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Background: Early hemorrhage control after interpersonal violence is the most urgent requirement to preserve life and is now recognized as a responsibility of law enforcement. Although earlier entry of first responders is advocated, many shooting scenes remain unsafe for humans, necessitating first responses conducted by robots. Thus, robotic hemorrhage control warrants study as a care-under-fire treatment option. Methods: Two bomb disposal robots (Wolverine and Dragon Runner) were retrofitted with hemostatic wound clamps. The robots' ability to apply a wound clamp to a simulated extremity exsanguination while controlled by 4 experienced operators was tested. The operators were randomly assigned to perform 10 trials using 1 robot each. A third surveillance robot (Stair Climber) provided further visualization for the operators. We assessed the success rate of the application of the wound clamp to the simulated wound, the time to application of the wound clamp and the amount of fluid loss. We also assessed the operators' efforts to apply the wound clamp after an initial attempt was unsuccessful or after the wound clamp was dropped. Results: Remote robotic application of a wound clamp was demonstrated to be feasible, with complete cessation of simulated bleeding in 60% of applications. This finding was consistent across all operators and both robots. There was no difference in the success rates with the 2 robots (p = 1.00). However, there were differences in fluid loss (p = 0.004) and application time (p < 0.001), with the larger (Wolverine) robot being faster and losing less fluid. Conclusion: Law enforcement tactical robots were consistently able to provide partial to complete hemorrhage control in a simulated extremity exsanguination. Consideration should be given to using this approach in care-under-fire and care-behind-the-barricade scenarios as well as further developing the technology and doctrine for robotic hemorrhage control. Contexte : Le contrdle precoce d'une hemorragie apres un acte de violence inter-personnelle est la condition la plus urgente pour preserver la vie et est desormais considere comme une responsabilite des forces de l'ordre. Une intervention plus precoce des premiers repondants est donc preconisee, mais comme de nombreuses scenes de fusillade sont trop dangereuses pour les humains, on utilise des robots. Par consequent, le contrdle robotique des hemorragies merite d'etre etudie en tant qu'option de traitement sous les tirs. Methodes : Deux robots de neutralisation d'explosifs (Wolverine et Dragon Runner) ont ete munis de clamps hemostatiques. La capacite des robots--contrdles par 4 operateurs experimentes--a appliquer un clamp sur une exsanguination de membre simulee a ete testee. Les operateurs etaient affectes au hasard pour effectuer 10 essais a l'aide d'un robot chacun. Un troisieme robot << de surveillance >> (Stair Climber) leur procurait une vue supplementaire. Nous avons evalue le taux de reussite de l'application du clamp sur la plaie simulee, le delai d'application du clamp et la quantite de liquide perdu. Nous avons egalement evalue les efforts deployes par les operateurs pour appliquer le clamp apres une premiere tentative infructueuse ou apres la chute d'un clamp. Resultats : Il a ete conclu que l'application robotique de clamp a distance etait faisable, un arret complet du saignement simule ayant ete obtenu dans 60 % des applications. Cette conclusion s'est averee pour tous les operateurs et les 2 robots. Il n'y a eu aucune difference sur le plan du taux de reussite des 2 robots (p = 1,00). Cependant, des differences ont ete observees au chapitre de la perte de liquide (p = 0,004) et du delai d'application (p < 0,001), une plus grande rapidite et une perte de liquide moindre ayant ete enregistrees pour le plus grand robot (Wolverine). Conclusion : Les robots tactiques des forces de l'ordre ont ete systematiquement en mesure d'offrir un contrdle partiel ou complet des hemorragies lors de simulations d'exsanguination de membre. Il faudrait envisager d'utiliser cette approche dans des situations critiques dangereuses, et de favoriser le developpement des technologies et de la theorie du contrdle robotique des hemorragies., Although primary prevention of mass shootings would be a laudable goal, these incidents continue to occur frequently and they represent a potential threat to the life of every citizen where [...]

Surgical and simulation development have always been closely associated with military activity. The last ten years have continued that trend, allowing for training in real time, under reality-based conditions, learning technical and clinical skills with the dynamic of true human factors and team training in the actual environment. We present data from diverse activities in three separate scenarios: second-year medical students in clinical scenarios; the U.S. Ski Team physicians training in austere conditions; the U.S. Navy Fleet Surgical Team training for sea and land deployment. [ABSTRACT FROM AUTHOR]

Objective: As the incidence of active shooters increase, local emergency response has also changed. South Metro Fire Rescue coordinated a series of hyper-realistic active shooter simulation drills involving multiple agencies., Methods: "The Next Nine Minutes" was one of the largest active shooter drills performed to date with 904 personnel that were trained in 18 mass casualty active shooter drills. Evaluation was from point of injury to and including care in the operating room (OR), and evaluation of real-time system logistics., Results: A total of 126 patients in Cut Suits® received a total of 479 procedures such as needle decompressions, cricothyrotomies, tourniquets, wound packs, and chest tubes. Central to this exercise, law enforcement (LE) established a warm zone from the initial shooting. EMS was able to move into the facility, locate casualties, extract the first victim, move them to a casualty collection point (CCP), and transport them to safety within 12 minutes., Conclusions: Strengths and weaknesses were identified in prehospital and in-hospital care. These included what roles agencies play in a true event, specific timing in establishing areas such as the warm zone and CCP, transportation, and logistics at the accepting hospitals. Only after the barriers to success were identified and addressed did the timing of casualty movement drastically improve. Lessons learned from this training were ultimately used to save lives at the STEM School, Highlands Ranch, and Colorado Shooting. This in situ immersion training should be practiced as a whole system.