Critical MEDICAL RESPONSE Training
Glemboski, Gary, Law & Order
Medical training for law enforcement personnel at the academy and inservice 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. …