Patrol Ready!

No words can or will ever describe the sadness felt by the senseless loss of children. Oregon and Connecticut are stark reminders that several times a day as law enforcement officers prepare to go on patrol, their mindset, training and equipment must be ready to respond to and protect our most precious commodity....human life. Friday morning without a second of hesitation, Connecticut law enforcement officers raced to and entered Sandy Hook Elementary school pursuing the sound of gun fire until they had put a human shield between the children and a crazed murderer. These officers are not Army Rangers, Green Berets, Navy Seals or SWAT, they are the men and women who make up the backbone of all US law enforcement....they are Patrol Officers!

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The Bail-out bag

Few careers allow an effective professional to arrive at their workplace without allocating time to prepare themselves mentally.  Some career professionals need to mentally and physically prepare, making equipment status checks and evaluating the immediate needs of the day crucial to their success.. Physicians, pilots, firefighters and law enforcement officers as well as many other professionals spend a portion of every work day going through surveys of equipment preparation, functionality and assessing any special requirements unique to the day's responsibilities.. Law enforcement officers start each day inspecting their uniform, duty belt, tools, and weapons for function and sign of wear. The patrol vehicle is next undergoing review for operation, wear and damage. Every officer has a unique routine and set of priorities for preparing for their shift. The amount of personal equipment loaded into the vehicle is often a function of an officer's current assignment and personal preferences. Of the many lessons learned from the North Hollywood Bank Robbery, being prepared to sustain long periods of action without logistical support at a crime scene or critical incident is vital. Tactical independence has become a major teaching point in all law enforcement training which requires police officers be mentally and physically prepared.

The term "Bailout" bag has become a popular term for the west coast law enforcement community. It refers to a collection of equipment readily available for use when immediate sustained action is required. It typically is loaded into a patrol vehicle at the start of a shift as part of the vehicle preparation. The bag commonly contains food, water, extra ammunition and a medical kit. Officers can create them individually with the mind set that it be accessible in a split second and it provide them the ability to be self sustaining for a minimum of several hours. In recent years, medical kits have become very popular additions to bailout bags. Though some officers choose to create their own kit, there are several commercial vendors selling pre-packaged kits at various cost. Commercial kits can cost between $25.00 to $100 dollars depending on the contents of the kit.  Many vendors will customize kits to fit specific police department’s needs. Contents often vary depending on the officer's assignment. SWAT or special operation team needs are different then the needs of a patrol officer.   Any first responder is potentially exposed to high risk injuries and the need for emergent medical attention, therefore, should always be required to carry, at minimum, a basic kit

Each member of our SWAT team carries a medical kit attached to their tactical vest. It typically contains a battle tourniquet, pressure bandage and scissors. Each operator is trained in individual care as well as buddy care. The team is supported by a police officer/ medic who carries a fully supplied trauma bag, AED (Automated External Defibrillator) and oxygen. The presence of the Bearcat tactical vehicle allows for immediate rescue and extraction. Unfortunately, patrol and non special operations officers are often not afforded the same immediate medical support as the tactical teams. When creating or purchasing a basic medical kit, assessing potential risk and determining the environment an individual will be operating in is important. The urban area of Los Angeles compared to the remote wilderness of Montana obviously have differences in evacuation complexity and transport time to an acute care hospital.  Many medical items are perishable, expensive and in many cases never used. The size and weight of a kit and, again, the environment of the officer will dictate the content. Expectantly, the Bail-out bag must be a manageable size to be functional.

Recommendations for medical kit content varies. The majority of vendors selling kits attempt to parallel military needs with that of law enforcement. Military statistics indicate 56% of battlefield ballistic injuries are non survivable and 44% of battlefield ballistic injuries are initially survivable. Statistics that clearly do not reflect the environment of U.S. law enforcement.  Of those who initially sustained a survivable wound and later died, 90% of those soldiers died before reaching a medical facility. The majority died from either bleeding to death or a chest wound. Unquestionably, the injury and death rate of the military in battle does not compare to the same statistics in law enforcement. Thousands of soldiers are injured or killed every year on the battlefield while felonious assaults leading to death have never reached such numbers in modern U.S. law enforcement. However, unlike the military, there is no detailed database of the type of injuries or exact causes of death of law enforcement officers. Thus, the mechanism of death associated with initially survivable injuries either on the battlefield or on the streets are arguably compared in light of the amount of military weaponry that has made it to the level of the street criminal. It would seem logical to assume acute bleeding and chest trauma would also be the most likely causes of death of a wounded law enforcement officer.

Consideration of the most probable mechanism of critical injury should guide a officer's decision on what to carry in a medical kit. Function, size and weight are factors. Delayed extraction and transport time are not, typically, considered in an urban environment. The combination use of a battle tourniquet and pressure bandage is the most effective way to prevent the number one cause of death from a survivable injury. Used in combination, almost all extremity bleeding either venous or arterial can be controlled long enough for rescue and transport to a medical facility. The use of clotting agents in civilian law enforcement does not have enough evidence to warrant recommendation. The incidence of survivable chest trauma in law enforcement deaths is not well documented. Typical law enforcement body armor protects against most handguns. Unlike the military battlefield, there is very little explosive shrapnel injuries in civilian law enforcement which is one of the main causes of the "sucking chest" wound along with small caliber ammunition.  Stabbings can also be cause of critical chest trauma but, based on available information, the number of officer deaths by stabbing is very small. These facts make it difficult to suggest the need to carry chest seals in a medical kit. Automatic weapons and rifles cause such extensive chest trauma, there is virtually no piece of first aid equipment available that would be beneficial in this situation.

Allocating time each day to mentally prepare as well as assessing equipment needs and equipment functional status will prepare an officer for almost any encounter.  However, standardizing a basic medical kit to include a battle tourniquet and a pressure bandage as part of a police officer’s equipment needs, such simple items readily available for immediate access, could make the difference of life and death in today’s world of law enforcement.

Why do the cops need a tank?

The tragic death of United States Park Ranger Margaret Anderson on Near Year’s day 2012 highlights one of the worst fears of the law enforcement medical community--a "down" officer with potentially survivable injuries who cannot be reached to receive medical care. After being wounded, Ranger Anderson was able to call for help, but fellow officers could not rescue her for over 90 minutes due to the ongoing gun battle. Back in 1997, the North Hollywood bank robbery brought to the forefront the lack of law enforcement resources available to launch an injured officer rescue in the face of a hostile environment.  By late morning February 28, 1997, numerous civilians and law enforcement officers laid injured and trapped while the fiercest gun battle in United States law enforcement history raged around them for almost 45 minutes. One the most critical decisions made by officers on scene that day was to utilize a bank armored car to rescue the injured caught in the crossfire. Several individuals rescued had sustained life threatening injuries that required emergent medical care to save their lives.  Fifteen years later, some in the general public still question whether life-saving armored vehicles should be afforded to our officers in the field.

 Armored vehicles for law enforcement have been sparsely available through military surplus since the 1960s. Until September 11, 2001, only a handful of armored vehicles specifically designed for the unique needs of law enforcement and rescue operations were in service.  Since 2001, several companies have entered into the law enforcement armored vehicle market. Arguably, the Lenco armored vehicle company has emerged as one the leaders in the industry.  The cost of these vehicles is significant with prices ranging from $200,000-$400,000 dollars. With the increased availability of Homeland Security grants after the terrorist acts of September 11, 2011, hundreds of law enforcement agencies across the United States have been able to purchase law enforcement specific armored vehicles.

The cost to the taxpayers combined with the current difficult economic landscape has led many citizens to question the need and fiscal responsibility associated with the purchase of one these vehicles. It is not difficult to appreciate these concerns when school funding, social services, and public works budgets are continually being reduced to manage increasing budget deficits. Almost every law enforcement agency in the country that has purchased an armored vehicle has encountered some negative publicity through town meetings or print and Internet media.  Fortunately, the need analysis for armored vehicles in law enforcement is overwhelmingly clear. The examples of officer protection provided by armored vehicles as well as serving as a secure platform for any rescue operation can be found in almost every major city in North America.  Countless lives have been saved by the presence of these vehicles in a time of unprecedented violence.

Criticism of such large public expenditures will only continue to grow unless the law enforcement community becomes aggressively proactive in educating the public in regards to the capabilities of these vehicles and the sequence of events associated with acute injuries, rescue time and the loss of life. Unfortunately, a significant percent of the general public build their perceptions and opinions of law enforcement operations from viewing fictional television shows or movies. Educating the public, though not always straight forward and simple, on factual historical data may benefit law enforcement agencies. The use of simulated reenactments of actual situations may make any local educational program more personal, realistic and informative.  The events in Waco, Texas, the North Hollywood bank robbery and Mount Rainier National Park all provide excellent history lessons on the reality of the world we live in.

It will never be known if Ranger Anderson would have been saved if a timely rescue had occurred by her fellow law enforcement officers or if there had been an armored vehicle with a trained tactical medic readily available. What is known is the difference between life and death is often measured in seconds and we need to take advantage of those seconds to preserve the lives of the officers who put their life at stake to serve and protect our communities.