Page 159 - Journal of Special Operations Medicine - Winter 2015

reviewed the impact of conducted energy weapons no one else was injured, provided care to those who
programs, and described the fundamental principles were injured, and ultimately ensured that the only loss
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of civilian-sector tactical EMS. Other writers have de- of life that day was that of the suspect. Even in times of
3
scribed attempts to prevent in-custody death by involve- utmost crisis, LEOs are capable not only of performing
ment of the medical examiner and attempts to codify traditional duties but also of providing care to individu-
4
the role of the law enforcement agency members as med- als around them. Because of the dynamic nature of an
ical first responders. 5 incident like that one, with two distinct scenes, continu-
ing gunfights, multiple IEDs, and multiple business and
Hemorrhage Control and the residential occupancies at risk, the scene is simply in-
Law Enforcement Officer accessible to non-law enforcement responders such as
It would be optimal to have a trauma surgeon at the side EMS and fire and rescue services. Had there been more
of every officer at the time of wounding, but that clearly injuries, care would have been the responsibility of the
is not feasible. Law enforcement physicians have been DPD officers there. What remains clear is that the care
instrumental in pushing medical techniques previously described in the Hartford Consensus represents the best
thought to be used only by certified medical providers response in the unique nexus of the roles of law enforce-
out to individuals with mere basic training. The transla- ment, trauma surgery, and public health.
tion of these skills from medical textbooks to wide ap-
plicability and their implementation by non-traditional
responders have saved and will continue to save lives. DALLAS POLICE DEPARTMENT
Based on principles established in the Tactical Combat DOWNED OFFICER KIT CONTENTS
Casualty Care program, these hemorrhage control tech- SOFTT-W tourniquet
niques are battlefield tested, have been supported by QuikClot Combat Gauze LE
data from both military and civilian sources, and have 4-inch modular bandage
eliminated preventable deaths in some battlefield spaces Latex/EMS gloves
by their widespread adoption. Officers who are trained
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in hemorrhage control and other medical techniques
can treat injured persons until they can receive more
advanced medical attention. LEO hemorrhage control The Hartford Consensus and the
programs must contain simple, easily replicable, easily Major Cities Chiefs Association
taught, and easily learned skills and must focus on those
interventions that can be applied by police officers to From its inception, the agencies represented by the Ma-
the injured at the point of wounding. jor Cities Chiefs Association (MCCA) and many other
law enforcement agencies around the U.S. and the world
Because the predominant cause of preventable battle- have been supporters and contributors to the Hartford
field death is exsanguinating extremity hemorrhage, the Consensus. In addition to the adoption of the response
use of tourniquets and other hemorrhage control tech- concepts represented by the acronym THREAT (Threat
niques plays a large role in the management of these suppression, Hemorrhage control, Rapid Extrication to
types of casualties. The table on page 58 lists the con- safety, Assessment by medical providers, and Transport
tents of a basic downed officer kit issued to every LEO to definitive care), the provision of hemorrhage control
with public contact in the Dallas (TX) Police Depart- has been recognized by many as a core law enforcement
ment (DPD). The contents mirror those of the Tactical skill. Although data regarding specific use of hemor-
Combat Casualty Care program, and each officer issued rhage control during active shooter situations are scarce,
these kits receives training to become expert in the use agencies across the country are reporting multiple lives
of these pieces of equipment in austere environments. saved with the use of these techniques. In Tucson, AZ,
the police and sheriff’s departments have a long history
Some detractors initially thought that the introduc- of a law enforcement agency–based hemorrhage con-
tion of these skills into the armamentarium of the trol program. Responsible for saving more than 75 lives
LEO would distract from other, more traditional law over the years, it is hailed as a real example of the im-
enforcement responsibilities. In fact, they have proven provement in community safety when LEOs can provide
to be very complementary, particularly in response to effective hemorrhage control at the point of wounding.
the active shooter. On June 12, 2015, an assailant in an
armored vehicle attacked the DPD headquarters build- At the October 2013 meeting of the MCCA, the Hart-
ing with automatic weapons and improvised explosive ford Consensus was presented to the membership and
devices (IEDs). While officers returned fire, negotiated its concepts unanimously endorsed. Since that meeting,
the IED-containing suspicious packages, and evacuated nearly 45 of the 70 agencies represented by the MCCA
endangered civilians, other DPD officers ensured that have completed or are in the process of training and

The Hartford Consensus 147