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Police Taking Page from the Military by Saving Lives with Tourniquets

In response to the rise of large-scale attacks in public places, a goal is to place tourniquets in malls, ballparks and universities.

Beside the horrific nature and senselessness of the acts, the Sandy Hook shooting and the Boston Marathon bombing share a critical commonality. In both cases, many of the fatalities were caused not by the immediate blast or bullet, but by rapid and catastrophic bleeding. It’s an increasing phenomenon that can be prevented.

With this in mind, many police departments and public safety advocates have turned to a simple solution in recent years, a tried-and-true method for emergency response to traumatic bleeding. It’s the return of the tourniquet.

“The name of this game is to stop bleeding to death, so you need to be empowered to stop the hemorrhaging. Can you do that? Yes, you can,” said Dr. Lenworth Jacobs, director of trauma and emergency medicine at Hartford Hospital in Connecticut.

In the wake of recent violent events, and with the backing of the American College of Surgeons, Jacobs founded the Hartford Consensus. This interagency task force encourages police and other first responders to train on, and be equipped with, tourniquets as part of their regular routine.

The trend toward tourniquets as a first responder tool comes in large measure from the experience of U.S. military forces in Iraq and Afghanistan over the past decade. As far back as 2005, the military has recognized the value of the simple constrictive devices, which can cost between $15 and $30 each.

At that time, some 38,000 nylon and plastic tourniquets were arriving at a staging area in Qatar, the first of 172,000 being rushed to the war zone, as reported in The Baltimore Sun. The Marine Corps was expecting to order more than 200,000 tourniquets.

That evolution came in response to a military study that found battlefield deaths from blood loss had not changed much since Vietnam, when about 7.4 percent of fatalities bled to death, the Associated Press reported at the time. Early on in the Afghanistan war, bleeding still caused about 7.8 percent of deaths.

Researchers declared that applying a tourniquet could cut those numbers. The military responded and by 2011, deaths from bleeding extremities had dropped to 2.6 percent.


Police Sign On


Under the guidance of the Hartford Consensus, law enforcement has been applying those lessons as well. Since 2013 some 200,000 police officers have begun to carry the devices, along with all FBI officers, Jacobs said.

The new tool is needed in response to the changing nature of emergencies, especially the rise of large-scale attacks in public places. Explosives are becoming more common, and the munitions in use are evolving too.

“When you are shot with a .22 or a .32 [caliber round], that bullet is generally going fairly slowly, so if it hits something fairly important like the liver or a major blood vessel, then you face the likelihood of being seriously injured or dying,” Jacobs said.

Today’s shooters on the other hand are more likely to be armed with high-speed military ammunition. “That blows things off and creates massive bleeding,” Jacobs said. Rather than dying immediately from the blow, “now you have a high likelihood of bleeding to death — but it is fast, within five or 10 minutes. So you need to have an immediate response.”

While the Hartford Consensus has had considerable success in making its case among law enforcement professionals, there have been challenges along the way.

There’s the money, of course, and the time and expense of training. And there are mindset issues as well. Police officers have been trained to control a crisis scene, to stop the bad guy, “and if you were bleeding to death they would step right over you to complete that mission,” Jacobs said.

The military, on the other hand, works on a buddy system. “If your buddy gets shot, you drop off and let your comrades carry on the mission,” Jacobs said. In civilian life, that means you stop the bleeding while others continue the crisis response. Police officers generally aren’t conditioned to think along those lines, so tourniquet advocates have needed to drive new ways of thinking.

The Hartford Consensus has been able to close the gap thanks in large measure to its broad base of membership. Representatives of major city police, fire and EMS departments all have been a part of the effort, thus helping to ensure a measure of buy-in from across the user base.

Boston police officers got 1,500 tourniquets and training within a month after the bombings in 2013. In Dallas, where police officers have been issued tourniquets, Lt. Alex Eastman said it’s about time. “I’ve been pushing for this for years,” he told New Jersey’s Courier Post. “But I think it was the Boston experience that pushed people to act.”

It has already paid off. A man was shot in the leg on Feb. 7 in an Allegheny County, Penn., mall, suffering a torn femoral artery. A police officer on the scene acted quickly with his department-issued tourniquet to staunch the heavy bleeding and save the man’s life. The officer and his colleagues were issued tourniquets last September.

In the long run, Jacobs would like to see tourniquet use expand beyond first responders, to assume a place in the public understanding as common as the Heimlich maneuver or CPR. One day, security guards in public spaces should all have tourniquets in their emergency supplies, right alongside the automatic external defibrillator.

“The goal is to put them in universities, in malls, in ballparks,” Jacobs said. “You want people who are close to the problem to be educated and to have access to these things.”
 



Adam Stone is a contributing writer for Government Technology magazine.