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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. 

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?