Field-Proven Medical Skills for Law-Enforcement Units

The military medical skills displayed by U.S. soldiers and Marines in both Afghanistan and Iraq contributed significantly to the highest survivability rate in U.S. history.  Nonetheless, and despite that encouraging example, domestic law-enforcement officers are generally provided nothing beyond basic first aid training.  There are some disturbing trends today, in fact, that – despite improved tactics and better protective equipment – make the law-enforcement profession, anywhere in the world, less safe than ever before.  Just on the other side of the U.S. border with Mexico, for example, law-enforcement units are being assaulted, with devastating results, by well armed and tactically skilled criminal teams.

In many other areas of the world, law-enforcement facilities and units are high on terrorist target lists.  According to a recently released FBI report – Law Enforcement Officers Killed and Assaulted (LEOKA) 2009 – nearly 33 percent of police officers who made the ultimate sacrifice had been ambushed.  Numerous incidents show that the planned premeditated ambush is more likely than not to result in severe injury to the officers targeted.

Motor vehicle accidents are another “leading indicator” of fatalities among the law-enforcement community.  In both types of situations – ambushes or vehicle accidents – the officer is likely to have to rely on his or her own skills for self preservation.

A Common Sense Approach Beyond Basic First Aid


The well publicized Pittsburgh (Pa.) ambush in April 2009 is but one example among many in which police officers, injured in an assault, were unable to escape from the danger zone – which itself had become too dangerous for medical personnel to come to their assistance.  In the Pittsburgh ambush, the assailant prepared for the deadly confrontation as officers were responding to a disturbance call.  The two officers – Stephen Mayhle and Paul Sciullo III – who initially responded were killed outright.  Officer Eric Kelly, the third responding officer to arrive on the scene, was fatally wounded by the assailant’s AK-47. Officer Timothy McManaway, who arrived later, was shot in the hand and therefore unable to assist Officer Kelly – who was still alive when McManaway arrived.

Deputy Chief Paul Donaldson arrived in time to see McManaway kneeling over Kelly and calling for assistance.  As more police arrived on the scene, a police van was improvised to provide the officer driving with some degree of ballistic protection (but probably not enough to preclude penetration of the 7.62x39mm bullet the assailant was using). The van was used as a rescue and extrication vehicle, but Kelly succumbed to his injuries after losing too much blood.  (In the infamous 1997 North Hollywood bank robbery shooting rampage the same type of improvised rescue method had been used to extricate a critically wounded officer suffering from significant blood loss.)

In the United States, approximately 80 percent of civilian trauma deaths in such incidents are attributed to the uncontrolled loss of blood. But there is a lack of reliable empirical data on law enforcement injury typologies – except for the initial cause: a gunshot wound. Largely for that reason, Dr. Matthew D. Sztajnkrycer, medical director of the Rochester (Minn.) Police Department, has called for deeper and more extensive epidemiological studies into life-threatening law-enforcement incidents and, not incidentally, also has recommended better and more comprehensive training in medical decision-making skills for police.

DOD Medical Training for Civilian L-E Agencies?


There is considerable evidence to suggest that current Basic First Aid and First Responder certifications fail to provide law enforcement officers the depth of knowledge necessary to save themselves and one another.  Moreover, the failure to train all officers on key fundamental medical skills from a self-treatment and active threat environment standpoint poses a potentially fatal risk to other officers who are compelled to bravely attempt hasty and improvised extrications while under fire from an unknown and frequently non-visible assailant.

The success of the U.S. Department of Defense (DOD) Tactical Combat Casualty Care (TCCC) program provides several teachable lessons for the nation’s domestic law-enforcement community.  The initiative for broader application of essential medical skills throughout the nation’s armed services was heavily influenced by the 1993 Battle of Mogadishu firefight in which a number of the U.S. casualties could have been prevented by prior training in essential “buddy-care” skills and, not incidentally, the acquisition and use of more and improved lifesaving tools and equipment.

The core principle of the TCCC program is to rapidly provide events-based medical care to battlefield casualties – while at the same time continuing to eliminate or at least mitigate the threat sources.  TCCC focuses on core combat medical decision-making and treatment skills for controlled bleeding, tension pneumothorax, and airway management.  A complicating factor in the law-enforcement field, though, is that – unlike military personnel, who seldom operate alone – police officers frequently do carry out their duties either alone or as part of a two-man team.

Inevitable Escalation & Other Ramifications


The application of TCCC event-based principles and practices might easily be – and probably should be – adapted for use in the domestic environment to deal with the types of injuries most likely to be encountered by police. Fortunately, the environment in which U.S. police services usually are carried out is seldom as austere as the combat environment faced by the nation’s armed forces.  Also, the domestic police officer is not as likely to experience the type of extreme injuries as those caused by improvised explosive devices (IEDs) used against armed forces personnel in Afghanistan and Iraq.

The nation’s law-enforcement agencies would be well advised both to adapt TCCC training for local police units and to provide them as well with such essential basic military medical equipment as combat application tourniquets (CATs) and improved modular dressings.  Unfortunately – and despite the efforts of the National Tactical Officers Association (NTOA), supported by the National Association of Emergency Medical Technicians (NAEMT), in developing general guidelines for adapting TCCC – there is still no uniform standard for training and equipping the officer on the street for exigent self or “buddy” stabilization and extrication.

Nonetheless, as violent trends continue to escalate both domestically and overseas, the urgency – particularly along the nation’s southern border – for enhanced combat medical skills throughout the law enforcement profession will undoubtedly become increasingly important.  Addressing this increased need with the battlefield-tested techniques demonstrated in the TCCC program – carefully and effectively adapted to the police profession – will and should be recognized as a mandatory officer-safety priority.