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Herrick Trauma Care Lessons Forgotten??

Poppycock

Old-Salt
One of the few positives to come out of Helmand was the advances in medical care for trauma injuries.

I believe huge advances were made specifically in stemming blood loss from IED injuries using quikclot powder, celox dressings, tourniquets, etc

I thought those lessons, skills & techniques had been learnt in Helmand and then shared with and implemented by the NHS via the TA / Reserve medical personnel returning from mobilisation & tours both as CMTs and in Bastion Role 3 hospital.

Now I've just seen this, and it appears that it has all been forgotten and at the very highest price you could imagine - the youngest victim of the Manchester Arena SIED attack surviving for an hour, talking to medical staff but then still bleeding to death from injuries to her legs, possibly because no one applied pressure to the wound, no one fitted a tourniquet, etc



Anyone in the know dare to respond to this?
What happened to all we learnt at so greater price in Helmand?
Was it passed on to paramedics & ER staff?
Could it really have been forgot so quickly?
 
Last edited:
Tragic.

Maybe though not a case of lessons forgotten, possibly the people who were there giving aid had never been in the TA/Reserves and just did not know what to do in that kind of a situation. For an A&E a mass casualty event can sometimes be overwhelming and someone who appears full of life and chipper actually needs some rapid attention, down to the triage.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
In the Jack Adcock case, the child's serious underlying condition was not recognised until he suddenly went into septic shock.
Up until then he was communicating cheerfully and his symptoms belied his sepsis.

Children not not always react in the same way as adults, they can cope relatively well with the onslaught on their bodies but then crash.
Adults tend to decline giving you more clues about how seriously unwell they are.
 

Daxx

MIA
Book Reviewer
Typical hypocritical after incident media bollocks. She may have survived, but she may have not despite being given immediate trauma care.

Noting this situation was a mass casualty, being managed by civilian blue light agencies not use to it; the majority of whom would have not served in Afghanistan, let alone in the med centre.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
Typical hypocritical after incident media bollocks. She may have survived, but she may have not despite being given immediate trauma care.

Noting this situation was a mass casualty, being managed by civilian blue light agencies not use to it; the majority of whom would have not served in Afghanistan, let alone in the med centre.

What is not reported is how many people were saved by the techniques brought back from recent conflicts.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
IIRC he report last, the independent experts appointed by teh inquiry have said that her injuries were not survival.

Even in the report the dad uses the term "our expert have suggested"

It is often the case during any investigation that it is possible to get differing opinions on what should have been down. And if there are legal proceedings it is easy for a lawyer to cast their net in order to find an expert who will give the opinion you need. Indeed doctors have been struck off for it.


I am not saying that this extreme has occurred in this case but n=merely highlighting that post incident analysis by those who were not there can often give conflicting results.
 

Yokel

LE
One of the few positives to come out of Helmand was the advances in medical care for trauma injuries.

I believe huge advances were made specifically in stemming blood loss from IED injuries using quikclot powder, celox dressings, tourniquets, etc

I thought those lessons, skills & techniques had been learnt in Helmand and then shared with and implemented by the NHS via the TA / Reserve medical personnel returning from mobilisation & tours both as CMTs and in Bastion Role 3 hospital.

Now I've just seen this, and it appears that it has all been forgotten and at the very highest price you could imagine - the youngest victim of the Manchester Arena SIED attack surviving for an hour, talking to medical staff but then still bleeding to death from injuries to her legs, possibly because no one applied pressure to the wound, no one fitted a tourniquet, etc



Anyone in the know dare to respond to this?
What happened to all we learnt at so greater price in Helmand?
Was it passed on to paramedics & ER staff?
Could it really have been forgot so quickly?

Exactly how many paramedics and emergency doctors/nurses do you think there are in Britain and how many of them are Reservists and saw service in Afghanistan?

Is the Combat Application Tourniquet approved for civilian use? Is it approved for paediatric use?

This sort of media hype really helps nobody. RIP Saffie.
 

theoriginalphantom

MIA
Book Reviewer
One of the few positives to come out of Helmand was the advances in medical care for trauma injuries.

I believe huge advances were made specifically in stemming blood loss from IED injuries using quikclot powder, celox dressings, tourniquets, etc

I thought those lessons, skills & techniques had been learnt in Helmand and then shared with and implemented by the NHS via the TA / Reserve medical personnel returning from mobilisation & tours both as CMTs and in Bastion Role 3 hospital.

Now I've just seen this, and it appears that it has all been forgotten and at the very highest price you could imagine - the youngest victim of the Manchester Arena SIED attack surviving for an hour, talking to medical staff but then still bleeding to death from injuries to her legs, possibly because no one applied pressure to the wound, no one fitted a tourniquet, etc



Anyone in the know dare to respond to this?
What happened to all we learnt at so greater price in Helmand?
Was it passed on to paramedics & ER staff?
Could it really have been forgot so quickly?


We had a little demo set up for the NHS, both 'front line' and management staff.
IIRC it covered as much as possible from 9 liners, CABC, tourniquets, novel haemostatics, ACS, emergency tracheostomy, needle decompression, simple triage (team medic/Battlefield first aid level )
i can't remember what else.
I do remember that the MT demanded that the vehicles used (which had all covered a few hundred meters) were all refuelled involving a trip of 7 miles due to the road works on Alison's road
 

ColdWarWorrier

Old-Salt
In the Jack Adcock case, the child's serious underlying condition was not recognised until he suddenly went into septic shock.
Up until then he was communicating cheerfully and his symptoms belied his sepsis.

Children not not always react in the same way as adults, they can cope relatively well with the onslaught on their bodies but then crash.
Adults tend to decline giving you more clues about how seriously unwell they are.
Adults deteriorate visibly due to serious injuries. There are four very recognisable stages of compensation as the body tries to cope with the injuries.

Childeren compensate very well for a while and then ‘fall off a cliff’. An A&E Consultant once told me that children also have four levels of compensation they go: “happy, happy, happy, dead’.
 
We had a little demo set up for the NHS, both 'front line' and management staff.
IIRC it covered as much as possible from 9 liners, CABC, tourniquets, novel haemostatics, ACS, emergency tracheostomy, needle decompression, simple triage (team medic/Battlefield first aid level )
i can't remember what else.
I do remember that the MT demanded that the vehicles used (which had all covered a few hundred meters) were all refuelled involving a trip of 7 miles due to the road works on Alison's road

You’ll know more about this kind of thing than I would: When my nephew was doing his patrol medic course he was out and about with civvy paramedics. They rolled up to a serious traffic accident and it was clear one of the participants was looking up the tunnel with the bright white light at the end of it. The paramedics said there was nothing they could do. Nephew had his bag of tricks with him, pulled out a widget and told them he could deal with it. They said in their world that was something only a Doc could do. He assured them it would work, they agreed if he carried the can and said he did it on his own when they got to the hospital. It was done, the bloke lived.
 
Now I've just seen this, and it appears that it has all been forgotten and at the very highest price you could imagine - the youngest victim of the Manchester Arena SIED attack surviving for an hour, talking to medical staff but then still bleeding to death from injuries to her legs, possibly because no one applied pressure to the wound, no one fitted a tourniquet, etc
I don't think 'apply pressure to a wound' or 'fitting a tourniquet' are Helmand specific - they've been around much longer than that. I feel this may be something else.
 

BratMedic

LE
Book Reviewer
Wait and see what the attending paramedics and the A&E staff say.
 

anglo

LE
Twenty-three people died because some bastard planted a bomb,
What these people are saying in so many words is that the medics
let her die, the medics were tending to lots of injured people
at the time, what do her parents want of the medics?,
The bomb killed the little girl not medics
 
The fundamental problem with comparing military and civilian responses to an incident, is that, well, one is civilian and the other military.

It is a fundamental principle that in an active shooter scenario (and they must be presumed to exist if there is any doubt), the only people to enter the “hot zone/red zone” are AFOs/SFOs. Not the Fire Service, not Paramedics or Pre-Hospital Doctors, just the Armed Police. Their job - as outlined in the Kerslake Report - is to turn the hot zone into a secured cold zone, not to provide immediate medical care.

In the words of the Kerslake Report

As described by Lord Harris in his review of London’s preparedness for a major terrorist incident, one of the key components of Joint Operating Principles is that responders to Marauding Terrorist Firearms Attacks operate in ‘hot’, ‘warm’ and ‘cold’ zones (Figure 2). Current Joint Operating Principles (version 4) are very clear that these zones describe dynamically determined boundaries that refer to ‘the firearms threat/threat from live terrorists, rather than solely an Improvised Explosive Device threat’.
1.44. In this context, the ‘hot zone’ refers to an area where active terrorist activity is occurring. Joint Operating Principles stipulate that only suitably trained and equipped police firearms officers should move forward into this zone to stop terrorist actions. By contrast, a ‘warm zone’ is regarded as an area where active terrorist activity has stopped, but cannot be guaranteed to be safe, for example the possibility of an Improvised Explosive Device may remain.
1.45. ‘Warm zone’ categorisation allows non-police responders wearing appropriate personal protective equipment, e.g. ballistic protection, to be deployed to both triage, treat and evacuate casualties to the ‘cold zone’ and to extinguish any fire. Joint Operating Principles allow for discretion on the ‘warm zone’ but not the ‘hot zone’.
1.46. The ‘cold zone’ is defined as an area where no terrorist threat remains, so this categorisation allows the deployment of non-specialist responders to continue casualty management and other duties.


It then follows that any medical care in the hot zone will be provided by bystanders, and if no-one gets a patient out of the hot zone, and they’re not fully triaged in the warm or cold zone, then significant delays could happen.

It’s worth reading the Kerslake report in detail to understand how and why things happened like they did that night before flinging poo...
 

Poppycock

Old-Salt
My thoughts go out to this hero, a poster seller who appears to be one of the few that ran towards the proverbial sound of battle to help:
 

BratMedic

LE
Book Reviewer
Whoa there fella, this is ARRSE, and the SOP is to dive straight in and pass (mis) judgement at the earliest opportunity.
Sorry Dan, I forgot, my bad. :grin: :salut:
 
Back in the 1950's when I was a Wolf Cub we were taught how to apply a tourniquet and which were the pressure points, and how often to release the tie. Has all this been ditched from public first aid training? Certainly I had none in the Army beyond being given a field dressing and a couple of ampules of morphine to tape to my dog tags.
 
You’ve got to love 20/20 hindsight..

Kits at work (NHS) have contained CAT, celox, Israeli dressings, IO guns, thoracostomy needles (no more brown cannulae and tape rolls) and Nightingale seals for years now.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
Back in the 1950's when I was a Wolf Cub we were taught how to apply a tourniquet and which were the pressure points, and how often to release the tie. Has all this been ditched from public first aid training? Certainly I had none in the Army beyond being given a field dressing and a couple of ampules of morphine to tape to my dog tags.


Was taught Tourniquets in Army, late 80s, and in 90s.
Marker pen T on casualty's forehead with time applied.

(M for morphine)
 

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