Here on ITS Tactical, we follow the CoTCCC (Committee on Tactical Combat Casualty Care) Guidelines very closely and have even... View ArticleView Article
The VALOR Project truly surprised me with information that changed what I thought I knew about self- and buddy-care in combat for law enforcement officers. Law enforcement shares many similarities with the military, though the missions are very different. Due to the the similarities, law enforcement frequently adopts methods, tools and techniques pioneered in military service.
Tactical Combat Casualty Care (TCCC), developed by the US military in the wake of the Battle of Mogadishu, is one of those protocols that is finding widespread acceptance in law enforcement. What if TCCC doesn’t properly prepare law enforcement officers for the realities of civilian combat? Is it possible that police officers are not learning the things they need to stay alive if wounded in combat?
That’s where the VALOR Project comes in.
Tactical Combat Casualty Care is a military protocol that integrates medical care for wounded servicemen into the tactical response to a combat situation. TCCC acknowledges that doing the “correct thing” for the medical treatment of the casualty may worsen the overall situation and survivability of the team. As Captain Frank K. Butler, Jr (USN) stated:
Good medicine can be bad tactics, and bad tactics can get everyone killed.
Therefore, civilian medical protocols for patient treatment are overridden by the realities of combat.
The US military determined that there are a certain number of casualties who are instantly killed or so massively wounded that no amount of medical care will allow the patient to survive. TCCC protocols were developed to address preventable combat deaths: deaths that could have been prevented with the proper intervention in the field.
Examining detailed casualty data, the US military determined that almost 2/3 (61%) of preventable deaths were due to hemorrhaging (bleeding) from isolated extremity trauma. From this fact, the rapid application of tourniquets to control life-threatening bleeding became a key component of TCCC.
The second most common form of preventable death in military combat was from tension pneumothorax (33%). Tension pneumothorax is a condition that frequently develops from penetrating wounds to the chest, which allows air from the lungs to fill the chest cavity, building a crushing pressure on the lungs and heart.
The third form of preventable death identified in the TCCC protocols is from airway compromise. This accounts for only about 6% of preventable combat deaths.
Based on the TCCC protocols, I presumed that preventable law enforcement deaths from felonious assaults should be in roughly the same proportion. Research conducted by Matthew D. Sztajnkrycer, MD, PhD, showed that my presumption was clearly suspect.
The VALOR Project collects data from a wide variety of sources regarding assaults on law enforcement officers, and police deaths and injuries. From the data, the Project then attempts to distill the data into information that can be used to help officers improve their odds of survival in a life-threatening situation.
Sztajnkrycer published several papers on the subjects of downed officer rescue, medical intervention for wounded officers and the feasibility of training non-medical personnel in needle thoracostomy (releasing the pressure of tension pneumothorax using a needle inserted into the chest). Additionally, Sztajnkrycer is working on several new research projects that study chest trauma, the use of helicopter EMS response and a wounding study using dash-cam video.
Sztajnkrycer has also created the Law Enforcement Near-Miss Database (LENMDB). The LENMDB is a voluntary reporting database where law enforcement officers can anonymously submit “near-miss” incidents. The VALOR Project defines a near-miss as “any event which had the potential to result in officer death, including those that resulted in life-threatening injuries, as well as those that resulted in minor or no injuries. “
In Learning from tragedy: Preventing officer deaths with medical interventions, Sztajnkrycer examined the data on 341 law enforcement officers killed in the line of duty from 1998 to 2007. Sztajnkrycer’s research showed that only two officers appeared to have died from an isolated extremity hemorrhage. This worked out to be about 1.6% of the potentially preventable deaths. Compared to the 61% found in military studies of combat troops, 1.6% suggests a large difference between law enforcement and military trauma.
Currently, there are no published studies on tension pneumothorax and officers killed in the line of duty. However, Sztajnkrycer points out that about 38% of the officers he studied died of chest trauma, suggesting that tension pneumothorax may be a larger issue in law enforcement deaths than we have previously considered.
Law Enforcement and TCCC
Does Sztajnkrycer’s research indicate that TCCC is not appropriate for law enforcement? Not hardly. Whether or not extremity hemorrhage is a preventable cause of death at the same rate in law enforcement as it is in the military does not mean that the precepts of TCCC are invalid.
What medical interventions we use on a wounded officer may vary from the military TCCC system depending on what research shows. Mechanisms of injury are likely to be very different between military combat and police combat. For example, soldiers are more likely to encounter IEDs and explosives, while police officers are more likely to be stabbed or shot with a handgun at close range. These differences require that we adapt medical training to address the most likely form of injury.
Adapting the kinds of medical intervention that we provide should be easy to do in the TCCC framework. Remember that one of the most basic concepts in TCCC is that helping a wounded soldier (or officer in this discussion) is a tactical decision.
What medical care we provide to a wounded partner takes a backseat to being able to safely treat him or her while minimizing risk to the others on the team. It may be that the best treatment to an injured officer is to neutralize the threat. This TCCC principle is still very valid.
It is also possible that, due to the relative closeness of trauma centers and a professional emergency medical system, most of the officers killed on duty suffer wounds that are non-survivable. In other words, we’re already saving most of the wounded officers from death due to timely EMS intervention.
However, we’re not saving everyone. While only two officers died from isolated extremity hemorrhage in Sztajnkrycer’s study, both of the officers had been shot through the femoral artery and bled to death on the scene. Had these officers had fast medical intervention with a tourniquet, their odds of survival would have been vastly improved.
While the percentages of the causes of death may be off from the military experience, we in law enforcement can still improve how many officers we save. Hopefully, using Sztajnkrycer’s research at the VALOR Project, we can gain additional insight and train our people with the skills they need to prevail.
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There is a survey going on right now at the Valor Project for LEO's. Make sure to take a few minutes to complete it (if you are a LEO).
I'd be interested in knowing how many injuries/deaths LEOs suffered from vehicle fires. You hear that we're just as often killed from motor vehicle accidents as being shot/stabbed in recent years yet most departments wear 100% polyester uniforms.
This is a great article fellas. As a Tactical EMS provider and team leader it's refreshing to see the TCCC model being researched and adapted for LE. I will be following the Valor Project must closer and awaiting any published results for the need for needle decompression. Thanks ITS!
Richard, Thanks of the info. I am currently developing in service training for my department based on the TCCC with help from Marc at Officer Survial Solutions. This is something we both believe in strongly. It has saved countless lives in Iraq and the Stan. We need to learn from those advances and do what we can to keep our selves and fellow officers alive.
The latest development in this vein is the Committee on Tactical Emergency Casualty Care which met in May.
From them: The Committee for Tactical Emergency Casualty Care (C-TECC) was convened to expedite the appropriate transition of military medical lessons leamed from the battlefield to civilian crisis response in order to reduce preventable causes of death in both our first responders and civilian population. C-TECC is modeled after the Committee for Tactical Combat Casualty Care (CoTCCC) and is comprised of a broad range of interagency operational and academic leaders in the practice of high threat medicine and fire/rescue from ac ross the nation, including members from emergency medicine, emergency medical services, police, fire, and the military Spec ial Operations community. C-TECC remains an independent civilian entity, but maintains a close relationship with CoTCCC for guidance and support.
The complete PDF is available online.
The latest development in this vein is the Committee on Tactical Emergency Casualty Care which met in May. From them: The Committee for Tactical Emergency Casualty Care (C-TECC) was convened to expedite the appropriate transition of military medical lessons leamed from the battlefield to civilian crisis response in order to reduce preventable causes of death in both our first responders and civilian population. C-TECC is modeled after the Committee for Tactical Combat Casualty Care (CoTCCC) and is comprised of a broad range of interagency operational and academic leaders in the practice of high threat medicine and fire/rescue from ac ross the nation, including members from emergency medicine, emergency medical services, police, fire, and the military Spec ial Operations community. C-TECC remains an independent civilian entity, but maintains a close relationship with CoTCCC for guidance and support. The complete PDF is available online.