Page 74 - Journal of Special Operations Medicine - Fall 2017

succumbed to head trauma and these injuries were likely non- that all SWAT operators have training in basic trauma care and
survivable. Although ballistic helmets are commonly used in casualty extraction. Once the situation is secure, these opera-
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SWAT operations, they are not necessarily worn during high- tors are able to augment and support trained tactical medical
risk warrant services performed by special task forces. Similarly, personnel in patient care, thereby extending the capacity of
although ballistic face masks are available, they are not com- limited medical resources. Based on the results of our study,
monly used in U.S. law enforcement tactical operations, presum- these recommendations should be extended to all law enforce-
ably because of factors including cost, comfort, and ergonomic ment units involved in high-risk law tactical incidents. Mili-
limitations (e.g., loss of peripheral vision, impaired breathing, tary experience has demonstrated dramatic improvements in
inability to simultaneously use chemical masks). Although they unit survival rates when all operational personnel are trained
may have a role in specific high-threat operations, further study in basic tactical medical skills. 29,30
is needed prior to developing specific recommendations.
Limitations
The study data showed 21 officers (38.2%) died of injuries to in addition to all the common limitations inherent in retro-
the trunk (Figure 3). Although the pathophysiology of the fatal spective analyses, including selection and recall bias, this study
injury cannot readily be determined from LEOKA summaries, suffers from several important limitations that may impact the
most of these individuals likely died of exsanguination from validity of subsequent analyses. Very little information is avail-
noncompressible truncal hemorrhage. Recent military data able on either the total number of tactical incidents during
suggest that hemorrhage is responsible for 90.9% of potentially the study period or the total number of personnel classified
survivable combat deaths, with 67.3% of potentially surviv- as tactical officers. Moreover, the limited data available only
able hemorrhage being truncal. In contrast, tension pneumo- addressed SWAT units. Thus, only absolute numbers of tacti-
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thorax accounted for 1.1% of potentially survivable deaths in cal officer fatalities were determined during the study period;
combat and no cases of law enforcement death. 16,17 Although incidence could not be calculated. As a consequence, the rela-
decedent officers were documented to be wearing body armor, tive risk of tactical officers compared with officers assigned to
the exact National Institutes of Justice level of the body armor nontactical duties could not be determined.
was not recorded. Although the fatal round may have exceeded
the protective capacity of the ballistic vest, 71.4% of fatal chest Although it is currently the most comprehensive source on law
and 75.0% of fatal upper back wounds occurred secondary enforcement fatalities secondary to felonious assault, the FBI
to the round penetrating the body cavity via the ballistic vest UCR LEOKA program was never intended to serve as a medi-
armhole. The ergonomics of ballistic vests are beyond the scope cal dataset. Some medical elements can be extrapolated from
of this paper, but there is clearly a need to balance the ability to the victim narratives; however, in many cases, data elements
function effectively with the need for protection. The inherent were either absent or incomplete. Specific care rendered, out-
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bias of fatality studies notwithstanding, the prevalence of axil- comes, and causes of death cannot be identified within the
lary strikes in decedent officers suggests possible opportunities LEOKA program. Thus, there is a critical knowledge gap in
for improved ballistic armor designs. terms of determining future personnel, training, and equip-
ment needs. The collection of injury-specific combat data by
Medical support of tactical operations has long been recognized the U.S. military has resulted in substantial decreases in poten-
as a fundamental aspect of modern SWAT operations. 9,19–25 tially preventable combat deaths. 15,29 This study highlights the
Despite this, a recent analysis of SWAT units identified that needs for a law enforcement-specific trauma registry.
only 54.8% reported the presence of medical personnel within
the tactical unit, and only 67.0% reported the routine use of Last, this study is highly biased secondary to the nature of the
an ambulance on standby during these operations. Use of fatality dataset. To be included in the dataset and, therefore,
5
such assets is less well documented among non-SWAT tactical this study, an officer had to be feloniously killed in the line of
units, but may have a role given the high-threat nature of these duty. Thus, the study results are biased toward fatal events.
operations. In this study, fugitive task force and narcotics task This may impact several data elements, including anatomic lo-
force operations accounted for 33.3% of fatal incidents. cation of injury and type of weapon used. As a consequence,
certain wounding patterns may be over-represented while
Although information regarding medical care afforded dece- others are under-represented. For example, the high propor-
dent officers is sparse in the LEOKA narratives, several im- tion of fatal axillary wounds may be driven by the fact that
portant observations can be made in terms of requirements strikes that did not violate the vest and, therefore, were nonfa-
for on-scene medical support. First, two or more officers were tal would not be captured by this study. Likewise, death from
killed in 8.8% of the incidents in this study. Almost half of isolated extremity hemorrhage remains extremely rare in the
all incidents resulting in the death of a tactical operator also civilian trauma environment. The U.S. military understands
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involved injuries to other tactical operators. Given the logis- the bias of mortality studies and has used such studies to de-
tics of caring for even a single critically injured officer during velop highly effective tactical medical programs. 32,33
circumstances of active threat, tactical and medical command-
ers should anticipate the need to care for multiple victims and Conclusion
train for such events. Second, 48% of victim officers survived
more than 1 hour from time of injury, suggesting opportunities On average, three officers each year are feloniously killed dur-
to intervene and potentially impact outcomes. Current civil- ing the performance of law enforcement duties during tactical
ian and military guidelines for high-threat emergency casualty incidents. These deaths most commonly occur during the
care emphasize limiting medical care during circumstances service of high-risk warrants and most often involve the first
of active threat to selected high-yield procedures, such as officer(s) to enter a scene, which suggests training opportu-
tourniquet application for life-threatening extremity hemor- nities. In addition to fatalities, injuries occurred to multiple
rhage. 26–28 Recently published national standards recommend officers during these events, highlighting a need for adequate

72 | JSOM Volume 17, Edition 3/Fall 2017