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You're about ready? Looks like the o'clock.

This is time to go.

Alright, so ladies and gentlemen, my name is Christopher Smith, and I am a national programs advisor with the National Institute of Corrections. On behalf of my team and the NIC, I would like to welcome you to our presentation today. Now, before we start today's lesson I do need to cover a couple of important housekeeping items. 1st one, there will be some graphic information shared and some images. If you are sensitive to that type of conversation or imagery.

Please be mindful. It will be coming. 1st, all of our webinars in this series are scheduled to last approximately 60 min. The sessions will be recorded and once captioned and made five oh eight compliant, they will be available on our website. This is a listen only event.

Meaning participant microphones are muted. However, we strongly encourage engagement through the Webex chat feature. Please use your chat to share your thoughts, ask questions or request technical support. We will address as many questions as possible during the Q and A portion at the end of the session.

Alright, so I know we've all been chatting, but we have an official practice. Let's practice our chat function real quick. So what we wanted you to do is how many of you have faced the life threatening emergency with two few hands, two little gear, and NO room for air? If you have, please say yes into your chat. If not, say NO.

I'll give everybody a couple of minutes. That was a very quick succession of yeses, but I'm glad to see that. Well I hate to see that everybody's had been in these situations where you've had too little support to do it, but I'm glad to see that everybody's chat features working.

So if you experience any audio difficulties where we recommend you connecting the webinar via the audio via telephone, they sent you when you got your invitation, there should have been a number there. You can, you can call it and you can still participate if you're having technical difficulties.

So my team and I, including some valuable members of our NIC library library, will be posting information in the chat during this presentation. So real quick, let me just say we have got a bunch of information just cram packed into this.

I want to tell you that that to just be prepared buck your seatbelt and be prepared to fly by the seat of your pants. There's gonna be a lot of information that's gonna be coming quick. We are definitely gonna fill up your hour. This is going to be a lot of information hour, so we hope you enjoy it and we hope you'll learn some stuff from it. So now please allow me to welcome Mary Kaffman. Miss Mary Kaffman is one of.

Are outstanding librarians that she's here to talk to us about the NIC Information Center. Mary, welcome.

Thank you Chris. It's great to be here. I am one of the information specialists at NIC. There are four of us and we are here to answer your questions about the corrections related field. So if you have any questions, just email us at support@NIC.gov. We're here Monday.

You through Friday and we are able to help you as best we can and refer you on to whoever can help you. On our website, we also have free trainings and webinars. We want you to check out the nIC.gov website and you can find out more information about how to learn from NIC. We also have the NIC Learn Center, which is where you can take self paced courses and take them yourself at your own time.

And get certificates for learning. On our website, we also have overdrive, which is free ebooks and audio books which you can check out. And finally we have scope, which is a database on research. You can do the research yourself or you can ask us at the nICIC.gov website and we can do it for you. Just email us at support@NICIC.gov. Thanks Chris.

Thank you Mary. You did a great job. Everybody, let me just tack on, I know Mary has talked about both of them, but let me just add in real quick real quick. Two things. One that Epsco hosts is tremendous. If you experience going through college, you probably use Epsco host research your papers. Well, now you can use it to research job questions.

Or information that you want to know about how to build a fence in the backyard. It has a tremendous amount of academic data that you can pull from it. And the other thing is Mary mentioned is the fact that they can do research, you can submit research questions or you can submit questions about corrections to them and they can help you with the research. So those and those.

They're both tools that I have used and they have been tremendous for me here in NIC. So just really want to make you aware of those. All right, so let's get down to business. Operational medicine and corrections, a domain where decisive action means institutional diversity and where clinical care must coexist with custody constraints. We'll be navigating the nexus of tactical.

Principles from the protocols and the unique realities of providing medical response behind bars. Before we jump into the tactical trenches, let's briefly outline our course compass. So we're gonna cover the challenges of emergency medical care and corrections. We're going to explore evolution and adaptation of tactical tactical medicine. We're going to dissect the chain of command and crisis, and perhaps most importantly, we're gonna ask ourselves.

Whether the battle battlefield playbook applies to correctional compounds. Also remember that good medicine often leads to bad tactics. Now, just to kind of open up and give you an idea of where we are, Tracy is going to give us a real quick story.

Good morning, everybody. It's Tracy. So if you ever ran into any emergency and froze for a second, forgot all of your training, I have, well working at the USP in Florence, I responded to my 1st murder in a housing unit.

I've been working for the bureau for about two years, just come home from deployment and was back at work. I'll never forget the day. It was a calm morning, nothing really out of the normal, then the radio came to life, and me and my partner here have a fight in the unit multiple inmates involved with weapons. We spring into action. My mind is already thinking about what we need to do when we get there secure.

For the areas secure the inmates involved treating the injuries if we can, escort them from the unit. It becomes second nature at that point, being at a USP. When I entered the unit, I froze. It was loud, the smell of OC hit me 1st and I held back a cough. It was so loud in the unit, staff were yelling for the inmates to lock down, Inmates were yelling back at their friends. The radio was going off telling staff.

To respond and what was going on. I saw a group of inmates on one side of the unit lying on the ground with staff placing hammer straints on them. As I scanned the rest of the unit, I saw blood on the ground on multiple spots, and that's my partner appointed to an inmate laying on the round, my blood surrounding him.

Said let's go. As we ran up, I was already thinking about what we, what we needed to do. We put on our rubber gloves gave him a quick once over so we could identify where the blood was coming from. I was focused on the inmate and nothing else. The inmate was lying on his back. It was.

Talking to us, but I could tell he was hurting. As we exposed his chest to look for the source of bleeding, I didn't see much at 1st on the front. We wrote him on his side and checked his back, and that's where we saw the holes from the shanks. At that time, myself and my partner had only carried one chest seal each.

And NO gods. We went to work and got the two 1st two chest seals placed on the upper left side of his back. As we continued to observed, we realized they had a couple more stop looms and need more chest seal. Only problem was we ran out of supplies. That's when we saw a nurse Bailey running towards us. It was like a scene, I'll never forget it. It was like a scene from a movie, time slowed down and.

Looked like he was running in slow motion. When he arrived, he didn't jump in and question everything that we had done. He simply asked, what do you guys need? We had built that relationship with our medical to where he trusted us in what we had done, and just simply asked, what do we need?

40 we needed more chest seals. He ripped up in his bag, handed us more chest seals and some gaz and we were ordered to patch up the rest of the holes that we saw. We got the innate up off the ground and onto the gurney. Now the task of moving the inmate from the unit up to the hill to medical.

Our institution kind of sits in like a triangle, and the unit is at the bottom of that triangle and it's uphill both ways depending on which way we went to medical, so we got him on the journey, we started running up through the corridor to medical. As we're running, I'm constantly checking to see if I saw any more blood. Inmate was still talking to me. Everything was going good.

Or so I thought. As we crossed in the medical, the immate took one breath, looked at me, stopped breathing. Other staff of medical took over and I stopped in the hallway. I started thinking to myself by everything I had done, did I do a good job? Did I miss something?

Then my brain went to I'm gonna get in trouble for doing something for not doing something correctly, started thinking about what I could have done if I could have done more. I want you all to know that I later learned that I did in fact do everything correctly, but injuries are so severe.

For the treatment on hand that there was nothing we could have done with what we had on hand. After the fight, we went and talked it over the tenants like we always do, reviewed the video and got our memos done. That's when I learned that I had done the one thing I had spent time telling rookie's staff not to do. I got tunnel vision.

I was so focused on the trauma in front of me that I completely failed to ensure the area was safe and the entire time I was kneeling on the ground with immate on the tear above me, another group of inmates were fighting. I now take time when I enter an area to fully scan the area and make sure I know where everything and everyone is.

Now it befalls me to tell you the part that you're really looking forward to. That's the legal notices. Alright, so this presentation is for informational wait, wait wait wait, let me start over. You guys don't like this. I have my our commercial legal voice already for you. This presentation is for informational purposes only. It does not constitute legal medical or policy advice. Used and opinions expressed in this presentation are those of the speakers and do not necessarily reflect, but she'll put the.

Position Institute of corrections, the Federal Bureau of prisons.

The US Department of justice or any other related government agency, the NIC does not endorse any specific policies, programs, products or commercial entities referenced in this presentation.

While every effort has been made to ensure accuracy and reliability of the information provided, NSC makes NO warranties expressed or implied regarding the content. Attendees and viewers are encouraged to consult with legal medical or subject matter experts before impend imp implementing any practices or policies discussed here in. This presentation may need discussion may include discussions of legal and regular.

For information. However, if it is not meant to be a substitute for a professional legal council, any reproduction distribution or use of this presentation or its materials without prior authorization for the NIC is strictly prohibited by participating in this presentation, attendees agree hold NIC as affiliates and presenters harmless for any claims of liability of use the information provided. Well, I hope that was as fun to hear that was to read. Alright.

Hey, one last thing I want to put into the legal notice.

But I thought it was very nice I can.

Thank you. Alright, one last thing about the legal notices is also please be advised that this webinar is a public forum, and you should not communicate any classified information law enforce law enforcement sensitive information.

Or any specific time, place, location, who, what, when, where or why, for any incident that we maybe talking, chatting or asking a good question about. Remember we're here to learn information not to pass out information. Alright, so the introduction, so.

Day our one of our hosts for the day is Captain Chad Garrett. He's a calm commander in the chaos of correction. Captain Garrett is a cool head of clinician with nearly three decades of nursing know how and over 30 trail blazing years in correctional operational medicine.

From Battlefield to self lock, he's brought good medicine to bad places with unshakable precision and purpose. Alright, next is me. It may look familiar to the screen. My name is Chris Smith I have over two decades of correctional experience.

Tina those years have been with the federal Bureau prisons. From minimum to maximum security, my BOP journey has crossed four federal institutions and all security levels culminating here in my position in IC headquarters. Uutanic commander Nicholas Bailey is an advanced practice practitioner with the federal bureau prisons.

At the federal correctional complex Influence, where he has served for the past twelve years. His clinical expertise spans correctional health care, the emergency medicine from a response and management, emergency prospe emergency procedures, and airway resuscitation and stabilization. Prior to joining the BOP leetonic Commander Bailey spent seven years in emerging emergency.

Medical services, providing mutual aid with medic one in the Seattle Tacoma, Washington Metropolitan area, all by three years in acute emergency department care. Lieutenant Lieutenant Austin Walters Tracy is a lieutenant with the Federal Bureau of Prisons at the Correctional Complex in Florence Colorado.

Where he has served for the past seven years. He specializes in tactical medicine and trauma response. Before joining the bureau of prisons, he spent five years of active duty in US army, and three with the Colorado Army national Guard. While on active duty, he was certified as a combat life serve saver and completed several tactical combat casualty care T triple C.

He also was a captain with his local volunteer fire department where he has served for eight years providing emergency medical care in the community. At FCC Florence, he's part of the disservance control team, the trains members and tactical emergency medical response.

The most important medical decision made during an emergency and a correctural facility is often made by someone who isn't a medical professional. Long before the nurse opens the medical bag, our physician gives an order, a correction officer has already assessed the scene, secure the environment, recognize the crisis, notify the need for assistance.

Since in many cases begun lifesaving care. Those 1st few minutes, those 1st few critical minutes, the platinum 5 min are where operational medicine lives. This is about preparing correctional professionals to own those moments with confidence, confidence, and complete commitment.

We're building a framework for you, framing and operational discipline rather than the clinical discipline. Operational medicine aggression begins long before a healthcare professional arrives on the scene, it starts and it starts again with the correction staff, the men and women who are most often the 1st to recognize that something has gone wrong.

And a 1st acts. Whether confronting a medical emergency, a violent assault overdose or mass cal event, it's your decisions, it's their decisions during those platinum 5 min that frequently determine the trajectory of the outcome. Those initial moments demand far more urgency. They require situational awareness.

Sound correctional judgment, decisive action, and the ability to balance two equally critical priorities, preserving life while maintaining safety and security. In the correctional environment, there is never just a medical emergency. It's always an operational event.

So when a medical emergency unfolds in a correctional facility, the very 1st staff member who arrives and is not hands on in the incident becomes the initial incident commander. Think about that. It could be the officer who's in the housing unit. This could be week one that he's at the unit and he's the 1st one on the scene that he's not actively involved.

This is not, this isn't a formality. This is one of the most important responsibilities in the entire emergency response. Those 1st critical moments who are the eyes, the ears of the administration, the control center, and ever responder who's on the way.

From an ICS perspective, the initial incident commander provides structure during the most chaotic and unpredictable part of the event. Your job is to stabilize the environment until command is formally handed off. And that starts with constant communication. You must keep control NO, you must keep control officers notified of what you see.

What you hear and what you think they need to know. If the supervisor isn't unscene yet, you're their lifeline feeding them real time information so they can deploy the right resources. Now, it doesn't mean that you're running the whole facility. It simply means that you're creating order where there is usually confusion and chaos. You're identifying threats establishing warm and cold zones, and making sure.

Incoming custody and medical staff have clear picture of the scene before they step into it. You're helping them to understand what's happening so they don't walk into something unsafe or lose time figuring out the basics. As the incident evolves, your role changes. Once the shift sergeant or lieutenant or whoever policy designates as the official incident commander arrives.

Your responsibility is to transition commands smoothly. That handoff is critical. You give them a clear briefing. You, what you saw when you arrived, what actions have been taken, what resources are in play, what still needs to be addressed? A clean handoff, keep the response coordinated and prevents duplication of misunderstandings or you.

Gaps in communication. All of this, the early command role, the communication, the coordination, the handoff comes directly from ICS principles. ICS isn't just extra veroxy or extra layers of doing things or something that's different. It's the structure that keeps medical custody and tactical teams working together instead of working against each other or repeating tasks.

Tasks, and as we apply, as and when we apply ICS correctly, we strengthen that medical response. Medical staff can walk in knowing the scene is sa is secure. Hazards are identified, zones have been cleared, and that the information they need is already flowing. Ultimately, that 1st staff member on the scene plays a major part in how successful the entire.

Emergency response will be, and those 1st critical moments on the X, you're not just present, you're leading. Your communication, your your control of the environment and your ability to pass command forward all help to determine how quickly and safely medical care can begin.

You're still muting and everybody again?

Going over the direct threat, indirect threat in the evacuation, your different zones, your hot zone, your warm zone, and your cords cold zone. I think that the hot zone as the immediate area where the fight or the injuries have happened. My 1st priority in the hot zone is getting the area secure and safe for my staff and the inmates involved and the other inmates.

The housing unit, getting the other inmates pushed away from the area and into their cells. And the hot zone is when most of us correction officers are gonna be using these medical skills, most of us officers, we live in that hot zone. The warm zone for me would be a secure corridor, the staff crossover, something like that. We're not completely away from the unit, but.

We're secure enough that medical and us can focus on the immediate threats to life on the inmates. At the heart of all this is the simple truth. Chaos is a given, but structured chaos saves lives. So the next time you're under metaphorical or literal fire, take a deep breath, find your zone and get to work. Our most common injuries in the hot zone is where we're gonna see our blood for our blood forced traumas.

Our shank wounds, burn injuries, stuff like that. So, we gotta make sure that the most important thing is getting off of that X, getting out of that hot zone as quickly as we can, because we don't always know what could possibly be happening around us as in my 1st story.

Good afternoon, everybody. This is Lieutenant Commander Bailey. So following up on where lieutenant Tracy left off, scene safety is actually this really imperative component, especially when you're considering these different kind of zones, right? So the utmost importance when we respond to emergencies in the prison setting is making sure that.

That everyone stays safe. Upon arriving to the scene of an incident, the number one priority is to secure that threat, any threat above all other actions. And this should be done before any medical care is administered or provided so further victims or complications do not occur.

The correctional emergency response team has the explicit duty to make sure that the scene is safe for the remaining responding staff and medical personnel. This requires tactical awareness and scene assessment to make sure that all threats are secured. And a great example of why this is important is, you know, is just as Tracy shared.

That experience that he and I had several years ago in the, in the penetentary. My side of the story is, is I arrived shortly after Lieutenant Tracy, one to 2 min later, as my response was coming from a different location and area.

I too, actually secured to the same potential problem issue there where, you know, I immediately saw where the greatest need for medical care was, was to be provided. But I made an assumption that, you know, that everything else was being taken care of. There was a lot of chaos going on. A lot of correctional staff were there. Inmates were being ordered into cells, and so.

My assumption was immediately that, well, the scene is safe, the scene is secure. And so I immediately went to go begin helping to manage and provide care. As Tracy mentioned before though, the scene wasn't safe. It wasn't secure. And while thankfully nothing significant or serious actually happened to us while we were providing medical care to this inmate, the possibility was there, the the ability for something very serious, maybe even someone not going home that day was a high potentiality. And so making sure, especially for the.

1st correctional officers that the 1st responding officers are there, that all threats have been secured in ensuring that NO further injuries can occur to other staff. The initiation of emergency medical interventions only comes after that's accomplished. We need to make sure to keep staff and members and other inmates potentially alive until they receive more advanced medical care, but that only comes after the scene is made secure.

So this gives an opportunity for us to really, really reflect on what we call near mrs., right? And, and near near mrs. are those, those events and those issues that can come where we could have had a serious event and thankfully we didn't in this time. And so.

So I'm gonna turn the time over to Chris and let him follow up with this.

We appreciate it. Thank you. We've obviously had a couple of times to talk about scene safety and we've talked.

About the one situation. Now I'm gonna tell you that it like like like they've also mentioned, it's not a singular event. You don't walk into an incident and then decide, oh, the scene is safe, I can interact. Scene safety is completely ongoing. I'm gonna tell you a story, my story and it's going to obviously change the names and events or locations, but.

So my situation was, I was in between an A unit, I was in a housing unit. There's the A side and the B side, my office, I was not a housing unit officer. My office was in between. On the A side, a fight was called out. There's one officer on that side, I went out to that side. 1st thing I did was see where the officer was. The officer was in the inside the main party.

The comp and the office or the, the housing unit, but he was off to the side and he was safe. Well, I knew I didn't need to get to the officer I could keep an eye on him and he was safe. Meanwhile, there are three or four different groups throughout the unit that are in the middle of a fight, each in their own little areas. So I immediately made sure that I had my back as close to the door and the walls I could or I could still keep an eye on the other.

Your officer, but I could be that one who started to call radio calls. I called out that there were multiple inmates in multiple areas and multiple parts of the unit that were in a bite, and then I added a radio call a moment later saying that there was more involved. A moment or two later I added that there were now weapons on the floor and that multiple racial groups were involved, it was just one or two. And so as things developed, I continued to rain you in as people started to come in, but quickly.

I kind of lost control of it too because one inmate was being chased by three inmates and that one inmate being chased ended up behind me and the three inmates were trying to get through me to get to that inmate. And thankfully it ended up resolving itself pretty quickly after that, but that's a good example of even where you're trying to put yourself in a situation where you don't have to.

Put yourself in more undue risk than you have to. You have to constantly be aware cause that scene's gonna be changing, and what could be safe one moment could be unsafe the next moment. So again, it's an ongoing, it's a moving target if you will.

Absolutely. Thank you very much Chris. You know, and, and making sure that's seen as safe and secure is the number one priority. Once it's safe and secure, the next step then is, is really moving in towards providing that emergency medical response. So think of an easy algorithm to really follow in this case is called March. All right? And so think of March as like combat medicine algorithm and and it works.

It works just as well in the correctional facilities as it doesn't condo hard. It's universally adaptable, imminently teachable, and critically dependable. Correctional emergencies demand correctional specific adaptations. We don't always have all the equipment that we'd have in one kind of environment versus another, so improvised equipment, security integration and.

The interpret interdisciplinary teamwork is imperative, but the principles remain constant, deliver the right care to the right patient at the right time in the right place. So in short, March is more than a protocol, it's a paradigm. A professional must pivot from chaos to care.

From trauma to triage, from threat to treatment. In 45 s or less, you might just turn tragedy into triumph. So let's go through this paradigm here. M is for massive hemorrhage. Takes top priority because blood lost is life lost. Our aim turn a cate triumph in under 45.

Whether you're wrapping a limb with a commercial device or improvising with ingenuity, speed and security are non negotiable. Mastery of a hemostatic dressing and wound packing isn't optional. It's operational gold. Airway comes after hemorrhage. Is the patient able to speak? Are they breathing? Is there a gerble sound? Your answers to determine your action. From every recovery positioning to I'm sorry, from pre recovery positioning to superglotic airways.

Your goal is a patent airway because without air, all else is airless. Often this is a great time or an opportunity to move someone onto their left side. This is one of the best ways to ensure an open airway, you know, assuming that NO significant trauma has happened to the person's head or neck.

Following airways, we're looking at respirations. While the airway maybe open, what is their lung patterns doing? Focus on open lungs, closed chest walls, chest seals, simple, sticky, but they're lifestaving. They're your best friend in the face of a sucking chest wound.

If the respiratory becomes compromised, it doesn't matter if the airways open, it still results in the same thing. No air, their air less. Making sure after making sure that the airway and the respiratory is taken care of circulation. It's not just about the bleeding. It's it.

Perfusing to the areas that it needs to get to? Is it getting to the brain? Is it getting to the heart? Look for signs of shock. Rapid initiation of IV access by medical professionals would be crucial at that point. But in the meantime, helping to increase perfusion to that victim is something that you can do.

Raising the legs to ensure that blood flow is now moved back towards the heart and the brain, wrapping them up in blackets, helping them, you know, calm down and to ensure that their circulation is, is improved are all things that you can do without having a medical staff member on hand at the moment. Lastly, in March is hyperthermia.

They're a head trauma.

Reminding us that cold kills quietly and head injuries hide in plain sight. It's very important that if we have the time and the ability that we need to wrap, warm, and monitor the victim. Don't be lowed into normal vitals or they look like they're doing ok, they're talking, and they seem ok.

We need to be watching and maintaining and making sure that things aren't changing. Trauma can be a ticking time bomb. So let me share an experience with you of how the March paradigm was really well applied. Several years ago while I was a registered nurse at the penetentury.

I was called to a fight in a, in a unit that involved multiple victims. In this case, the intended victim actually ended up being the one that caused all of the, all of the trauma. We had two inmates that were following one inmate with the intents to stab him significantly and then attempt to kill him, but he saw it coming. So the moment they're not.

Nice came out, he turned on them, took the knice from them and ended up stabbing both of the other inmates multiple times before fleing from the scene. The fight was called, the emergency response teams were there, and upon my arrival, I was really impressed. My correctional officers were on top of this. They were marching through this really, really well. The area was secured, NO threats were were presently at hand upon my arrival, and inmates that were.

A good circulation His color was good. We moved through that March algorithm and identified that his primary issue was just that open wound. Ultimately though, I had to advise the correction of staff that those pressure dressings were not adequate enough and we had to move to a tourniquet, always getting that, that bleeding under control. Seeing that they were implementing the instructions that I did.

Given them I moved over to 2nd patient. Now this patient was, was a lot different. He seemed absolutely normal. He denied really having any injuries at all. He said he was fine. He didn't appear to be in any pain. He had NO obvious injuries. And obviously he seemed to be the less significant injured inmate.

Between the two. I asked the correctional officers to continue to monitor them and make sure nothing changed while I went back to what seemed to be the more critical one. I was, you know, I made a mistake in this part and that I didn't, you know, do a full makeover or a full walk work over, but I didn't pass that down off to my nurse practitioner that it arrived.

So as I returned back to the, the, the inmate with the bleeding hand, we began to move inmates up to medical. As 2nd inmate was beginning to move up to medical, he started to feel unstable on his feet. He started to get lightheaded and dizzy. His condition changed. Upon his condition changing, the nurse practitioner stripped away his clothes, his shirt, and noticed he had three puncture wounds just under the solar plexes of.

The abdomen. Upon further inspection of that, the the nurse practitioner needed to know how deep that wound was, and so upon checking the wound briefly with his hands suddenly large amounts of blood began to gush out of the inmate. He had, they had nicked his, one of his primary arteries right there in the.

This suddenly went from someone who seemed like a very mild case to a very, very emergent case. But again, it's this whole thing of going through that march. We noticed that things changed in hi in his presentation, and so the secondary assessment, was, was what helped to.

To make sure and ensure that that inmate was, was being monitored and continued after that. Both of these inmates were provided appropriate care and we were able to get them to the emergency services that were needed. But you can see how the March system really helps you keep in mind the next step, the next step, and the next step.

Tracy again, I'm gonna cover some of the kit and outfit that we use being at the pin for such a long time, I stressed to my guys once I got promoted to lieutenant. Even before that, we used to stress to the officers.

Carry something, carry a chest seal, carry some combat guys, carry some compressed guys, turnique at, you know, at the minimum. You know, we all know that all of us here that have worked in corrections.

Sometimes, most of the time the inmates don't act up during the day when we have a plethora of staff. They like to act up on the off shifts when, you know, we might only have one medical person who's in another part of the institution dealing with something.

Or it's the evening time and medical has already gone home for the day and now we're waiting for the ambulance to get there. So it might just be us question officers until the ambulance gets there. Sometimes our tools that we carry on us.

Are the saving deciding factor between an inmate surviving his injuries or an inmate possibly not surviving his injuries. So some of the things that I've adapted over the years and carried, I've started carrying my little IFAC on my belt.

It's nice, pulls out. I'm able to pull it around in my front, inside my IFAC I carry a thing of compressed gause. I carry a chest seal. I also have three other chest seals on me.

I carry a an emergency bandage in ETD and I carry some combat guys with the hemostatic agent at the health clock the blood. I've, you know, most of us know you were dealing with.

Blood force trauma, whether it's you know it's a locking a sock, we're dealing with shanks, it makes getting their heads kicked in, stuff like that. Sometimes, you know, just us having the gods in the right place at the right time is enough to stop the bleeding enough for either medical to get.

Get there or us get them to medical or for the ambulance to get there and us be able to get them out to the hospital for further treatment. So those are just some of the things that I've implemented in my personal stuff. And then on my team, I've actually made full kits.

For our disturbance control team cause you know sometimes it might not be safe enough for medical to come into the emergency area during a disturbance and it might be my guys providing that emergency medical until we were able to get the scene safe enough for medical to be able to come in. So these are just some of the things that I've started carrying.

To myself. And one of the things that I will.

I wanted to just reiterate is that having all this kit and equipment is crucial, absolutely crucial, but you have to practice, you have to go over it again and again. When you're in the emergency is not the time to try to figure out how to work a cat tourniquet, how to open up your Z folded gozz, even how to use the chest seal.

I can tell you that our our folks from Florence, so our experts from Florence spent a lot of time exercising and using all of these tools over and over again until it's becoming a mind muscle memory.

And I put into the group chat for everybody, a training.

Place that we use.

They've come out a couple of times and done trains for us, completely free, doesn't cost you anything. They're completely funded by Congress. I highly recommend using them. They are fantastic at their trade.

Thank you very much Lutoni and Tracy, those are very useful tools and from a medical standpoint, I mean, they're, they're top notch and definitely valuable to have on anyone's duty belt, not just medical staff, but anyones. So I briefly mentioned on on my.

On my previous story, something about a secondary assessment. And this is really critical for trauma care. And this is something that non medical staff can do just as easily as medical staff. And for non medical staff, correctional staff, the amount of time that it takes from your response to a medical emergency and medical arriving, it varies. You may have medical staff that are very, very close.

Just as Tracy mentioned, some institutions, they don't have medical staff 2047, and so there may not be any medical staff coming, and so a lot of these duties and responsibilities of of really ensuring the stability of the victim is gonna fall upon you. So when you've completed your initial life saving interventions.

There's more that still needs to be done, right? It's time to do this secondary assess assessment, and the purpose of that secondary assessment is to make sure there's NO other problems that have been missed and evaluate the effectiveness of your life saving measures that you've already put into place.

So your primary approach to this secondary assessment is going to start with, your CABs, which is your circulation, your airway, your breathing. So how are they breathing? Are there sounds coming from the airway that sounds con that sound concerning? Is there fluid in their airway? How is the.

Their pulse? Is it fast, weak, slow, strong? Can you even find it? You know, what do you do next if things aren't right? Primarily for our airway, we want to make sure that that airway is gonna be kept open, that they're continuing to breathe, that their pulse is continuing. And if those things become compromised, obviously we're gonna move into the steps of CPR and continue to do life saving measures that way. But otherwise.

A simple adjustment sometimes could sometimes can fix those things. If someone is having fluid in their mouth, having them turned on their side so that escapes clearly opens up the airway and you've restored the stability of that airway and to facilitate their breathing. Keeping that airway functional is of your utmost priority. Often change in the patient's position, helps maintain that functionality. So when we're checking their circulation, how is their pulse? We talked about how important blood flow is to the brain and ensuring the blood flow to the heart. Those are the primary.

Very concerns. If the pulse seems weak or rapid, we need to elevate those legs like I mentioned before, help moving that blood to the important parts of the body. If there's areas that seem to be getting worse, getting the patient to a medical provider's care as soon as possible becomes your primary responsibility.

If you've done your assessment, you find that all the CABs are stable. We move on to their mental state. Has anything changed with their behavior? Are they combative? Lithargic? Are they unconscious? Is there a mental state worse than it was before? Noting these changes is essential for the medical professionals that will be taking over the patient's care. Documenting time.

Time when things changed or how long ago something changed. Noting what kind of this mental state they had on your initial arrival to what it is now or if it came back. If they go unresponsive, go back to those CABs, making sure that their, their airways open, their circulation is is appropriate and that they are breeding.

Checking your interventions is absolutely imperative. Is everything working like it's supposed to or something failed? Is the bleeding still controlled with your pressure dressings, your gaze? Are your chest seals still in place and are they still functioning like they're designed to?

If not, you need to adjust your interventions. So I'll refer back to that story where I talked about the inmate that had the arterial bleed out of his hand. The correction options at the time had really fixated on just getting those pressure dressings right onto that hand. They'd applied three separate breasts, three separate dressings on and it was still soaking up the guard.

None of them had really made that click or that, that next step changed. It's like alright, this isn't working, we need to go do something else. And so upon giving them a tourniquet for them to apply, they immediately applied it and they applied it correctly because we train on these things every single year in the federal Bureau of prisons, and they were able to get the bleeding controlled and stopped. Chad, did you want to add anything?

No, I'm good right now. Go ahead so.

Last thing to really cover on this is do not allow yourself to develop that tunnel vision that Lieutenant Tracy and I were talking about earlier. If we become so fixated on one thing, or even one patient perhaps, we need to make sure that we're not missing other things.

If we, we need to make sure that we maintain a large general sense of everything. And lastly, make sure to do that full check of a patient. So after we've made sure that the CAB CABs are good, their mental statuses is stable, and all of our interventions are still working the way they're supposed to do a full body check. You can see on this.

Picture here I've got this paramedic and he's he's looking at a minor wound on this guy's arm, but there's a whole bleed going on on the left on the left side of this guy's body that's not even being addressed. Don't get hyperfixated of one problem because it can lead to other even more serious problems being missed.

Hi, good afternoon everybody again. Thanks Tracy. I'm going into another story here. So this one.

We named it to 45 s of assault cause this picture on the slide is actually from, the assault, and this was just a total of 45 s. They were jumping on the inmates head as well as kicking the inmates head into.

The barrier at the bottom of the top tier, and this story kind of brings everything that we've been talking about. It all kind of comes full circle, and this is a good example of when things actually went well. So in the story earlier I shared time when we didn't do the best at communication, scene safety, and we got tunnel vision. This.

Story, everything seemed to go well. It was just another comp day, nothing seemed about the ordinary. I had been on the compound as a compound officer at the USP. I had just walked into the unit, went down to talk to the officers in the unit for a minute. As I was leaving the unit, I got to the end of the building on the sidewalk and I heard over the radio.

That they had a fight in the unit, and I immediately turned around and ran right back in. You know, same thoughts run through my head. When I get in there, you know, just take a second, stop, look around, assess the area, figure out what's going on, and then react. When I got into the unit, there was one staff member already yelling at the inmates to lock down and.

The inmates were already going back to their cell, and the other staff member was securing the immediate area around the victim. I ran up the stairs and the officer asked for a set of handcuffs, gave them the handcuffs, they already had one of the assailants handcuffed at that time. We handcuffed 2nd assailant and I immediately went to work on.

Assessing the patient. So when I arrived, the immy was lying on his back, struggling to breathe and had obvious head trauma. By this time another officer had arrived to the unit that also had extensive medical experience and we went to work assessing on how to help this inmate.

We rolled him onto his left side into recovery position, which did help him breathe a little bit better. We started then doing that March assessment, you know, we went from head to toe, kind of checking over everything to kind of see where the blood and injuries were coming from.

We didn't see much on the rest of the body, but we did see the obvious massive head trauma. As we rolled the inmate over, we realized that there was a coagulated blood spot about the size of a dinner plate on the ground where he had been laying. So at that point we obviously knew that we had some massive hemorrhage somewhere on the head that we were.

Trying to identify. As we got him into that recovery position, a sea color arrived, we got the sea color placed on him to help protect that neck. We started asking the officer, hey, like, what did you see? What, what did you see when you called the fight? Like, what do we need to be looking for here? And that's when they informed us that it was and.

Been about 45 s, they were stomping on the head, kicking the head. So we went to work kind of looking over that head, trying to figure out what we could do to help protect his airway, stop the bleeding. We did have some gods on hand. We started assessing the head, realized that the whole right side of his head had been caved in from being kicked into repeatedly kicked into the metal bar at the bottom of the tier.

And from them jumping on the inmate. We wrapped the head up the best we can as you can see in the picture, kind of stopped the bleeding a little bit. The bleeding had already started to kind of stop itself at that point. Additional staff arrived, we directed them to get the backboard so that we could move the inmate safely.

About that time medical had arrived to the unit. I remember medical looked up and it was actually Bailey looked up and we already had nine people in this little area. It's a little like 4 ft by 6 ft area right in front of the showers, top the stairs, not a whole lot of room up there. So medical, knowing that the people he.

Saw up there assessing the patient trusted what we were saying to him. I looked at Bailey and said, I think we're gonna need a helicopter to which Bailey agreed that we needed to get that in me out of there and get him to medical so we could get him on a helicopter to the next.

To the trauma center as quickly as possible. I communicated to the medical staff of the possible fracture on the right side of the head and the mass of facial trauma. Once we got the packaged in, the inmate packaged up to moved out of the hot zone. Medical checked out our interventions, told us that everything looked good, that they, they didn't see anything that we could have done different with what we had and that we did a great job.

That was a very good example for.

For me of cause I had some younger staff there that had never been in this situation of, you know, we were able to quickly do ahead to toe, figured out this was our area of focus. We were already kind of in the hot zone, but kind of going to the warm zone cause the unit was locking down and we were able to save the inmates life with minor minor repercussions later on.

Yeah, he, he actually did return to the institution. I believe it was only four or five days later. I would, you know, upon the original like seeing his condition on that 1st scene, I really thought he was gonna be a long term hospital patient and due to the quick interventions on the correctional staff side of things, they really prevented even more serious harm from happening to that enemy and his recovery was really fast because of it.

Yeah, I have to just say this is a great example, and I, if this would have happened outside of a hospital, his care would not have been any better. I would argue that that it may have even been lacking and that the care that this person receives at that correctional facility because.

The correction officers were trained and they had the correct tools in their tool belt to do what they needed at the right time in the right place. Our correctional officers can be amazing when you give them the right tools, and you give them that training that they need.

And that was a great example. So, the stall principles are perceptional rules. Today was not about making you some sort of medic. It was making you more prepared. We are only providing you with the beginning framework, not a finish line.

For sure. They get this session as the 1st tools in your operational medicine tool built. They're providing a foundation for recognizing emergencies, making sound decisions under pressure and taking that meaningful action during the moments that matter most. Remember, correctional staff.

And correctional operators are a different breed. We don't run away from trouble, we run towards issues. But a toolbelts only is good and it's only as valuable as the training and practice that you put behind it. Operational confidence is not built in a single hour, a year.

That's your refresher course. It's not built in 2 h a year. It's forged with continuous learning, realistic training, repetitions, and the willingness to improve every day. So really.

Where do you go from here? I'm gonna tell you that there's a lot of places to seek out training. I think we've put a couple in the chat. Become proficient in the basics. CPR, AED, stop the bleed, 1st aid, incident command. Emergency response.

Principles. Participate in drills. Make sure that medical's being included in your drills and that the medical that's being included in the drills is realistic training. And you're allowing your officers to use the tools that you give them and train with those tools so that the skills that you're training today are gonna save a life tomorrow.

The essence, the essence of this is simple. It's easy. Our job is to ensure that casualty survive long enough to benefit from definitive medical care. Easy, it's easy to say. And that responsibility belongs to every member of the correctional team, not just healthcare professionals, especially not just health care professionals, belongs to the frontline correctional.

Staff. You may never know when you're gonna be called upon to act, but you can decide today whether you will be ready. Faith favors the prepared mind. When that moment comes, don't hope you know what to do. Hope is a terrible plan. Train, prepare, respond, make a difference.

Yeah, just to continue with Chad said, the emergency you prepare prepare for today is the life you may save tomorrow. Never stop learning, never stop training and never underestimate the difference you can make in the 1st 5 min. And remember everybody that the information that you as officers or staff or youth administrators are able to impart onto your staff, the this knowledge, this medical, this emergency response knowledge doesn't stop at the gate entrance.

It proceeds home when there's an accident along the side of the street or when a family member is having a heart attack or a drowning in the pool, all this information that we're using that we want you to learn to help inmates can help you in your everyday life too. So always expand and remember it doesn't that knowledge and that ability doesn't stop the gate.

Whether triggered by violence, structural failure, fire, infectious disease transportation accidents, natural natural disasters or coordinated assaults. And these events rapidly overwhelm available resources and require responders to shift from individual patient care to population based decision making.

Unlike traditional emergency medicine where clinicians strive to provide the greatest possible care to every patient, operational medicine during an MCI or or mass casualty incident is guided by a different ethical imperative. It's doing the greatest good for the greatest number.

It's not an individual thing. Inside this correctional environment, this challenge is compounded by security concerns, controlled movement, limited access, and delayed evacuation, and a simultaneous need to protect staff incarcerated persons and the public. This course is not about practicing medicine under ideal conditions.

That is about making the making disciplined evidence and formed decisions when resources are insufficient. Time is compressed and every action has an operational consequence. Alright, now it comes to a really important time in the presentation.

As you probably noticed a couple of times I've put the link the survey in the chat. Well, now is the time or the survey. I've put it again in your chat just now. Look guys, I know I know the exciting part is not the survey at the end. Just please take a couple of more minutes literally.

Showing everybody for me to the NIC director.

We all take this super serious. Everything you say is important, whether it's, whether it's NPA Smith looked great on on the video footage. He was awesome face for NIC or whether you had a concern with what we were doing. Please, really good or bad we wanna hear from you because this is what's gonna help to position us for training that we provide in the future. So just take a few minutes. We have if you're in a place where you could shoot the QR code with your phone or the link in the chat, please drop the survey. It really is beneficial to us.

We, we do review all of the comments, all of the responses, and this is used to develop your program. The NIC, we're here for you. This is your program, and this is your opportunity to help define what we will be covering.

Over the next years, couple years. It's very, very important to us on how we can better serve you directly goes to justification and yeah, we directly use this in in our justification for, for trainings as we move forward. So this again.

The survey is critical, tell us what we can do better and I can't tell you how excited I am for our our next presentation. I love triage. It will be a hoot. And if that, we've got, oh, just a minute or two, if anyone has any questions they want to throw into the chat.

Most institutions go above and beyond that for the correction of staff, especially for their specialized teams. For the level of training that, that is provided next, it really depends on.

What you need at your facility. It differs a little bit. Our Florence folks will tell you about their time in the pen and how busy they were versus, you know, some other places that are a little less busy with them. You can always reach out and we can take a little deeper dive into that if you like.

And with that.

If, anybody has any special teams, and you're, you're looking for some training ideas that you can incorporate into your regular training, feel free to shoot me an email, I can give you some ideas of stuff that we do. I just throw random medical stuff in my guys when they're not expecting it.

Just to see if they retain the information. So there's different little things you can do.

Yeah, and I want to thank you guys both tremendously from the bottom of my heart. You guys have brought such a wealth of experience on the front line that really.

He really brings this presentation.

To the forefront because you guys know how important it is. You've used it, you've seen it work, you've seen what's not worked. You guys are amazing. I can't tell you enough how much I appreciate you and how awesome your presentation was. And with that.

And if you guys enjoyed them, they'll be our speakers for the next webinar as well.

Thank you so much for your time. We know your time is valuable and we're glad that you chose us for this hour.

And with that Chris, do you have any closing words or.

I just want to say thank you. You know this what you guys see here takes time and effort from a, from a group of people. So it's not just us sitting down one day deciding what, what we wanna do and doing it the next day. There's a lot of work in our.

Effort that goes into this, so I hope you guys appreciate it.

And like we said, this is us building a future and corrections that is safer for all of us. So, thank you.