CAT tourniquet (courtesy combattourniquet.com)

“Police officers remain our primary first responders to active shooter incidents and mass-casualty events,” the The National Tactical Officers Association (NTOA) press release proclaims, calling for more medical training for beat cops. [Full text after the jump.] “Responding officers can prevent unnecessary deaths by addressing immediate threats, and then providing emergency care including the application of tourniquets and pressure dressings to prevent hemorrhage, triaging casualties, establishing secure casualty collection points, and coordinating care with existing EMS responders.” Yes, well, we are the first responders. We The People of the Gun, civilians who are mentally prepared to deal with the S hitting the F, need this training just as much as the cops do, if not more. Get it. And keep a tourniquet and quick clot in your desk, car and home.

The National Tactical Officers Association (NTOA) Calls for Increased Emergency Medical Training for Police Officers

Revised Position Statement recognizes the need to provide all police officers with basic Tactical Emergency Medical Support (TEMS) training

Doylestown, PA (October 2013) – The National Tactical Officers Association is calling for basic Tactical Emergency Medical Support (TEMS) training for all police officers in light of recent incidents of mass violence.

The Navy Yard massacre in Washington, D.C., the Boston Marathon bombing and lone shooters in Tucson and Newtown have focused attention on the response to changing threats in our society. These tragic events highlight the need to provide patrol officers with basic TEMS medical training and equipment.

Dr. Kevin Gerold, a physician at the Johns Hopkins School of Medicine and the Chair of NTOA’s TEMS Section, states that, “Patrol officers are now trained and equipped to respond to active, violent incidents using tactics that were once reserved for special weapons and tactics (SWAT) teams. The time has come to also provide these officers with basic TEMS training and equipment in order to potentially save the lives of victims, bystanders, police officers and suspects in the event they are wounded.”

TEMS is not intended as a replacement for EMS services; rather, it’s an operational medical element that complements these resources in order to promote the success and safety of the law enforcement mission. Federal, state and local governments should recognize this need and provide the necessary funding to train and equip police officers for an effective response to mass casualties.

The NTOA, a national non-profit resource and training organization established in 1983 to support law enforcement officers, was a pioneer in recognizing the contribution that TEMS makes to law enforcement, and remains a leader in TEMS advocacy and training.

The organization recently revised its TEMS Position Statement, which provides direction for law enforcement departments attempting to incorporate medical support into their law enforcement mission and outlines the priorities for TEMS training. NTOA’s award-winning journal, The Tactical Edge, will publish the Position Statement in its Fall 2013 issue.

The NTOA acknowledges that there is no single model for providing care during law enforcement operations, and that its basic principles should be considered core skills relevant to all police operations. First published in 1994 and last revised in 2007, the updated TEMS Position Statement represents the evolution of TEMS as a specialized area of medical practice.

The full TEMS position statement can be found on the NTOA website. Dr. Kevin Gerold can be reached at [email protected].

For more information on the National Tactical Officers Association visit www.ntoa.org or call 800-279-9127. Join the NTOA today and start receiving the benefits of better training and stay on top of the ever changing and challenging world of law enforcement.

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41 COMMENTS

  1. Makes sense to me. In the AF I have gone through the basic Self-Aid and Buddy Care (SABC) training and while the emphasis was for use in a deployed environment the focus also evolved while I was an instructor to include mass casualty/basic emergency care as well. In any emergency there will be people who are injured and any responding to that even should be prepared to render aid until the next highest level of competent medical care arrives.

    As a side note, two of the three AF Security Forces (SF) individuals I have worked with in the last 2.5 years were also certified EMT-Bs. maybe that is because of the broader mission SF has beyond LE but it also just strikes me as good thinking.

  2. CAT tourniquet is good stuff. Pricey, but muy bueno.

    Get some training in their application and that of the Israeli Battle Dressing.

    In fact, if I had to choose between the two, I’d choose the IBD first.

    Those two items alone can and will save lives if you ever need them.

    John

  3. I took a med class with the folks I train with (VATA Group out of Louisiana) it was eye opening. I now have a trauma kit in my office desk drawer, in my range bag, in my car and I carry a cat-t in my daily carry portfolio.

    If you carry a gun then you have already come to expect that some day you will use it (you pray that never happens of course) and if you are in a gun fight someone will get shot, it might be you, it might be a loved one or it might be an innocent by stander. Having the knowledge to keep that person going until more capable medical help arrives makes all the difference in the world.

  5. Tourniquets save lives. Quick clot is good, but I think too many people over-estimate its capabilities. The most important thing you can do is get some quality training.

  6. “And keep a tourniquet and quick clot in your desk, car and home.”

    As both a civilian shooter and a tactical EMT this statement is spot on.

    Some notes:

    1) I prefer the quik clot gauze to the granulated stuff. YMMV

    2) Don’t stress out about any potential quik-clot related burns. You’re overthinking it. If you have an arterial bleed the burns are the least of your worries and most of the new stuff doesn’t burn anyway.

    3) Add an Israeli bandage to Mr. Farago’s list.

    4) There are TONS of great places to keep a tourniquet:
    – attached to rifle stock (Mayflower research used to make a handly little shock cord thingy for this and may still do so)
    – on your plate carrier/vest/lbe/lbv (along with the rest of your blow-out kit)
    – on your gun belt

    5) I keep blowout kits in my nightstand, our stronghold room (with all sorts of other home defense goodies), in the downstairs bathroom with the family first aid kit and in my vehicle just as RF pointed out. When you need one you won’t want to go far. I keep them clean and serviceable by keeping them in ziplock bags (Texas is dusty).

    • The burning, powder quickclot is phased out and mostly gone. I haven’t seen it in years. Now it’s the quickcloy, nonburning gauze.

      • Yup. I only said it because the last time I remember having an in-depth TTAG foray into tactical medicine I saw a few posters express concerns.

    • In sorry, my FA knowledge is limited to the Boy Scout merit badge (and that was years ago), what is a blowout bag?

      Also, what type of training should we be looking for?

      • Think of a fast leak on a blown tire. Blow out kit has the gear to make quick patch to mitigate the main things that kill folks that don’t die instantly, massive bleeding,airway occlusion, stopped breathing. Google tccc. Blow out kit has a tourniquet for extremities, gauze for packing wounds, and an airway and chest needle. Contents vary.

  7. I don’t have a kit, it’s on my list. But could you guys that do link to the one you have, or the better one you want? I’m looking for suggestions.

    • If you have a spare 5.56 mag pouch that holds 2-3 mags lying around you can make your own on the cheap cheap. Most 5.56 mag pouches can hold the following which can be purchased off amazon:

      1 CAT or SOF tourniquet
      1 pouch quikclot or quickclot gauze
      1 Israeli pressure dressing
      1 pair EMT scissors
      1 pair latex gloves

      It might not be ideal, you may have to stuff the stuff in there pretty tight and the materials may not be arrayed exactly as you need them (e.g. you need quikclot and it’s jammed underneath an Israeili dressing) but it’s a cheaper solution for someone who might not want to spend 1-2 hundred bucks on a pre-made kit. Just be sure to mark the pouch with a cross or write “TRAUMA” on it. If you’re putting it on gear then place it somewhere on your vest other than where you keep mag pouches.

      For aftermarket kits that are nice Google north american rescue or dark angel.

  9. 30 years as EMT-I and ER RN Trauma Nurse Specialist. I cringe when a discussion of first aid starts with tourniquets. The have their place, but very rarely.
    Israeli Battle Dressings or ABD’s or Tampons should be more than adequate for wound dressings. Tampons aren’t medically sterile but are considered medically clean. A gunshot wound (gsw) is always treated as contaminated, so any of the above are good for wound coverage.
    Proper training for, and having a Heimlich valve would be important for gsw chest wounds.
    “Trauma shears,” the big oversize scissors to cut away clothing and you’ve got almost everything covered for a gsw at the range or in the field.
    I’d urge everyone to take first aid and cpr courses. You’ll learn to improvise for splints, make a paste of meat tenderizer and water to put on bee stings, and snake bites need a hospital and NEVER somebody cutting and sucking! Throw out the commercial snake bite kits. They will only waste time and make the wound worse.

    • The scissors I talk about usually have large bright plastic handles and should only cost a few dollars.

    • Let me preface this by saying that this is not an attack. I am not disrespecting your years of experience and all the good I am sure you have done for your patients.

      A healthy love for tourniquets comes from lessons learned in operational environments; it did not originate in civilian trauma centers where gunshot and shrapnel wounds make up a small percentage of most centers’ patients. A tampon and even an Israeli dressing will simply not be enough to stop many arterial bleeds on limbs.

      Now, don’t confuse my tourniquet fanboyishness with me saying that the discussion “starts” with a tourniquet… as you say. The discussion starts with the nature of the wound, which is why Mr. Farago and other posters here have emphasized the need for training. Quikclot, Israeli dressings and tourniquets all have specific applications and users need that training to make educated decisions regarding the application of any of these devices.

      +1 on the flutter valve though. You’re spot on there.

      • Well spoken sir. Thanks for your graciousness. I wasn’t meaning to focus on you, Hal (loved you in 2001). I would also add a cheap aluminum foil type “space blanket” available for a few dollars. In trying to equip a first aid kit, important to know is location, location, location. AT 60 years and sidelined by muscular dystrophy, I tend to visualize dealing with wounds at home, at the range, or the 3 miles between my two favorite locations.

        Heard of a medic making a flutter valve from an angiocath and the cellophane covering a cigarette pack, and a rubber band. I once stopped an overdose with cricoid pressure. Ah, the good old days.

        • Are you in TX? I’ll buy you some beers because I would love to learn what you have to teach.

          It’s easy for those of us on the tactical medicine side to focus on the founds likely to be sustained in a gunfight or an explosion but I totally see where you are coming from.

          One of our patrols kept a roll of reynolds wrap in their up-armored to make hasty flutter valves.

          “I can’t do that, Dave”

          Ha!!

      • EMS “industry” has a coronary when you mention the long banned T word. More worrried about protocol (butt coveriing/lawyer footkissing) than results. The stereotypical upper echelon EMS type (as at State Dept of Health) are of the AntiBush/shouldn’t be in Iran/Afganistan so the discount any of the lessons learned there (as tourniquet). In Iowa will not even recognize that a Combat Lifesaver might be a useful asset to a rural community. Nationally EMR is so dumbed down can’t do diddly beyond hand holding.

        Cop as 1st responder? Bah Nearest cop is 30mi away. I can be in a fire truck in 30 seconds.

  10. After the Dark Angel article here on TTAG I bought two of them. They are for you or your buddy/loved one though.Don’t run around giving first aid to other people until the threat is neutralized and the scene is secure. The tourniquet/bandage you have may be needed by you or yours.

  11. “Open the pod bay doors Hal!” LOL, I’m In El Paso. Shoot at Fort Bliss. My daughter just got out of the Army here, was a medic (68W) and I gotta tell you, by all accounts I was a top notch trauma nurse, but what they taught my daughter in a few months makes it very, very hard to one up her when we compete on medical knowledge. Get down this way and we’ll tip some cold ones. At night we can go down by the Rio and listen to the screams of the victim in Juarez for savage amusement.

  12. I have a CAT on my duty belt, 2 in my go bag, 2 in my patrol car, 2 in both of my personal vehicles.

    As well as 6 Israeli bandages in my patrol car, 4 in my go bag and 2 each in both of my personal vehicles.

    I’m waiting to see if my department issues us the quick clot gauze or if I’ll have to purchase it myself. I plan on having a dozen or so in my patrol car, several in my go bag and a few in each personal vehicle. I already have a few of those nifty scissors.

    I’m also hoping we get time for additional Active Shooter level 2 training. We’re really lucky in that we have a couple Army combat medics that work for us and they occasionally give us training lessons on GSW’s, etc.

  13. Very sound advice. Former paramedic here. Anytime I go shooting, my medic kits go with my range bag. It just makes sense.
    Having 3 kids in the USMC, one in supply, I’m the happy owner of some nice kits.

    • My trauma kit goes to every range with me as well, regardless of the level of intensity or dynamics the range will consist of.

      There is a reason why we grunts hate supply guys, because they syphon off gear and equipment that we need and end up being shorted on my end, the end that actually matters. Although Marine supply does not deal with anything medical, all that goes through requests from BAS to Division with their own supply and logistics. Still, my point remains, and so does my animosity towards POGs.

  15. Bought a dark angel kit right before the article here but sadly, I dont have anything near what I feel is an adequate level of first aid training. Time for some google fu and budgeting I suppose.

  16. I took a trauma course a couple of years ago. It was helpful and I encourage every shooter to take such a course. I expect to take another in the next few months because skills not used are highly perishable.

  17. Unless you truly are trained and understand how to assess and treat a casualty, I do NOT recommend carrying tourniquets and especially any hemostatic agent such as Quick clot or even quick clot gauze. The improper use or application of just these two tools can do more damage than help.

    Those here who know, already have their kits set up and know what they are doing. Those who do not (which is the vast majority of you) should stick to a few rolls of Kerlix, a couple packs of compressed H&H gauze, a roll of coban, a roll of medical tape, and a roll of gorilla tape. Anything requiring more than this will be taken care of by someone more trained and experienced than you.

    • I agree that none of these devices should be employed without training and/or study.

      However, I am one of the people on here that is trained and experienced with these tools and I am here to say that they (flutter valve, tourniquet, quikclot, Israeli bandage) aren’t rocket science. In fact, their propper use takes FAR less time to master than shooting. I encourage everyone to get their hands on a minimum of one of each; one for training and one for your kit. The uses and contraindications can be learned in a DAY of formal training. The dedicated cheapo could probably self-educate using EMT textbooks over time provided that they took such study VERY seriously and practiced with the tools. Running down to the local fire station and playing with the EMTs can’t hurt either.

      If we apply what you’re proposing to firearms it would sound like this: “unless you’re a cop, an Infantryman or you’ve trained with Paul Howe then you’d better just stick to using a slingshot, a can of mace, a Swiss Army knife and a spork. Anything requiring more than this will be taken care of by someone more trained and experienced than you.”

      See how that sounds? Accordingly, I strongly disagree.

    • “The improper use or application of just these two tools can do more damage than help. ”

      No offense, but that is the old way of thinking. The conclusions of study after study, involving data collected from many different situations, suggests even an improperly applied tourniquet does far more good than harm in a situation where it is warranted, and even if used in a situation where it’s not advised, any “harm” is temporary and recoverable.

      I don’t mean to be condescending. It’s just that I’ve sat through hours of classes on the subject, and the procedure, demonstration, and practice were a tiny fraction of that time. I was in the Air Force when they transitioned annual training to be based around a standardized kit, and they introduced a factory made tourniquet for the first time to those of us who were given only the most basic (by military standards) first aid training. There was a lot of resistance from the guys who had been around forever, including an officer walking out of the class one year. When I was with the Forest Service after that, one of our EMTs did a tourniquet workshop on one of our training days. People who just have had that one idea drilled into their head, year after year, for decades, just couldn’t understand how the advice could suddenly change.

    • The other thing to consider is even if you don’t have adequate training to use some of these items, having them with you might enable someone who is there and has the training, but doesn’t have items, to save someone (or even you!)

  19. Never really gave much thought to a Med kit until I took a few classes from Paul Howe. Now I keep a ziploc bag with SOF-T tourniquet, combat gauze, med scissors, gauze, and wrap in my vehicle and go bag.

  21. So basically they’re pushing for LE to receive the equivalent of CLS training, a move I’m totally in favor of. For those of you looking for a decent blowout kit, the GI IFAK (Improved First Aid Kit) hits all the needed points, just make sure you are properly trained on the entire kit. On the commercial side, ITSTactical produces their EDC First Aid kit, which checks most of the same boxes. A little tip: The only difference between the Military-grade QuikClot gauze and the non-GI, is a strip of X-ray reflective material that cause the gauze to show up on X-ray. +1 for mentioning the CAT, and while accessibility is important, unneeded exposure to the elements has been shown to weaken the material over time-guidance from Uncle Sam is to keep it tucked away in one of various pockets on the uniform-just my 3.5 cents.

  22. In my 12 years as a paramedic, I never ONCE applied a tourniquet, working in a major city and dealing with multiple shooting and stabbing victims. 99.9% of all bleeding can be controlled with direct pressure. A tourniquet causes more damage than it prevents. If you are carrying one, discard it and add more pressure dressings.

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