In a critical incident, there is an unspecified amount of time where even the best intentioned EMTs may not be able to get to you — you are on your own
Much of what we do as police officers today in self-aid/buddy-aid was passed on by our military troops who paid a high price for the lessons learned. But what is now accepted practice for them is still somewhat of a hard sell for law enforcement. Many officers fall prey to complacency and an “it will never happen to me” attitude.
Calls for service are “come as you are” events. Absent the proper training and the necessary equipment on your person, the potential for a bad outcome is high. There are generally three categories of injuries in the field:
1. Injuries that no matter where you are or what resources are available, you are going to die
2. Injuries that no matter where you are or what resources are available, you’re going to live
3. Injuries where what you do — or don’t do — before more definitive medical care is available will be the difference between whether you live or die
The third category of injuries is the area we must focus on. In a critical incident, there is an unspecified amount of time where even the best intentioned EMTs and paramedics may not be able to get to you — you are on your own. You must be prepared with the necessary training and equipment. Let’s look to a lesson learned in Iraq for an example of precisely how important this training and equipment is.
An Attack in Iraq
On September 11, 2004 — while deployed to Iraq — U.S. Army Staff Sergeant/Medic (ret.) Chris Cook was en route to the “Green Zone” hospital with blood samples from his unit’s medical facility. A three-vehicle convoy was stopped by US forces due to a hidden Improvised Explosive Device (IED) that had been buried in the roadside and blocked their path. The convoy commander elected to stop (breaking a cardinal rule) and provide perimeter security while awaiting an Explosive Ordnance Disposal (EOD) team.
The convoy, consisting of three 1/2 armored Humvees armed with .50 caliber and M249 SAW machine guns, formed a 360 degree perimeter. Cook was positioned on the road side of the convoy. After approximately 30 minutes, a lone vehicle broke out of the normal traffic flow and drove in the direction of the convoy at a high rate of speed.
A little voice inside Cook’s head told him this was a bad thing — a very bad thing. His training kicked in as he raised his M16A2 rifle and aligned his sights on the forehead of the driver and squeezed off two rounds. Immediately after firing the second round, the vehicle exploded approximately 25-30 yards from Cook’s position. He doesn’t recall hearing the explosion, but saw a bright orange ball of flames and felt the heat from it. The force of the blast slammed him to the ground next to his Humvee which was engulfed in flames.
He grabbed the brush guards in an attempt to stand, but couldn’t. His vision was blurred as he looked down through his protective glasses. He flicked off his eyewear to see his left leg from the knee down twisted and backwards. Blood was visible on his camouflage uniform and he could read the blood type marked on the back of his boots. His right ankle had swollen to the size of a softball.
He tried to stand again, but couldn’t. Then the pain started — intense pain as if his legs were on fire. He flashed back to his training and heard his instructor’s voice yelling “ambush…ambush…ambush.”
As live rounds began to cook off, he tried to crawl on his forearms away from the burning Humvee to a point of cover. He was able to crawl to the median and began screaming for help. He could hear himself screaming, but it was very quiet, almost surreal, like an echo in his head. He was spitting up copious amounts of bright red blood.
One of his buddies came to his aid and dragged him clear of the burning vehicles. Cook — at over 200 lbs. fully kitted — was dead weight. As he rolled onto his back, he remembered that about a week prior, he’d been issued a Combat Application Tourniquet (CAT). CATs were issued to all medics with instructions to keep them handy at all times. He rolled onto his back, removed the CAT from a pocket on his body armor, and attempted to open it from the factory wrapper.
His heart was racing, his hands were shaking, his leg was visibly a mess, and he no longer had the fine motor skills to remove the CAT from its packaging. Fearing he would soon go unconscious and bleed out, he began to gnaw at the packaging. He was finally able to remove the CAT and apply it to his injured leg in time to save his life.
Cook was subsequently rescued by members of another unit who arrived on scene. He was taken to the 31st Combat Surgical Hospital in the “Green Zone,” which ironically was where he was headed before the explosion. There, he would undergo the first of 21 surgeries to repair the near amputation of his left leg, a fractured right ankle, and numerous other shrapnel injuries. This was the start of a long and arduous road to physical and mental recovery.
Many thoughts went through his mind during those critical moments. He offers the following key learning points:
1. Stop the threat. The best medical care in the world is of no value if you’re dead. That day, my training saved my life.
2. If you are going to carry a piece of equipment, whether it be in the military or law enforcement, train with it. Don’t just put it into a fancy MOLLE pouch and forget about it. In doing so, when the time comes, you will not have the necessary skills to use it effectively and efficiently.
3. Tourniquets must be placed on your kit so that they can be accessed with either hand. In the event one arm is incapacitated, it would be a shame to bleed to death from survivable extremity wound with a tourniquet only an arms-length away.
4. Unless the medical kit has to remain in the factory packaging to maintain sterility, remove it. Under stress, it’s unlikely you will possess the fine motor skills necessary to remove a tourniquet from its packaging.
5. Have a proven system in place for moving/dragging a casualty to safety and train with dead weight consistent with a real operator in full gear. This is not easy, but it’s absolutely essential.
6. Develop and maintain BUSHIDO — the “way of the warrior.” This mindset can and will help you triumph over your adversary, no matter your location, mission or circumstance.
Ready to Use At a Critical Moment
Preloading your gear so that it is ready to use at the critical moment is essential. The tactical tourniquet should be removed from all factory packaging (figure 1). The tourniquet should then be preloaded with the red-tipped end of the CAT strap threaded through the friction buckle opening closest to where its attached, securing an inch or two of the Velcro leaving the tourniquet with as large an opening as possible to accommodate an injured extremity without further adjustment (figure 2). The tourniquet should then be neatly folded and affixed to your gear in a manner that is accessible with either hand (figure 3). When the tourniquet is drawn, it should be ready for immediate application.
It’s important to note that there are currently two popular tactical tourniquets in wide use by the military, law enforcement, and EMS. They are the CAT and the Special Operations Forces Tactical Tourniquet (SOFTT).
There are several generations of each tourniquet type which may have slight variations in the preparation procedures. Generally with a new tourniquet, it should be removed from all factory packaging, inspected for obvious manufacturer’s defects, and prepped for service. It should be noted that if the tourniquet will be carried exposed to the elements (i.e. strapped directly onto a vest or plate carrier), it should be replaced periodically due to the potential for material deterioration. The replacement time will vary depending on the climate, but one year is a good standard.
There are three different colors available (blue for training, black for tactical, and orange for rescue/EMS). All devices are exactly the same and are color-coded so that training gear is not confused with operational gear. Neveruse an actual duty tourniquet for training. Use only a color-coded or clearly marked training device for training.
A special thanks to SSG Chris Cook (ret.) for sharing his story and valuable training insight. Thanks to all of our military troops and first responders for their service to our nation — especially those who have endured and prevailed in similar critical incidents and have taught us how to be better prepared.
This article originally appeared on PoliceOne, the leading online resource for law enforcement, and is reprinted by permission of the PoliceOne editorial team. Visit www.PoliceOne.com to access news, commentary, education information, and training resources that help officers protect their communities and stay safe on the streets.