Thoughts on TCCC for Law Enforcement and Armed Individuals

In the most recent newsletter (#158) from Force Science Research Center (which always brings interesting material to the fore) the lead article is on research being done, and a recent report, by Dr. Matthew Sztajnkrycer, (a Mayo Clinic emergency medicine consultant as well as medical director and tactical physician for Rochester, Mn. PD) on first response medical care for Law Enforcement. There some pretty interesting stuff in said article, but unfortunately, the Force Science News website is several issues behind and we can’t directly link to it. We can, however, link to the report the article discusses; Learning from Tragedy: Preventing Officer Deaths with Medical Interventions; and pull a couple snippets from the article in question.

I think this is a vitally important line of questioning, and has implications outside of law enforcement.
I would expect that the injury patterns seen in law enforcement are more consistent with those seen in armed citizens than the patterns suggested by the strict Tactical Combat Casualty Care model. The armed individual environment is much more similar to that of law enforcement officers, than any combat zone, after all.
Unfortunately, a cohesive picture of injury patterns in civilian cases doesn’t exist. Though I believe many instructors teaching civilians “combat/tactical” medicine have been informally collecting cases, I’m not aware of anyone putting out a compilation. BFE Labs own small collection supports the idea that civilian cases would be similar to what Sztajnkrycer has documented about LEO injuries, however. With this in mind, the suggested study of more data on Law Enforcement injuries, and successful interventions, would be fairly illustrative for armed citizens as well – It also presents as being easier to compile.

This line of questioning raises interesting thoughts about the direction things are headed, and what will be “the way” in a few years, vs. what is “the way” now.
The argument about tourniquets has greatly wound down with a wider acceptance of the practice in civilian EMS having come about based on recent war experience (an acceptance that seems to also have trickled down to law enforcement). Hemostatics are coming along as well, though there is still a reticence (and a confusion) about them that exists among many end-users. What of needle decompression?
In civilian EMS, needle decompression commonly remains a para-god skill, which will have a lot of influence on doctrine in other environments. Meanwhile, the military is teaching it broadly, and it is taught commonly in non-licensure/non-accredited courses focused on combat/tactical medicine at varying levels. As noted in “Learning from Tragedy:…” the ability of medical lay-person police officers to learn, perform and retain skill at needle decompression has been found to be high (Dr. Sztajnkrycer is also the author of the mentioned paper which examines the performance of LEO’s trained in needle decompression – It is worth a read in its entirety: Needle Thoracostomy by Non-Medical Law Enforcement Personnel)

And what of self care? There should be little argument that managing injuries in the fight, when you’re the only one in the fight, and the only one dealing with injuries, is a gourmet shit-sandwich. There are some injuries for which no one is going to be performing self-care, simple as that. Perhaps, though, a better knowledge of injury patterns in non-military tactical environments would lead to some innovations in this realm of care.

Sztajncrycer is not anti-TCCC by any means, and clarifies this in the unlinkable Force Science News article: “At the moment, TCCC is the best formalized approach to treating combat casualties that we have. Tourniquets can save lives in certain circumstances, and they may have saved many near-misses that we have not currently documented. Using a tourniquet is a skill every officer should have.”
He continues, saying, “… TCCC teaches a certain disciplined mind-set in approaching medical problems in threat situations that is important for officers to integrate.”
This mindset is fundamental. Taking ownership of medical skill (particularly when it includes self-care) adds a great deal of resiliency. Too much we are taught that injuries, of any kind, are impossible to overcome, when was is needed is the firm idea that when injured, one can press on, and prevail.

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