Page 17 - Journal of Special Operations Medicine - Fall 2014

incidents; this is true even in the nontactical environment. isolation, reflecting the current system of response in
In this case, off-duty law enforcement was immediately each subject community, a more dramatic benefit was
on scene and the patrol officer arrived within 3 minutes observed, with defibrillation initiated 3.8 minutes sooner
16
of the incident. The commercial tourniquet was secured and survival being 14.3% higher in the LEO cases.
and hemorrhage controlled 3 minutes before BLS person- Other data have also shown that LEOs often present
nel arrival and 6 minutes before advanced life support more quickly to the patient’s side after arriving on scene
(ALS) personnel arrival. Second, properly trained LEOs secondary to the ease and speed of LEO movement in the
can identify appropriate indications for tourniquets field (e.g., less equipment, fewer personnel, more robust
and effectively execute critical life-saving interventions. threat mitigation tactics, etc.) compared with other tra-
Again, in this case, the off-duty officers recognized the ditional medical prehospital providers. Finally, a recent
requirement for hemorrhage control and implemented a retrospective study from Band et al. in Philadelphia dem-
combination of improvised tourniquet and direct pres- onstrated that law enforcement transportation of trauma
sure. Finally, LEOs can effectively perform basic life- patients resulted in similar adjusted mortality rates for
saving interventions without jeopardizing their primary patients with penetrating trauma. 17
mission of community security and policing; this creates
a major force multiplier effect for trauma care. In high-threat scenarios such as the active shooter in-
cident at the Century Theater in Aurora or the Boston
This most recent case report supports a larger case se- bombing, LEOs were not only first on scene but also
ries in the Charlotte-Mecklenburg area of four addi- had earlier access to casualties than any other first re-
tional cases of LEO-applied tourniquets. Three of the sponders. In Aurora, preliminary after-action reports
four patients in the prior series had significant vascular revealed that LEOs transported to hospitals 75% of the
injury with life-threatening hemorrhage. In all cases, an casualties within the first 30 minutes post event (Aurora
LEO-applied tourniquet resulted in hemorrhage control Shoo, personal communication). Taken in totality, this
before BLS/ALS arrival on scene. The three patients with suggests that LEOs can play a significant role in both
vascular injury arrived at the ED in class III or IV shock, routine response and dynamic high-threat incidents.
received immediate blood products, and were taken The key factors are robust training, solid quality assur-
emergently to the operating theater. All have made full ance, and interagency collaboration.
recovery without significant sequelae. 8
Law Enforcement Can Learn
Law Enforcement First on Scene and Execute Life-Saving Interventions
Modern combat data clearly demonstrate that early Various studies have demonstrated the ability of LEOs
tourniquet application reduces mortality. 9,10 Extensive to evaluate patients with complex medical complaints
military, and now expanding civilian, data demonstrate and to perform life-saving medical/trauma tasks. The
that early application of tourniquets is the essential first work conducted by Husain and Eisenberg described
step in effective damage control resuscitation strategies, earlier showed that patrol LEOs can undergo training,
with survival benefit being greatest when tourniquets are retain knowledge, and effectively deploy AEDs in the
applied prior to the patient entering a shock state. 1,11–14 field, with a dramatic impact on mortality. With tactical
Kragh et al. demonstrated that TQ application prior to law enforcement teams, Sztajnkrycer observed that after
onset of clinical shock reduced mortality from 96% to a 90-minute didactic and practical application session,
1
4%. Further analysis of one of two data sets used in this nonmedical LEOs were able to learn to identify and treat
study also suggests a greater than twofold reduction in tension pneumothoraces with needle thoracentesis. Im-
mortality if the tourniquet is applied in the prehospital portantly, LEOs retained this knowledge at 6 months. 18
arena versus first application in the ED. 1
There are multiple reports in the popular press of law
In the civilian setting, LEOs are first on scene in a majority enforcement–applied tourniquets to fellow officers and
15
of medical and trauma calls. In the nontactical environ- even the occasional civilian. 18,19 However, very little data
ment, LEOs can play an important role beyond securing exist regarding law enforcement tourniquet use on com-
the scene and preserving evidence; LEOs can function as munity civilians. This case report reaffirms what prior
the first link in the medical and trauma “Chain of Sur- data have suggested: LEOs can deploy tourniquets in
vival.” A meta-analysis by Husain and Eisenberg from the field with life-saving benefit. The authors have ob-
March 2013 looked at the response times and survival served four additional cases of LEO-applied prehospi-
data of police-and-EMS combined automated external tal tourniquets following violent trauma that resulted
defibrillator (AED) programs versus EMS-alone pro- in life- and, in those cases, limb-saving results for the
grams. If an LEO was first on scene, the mean time to victims. Furthermore, this case report highlights the
defibrillation was 3.4 minutes shorter and survival im- importance of appreciating that LEO tourniquet use
proved by 10.8%. If examining the most recent data in expands outside of violent trauma. Modern combat

Law Enforcement–Applied Tourniquets Save Lives 9