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Lastly, there are no records of whether or not any of the of- 4. Jacob LM, McSwain NE, Rotondo MF, et al. Improving survival
ficers involved in applying tourniquets received any refresher from active shooter events: the Hartford Consensus. J Trauma
training following their initial instruction in the TCC-LEFR Acute Care Surg. 2013;74:1399–1400.
course. In fact, there are few, if any, refresher courses avail- 5. Jacobs LM. Joint committee to create a national policy to en-
able. The ideal time frame for such a refresher has not been hance survivability from mass casualty shooting events: Hartford
Consensus II. J Am Coll Surg. 2013;218:476–478.
identified, although we would suggest annual or biennial pro- 6. Jacobs LM. Hartford Consensus III: implementation of bleeding
grams. This is an important point given that in one case, the control. Bull Am Coll Surg. 2015;100(7):20–26.
tourniquet is documented as having been applied below the 7. American College of Surgeons. Strategies to enhance survival in
wound and in another case the application was described as active shooter and intentional mass casualty events: a compen-
unsuccessful in stopping a distal hemorrhage. This study how- dium. Bull Am Coll Surg. 2015;100(15):1–90.
ever does suggest that since the initial training began almost 6 8. Jacobs LM. The Hartford Consensus IV: a call for increased na-
tional resilience. Bull Am Coll Surg. 2016;101(3):17–24.
years ago, in general police officers retain the skill and deci- 9. Pons PT, Jerome J, McMullen J, et al. The Hartford Consensus
sion-making to appropriately apply a tourniquet. on active shooters: implementing the continuum of prehospital
trauma response. J Emerg Med. 2015;49(6):878–885.
10. Committee for Tactical Emergency Casualty Care. Accessed 2
Conclusion December 2020.
11. 2017 Annual Report, Aurora, Colorado Police Department.
This review of police applied tourniquets reveals that police https://www.auroragov.org/UserFiles/Servers/Server_1881137/
officers recognize the need for rapid hemorrhage control from File/Residents/Public%20Safety/Police/Public%20Reports%20
a variety of trauma etiologies and can apply a tourniquet to and%20Crime%20Data/2017%20Police%20Annual%20
the injured limb, whether on themselves, a fellow officer, or Report%20FINAL.pdf Accessed 2 December 2020.
an injured civilian. In addition, this study showed that police 12. https://www.auroragov.org/cms/One.aspx?portalId=
officers often arrive at a trauma scene in advance of EMS re- 16242704&pageId=16411021
sponders, saving time to hemorrhage control. 13. Basic Academy Training Program. https://www.colorado.gov
/pacific/post/atom/125226. Accessed 2 December 2020.
14. Maughon JS. An inquiry into the nature of wounds resulting in
Acknowledgments killed in action in Vietnam. Mil Med. 1970;135:8–13.
The authors would like to acknowledge and thank Amy Mor- 15. Kelly JF, Ritenour AE, McLaughlin DF, et al. Injury severity and
ris, specialist, Public Safety Communications Department, causes of death from Operation Iraqi Freedom and Operation
City of Aurora, Colorado, for her invaluable assistance in Enduring Freedom: 2003–2004 versus 2006. J Trauma. 2008;64:
searching communications records and reports for cases of S21–S27.
tourniquet application by police officers and for helping to 16. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
(2001–2011): implications for the future of combat casualty care
obtain dispatch data and times. [published correction appears in J Trauma Acute Care Surg. 2013
Feb;74(2):706. Kotwal, Russell S [corrected to Kotwal, Russ S]]. J
Funding Trauma Acute Care Surg. 2012;73(6 suppl 5):S431–S437.
The work was supported by the Aurora Police Department in 17. Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emergency
the form of donated time for the officers and the communica- tourniquet use to stop bleeding in major limb trauma. Ann Surg.
2009;249(1):1–7.
tions specialist involved. 18. Kragh JF Jr, Littrel ML, Jones JA, et al. Battle casualty survival
with emergency tourniquet use to stop limb bleeding. J Emerg
Financial Disclosure Med. 2011;41(6):590–597.
The authors have no financial relationship relevant to this pa- 19. Kragh JF Jr, Walters TJ, Baer DG, et al. Practical use of emergency
per. JSH is supported by R01DA042982 (National Institute tourniquets to stop bleeding in major limb trauma. J Trauma.
on Drug Abuse), R01CE003006 (Centers for Disease Control 2008;64(2 suppl):S38–S50.
and Prevention), U01HL123010 (National Heart, Lung, and 20. Heiskell L. Why officers need advanced medical training. Police
Blood Institute), and W81XWH-16-D-0024 and JW190515 Magazine. 9 June 2016. https://www.policemag.com/342050/why
-officers-need-advanced-medical-training. Accessed 2 December
(Department of Defense). 2020.
21. Robertson J, McCahill P, Riddle A, Callaway D. Another civilian
Author Contributions life saved by law enforcement-applied tourniquets. J Spec Oper
JJ conceived the study concept and coordinated data collec- Med. 2014;14(3):7–11.
tion. JJ and PTP reviewed and analyzed the data, and wrote 22. Callaway DW, Robertson J, Sztajnkrycer MD. Law enforce-
the first draft. PTP and JSH conducted the statistical analysis ment-applied tourniquets: a case series of life-saving interven-
tions. Prehosp Emerg Care. 2015;19(2):320–327.
and report. All authors read, reviewed, edited, and approved 23. Stiles CM, Cook C, Sztajnkrycer MD. A descriptive analysis of
the final manuscript. Tactical Casualty Care interventions performed by law enforce-
ment personnel in the state of Wisconsin, 2010–2015. Prehosp
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