Saving lives in the tactical space: Using the 'Casualty Collection Point'

Part two of a two-part series

The option of Casualty Collection Point (CCP) is no different in its utilitarian approach than any other trained tactic.

It relies on flexible understanding of several disciplines, interoperability, and basic fundamentals. It is probably something which many of use almost daily, without giving it much consideration in other content.

Consider a fight at your local pub, where you arrive and separate several individuals, determine need for additional medical or law enforcement resources, and take an injured party out to the parking lot to meet an arriving ambulance.

Police Use of CCPs
Though the CCP is most typically associated with Mass Casualty Incidents (MCIs), it can be practiced for any number of patients or injured officers. I specifically would like to refrain from using any recent tragedies as examples, because every news media and political outfit has used them for their own purposes.

Suffice to say that if you look at the footage of any of those examples (or read the debriefs), you will find that the majority of treatment, evaluation, and triage was done at a CCP.

The casualties — including downed officer(s) — were extracted after the threat was neutralized or controlled.

Interestingly enough, you will find that a large portion of those CCPs were set-up by law enforcement and not EMS. Officers were first on scene, first to assess the situation, get to the victims, and set up command and control.

Officers will also remain with the victims and patients at the CCP, if nothing else but to control the scene and obtain relevant information.

Even if you don’t train to perform any medical triage, you may find yourself doing it to some extent in these incidents.

The nature of active shooter training all but dictates that some problems be addressed before others including downed officers and citizens, whatever the parameters of the law enforcement response may be.

Training and Pre-planning
While most CCPs will end up being hastily set up, meaning that responding officers will determine what is best upon gaining control of the initial response, a lot can be done to prepare and pre-plan them.

Since most such threats and responses will be the responsibility of the first responding patrol elements, we find once again that these tactics are not reserved for tactical/SWAT resources.

You know what the soft targets are in your jurisdiction, patrol beat, and even the neighboring communities. You can bet that criminals know them, too. Chances are they have also taken the time to stake them out, figure out the routines of their activities, entrances, exits, and law enforcement presence.

Pre-planning during regular patrol operations as to what the CCPs may be if your school, shopping mall, or community fair became a target will save time and resources if such an incident occurs.

It will also ensure a more dynamic and fluid response and resolution. Keep several CCP options in mind, also recognizing the fact that it is not always possible to have a CCP in the outer perimeter.

A couple things to consider during the management of the CCP are the security and patient accountability:

The security aspect should encompass any unknown threats, providing for an appropriate over watch
Bystanders, media, and family members all affect the level of activities, and will probably have to be addressed
Patients’ behavior may be affected by the events themselves, as well as injuries — they may try to leave, or simply wander off

The command and control personnel responsible for the operation of the CCP should consider keeping a log of individuals present, treated, and transported. This command individual(s) should focus on management of the CCP where possible, and remove themselves from the actual hand-on responsibilities.

Ideally (in a perfect dream), the CCP will be removed from the problem, have sufficient cover, personnel, communication capabilities, and will encompass several tasks.

These include maintaining a safe zone, providing initial triage, treating the casualties, having options for their transport, and some very limited information gathering from those who are able to provide it.

This is where working with your emergency medical services becomes critical. Jurisdictions with more rural or limited EMS, especially where an MCI will require significant response outside of the community, may find law enforcement assuming EMS duties for some time.

Again, several factors will determine the proximity of the CCP to other command and control elements, such as the command post and staging areas.

Use What You’ve Got
A hasty CCP may be as simple as an underground garage in a separate wing of an apartment complex. Removed from the threat, downed officers may be assessed, treated, and transported by their colleagues in lieu of EMS.

Keeping in mind that this hasty setup will be dynamically improvised based on any number of elements, you may find that the CCP is not merely a flat ground on which a casualty can be carried, or simply escorted to an awaiting ambulance.

Picture a technical school in your jurisdiction. Chances are that there is a main building with a foyer, a large reception area or hall, and several open stairwells. There are probably several elevated exits located one or two stories above ground level.

Had a CCP been set up in a vicinity of such an egress, an exposed floor of a single family residence, or blocked by a hot hallway in an apartment complex, other considerations will have to be made.

“Fluid egress” of casualties has to be considered in our training, to include adjuncts such as lines and ropes, stretchers and options of mechanical advantage to lower the casualties down to the next level of care.

The lone officer stuck in the same environment, may also find that they will have to set up a system to lower themselves to a level where they are easier accessible by friendly resources. Once again, this can be improvised on the fly or planned for and trained with ahead of time.

I would advocate for the latter.

Additional things to consider ahead of time may be a landing zone for an aero-medical asset. Since timing and resource allocation are critical, given the unique nature of some environments, anyone may find themselves in an incident command role, and be required to make this decision.

The use of a CCP is an option for organized and efficient rescue efforts — specifically in active shooter and multiple threat incidents.

The concept is once again applied from the practices and lessons learned by our veterans in the current combat engagements, and directed by the guidelines of TCCC. We are grateful to be able to utilize the hard lessons learned on our battlefields, and apply them to the service of our communities.

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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