1. Emergency Field Tourniquet Certification RESCUE Operations international group The L.E.A.R.N. Initiative RESCUE Operations international group The L.E.A.R.N. Initiative

2. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies Course Objectives By the end of this course students should be able to:  Explain the void from civilian first aid to providing aid in the tactical setting L.E.A.R.N.  Describe the phases of the L.E.A.R.N. initiative L.E.A.R.N.  Demonstrate treatment methodologies of the L.E.A.R.N. initiative  Demonstrate a working knowledge of hemorrhage control techniques  Demonstrate a working knowledge of basic airway management  Describe the process for notifying responders using the L.E.A.R.N. methodology

3. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live “ What you have seen in Russia I will bring to America” ~ Osama Bin Laden The sanctity and safety of our schools has been shattered by episodes of school violence across our country. Incidents such as Virginia Tech, Columbine, Jonesboro and several other tragic events, have highlighted the vulnerability of our educational institutions.

4. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies First priority within our nation’s school system is the safety and security of students, faculty and staff Development and implementation of procedures and protocols associated with casualty reduction, evacuation and treatment, will need to be an integral part of the pre incident plan Incident survival and the mitigation of long term injuries are dependent on limiting the amount of injuries sustained, timely application of proper medical treatment and extraction of casualties L.E.A.R.N. to Live

5. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies 2009–10 school year, 85 percent of public schools recorded approximately 1.9 million crimes Translates to a rate of about 40 crimes per 1,000 students enrolled in 2009–10 L.E.A.R.N. to Live

6. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Critical Issues for School Safety

7. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live L.E.A.R.N. The L.E.A.R.N.. TM initiative is a mnemonic created to empower staff, students and faculty to assist others as well as themselves in the event of a large scale catastrophic incident on campus L L - Lockdown procedures E E - Exsanguination Escape A A – Airway management R R - Recovery position, Reassure, Reassess N N - Notify rescuers of number of casualties and their status

8. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live LOCKDOWN PROCEDURES ** (Act No. 187 and Act No. 337) Minimum of 2 drills for each school year, in which occupants are restricted to the interior of the building and the building is secured Must be conducted at all schools that operate any grades K to 12, with security measures that are appropriate to an emergency, such as the release of hazardous material or presence of armed individual on / near premises ** ** Statewide Policy for Strengthening Domestic Security in Florida’s Public Schools Approval Date: October 10, 2003

9. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live LOCKDOWN PROCEDURES Inside Threat Intruder, Active Shooter, threat inside the building/s Immediate Actions i.Activate the internal notification system ii.Call 911 Protective Measures i.Outside activities routed away to safe location ii.Check immediate area for students iii.Close and lock doors and windows iv.Move students to a safe corner to reduce visibility v.Turn off lights, computer monitors, projectors and place phones on vibrate vi.Verify attendance vii.Remain in position until all clear and notified by law enforcement, fire, principal or designee * Consider use of code word for all clear

10. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live LOCKDOWN PROCEDURES Outside Threat Potential Intruder, Active Shooter, threat outside the building/s Immediate Actions i.Activate the internal notification system ii.Call 911 Protective Measures i.Check immediate area for students ii.Close and lock doors and windows iii.Move students to a safe corner to reduce visibility iv.Turn off lights, computer monitors, projectors and place phones on vibrate v.Verify attendance vi.Remain in position until all clear and notified by law enforcement, fire, principal or designee * Consider use of code word for all clear

11. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live LOCKDOWN PROCEDURES Shelter in Place Hazardous material or chemical incident outside of building Immediate Actions i.Activate the internal notification system ii.Call 911 Protective Measures i.Individuals outside the building should be relocated and separated from the other building population ii.Close and lock doors and windows (No entrance or exit) iii.Shutdown HVAC system iv.Ensure students and staff are in a safe area v.Verify attendance vi.Remain in position until all clear and notified by law enforcement, fire, principal or designee

12. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Exsanguination Hemorrhage Control “ The hemorrhage that takes place when a main artery is divided is usually so rapid and so copious that the wounded man dies before help can reach him”. ~ COL H.M. Gray 19 19

13. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Exsanguination Hemorrhage Control How long does it take to bleed to death from a complete femoral artery dissection? Answer: About 3- 5 minutes.

14. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Exsanguination Hemorrhage Control What does massive hemorrhage look like?.

15. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Exsanguination Hemorrhage Control Increase the chance of survival by: -Direct Pressure -Tourniquet -Hemostatic Agent -Pressure Bandage -Splinting

16. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Exsanguination Hemorrhage Control DIRECT PRESSURE -Immediate / self care -“Take a knee” -Real “Palm” Pressure -In the wound (packing)

17. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Exsanguination Hemorrhage Control Tourniquets

18. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Exsanguination Hemorrhage Control No longer last resort TQ’s have been used for many years to control bleeding Used for hours during surgeries without negative outcomes Two commercially available tourniquets recommended by USAISR CAT TQ SOFTT-W Tourniquets

19. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Exsanguination Hemorrhage Control Tourniquet Mistakes Not putting one on when you should Waiting too long to put a tourniquet on Not putting the tourniquet on tight enough Taking the tourniquet off when you shouldn’t Loosening the tourniquet to allow for blood flow to the injured extremity

20. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Airway Airway Management Should be done as soon as hemorrhage has been controlled (can be done simultaneously if enough hands) Signs of an obstructed airway  Snoring (Obstruction, probably the tongue)  Stridor/Wheezing (Upper airway obstruction)  Hoarseness (Swelling around vocal cords)  Gurgling (Fluid)

21. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Airway Airway Management Positioning Conscious patients to sit up if it helps them breathe o Allow fluids, blood vomitus to drain from their mouth o Unconscious / semiconscious patients placed in recovery position Jaw Thrust / Trauma Chin lift o If the victim is not breathing, attempt a jaw thrust or trauma chin lift

22. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Respirations Breathing assesses for: o Rate - fast, slow, or normal o Rhythm – Regular or irregular o Quality- normal, shallow, labored, or absent Injuries to the neck and torso should be covered by a three sided occlusive dressing.

23. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Recovery Position Obtunded or unconscious patients should be placed in a recovery position to better protect them from aspiration or obstruction (most often the patients tongue) o Listen for o Snoring o Wheezing o Gurgling

24. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Reassure Reassure patient to keep them focused on survival and to diminish fear and anxiety. Panic is contagious it is important to keep victims and witnesses calm Avoid negative remarks or comments about a victims condition Hearing is one of the last senses to be lost even when someone appears to be unconscious

25. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Notify Use the color coded placards to notify rescuers of number and classification of injury o Green: very minor or no injuries o Yellow: has injuries but is conscious, breathing and has a good pulse and no signs of active bleeding or difficulty breathing o Red: Has a serious injury and needs immediate help o Black: The person is believed to be deceased

26. Points of Instruction Tourniquet history Dispelling the myths Familiarization with CoTCCC approved tourniquets Indications for tourniquet use Tourniquet protocol per TCCC guidelines Proper placement and procedures for tourniquets Tourniquet use in Care Under Fire Tourniquet use in Tactical Field Care Tourniquet removal and/or movement Foundational vignettes and studies L.E.A.R.N. to Live Summary L.E.A.R.N. Use the L.E.A.R.N. program to assist in treating victims of a man made or natural disaster until help arrives L.E.A.R.N. The L.E.A.R.N. neumonic utilizes lockdown procedures currently in place by most schools Escape from an incident is the best course of action if feasible, otherwise treatment of the injured will potentially reduce mortality Control all hemorrhage to reduce the likelihood of early death Reassure all victims and avoid panic Notify rescuers of the number of victims and their condition by using the placards provided