Tactical Medicine:
Pre-Hospital Trauma Care in Austere
Environments for Law Enforcement
By: Arthur J. Miller, Chief of Police, South Pasadena Police Department
Threats and challenges to law
enforcement operations are constantly
evolving and increasing in complexity. At any given moment, any law
enforcement officer in the country
may find themselves thrust right into
the middle of an active shooter event
[or insert any multi-casualty incident
here] whose efficient and effective response can directly impact the number
of lives saved. Time to treatment is an
important variable in these situations
and when reduced, can save lives. By
teaching officers to be self-sufficient
and provide for their own medical
support in those environments where
traditional EMS resources cannot provide treatment based upon the tactical
situation, we can directly impact the
number of lives saved both for the
officers and for the members of the
communities in which we serve.
In April of 2014, members of
the South Pasadena Police Department’s Special Enforcement Team
(SET) recognized that the medical
support provided by traditional EMS
resources during “Hot Zone” oper-
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ations wouldn’t allow for the type
of pre-hospital trauma care support
which would be needed. In fact,
“Warm Zone” operations where law
enforcement provides force protection
for EMS elements to go downrange
and treat casualties within the zone(s)
of operation where the threat is not
direct or immediate, is continuing to
evolve and mature. It was the desire
of the SPPD SET to search for a system
of pre-hospital trauma care that would
fill that void and achieve two goals.
First, the system of care would need
to be extremely effective in treating
the leading causes of preventable
death (i.e. uncontrolled hemorrhage)
in austere environments. Secondly,
instead of being confined just to the
law enforcement special operations
community (SWAT), the system of
care needed to be such that it could be
taught to all officers and deputies that
work the streets and do the everyday
heavy lifting. After a comprehensive
search, the SPPD SET found a system
of pre-hospital trauma care ideally
suited to law enforcement operations.
Wounding patterns we find
occurring in the law enforcement
environment are remarkably similar
to those occurring on the battlefield.
Penetrating trauma from gunfire
and blast injuries are two of the most
notable similarities with uncontrolled
hemorrhage being the leading cause of
preventable death in austere environments. Tactical Combat Casualty Care
(TCCC) is a system of pre-hospital
trauma care that comes to us from the
US Military and focuses on effectively
treating the leading causes of preventable death in austere environments.
Born in the Naval Special Warfare
Community in 1993, TCCC has been
repeatedly shown through multiple
studies to be extremely effective in
treating the leading cases of preventable death on the battlefield. So much
so that TCCC is now taught to all US
Military combatants being deployed in
country. TCCC together with its civilian version, Tactical Emergency Casualty Care (TECC), a system of effective
pre-hospital trauma care for police
officers not only exists, but is ideally