Being shot is a very real possibility for every patrol officer. When your shift begins, it is impossible to know what it holds for you. Even simple calls can turn deadly in a heartbeat.
Most departments train officers on how to move and shoot under fire. We teach our officers to use light, cover and team tactics to overwhelm a violent attacker. But, when it comes to teaching officers how to treat their own injuries, we barely pay that lip service.
Many officers are taught basic first aid in the police academy and most agencies provide annual training in CPR. Beyond that, many officers never receive any lifesaving medical training. After all, fire rescue and EMS are just a few minutes away. Why would we need to teach our personnel liability sensitive topics from the medical field?
“All Units – Officer Needs Help at the Bank of America”
On February 28, 1997, two heavily armed men walked into the North Hollywood branch of the Bank of America. During the next half hour, hundreds of rounds were fired and multiple officers were shot. Radio traffic was understandably frantic:
“We need help out here…we’ve got officers down!”
“Any unit know how many officers are down?”
“More than one! More than one!”
“We are all pinned down by automatic gunfire…”
During the incident, officers who were hit were largely without help. Withering gunfire from the suspects made it nearly impossible for backup units to affect any kind of rescue for many of the wounded officers.
EMS and fire rescue were not able to get to the wounded officers. A man can bleed to death in just a few minutes, yet paramedics could not treat the wounded officers for half an hour or more. If shot and pinned down, do your officers have the tools and skills to stop massive bleeding and stay alive long enough to be rescued?
Care Under Fire
After the Battle of Mogadishu in 1993, the United States military developed a new protocol for treating battlefield injuries called Tactical Combat Casualty Care (TCCC). Initially, the Special Forces used TCCC; however, due to the success of the program, the protocol was expanded to all combat troops.
TCCC looks at treating casualties under fire as part of the overall tactical problem, rather than solely as a medical response. In the civilian world, EMS will not deploy into an unsafe scene where an officer may be injured. Officers must solve the tactical problem first before medical assistance can be deployed. Therefore, it would appear that the TCCC structure makes sense for adaptation to the law enforcement arena.
The TCCC model considers various phases of medical intervention including care under fire, tactical field care and tactical evacuation care. For the purposes of this article, we will deal with the care under fire aspect only.
TCCC identifies the three most common causes of preventable battlefield deaths: bleeding (hemorrhage) from an extremity injury (about 61% of preventable deaths); tension pneumothorax (a buildup of pressure in the chest from a penetrating injury which is responsible for about 33% of preventable deaths); and airway obstruction (about six percent of preventable deaths). Some wounds are non-survivable and were not included in the military’s research.
In developing the TCCC model, the military took into consideration the most common causes of preventable combat deaths; the need to accomplish the overall mission; and the need to prevent additional casualties to those who might try to treat or rescue the original casualty. With these objectives in mind, the most recent TCCC guidelines for care under fire are:
- Return fire and take cover;
- Direct casualty to remain engaged as a combatant, if appropriate;
- Direct casualty to move to cover and apply self-aid, if possible;
- Try to keep casualty from sustaining additional wounds;
- Casualties should be extricated from burning vehicles or buildings and moved to places of relative safety. Do what is necessary to stop the burning process;
- Airway management is generally best deferred until the tactical field care phase; and
- Stop life threatening external hemorrhage, if tactically feasible:
- Direct casualty to control hemorrhage by self-aid, if able;
- Use a CoTCCC recommended tourniquet for a hemorrhage which is anatomically amenable to tourniquet application; and
- Apply the tourniquet proximal to the bleeding site, over the uniform, tighten, and move the casualty to cover.
Keep in mind that the statistics on preventable battlefield deaths are military specific. It is easy to assume that, since police officers in combat are likely to suffer similar injuries to soldiers in combat, the stats on officers would be similar.
However, police officer statistics might be significantly different.
No Best Practices for Police
Currently, there is not a universally accepted model for the application of TCCC concepts to police work. Additionally, there is only the beginning of medical research to show what are “best practices” for TCCC in law enforcement.
In “Learning from tragedy: Preventing officer deaths with medical interventions,” Matthew D. Sztajnkrycer, MD, studied the circumstances of officers murdered in the line of duty from 1998 through 2007. His examination of the data on murdered police officers suggested that officers killed by extremity injury hemorrhaging might be significantly fewer (by percentage) than the same cause of death in military casualties.
Additionally, Sztajnkrycer determined that the majority of preventable police officer deaths were chest wounds (about 73%) and only about 1.6% of preventable deaths were from extremity injuries. However, Sztajnkrycer noted that the use of a tourniquet on scene would have likely saved the officers killed by extremity wounds in this time frame.
While Sztajnkrycer’s research does not include data on officers who were assaulted and subsequently saved by rapid medical intervention, it does suggest that there may be significant differences between military and law enforcement injuries and that different interventions may be needed.
Care under fire emphasizes controlling bleeding as a primary form of medical intervention. Other medical interventions, such as treating tension pneumothorax, are typically not feasible in an under fire situation. However, future research may show treating tension pneumothorax may be more important in the law enforcement setting than in the military context.
Incorporating TCCC into your department should involve an initial introductory class with follow-up practical exercises. Additionally, TCCC should be incorporated into all future scenario and force training exercises. The ultimate goal is for the skills to be a well integrated part of the officers’ overall training.
Steve Rabinovich is a police veteran and Director of Operations for The E.C.H.O. Group, a not for profit organization which teaches TCCC concepts for law enforcement. Rabinovich said introducing TCCC skills should be done in a classroom environment and then integrated with other law enforcement skill training. “The unique concepts, new skills and levels of appreciation for them simply dictate that, initially, it can’t be combined,” said Rabinovich. “However, the medical tactics don’t function in an environment separate from others already taught and are part of the whole picture. They have to be implemented with defensive tactics; firearms; and, most importantly, force on force scenario-based training.”
Introductory classes can be from four hours to two full days, depending on the skills which a department wants to teach. At a minimum, officers should be taught the general concepts of TCCC and how to control bleeding, including the use of a tourniquet.
The basic class should demonstrate the use of any tools which will be used and must include practical exercises for the officers to practice the skills and demonstrate proficiency.
With many agencies, small steps are easier to accomplish than radical changes to policy. “A basic introduction on all TCCC facets is necessary, but focus can remain with care under fire, massive hemorrhage control and use of tourniquets, at least initially,” said Rabinovich.
After completing basic TCCC training, all future scenario training should include medical self- and buddy-care. Scenario training should not end when a suspect has been neutralized. Officers should go through all of the steps to control bleeding or otherwise address wounds. Possible scenarios include: • An officer is ambushed when arriving on a bank alarm call. The suspects withdraw, but are still in the area. The officer has been shot in the leg and there is massive bleeding. A backup officer provides cover and directs the wounded officer to employ the tourniquet. The backup officer then directs the wounded officer to engage suspects when they reappear.
• An officer responds to an officer down call. Upon arriving, the officer observes a subject with a gun shooting at people. The officer must neutralize the gunman and then provide care to a wounded officer who is unable to care for himself.
• The officer responds to back up another officer on a traffic stop. On arrival, the suspect vehicle is on scene, but the driver is not anywhere in the area. The primary officer is unconscious on the pavement. The backup officer must address the threat of an unknown suspect who may be in the area. The unconscious officer has been shot with a rifle through his vest, but there is no obvious injury. Responding officers have to check under the vest and they will discover the penetrating injury.
These are just a few of the possible scenarios which can be specifically made for practicing TCCC skills. Each of the scenarios emphasizes an unsafe scene into which EMS will not respond. Additional aspects, like directing the injured person to care for himself or to remain a combatant, are also included.
The skill set of your department’s officers will largely determine what medical gear is needed. At the minimum, all officers should be issued a tourniquet which can be applied one-handed, such as the Combat Action Tourniquet (CAT) and the Special Operation Forces Tourniquet-Wide (SOFT-W).
Additional supplies (such as an Israeli pressure bandage, occlusive dressings, QuikClot® Combat Gauze and decompression needles) should also be provided to match training and skill levels.
One of the best kits on the market is the ETA Trauma Kit made by ITS Tactical. The kit is a vacuum-packed pouch containing the tools needed to address casualties during care under fire. Add a tourniquet to the kit and your officers will be well outfitted to handle combat casualties.
Having the equipment to treat wounds under fire is only useful if the officers have it with them when they need it. A pretty box loaded with medical gear is useless sitting in the patrol car’s trunk. Wounded officers need the gear where they are.
The best solution is to carry the gear on your person at all times. For officers wearing a nontraditional uniform with BDU-type pockets or wearing an external vest with pouches, this is easily accomplished. For officers wearing a traditional uniform, compromise may be needed.
A tourniquet can be worn in a belt pouch if there is room between all of the other gear. BLACKHAWK! manufactures a tourniquet pouch with an opening strap which runs under the tourniquet. When the officer pulls the flap open, the tourniquet is automatically pulled up and into the hand.
Alternatively, an officer can carry the tourniquet under his uniform shirt. Carried under the shirt is not ideal, as a buddy officer isn’t likely to know it is there if he needs to apply it to the downed officer. But, having it with the person is far better than leaving it in the car.
A small kit containing additional medical gear can be kept on the front seat of the patrol car as part of a bailout bag. When the officer arrives on a hot call, he can sling the bag over his body and he will have the supplemental gear wherever he goes.
There are countless examples of officers who have been injured when EMS response was not readily available to them due to hostile fire and other more mundane reasons. Similar incidents in the future are a certainty. Law enforcement officers must have the skills and basic tools to be able to treat themselves or a buddy so he will not die waiting for an ambulance.
About the Author: Richard Johnson is a police officer and trainer with a mid-sized police department in Central Florida. He operates the police training Web site, BlueSheepdog www.BlueSheepdog.com.
This article is a contribution from articles and gear reviews for the patrol officer. P&SN is a valued supporter of BlueSheepdog and the Blue Crew. You can obtain a free subscription to the Police & Security News magazine by joining the Blue Crew.