In order to maintain the readiness mind-set at all times, officers tell themselves there is nothing routine about police work, and they are quick to scold others when they use the “R word” in the context of police work. However, in truth, the vast majority of day-to-day police work can be construed as “routine.” It is the potential that lies in wait that most concerns law enforcement, thus the “High Risk, Low Frequency” from Gordon Graham’s Risk Management Paradigm.¹ All officers have heard the adage “prepare for the fight of your life” at some point in their career. Most people connect this saying to physical and mental preparation, but they rarely break it down and consider some of the other details of preparation.

In the last decade, active community violence situations have brought much to light in the way law enforcement responds to and mitigates mass violence incidents. One particular area that warrants attention and consideration is how medical care will be provided to victims during the initial phases of a law enforcement response. Typically, the first emergency personnel on the scene are the police, and, depending on scene safety, they may be the only respondents. As the first on the scene, police officers should be capable of providing self-aid, buddy-aid, and aid to other injured first responders, as well as civilians. Therefore, the decision to implement a tactical medical program is an important consideration that should be on the forefront of police planning and training. History and research have consistently shown that having medical providers at the side of a downed officer within seconds of being injured provides the best chances of survival.²

According to the National Law Enforcement Officers Memorial Fund, as of April 9, 2015, there had been 33 U.S. line-of-duty deaths this year. In 2014, 117 law enforcement line-of-duty deaths occurred in the United States, which is up from 107 in 2013. In 2013, there were also 51,625 reported assaults on law enforcement personnel, 14,857 of which resulted in injuries.³

While the exact science behind the change in statistics from year to year may never be entirely known, there are measures that can save the lives of more officers and members of the public. Certainly, any correlation between the increase in medically trained and equipped officers and the decrease in casualty rates should be noted as policing continues into the future.

Emergency Medicine in the Field

The U.S. military has determined the following to be the top three preventable causes of death on the battlefield, and it’s clear that these can also be applied to the situations faced by police.⁴ Although emergency medical service (EMS) teams are often part of the response to critical incidents, most EMS will not enter the scene until it is secure, instead staging several blocks down the road. Although, this does little good for critically injured officers and civilians, the EMS decision to wait for a secure scene is necessary. Most EMS providers are not trained or equipped to go into an environment that involves a violent, unstable, or dangerous person or situation. While the scene remains dangerous, injured officers or civilians who need emergent medical care may be pinned down by gunfire or simply unable to self-extricate, and thus unable to access or be transported to EMS. This unfortunate reality has occurred a number times in the past, at such incidents as the North Hollywood Police/Bank Robbery Shootout (Los Angeles, California) in 1997; the Tucson, Arizona, shooting at a constituent meeting for U.S. Representative Gabrielle Giffords in 2011; and the Aurora, Colorado, movie theater shooting in 2012. It is at these critical situations that medically trained law enforcement personnel can be an invaluable resource that can and have saved lives.

1. Exsanguination (bleeding out from extremity wounds)
2. Tension pneumothorax (penetrating/blunt injuries to chest)
3. Suffocation (airway blockage from the tongue or fluids)

These three types of traumas account for a significant portion of battlefield fatalities, and they are common causes of law enforcement fatalities, as well. These injuries can be managed and treated in the field if officers have the appropriate equipment and training.

In addition to these types of trauma, shock is a common condition faced in the law enforcement realm. Personnel should be trained to recognize and treat shock until the injured officer or civilian can be extracted and transferred to a more definitive care setting. It has been demonstrated that time is always of the essence when dealing with preventable deaths, and officers cannot hope that they, their partners, or citizens will simply “hang on” until the ambulance arrives. Of those who experience one of the three preventable causes of death, 25 percent will die within 5 minutes and 15 percent will succumb to their injuries within 30 minutes. Without treatment, injured persons with serious uncontrolled bleeding will generally bleed out in 1-3 minutes; and a compromised airway leading to inadequate oxygenation usually leads to death in 4-5 minutes; and if a penetrating injury to the chest that causes a tension pneumothorax goes untreated for more than 10 minutes, it will typically result in death, as well.⁵ As short as these timeframes are, effective lifesaving measures can be taken during these first minutes after the injury.⁶

As soon as possible, the priority should be getting the injured person to definitive care, which may involve getting through various barriers (e.g., warm zone, onlookers, media). Police agencies should have a plan in place to call for a medevac as well. Definitive care for these types of injuries is often rapid surgical intervention, and, if a medevac is called only after EMS accesses and evaluates the injured officer or civilian, it may be too late. Law enforcement personnel are able to recognize severe injuries; an understanding should be in place for special circumstances in which law enforcement may call for medevac response prior to the casualty being evaluated by a non-law enforcement EMS provider.

Many agencies have recognized this significant and potentially life-altering paradigm shift in policing and have begun providing basic training and medical kits that allow for self-aid/buddy aid, along with teaching officers skills, such as chest needle decompression for tension pneumothorax. However, at times, a more advanced level of tactical medical care will be needed. Establishing a law enforcement medic (tactical medic) program would not only address the need for advanced tactical medical care during critical incidents, but may also prove to be beneficial in the form of preventative medicine. Keeping the boots on the ground in a constant state of good health is an integral part of being prepared.

Another area where law enforcement medics or officers with medical training can be utilized is in the special operations realm. While there is a high propensity for injury during tactical team operations, there is also a high risk for injuries or illnesses during police dive operations, search and rescue operations, civil disturbance operations, and marine enforcement operations. Many of these situations are such that it is neither safe nor practical for fire services or EMS to position themselves for rapid aid, should it be needed. In these instances, cross-trained law enforcement medical personnel are able to provide an invaluable service.

Establishing protocols, training, and support of law enforcement personnel who can double as emergency medical technicians or medics is an important element in policing. Endorsing such a program and equipping these persons to provide medical care prior to the arrival of EMS should be one of the next “big trends” in law enforcement—it is time for agencies to implement this relatively straightforward measure to protect and support their officers when they need it most. Departments in the United States are beginning to embrace the need for tactical medical intervention and are training staff in the use of trauma equipment such as tourniquets, hemostatic gauze, compressing dressings, chest seals, and so forth. This is a positive first step, but law enforcement needs to be proficient with all issued tools and stay abreast of current trends and training. Officers must constantly learn as much as they can about anything related to policing, including emergency medical care during tactical situations. Knowledge and training are key to being prepared for that “fight of your life.” In order to best be prepared, it is each agency’s and officer’s obligation to work toward being one step ahead in every aspect, especially when intervention may make the difference between life and death. ♦

Notes:
^1 “Measuring the Risk in High-Low Frequency Tasks,” Security Magazine, August 13, 2012, http://www.securitymagazine.com/articles/83398-measuring-the-risk-in-high-low-frequency-tasks (accessed April 15, 2015).
²Ronald F. Bellamy, “Combat Trauma Overview,?”in Textbook of Military Medicine, Anesthesia and Perioperative Care of the Combat Casualty, eds. Russ Zajtchuk and Christopher M. Grande (Falls Church, VA: Office of the Surgeon General, United States Army, 1995), 1-42.
³National Law Enforcement Officers Memorial Fund, “Law Enforcement Facts,” http://www.nleomf.org/facts/enforcement (accessed April 16, 2015).
⁴Wound Data and Munitions Effectiveness Team, The WDMET Study [1970 Original data are in the possession of the Uniformed Services, University of the Health Sciences, Bethesda, MD].
⁵Ibid.; Ronald F. Bellamy, “The Causes of Death in Conventional Land Warfare: Implications for Combat Casualty Care Research,” Military Medicine 149, no. 2 (February 1984): 55-62.
⁶Bellamy, “The Causes of Death in Conventional Land Warfare.”

Please cite as

Jimmy D. Pearce and Scott Goldstein, “Not Just for SWAT Teams: The Importance of Training Officers in Tactical Emergency Medicine,” The Police Chief 82 (April 2015): web-only article.