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Wounded on a SWAT callout: Why tactical casualty care training is essential for officer survival

Law enforcement personnel need to be able to treat themselves and their partners if and when disaster strikes

In what is already a dangerous profession, SWAT officers face a particularly high risk of suffering serious on-duty injuries compared to others in law enforcement. When SWAT responds to a call, it is usually because the situation is too dangerous for the average first responder.

Many SWAT teams incorporate tactical emergency medics (TEMS) into their teams. They are a great acquisition, but TEMS personnel might not always be able to get to injured personnel (or they may become a casualty themselves). Law enforcement personnel need to be able to treat themselves and their partners if and when disaster strikes and we become casualties.

Rapid, Simple, and Effective

Tactical Casualty Care for law enforcement is a course of education that is springing up all over the country. This course is designed to prepare law enforcement officers to treat themselves if necessary, or others, in a tactical environment where traditional caregivers are either not present or unable to assist.

Brian Keith of Tactical Encounters Inc. — who has been teaching this course to all levels of LE personnel — offered his thoughts on the rationale behind the training. “The main focus is treating preventable death combat wounds. What that means is that we only focus on wounds that would cause death and that we have an available remedy,” Keith said.

Keith also said that other injuries such as head wounds, torso hemorrhage, airway obstructions and non-life threatening bleeding are lightly discussed, but these types of wounds are either too difficult to treat or have high mortality rates. Again, the focus is treating preventable deaths sustained in a tactical/combat environment.

Keith’s teaching philosophy is that the training techniques have to be rapid, simple, and effective.

“We focus on the simple procedures that have the biggest impact on survivability. When students leave our class I believe they have the confidence to remember, master and perform the techniques shown to them,” he said.

Assessing Threat Level and Treatment

Students are given guidelines that enable them to recognize what treatments should be administered and assess what threat level they are facing in the treatment environment. This criterion has been modified from the Tactical Combat Casualty Care model and adapted for civilian and law enforcement applications. This allows students to make rapid threat assessments in a tactical environment. The three threat levels are:

  1. Direct Threat: Care rendered while under effective hostile fire.
  2. Indirect Threat: Care rendered while no longer under effective hostile fire, or an area protected from that threat.
  3. Tactical Evacuation: Moving casualty to a cold zone for a higher level of treatment.

Patient assessment is the next priority and can become complicated for non-EMS personnel. To keep things simple, and to stay focused on preventable combat wounds, students learn to use the MARCH model:

  • Massive Hemorrhage (only fixable bleeding)
  • Airway
  • Respirations (penetrating chest trauma, preventing pneumothorax)
  • Circulation (other non-life threatening bleeding, preventing shock)
  • Head injuries/Hypothermia

In order to facilitate this method, students are instructed to perform a blood sweep of extremities/junctions first, assess the airway second, and perform a blood sweep of the torso last. This assessment can be performed in less than 30 seconds.

In addition to keeping things simple, they also have to be effective. Students learn the application of:

  • Tourniquets (self-application and buddy aid)
  • Wound packing for junctional trauma (using hemostatic blood clotting gauze to pack wounds) with pressure dressings

In order for officers to be able to conduct such rescues they need to have the proper tools and training. Each officer should be equipped with an emergency kit furnished with the aforementioned items and then train with them in order to be proficient.

Tactical Casualty Care training is an essential aspect of operating in a tactical environment. We cannot always rely on TEMS (or other medical personnel) to be able to aid us. We must consider that we may have to provide aid to one of our own. For these reasons, it is imperative that we prepare with the proper equipment, training, and mindset to respond in a rapid and effective manner while maintaining simple procedures that can be recalled under stress to save our life or the lives of others.

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Dan Danaher is a retired sergeant with 28 years of law enforcement experience. He has been retained by his former agency as the range master to oversee the firearms and TASER programs. Dan is also the co-founder of Tactical Encounters Inc., a law enforcement training company based out of Michigan.