Saving lives in the tactical space: Training to use tourniquets

Part one of a two-part series

Over the last couple of years, the field of medical tactics (a.k.a. Tactical Medicine, or several other names by which it may be known in your neck of the woods) has undergone significant progress as it relates to applications in mainstream law enforcement.

This is partially due to a shift in our training methodologies and a new recognition that these tactics must be applied to our skills sets, regardless of venue or time on the job. It has come based on embracing the fact that our threats are ever-changing, and often change faster than we can address in our training.

It has come at a price of understanding that unless we truly prepare to mitigate them, we will be caught off guard. This understanding has not — and unfortunately still does not — come easy.

Training Scars and Real Wounds
One point mentioned in previous articles is the development of Tactical Emergency Casualty Care (TECC), and the Committee (C-) which guides it. The feedback to the instructors and operators provided by the C-TECC has been a combination of lessons from our combat engagements and operational feedback from homeland law enforcement, medical providers and research applicable specifically to us.

I would argue that TECC is probably the overall most dynamic and evolving skillset in our profession today. I say this because the tactics involved in the proper application of the TECC necessarily encompass several disciplines.

Whether you call if Self Aid/Buddy Care, Tactical Combat Casualty Care (TCCC) or TECC, from a simple application of a bandage or a tourniquet to a complex rescue of multiple casualties at a hotel with unknown threats, the medical tactics can not be applied unilaterally.

Herein lies a training scar — which we have created over the years — and which Tony Blauer very effectively addresses in his training. Tony notes that many isolation drills have a specific fighting position and a predictable course of movement, creating an unrealistic expectation for true combat engagements.

Traditionally, officers are subjected to a known start point, end point, and the movements practiced.

It’s almost as if the motions are set up with very few variables left to the actual training or critical thinking process.

This predictability and lack of dynamic realism deters from an effective and purposeful learning, according to Blauer. While in some training environments these drills are necessary, in real life and particularly in high risk encounters, there become more unknowns than elements of control.

For instance, the tourniquet application practiced calmly in a well lit room becomes a cluster in a real life application. That is, unless, the tourniquet is properly accessible and we are trained in the environments where it is to be used.

Proper and complete TECC training should combine tactical movement, room clearing, breaching, vehicle rescue, downed officer rescue, communications, shield operations, and the like.

To do one skill at a time and expect a complete result is a disservice to us. These skills are no longer new. What is new is the understanding of how they apply to our daily work, and potentially to every contact on the street.

Likewise, the application of tourniquets is not new. Where at one point our instructors had to convince the audience of the need for tourniquet proficiency, we find that a lot of officers come to class having already applied or at least carried the right type of tourniquet in their daily work tasks.

Battlefields and City Streets
Yet, the debate on whether or not these life-saving tools are applicable to law enforcement and specific Emergency Medical Services (EMS) environments persists in some circles.

If you are still “debating” on the subject, you either don’t have the facts for whatever reason or choose to ignore them. Regardless of personal opinions, tourniquets save lives.

On battlefields and on city streets, cops have used them successfully to save their lives, lives of their partners, and lives of citizens. These included improvised tourniquets and commercially available tactical tourniquets such as CAT and SOFT-T, and it is clearly reflected by the fact-based recommendations of the C-TECC.

In that regard, the updated Gen III model of the SOF-T tourniquet offers some unique flexibility in applications, based on real-life feedback.

The problem is that unless you’re looking for specific data or seeing the dedicated media publications, these statistics don’t often jump out at you.

What we hear is “officer inured in the line of duty” with no details and, typically, no organized data. It’s a fact that many injuries and deaths can reduced with proper training and simple tools.

Our group of trainers approached the FBI’s LEOKA program several years ago in the hope of keeping better data for officers killed in the line of duty, and continued research on options to mitigate and prevent additional deaths.

To that end, the Valor Project, designed and maintained by Dr. Matthew Sztajnkrycer, has been a great example of the extra effort to collect that type of information. Doc has been a great asset over the years, and his research is shared through the Force Science Institute, and several professional development venues.

It’s inexcusable in this day and age to lose an officer in the line of duty, simply due to an extremity bleeding.

With such a multitude of options available for training and easy to carry and use equipment, we can not permit ourselves to lose our own for not having these tools on hand. There is also a reason we routinely refer to these as “tactics” and “tools.”

At no point is there intent to deliver this as medicine. It is an option to safely and efficiently complete a task — much like any other skill we were taught — and to be used in conjunction with those skills.

The Casualty Collection Point, addressed next month in part two of this two-part series, is one such option...

The Committee for Tactical Emergency Casualty Care:
The Valor Project:
Force Science Institute:
Tony Blauer and S.P.E.A.R. System:
Delia Tactical International: 

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