Oxygen: Tactical Administration (Part 2)

  Providing the best medical care in the austere environment.

 

BY: David E. Hall, Jr., NREMT-P

Since part-1 of this article was written almost a year ago several enhancements have been made to the design and application of the “Tactical O2 System. The most significant being a redesign in the nipple direction of the flow output. By turning the flow output to the side (from pointing toward the top or up-wards) we have been able to reduce the overall height and shortened the system. The length (height) in now only a little more than 15 inches.

So what’s the big deal? Any modification that will assist the SWAT or Tactical Team member receive oxygen, when necessary, is a big deal. Many “Tactical Medics” operate today without any means of delivering oxygen to a tactical officer at the scene (of the injury). They function without taking oxygen in the field.

Without a question, Oxygen administration is an early medical intervention that is beneficial to our patients. We are taught, beginning in the EMT-Basic course, that O2 should be administered in high doses and as soon as possible for all serious trauma patients. As I scroll through the BTLS (Basic Trauma Life Support) slides, I find that all treatment and management slides, include oxygen as a primary treatment modality.

So why are Tactical Medics not taking oxygen with them? The answer is simple, size and weight. Tactical Medics* must choose each item carried and taken into the hot zone, using extreme care in selecting the most beneficial to their patients. Only the flight medic comes close to the tactical medic when it comes to carefully selecting each piece of medical gear. Because of the possibility of extended operations (several days) and the necessity to carry their gear over long distances, a careful selection process becomes a necessity based on size and weight and benefit to the patient.

The typical tactical medic has basically three means of transporting their gear. The medic vest that is worn by the medic; a small fanny pack or other small bag that is strapped to the medic; a large bag - medical or trauma bag (most common is the Black Hawk - Stomp II Trauma Bag). Typically, the large bag is left at the scene in a place that is considered a safe zone. It is the place, determined by the medic, that a patient will be extracted to and advanced level medical care is begun at this position. Because of the size and weight of the "large bag" it is not practical to carry it into a hot zone, where the primary patient care focus is on airway control, bleeding control and extraction to the safe zone to begin advanced care.

Because of size and weight considerations, the typical “ambulance” portable O2, "D" cylinder system is not considered practical as an item carried by the tactical medic. This is where the “Tactical O2 System” comes in.

After years of discussing (with other medics and physicians) the practicality of taking portable O2 into the tactical environment, it was determined that we would have to create our own system if we wanted one to be light weight, small in size, easy to operate, provide enough oxygen to be of benefit and be inexpensive.

We took our idea and design of a Tactical O2 System to the expert oxygen system builders at “Flotec Inc”, a major EMS oxygen system manufacturer, last year. They agreed to build one for us in tactical medical community to try. The prototype was awesome and proved to be exactly what we were looking for in a set-up that is lightweight, compact, easy to operate and practical for the tactical setting. But most importantly, it can deliver enough O2 that is of a benefit to our patients: 14 minutes at 12 LPM to be exact. At a cost of less than $200 per system, we knew we were on to something.

Specs:

Together, Flotec Inc and Rescue Training Inc came up with was a very small O2 regulator (Figure 1) that is not adjustable, just one knob (on/off) fixed to deliver a set flow rate of 12 Liters per minute (LPM); a small "B" cylinder (170 L) that is made of aluminum and weighs a little over 2 lbs (Figure 2). We put them together, ready to go, in a unidirectional designed black Regency Laminate bag (Figure 3).  All together the "Tactical O2 System" weighs around 3 lbs, delivers 12LPM of 100% O2 for 14 minutes, and is small enough in size to easily fit into the "Black Hawk" bag. It is comparable to the size and weight of a 1000 cc bag of Normal Saline. (Figure 4)

This O2 set-up will allow the tactical medic to have an O2 system in his large bag (or carry on) that will provide the necessary oxygen for a non-rebreathing mask or the bag-valve-mask resuscitator for 14 minutes while awaiting the arrival of transportation from the tactical scene. Just what we needed!!!

Redesigned:

We have reduced the size but not the medication. It is smaller but still delivers 12 LPM for 14 minutes. We examined reducing the flow rate to 10 LPM, which would increase the total delivery time to 17 minutes. We found that that would be fine for a patient on a non-rebreathing mask, but it is pushing the limit on delivering an adequate tidal volume for an adult size BMV (bag-valve-mask) with or without an endotrachael tube. A flow rate of 10 LPM will not deliver 600cc per bag reservoir fill (squeeze) for 20 breath per minute. We elected to stick with the 12 LPM without options to adjust (to keep the size as small as possible). And we all felt that 14 minutes was an adequate / typical amount of time of O2 administration while waiting for the scene to stabilize enough for an EMS unit to be brought in or for the medic to transport the patient to an EMS rendezvous point.

If you would like more information on the "Tactical O2 System", call Dave Hall toll free at (877) 692-8911.

 

FUGURE 1 Ready to travel

FIGURE 2

Old Design

 

* The Tactical Medic (Physician, Paramedic, or EMT) providing medical support to SWAT or Tactical Teams requires a skill and knowledge base unique to paramedical personnel. Very dangerous conditions and unconventional hazards are commonplace for tactical law enforcement (SWAT) teams. Most teams are equipped and trained to handle hostage incidents, barricades, high risk warrant service and counter-terrorism missions. Many teams have additional duties which put them at high risk for injury, such as tactical diving and other marine activities, back country law enforcement, air operations or search and rescue. These teams are highly trained to operate in these adverse and austere conditions. Due to the nature of the missions and the special training of these teams, personnel continuously work at the edge of the safety envelope. Manpower maintenance and appropriate medical support are essential to mission accomplishment. Medical support for tactical law enforcement operations requires a unique expertise beyond medical competence. Not every EMT, paramedic or physician is trained or qualified to provide such support. Tactical Medics complete specialized training, which teaches the skills necessary to operate in the austere environment.

 The tactical medic provides rapid and potentially life saving interventions to SWAT team, citizens and suspects who have been injured during situations that have necessitated the use of the SWAT team. An important goal of the tactical medic program is to extend medical personnel into situations to provide basic and advanced life support where it currently is not available. The intent of this objective is to improve survival by providing early treatment and supporting rapid extraction to severely inured people in a variety of tactical situations. The medics maintain close contact with the on-scene physician if available or through direct radio contact with the medical advisor or emergency department physician if necessary during these incidents.

 

David E. Hall Jr., NREMT-P

CEO / Instructor – Rescue Training Inc

 

Dave is the founder and president of RTI (1992). He is the director of the Chatham County Citizen Corps Office of Community Preparedness and has over 27 years as a Medic and an EMS Administrator with 16 years managing the largest EMS agency in southeast Georgia; many years as a medic-supervisor for a large County Police operated EMS. His certifications include a degree in Business Administration; Flight Paramedic; Tactical Medic Instructor; EMT-Intermediate Instructor; Nationally Registered Paramedic and Paramedic licensed in the states of Georgia and Florida. He received his initial Tactical Medic training at CONTOMS (Counter Narcotics Tactical Operations Medical Support) program in Bethesda, MD and served as staff member for the CONTOMS program at FLETC (Federal Law Enforcement Training Center) in Brunswick, GA. Dave became the first Tactical Medic assigned to the Savannah Police Department's Emergency Response Team (SWAT). He is also a licensed US Coast Guard Captain (charter boat). Dave is a board member of several companies and is a current member and past chairman of the Chatham County Local Emergency Planning Committee.