First Five Minutes Program Trains Police to Deliver Lifesaving Care

David Kleinman, EMT-P

Original Contribution

First Five Minutes Program Trains Police to Deliver Lifesaving Care

October 2012

At 10:09 a.m. on January 8, 2011, the Pima County (AZ) Sheriff’s Department received a 9-1-1 call for a shooting in progress at a local shopping center. During the next 20 minutes, details of a horrific scene unfolded. A lone shooter had fired 30 rounds into a crowd gathered for Rep. Gabrielle Giffords’ “Congress on Your Corner” event outside a busy Safeway grocery store. Though the shooter was taken into custody within five minutes of the call, arriving deputies faced 19 injured and/or dying people, all in close proximity.

In the 47 minutes deputies were with the injured at the scene, they treated 10 victims. Deputies controlled bleeding, provided chest compressions and rescue breathing, used hemostatic agents, bandaged wounds and assisted citizens in care of the injured. Emergency department physicians and trauma surgeons from Tucson’s Level 1 facility, University Medical Center, acknowledge that the quick actions of the Pima County deputies resulted in decreased hemorrhage, improved arrival vital signs and decreased need for resuscitation such as transfusions for multiple victims.

A 2007 study published in Prehospital and Disaster Medicine noted that “No widely accepted, specialized medical training exists for police officers confronted with medical emergencies while under conditions of active threat.”¹ Given the knowledge we’ve acquired from historical and modern battle, which has culminated in the Trauma Combat Casualty Care (TCCC) guidelines, we know the causes of preventable death on the battlefield are hemorrhage from extremity wounds, tension pneumothorax and airway problems. Each of these emergencies can be readily managed using relatively simple techniques and minimal equipment. Unfortunately these techniques and equipment are rarely taught to law enforcement officers.

Officer Self-Care

Even in an urban environment, the time it takes for EMS to arrive on scene can mean the difference between life and death for the wounded. Too often the first responder is a law enforcement officer faced with a tactical situation, whose law enforcement function must quickly transition into providing first care to civilians or fellow officers. In Pima County this happened in a location readily served by multiple paramedic units from three large fire departments, but it is conceivable this same scenario could occur with complications:

• A rural setting with an extended ETA for EMS;

• EMS gets lost;

• EMS breaks down;

• The scene is unsafe, and EMS cannot approach.

Any of these complications could significantly delay EMS arrival and affect the well-being of the wounded. It is essential that treatment begin immediately and patients be transported expeditiously in accordance with the severity of their injuries.

Special weapons and tactics (SWAT) teams have long understood how important it is to have paramedics embedded in their teams, tactically trained and immediately available for any medical need. These tactical emergency medical service (TEMS) providers can readily address airway, breathing and circulation problems that create an urgency that transcends the response times of most staged civilian medical assistance units. While it is not practical for law enforcement agencies to employ paramedics to work in the field with officers, much can be done to train police officers to care for themselves.

The Pima County Sheriff’s Department leadership acknowledged the need for global training for all staff with “feet on the street” long before the Giffords shooting. Taking elements of TCCC and results from research done by the Valor Project (www.valorproject.org), they provided a tactical emergency medical training program called the “First Five Minutes” to all deputies during annual advanced officer training in the spring of 2009. The program was developed by officer/paramedic David Kleinman in consultation with former U.S. Surgeon General Richard Carmona, MD, who once led and provided medical direction for the Pima Sheriff’s SWAT team, and Tammy Kastre, MD, the team’s current medical director and a board-certified ED physician.

The First Five Minutes isn’t the first medical program taught to agency first responders, but its goal is somewhat different than that of the normal medical training provided to law enforcement. The primary goal is now to give officers the training necessary to sustain themselves or other officers in life-threatening medical emergencies.

Along with the training, Pima leaders had to develop a medical equipment kit that would be issued to all deputies after their training. They assembled the law enforcement individual first aid kit (IFAK) based on the three most common causes of preventable traumatic death. Its contents:

• A zippered bag with interior elastic straps for holding contents in place. The exterior of the bag has MOLLE systems both front and back for multiple attachment points;

• A set of trauma shears;

• 2 emergency bandages;

• 1 package of combat gauze;

• 1 Asherman Chest Seal;

• 1 CAT or SOF tourniquet.

Every aspect of the lesson plan incorporates officer safety and tactical considerations. We remind attendees they are police officers first and medical providers second. The introduction to the class relates the importance of providing immediate medical care to the downed officer. We use the 2009 Ft. Hood shooting and 2010 murder of Phoenix police officer Travis Murphy to illustrate this issue. At numerous points instructors emphasize that this is not a first aid class, but rather a survival class for police officers. The law enforcement IFAK is given to students at the beginning of the class, and they are encouraged to open it and explore the contents, because the more comfortable they are with the equipment, the faster they will learn how to use it. While the purpose of the IFAK is treating fellow officers, deputies can use their discretion and utilize it when they feel it is necessary.

Elements of the four-hour training include:

• Scene safety to include familiarity with fire and EMS agencies and services in the areas to which officers are assigned, capabilities of local hospitals and the availability of helicopter rescue;

• Body substance isolation (BSI) and real-world applications;

• The C-A-B assessment for circulation/compressions, airway and breathing, with a CPR refresher that includes cardiocerebral resuscitation (CCR);

• A 90-second assessment of situation and medical condition with a focus on hemorrhage-control maneuvers and identification of shock. At the end of the assessment, deputies are encouraged to make a transport decision: Do they stay at the scene and wait for EMS, or do they transport the wounded?

• Skills lab to include use of the emergency bandage, combat gauze, Asherman Chest Seal and tourniquet; and

• Transfer of care. Officers are told to report to EMS workers the nature of the injury, mental status, mental status changes, airway control, rates of breathing and circulation, what injuries they saw, what injuries they treated, how they did it and any unusual findings. Since the assisting officer is often the first to contact the injured person, the training stresses that their observations and findings are the most significant issues in that person’s long-term care and recovery.

At the conclusion of the training, scenarios help evaluate students’ skills. Each scenario has two evaluators. One considers officer safety, use of cover and concealment, tactical movement and other skills related to police work; the second, usually an EMT or paramedic, evaluates the medical triage and care provided to the victim.

Conclusion

Not all law enforcement agencies consider first aid a part of the police officer’s job. With the ever-increasing call load and requirements placed upon officers, it is easy to see how agencies can lessen liability and workload by eliminating a job that’s already filled by EMS and fire departments. However, a wounded officer or an officer responding well in advance of EMS on a mass-causality incident is a completely different situation. Every officer should have the necessary training and equipment to provide on-scene emergency medical care for themselves, any other officer in need or any civilian they are sworn to protect.

One key to a successful program is simplicity and ease of use. Without those two factors, officers are limited in what they can effectively do at a scene. The First Five Minutes program has proven to be simple and effective. In the response to the Safeway shooting, every item supplied with the IFAK was utilized at some point by law enforcement personnel prior to EMS gaining access to the scene. The training and equipment provided to those deputies saved lives.

Specialized Tactics for Operational Rescue and Medicine

Similar emergency medical training programs, such as the Specialized Tactics for Operational Rescue and Medicine (STORM) program developed by Georgia Health Sciences University in conjunction with the National Tactical Officers Association, also address this training need. The STORM courses provide clearly defined medical strategies, procedures and rescue techniques to enhance the safety of law enforcement personnel and those they serve. STORM is tailored to five unique tactical audiences: self-aid/buddy care, operator, medic, medical director and commander. Each course consists of didactics, hands-on skills stations and tactical scenario-based training.

• STORM/NTOA site

• STORM GHSU site

• National Tactical Officers Association

References