The year 2014 is shaping
up to be one of the most violent years for law enforcement in recent times. Thirty-three
officers have been shot and killed between January 2014 and September 9, 2014. By
comparison, there is a 72% increase in gun related deaths in 2014 over the same
period in 2013. Seventy three law enforcement officers in total have lost
their lives on duty so far in 2014. (www.odmp.org)
Being shot and killed
remains the number one cause of death for law enforcement officers and the
numbers are growing. It is almost double that of car accidents. In
addition to human deaths, seven law enforcement service dogs have been
killed in 2014. Five being shot to death and two stabbed. Despite what
appears to be a growing public perception that law enforcement officers can
make "superman" like decisions in split seconds, and have adequate
training to prepare them for all types of situations, the numbers are asserting
otherwise. There is no acceptable rate of injury or death for those who protect
and serve us making continuous learning necessary to keep up with today’s
violence.
An important part of
officer safety is training both the law enforcement officer and the first
responders in civilian tactical medicine. The medical community is actively
working on evidenced based pre hospital care that is designed and proven
to be effective for civilian first responders. Currently, the
military's Tactical Combat Casualty Care doctrine (“TCCC”) is the only
proven type of training that has been shown with great success to be effective
on the battlefield. Unfortunately, the mechanism of battlefield injury does not
parallel the injuries seen predominately in civilian life. The tactical
situations of the battlefield, though occasionally compared, have few
similarities with majority of the situations encountered by law enforcement.
Evacuation and transportation to tertiary care centers is typically fairly
constant throughout the metropolitan areas of the United States, thus
unlike the military, does not play a significant role in injury survival.
Catastrophic bleeding, similar to military
findings, is the number one cause of civilian trauma death with
survivable injuries. It is recognized that an arterial injury can lead to
death in as little as three minutes with loss of consciousness occurring as
fast as 90 seconds. The importance of bleeding control has trickled into
first responder training in various regions of the country. There are,
now, numerous case reports in the civilian literature regarding
immediate blood loss control by first responders, including law
enforcement officers, where the victim survived due to the care they received
at the site of injury.
The introduction of the modern battle
tourniquet has been the most significant contributor to civilian tactical medicine
training and pre hospital bleeding control since the US Civil War. In
2006 after uniform distribution of tourniquets to all US combat forces, the US
Army Institute of Research reported an 85% reduction in extremity bleeding
deaths in Afghanistan and Iraq. On the civilian side, the aftermath of the
Boston Marathon Bombing saw the largest use of tourniquets for
bleeding control than in any other previous critical incident in the
United States. The quick action of the numerous Massachusetts National
Guardsmen who were present, all previously trained in TCCC, saved the lives of
many of the victims by using their issued battle tourniquets. Their actions
were mimicked by multiple Good Samaritans who used anything they could find to
create a tourniquets and saving even more lives.
As specifics of civilian trauma death are
further defined, more research is being performed to develop a TCCC like tactical
medicine doctrine for civilian first responders. Definitions regarding the
immediate tactical situation are being adapted from TCCC to give first
responders guidelines on when medical care is appropriate and expected versus
the volatile situation where rendering medical aid is too tactically risky.
It is recognized that poor tactics or omitting
high risk zones are not acceptable protocol in first responder doctrine or training. The
creation of tactical zone language has helped define the priorities in high
risk critical incidents where tactics and injury management are combined.
The high risk zone or "Hot Zone” is defined as an area where
an immediate threat is imminent and the top priority is threat
management. Active shooters, structurally unstable buildings, bombings and
natural disasters may all be considered hot zone situations where medical aid
stands behind tactical considerations in regards to priority
decisions. The "Warm Zone" is defined as the area close to an
imminent threat that has some form of security and protection. In this
location, tactical considerations remain top priority, but with adequate
security, medical aid can be initiated following the medical BABC's (Bleeding,
Airway, Breathing and Circulation). The warm zone may at any time convert back
to a hot zone where the top priority converts back to threat management with
the emphasis on tactics. The warm zone is mostly where the
services of law enforcement, Fire and EMS will merge and work in union, each
bringing their unique expertise. The "Cold Zone" is defined
as where advanced medical aid is performed and transportation and
evacuation are planned and executed. This area is either a significant distance
from the ongoing imminent danger or the threat has been neutralized whereas the
location has been declared safe.
The definitions of the tactical zones are an
example of how civilian tactical medical response can be performed in an
effective and safe manner. Additionally, continued civilian
based research driving improvement to pre hospital care training, will
provide first responders the knowledge, mindset and skillset to operate
and survive in the increasingly violent environment that today’s
millennial society is becoming. The seventy-three law enforcement
officers who have died while on duty in 2014 are only a fraction of the first
responders on duty deaths this year. Firefighters and EMS personal also face
high risk situations. September 11, 2001 is a somber reminder of this fact. Uniform
process, updated training procedures and continued research are paramount in
keeping our law enforcement and first responders safe.
As an aside, though very graphic, the video of
the 2011 Sindh Ranger shooting in Karachi, Pakistan displays how quickly
human mental status changes with severe blood loss followed by
death and stresses the need for civilian tactical medical training for first
responders.
