At 10:09 a.m. on January 8, 2011, the Pima County (AZ) Sheriff’s Department received a 9-1-1 call for a shooting in progress at a local shopping center. During the next 20 minutes, details of a horrific scene unfolded. A lone shooter had fired 30 rounds into a crowd gathered for Rep. Gabrielle Giffords’ “Congress on Your Corner” event outside a busy Safeway grocery store. Though the shooter was taken into custody within five minutes of the call, arriving deputies faced 19 injured and/or dying people, all in close proximity.
In the 47 minutes deputies were with the injured at the scene, they treated 10 victims. Deputies controlled bleeding, provided chest compressions and rescue breathing, used hemostatic agents, bandaged wounds and assisted citizens in care of the injured. Emergency department physicians and trauma surgeons from Tucson’s Level 1 facility, University Medical Center, acknowledge that the quick actions of the Pima County deputies resulted in decreased hemorrhage, improved arrival vital signs and decreased need for resuscitation such as transfusions for multiple victims.
A 2007 study published in Prehospital and Disaster Medicine noted that “No widely accepted, specialized medical training exists for police officers confronted with medical emergencies while under conditions of active threat.”1 Given the knowledge we’ve acquired from historical and modern battle, which has culminated in the Trauma Combat Casualty Care (TCCC) guidelines, we know the causes of preventable death on the battlefield are hemorrhage from extremity wounds, tension pneumothorax and airway problems. Each of these emergencies can be readily managed using relatively simple techniques and minimal equipment. Unfortunately these techniques and equipment are rarely taught to law enforcement officers.
Even in an urban environment, the time it takes for EMS to arrive on scene can mean the difference between life and death for the wounded. Too often the first responder is a law enforcement officer faced with a tactical situation, whose law enforcement function must quickly transition into providing first care to civilians or fellow officers. In Pima County this happened in a location readily served by multiple paramedic units from three large fire departments, but it is conceivable this same scenario could occur with any of the following complications:
• A rural setting with an extended ETA for EMS;
• EMS gets lost;
• EMS breaks down;
• The scene is unsafe, and EMS cannot approach.
Any of these complications could significantly delay EMS arrival and affect the well-being of the wounded. It is essential that treatment begin immediately and patients be transported expeditiously in accordance with the severity of their injuries.
Special weapons and tactics (SWAT) teams have long understood how important it is to have paramedics embedded in their teams, tactically trained and immediately available for any medical need. These tactical emergency medical service (TEMS) providers can readily address airway, breathing and circulation problems that create an urgency that transcends the response times of most staged civilian medical assistance units. While it is not practical for law enforcement agencies to employ paramedics to work in the field with officers, much can be done to train police officers to care for themselves.
The Pima County Sheriff’s Department leadership acknowledged the need for global training for all staff with “feet on the street” long before the Giffords shooting.
Taking elements of TCCC and results from research done by the Valor Project (www.valorproject.org), they provided a tactical emergency medical training program called the “First Five Minutes” to all deputies during annual advanced officer training in the spring of 2009. The program was developed by officer/paramedic David Kleinman in consultation with former U.S. Surgeon General Richard Carmona, MD, who once led and provided medical direction for the Pima Sheriff’s SWAT team, and Tammy Kastre, MD, the team’s current medical director and a board-certified ED physician.