Page 15 - Journal of Special Operations Medicine - Fall 2014

Another Civilian Life Saved by
Law Enforcement–Applied Tourniquets

Josh Robertson, MD; Peter McCahill, MD; Andrew Riddle;
David Callaway, MD, MPA

ABSTRACT
Increasing data and anecdotal operational reports are Casualty Care (TCCC), resulting in a 0% prehospital
supporting the early, aggressive, prehospital application preventable death rate. 6
of tourniquets in potentially life-threatening extremity
trauma. Especially in the civilian urban setting where While tourniquets are gaining wider acceptance in the
transport times are short, the benefit in terms of lives traditional medical prehospital environment, expansion
saved far outweighs the potential risk to the extremity. of hemorrhage control strategies to include nonmedical
The popular press has reported frequently on law en- first responders (e.g., law enforcement officers [LEOs])
forcement–applied tourniquets, but to date, no group is critical to achieving the levels of success seen by the
has published a scientific review of any of these cases. Rangers. This report details the case of a patrol offi-
This case report suggests that law enforcement person- cer who applied a tourniquet with life-saving results to
nel can be trained to safely identify indications for tour- a civilian suffering massive, life-threatening extremity
niquet application, properly apply them with limited trauma in a nontactical environment.
training, and function as effective first care providers.

Keywords: tourniquet, law enforcement, tactical medicine Case Report

Prehospital Course
An on-duty patrol officer operating in a marked patrol
Introduction
vehicle received an off-duty call for assistance at 1537
Prehospital application of tourniquets to control life- hours. The off-duty officer described a male subject who
threatening extremity hemorrhage saves lives. In com- had stepped in front of a moving train, resulting in high
1,2
bat, isolated extremity hemorrhage remains the number amputation of his right upper extremity. The off-duty
one potentially preventable cause of death, declining officer used a leather belt to create an improvised tour-
from 9% in Vietnam to approximately 2% in Operation niquet on the right upper extremity stump. A second
Iraqi and Operation Enduring Freedom. In the civilian off-duty officer applied pressure over the distal aspect
3
setting, hemorrhage is the second leading cause of death of the wound.
behind head injury. Recent experience from the Au-
4,5
rora Century Theater shooting and the Boston bombing The patrol officer arrived at 1539. On arrival, no obvi-
further validates the critical importance of robust, early ous threats were visualized. The victim was lying on a
hemorrhage control strategies, including tourniquets in concrete surface, naked and covered in blood. Per of-
the civilian setting. 6 ficer report:

Civilian trauma scenarios are distinct from combat I could see the victim was missing his right
scenarios, but extremity hemorrhage remains an easily arm several inches above the elbow and
preventable cause of potential mortality. Combat data decided that a tourniquet would be helpful
indicate that successful reductions in mortality required in this type of traumatic injury. The belt was
a comprehensive trauma management system with tra- placed up near the arm pit and since it was
ditionally nonmedical personnel playing a critical role slowing some of the blood loss I decided to
in creating access, providing security, initiating hem- leave it in place while the tourniquet was
orrhage control with tourniquets, and assisting with applied. I applied my C-A-T tourniquet below
evacuation. The US Army Rangers demonstrated the the belt and as high up on the arm as possible.
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value of training all unit members in Tactical Combat That TQ was in place in less than 30 seconds.

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