Tactical… What?

A Theory of Surviving and Shifting the Paradigm

Of all the terms and words contributed to the English language from modern law enforcement, and war fighting, “tactical” is probably used more times then “hello.”  The word itself, in its root has not anything directly to do with high risk teams like SWAT, ERT, CERT, ERU, HRTU and the many other acronyms that inspire excitement and drops of sweat in even some of the most seasoned officers.  When applied in the Merriam-Webster online dictionary, “tactical” has a link to “Pocket sized trauma kit for treatment of gunshot and stab wound.”

The meaning of the word simply refers to a planned action or maneuver to “accomplish a purpose.”  Simply put, in law enforcement, it’s anything that we use in training to be prepared for anything in real life.  It’s something that perhaps gives us an edge, to be custom tailored to our mission and its successful and safe accomplishment – as in Tactical Medicine.

I believe in the last three months I have read and seen more headlines, stories and funerals of officers killed and injured than in my ten year career so far.  The most recent events of the multiple slayings of police officers in Oakland, California and Pittsburgh, Pennsylvania have prompted me to write this.  We have learned to accept that sometimes certain situations that affect our lives and our safety are beyond our control. Other times we can affect the outcome. In all of those instances, there are things we can do to help achieve success and mitigate disaster, things which for years we have not done.

Police officers are trained to be the first into and the last out of the worst of situations. We confront active shooters, and reckless drivers who aim their cars at us. We deal with a multitude of problems presented by people we have never met, and may never see again.

Until recently, not much has been said on how the police can take care of themselves.  How many years have we been taught to use our reaction-side hand to return fire, when the strong hand is injured?  When was it ever addressed, what to do with the injured hand or arm until we can access emergency medicine?

There are many reasons why tactical and high risk teams now train side by side with their own medical support.  After many tragic incidents in the late 1970’s, the idea was born and implemented, a medic should accompany tactical teams.  What was overlooked for many years is the fact that elements of our military doing daily, consistent, and some might say “routine” things, have their own medics. Military teams in combat, kicking in doors, patrolling, interviewing and conducting public relations have all had a basic level of self-help and buddy-aid training. This was followed by a tiered system of a combat medic, flight medic, and doctors in battalion aid stations and field hospitals.

Are these hard-working, forward-deployed grunts on the front line of every mission, not unlike our own police patrol officers?   Looking at it in this light, while the work of a typical tactical team is inherently dangerous during every mission, it is also more planned.  Compare their fastidious entry plans to a patrol officer responding to a call for help in a domestic violence incident. Who typically has more unknown variables, less resources, time to plan, and equipment?  Who will rush in and help a downed partner or a civilian, without waiting for a tactical team?  Many posts here on OfficerResource.com have proven time and time again, that a lone patrol officer will address the unknown threat with little pre-planning.

My colleagues and I have been teaching the principles of Tactical Combat Casualty Care for years.  We have tried to overcome the common mentality that “My EMS will get to me…whenever,” and push forward a standardized approach to officer care under fire.

This does not have to be fire from a machine gun, or even a lone shooter.  What has been neglected until recently is the fact that patrol officers, often, are not taught the tactical skills necessary to conduct emergency medicine in hostile environments. Rescue often “stages” a few blocks away while patrol officers go to those places and situations where traditional medicine will not enter, and will not effectively function.

Please note, that as an EMT and a former Army Medic, I fully appreciate that the First Responder principle of the civilian medicine is well suited, and effective…for it’s own environments.  Our environments, where any threat is still effective, where scenes are not yet safe, and where perimeters are set up, mandates Tactical Medicine.

The concept is simple, “the right care at the right time.”  There are always two priorities, tactical and medical.  The first and foremost is to address the threat and control the scene.  In many of the worst critical incidents that may mean to return fire.  Second is to determine the type of injury you or your partner might have.

For instance, the biggest concern is a severe arterial extremity bleed.  If one of those is found, the only treatment is a tourniquet.  Keep in mind that this critical injury or any others, may have to be determined from a distance.  Despite every instinct to rush in and help, often times our assessment of our partner’s injuries will have to be done from behind cover. Talking to your partner, and telling him to breathe, or directing him to apply pressure to the wound, are all medical interventions that may have to be done remotely.

Tactical Medicine principles are not limited to hands-on actual interventions.  Extrication and extraction, drags and carries should all be trained for as well.

Once the threat is contained and the priority injuries addressed, the Tactical Field Care stage of Combat Tactical Casualty Care will enable us to re-assess, conduct a sweep for additional injuries, treatment, communication and application of additional needed resources.  Following that, you can plan on turning yourself or partner over to advanced medical care.

These principles are only summarized and simplified here.  Training in this area is out there, and readily available.  Despite sheltered administrators, limited budgets, and our own time constraints, we owe it to ourselves to secure some of these skills and practice them regularly.  The simplest bandaging will become a burden and a hazard if it is used for the first time on your partner who’s screaming, bleeding, and hovering for cover.

Unfortunately, much like many other areas of our work, equipment needs have become commercialized.  In researching what to carry and use, please be thorough.  Talk with your local doctors and EMS providers, check into attending a drill with a local National Guard or Reserve medical unit, and your tactical team.  We have to work with our fire and EMS departments on this. Working together in training will foster professionalism and respect.

When it comes to saving a cop’s life, I believe the mission is always the same, do it as safely and efficiently as possible.

Stay Safe.

Relevant Links

www.otma.org (Ohio Tactical Medicine Association)
www.narescue.com (North American Rescue)
www.chinookmed.com (Chinook Medical)

The author, Steve Rabinovich, has been a career police officer since 1998 and has experience serving in municipal and federal government agencies. He has served in a marine unit, a bicycle unit, and mounted patrol. Since 2001, Steve has been an Emergency Medical Technician, fire fighter, and rescue diver in addition to his police duties.  In 2007 Steve began bringing his medical knowledge to police work, training both SWAT and patrol officers in Tactical Medicine. Steve is also working with the Emergency Care in Hostile Operations (ECHO) Group.

Steve Rabinovich can be reached at SRabinovich AT franklinwi DOT gov.

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