect threats.
The members of the team have to maintain “unique and discreet communications” between themselves. Essentially, that means they have a shared language of signals and words that is understandable only among themselves. They have to be careful to protect evidence at a scene, and they might have to work with little light and minimal equipment.
While Ottawa’s tactical paramedic teams are prepared to rush to a high-stress scenario at any time. But most of the time they are on everyday calls — chest pains, car accidents and falls, for example, MacInnes says.
Tactical calls represent only a small fraction of the paramedic service’s total workload. They enter a scene only when they are allowed by police and they don’t carry weapons.
Ottawa tactical paramedics train for two months, plus one day every month to keep up their skills. The team also participates in one-week team training every year.
The unit asks for expressions of interest when new team members are needed. Candidates are asked for an essay and a letter of recommendation from their superintendent.
They’re expected to have a clear employee file. There’s also an interview and baseline physical testing — every tactical paramedic wears a 25-pound ballistic vest and carries more than 50 pounds of additional equipment. Candidates who clear these hurdles are tested for physical, medical and psychological aptitude. Successful candidates then move on to an intake course.
Tactical paramedics take “stress inoculation training” in which they are exposed to situations from a chaotic crowd to the absolute silence of a field of long grass.
“We are always prepared,” says Greg Forsyth, superintendent of special operations with the Ottawa Paramedic Service. “We know that these environments exist. Is there more stress? I don’t think it’s any worse, except for the volume.”

Originally published at https://www.blokumenn.com. Blokumenn Ltd