Any tactical first aid kit should include combat vetted and tested treatments for the most common and deadly types of injuries found in a hazardous environment.
“No widely accepted, specialized medical training exists for police officers confronted with medical emergencies while under conditions of active threat,” researchers noted in “Police officer response to the injured officer: a survey-based analysis of medical care decisions,” published in Prehospital and Disaster Medicine in 2007. This training shortfall has recently begun to be addressed as Trauma Combat Casualty Care (TCCC) guidelines established to manage the most common causes of death on the battlefield – hemorrhage from extremity wounds, tension pneumothorax and airway problems – are being adapted for law enforcement. But, while some of the greatest advances in field medicine were developed on the battlefield, it is important to note the differences between military and law enforcement situations. “Domestic law enforcement personnel and civilians typically have greater access to rapid medical assistance and trauma centers than military personnel engaged in combat operations. Unlike combat, the most common weapons used to attack officers or civilians are usually low velocity weapons such as handguns, stabbing instruments, blunt objects or personal weapons (hands, feet, etc.),” Lt Eric Dickinson wrote in The Street Officer’s Guide to Emergency Medical Tactics. “Law enforcement officers performing medical skills must often operate in an environment controlled and restricted by civilian physicians, civilian EMS personnel, state medical protocols and state laws,” he adds.
Better Response to an Increasing Problem
In response to mass casualty events, including the Sandy Hook Elementary School shootings in 2012 and the Boston Marathon bombing in 2013, the American College of Surgeons met with first responders from law enforcement, fire departments, emergency medical services, and the military to discuss how to respond to these events more effectively. Their findings, published as the Hartford Consensus and last updated in 2015, focused on extremity wounds and the use of kits containing tourniquets and hemostatic dressings, as well as better coordination between law enforcement and medical teams in the triage of their efforts. The groups proposed a simple acronym to help educate first responders on the proper aid in a mass casualty event: THREAT (Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical providers, and Transport to definitive care).
“This is not to say that the intent is to turn police officers into EMTs. No, medical experienced and invaluable medical professionals who can respond to a multitude of emergency situations. But, what protocols like the Hartford Consensus do is recognize that first responders – like the police or like engaged civilians – can, with enough equipment, keep those with life threatening injuries alive until the medical first responders arrive,” says Paul X. Harder, JD, President of H&H Medical Corporation.
Industry professionals echo the Hartford Consensus’ focus on tourniquets to improve downed officer survival. “The most immediate cause of preventable death is arterial hemorrhaging from the extremity. A person can lose a fatal amount of blood from an artery in as little as three to five minutes,” says Marc Fridley, Sales & Training, Tactical Medical Solutions. “Tourniquets are widely accepted as the greatest innovation to trauma care after a penetrating injury,” says S. Brock Blankenship, MD, President of TEMS Solutions. “It is widely accepted that the best tourniquet is the one you have on you when needed. For this reason, we recommend all officers train on and carry [on their person] their tourniquet.”
Agencies, however, have only just begun to overcome the bias against tourniquets stemming from the dangers associated with the early tourniquets used in the 1970s. “It took several years of research, battlefield testing and the redesign and manufacture of commercially made tourniquets for acceptance to occur,” David Flory, NREMT-P, TPC, Police Chief, Hot Springs, Arkansas, wrote in The Police Chief magazine. Now, tourniquets are credited with saving the lives of officers, as well as civilians, suffering from gunshot wounds, vehicle accidents and other injuries, he says. “The most significant change to first aid procedures comes as a result of the war experience in Iraq and Afghanistan,” says Peter Pons, MD, Associate Medical Director of the NAEMT Prehospital Trauma Life Support (PHTLS) Committee, and an emergency physician in Denver, Colorado. “From this protracted conflict, we have learned that the use of an approved tourniquet for hemorrhage control is, in fact, a safe procedure and that the application of direct pressure to a wound in combination with packing the wound will also stop most bleeding. These two procedures have been incorporated into the practice of many responding agencies in the past two to three years.”
“Every officer needs to evaluate his/her own work environment and likely scenarios,” Dickinson writes. The training you need will depend on the types of injuries you are most likely to encounter and the first aid gear you choose to carry. There are many venues for training on the use of first aid tools, including manufacturers’ videos, packaging instructions and hands-on training courses, Harder says. “Hands-on training is the best way to reinforce how to use these kinds of products and how to respond to medical emergencies. Frequent refresher courses help keep skills fresh to be prepared to respond to any situation.”
The Pima County Sheriff’s Department developed a program to train all street officers on how to sustain themselves or other officers in life threatening medical emergencies. Based on Tactical Combat Casualty Care (TCCC) guidelines and research from the Valor Project, the agency’s “First Five Minutes” course teaches officers scene safety, body substance isolation, medical assessment techniques, CPR, use of emergency bandages, combat gauze, Asherman Chest Seal and tourniquets, and transfer of care. All officers are issued an individual first aid kit equipped to address the most common causes of preventable traumatic death (www.emsworld.com/article/10770951/police-first-aid).
Law Enforcement and First Response Tactical Casualty Care teaches public safety first responders, including law enforcement officers, firefighters and other first responders, the basic medical care interventions which will help save an injured responder’s life until EMS practitioners can safely enter a tactical scene. It combines the principles of PHTLS and TCCC and meets the recommendations of the Hartford Consensus document and TECC guidelines (www.naemt.org/education/LEFR-TCC.aspx).
The Advanced Law Enforcement Rapid Response Training (ALERRT) Center at Texas State University addresses the need for active shooter response training for first responders. The ALERRT Center delivers 13 grant funded first responder courses across the nation including Active Shooter Events and Response, Active Threat Integrated Response Course and Terrorism Response Tactics – First Responder Breaching (www.alerrt.org).
The Law Enforcement First Responder Training Program (LEFRTP) is designed to provide topics most applicable to law enforcement officers as first responders at the state and local levels. Law enforcement officers must be trained and equipped to respond to virtually any situation, including criminal acts, terrorist attacks and other large-scale emergencies. The LEFRTP will provide training, guidelines and resources to address these, as well as other important issues (www.fletc.gov/training-program/law-enforcement-first-responder-training-program).
First Aid Equipment
“The key to any tactical first aid kit is the ability to deal with a life threatening injury. The problem for law enforcement is carrying enough product to deal with the casualty in a pack or kit which doesn’t interfere with all the other items an officer may carry. So, you look for products which are small in size, but complete, easy to use out of the package with minimal training and effective at dealing with the injury. And, the kit itself must be easy to open, organized and readily available,” Harder says.
Depending on your specific location, your needs could vary. Likewise, your agency’s resources and policies will dictate what type of kit may be most appropriate. Whether you choose a pre-assembled kit from a reputable manufacturer or assemble your own, you’ll want to be sure to familiarize yourself with the contents and be sure to train on each piece of equipment. While recommendations vary, most experts agree that individual first aid kits should include the following:
- TCCC approved tourniquets to treat life threatening arterial bleeding found on the arms and legs – “Tourniquets alone could save 60% of all the preventable deaths from combat trauma,” Dr. Fabrice Czarnecki told PoliceOne. A tourniquet is the single most crucial piece of equipment to have on hand, Fridley agrees.
- Chest seals (vented or nonvented) or materials to make an occlusive seal (like petroleum gauze and two inch tape) to treat any penetrating torso injury
- Trauma or pressure dressings to treat severe venous bleeding or arterial bleeding not found on the arms or the legs – “A compression bandage should be one with a large enough pad to cover the wound, preferably one which has the pad sewn to an elastic wrap to make it easier to apply the bandage and create pressure around the wound. Most higher end bandages come with devices such as bars or cleats to force more direct pressure down over the wound,” Harder says.
- Hemostatic dressing or blood clotting agents – hemostatic dressings are gauzes designed to be pushed or forced into a wound where there is significant blood loss to create a clot and stop or slow the arterial bleeding. The most basic of these products is cotton gauze and there are several gauze rolls which are packed small and compact for easy carrying. After that, there are numerous hemostatic products – some with chemicals and some without – which have proven effectiveness in stopping blood loss.
- Quality latex-free gloves
- Trauma shears can cut away clothing, as well as improvised bandages, slings, etc.
- A simple airway device, like a CPR face shield or, more preferably, a NasoPharyngeal Airway (NPA) – if training on these devices is not available, or within the agencies medical guidelines, some basic training in the use of patient positioning to promote the opening of the airway, specifically the recovery position, is important.
“If carrying [an individual first aid kit] on your person is not possible or feasible, consider carrying multiple small blowout kits strategically placed throughout your patrol vehicle or other work environment. Placing a kit in each front door pocket and attaching one to your trunk lid or truck tailgate permits access from multiple sides if needed. You may also choose to place the kits in a conspicuous place such as attached to the prisoner cage of a patrol car where it can be seen from outside,” Dickinson writes.
Officers should also consider carrying a laminated card with their medical information in case of a serious injury, Dickinson says. The card should include name, birth date, social security number, food and drug allergies, medications including over-the-counter medicines taken regularly, key medical history, primary physician, emergency contacts, and information concerning a living will or medical power of attorney, if it exists.
A larger medical kit can be kept in patrol cars or sent with teams engaging in high risk activities. These kits should contain two (or more) medical kits, wrapped separately, and used only for penetrating traumas; a CPR mask; self-adherent cohesive bandages; a splint; nonadherent dressings; bandage strips or wound closure tape; 4 x 4 gauze pads; tape; elastic wraps; safety pins; space blankets; EMT shears; cold compresses; medications (acetaminophen, ibuprofen, triple antibiotic ointment, aspirin); artificial tears (saline); antiseptic solution; alcohol gel; and an Automated External Defibrillator (AED) is recommended for use by trained officers, if available.
Downed Officer Kit
The TacMed™ Downed Officer Kit (DOK) is a compact kit which contains the items essential for treatment of serious injuries encountered by law enforcement while fitting in a cargo pocket or glove box. It can also mount to a roll bar/protective shield in a patrol car or tactical vehicle. The DOK is packed in a heavyweight resealable bag, allowing easy replacement of individual kit items. Kit components can also be periodically inspected without damaging the integrity of the packaging. The kit’s contents can be modified to meet your individual requirements or several prepacked kits are available with or without hemostatic agents. It costs $39.90 (standard kit), www.tacmedsolutions.com/product/downed-officer-kit/.
The Eagle IFAK is a compact, versatile, individual first aid kit which offers both MOLLE/PALS-style connectors to attach to an assault vest/body armor and an upper or lower mounted 2.25" belt loop attachment to secure the kit in the high or low position on your duty/pistol belt – all in one carrying platform. The smallest IFAK in the North American Rescue product line, the Eagle IFAK contains all of the essential equipment for point of wounding and self-aid/buddy-aid care to address penetrating, blast or other traumatic injuries. Featuring a Quick Pull Tab, the carrying bag easily opens to reveal the removable kit with just one hand. The kit has a unique, detachable shock cord inner panel which can be adjusted to carry different components and provides easy access to the contents. Available from North American Rescue, it costs $204.99, www.narescue.com/eagle-ifak.
The patented Combat Application Tourniquet (C-A-T) utilizes a durable windlass system with a free-moving internal band providing true circumferential pressure to the extremity. Once adequately tightened, bleeding will cease and the windlass is locked into place. A hook and loop windlass retention strap is then applied, securing the windlass to maintain pressure during casualty evacuation. The C-A-T’s unique dual securing system avoids the use of screws and clips which can become difficult to operate under survival stress or where fine motor skills are compromised. Also available from North American Rescue, it costs $29.99, www.narescue.com/combat-application-tourniquet-c-a-t.
TACOPS Rolling Mass Casualty Kit
TSSi’s Rolling Mass Casualty Kit was designed for civilian first responders to use in any location where large crowds typically gather. A large rolling duffle with removable shoulder straps enables the kit to be easily transported over long distances. Inside are ten removable trauma pouches, each capable of treating three to four casualties with traumatic injuries. Two additional pouches contain larger abdominal bandages and hypothermia blankets. Within the lid are multiple moldable splints and burn/ blast dressings. On either side of the inner compartment are six disposable poleless litters. Manufactured by TSSi, it is available at https://issuu.com/tssiops/docs/rmck_ts_05162016.
The Patrol Officer Casualty Kit for Emergency Trauma (POCKET) puts the tools to immediately respond to a major trauma in a package designed to fit in small spaces (4.5" x 4.5" x 2") and weighs less than a pound. Easy opening, each component is individually vacuum sealed and packaged as one kit for quick deployment. Manufactured by H&H Medical Corporation, it costs $37.50, http://buyhandh.com/collections/all/products/pocket-law-enforcement-kit.
Pocket Medical Kit
The TacMed™ Pocket Medical Kit, or PMK, provides the necessary medical equipment to immediately treat life threatening traumatic injuries. The SOFTT-Wide included in the kit is rescue orange, making its application readily apparent for additional first responders. The PMK is designed to fit neatly into the chest pocket of a duty shirt, trauma plate pouch of a concealed armor carrier or the back pocket of your jeans. It costs $53.31, www.tacmedsolutions.com/product/tacmedtm-pocket-medical-kit/.
Operational Medical Kit
Designed to be small, low profile and packed with the essentials, the Operational Medical Kit (OMK) exceeds the requirements of the Hartford Consensus for hemorrhage control by providing more lifesaving gear in a tight pouch the size of a double magazine. The kit is packed in the H&H Personal Trauma Pouch with Molle straps, a hook-and-loop patch for identification and easy access. Made by H&H Medical Corporation, it costs $87.50, http://buyhandh.com/collections/all/products/operational-medical-kit.
POW Response Pack
The POW™ (Point of Wounding Care) response pack provides the quickly needed tools to provide quick “Life Saving Interventions” during the triage process, particularly bleeding control, while being worn by the rescuer. The pack is built from water-resistant Cordura® with taped seams and ergonomic shaping. The main pocket opens to reveal multiple sleeves and stacked elastic to provide instant access to tourniquets, battle dressings, clotting agents, chest seals, etc. The front pocket is divided for use with chem lights, extra PPE or a stethoscope. The wings of the pack are clearly labeled for triage. The left wing contains a Fox 40 whistle on a lanyard (you can also stow extra gloves here). The right wing is for tape ends. Available from Conterra Inc., it costs $399.00 (fully loaded), www.conterra-inc.com/products/pow-responsepack.
First Aid Flowchart
The “at a glance” foldout first aid flowchart is packed with information for helping you assess your emergency and make decisions quickly. The flowchart is broken into eight first aid categories: Critical Body Systems, Wounds and Burns, Muscle Skeletal/ Spine, Anaphylaxis (Allergic Reaction), Medical Emergencies, Toxins, Environmental Emergencies and Gastro Intestinal/Genito Urinary. It also includes illustrated steps for splinting, hypothermia wraps, blisters and more. Printed on waterproof paper, the 17" x 11" chart folds down to 4" x 6". Also from Conterra Inc., it costs $8.00, www.conterra-inc.com/collections/first-aid/products/first-aidflowchart.
The SWAT-Tourniquet (SWAT-T) is an easy to use alternative to windlass tourniquets. Designed to be applied in seconds, the SWAT-T is effective for self-application – even in wet or bloody conditions. Also effective as a pressure dressing or all-purpose wrap, the SWAT-T comes in rescue orange or tactical black. Manufactured by TEMS Solutions, LLC, it costs approximately $10 (price varies by reseller), www.swattourniquet.com.
TUFF Active Shooter Kit
The TUFF Active Shooter Kit (T.A.S.K.) is an all in one leg rig system which holds (but are not included) four 20 or 30 round AR-15/M4 magazines, EMT shears, latex gloves, surgical tape, modular bandage, tourniquet, and chest seal. Everything stores conveniently into the zippered Personal Trauma Kit Pouch. The elastic leg strap and buckle system wraps around the thigh securely and the leg drop is adjustable to different heights with a TUFF Hook System. The T.A.S.K. is manufactured with rugged 1680 denier black ballistic nylon and double layered scuba webbing. The included TUFF Quick Hook Mounting System comes with a heavy metal snap hook and a notched polymer ring for saving belt space and easy on and off attachment. Made by TUFF Products, it costs $79.00, www.tuffproducts.com/3902-tuff-t-a-s-k-active-shooter-leg-rigwith-p-t-k/.
Formerly the Editor-In-Chief for Forensic Magazine, Rebecca Waters is a freelance writer and editor. Rebecca Waters Photo courtesy of North American Rescue