Quality Corner: Improvement Beyond Your Agency`s Door

The quality coordinator is the conscience of EMS, always looking for opportunities to improve patient care and save lives. Sometimes opportunities to save lives extend beyond the doors of the EMS agency.

One such opportunity became apparent to us at Bucks County Rescue Squad as we began ramping up our tactical emergency medical support (TEMS) team a while back. Tactical medicine is as fashionable and in vogue nowadays as it is necessary. But sometimes TEMS can become more about EMS than supporting law enforcement as much as we should. Frequently the total focus is on training, equipping and embedding medics into the stack. There is nothing wrong with this, and many times it may the right thing to do. Because when things go bad during a tactical operation, operators need to operate with total focus on the mission and total confidence that if anything should happen to them they will receive prompt and efficient care. And in order to help the injured operator, the medic has to be there with them and not left behind at some remote staging site. But this is not the end all be all of tactical medicine.

During our initial needs analysis for tactical medical support we quickly recognized the greatest service we could provide to our law enforcement partners did not involve direct action by tactical medics but rather simply training every patrol officer how to recognize and stop life-threatening bleeding on their own and supplying them with tourniquets to do so.

Dr. Barry Burton, our TEMS unit medical director discovered while doing some research that line-of-duty deaths most often occur during routine patrol; situations where it is not practical to have a TEMS medic with the officers. Teaching police officers to provide self-aid and buddy care is the only means of treating these life-threatening wounds and saving those salvageable lives. It is also the main objective of the National Association of Chiefs of Police’s Save Our Own campaign first introduced in 2010.

The recent change in priorities for sudden cardiac arrest from A-B-C (airway, breathing, circulation) to C-A-B (circulation, airway, breathing) is even more true in tactical casualty care. In matters of basic physiology you can bleed to death from disruption of a major blood vessel even quicker than you can from an interruption of respiration. Additionally, control of major hemorrhage is the priority treatment in the law enforcement environment because it is by far the most common cause of death by way of gunshot and stab wounds.

The following two case histories help dramatize the importance of all patrol officers being trained in tactical casualty care. The first case took place in Las Vegas, NV, in March 2010 when two metro police officers engaged an armed robbery suspect. During the exchange of gunfire, one of the officers was struck twice, once in the chest and once in the leg. The round that struck the officer in the chest was successfully stopped by his body armor, but the round that struck the officer in the leg severed his femoral artery resulting in a life-threatening bleed. The wounded officer did not wait for someone to come help him, but rather immediately began self-aid. As soon as the tactical situation permitted he was assisted by the other officer. After the life-threatening bleeding was controlled, the officer was transported to the hospital where he survived and recovered. Conversely, in January 2011 one of two officers serving a warrant in Florida was shot in the leg severing his femoral artery. In this case, his partner put the injured officer into their patrol car and rushed him to the closest hospital. Unfortunately in this case, the injured officer died by the time he arrived at the hospital from uncontrolled hemorrhage.

In 2012 Scott Bahner, chief of Bucks County Rescue Squad, and Dr. Barry Burton, TEMS unit medical director, put together a brief 20-minute training program detailing the basic physiology of gunshot wounds with major vessel involvement and the need for immediate treatment. Bahner then applied for and received a grant to purchase and issue tourniquets to patrol officers. The Bristol Township and Bristol Borough Police departments were the first to recognize the importance and agree to train their officers in tactical casualty care. This training was conducted at roll call at the beginning of each shift. Within about a month all officers of both departments were trained in the recognition of life-threatening gunshot and stab wounds as well as self-aid and buddy care.

This training has since been requested by several police departments in surrounding communities for their officers. Among them, the fourth largest police department in the United States, the Philadelphia Police Department.

While no police officers have yet been saved by this training, officers who have received this training have saved the lives of nineteen civilians as of this writing which is not a bad off shoot benefit.