FBINAA Associate Q1 Magazine

Continued from "Critical Medical Response Training", on page 14

Recent advances in combat casualty care have produced several excellent pieces of gear. These include inexpensive yet highly effective tourniquets and pressure dressings to stop hem - orrhage. Dr. Gunn, an ER surgeon on the east coast states, "In the case of a gaping wound, many advocate first stuffing something into it that will act as a matrix for blood to fill and then clot. The method is known as Deep Packing with Deep Pressure (DPDP). By stuffing the wound full of gauze, you will necessarily apply pressure directly to wounded tissues, thus controlling bleeding better, at least in theory, than via pressure on the surface alone. The problem is, when the packing is subsequently disturbed and/or dislodged, an eventuality difficult to prevent in the field, bleeding will resume. As with all probing of wounds, particularly in the field, you may well make matters worse. A better plan is to quickly apply Israeli Battle Dressing (IBD) (Figure 5) over the wound and use it to pull the injured tissues together and apply pressure to the wound. Blood will fill open spaces, and clot. Then, you need to get him to a surgeon and an ER, as there is little more you can do. Bottom line: It's best, in general, to simply apply IBDs, skillfully and quickly... then, get him to an ER. Our job in the field is to ensure that he gets there alive, and none the worse for wear!" It is recommended that officers always carry a small kit with basic lifesaving medical gear, and they should definitely carry one during high-risk activities, like warrant service, protective details, and during firearms training (in case of accidental injuries). TRAINING If it is agreed that law enforcement officers and the public would benefit from the additional medical training, there are several questions that must be answered: What type(s) of training would be appropriate? Would there be certification issues? Would there be a different standard of care? What is needed for law enforcement is a ”down and dirty” course that primarily addresses the bleeding and breathing issues as simply as possible. Something simple enough to be taught in a relatively short period of time with a minimal amount of skill and equipment needed, with results replicable in the field. There are many options available for qualified individuals to instruct at the level necessary to accomplish the overall goals. Many courses are available, and they range from first responder to paramedic and everything in between. Most officers would not want to invest the time to become a paramedic but less time-intensive courses would serve the intended purpose. As mentioned, the military has in- stituted the TCCC, and the Combat Lifesaver courses are both gener- ally 3-5 days or less in length. The TCCC course stresses the treatment of penetrating trauma (gunshot wounds) over other kinds of trauma (burns, fractures, etc.) although field-expedient treatment is covered. CONCLUSION As the initial responders at many violent and traumatic events, officers are frequently placed in positions to help themselves, their fellow officers, or the public. Basic medical training and equipment can be highly valuable – even lifesaving – in these situations. It is not the author’s intention to initiate a “Cops vs. Medic” conflict by infer- ring paramedics and EMTs do not have the ability to perform their mission or maintain a high standard of care. Police medical training would focus on two primary issues:

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. Rendered once the casualty is no longer under hostile fire. Medical equipment is still lim- ited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours. Rendered while the casualty is evacuated to a higher echelon of care. Any additional person- nel and medical equipment pre-staged in these assets will be available during this phase.

Care Under Fire

Tactical Field Care

Combat Casualty Evacuation Care (CASEVAC)

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 these are the two easiest treatments that a minimally trained officer can perform and need no special equip - ment. The third condition, tension pneumothorax, is a severe type of collapsed lung. Relieving it by needle thoracentesis (i.e., chest decompression) requires specific training and equipment, and is generally not recommended for minimally trained individuals. While the above illustrates only a small percentage of the gun battles law enforcement have engaged in during the past 130 years, what is interesting is the number of potential ”saves” that are noted. The life-saving potential existing in even a modi- cum of training would seem to be well worth the effort. EQUIPMENT In the case of performing care under fire, the equipment and supplies you have with you are what you will be forced to use. Dr. F. Czarnecki, Director of Medical-Legal Research with The Gables Group, Inc., states that police officers should carry a medical kit specifically designed for penetrating trauma (gunshot wounds and stab wounds). Such a kit, carried in a plastic sandwich bag, can be assembled for a low cost. A basic kit should include the supplies listed below:

• 2 pairs of gloves • 1 or 2 tourniquets • 1 or 2 trauma dressings • 1 or 2 rolls of gauze

Many companies have developed individual “trauma kits” that contain the basic equipment necessary for care-under-fire scenarios. The basic load usually consists of a large trauma dressing, gauze pads, nasopharyngeal airway, and a good tourni - quet.

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