The Med Tac training program teaches

non-medical bystanders the life-saving steps they can administer to individuals experiencing health crises in the critical minutes before first responders arrive.

By William Adcox, Dr. Gregory Botz, Charles Denham III & Dr. Charles Denham II

IT IS ONLY A MATTER OF TIME before you encounter a medical emergency, ei- ther on campus or in your private life. When a health crisis happens — whether you are a teacher/faculty member, staff member, student, law enforcement officer, medical professional, administrator or just a concerned citizen — you are the first re- sponder. On average, it will take 10 minutes for professional first responders to arrive.

The most common types of emergen- cies you or someone you know or love will face are sudden cardiac arrest, choking and drowning, opioid overdose, anaphy- laxis and allergic reactions, major trau- ma and bleeding, common accidents, non-traffic related vehicular accidents, and bullying and workplace violence.

What would you do if you encoun- tered one of these emergencies? Are you ready to respond appropriately? Are oth- ers in your organization prepared? Major

disaster and accident studies reveal that, when situations like these happen, we behave better — and worse — than we hope. In an emergency, humans some- times fight, some take flight, but most often … we freeze.

The purpose of this article is to in- troduce a global bystander care training program that focuses on responding to medical emergencies in the vital first few minutes before professional first re- sponders arrive on scene. The training initiative is the Medical Tactical Certifi- cate Program, called Med Tac for short. Many elements of the program may be found in other standalone individual initiatives. However, as a fully integrat- ed program tackling the most common causes of preventable death together, it may be the first its kind.

While we were developing an active shooter program in the Texas Medical Cen-

ter, we consulted Michael Dorn, an inter- nationally recognized authority on campus safety. He expressed his frustration with the focus on active shooter attacks and the lack of awareness of the many more deaths at schools and campuses from other causes, such as cardiac arrest, fatal allergic reac- tions, overdoses, choking and more.

Our research of the literature and con- sultation of leading experts confirmed the staggering number of deaths and injuries that can be prevented or mitigated by non-medical bystanders in the precious minutes before professional first respond- ers arrive. Our integrated founding pro- grams tackling these causes together be- gan in schools, scout groups and the MD Anderson Cancer Center. The work has expanded to four states. We have an active R&D program, are producing a documen- tary and developing specialty programs for lifeguards, divers, aviation and corporations. We are looking for great partners and invite school district, university and healthcare leaders to join us.

HOW MED TAC BEGAN

It all started with Cub Scouts and elemen- tary and middle school students when we tested whether children could learn CPR/ AED and Stop-the-Bleed techniques. Then when David Beshk — an award-winning teacher and one of our instructors — saved a life during an emergency using a skill he learned and learned to teach just three days earlier, we knew we had something.

In Beshk’s case, an unconscious victim was found lying on his back while vom- iting, which significantly increased the risk for choking and aspiration. A crowd of bystanders, including several medi- cal professionals, stood by, not knowing what to do. Relying on his training, Beshk used an intervention that reduces the risk for choking and aspiration called the “re- covery position” — a method of saving an unconscious victim who is vomiting by keeping their airway clear.

As our momentum grew, we learned more about the first few minutes of emer- gencies and how medical evidence sup- ports, in fact calls for, bystander care.

We expanded the program to older stu- dents, Boy Scouts and families wanting to improve their disaster preparedness skills. We were surprised by how fast they learned and became competent with such skills. We now deliver training to college students at some of our leading universities and faith-based organizations. We have devel- oped a comprehensive program for law enforcement and security professionals at one of our global medical centers.

Our leadership team includes national medical leaders and educators, simula- tion experts and law enforcement threat experts who have tackled the most fre- quent, severe and preventable causes of harm to children and adults with one in- tegrated approach.The initiative for children and youth is starting its second year with after-school and summer-school programs. Our Boy Scout program enables scouts to fulfill the video the program to grade schools, scout- ing groups and faith-based organizations at zero cost to them.

1. Bystander Care: Our global bystand- er care training program development fo- cuses on the vital first few lifesaving minutes before professional first responders arrive. The curriculum is continually updated to mirror the latest evidence-based medicine guidelines and developments accepted by national emergency medicine and critical care organizations.

2. Blended Learning: We use a blend- ed learning approach of online knowl- edge transfer, complemented by onsite skill training and deliberative practice led by local trainers. The program is designed to be free to grade schools, scouting orga- nizations and faith-based institutions for the online component. The only costs to them are for local, qualified instructors who are engaged and paid directly by them. The online content can be taken anywhere and at any time through mobile technologies.

Fast Fact: If effective bystander care can be delivered to victims experiencing a medical emergency within 3 minutes, survival and permanent harm can be dramatically and positively impacted.

3. Immersive Simulation: Simulation techniques using real-life scenarios im- prove reaction during high stress crises. Scenarios include making 911 calls, com- municating with first responders, key task assignments, performing CPR and using AEDs, practice caring for severe bleeding, using epinephrine auto-injectors and us-

Med Tac began with Cub Scouts and elementary and middle school students who were taught CPR/AED and Stop-the-Bleed techniques.

We launched our program for young adults at Stanford University with stu- dents from medical schools and under- graduate programs, including student athletes from multiple sports. The pro- gram delivers content uniquely suited to college students with emphasis on the most common accidents occurring in their age group in campus communities and in membership organizations such as sororities and fraternities. Specific content areas include alcohol and sub- stance abuse issues, as well as the most common causes of severe trauma in their age group. A recurring student-led program has been launched at the Uni- versity of Florida.

Med Tac launched a program for young adults at Stanford University with students from medical schools and undergraduate programs, including student athletes from multiple sports.

Med Tac Lifeline Behaviors where they earn CPR/AED and Stop-the-Bleed certificates for successfully completing the curricula in these lifeline behaviors. This program allows Boy Scouts to fulfill all their require- ments for their emergency preparedness merit badge, which includes a family emer- gency preparedness plan and gear pack.

A program for law enforcement offi- cers and first responders was launched with the University of Texas Police De- partment at the MD Anderson Cancer Center. It is the most tactical of our pro- grams with comprehensive attention to active shooter events.

A special program for Eagle Scout can- didates who want to launch a Med Tac program in their community is being de- veloped to guide them in the implementa- tion of this lifesaving program locally.

KidLeaders is a mentorship program including but not limited to scouts that will help grade school students understand the core values and behaviors of great leaders.

Med Tac students learn how to rec- ognize and reduce harm from the most common preventable health hazards to children and adults. (See Most Common Preventable Health Hazards on p. 13)

THE 4 ELEMENTS OF THE PROGRAM

There are four major elements to our en- terprise model that allow us to take Med Tac to a global scale. We leverage technology and leaders in communities to proving opioid-reversal agents.

4. Team of Teams and Network of Networks: Our model enables us to tap existing training networks of educators and membership organi- zations such as schools, scouts, clubs and faith-based platforms. We lever- age a multigenerational team from lo- cal networks to meet the needs of the broad age range of our students.

Our funding support to date has been solely by founder philanthropy with no direct or indirect financial support from

healthcare device or pharmaceutical com- panies. We will be seeking funding from sources with a zero conflict of interest pro- file to allow us to scale globally without real or perceived conflict of interest.

DOCUMENTARIES PROVIDE SUPPORT FOR THE PROGRAM
Members of our team have produced global documentaries for the Discovery Channel including Chasing Zero: Winning the War on Healthcare Harm and Surfing the Healthcare Tsunami: Bring Your Best

Board. Our work calls on expert contribu- tors to deliver a call to action that supports bystander care in the future film and me- dia described below.

◆ 3 Minutes and Counting Documen- tary: This film uses real-life stories to motivate the public and leaders of institutions to start and support pro- grams in their own communities. We are taking real facilities and creating simulation models to identify the best combination of trained bystanders and properly positioned supplies frequency and effectiveness of bystander responses to emergencies.

Recent studies have shown that by- stander skills degrade over time, so try to assure “competency-currency.” Regular, repeated training, with deliberate practice of bystander care skills, complemented by readily accessible emergency care sup- plies, is the winning combination for a campus team to help serve those entrust- ed in their care.

Remember, odds are that a medical emergency will happen on your campus and your students, clinicians, public safe-

ty officers, teachers, staff members and administrators will be the immediate re- sponders until professional help can ar- rive. Med Tac can provide them with the skills they need to respond appropriately and save lives.

to enable delivery of lifesaving by- stander care within 3 minutes of an event and until professional first re- sponders arrive in 8-10 minutes.

◆ Video Stories: Our learning man- agement approach uses the power of stories to communicate concepts, illustrate tools and describe resourc- es. We are continuously capturing stories and adding them to our mul- timedia curriculum.

◆Immersive Simulation Scenarios: The many stories used in our online training allow us to develop simu- lation scenarios, putting students in real-life situations that apply and reinforce key concepts. We use tech- niques pioneered in aviation and other industries to drive retention and competency impact.

Although the Med Tac Team won the 2018 Pete Conrad Global Patient Safety Award for its work, we believe any communi- ty, inspired by the “all teach — all learn” mantra, can easily start a program like ours. We challenge others to start similar initiatives or join us in this cause. We believe the CPR/AED/First Aid programs of the American Heart Association are excellent. Instructors of those programs are ideally suited to engage with campus programs. Further, the Stop-the-Bleed pro- gram sponsored by the American College of Surgeons is also excellent when it is taught as designed. The combination of these two programs can dramatically improve the

The University of Texas Police Department serving the UT MD Anderson Cancer Center and the UT Health Science Center at Houston are pioneering a Med Tac program to specifically address the needs of major medical centers and healthcare institutions. Chief William Adcox and the security team at MD Anderson are pioneering the new study domain of inside and outside threats to the caregivers who serve, the patients they serve and the property they need to deliver their care.