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April 18, 2017

Beyond CPR: One community prepares to call on citizens in a disaster

Daily Briefing

    Health care providers say civilian bystanders are often the first to respond in the wake of a mass casualty emergency—and local officials in one California city are training bystanders to respond and deliver emergency medical assistance beyond CPR, Soumya Karlamangla reports for the Los Angeles Times.

    Fire and law enforcement officials in Rancho Cucamonga in California regularly trains bystanders to provide emergency care in the aftermath of a shooting, which Karlamangla says is one example of a nationwide push to prepare civilians to deliver emergency medical assistance beyond CPR.

    'Civilians are always there first'

    In the aftermath of the Boston Marathon bombing, many bystanders—some of whom were off-duty health care professionals—provided emergency care for the wounded. James Hooley, chief of Boston's emergency medical services agency, said such civilians used T-shirts to stem bleeding and even used store shelves to fashion makeshift stretchers. When paramedics arrived, many patients had already been triaged by severity.

    Boston hospitals: What we learned from the Marathon bombings

    Hooley said civilian first responders helped keep the death toll relatively low compared to the total number of people wounded in the attack. "With a population that's even minimally trained, they can be a very good force multiplier," he said.

    Ofer Lichtman—the Rancho Cucamonga Fire District's terrorism liaison coordinator, who helped create the program—added, "Whether it's a vehicle attack in Sweden, a church bombing in Egypt, or an elementary school shooting in San Bernardino, the common denominators is that civilians are always there first."

    Special training

    With those lessons in mind, Rancho Cucamonga's fire and law enforcement officials are holding classes to teach emergency response techniques to civilians. The program started in January of last year following the deadly mass shooting in nearby San Bernardino.

    At one recent training, Fire Capt. Patrick Lewis told trainees that they would need to push through their fear and be "clinical" if they are in a position to help in the aftermath of a shooting or other attack. "Who's going to make the biggest difference? You guys," he told the group.

    According to Karlamangla, the training sessions last about three hours and cover topics such as:

    • How to carry someone who is seriously injured;
    • Triage techniques;
    • How to position the wounded to minimize airway obstructions;
    • How to apply a seal for a chest wound;
    • Keeping shooting victims warm so their body temperatures don't drop dramatically; and
    • How to tie a tourniquet.

    In regard to tying a tourniquet, Lewis advised, "Stop when the bleeding stops, not when the screaming starts." So far, the program has trained about 6,000 civilians, as well as local school and municipal employees and law enforcement officers from outside of the area.

    A broader trend

    Rancho Cucamonga's training can be viewed as part of a broader push to give civilians more skills to respond to medical emergencies, Karlamangla writes. For instance, in 2015 the White House launched a national "Stop the Bleed" campaign to encourage Americans to treat bleeding after a serious injury by applying pressure and a tourniquet.

    Matt Levy, the head of the Stop the Bleeding Coalition, a not-for-profit that provides resources to people who want to teach such skills, said the training is not just useful during a terrorist attack, but after workplace injuries and other accidents. "My hope is that one day this will be taught in schools just like CPR," he said (Karlamangla, Los Angeles Times, 4/15).

    From bombings to hurricanes: How can hospitals prepare for disasters?

    Hospitals must be prepared for myriad disasters that can stress health care systems to the breaking point and disrupt delivery of vital health care services.

    Advisory Board has compiled step-by-step procedures for various threats your facility may encounter—though we hope you'll never need to use them.


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