Tactical Combat Casualty Care (TCCC)
Let me start this article off by saying if you are not carrying at least a tourniquet (ON YOUR PERSON), while you are on duty, then you have failed! You have failed yourself, your partners, your family, your department, and your community. I fully confess my faults by admitting that I have only started to carry a tourniquet (SOF-T) while on duty in the last two years of my 18 year career. I’m ashamed of my ignorance. Thankfully I was introduced to modern TCCC, Tactical Combat Casualty Care about 3 years ago, and have been praising its concepts ever since.
You must understand that TCCC does NOT override Active Shooter Response training. Officers should still move to the threat, isolate the threat, and if required kill the active threat. Only after the threat has been isolated or eliminated, should TCCC efforts begin. That includes fallen officers. It does the situation no good if officers are stopping to treat the injured (officers included) when the active threat is still able to move and cause more casualties. However, if all officers are trained in TCCC, then a fallen officer can “self treat” themselves until more assistance can arrive once the threat has been stopped.
The statistics are horrifying. The majority of combat deaths are not instantaneous, rather the result of a lack of rapid treatment to critical wounds of preventable death. You may be picturing a serious leg wound, but I’m talking about full amputations and arterial severance from blunt force trauma. Even these incredibly traumatic injuries, if treated quickly and properly, are absolutely survivable in most circumstances. The same is true in civilian mass casualty incidents.
The problem has been associated to untreated extremity bleeding. The solution is TCCC.
In fact, the Army Combat Medics that taught our TCCC course reported that the “save” percentage on traumatic injuries in Iraq and Afghanistan is over 90% when treatment is applied quickly and properly. And that includes troops critically wounded in a hot zone, that had to wait hours before medi-vac removal and arrival at an Army Surgical Hospital. That should be a huge boost to your mindset if you get critically injured! If you and your buddies know TCCC, you should have that statistic burned into your mind – “I can survive this!”
Almost every cop is taught some form of basic first aid during the Academy or OTJ training. Even if it is nothing more than “apply direct pressure” or CPR, cops are expected to know some basic life saving techniques. Tragically, however, few officers are taught critical life-saving skills through the application of well-known and widely available medical supplies.
It has taken two long wars, mass casualty incidents, and plenty of first-hand experience by our brave military, law enforcement, and EMS personnel, to teach everyone in the first responder role, how to save lives from unconfined blood loss. The concept of treatment has been codified in the military and SWAT world for several years now, but has yet to penetrate the masses of patrol, investigative, and administrative officers. Those lessons center around just a few easily taught items:
Every officer should be intimately familiar with these casualty care items:
- Tourniquet – the only sure way to stop arterial bleeding in the extremities
- Pressure Bandage – stretch elastic bandage with an expanding bandage pad
- Kerlix Gauze – the wonder bandage – it absorbs blood and expands, helping to stop bleeding
- Occlusive Dressing – simply put, a piece of plastic for solving sucking chest wounds
- Tape – when blood is flowing you need something to keep bandages in place
- The Army IFAK (Individual First Aid Kit) also includes nitrile gloves, and trauma shears.
Learning Through Field Training Exercises (FTX)
Thankfully, my department has a very open and progressive Operations Division Commander. He was quick to see the benefit of this training, and the need for the supplies. This belief was only emphasized during a Field Training Exercise (FTX) based upon an active shooter and bomber at a very large, muli-tenant office building in our city.
While officers were following Active Shooter Response protocol, the proctors were pointing out to Police Command the large number of wounded who were “bleeding out”. At the Unified Command Center our Division Commander quickly turned to the Fire Department Commander (our Fire Department is dual Fire and EMS) and requested assistance in evacuating the injured. To which, the Fire Commander (following the current National Fire Standards) advised that Fire personnel would NOT be entering or coming close to the structure until Police had “secured the scene”.
This quote is directly from the Texas State University lesson on Advanced Law Enforcement Rapid Response Training (ALERRT) referenced in the link below:
“Because EMS will not enter an unsecured scene, police officers should be trained to deliver immediate lifesaving care that can stabilize victims until higher levels of care can be provided. This medical training primarily involves teaching officers to control hemorrhaging using a few simple adjuncts (including tourniquets). The Committee for Tactical Emergency Casualty Care (c-tecc.org) has developed standards for this type of training.”
When the proctors start continually adding to the numbers of “injured” who had died from their survivable injuries our Command Staff about lost their minds. Suddenly the reality of what the public would do in that situation sank in. And that is how we got TCCC and trauma kits in every patrol car, along with an individual tourniquet to every police officer. It’s funny how quickly money can appear when “A Political Emergency” (APE) case lands on a Commander’s lap.
Fire and EMS Response to Active Shooter Events
Interestingly, our Fire Commanders also had an eye-opening experience with that FTX. Suddenly, hiding behind the National Fire Codes on response did not seem so valid and strong. When the FTX proctors asked the Fire Commanders how they were going to explain why their ambulances (shown on media helicopters, and TV cameras) remained a long distance away from the carnage so long, the solid wall of “National Fire Standards” quickly began to crumble.
Our Fire Department has gone as far as to enter a structure where an active shooter is “contained”, and where unexploded bombs are nearby, to assist in rescuing the critically wounded. That brothers and sisters is HUGE! And you can do the same thing. Even the National Fire Standards keepers are starting to reevaluate things after Aurora, CO (where police transported injured in police cars because ambulances would not respond), and the Boston bombing where mostly police, military, and civilians evacuated the injured while EMS waited several blocks away.
It’s never easy to sway a commander that the department needs to spend thousands of dollars, on non-budgeted items, to serve a greater good. However, it can be done. Our experiences from above, and the suggestions below should provide you a great start to life-saving training and equipment.
How you can be a powerful force for positive change in your agency:
- Study and master the concepts of TCCC – attend a course if you can (the Army puts them on cheap)
- Examine the different manufactures of the key treatment items and choose the best for you
- Prepare a list of mass casualty events in just the last 10 years (Boston bombing, Aurora theater shooting, etc.). Don’t be afraid to go global (Mumbai, India; Beslan, Russia, etc.).
- Prepare a memo, Power Point presentation, or “paper” on your findings. Include your research into the TCCC concepts and the proper medical supplies to treat traumatic injuries.
- If possible, arrange a Field Training Exercise (FTX) on an Active Shooter/Mass Casualty event. It doesn’t have to be grand, just enough to show the chaotic chain of events and resultant loss of life.
- Finally, show the cost of the supplies, and the time needed to train every officer on their use.
- The cost becomes insignificant when they see “real” loss of life, that could have been saved, due to massive and untreated blood loss. Training should be able to be accomplished in 2-3 hours.
Don’t think it won’t happen where you are at. Many of the active shooter incidents and mass casualty events have occurred in small, rural locations. These events are not isolated to major metropolitan areas.
These are just a few samples of mass casualties in rural America:
1988 – Greenwood, South Carolina – 2 killed several wounded
1997 – Pearl, Mississippi – high schooler kills ex-girlfriend and another, wounding several
1997 – Paducah, Kentucky – A student kills three and wounds several at a high school
1998 – Craighead County, Arkansas – School shooting with 5 dead and 10 wounded
1998 – Springfield, Oregon – High schooler kills 4 and wounds 23
2001 – Santee, California – 2 killed and 13 wounded in school shooting
2005 – Red Lake, Minnesota – school shooting resulting in 10 dead and 7 wounded
2006 – Rural Pennsylvania – armed intruder kills several Amish girls in a rural schoolhouse
2007 – Blacksburg, Virginia – the Virginia Tech mass killing, 33 killed and 25 wounded
2008 – DeKalb, Illinois – 6 killed and 21 wounded at Northern Illinois University
2014 – Isla Vista, California – college student kills 7, and wounds 13 near UC-Santa Barbara
Great TCCC Website Resources:
National Association of Emergency Medical Technicians
Military Health Training on TCCC
North American Rescue TCCC Guidelines
Great Active Shooter Website Resources:
The next article will cover a great Trauma Kit option from Phokus Research Group – the Sons Trauma Kit.