The Use of Tourniquets by Law Enforcement May 2014 Voiceover: Beat Intro 00:00 This is the Beat—a podcast series that keeps you in the know about the latest community policing topics facing our nation. Debra McCullough 00:08 This is Debra McCullough with the U.S. Department of Justice, COPS Office. With us today is Lieutenant Alexander Eastman, who serves as deputy medical director and tactical physician of the Dallas, Texas, Police Department. Lieutenant Eastman is also chief of trauma surgery at the University of Texas, Southwestern Medical Center and Parkland Memorial Hospital. We have a few questions for Lieutenant Eastman on the use of tourniquets to enhance the survivability of the severely wounded, particularly in mass-casualty events. Alex, could you briefly describe the role of tourniquets in emergency response? Lieutenant Alexander Eastman 00:48 Sure, Deb, and again, thanks for the invitation to come here. We, in the world of policing in the modern era, are in the business of confronting emerging threats. When you talk about the use of tourniquets by law enforcement officers, we are at the relative beginning of a new era of policing in the United States. That is to utilize the fact that we, as police officers, are the first responders to nearly every critical incident that involves mass casualties, mass trauma, whether intentional or unintentional. We are building, based on the military’s experience of teaching non-medical providers to use life- saving devices like a tourniquet. We’ve seen that they have done such a fantastic job at distilling that training down where it’s easy to understand—that a non-medical provider can easily and correctly apply one of these devices and save his or her life, the life of his partner, or the life of citizens in their community. Debra 01:55 Now, you just talked about how the use of tourniquets by law enforcement is gaining attention as a core skill for all police officers. Now this practice has been a life-saving response in military combat for many years. What do you think has changed in policing’s view of tourniquets? Alex 02:16 Well, I think it’s interesting, because if you look at the way the military treats people who are injured, it’s done with a very robust scientific study. I don’t mean that there’s a bunch of guys with pocket protectors and pens and pencils and things like that, but the military takes a very scientific view of analyzing how people get injured. In response to some bad outcomes accompanied by some bad medical care in battles in Somalia, the military really looked at what they could do to improve survivability. A lot of those lessons are applicable to us but we’re just now integrating the idea of a law enforcement officer providing for his own survival. This is a key component of many officers’ safety initiatives that are out there, and the one that I think has a lot of bang for the buck. If you ask what’s different now, it’s that we have really started to take a more critical look at our own safety. We’ve started to really integrate lessons from non-law enforcement partners that are out there. The idea of having a medical officer integrated into your police department is something that didn’t exist 10 years ago. Now all of those things are coming together and we’re taking the best that other people have learned and applying it to the law enforcement profession. This really is the cutting edge of officer safety programs. Debra 03:46 Why might some agencies be hesitant to establish a law enforcement hemorrhage control program or a tourniquet program? Alex 03:55 I think that the answer to that question has two parts. Let’s take the hemorrhage control program first. I think many law enforcement agencies historically have deferred the care of our own personnel to the fire rescue or emergency services organization in that community. That is, we rely on others to come help us if we’re hurt. Unfortunately, when officers are put under hostile or austere conditions, we can’t rely on our fire rescue EMS partners to come provide our life saving care. They’re quite simply not trained for that. They’re not equipped for that. They really shouldn’t be put in the position of putting themselves into harm’s way in some of our scenarios where we get injured. The idea of saving our own was born out of necessity. We have to be able to save ourselves if we’re injured in a situation where we’re not accessible to other more routine rescuers. The idea of why you start a law enforcement hemorrhage control program, first and foremost, is to save your own personnel. There has been historic reticence among emergency service providers to use tourniquets based on some very old scientific and medical data from old wars. We’re talking World War I, World War II. We now know, after much more modern study of tourniquet use on the battlefield that these devices are safe. They’re effective. They’re easy to use. They’re easy to train. They are basically a little, mere $30, insurance policy for a life-threatening wound that could kill you in the line of duty. We know, again, extrapolating from our military partners, that uncontrolled hemorrhage is the number one cause of preventable death on the battlefield. When that occurs in the extremities, that is so easily treatable with a tourniquet, that it just doesn’t make sense not to equip our personnel with the ability to combat those injuries. That’s what law enforcement hemorrhage control programs and that’s what a law enforcement tourniquet program is all about. The additional benefit to, not just your law enforcement agency but to the community, is these same skills that can be used in a save-our-own program for law enforcement officers are the same skills your officers can use when they turn them outward at an incident like an active shooter situation or the Boston marathon bombing. Same skills, same equipment. Not only do you get training for your officers to save themselves but you make your community a more safe place to live when you institute this type of program. Debra 06:41 Could you tell us a little bit about the Dallas Police Department tourniquet training? Alex 06:46 Absolutely. We are just in the process of finishing the implementation of a department-wide self-aid, buddy-aid training program. That program, which was initially born in our special operations unit, like the SWAT team, our high-intensity drug-trafficking task force, high-intensity patrol unit, proved to be wildly successful. Which is that if we train and equip our officers with some very simple life-saving equipment, we know that they will go out and use that at the right time and the right place. We’ve had law enforcement officers save their partners and friends by the application of these bandages and tourniquets. It just made sense to bring those skills and project them department-wide. Right now, every Dallas police officer is being issued an Olaes Modular Bandage, a specialized hemorrhage control bandage that was proven in the mountains of Afghanistan. We’ve issued that to every officer. A specialized operations forces tourniquet. Again, one of two tourniquets that’s approved by the U.S. military for use in the field. It’s a specialized tourniquet device that’s easy to use. The officer can apply it to himself or his partner or a citizen and they’re easy to train on and easy to use: Two of their best features. We’re also equipping them with a roll of quick-clot combat gauze, which is a specially-treated gauze material that’s used on wounds that are maybe not tourniquet appropriate, but it’s used to basically pack into a wound and stop bleeding. The bottom line is when you’re injured and you’re bleeding, the thing that’s most important is not your airway, it’s not some of the things that are historically taught in CPR and first-aid classes. The bottom line is we need to control bleeding and we need to do it quickly. Hemorrhage control and hemorrhage mitigation has got to be as much of a core skill for a law enforcement officer as shooting, driving, community relations, all of those things. This has to be just another skill in a police officer’s armamentarium. Debra 08:55 What sorts of time and financial investments would a police agency have to make to develop that kind of training program? Alex 09:05 Well let’s take those questions in reverse order. Let’s talk about financial commitments. There are some costs that you simply cannot escape, and that is the cost of the equipment. The bandages, the specialized bandages—there’s a number of them out there. We use the Olaes bandage because it is, I think, the most complete package that’s out there on the market. Those run in the few dollar range. The tourniquets and the combat gauze run anywhere between, probably, $28 to $35 a piece, depending on how many that you buy. So you’re looking at about a $50 to $60 kit of equipment for your officer. How much is an insurance policy worth to bring your officer home at the end of his shift? I would argue that a $60 expenditure for each officer, not only to be able to make sure that if there is preventable cause of death in the field, they’d be able to address it right then and there, they’d be able to address their own hemorrhage. They can also use that same kit to turn to one of your citizens out there. What’s that worth? I would argue that it’s a relatively paltry sum to spend. Even in a large agency like ours, we’ve found that this expenditure is an important message to send to our officers. It says that not only do we care about the community and the job that you do, but this equipment is designed to save yourself and save your partner, and there’s nothing more sacred than that to us. In addition to the training costs, there’s certainly some time involved. We have chosen to introduce these kits into the department in a relatively novel way. It’s a four-step training process that we’ve used. The first two steps are training videos. We have produced a roll call training video—short, high- intensity video, to be played at the beginning of each shift in the department—that introduces the equipment and how they’re used. There’s one that covers the basic principles and the bandages, and the second video covers the tourniquet. Following viewing those two videos, the quick-clot combat gauze has an online training module that the officers can log in and watch at their convenience. The fourth piece, the fourth pillar of this training program, is that in our continuing education, continuing in-service training for the officers, a four-hour block of tactical first aid and scenario-based training is incorporated into that training. Those four components allow the officers to learn the contents of the kit, understand the theories that they’re used, practice it, and then actually deploy these in reality-based training scenarios. It’s proven to be very effective to teach these officers and make them comfortable at using this equipment. Debra 11:58 Do you have any resources or recommendations that you can give an agency who is looking for more information on how to start this? Alex 12:08 If you are an agency that is starting from scratch, the first thing that I can tell you is that you should reach out to a local trauma surgeon or emergency physician in your community that has some interest. You’ve got to have a medical champion for these things in your department. If you are having trouble finding one, then I would strongly suggest you reach out to me and I will do my best to link you up with someone in your community that can get you on the right track to incorporate some of these things into your training. There are guidelines out there, right now, to help law enforcement agencies do these things. One of the core documents I would point you toward was a product of the American College of Surgeons, the Federal Bureau of Investigation, the Major City Chiefs Association, and that is called the Hartford Consensus. This is a group that sat down and looked at ways to improve survivability from active shooters. That group clearly makes the case that hemorrhage control training has to be a core law enforcement skill. Many police agencies, when they’re going to their governing bodies and their local governments and saying, “Hey look, we need to do this,” the Hartford Consensus represents what’s determined to be best practices and will help give you some guidance. Debra 13:31 Do you have an email address? Alex 13:33 Sure. My email address is alex.eastman@dpd.ci.dallas.tx.us. My apologies in advance that it’s so long, but I didn’t write it. Debra 13:56 How about a phone number or general phone number? Is that easier? Alex 14:01 Yep. Sure, if it’s easier to reach out on the phone, feel free to give me a call. My office phone number is 214-648-0299. Debra 14:11 Alex, thank you so much for providing us your expertise your and time today. Alex 14:16 You’re very welcome. Look forward to hearing from you. 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