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Medical Interventions and Preventing LODD

Every nine minutes an officer is feloniously assaulted in the United States.  Tragically 53 of these result in the death of the officer annually.  While it’s unknown how many of these deaths could be prevented by appropriate, early medical care; it is a stark reminder that the current dearth of tactical medical training for most police officers is a serious shortcoming.  It’s no longer acceptable to attend a simple 8 hour American Red Cross course on how to make a splint from a newspaper.  If we want our officers to come home at the end of the shift, we need to not only give them the tools to prevent the unthinkable (DT’s, range time, etc.), but also save themselves and their partners after the injury has occurred. 

A few years ago, one of our personal heroes for his work with law enforcement, Matthew D. Sztajnkrycer, MD, PhD, FACEP; released a retrospective study on preventable law enforcement officer deaths and how early medical intervention may have changed the outcome.  Of course, we have no idea whether any intervention would have saved some of these officers, and the limited information often leaves us wondering as to what care they did receive; but the fact remains that it’s the best data we have to work from.  After removing those deaths which were not immediate (thereby likely unalterable by early care), and those caused by blunt trauma (which typically requires a surgeon to significantly alter the outcome), Dr. Sztajnkrycer whittled the number of LEO deaths over a ten year period to 341.  He then looked at the cause of death and came up with the following numbers:

Taking this total number of 341, the study then looked at how many of these deaths could have been prevented by early intervention of one of the TCCC Skills.  Of the original 341, 123 or 36% we determined to be preventable. 

So, of the 123, what caused their death and what could have prevented it from the TCCC skill sets?  The numbers are surprisingly different from what the military has found.

In the military studies, up to 61% of all preventable combat deaths came from isolated extremity bleeding.  Understanding that more than half of all deaths comes from simple bleeding, it’s pretty easy to understand why there has been such a significant push for tourniquets, a device that has proven absolutely life saving and essential in the combat setting.  On the other hand, out of our 123 preventable LEO deaths, how many came from similar injuries?  Two.  Only two.  That’s less than 2% of the total pool of brother and sister officers who have been killed.  Does that mean that we shouldn’t keep training with tourniquets?  Of course not.  Tourniquets are an affordable, simple-to-operate tool that belongs in every tactical first aid kit.  Furthermore, we don’t want to slow anybody down from training on their tourniquets.  The recent growth in tactical medical training in LE has been fantastic to see and the tourniquet gives a simple thing to focus on and a tactile tool to open the door to additional medical training.  Finally, as Dr.  Sztajnkrycer points out, it’s a great opportunity for the officer to practice transitioning in and out of a tactical mind set to a medical one, and back again.  This ability to transition the brain is essential if we’re going to survive the fight. 

In the area of chest trauma, Dr. Sztajnkrycer finds the data a bit more on par.  Military data shows that tension pneumothorax (air trapped in the chest collapsing the lung and possibly other thoracic structures) resulted in 33% of combat fatalities.  While similar precision was not available for law enforcement deaths, we do know that 37.8% of those killed suffered some chest trauma, and in 90 cases it was the cause of their death.  If we extrapolate out the military data, anywhere from 11-29 of these injuries resulted in tension pneumothorax.  Compared to our total of 123 preventable deaths, that means that 9% to 32% may have survived had there been early recognition and treatment of the injury.  Also based on these numbers, Dr. Sztajnkrycer states that law enforcement officers are 550% to 1450% more likely to die from a tension pneumothorax than they are from an isolated extremity hemorrhage.  While the treatment of tension pneumothorax has long been held as an advanced skill, available only to physicians and paramedics, this has been completely rethought by the military and, in our opinion, deserves similar rethinking in the civilian law enforcement side.  Additionally, this data regarding chest trauma demands that we revisit the treatment of open (“sucking”) chest wounds and ensure that it’s included in our training.

The last component of the TCCC skill set, basic airway management, is where most of our traditional first aid training has focused and, ironically, is apparently one of the least likely causes of preventable death that is also one of the hardest to manage. According to Dr. Sztajnkrycer, the data indicates that about 6.2% of total deaths could likely be attributed to an airway injury, most involving significant head, neck, or face trauma.  The management of these injuries is often complex and difficult, and far beyond what could be reasonably expected to be included in a basic LEO Tactical Lifesaver course.  It doesn’t mean that nasal airways are bad or that we shouldn’t include airway management training, just that we need to rethink our approach.

The final consideration in all of this, besides the tactics of care and rescue, is self-care vs. buddy care.  Here is where the military and civilian worlds completely diverge.  Rarely is a soldier without his squad.  Rarely does a police officer have a partner, especially in this day and age of budget cuts and fiscal shortfalls.  Unfortunately, two of the three TCCC skill set interventions are buddy aid in nature and not self-care.  In fact, looking at the data again, we find that 44 of the 123 potentially preventable deaths (36%) were alone at the time of their deaths meaning that even with proper training they may not have survived. 

So what does all this mean?  At least some of these officers died when they could have been saved by appropriate intervention.  Two of them could have been saved with a simple tourniquet.  1.6% isn’t a big number, but to their families, their departments, and the community as a whole, it’s two more that could still be on the street today.  We need to take a look at TCCC, accept its conceptual approach of the right intervention at the right time with tactical considerations, but customize it to fit our setting.  We need to put the tools and the training in the hands of our officers to make sure they come out on the right side of the fight.  We need to step outside the box and realize that tactical first aid is not just something we have to in-service on each year, but is a necessary skill that may save our lives at the end of the day. 

Finally, if you find this information even slightly useful, please see Dr. Sztajnkrycer’s site at www.valorproject.org, where this study was sourced.

About Hugh C.

Hugh C. is a paramedic with over 15 combined years of experience in field medicine.  Hugh has multiple overseas deployments providing acute care in austere settings and was instrumental in establishing a local TEMS program.  Hugh holds a BS in paramedics.

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