Hostage situations to lifesaving medics - transforming emergency care

01 May 2024

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Dr. Simon Hendel (VIC, 2020), Churchill Fellow and leading trauma anaesthetist, has released a groundbreaking report with findings to transform emergency medical care in Australia.

Simon’s Churchill Fellowship took him to Belgium, France, Germany, the United Kingdom, where he assessed Police Tactical Emergency Medical Support (TEMS). From hostage negotiation teams within police tactical emergency to public responses, Simon’s experiences overseas have provided him with a global perspective on best practices in emergency medical response, which he now seeks to adapt and implement within the Australian context.

Driven by a relentless dedication to enhancing survival rates for the critically injured, Simon’s report reveals the critical importance of early and effective intervention in saving lives.

As the head of trauma anaesthesia and a trauma consultant at The Alfred Hospital, renowned as Australia’s busiest trauma center, Simon’s expertise is unparalleled. His collaboration with Ambulance Victoria and Victoria Police further demonstrates his commitment to enhancing emergency response capabilities, particularly in high-threat and complex situations.

A French Police Nationale RAID Doctor during a hostage rescue exercise (RAID doctors are integrated but unarmed – note their PPE and communication equipment is the same as the tactical teams) LASD Air 5 'Super Puma' helicopter on a mountaintop in Los Angeles County

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Simon’s report draws upon his extensive experience, including deployments with special forces in Afghanistan and service as a medical officer in the Australian Army. He advocates for the integration of battlefield trauma principles into civilian emergency care, ensuring that lessons learned in extreme environments are applied effectively to save lives domestically.

Some of his recommendations include the development and maintenance of ‘medic’ first responders within all Australian police forces, enhancing their capacity to deliver immediate medical assistance in tactical situations.

Simon recalled a conversation with one of the tactical paramedics who was also an accomplished amateur triathlete (which Simon is not): “He said, Triathlons are really a four-event sport: swim, cycle, run, and transitions. Triathletes are of course developed and competent swimmers, cyclists, and runners,”

“Winning triathletes are obsessive about reducing the time it takes them to transition between these disciplines. Surviving from point of injury and through definitive care is like that,”

“So, in many ways, a successful TEMS system is about emphasising and obsessing over those transitions,”

“If we want to win the Tactical Trauma Triathlon, we must be obsessive about transitioning from initial lifesaving care in the warm zone, to advanced prehospital response and triage at the FTA, to rapid evacuation and definitive care at a trauma centre. That means breaking down the silos that slow our transitions and keep us all in our tribes,”

“Inquiry after inquiry (from London, Manchester, and Brussels to Cologne, Christchurch, and Texas) have identified communication, coordination, and integration as contributing to delays in care, potentially preventable, and poor outcomes,”

“In the Australian police, EMS, and trauma system, we have very good swimmers, cyclists, and runners. But if we want to win in the high threat environment, we need to become tactical trauma triathletes. Now is the opportunity to develop functional local TEMS capability and build world class TEMS standards.” Simon shared.

Simon is calling for the adoption of a standardized approach to ensure consistent and timely treatment for injured individuals across all levels of care. He is also calling for further training and expanded capabilities for personnel providing prolonged field care, including wilderness first aid training and access to specialized medications.

He sees value in police forces appointing operational medical directors to provide comprehensive medical support, including training, clinical governance, and interagency liaison.

Simon proposes the establishment of national minimum standards for Tactical Emergency Medical Support operations, encompassing various scenarios and ensuring uniformity in clinical practice and operational governance.

Other recommendations include a national public safety campaign to educate and empower the public with basic lifesaving skills, increasing their chances of survival in emergencies. Basic hemorrhage control supplies should be strategically placed at major public sites alongside defibrillators, enhancing public access to critical medical resources. He advocates for the provision of standardized Tactical Emergency Casualty Care (TECC) training to all frontline emergency service personnel, bolstering their ability to respond effectively to crises.

Dr. Hendel’s report represents a significant step forward in enhancing Australia’s emergency medical response capabilities. By implementing his recommendations, Australia can better safeguard people’s health and safety, ensuring that lifesaving care is readily available when it is needed most.

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