Page 76 - JSOM Spring 2021

TABLE 1 Tactical Casualty Care for Police and First Responders Methods
Hemorrhage control The City of Aurora is the second-largest city in the state of
• Tourniquet application Colorado. It comprises 161 square miles with a resident pop-
• Direct pressure ulation of approximately 379,000 people.
• Topical hemostatic agent use
• Wound packing The Aurora Police Department employs 729 sworn officers.
Airway management Officers annually respond to more than 2,000 major violent
• Manual airway opening techniques crimes (including 80 gunshot wound victims) and 13,000 mo-
• Trauma jaw thrust tor vehicle crashes of which more than 900 result in injuries or
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Breathing death. EMS in Aurora is provided by the Aurora Fire-Rescue
Department, with transport of patients performed by a private
• Recognize and treat open pneumothorax (sucking chest wound) ambulance company dispatched at the same time as the fire
• Recognize tension pneumothorax department. There are more than 30,000 calls for EMS annu-
Clinical Scenarios ally. The City of Aurora has a Level I trauma center, a Level
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• Recognition of need for and application of skills II trauma center, and a regional pediatric trauma center within
Components of the TCC-LEFR course from Pons PT, Jerome J, Mc- its borders. All police officers in Aurora were trained in the
Mullen J, Manson J, Robinson J, Chapleau W. The Hartford Consen- use of a Combat Application Tourniquet (C-A-T) by attending
sus on active shooters: implementing the continuum of prehospital the mandated TCC-LEFR course. New recruits are required to
trauma response. J Emerg Med. 2015;49(6):878–885.
attend the course (or equivalent) by the Colorado Peace Offi-
cers Standards and Training Board prior to completion of their
TABLE 2 Indications for External Hemorrhage Control 13
police academy training. The Aurora Police Department has
• Blood spurting/pumping/pulsing from wound also issued every officer trained in bleeding control an individ-
• Blood flowing continuously from wound ual first aid kit with a CAT to carry when on patrol.
• Blood soaking through clothing or previously applied bandage
A retrospective review of tourniquet applications initiated by
• Blood pooling under the patient or on the ground police officers in the City of Aurora, Colorado from March
• Limb amputation 2014 to December 2019 was conducted. A computer search
Recommended indications for application of hemorrhage control skills of police officers’ reports and public safety communications
(from Stop the Bleed, TCCC, and TCC-LEFR educational programs). center records was performed for the word “tourniquet.” All
identified reports of CAT tourniquet application by police of-
ficers were de-identified, reviewed by two of the authors (J.J.
offered nationally, was modified from the US military TCCC and P.P.), and abstracted. The narrative describing the indica-
course and combined didactic lecture with clinical skills and tion for tourniquet application was reviewed. Cases in which
scenario training in the essentials of recognizing and treating the word “tourniquet” appeared that clearly referred to drug
exsanguinating limb hemorrhage. Given the military nature paraphernalia confiscated from a suspect were excluded.
of the TCCC course, a civilian set of management and treat-

ment guidelines that mirror those of the TCCC course was Response times from the time of 9- 1-1 call receipt until of-

promulgated by the Committee on Tactical Emergency Casu- ficer and EMS arrival were collected and compared using
alty Care (CoTECC). The TECC recommendations represent Mann-Whitney U-test. Police and EMS response times were

an all-hazards approach to casualty management, not just for calculated from the time of 9- 1-1 call until the report of arrival

active shooter situations. Finally, the citizen bystander role to the scene, respectively.
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in hemorrhage control was formally recognized, again by the
Denver Health Paramedics EMS Education Department and The study was reviewed by our local institution review board
the PHTLS Committee of the National Association of EMTs, and received a nonhuman subjects designation.
of the Bleeding Control for Citizens course, now offered as the
Stop The Bleed course by the American College of Surgeons. Results
The Stop The Bleed campaign initiated by the White House
has provided a further impetus to the widespread implemen- Forty-three incidents were identified during the study period
tation of training, education, and deployment of hemorrhage in which officers were on scene or responded to an incident,
control supplies and equipment. recognized an injury associated with severe blood loss, and
placed a department-approved tourniquet. The mechanism of
A significant portion of the training time in the TCC-LEFR injury for these incidents is described in Table 3. The majority
course focuses on the appropriate steps to take and skills of cases involved gunshot wounds, followed by self-inflicted
needed to manage external hemorrhage, especially as it relates lacerations of the wrist. Table 4 reports the rationale used by
to active shooter incidents. However, the importance of pro- the treating police officers for application of the tourniquet.
viding hemorrhage control in other trauma-related incidents Comparison of the officers’ documentation and justification
is also stressed. 9 for tourniquet use reveals that the majority, although not all,
of the tourniquets applied were based upon the bleeding con-
In an effort to follow up on the effectiveness of the hemor- trol criteria for significant hemorrhage. Table 5 and Figure 1
rhage control training, we review the experience of the police describe response times for both police and EMS. On average,
department in Aurora, Colorado, in responding to trauma police arrived at the scene slightly more than 4 minutes earlier
incidents of all types, providing the initial interventions, and than EMS (p < .001). In some cases, EMS was not dispatched
analyzing to whom that care is provided. until after police arrival and recognition of an injury requiring
72 | JSOM Volume 21, Edition 1 / Spring 2021