Page 62 - Journal of Special Operations Medicine - Fall 2015

and automated external defibrillator training have vali- concerns that tourniquet training for nonmedical re-
dated the importance of a standardized and consistent sponders is expensive and inefficient. As LEOs are
39
training curriculum and can serve as a model for FCP overwhelmingly first on scene, with data showing the
trauma training. 32,35 In the civilian AVI setting, TECC value of early prehospital hemorrhage control and
provides this common language and furthers the integra- nominal time and resources to create trained users, LEO
tion of FCPs as the first link in the Chain of Survival. hemorrhage-control programs appear to be an essential
36
Recently, The Hartford Consensus II also recognized the area for investment.
important role that citizens can play in saving lives, add-
ing the weight of the American College of Surgeons to There have been numerous reports in the popular press,
the support of the FCP concept. 37 and now case reports in the peer-reviewed medical liter-
ature, of LEO tourniquet applications saving lives. 40–43
To date, there are no documented reports of morbid-
Every Cop a Ranger: ity associated with LEO-applied tourniquets. Unlike
44
Nonmedical Professional First Responders
SCA response, there remains no universal trauma re-
Immediate law enforcement response to active violent sponse protocol for prehospital providers; thus, these
incidents has two critical components: stop the killing tourniquet examples remain unique for trauma re-
and stop the dying. Patrol officers play a critical role sponse, training, and equipment, which emphasizes the
in both of these tasks and, as with Rangers, maintain value of the universal language and training of RFR
primary and secondary tasks. In the case of civilian and TECC.
AVIs, the primary role of LEOs is threat mitigation (i.e.,
stopping the killing). However, as resources flow to the Using RFR as a model for implementation of TECC
scene or the tactical scenario changes, LEOs must be concepts, all patrol officers should develop a mastery
trained and empowered to rapidly transition to “stop of tourniquet use, with an associated proficiency in ba-
the dying.” This transition requires understanding both sic hemorrhage-control techniques and a minimum of
strategies to effectively access the patient as well as ad- familiarization in damage control resuscitation (DCR)
dress the principle causes of preventable mortality. concepts. Further, LEOs should be able to demonstrate
proficiency in facilitating casualty access (e.g., rescue
For prehospital hemorrhage control, time is critical. task-force operations, mechanical breaching) (Figure 4).
Kragh et al. demonstrated that tourniquet application
prior to onset of shock dramatically improves survival. A 2007 study noted, “No widely accepted, specialized
In the United States, law enforcement is the initial first medical training exists for police officers confronted
responder on scene for approximately 60%–80% of with medical emergencies while under conditions of
9-1-1 dispatched emergency trauma calls. This per- active threat.” Since that time, two geographically
38
45
cent reflects routine or standard operations and does separate but equally successful examples of law enforce-
not take into account the potential for dynamic envi- ment trauma programs modeled after the RFR program
ronments such as active crime scenes or active shooter can be found in Tuscan, Arizona, and Charlotte, North
scenarios where fire, rescue, or EMS personnel are of- Carolina.
ten prevented from providing care until further scene
security is ensured. Jacobs and Burns demonstrated that The Tucson Police Department created a command-
minimal time and resources are required to train non- driven protocol for individualized first aid kits (IFAKs)
medical laypeople in tourniquet application, disputing based on TECC guidelines. As with the RFR program,

Figure 4 Civilian TECC skill matrix.
Casualty
Hemorrhage Control Extraction Airway Chest Trauma DCR
Pressure
Tourniquet Hemostatic Dressing Positioning NPA Advanced
Civilian Proficiency Familiarization Familiarization Familiarization Familiarization NA NA Familiarization NA
Patrol Proficiency Proficiency Familiarization Familiarization Proficiency Familiarization NA Familiarization Familiarization
SWAT Mastery Mastery Proficiency Proficiency Proficiency Proficiency NA Proficiency Familiarization
BLS Mastery Mastery Mastery Mastery Proficiency Proficiency Familiarization Proficiency Proficiency*
ALS Mastery Mastery Mastery Mastery Mastery Mastery Mastery Mastery Proficiency
Leadership Mastery Mastery Mastery Mastery Mastery Mastery Mastery Mastery Mastery
Note: *Should possess this level of knowledge for their component of the skill set (e.g., someone trained in BLS should know hypothermia prevention for DCR. ALS,
Advanced Life Support; BLS, Basic Life Support; DCR, damage control resuscitation; NA, not applicable; NPA, nasopharyngeal airway; SWAT, Specialized Weapons
and Tactics.

50 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015