‘Sound backward? That’s because it is. But not in a war zone. Based on lessons learned in Iraq and Afghanistan our military adopted a doctrine called Tactical Combat Casualty Care (TCCC) for treatment of injuries immediately after they are sustained. It uses X-
Possibly this is where the Working Group derived the concept. This would be valid if we were next to our patients when they were injured but we won’t be. An MCI is not an active battlefield. In non-
In SALT’s overly ambitious attempt to emphasize LSI they put this principal aside and recommend the application of hemorrhage control, chest decompressions or antidote use before confirming the patient has respirations.
Maybe this was just the Working Group’s attempt to simplify the algorithm and assumed we would apply a logical START-
Or maybe, like other components of SALT, they just didn’t think it through. Tactical is not always practical. Regardless of how it came to be, if we obey SALT we apply LSI to dead patients. Anything can be fixed so we took the liberty of giving SALT some LSI of our own to prevent resources from wasting time caring for the dead. (See problem / solution to the right)
TCCC: Time to Treatment Guidelines
I’m Bleeding as Fast as I can:
START instructs to “control bleeding’”. In SALT’s haste to adopt TCCC guidelines they use the expression “control major hemorrhage”. Given our normal response time to an incident we are unlikely to experience these except for patients that have received traumatic articular injuries but had a means to prevent exsanguination via pressure or constriction. The expression does not account for injuries to smaller veins or artery nicks that present slower flows. These are not observed as major hemorrhages. Fortunately it can be assumed some responders will break the SALT rules and apply pressure dressings or tourniquets to these types of injuries as well, providing a more START-