Who's responsible for saving lives?

Should officers receive medical training beyond basic first responder or CPR competency?  I think so. In a growing trend among law enforcement agencies the traditional role of officers has been redefined to include medical training. Although it may...


Should officers receive medical training beyond basic first responder or CPR competency? 
I think so.
In a growing trend among law enforcement agencies the traditional role of officers has been redefined to include medical training. Although it may appear to blur some lines of responsibilities, this trend has brought lifesaving practices to the fight. Most will submit that the advantages outweigh the disadvantages. For example, immediate care applied early is usually more effective than deliberate care administered in a less timely fashion.
I interviewed Dr. Kevin Gerold, D.O., J.D., the Chairman of the National Tactical Officers Association (NTOA) Tactical Emergency Medical Support (TEMS) Section. In addition to his position, Gerold is the senior medical officer at the Johns Hopkins Center for Law Enforcement Medicine and a Special Deputy United States Marshall. He says that historically the tactical response to many situations was methodical. That is, a team would surround, and then contain, the incident. After Columbine trainers realized this type of approach could be costly. Now tactics includes quickly assembling an ad hoc team with the first one or two officers to arrive, after which they proceed directly toward the gunfire. Following the point in time when the immediate threat is extinguished there is a delay between the time the dust settles and the time medical professionals can enter a scene. This delay can be fatal to some victims. Dr. Gerold told me no one could overlook the tremendous amount of impact Columbine had on law enforcement. The methodical approach was entirely too slow.
Our military also looked at patient care during battle and viewed combat associated deaths from delayed wound care as preventable casualties. That is, if timely, proper care had been applied the patient would have lived. They began to adjust the focus on a reasonable level of resources and a reasonable level of sophistication for improvement in patient care.
The military concept of care was pushed down to the patrol level, according to Dr. Gerold. Now the focus was on hemorrhage control, where training at this level should focus on immediate care. Hemorrhage control (specifically, controlling an exsanguinating extremity hemorrhage where a tourniquet or direct pressure would save a patient), according to Dr. Gerold, can be addressed with only a moderate level of sophistication.
If you think about it, there are several competing events in emergency operations. This was obvious to me was when I had a victim of a gunshot wound. I wanted to help the patient, but I also needed the evidence left by the suspect, which would not be as important to a medical professional working on him. Although the suspect had fled, witnesses indicated he lived there. We had to consider maintaining a protective perimeter in order to prevent further crimes, while rendering aid until we could get medical professionals in.
Having an officer with advanced training would have helped. If an officer can communicate with the next echelon of care, having common medical nomenclature will improve things for the patient. I told Dr. Gerold I had heard the attitude about tourniquet use has changed: Was the tourniquet “in”?
Dr. Gerold says that originally, the context of tourniquet use was use as a last resort. That is, at one point it was assumed a patient with an applied tourniquet would lose that limb. The military actually reintroduced the tourniquet. Dr. Gerold says if the patient was transported to a hospital in a reasonable amount of time, the tourniquet was not about limb losing, but life saving.
In previous conflicts like World War II, patients might not have gotten a timely evac depending on the tactical situation. Technology made the battlefield more mobile and new medical doctrine, like attached 68W (medics) and embedded CLS (Combat Life Savers-non-medic soldiers with training that goes beyond buddy aid) have strengthened the chain of evacuation. Current wars have proven that the applied tourniquet can work in law enforcement.
Various other technology improvements have changed the priorities of emergency care. We talked about the “ABC” protocol, which is Airway, Breathing and Circulation. This was how everyone learning mass education of CPR was trained. The truth is, the highest priority should be to keep the patient from losing too much blood in a very short time. Ballistic panel technology made the most likely avenue of blood loss through the limbs, hence the tourniquet.
I asked Dr. Gerold, “What can small agencies can do now when it comes to emergency care?” His reply: It comes down to money and time. Medical training competes with officer safety training. The question boils down to how much training can be allotted to life saving procedures. Obviously, the more sophisticated the training sessions, the greater the time block. As a minimum, officers should be equipped with a tourniquet and a pressure dressing, not in the car, but on the patrol belt. A kit in the car does nothing if the officer is bleeding on the other side of a building. The IFAK (Individual First Aid Kit) should be on the officer’s person for self or the life of someone else.
Last month, LET reviewed the LEMK-PO from Chinook Medical Gear Inc. I recommend this type of kit.
Gerold said a culture change is necessary in how we look at lifesaving care. That is, every citizen should have basic medical survival care training. Other countries do it and we should, too. 
Also the current “911 approach” is somewhat of a disappointment. Vendors are selling kits with extensive component lists while simple equipment and basic skills are most valuable. 
Where do agencies start in regards to training? The NTOA offers two appropriate training sessions: STORM (Specialized Tactics for Operational Rescue and Medicine), a 16-hour course and STORM Medic, a 
32-hour course.
While I was putting together this article, I had a unique opportunity to watch a Defensive Medicine class in session on my local range. First of all, my local range, Safety First Shooting Association (SFSA), provides training in various aspects of firearms skills: working with local agencies, civic organizations and even teaching shooting skills to (gulp!) local college students.
Dave Givens of Hammer Stryke Self-Reliance Training Inc. invited me to a Defensive Medicine Class at SFSA. I’ve known Dave for a while, having provided training myself there for law enforcement and civilian participants in our regular training programs. He also helps coordinate training at the range.
This class was a collaborative effort between NorCal MedTac and Hammer Stryke. Both training providers have “portable curriculum.” They can come to an agency’s range.
NorCal MedTac uses powerful reinforcers for training skills. They show up to the range with several coolers full of sides of beef. Students perform patient rescue with dummies and fellow students, then go to work on the beef. Not only does it add realism in the “feel” of a patient, the sense of urgency increases when the student drags a dummy to cover, then has a side of beef thrown on top of the dummy. The classroom-like feel goes away. Students are reminded to view the entire problem, not just the gunfight or the patient. This material is stressful and challenging.
The three Defensive Medicine classes from NorCal MedTac, Defensive Medicine 101, 102 and 103 are 8-, 16- and 24-hour classes respectively.
NorCal MedTac’s Brannon Schell told me the beef sides are a great method for teaching trainees realistic would care. For example, when users simply pack a clotting product like a QuikClot bandage over a bleeding wound, it won’t benefit the patient. Users have to feel the wound and place the bandage in the correct area. QuikClot products, by the way, are game changers. This product creates a powerful natural clot, resulting in hemostasis.
Brannon told me that many students come to training and begin to arrange bandages and tourniquets 
on wounds, only to find they are 
preconfigured for use.
Bleeding, according to Schell, is the highest priority, after making the environment safe to perform patient care. A person can bleed out in 29 seconds.
Schell explained that gunfights are violent and often over in seconds. All of their training scenarios begin with a shooting sequence. There is even a scenario where a student has to talk a “pinned down” shooter through self care over the radio.
Critical incidents are fluid and dynamic. Medical self and patient care often requires immediate and effective intervention. A medic-trained officer just may be an ounce of prevention.

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