Trauma on the battlefield and The Watch

Earlier this week I went though crowd control training and one of the items covered was use of a tourniquet in case of a major injury. And we were told, in the era of the Boston Bombings, etc, we should expect more of this. Personally I started carrying on tourniquet in my body armor a couple of years ago, and after this class I'll carry two. Better to have and not need, that to need and not have.

From PoliceOne, a good review of lessons learned from the front, lessons that can help us on The Watch.

6 life-saving lessons for cops learned on the battlefield

In a critical incident, there is an unspecified amount of time where even the best intentioned EMTs may not be able to get to you — you are on your own

Mar 16, 2016

Much of what we do as police officers today in self-aid/buddy-aid was passed on by our military troops who paid a high price for the lessons learned. But what is now accepted practice for them is still somewhat of a hard sell for law enforcement. Many officers fall prey to complacency and an “it will never happen to me” attitude.

Calls for service are “come as you are” events. Absent the proper training and the necessary equipment on your person, the potential for a bad outcome is high. There are generally three categories of injuries in the field:

1. Injuries that no matter where you are or what resources are available, you are going to die

2. Injuries that no matter where you are or what resources are available, you're going to live

3. Injuries where what you do — or don’t do — before more definitive medical care is available will be the difference between whether you live or die

The third category of injuries is the area we must focus on. In a critical incident, there is an unspecified amount of time where even the best intentioned EMTs and paramedics may not be able to get to you — you are on your own. You must be prepared with the necessary training and equipment. Let’s look to a lesson learned in Iraq for an example of precisely how important this training and equipment is.

An Attack in Iraq
On September 11, 2004 — while deployed to Iraq — U.S. Army Staff Sergeant/Medic (ret.) Chris Cook was en route to the “Green Zone” hospital with blood samples from his unit's medical facility. A three-vehicle convoy was stopped by US forces due to a hidden Improvised Explosive Device (IED) that had been buried in the roadside and blocked their path. The convoy commander elected to stop (breaking a cardinal rule) and provide perimeter security while awaiting an Explosive Ordnance Disposal (EOD) team.

The convoy, consisting of three 1/2 armored Humvees armed with .50 caliber and M249 SAW machine guns, formed a 360 degree perimeter. Cook was positioned on the road side of the convoy. After approximately 30 minutes, a lone vehicle broke out of the normal traffic flow and drove in the direction of the convoy at a high rate of speed.

A little voice inside Cook’s head told him this was a bad thing — a very bad thing. His training kicked in as he raised his M16A2 rifle and aligned his sights on the forehead of the driver and squeezed off two rounds. Immediately after firing the second round, the vehicle exploded approximately 25-30 yards from Cook’s position. He doesn’t recall hearing the explosion, but saw a bright orange ball of flames and felt the heat from it. The force of the blast slammed him to the ground next to his Humvee which was engulfed in flames.

He grabbed the brush guards in an attempt to stand, but couldn’t. His vision was blurred as he looked down through his protective glasses. He flicked off his eyewear to see his left leg from the knee down twisted and backwards. Blood was visible on his camouflage uniform and he could read the blood type marked on the back of his boots. His right ankle had swollen to the size of a softball.

He tried to stand again, but couldn’t. Then the pain started — intense pain as if his legs were on fire. He flashed back to his training and heard his instructor’s voice yelling “ambush…ambush…ambush.”

One of his buddies came to his aid and dragged him clear of the burning vehicles. Cook — at over 200 lbs. fully kitted — was dead weight. As he rolled onto his back, he remembered that about a week prior, he’d been issued a Combat Application Tourniquet (CAT). CATs were issued to all medics with instructions to keep them handy at all times. He rolled onto his back, removed the CAT from a pocket on his body armor, and attempted to open it from the factory wrapper.

His heart was racing, his hands were shaking, his leg was visibly a mess, and he no longer had the fine motor skills to remove the CAT from its packaging. Fearing he would soon go unconscious and bleed out, he began to gnaw at the packaging. He was finally able to remove the CAT and apply it to his injured leg in time to save his life.

Lessons Learned
Cook was subsequently rescued by members of another unit who arrived on scene. He was taken to the 31st Combat Surgical Hospital in the “Green Zone,” which ironically was where he was headed before the explosion. There, he would undergo the first of 21 surgeries to repair the near amputation of his left leg, a fractured right ankle, and numerous other shrapnel injuries. This was the start of a long and arduous road to physical and mental recovery.

Many thoughts went through his mind during those critical moments. He offers the following key learning points:

1. Stop the threat. The best medical care in the world is of no value if you’re dead. That day, my training saved my life.

2. If you are going to carry a piece of equipment, whether it be in the military or law enforcement, train with it. Don’t just put it into a fancy MOLLE pouch and forget about it. In doing so, when the time comes, you will not have the necessary skills to use it effectively and efficiently.

3. Tourniquets must be placed on your kit so that they can be accessed with either hand. In the event one arm is incapacitated, it would be a shame to bleed to death from survivable extremity wound with a tourniquet only an arms-length away.

4. Unless the medical kit has to remain in the factory packaging to maintain sterility, remove it. Under stress, it’s unlikely you will possess the fine motor skills necessary to remove a tourniquet from its packaging.

5. Have a proven system in place for moving/dragging a casualty to safety and train with dead weight consistent with a real operator in full gear. This is not easy, but it’s absolutely essential.

6. Develop and maintain BUSHIDO — the “way of the warrior.” This mindset can and will help you triumph over your adversary, no matter your location, mission or circumstance...

I can't recall who said it, but it fits with this story: "Any fool can learn from his own mistakes. I want to learn from other men's mistakes."

Be safe out there.