The arrival of a Lenco Bearcat...a new era of safety

"If tomorrow you were going to be in a fight for your life, how would you train today?"  The protection and safety provided by a Bearcat G4 allows operators to deploy very close to the target, avoid the danger of open ground approaches and improve visual coverage for the snipers. The vehicle also creates significant cover if a firefight erupts and team members need to fall back for protection and regrouping. The distance and time between rally point and an officer rescue should dramatically improve as well. If the rescue team is not close to the injured officer, the Bearcat can deliver the rescue team right to the officer or at least to the entry of the structure containing the "officer down". The trained driver can position the vehicle as to provide maximum protection for the down officer and the rescue team. Within seconds, the injured officer can be loaded into the vehicle and full advanced traumatic life support initiated within the safety of armored walls. Penetrating chest trauma and major vascular injuries, the two most survivable lethal injuries law enforcement officers face, will be treated immediately. The Bearcat will provide the medical platform for large volume fluid resuscitation, chest decompression, vascular injury control and intubation with dual and single lung ventilation. Along with trauma care, advanced cardiac life support capabilities will be present. Treatment of cardiac arrhythmia's and defibrillation of a lethal heart rhythm can occur in seconds and not minutes--the time often separating life and death. With arrival of our new Lenco Bearcat G4, officer safety for our SWAT team has reached a new level. Like all aspects of law enforcement, training with new equipment is paramount. A new leap in safety has arrived for our SWAT team. 

The need for ballistic helmets

The topic of body armor and personal protection equipment seems to get increased awareness in the national law enforcement literature every couple of months. The tragic death of a law enforcement officer not wearing body armor is usually the igniting factor to readdress the topic. In California, the majority of law enforcement agencies require their officers to wear body armor while in uniform and assigned to patrol or traffic assignments. This is not the case with many agencies within the other 49 states. Either due to budget constraints or a resistance to change, a significant number of officers put their uniform on each day without the protection of body armor. As of October 20, 2011, fifty law enforcement officers have been shot and killed in the line of duty. A 16% increase in comparison to October 2010. In May 2011, the preliminary FBI 2010 Law Enforcement Officers Killed statistics were released. There was a 9% year over year increase in the number of officers shot and killed in 2010 compared to 2009.  28% of those killed were shot with rifles. Out of the 56 officers shot and killed in 2010, only 67% were wearing body armor.  In the last year, three law enforcement officers in San Diego County, CA have been shot in the head in the line of duty. Two of them died from their injuries and the third was critically injured but survived. The type of injuries these officers suffered sparked a discussion with some of my medical colleagues on the need for ballistic helmets for officers. Ballistic head protection is standard for special operations teams operating throughout the world. For the majority of line officers that also risk their lives day-to-day, this is not the case. Despite the lack of scientific data strongly supporting the effectiveness of ballistic helmets, the need is apparent and their use seems obvious to the medical staff treating these officers and the families of those who have been injured. In May 2009, a city of Oakland, CA SWAT officer was able to shoot and kill a murder suspect wanted in the killing of four police officers after suspect shot him in the head at point blank distance. His helmet not only saved his life, it gave him the opportunity to act--which most likely saved the lives of several team members. The 25% increase in shooting deaths of law enforcement officers in the last 2 years is a very sobering fact.  Patrol rifles have become standard equipment, similarly ballistic helmets should also be issued to every officer….such a simple change could be the difference between life and death.

Regardless of the profession, complicated tasks are mastered through practice and the development of proper techniques.  In theory, while a skill may seem very easy to perform in reality it requires significant coordination and complex decision making to execute. We are given an example of this through the live action video of an El Cajon, CA police officer who was shot in the head after responding to a domestic violence call. After collapsing, the officer's rookie partner runs to his aid and attempts to drag him to safety. The difficulty the "rookie" partner has dragging his medium sized partner to safety further exasperates situation. During the rescue, the injured officer and rookie have their backs to the shooter exposing both to more gun fire. The rookie has to holster his weapon to grasp his partner and can no longer engage further threats. The attempt to drag the wounded officer is unsuccessful. It takes two Good Samaritans assisting to finally get the wounded officer to the safety of cover and putting all three at risk. The difficulty of the "man down" drag is again seen during the extraction phase of the rescue. One large framed officer attempts to drag his wounded colleague into the back of a patrol vehicle. Despite the size and strength of an officer, the video clearly shows how difficult the task is. Technique is key to increasing success and officer safety. Strength is not the main factor for success. Positioning and technique developed through consistent practice are the elements of success. Through live simulation training, these skills can be mastered where all elements are incorporated. Body positioning, use of cover or concealment, ability to address a deadly threat and skills to prevent further injuries are all teachable components of a successful man down drill that can be mastered with crisis management simulation training.

How efficient have you become at man down drills?....are you ready for a crisis?

Crisis management is an intricate part of many professions. For decades, airplane pilots and anesthesiologists have recognized the importance of teaching and developing crisis management skills. With critical incidents occurring so infrequently during an individual's career, it was recognized decades ago that book knowledge was not sufficient enough to prepare someone to successfully manage an event like landing a commercial airliner in the Hudson River or salvaging a pediatric cardiac arrest in the operating room. Both professions dedicated significant resources toward developing training protocols that provided real time realistic crisis scenarios.  Flight simulation training began developing over 50 years ago and Anesthesiology related simulation saw its beginnings in the early 1980s. In a protected, non life threatening environment, trainees were able to experience critical events over and over where in reality the same incident may not actually occur ever on one's career.Simulation allows book knowledge to be interwoven into hands on critical thinking. Creating a parallel between the vital situations faced by a pilot or anesthesiologist with those faced by a law enforcement officer is not difficult to imagine. An officer involved shooting may never occur in a officer's career but it is something that is thought about and trained for by every law enforcement officer in the United States. Simulation training for law enforcement officers is becoming mainstream for deadly force scenarios like an active shooter or hostage rescue. This style of training has become an intricate part of the training of almost all special operation teams.  How efficient have we become in getting a severely hurt, dead weight 220lb teammate in full gear out of a second story bedroom to a rally point where medics can start needed care? Can this style of training be adapted to teach and train law enforcement officers in life saving medical techniques? When help is too far away, can we save a critically injured teammate by utilizing skills learned through simulation medical training? Is book knowledge enough to manage this crisis?

Physicians becoming involved in law enforcement is not a new phenomena. Physicians, like Lawrence Heiskell MD, have been advocating advanced medical care at the street level for many years. Though a small group currently, physicians are increasingly adding their expertise and time to law enforcement throughout the United States. Media exposure highlighting the heroic actions of "SWAT Docs" in areas like Tennessee and Dallas has only helped bring public attention to the dangers police officers face every day. My career in law enforcement began in 1985 with a small municipal police department. When I started my college studies, I was hired by a state police department in California. After being accepted to medical school, my relationship with law enforcement ended temporarily until 1999.  While completing my fellowship in Critical Care Medicine, I was fortunate enough to supervise the care of a deputy sheriff who had been shot in the line of duty. This young man left a lasting impression on me. This experience coupled with the handful of other injured peace officers I have provided care for in my career has led me to join the ranks of physicians who also hold the honor of being called police officers. In 2006, I enrolled in a P.O.S.T certified extended modular police academy in Southern California. Approximately 14 months later, I graduated from the basic academy. In early 2008, I joined a moderate size municipal police department and started the FTO program within the patrol division. After three years in the patrol division working weekend swing shift as well as consulting on various medical projects within the department, I was invited to join our SWAT team. In 2011, I graduated from the Los Angeles County Sheriff's Special Enforcement Bureau SWAT Academy. Using this experience, I feel honored to be part of the evolution of critical medical care, crisis management and leadership training physicians are bringing to the men and women who protect us every day.

Medicine and Law Enforcement

76 law enforcement officers have so far lost their lives in the line of duty in 2011. 32 of these officers were shot and killed. Its often spoken that motor vehicle accidents are the number one threat officers face in the line of duty but this is not true. From information collected by the Officer Down Memorial web site, each year for the last 10 years, more law enforcement officers have been shot and killed than died in car accidents. With the increasing threat of rifles to law enforcement officers, the time between injury and starting medical care has become critical. The "Golden Hour" defined as the time a critically injured patient should arrive at a trauma center for care has arguably decreased to "golden minutes" with death occurring as quickly as a 180 seconds. Tactical medicine courses, seminars and programs are increasing in number to help combat this increasing threat. Can we do more? Can medicine and law enforcement further join together to bring life saving care to the streets?