Tactical Update – A Report from TacT17

OK it’s a few weeks back, but here’s Greg Brown with the lowdown on a conference about tactical matters. 

Conferences: a formal meeting of people with a shared interest, typically one that takes place over several days; the means by which professionals from around the globe congregate with a view to learning from each other. Sometimes also referred to as junkets, jollies, paid holidays and tax write-offs.

But in all honesty, oftentimes the only way one can be afforded the chance to be surrounded by like-minded professionals with a view to learning from the experience of others, benchmarking your intellectual property against that of other organisations operating in the same “space” and refining your knowledge thanks to the latest in international research is to travel to the other side of the world and attend a conference. So, as one of the few non-government providers of tactical medicine training in Australia, that’s precisely what we did.

In mid-October 2017 two of CareFlight Education’s staff travelled to sunny (well, we assume there was sun above the pouring rain) Sundsvall, Sweden, to attend the inaugural Tactical Trauma conference.  If you are on Twitter, you can search for it using #TacT17. If you are not on Twitter, then join Twitter and search for it using #TacT17….

This post provides a summary of what we found, what we liked, what we didn’t like and some takeaway points.

Patch
The words are cool probably, but maybe put a shirt on when you hold Death back buddy.

The Peeps

This was truly an international event. Presenters came from across Europe (with a strong Scandinavian presence, as expected), North America, the Middle East and even Australia. Participants included both hospital and pre-hospital doctors, nurses, paramedics, police medics, retrieval (road and air) clinicians and military folk.

The Stuff to Chew On

As the name “Tactical Trauma” suggests, the conference was focussed on the medical management of trauma with a tactical twist. It should be noted that discussions regarding any tactical imperatives were limited by the realities of operational security. For obvious reasons, nobody wished to describe their unit’s tactics in great detail.  They were enough to paint the scene though.

Therefore, if you were looking to learn how to become the next big thing in SWAT team medicine then this conference probably wasn’t for you – and there certainly were no skill sessions on how to kick in doors, breach a terrorist stronghold or fast rope from a helicopter (although these might be popular sessions next time).

Rather, focus was placed on the provision of “good medicine in bad places”. There were sessions by military doctors discussing what worked (and what didn’t) on recent deployments (including topics such as blast injuries, penetrating chest injuries and rates of injuries in dynamic events), the usefulness (or otherwise) of helicopter emergency medical services in hostile mass casualty events, comparisons of contemporary haemostatic agents versus conventional bandages in wound packing, the perils of acute traumatic coagulopathy, discussions on vascular access options, and the progress over the years in the application of clinical management strategies. It is also worth noting that since this is in fact 2017 no medical conference would be complete without at least one presentation on POCUS (that’s Point Of Care UltraSound – and yes, it is very useful) and one on REBOA (or Resuscitative Endovascular Balloon Occlusion of the Aorta – and no, there is not enough evidence to definitively support it); these were dutifully attended to.

Case studies are always useful; in this instance we were treated to reviews by the Finnish and Norwegians of their tactical emergency medical support systems, the Israelis and their medical response to contemporary domestic contingencies and both the French and Swedish on their responses to recent mass casualty events. There were also a few “closed door” sessions for police medics regarding recent mass casualty events in the USA.

But finally, as most of us already appreciate, being outstanding at your trade is only part of the job; the ability to communicate effectively with your team members whilst managing your own stress levels are also vital in providing optimal patient care. As such, sessions on crew resource management skills, the cognitive revolution, tips for centring one’s self prior to and during a job, and how to get the rollout of good ideas actually rolling were welcome additions to the program.

Things We Liked

  • Firstly, whilst it is obvious that military experiences inform civilian practices, we appreciated the fact that this conference was focussed on civilian (not military) practice. Other conferences of the type claim to do this yet the majority of the auditorium is filled with uniforms of various militaries.
  • Secondly, sessions were kept at a length that were short enough to retain audience attention but long enough to cover the required level of detail for the given topic. If a topic was not floating your boat, a new topic would commence in 20 minutes.
  • Thirdly, at no point did we hear “you must do it this way – if not, you are wrong”. The overall feel of the conference was that no single entity had all the answers but that through collaboration we can all improve. Participants were encouraged to seek out presenters (who were all easy to find) and undertake collaboration.
  • Finally, the focus was on “good medicine in bad places” and not cool Velcro patches, the latest fashion in tactical gear (which would obviously only come in black and be stamped with a label consisting only of numbers) and the liberal application of mutual back-slapping.

Things That Were Not the Business For Us

  • Despite the fact that the conference was aimed at civilian practice, the majority of presenters referred to TCCC (Tactical Combat Casualty Care) and not TECC (Tactical Emergency Casualty Care). It is possible that the presenters were using the term TCCC out of habit, but when one considers that the latest review of TCCC by the Committee has lead to their terms coming closer into line with that of TECC (and not vice versa), it is time that the world started embracing the correct terminology.
  • Having a single track makes it hard to keep everybody interested, and at times we felt sorry for certain members in the room. These folks included frontline police officers who have a secondary role of medical response – whilst the clinicians were riveted by the maps of clotting cascades and stories of roadside REBOA, the Police Medics just wanted to know (a) how best to plug the hole, and (b) how fast to drive.

[Note: we got the impression that the conference convenors were victims of their own success – we are not sure they realised just how popular it might be when they originally floated the idea on social media. We are confident that this issue will be alleviated next time.]

The Takeaways

If you had to sum up the content of a jam-packed two-day conference in just a handful of points then these would be them [note: these are more paraphrases than quotes]:

  • “Learn from the experiences of others. Recognise that no single agency has all the answers, so work with and not against each other.” Matt Libby, flight paramedic with Boston Med Flight, USA
  • “In resuscitation, the most effective therapies are those that can be applied quickly. Time is blood.” Dr Richard Dutton, trauma anaesthetist, USA
  • “You can possess all the best haemorrhage control devices in the world, but if you are not using them properly then they are worthless. Training is key.” Dr Mark Forrest, medical director of ATACC, UK
  • “Battlefield medicine is like plumbing: if it’s blocked, clear it; if it’s leaking, plug it.” Gary Grossman, CSAR paramedic, Israel
  • “In a high risk or major incident, it makes sense to have all rescue agencies working together under a common SOP that has been tested prior.” Dr Stephen Sollid, medical director and retrievalist, Norway
  • “REBOA has a place in pre-hospital care; we are just not quite sure what that place is. Blood will still be lost from backflow.” Dr Tal Hörer, vascular surgeon, Sweden
  • “Medics in the hot zone should focus on not getting themselves killed and not endangering the mission. Cross training is vital.” Dr (LTCOL) Ishay Ostfeld, IDF and cardiothoracic surgeon, Israel
  • “In a critical patient, performance of life saving interventions should take precedence over applying rigid protocols around immobilisation.” Dr Thomas Dolven, intensivist and retrievalist, Norway
  • “People only improve if they actually want to. You cannot force improvement.” Michael Lauria, former USAF PJ and current medical student, USA
  • “When it comes to vascular access, there should not be different hospital standards and prehospital standards. There should just be standards.” Dr Knut Taxbro, anaesthetist and retrievalist, Sweden.

The Recommendation

So I guess the big question that remains for everyone is “was 50+ hours of travel from Australia to central Sweden for a 17 hour conference really worth it?” Given that we were able to assess the content of our training against that which other like-minded organisations from around the world provide in an open and non-threatening forum, tweak our content in line with the latest evidence, build contacts with groups and individuals that have the same struggles as we do in Australia, and provide some guidance to participants who were looking to develop their own tactical medicine training – the answer is obvious.

Moose
Look it’s hard to respect an animal mascot that doesn’t spend most of its time sleeping like a koala but good effort I guess.

Wait, I almost forgot the really vital lessons

These things:

  • The Swedish love speed cameras. I mean, seriously, they are everywhere!
  • Reindeer is actually quite tasty.
  • Moose is a bit, well, meh….
  • When it comes to rivalries, Norway is to Sweden what New Zealand is to Australia.
  • The Australian TV shows “Prisoner” and “Flying Doctors” are compulsory viewing for Swedes.
  • And 50+ hours of travel by air is in fact a very long way – but it beats driving.

 

Notes:

Hey, are you interested in this stuff?

Well you could choose to read our previous posts about TECC here, here, or here. If you do you’ll find heaps of references and further reading on all things tactical.

CareFlight does have courses on that sort of stuff (it’s one of the bits you can find here) so you might find a bit of interest in that or, [looks shy, kicks dirt] y’know, do whatever. If you were interested (but no pressure) it runs pretty regularly (like in 2018 it’s happening on 12 February, 26 May, 20 August and 24 November).

Meanwhile if you like the stuff on the site you could always share it around. Or even sign up to get the emails whenever things hit.

 

 

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