RESUMEN
This report describes the development of an evidence-based guideline for external hemorrhage control in the prehospital setting. This project included a systematic review of the literature regarding the use of tourniquets and hemostatic agents for management of life-threatening extremity and junctional hemorrhage. Using the GRADE methodology to define the key clinical questions, an expert panel then reviewed the results of the literature review, established the quality of the evidence and made recommendations for EMS care. A clinical care guideline is proposed for adoption by EMS systems. Key words: tourniquet; hemostatic agents; external hemorrhage.
Asunto(s)
Servicios Médicos de Urgencia/normas , Medicina Basada en la Evidencia/normas , Hemorragia/terapia , Hemostáticos/administración & dosificación , Guías de Práctica Clínica como Asunto , Torniquetes/normas , Administración Tópica , Servicios Médicos de Urgencia/métodos , Extremidades/lesiones , Hemorragia/mortalidad , Hemostáticos/normas , Humanos , Recuperación del Miembro/métodos , Medicina Militar/métodos , Medicina Militar/normas , Choque/prevención & control , Choque/terapia , Estados Unidos , Heridas y Lesiones/complicaciones , Heridas y Lesiones/mortalidad , Heridas y Lesiones/terapiaRESUMEN
INTRODUCTION: Tactical teams are at high risk of sustaining injuries. Caring for these casualties in the field involves unique requirements beyond what is provided by traditional civilian emergency medical services (EMS) systems. Despite this need, the training objectives and competencies are not uniformly agreed to or taught. METHODS: An expert panel was convened that included members from the Departments of Defense, Homeland Security, Justice, and Health and Human Services, as well as federal, state, and local law-enforcement officers who were recruited through requests to stakeholder agencies and open invitations to individuals involved in Tactical Emergency Medical Services (TEMS) or its oversight. Two face-to-face meetings took place. Using a modified Delphi technique, previously published TEMS competencies were reviewed and updated. RESULTS: The original 17 competency domains were modified and the most significant changes were the addition of Tactical Emergency Casualty Care (TECC), Tactical Familiarization, Legal Aspects of TEMS, and Mass Casualty Triage to the competency domains. Additionally, enabling and terminal learning objectives were developed for each competency domain. CONCLUSION: This project has developed a minimum set of medical competencies and learning objectives for both tactical medical providers and operators. This work should serve as a platform for ensuring minimum knowledge among providers, which will serve enhance team interoperability and improve the health and safety of tactical teams and the public.