Page 75 - JSOM Spring 2021

Tourniquet Application by Urban Police Officers

The Aurora, Colorado Experience

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Jesse Jerome, EMT-P *; Peter T. Pons, MD ; Jason S. Haukoos, MD, MSc ;
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James Manson, EMT-P ; Stephanie Gravitz, MPH 5

ABSTRACT
Background: Uncontrolled external hemorrhage is a common the effort to decrease the incidence of preventable death from
cause of preventable death. The Hartford Consensus recom- hemorrhage after trauma. As recommended by the Hartford
mendations presented the concept of a continuum of care, in Consensus on Improving Survival from Active Shooter Events,
which police officers should be considered an integral com- police officers are an important component in the continuum
ponent of the emergency medical response to active shooter of trauma care, which begins with the civilian bystander (also
incidents. Recent publications have reported individual cases referred to as the immediate responder) and progresses to in-
of tourniquet application by police officers. This report ana- clude arriving police officers and then emergency medical ser-
lyzed all documented cases of hemorrhage control using tour- vices (EMS). Police officers are often the first public safety
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niquets applied by police officers in a single large metropolitan responders to arrive to the scene of violent or other traumatic
police department. Methods: A retrospective computerized incidents. If trained appropriately, they can and should serve
search of all public safety communications center reports and as the first line of emergency medical care for severely injured
police officer documentation for cases of tourniquet applica- persons as scene security is being established, particularly if
tion was conducted by searching for the word “tourniquet.” EMS responders have not yet arrived on the scene. A tiered
Each case was evaluated for indication and appropriateness educational program that describes the training goals for each
using Stop The Bleed criteria for tourniquet placement. In ad- of the various responders in the continuum of care has been
dition, police response time was compared to emergency med- previously described. 9
ical services (EMS) response time in an effort to determine if
there was a time difference in response to the bleeding patient In 2012, a gunman began shooting in a movie theater in Au-
that could potentially impact patient outcomes. Results: For- rora, Colorado, resulting in 12 deaths and 70 others injured.
ty-three cases were identified over the 6-year period ending As a follow-up action to that shooting incident, the chief of the
in December 2019. The majority of cases involved gunshot Aurora Police Department decided that all officers were to be
wounds and most were civilian victims. Injured police offi- trained in Tactical Casualty Care for Police and First Respond-
cers accounted for two cases (gunshot wound and dog bite). ers (TCC-LEFR). This 1-day educational program combines
Review of the officers’ narratives indicated that most applica- didactic lecture, hands-on skills stations, and clinical trauma
tions appeared justified using the Stop The Bleed criteria (two scenarios designed primarily for police officers (Table 1). The
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cases were questionable if a tourniquet was necessary and one indications for external hemorrhage control as taught in that
may have been placed in an incorrect location). On average, course are similar to those recommended as part of the Stop
police arrived 4 minutes sooner than EMS did. Conclusion: The Bleed initiative and the TCC courses, whether military or
Several reports in the literature document the success of police civilian (Table 2).
officer application of tourniquets to control limb hemorrhage.
Most of the reports involved a small number of case reports. The military Tactical Combat Casualty Care (TCCC) course
This is the largest case series to date from a single urban police focuses on the treatment of battlefield related injuries and uses
department. terminology that is military centric. The combat experiences
in Iraq and Afghanistan lead to a reevaluation of the use of
Keywords: tourniquet; hemorrhage control; police; emer- tourniquets in the civilian setting, particularly as it related to
gency medical services penetrating limb injuries following some of the mass shoot-
ing incidents in the United States. Training of police officers
in hemorrhage control has been formally offered since 2013
Introduction with the development of the TCC-LEFR course by the Denver
Health EMS Education Department of the Denver, Colorado
Uncontrolled bleeding after trauma is a major cause of pre- Paramedics and the Prehospital Trauma Life Support (PHTLS)
ventable death. Recognition and control of external hemor- Committee of the National Association of Emergency Med-
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rhage are the focal points of the Stop The Bleed initiative and ical Technicians (EMTs). This 1-day educational program,
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*Correspondence to JesseEJerome@gmail.com
1 Mr Jerome is a paramedic and police officer in the Aurora Police Department in Aurora, CO. Dr Pons is an emergency medicine physician
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in the Department of Emergency Medicine at Denver Health in Denver, CO, and a professor emeritus at the University of Colorado School of
Medicine in Aurora. Dr Haukoos is an emergency medicine physician and professor in the Department of Emergency Medicine at Denver Health
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in Denver. Mr Manson is a paramedic in the Freeport Rural Fire Protection District in Freeport, IL, and the former chief of EMS education at
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Denver Paramedics in Denver. Ms Gravitz is a research associate at Denver Health in Denver.
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