Why Law Enforcement is just as Trainable in Combat Life Saving Skills as our Military - ITS Tactical

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Why Law Enforcement is just as Trainable in Combat Life Saving Skills as our Military

By Rafael Navarro

After returning from my overseas tour, I was given an assignment within the training unit at my agency. It didn’t take long before I realized that there were some shortfalls to the First Aid and Self First Aid program we were offering.

The most outstanding concern was the lack of training concerning the use and deployment of a tourniquet. After taking a good look at our program, I proposed a lesson plan, which included the purpose and use of the tourniquet.  It was approved after a short review and the trend began. Slowly, I was able to affect the entire agency, by exposing them to tourniquet training.

This is when I realized the enormous communication gap between our Military and Law Enforcement agencies. I began a personal campaign to bring attention to the fact that our soldiers (young as they may be) are considered trainable in combat life saving skills by our government and most of the Law Enforcement agencies in our country consider this type of training,”out of the realm or scope” and perhaps too difficult.

The Need For Training

That fact of the matter is that the skills needed to become proficient in combat life saving skills can be taught to police officers in the same manner it’s taught to soldiers. It’s common knowledge that special units have this type of training, but what about the patrol officer?

I often make this statement when I’m asked to sum up my reasons or inspirations for writing my book, A Police Officer’s Guide and Handbook to Tactical Casualty Care (Under Fire). When a Deputy or Police Officer approaches the next door of the next house on the next call and they get shot through the front door, for the next several minutes they may be fighting for their lives. During those few moments, he or she is in “COMBAT.”  So then, why do we fail to prepare them for this increasingly common event?

For the most part, the response is just silence. I strongly believe that there is no reason our patrol officers should be at a disadvantage.

The Book

The target audience of my book is Law Enforcement. Whether on patrol, the court room or in a correctional facility, the concepts and skills organized in this book apply to everyone.

It’s designed to supplement the First Aid and Self First Aid courses mandated by Police Academies and presented in most agencies. It focuses on immediate hemorrhage control and explains the mindset required to survive such a traumatic event.

Here’s a look inside the book and what you’ll find within the chapters. I’ve included a few relevant quotes from each chapter too.

  • Chapter One – Concepts, Goals and Relevance of Tactical Casualty Care to The Law Enforcement Community.  “Several well written books have covered this subject very thoroughly but I have yet to find one that covers the subject of care under fire dedicated for the officer on patrol or who is not part of a specialized team.”
  • Chapter  Two – Three Stages of Care During a Critical Incident and Factors that Influence This Care.  “Many agencies require medical transport to be summoned to your location to transport an injured person. Some agencies don’t address the issue at all. Think about this for a moment; would a violation of your agency’s policy be justified to save the life of a fellow officer?”
  • Chapter  Three – How to distinguish the Difference Between Life Threatening and Non-Life Threatening Injuries.  “Keep in mind, the officer’s status is just one factor in your hasty rescue plan. Do not allow yourself to become emotionally involved and get drawn into becoming another victim. If this occurs, you won’t be able to perform the rescue, and now a second rescue (for you) will be required. Think scene safety!”
  • Chapter  Four – Understanding When and Where to Treat Life Threatening and Non-Life Threatening Injuries.  “If the officer is awake and able to move, order the officer to initiate self-aid as appropriate, while awaiting rescue. Unfortunately, many people equate being shot with being helpless or dead, something frequently reinforced in training. Nothing could be further from the truth.”
  • Chapter  Five – The Application and Use of Field Dressings, Pressure Dressings, and Tourniquets.  “The tourniquet has always been a subject of controversy. As a matter fact, some agencies may not even allow the subject to be used or even trained. Until about three years ago, my agency experienced the same issue. When the concerns were identified to our staff, examples and supporting documentation was provided showing in our case specifically, the training and use of the tourniquet would be beneficial, the training and use was approved.”  
  • Chapter  Six – Recommendations for Assembling a “Gunshot Kit.”  “*TUCSON – Some of the first deputies to arrive at the scene of the Jan. 8 shooting rampage here described a scene of “silent chaos” on Friday, and they added that the carnage probably would have been much worse without the help of a $99 first-aid kit that recently became standard-issue.”  
  • Chapter  Seven – Techniques for Moving Casualties.  “The primary purpose of all rescue work is to get injured people out of danger and to medical help as quickly as possible. If you have never attempted to physically move another person, you will be surprised to learn that it is not always as easy as it looks.”
  • Chapter  Eight  – Scenario Based, Realistic and Dynamic Training.  “No matter how you look at it, tactical casualty care under fire, addresses a moment in time which requires your immediate reaction and responses to a deadly attack. To assume that being exposed to a four-hour block of instruction in a classroom setting is enough, would be a huge misunderstanding of how your mind and body reacts to these types of emergencies.”
  • Chapter  Nine – Sample Lesson Plan.  “Students will have an understanding of what “Tactical Casualty Care (Under Fire)” is and how the “Warrior mindset” plays an important role.”
  • Chapter  Ten – Sample Scenario Script with Timeline.  “1st two hours, classroom with concepts and practical exercises. 2nd two hours, step by step application and scenarios.”

It is my intent to present this material to as many Law Enforcement personnel as possible, with the hopes to provide the basic knowledge and skills needed for survival. It would be a great add-on to the basic First Aid courses provided in most Law Enforcement Academies.

Editor’s note: Please join us in welcoming Rafael Navarro as a contributor on ITS Tactical. He’s currently serving in the Law Enforcement Training Division of the Pinellas County Sheriff’s Office, Florida. Rafael’s been in Law Enforcement since 2000; serving 4 years with the SWAT team, retiring as a SFC/E-7 after 21 Years of military service with the United States Army, Military Police Corps. and 24 months in Afghanistan in support of combat operations during Operation Enduring Freedom.

*By Sandhya Somashekhar and Sari Horwitz,  Washington Post Staff Writers,  Friday, January 21, 2011

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  • Chris Doucette

    It’s sad that I’m thought of as ‘weird’ for keeping a CAT tourniquet in my thigh pocket at all times while on patrol. Being a former EMT-Basic, I immediately recognized the need for better First Aid training to Officers, and when I’ve brought it up, I was given the same BS response as noted in the article- ‘That’s not our job. EMS is always very close’. And no, they never had an answer for Care under Fire. I’ll definitely be picking up this book, as it is the first one I’ve seen aimed at the Patrol Officer, instead of SWAT operators. And be forwarding the information on to my Training Coordinator.

    • Chris, I would like to personally thank you for your insight. You are correct! My goal was to write it for our Police Officers. I hope that you enjoy the book. When your done, give us some feed back!

      Thank you!
      Rafael Navarro

  • TOR

    To be honest it shocks and kind of depresses me that all Cops do not get this kind of training. Survivability is important and in terms of trama (GSW, stabbings, etc) the benefits of some decent training and a bit of equipment are enormous. -TOR

    • TOR, I like your thinking! however my friend, don’t get frustrated, get focused! It people like yourself that can make a difference and spread the word!

      Rafael Navarro

    • Hello sir and love the book. I am a tactical medic instructor and teach many courses in the US. I also teach an officer down class and would like to use your book as well. Could you email me so we can talk about how to by this book in the case.

      Chris McCord

  • I have been stressing “What if it is you?” or “Your partner?” in my classes with LEOs. I am involved in training all the Highway Patrol in my State and many police, sheriff and security officers. I learned a while back that although they are :mandated: to take 1st Aid and are required to be 1st Responders, they don’t like it. Their ABCs are often refereed to as “Ambulance Be Coming”.
    But once I started using “What if?” scenarios they started to think and now many have their CATs “handier as in not in the 1st Aid bag in their trunks but somewhere in the Drivers or Passenger doors.
    So I am seeing an improvement…And have received a few “Thank You’s”
    I also have stressed the Chest Trauma and what to do if…..
    All is being received fairly well when it applies to them…

    • Hey MADDMEDIC, what your are experiencing is common through the United States, UK and Australia. I have had many interviews with folks as yourself and everyone, I mean everyone!, has been fighting the same battle. However, as you mention, the thinking is slowly coming around. Unfortunately, it takes time or worst of all, after something wrong happens and only after it, they see the need.

      Keep your head up, we need you in there.

      Rafael Navarro

  • TidalMedic

    I work on the other side of the fence as a Firefighter/Paramedic. I’m also slated to head to basic for 68w, ARNG. Let me paint the picture for what we see on our side, which may or may not hold true to where you are. I’ve been to many accidents, shootings, stabbings, etc. where a patient was bleeding quite significantly where law enforcement has not even attempted to stop the bleeding. Now I understand there’s a lot more going on in the mind of a LEO related to the call, but the lackadaisical attitude I get from them in life-threatening situations worries me. Our agencies that surround us do not have a very good plan for self-preservation/self-rescue for if the SHTF. Luckily I’ve only had one officer-involved shooting in my young career, and he was lucky enough to have a SWAT medic behind him (serving a warrant), but all it takes is that one bad traffic stop or domestic violence call. When will LEO take our concerns into consideration? I would rather be behind the eight-ball playing catch-up to a patient that knew how to apply a tourniquet from his personal equipment or agency-issued equipment than show up to an officer that we know won’t make it because they either didn’t want to learn, didn’t have the idea presented, or didn’t care.

    • Hello Tidalmedic!

      Hey your right! As a deputy, I can tell you when we get on scene, there are lots of other things that we have concerns with. However, your also right when you say that immediate action in order to save a victims life should not be ignored. I have actually covered this issue in my book, with the hopes that more officers understand that we too can held liable if we just stand there and wait for paramedics.

      Providing all of the other concerns (scene safety, no more bad guys, etc.) Officers should be able to assist with hemorrhaging for example. I sure your aware, but there is a fine balance when it come to how much an officer should do. Now, Care Under Fire, game on, its what I can do for you and and I can do for me right now!

      Thank you for your comments.

      Rafael Navarro

  • First Aid isn’t Tacticool. If you thought up a way that you could use a CAT to restrain a terrorist wearing a suicide bomb, you would see three on every officer.

    • I agree that terrorist and their vests are not cool! I there was a way to control that, we would! However, what we can control most of the time is hemorrhaging!

      Thank you

      Rafael Navarro

    • Actually, tourniquets are Tacticool – they are available in black, and most have Velcro(R). Now if we can just get the companies to add a “Tactical” or “SWAT” label on it…

      I have implemented casualty care into our state training program for high risk warrant and arrest tactics. Thus far, the emergency medical and rescue techniques have been extremely well received by all students. I am sure that a book on this important topic will be well received in the training community!

      -Steve Barnhart, Georgia law enforcement instructor

  • Whiskey922

    2 years ago my agency implemented and conducts downed officer/personnel rescue training for all officers regardless of rank and/or assignment, and includes force on force with simunitions to be incorporated to simulate care under fire. In addition we conduct live fire training on the range as well. We purchased IFAKs for every officer, they are required to carry the IFAK in the front seat or attached to the cage of their vehicles. SRT are issued 2 IFAKs one is carried on their armor and the second is carried in the front of their vehicle too.

    All of our kits contain hemostatic agents, compression bandages, and SOF tourniquete, officers are issued extra SOF tourniquete to carry on their person at all times. We train wound care and extraction techniques in low light and darkness as well, self aid too. All officers are certified annualy through American Heart Association for first aid and CCR. We issue AED’s in the field too.

    Our policy was changed to allow the officer to use his/her discretion based upon their training as to whether or not a patient needs to be transported by patrol vehicle in which life threatening circumstances exist, in the event that EMS has an extended response time.

    I cannot understand why the attitude continues to exist in the minds of masny LEO that it is strictly an EMS issue. History has shown, North Hollywood just for example, that we may be thrust in a “combat” situation at any moment. It may be a well armed and trained individual or it may be someone with little or no training but determined to take a life or inflict as much carnage as possible, such as the shooting of Gabrielle Giffords and several others in Tucson, AZ. this past January. As any deputy or highway patrol officer can attest, the nearest EMS may be hours away.

    Since our agency has implemented the practice of all officers being trained and equiped for wound care, we have saved two shooting victims by performing basic wound treatment and transporting the victims by patrol vehicle due to EMS having a 30 minute ETA.

    • Your situation and attitude is what my goal is for my book. I hope to change and save the lives of many by introducing them to the very same concepts, procedures and policies you mention. My sincere congrats and well wishes. Please keep focused and help me spread the word, so that all agencies comes to your standards!

      Thank you
      Rafael Navarro

    • Whiskey922

      Roger that, I am looking forward to reading your book. Be safe out there, and if your ever in South Eastern Arizona, look me up.

      Chief Jake Weaver
      Willcox Police Dept.

  • tom

    I ordered the book right away.
    I can´t want to get my hands on.

    german state police

    • Thank you Tom, I really do you enjoy the book.

      Rafael Navarro

  • Terry Kowalik

    I’ve always thought that any officer who is issued a firearm and authorised (in certain circumstances) to shoot people with it, should carry a blowout kit and should have the ability to treat a gunshot wound. This sounds like an excellent book that I intend on reading – I’ll order a copy once it’s been added to the ITS store 😉

  • TacticalTom

    I’ve been looking for just such a book. I will be buying this immediately.
    Also, I want to take a hands on course as soon as I can.

    I beleive this training should be mandatory for every officer. I wish my department would add this training to our academy with a yearly refresher. Like Chris, I’m tired of taking flak for carrying a tourniquet in my pocket, a trauma first aid kit on my vest, and preaching the value of it to people who should already know better!!

    Thanks for all the good info and gear ITS. Love the site and I’ll be at next years Hog Hunt. Save me a spot.
    Everybody watch your six and keep each other safe. Better to not need it and have it.

  • P Willy

    I ordered this book through Amazon and received it today, but it not the book I expected. The cover is the samebut the insides are another book called “The Topics of Heroes” by JP Elder. I assume it’s some kind of publisher mistake to put the wrong cover on it. Something to be aware of.

    • Please let us know what Amazone says about this. I’ll let Rafeal know also since this is big issue.

  • P. Willy, Eric, I assure your that if Amazon made a printing mistake, they will make it right. If for some reason there is an issue, [email protected]. I will handle it myself. P Willy, Thank you for the heads up.

  • TA2D_COP

    I ordered the book as soon as I saw this post. I had been trying to develope my own lesson plan for my department based on the military’s TCCC stuff, but with little experience and knowledge in the field, and no local “experts” in TCCC to sit down with, it was a lot to sort through and a little over my head. I got the book in the mail Thursday and have been reading it for the last few days. Its a easy read and simple to understand. Just enough knowledge and detail to explain the how and why, without all the fancy wording and mumbo-jumbo.

    I tried to get my Department to buy pocket blow out kits for our Officers earlier in the year, but getting new uniforms was a higher priority to the PD administration and city hall, so they blocked the funding. Now we are working with local comunity orginizations to try to get the kits donated to all the surrounding agencies and getting the guys the basic training they need to save themselves if and when they need too. This Guide will go a long way in developing that training.

    SFC. Navarro, I want to thank you for breaking this down for the first line guys like me and my men who have to seek this knowledge out on their own and don’t have the background and understanding of the technical medical side of this. Your guide gives it straight up and simple, as needed, with the bonus of a lesson plan and training scenarios for the “RED SHIRT” side of the house to spead the knowledge. Again, thank you and SEMPER FI!- Jason

    • Jason,
      I am happy to read that you have received the exact message that is intended. Make sure you continue to do your research, as you may already know, there are many Kits, devices and approaches to training TCCC. If you have any questions, please feel free to email me @ [email protected].

      Thank you!

  • IanMcDevitt

    Sounds like a book I need to check out. Sgt. Navarro, what’s your backround medical-wise if you don’t mind me asking ? Have you had many patient’s with uncontrolled extremity bleeds ? Have you used the different forms of hemostatic agents ? Which one’s would you reccommend ?

    • Ian,

      Hey in reference to your question on Medical Background, Thanks for asking! I’m sure your aware of the Army’s Combat Life Savers Course. The combat lifesaver is a bridge between the self-aid/buddy-aid (first aid) training given all soldiers during basic training and the medical training given to the combat medic. The combat lifesaver is a nonmedical soldier who provides lifesaving
      measures as a secondary mission as his primary (combat) mission allows. A major advantage of the combat lifesaver is that he will probably be nearby if a member of his squad or crew is injured. It may take a combat medic several minutes or longer to reach the casualty, especially if there are several other casualties and/or the medic is at another location. The combat lifesaver is trained to provide immediate care that can save a casualty’s life, such as stopping severe bleeding and performing needle chest decompression for a casualty with tension pneumothorax. Please understand, I’m not trying to be spiteful. That course at times, is underestimated. Brother as far as how many? 24 months in Afghanistan, will provide many “wins and Losses”. I honestly can’t begin to try a number. The only homeostatic agent , I have had access to, under those conditions, (Quik Clot) gen 1 and 2. Works well.

      As a Police trainer/ Former SWAT Operator, required instructor courses in 1st Aid. I hope this helps……….Thank you.

    • Ian McDevitt

      Yep, I am familiar with the CLS course. I teach it for the DOD Anti-Terrorist Assistance Program. Also hear you about Afghanistan, I did the year of 2003 and set up the Tactical Medicine for the US Embassy during the changeover from Marines to WPPS contract. You actually used the Q-clot 1st generation more than once? If I remember right, the CCCRC advised it pulled pretty quickly after the exothermic reaction exhibited and the granulated wounds it caused ?

    • Wow Great memories! I remember calling it the Drano effect…..when asked, I said it was like pouring Drano down a the drain. Not that I was constantly using, but got back field updates, with another concerning issue being Rotor Wash. Gen 1 would get caught in it and be inhaled by Medics. Anyways, thanks for the support and the memory. Oh, I think 2008 was when Gen was pulled…..have to research.


    Well aware that I’m late to this party but just thought I’d put in some food for thought…..as a LEO and a Combat Medic I was trained to deal rapidly with critical situations….unfortunatly the mix has not always been a good one as I was trained to save lives as a medic first. One of the first things I was told to let go of in the accademy was the medic mentality….when I questioned this of my instructors they advised that because EMS is insured for medical and we are not we leave the State, County, City open for litigation and millions in loss. This is the same reason that most FD and EMS hang back and wait until law enforcment clears a scene for entry…..It’s not about weather officers can save lives or not and we often do but the fact is every single time I have the pat on the back afterwards for doing a great job also came with a quiet your damb lucky because that little stunt could have cost the taxpayers a mint and you your job.


      Thank the insurance industry…my personal view is all LOE’s should be crosstrained as Paramedics and all Paramedics as LEO’s …..the fact is Good Sam laws only apply to civilians, those of us who choose the peace officer or EMS world are often told do your job not theirs.

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