Page 18 - Journal of Special Operations Medicine - Fall 2014

tourniquets have altered the treatment paradigm of ex- Finally, the 2013 Hartford Consensus statement supports

tremity hemorrhage, and the authors postulate that ex- the position that medical training for external hemor-
peditious and extensive use of tourniquets, specifically rhage control techniques is essential for all law enforce-
by nonmedical LEOs, has immense potential benefit to ment officers. This case report further demonstrates
22
our communities. the survival benefit of LEO tourniquet application with
expansion beyond active violent incidents and violent
Law Enforcement as Force Multipliers trauma to injury sustained in nondynamic environments
The quantity of marked, unmarked, and off-duty patrol (e.g., no active threat to first responders).
officers in a given metropolitan area that can potentially
respond to a 911 dispatch far outnumber the available With extensive experience from training LEOs in both
EMS units. In Charlotte, NC, there are approximately tourniquet use and advanced prehospital care such as
25 to 50 units divided into three shifts, deployed daily TECC, it is the authors’ belief that patrol LEOs can be
to cover an area of 300 square miles and 1 million peo- efficiently trained to use tourniquets in the appropriate
ple. There are an additional approximately 100 patrol setting with effective results.
officers per shift per day (approximately 300 in total)
divided into 13 districts. Similar to the military model, Study Limitations
highlighted by the Rangers, expanded training to non- The primary limitation of this report is that it is a case
medical personnel is a force multiplier in initial casualty report. Additional research is needed to further compare
management and mass casualty incidents. In most com- LEO- and EMS-applied tourniquets to evaluate efficacy
munities, LEOs are an untapped resource for expanding following training and mortality benefit. Some stud-
initial trauma care and reducing mortality. ies have pointed out a hesitation of police officers to
participate in medical training. It is important to note,
however, that other studies have shown an increased
Conclusion
willingness of LEOs to participate in trauma and tour-
Law enforcement tourniquet programs are important niquet training compared with other forms of medical
components of multiagency, tiered trauma response sys- training. 19,23 The authors also appreciate that undertak-
tems. In the civilian arena, the Committee for Tactical ing a training regimen for entire community police de-
Emergency Casualty Care (C-TECC), a nonprofit, best partments is a large commitment.
practice development group for prehospital care in high-
threat environments, also supports expanded tourniquet
use. Combat data indicate that successful reductions in Disclosures
mortality require a comprehensive trauma management The authors have nothing to disclose.
system, with traditionally nonmedical personnel playing
a critical role in initiating hemorrhage control and assist-
ing with evacuation. The C-TECC strongly endorses References
20
LEO-based tourniquet programs as a critical component 1. Kragh JF Jr, Littrel ML, Jones JA, et al. Battle casualty sur-
of this “Chain of Survival” in traumatic mass casualty vival with emergency tourniquet use to stop limb bleeding.
incidents and active violent incidents (Figure 3). In ad- J Emerg Med Serv. 2011;41:590–597.
dition, the American College of Surgeons also recently 2. Beekley AC, Sebesta JA, Blackbourne LH, et al.; 31st Com-
released evidence-based guidelines for hemorrhage con- bat Support Hospital Research Group. Prehospital tourni-
quet use in Operation Iraqi Freedom: effect on hemorrhage
trol in the prehospital setting call for early tourniquet use control and outcomes. J Trauma. 2008;64(2 Suppl):S28–
and seem to support LEO-based tourniquet programs. S37; discussion S37.
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10 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014