Fire and EMS inherently work in high-risk environments. By understanding the priorities of patient management, i.e., what is killing the patient right now, you can provide the required care without wasting time on unimportant details and treatments, which just increases the risk to everyone working in a dangerous environment.  All of these factors apply equally in a burning or unstable building after an earthquake or explosion.

Although the first step of an EMS testing scenario is to “ensure scene safety,” In active violent incidents*, you can never ensure scene safety. Rather, your goal is to mitigate risk. Fighting fires is not safe, it is inherently dangerous, but you mitigate the risk to rescuers and casualties with training and equipment.  

In December 1970 the US government published a study showing what killed casualties in Vietnam. The report identified three preventable and treatable causes of death: massive external hemorrhage, tension pneumothorax, and airway occlusion. That data eventually led to the DOD’s Tactical Combat Casualty Care (TCCC) guidelines. 

Those TCCC guidelines are optimized for patient care on the battlefield. Tactical Emergency Casualty Care (TECC) guidelines used TCCC guidelines as an evidenced-based starting point for managing civilian trauma patients in high-risk environments. 

If you are trained to manage those three causes of preventable death in a high-risk environment, doing them at a more typical scene call, car crash, or other accident it is simply easier.

Crisis Medicine’s courses don’t just present what is in the TCCC or TECC guidelines but also discuss the medical literature supporting or, in some cases, contradicting guidelines recommendations. 

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In one sad case, a local fire service was taught all tourniquets are placed “high & tight” on a limb regardless of the situation because that is how their former military trainer was taught. Subsequently, that fire service placed a tourniquet high on the thigh of a forklift operator with a partial foot amputation after a warehouse accident. Eventually, the worker lost his entire lower extremity to the level of the tourniquet. An exceptionally rare and unnecessary complication could have been prevented with proper training.

US Army Special Forces Medics are the best-trained combat medics in the world: however, taking care of a casualty in a wadi in Afghanistan is not identical to managing a casualty in a nightclub shooting. You need to evaluate your instructor’s credentials to ensure you are getting a complete analysis of the medical evidence behind the techniques, not just something that worked once for them in a bad situation. 

Is your service using a TCCC recommended tourniquet? If you are, what is the medical literature in support of the one chosen? What is the evidence supporting its use and efficacy? Most Emergency Physicians don’t know this literature, so even your medical director may not have the most up-to-date information.

We know most online training is mediocre. Ours is professionally filmed on a soundstage with clear audio, scientific backing, and step-by-step skills demonstrations of all the techniques taught. These skills stations will allow Fire and EMS to practice the skills independently, perfecting their techniques so they are amply prepared to save lives in dangerous situations. Note: Please review the content warning. The course uses photographs of actual injuries, diagrams of wounds, and step-by-step demonstrations. Strong language is occasionally used.

An Emergency Medicine physician can teach you the science. A former special operations veteran can tell you what works. Mike Shertz, MD-18D, can do both. With over 20 years as a Fire and EMS medical director and law enforcement experience running a tactical medical program, Mike integrates medicine and tactics to apply them to inherently dangerous environments.

*Although traditionally thought of as active shooter events, after the 2013 Boston Marathon Bombing, where 264 casualties were wounded, three triple amputees, and three killed, but no one was shot, the term was changed to more expansively cover these events.