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Law Enforcement Trauma Care

Written by Sam Smith

Pelham Tactical’s Law Enforcement Tactical Trauma Course (LETTC) utilizes paintballs and Simunition® rounds to induce “stress inoculation” in several force-on-force scenarios. This adrenaline-rushed training allows first responders to perform under intense pressure after they have lost their fine motor skills.

This “hands-on” training puts police officers in several active-shooter situations requiring them to address a threat, perform trauma care under fire, and execute a tactical rescue. Participants learn how to combine both medical trauma care and SWAT tactics to rescue wounded team members. These scenarios have been designed to build officers’ confidence while developing their tactical skills.

The LETTC two-day agenda was created to provide cops with the medical skill sets required to stabilize a “life threatening” injury that may be sustained in the course of one’s duties. LETTC examines several “officer-down” events. Many of these scenarios were re-created so the participants could treat and rescue the injured while fighting their way out of a combat zone.

Attendees were provided with a layman’s working knowledge of medical procedures necessary to treat critical injuries such as gunshot wounds, explosions and falls. Several other life-threatening combat injuries were covered as well. Students were taught how to correctly apply tourniquets, treat sucking chest wounds, and prevent shock; all aggressive medical strategies that go well beyond the first responder skills taught in most police academies and in-service training.

The first day was spent inside a classroom. Master Sergeant Mark Wilson relied on the principles of the U.S. military’s Tactical Combat Casualty Care (TCCC) of applying trauma care while under enemy fire.
TCCC was designed for military medics, corpsmen and para-rescuemen who are about to be deployed in combat operations. TCCC teaches that casualty care on the battlefield has to be the best possible combination of good medicine and good small-unit tactics. TCCC structures its guidelines to accomplish three primary goals: 1) treat the casualty, 2) prevent additional casualties, and 3) complete the mission.

Sgt. Wilson began with a basic lesson on anatomy and physiology. The respiratory system is made up of the upper and lower airways. The upper airway consists of the nasal and oral cavities and the lower airway includes the trachea and lungs. Next, he covered the circulatory system and explained how the heart, the size of one’s fist, pumps five-to-six liters of blood throughout the body. He pointed out that the respiratory and circulatory systems are dependent on one another and the two main ways of preventing death on the battlefield is by stopping bleeding and keeping the airways open.

Wilson stressed the importance of the first responder. In warfare, 90 percent of all combat deaths occur before the casualty ever reaches a medical facility. The fate of the injured often lies in the hands of those who treat him first.

One combat injury contributing to both hemorrhaging and a restricted airway is a chest injury. According to Wilson, “Anytime you have two or three ribs broken in one area, you have a problem.” It is called a flail chest. “With every breath, the broken shards are cutting tissue and arteries. The broken ribs cause internal bleeding.” The medic uses his spread fingers, thumbs together, to check for the equal rise and fall of the chest. If the torso is asymmetrical, the ribs are fractured.

Normally, chest injuries come in two varieties: open and closed. “If you have a chest wound the size of a nickel, you have a problem! This hole competes with a breathing passage. You have to patch the hole!” Wilson urged. He showed the class how to use a HALO chest seal, an oval-shaped adhesive bandage specifically designed for casualties with excessive bleeding and heavy perspiration.

He demonstrated the “tactical sweep” for open wounds on the upper body. He placed his knee in the femoral region of the thigh, checking the neck first, and running his fingers down the torso. “Don’t ‘sweep’ with fingers,” he said. “Rake with the fingers! It’s very important to check under the armpits of the body armor.”

First responders should be aware of a hazardous condition called “airway occulation.” This occurs when the tongue relaxes and falls back into the throat blocking the airway. In the past, medics have contributed to the death toll by laying soldiers on their backs. Many combatants died of affixation. Today, paramedics are rolling victims onto their sides before treatment. This keeps the airway open. Another method used to keep the airway open is allowing a conscious patient to sit up in a comfortable position.

In extreme trauma cases, medics may have to use a Nasopharyngeal, a lubricated rubber tube inserted through the nose into the throat. They come in various sizes and widths. Wilson gave the following tip: “Look at the victim’s pinkie. The size of the pinkie is usually the size of one’s nostrils.”

Wilson instructed the class participants to look for signs of shock. “Shock is something that we can prevent, but yet we can’t prevent.” He further elaborated that the medic cannot afford to wait for signs of shock before treating for shock. Upon initial contact with the victim, the first responder must begin caring for shock based on the mechanism of the injuries.

One type of shock is “hypovolemic,” which is a result of blood or fluid loss. The symptoms are weakness, nausea, dizziness, restlessness and fear. Thirst is also a sign of shock. “It’s the body’s survival mechanism to get the volume up.” Wilson compared it to what a dying deer experiences after it has been shot and instinctively begins searching for a stream because it’s thirsty. Medics were reluctant to give wounded soldiers water to drink in the past, but now they let them drink because it prevents the onset of shock.

According to Wilson, “Shock is the failure of the body’s circulatory system to provide enough oxygenated blood to all vital organs and tissues.” He cautioned that the body’s natural attempt to solve the circulatory problem may worsen the situation. Shock is a downward spiraling problem. “You don’t wait to see signs of shock…you prevent it,” he emphasized. “You save every drop of blood that you can and prevent the victim from losing precious body heat.”

The medic must facilitate blood circulation to prevent shock and stop the body from cooling down. Hypothermia can be forestalled by removing wet clothing and wrapping the casualty in a survival blanket from head to toe. Wilson showed a thin, silver thermal blanket engineered to preserve body heat. Survival blankets are designed to reflect heat back to the body. They prevent shock by retaining warmth and are compact enough to be stored inside a tactical team member’s portable battle pack.

To help blood circulation, the medic must see that all bleeding is controlled and properly addressed by applying a tourniquet and packing a large wound with gauze. He must be prepared to apply IVs and fluids and consider supplying the casualty with water to drink. He must reassess and remove any tourniquets as needed. Nonetheless, a tourniquet can stay on someone for four to six hours.

Wilson stressed the priority of correctly applying tourniquets. “Place the tourniquets two to three inches above the injuries, and never, ever place a tourniquet below a knee or below an elbow! Why?” he rhetorically asked. “Because of the two bones,” he explained. “The tourniquet compresses the bones and not the arteries.” He showed the class the progression of several tourniquets from the Boy Scouts—to the Vietnam era—to an Israeli bandage, adding that it was an “excellent dressing.” He endorsed the Sof™ Tactical Tourniquet, which can be self-applied, using one hand, by a wounded fighter.

Not only are front line medics throwing on tourniquets and HALO chest seals in the combat zone, but now they are immediately applying antibiotics. “Infections are killing soldiers,” Wilson said. “The immediate application of antibiotics is saving lives and preventing infections down the road.” Any time there is a traumatic injury, there is a risk of introducing harmful organisms into one’s system.

Wilson, a combat medic, pointed out the importance of preventing a patient from “bleeding out.” Humans have about five to six liters of blood circulating through their systems. Red blood cells carry oxygen. “Therefore, every single drop that bleeds out is a drop that’s carrying oxygen. We have to look at every single drop as counting,” he said. “This is why tourniquets are so important. Every drop counts! And with every drop spilt on the battlefield, you’re losing the ability to fight infections.”

On the second day, LETTC participants were issued a “Battle Pack” that included a Combat Application Tourniquet (C-A-T), combat gauze, pressure dressing (bleeding control), HALO chest seal, Nasal-Pharyngeal-Airway (NPA), pair of gloves and lubrication. One of the drills, known as the bleeding lab, involved officers treating a ghastly wound to the thigh. Wilson laid out six blue jeans-clad mannequin legs and told the first responders they had to stop the bleeding and treat the injury. They were reminded that “every drop of blood counts.”

The officers had to place a knee in the groin area and find the femoral crease—where the upper leg meets the pelvis—to apply pressure to stop the flow of blood. Next, they had to stick their fingers inside the gore and find the femur and femoral artery. To prevent further blood loss, they had to tourniquet the thigh and pack the wound with gauze. “Pack it to the bone,” Wilson told them.

Afterward, participants traveled to an abandoned schoolhouse for several force-on-force scenarios involving Simunition. They were expected to address the threat, perform trauma care while taking fire, and carry out a tactical rescue. “Our best medicine is to put lead down range,” Wilson stressed.

The “Care Under Fire” portion of LETTC requires officers to engage their enemies in combat after the casualty and care provider are in a position of adequate cover. “Fire power is the best preventative medicine,” Wilson added. He instructed team members to use gunfire to pin down their adversaries. During the heat of the battle, officers should call out to the casualty before trying to save him. “If he answers then he has an open airway.” He may have to treat himself until the team can attempt a tactical rescue.

Wilson gave the students five Care Under Fire pearls: Keep the basics accessible. Cross load your expendables. Re-supply your kit with the casualty’s kit after you use yours. Minimize the exposure of your casualty by leaving on his body armor. Train to work in confined spaces.

By the conclusion of the second day, the participants left the LETTC seminar with a newfound set of medical and tactical skills. They had a renewed sense of confidence that they could treat and rescue themselves and others while under fire.

Sergeant Sam Smith is a 16-year veteran of the Evansville, Ind. Police Department. He is currently the detective sergeant over Financial Crimes and Cyber Crimes. He may be reached at bobbiroehr@sbcglobal.net.

Published in Law and Order, Dec 2011

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