To grasp that this was not a typical training cohort at the University of Colorado School of Medicine’s Center for Surgical Innovation (CSI), one needed to look no further than the locked closet in which the 20 or so participants had deposited their 40-odd guns.
No, these were not the board-certified surgeons, residents, and medical students who typically pass through the CSI to learn new tools and techniques at this internationally recognized surgical center of excellence. This group, predominantly male and thoroughly muscular, was comprised of FBI agents from all over the country.
They were members of Special Weapons and Tactics (SWAT) teams that specialize in responding to active shooters, hostage crises, airline hijackings and terrorist attacks, among other emergencies. Every FBI SWAT team has at least one certified emergency medical technician (EMT). They came to CU to learn, through hands-on training with CU School of Medicine/UCHealth trauma surgeons and emergency medicine specialists, about what to do when weapons like the ones they’d just locked up leave the lives of victims – good guys or bad – hanging in the balance.
“In a moment, we go from law enforcement to saving somebody’s life,” said one of the agents, who will remain anonymous because they sometimes work undercover.
Extended mission
While happy accident played a role in the FBI School of Operational Medicine spending a day of its three-day Colorado workshop on the Anschutz Medical Campus, the program was part of a deliberate extension of the CSI’s longstanding training mission.
The happy accident involved Dr. Shannon Sovndal, the City of Boulder Fire Rescue’s medical director, reaching out to the UCHealth University of Colorado Hospital Trauma Program about the possibility of leading training sessions for an FBI group. Sovndal did so because he knew that a CU team of doctors and other trauma specialists had been developing a curriculum that used real human cadavers – rather than the typical mannequins – to train ambulance crews and other first responders on trauma care.
The program focuses on opening the airway, maintaining breathing, stanching bleeding and ensuring blood flow. The first training session, for street paramedics from Aurora, Northglenn, Eagle County and elsewhere, happened Feb. 20. The training is part of UCHealth’s mission of taking care of trauma patients and providing the highest level of trauma training in the region, said Robbie Dumond, senior director of trauma services at UCHealth University of Colorado Hospital at the Anschutz Medical Campus (UCH).
“It’s about doing everything we can to save as many lives as possible,” Dumond said. “Our goal is to offer the course three or four times a year, at minimum, to the front-line people who really need it.”
And so a central facet of the FBI School of Operational Medicine’s quarterly training landed at the Anschutz Medical Campus on the second Tuesday in April. In a conference room, Dumond led a moment of silence to honor the donors and families whose generosity stands to save future lives. Then the FBI men and women suited up in scrubs, plastic bibs, masks, hair nets, and clear glasses and entered the CSI’s Surgical Bioskills Lab at around 8:30 a.m.
Hands-on
Dr. Erik Peltz, a CU School of Medicine trauma surgeon and assistant director of the UCH Trauma Center; his fellow trauma surgeon Dr. Laura Harmon; and UCH Emergency Medicine specialist Dr. Danny Willner had been prepping the cadavers and doing additional setup since 6 a.m. The three of them, Dumond, and Scott Bookman, UCHealth’s director of emergency medical services, had collaborated on creating the training curriculum.
The FBI agents clustered around a cadaver on each of two tables brightly lit with overhead articulating surgical lights. Peltz served as guide at one; Willner did so at the other. Three big flat screen monitors projected prepared slides, the first of them having to do with ways to open airways – the i-gel supraglottic airway and the King LT-D. Peltz went over pros and cons of each of these emergency intubation tools and walked through mnemonic acronyms (“RODS” and “MOANS”) to remind of challenges with establishing a good mask seal on an unconscious patient – beards, obstructions such as a big tongue, a lack of teeth, and mask stiffness among them. Then, one after the next, the FBI agents intubated the expired bodies using both nasal tubes and masks.
After his turn, an agent from Los Angeles explained, “Being able to interact with a cadaver – real tissue – is invaluable, priceless training.”
He added that the weight, resistance and anatomy of an actual human body versus that of a mannequin were all vastly different. “You have real bones and functional movement – real bones, real tissue. And it’s dead weight: if somebody’s unconscious, they can’t help you. It’s very similar to working with someone who’s unconscious.”
Said another, “The mannequin’s rigid plastic. There’s no feel. There’s not tongue that gets in the way. You’re not looking them in the eye. When I do this, I think about my kids: How am I going to save one of their lives?”
Not just how, but also why
If intubation through nose or mouth can’t be done due to injury or swelling, one must cut a new opening through the neck. Two surgical residents were corralled from a neighboring training session to perform tracheostomies on the cadavers as Peltz, Willner and CU School of Medicine/UCHealth trauma surgeon Dr. Franklin Wright, who had come by to volunteer his expertise, explained how it’s done, where to go in, and what to avoid (in particular the thyroid gland and vocal cords).
Field tracheotomies are rare, but, as Wright put it, “If you need an airway and they’re going to die without it, everything is negotiable.”
The training moved on to using four-inch needles to release pressure from something called tension pneumothorax (a.k.a. collapsed lung) which happens when air from a lung punctured by a bullet or shrapnel escapes into the chest cavity and can’t get out. Victims die not from suffocation, but from a lack of blood flow as veins leading to the heart become kinked as the pressure pushes the heart to the opposite side of the chest cavity. Again, the agents took turns inserting needles through particular ribs in two spots medical science has shown to be both effective and safe.
“Putting a needle in the heart is less than ideal,” Peltz told the group; Willner added, “Better high than low: if you go low, you’re giving him a liver or spleen biopsy.”
After lunch, the training shifted to stopping blood through using pressure or tourniquets. The aim, Dumond said, was to show not only how to stop the bleeding, but also the nature of the damage that bullets, shrapnel, blast injuries and other grave physical insults do and where in the body the bleeding typically comes from.
Michael Biamonte, the FBI School of Operational Medicine’s program director, interjected here and there based on his 32 years of work as a paramedic with the FBI and elsewhere. He described cadaver-based training as “a luxury.”
“These people who have donated their bodies to science have done us a great service by allowing us to use their bodies to learn and save lives out in the field,” he said. “These opportunities are so hard to come by, and it’s so, so important for a facility like this to open its doors and avail their team and their cadre. Look at the cadre they’ve provided us with – they’re fantastic. We’re frankly honored that they’ve allowed us to come in and learn from them.”