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Critical Medical Response Training

Written by Glen Glembrowski

Medical training for law enforcement personnel at the academy and in-service level has changed very little since in the late-1970s. The basic recruit will only generally get a CPR and basic first-aid class. Often, the recruits do not even receive a certification. This is left up to their departments. This needs to change. We need to teach law enforcement officers the skills necessary to perform lifesaving interventions in critical situations.

The military has been training its personnel at several higher levels for some time. Many soldiers have received Combat Lifesaver and Tactical Combat Casualty Care (TCCC) training. Each tier offers more advanced skills and constantly re-emphasizes the basic phases of emergency care. This information is applicable to all law enforcement officers as well, and may allow you to save a life.

Research using data from World War II until the present has reached the same conclusion. The overwhelming cause of preventable death on the battlefield was extremity hemorrhage. The TCCC curriculum states that 60% of battlefield deaths are the result of extremity hemorrhage. Tension pneumothorax and airway obstruction account for 33% and 6%, respectively. However, until recently, personnel were not adequately trained or equipped to control life-threatening hemorrhage.

In 1990, Captain Frank Butler, a former Navy SEAL and director of Biomedical Research for the Naval Special Warfare Command, wrote a treatise for SEAL Mission Commanders addressing the need for enhanced medical training for Special Operations Forces (SOF) operators. The result was the Tactical Combat Casualty Care (TCCC) guidelines. These recommendations are now contained in the Pre-hospital Trauma Life Support Manual (Mosby) and they carry the endorsement of the American College of Surgeons Committee on Trauma and the National Association of EMTs. The TCCC guidelines are the only set of battlefield trauma guidelines ever to have received this dual endorsement.

Phases of Care
Using the TCCC guidelines, the military presently identifies three separate phases of casualty care. “Care under fire” is rendered at the scene of the injury while both the medic and the casualty are under effective hostile fire. Available medical equipment is limited to that carried by the operators and medic. “Tactical field care” is rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time before evacuation may range from a few minutes to many hours. “Combat casualty evacuation care” (CASEVAC) is rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.

Due to the circumstances law enforcement officers often find themselves in, the need for a level of medical training above basic CPR/first aid is necessary. Quite often, officers are the first to arrive at a critical incident scene involving serious trauma such as gunshot wounds. Traffic accidents are also a cause of serious injury, and officers must be prepared to render appropriate aid when necessary. Using the TCCC guidelines above, law enforcement officers should consider learning how to deliver care under fire as well.

According to the statistics noted above, controlling bleeding and ensuring an open airway could potentially save two-thirds of potentially salvageable officers / victims with battlefield-type injuries. The upside is that these are the two easiest treatments that a minimally trained officer can perform, and they require no special equipment. The third condition, tension pneumothorax, is a severe type of collapsed lung. Relieving it by needle thoracentesis, or chest decompression, requires specific training and equipment. The dozens of injuries and deaths that were incurred during many famous gunfights illustrate that a number victims could have possibly benefited from a higher level of medical care. Given this information, it appears that officers who have this training could have a significant impact on saving lives. The lifesaving potential existing in even a modicum of training would seem to be well worth the effort.

Equipment
In the case of performing care under fire, the equipment and supplies you have with you are what you will be forced to use. Dr. F. Czarnecki, director of the Medical-Legal Research with The Gables Group Inc., said police officers should carry a medical kit specifically designed for penetrating trauma (gunshot wounds and stab wounds). Such a kit, carried in a plastic sandwich bag, can be assembled at a fairly low cost. A basic kit would include two pairs of gloves, one or two tourniquets (CAT®, SOFT-T or similar), one or two trauma dressings—Israeli Battle Dressing (IBD)—one two rolls of gauze, and one Nasopharyngeal airway (NPA). Vacuum sealing the kit prevents “pilfering” of the contents for non-emergency occasions such as minor wounds, and it keeps the contents waterproof and easily accessible. The whole kit fits easily in a cargo pocket.

Many companies, such as North American Rescue, have developed individual “trauma” kits that contain the basic equipment necessary for care under fire scenarios. The basic load usually consists of an Israeli Battle Dressing or other large trauma dressing, gauze pads, nasopharyngeal airway and a good tourniquet such as the C-A-T or SOFT-T.

Recent advances in combat casualty care have produced several excellent pieces of gear. These include inexpensive yet highly effective tourniquets and pressure dressings to stop hemorrhage. Dr. Gunn, an ER surgeon on the East Coast, said, “In the case of a gaping wound, many advocate first stuffing something into it that will act as a matrix for blood to fill and then clot.” The method is known as ‘DPDP’ (deep packing w/deep pressure). By stuffing the wound full of gauze, you will necessarily apply pressure directly to wounded tissues, thus controlling bleeding better, at least in theory, than via pressure on the surface alone.

The problem is, when the packing is subsequently disturbed or dislodged, an eventuality difficult to prevent in the field, bleeding will resume. As with all “probing” of wounds, particularly in the field, you may well make matters worse. A better plan is to quickly apply an IBD over the wound and use it to pull the injured tissues together and apply pressure to the wound. Blood will fill the open spaces and clot. Then you need to get him to a surgeon and an ER, as there is little more you can do. Bottom line: it’s best, in general, to simply apply IBDs skillfully and quickly…then get the victim to an ER. Our job in the field is to ensure that he gets there alive, and none the worse for wear!

While it would be a good idea for officers to carry a small kit with basic lifesaving medical gear at all times, they should definitely carry it during high-risk activities such as warrant service, protective details, and during firearms training (in case of accidental injuries).

Training
What type of training for law enforcement would be appropriate? Would there be certification issues? Would there be a different “standard of care?” The answer is that the training needed for law enforcement is a “down and dirty” course that primarily addresses the bleeding and breathing issues as simply as possible. It should be something simple enough to be taught in a relatively short period of time with a minimal amount of skill and equipment needed, with results replicable in the field. There are a number of people available who are adequately qualified to instruct at the level necessary to accomplish the overall goals.

A number of courses are available. They range from First Responder to Paramedic and everything in between. Most officers would not want to invest the time to become a paramedic but, less time-intensive courses would serve the intended purpose. As mentioned, the military has instituted the TCCC and the Combat Lifesaver courses both generally three to five days in length. The TCCC course stresses the treatment of penetrating trauma (gunshot wounds) over other trauma (burns, fractures, etc.) although field expedient treatment is covered.

As the initial responders at many violent and traumatic events, officers are frequently placed in a position to help themselves, their fellow officers or the public. Basic medical training and equipment can be highly valuable or even lifesaving in these situations. This is not meant to stir a “cops versus medic” conflict by inferring that paramedics and EMTs do not have the ability to perform their mission or maintain a high standard of care.

Instead, this is a focus on police medical training with two primary issues. First, it will give police officers and other non-medical first responders the training to effectively deal with potentially life-threatening injuries in non-permissive environments with minimal equipment. Second it will make police available as a “force multiplier” for EMS providers, resulting in more lives saved. The overall assessment of initiating a higher level of medical skill training for law enforcement officers is positive. The initial expenditure in training time and equipment will pay huge dividends in the future.

Gary J. Glemboski is currently a lieutenant in the Patrol Division of the Savannah, GA Police. He served on the department’s SWAT team for 23 years. He is an EMT and is currently certified as an NREMT-I and is a Level 1 EMS instructor. He teaches TEMS courses across the country and is the director of Global Tactical Training Group (www.gtactical.com).

Published in Law and Order, Mar 2008

Rating : 9.0


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