Page 77 - JSOM Spring 2021

TABLE 3 Mechanisms of Injury for Victims With LE Applied The Hartford Consensus authors advocated the acronym
Tourniquets “THREAT” that clearly defines the important role of police
Civilians Injured Police Officers Injured in an active shooter situation (Table 6). The “T” stands for
Mechanism of Injury (n=43) (n=2) “threat suppression,” representing the primary function of
Gunshot 28 1 police – to identify and deal with any on-going threat to the
Laceration 9 safety of victims or the public as well as to themselves. This
Motor vehicle crash 1 is followed immediately by “H” for “hemorrhage control,”
Motorcycle crash 1 which is the next most important action once any threat has
Train accident 1 been dealt with. If survival after traumatic injury is to be op-
Dogbite 1 timized, exsanguination from compressible external hemor-
rhage must be prevented.
1,2
Amputation finger 1
In 2014, Robertson et al. reported the case of an upper limb
amputation treated with a tourniquet by a responding police
officer. This was followed up by Callaway with a four patient
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case series of limb gunshot wounds managed by police applied
tourniquets. Stiles et al. published a report on all incidents
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in the state of Wisconsin involving police officers who applied
TCCC principles to injured victims during the 6-year period
ending December 2015. Of 56 incidents that met inclusion
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criteria, four cases involved wounded police officers and the
remainder were civilian casualties. Tourniquets were used in
42 of the cases. Interestingly, seven victims had improvised
tourniquets placed, of which six failed to control the bleeding
and were transitioned to a commercial tourniquet.

Rothschild et al. reviewed after action questionnaires and po-
lice reports regarding the importance of Tactical Emergency
Casualty Care (the civilian counterpart to TCCC) training to
medical transport. In other cases, EMS was dispatched simul- police officers. Forty-six cases were identified, of which offi-
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taneously with police but staged at a safe location until cleared cers expressed 100% success in performing the necessary pro-
by police to enter the scene. cedures and stabilizing the injured individual. Several lessons
learned from this study included that officers often had diffi-
culty in cutting the zip tie securing the medical aid kit, the scis-
Discussion
sors provided to cut victim’s clothing were often inadequate
The wartime experiences in Iraq and Afghanistan beginning to the task, and the need to deal with combative individuals
in 2001 demonstrated the importance of external hemorrhage made providing care difficult. Of note, one additional concern
control in decreasing preventable death. Initial studies per- voiced by some officers was the lack of time available to be-
formed during this conflict revealed that despite the passage come familiar with and practice using the medical equipment.
of five decades since the conclusion of the Vietnam war, mor-
tality from hemorrhage due to limb wounds was unchanged Ali et al. published a before and after study on the effect of
(Vietnam – 7.4% of all combat fatalities, Iraq and Afghan- training for police officers and security personnel on the com-
istan – 7.8%). 14,15 As a direct result of this finding, the mili- fort level and speed of application of a tourniquet. Prior to
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tary developed the TCCC course. The use of tourniquets to participating in the educational program, officers comfort level
control limb hemorrhage was implemented and expanded was reported as 5.1 ± 3.3 on a Likert scale of 1–10, with 10
service-wide. Subsequent studies demonstrated the efficacy of being very comfortable. Correct placement occurred 17.2% of
these devices in reducing soldier mortality from limb wound the applications, and the mean time to complete the procedure
hemorrhage (mortality reduced from 23.3 deaths per year to was 29.8 ± 18.5 seconds. After training, the comfort level in-
3.5 per year after full tourniquet deployment) and, despite al- creased to 8.8 ± 2.2 seconds, correct placement improved to
most a century of teaching to the contrary, the actual safety of 92.7% and time to placement decreased to 18.7 ± 6.7 seconds.
recommended tourniquets. 16–18 Studies from the military docu-
mented that no cases of amputation resulted from the applica- The current study looks at the hemorrhage control experience
tion of a tourniquet, with one exception in a victim who had a using tourniquets of one large urban police department and
tourniquet left in place for approximately 8 hours while other is the largest single police department report to date. Simi-
major life-threatening injuries were being addressed. 19 lar to other publications, gunshot wounds were the primary
cause for tourniquet application. However most importantly,
Police officers have traditionally not been trained to perform officers recognized the need for controlling bleeding, not just
medical interventions beyond cardiopulmonary resuscitation from gunshots, but also from many other causes of traumatic
(CPR). In general, they have typically awaited the arrival of injury and treated both themselves or fellow officers as well as
EMS personnel for medical care to be provided, even after the injured civilians.
situation requiring their presence has been controlled and the
scene rendered safe. Even if trained, some police departments Importantly, police officers responded to many of these scenes
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have prohibited their officers from intervening medically be- approximately four minutes before EMS arrival, which is more
cause of liability concerns. than ample time for a victim to exsanguinate from an arterial

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