Lafayette LA Police Chief Jim Craft and Louisiana Governor Bobby Jindal credit Individual First Aid Kits (IFAK) carried by Lafayette police officers as being instrumental in saving multiple lives at the Lafayette movie theater active shooter incident Thursday night.
JEMS: Three Killed, Nine Wounded in Louisiana Theater Shooting
Chief Kraft stated at a Friday afternoon news conference that his officers were originally trained and issued IFAKs to enable them to render self-help in the event they were wounded in the performance of their duties. However, they were also aware the kits could be instrumental in saving lives during an active shooter or other traumatic event.
On Thursday night, Lafayette officers, advancing on the active shooter in the movie theater, carried and utilized their IFAKs to cease significant bleeding on multiple shooting victims.
Lafayette LA Police Chief Jim Craft and Louisiana Governor Bobby Jindal credit Individual First Aid Kits (IFAK) carried by Lafayette police officers as being instrumental in saving multiple lives at the Lafayette movie theater active shooter incident Thursday night.Chief Kraft stated at a Friday afternoon news conference that his officers were originally trained and issued IFAKs to enable them to render self-help in the event they were wounded in the performance of their duties. However, they were also aware the kits could be instrumental in saving lives during an active shooter or other traumatic event.
On Thursday night, Lafayette officers, advancing on the active shooter in the movie theater, carried and utilized their IFAKto cease significant bleeding on multiple shooting victims.
JEMS has been a staunch supporter of police involvement in EMS aspects of active shooter and tactical incidents for years with emphasis on the “Hartford Consensus” recommendations for equipping of police with IFAKs and integration into EMS operations and care.
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The authors have seen discussions on message boards-even in training classes-where officers suggest the only training needed to respond to ASEs is to get to the scene quickly. The belief is that most events will be over, or suspects will kill themselves.
While it is true that 1) 49 percent of the events end before officers arrive and 2) suspects kill themselves after the police arrive 14 percent of the time, responding officers used force to stop the attack in 31 percent of the ASEs assessed. This 1 in 3 chance of having to use force makes it clear that simply training officers to show up is not enough.
Officers must learn the tactical skills needed to successfully resolve these events. Because not all events occur indoors (18 percent happen outdoors), officers must be trained to operate in both environments. Indoor (i.e., close-quarters) battle tactics are not suitable in outdoor environments, and using them outdoors can be fatal.
Law Enforcement Must be Ready to Provide Medical Assistance
During the confusion of an ASE, it is common for different descriptions of the shooter to be phoned into 9-1-1 or communicated to responding officers. This often creates a situation where, even though the police have found the body of or dealt with a shooter directly, they cannot be certain that this was the only shooter.
Additionally, it is common for people to continue to call in reports of people with guns after the shooter has been dealt with. In some cases, this is caused by a lag between observation and reporting. The person calling saw the actual shooter, fled, and then reported what he or she saw several minutes later.
In others, the caller has seen police officers responding in plain clothes or nontraditional uniforms and mistaken the officers for attackers. In yet other cases, the callers are simply wrong.
Regardless of the cause of the confusion, the officers on scene often must engage in a systematic search of the attack location to confirm that there is not another shooter. In a large attack site, this search can take hours.
This creates a problem for those wounded and in need of medical care because most EMS providers will not enter a scene until it is declared “secure” or “cold.” Securing the scene can take hours.
During this time, victims may bleed to death or go into shock and die. To combat this problem, national organizations have endorsed the Rescue Task Force (RTF) concept.[5]
This involves having EMS personnel enter attack sites to stabilize and rapidly remove the injured, while a ballistic or explosive threat still may exist. EMS personnel operating in RTFs wear body armor and are provided security by law enforcement personnel.
This concept represents a significant improvement in EMS response to ASEs, but it undoubtedly will take substantial time to implement nationwide.
Even with faster EMS response, responding officers will face situations where they can save the lives of victims by quickly applying proper hemorrhage control techniques after the immediate threat has been dealt with.
Additionally, in a mass-casualty event, the number of wounded may overwhelm the capabilities of responding EMS personnel. Recognizing that the primary objective of a responding officer is to neutralize the threat, if officers have some medical training, they may be in a position to aid the injured and possibly save lives.[6]
This training currently is available, and the authors strongly recommend that all law enforcement officers receive it to maximize their ability to help those injured during these horrible events.[7]
Obviously, if officers are going to be trained to provide medical aid, they need equipment to provide this aid. Numerous wound care kits are commercially available and easily can be attached to a plate carrier.
Also, the authors suggest that all officers carry tourniquets. Tourniquets are useful for stopping extremity bleeding, whether it is caused by a gunshot wound or other trauma. In numerous cases across the country, officers have saved not only the lives of other officers but also civilians by applying a tourniquet.
Interagency Board; Health, Medical & Responder Safety Subgroup
Law Enforcement Tactical Emergency Casualty Care (TECC)
Training and Individual First Aid Kits (IFAK) White Paper
Programs are being developed to provide LEOs with very basic medical training and equipment for self- or buddy-treatment of injured officers in the first few minutes after wounding. This rapid point-of-wounding care necessitates initiation of medical care prior to complete tactical control of active threats and prior to the availability of traditional emergency medical responders.
Pre-hospital fire/EMS medical response to an injured LEO is often delayed due to scene safety concerns. The window of opportunity for critical, live-saving interventions can be lost with even short delays in care after penetrating trauma.
LEO medical capabilities should address care that must be performed immediately, prior to the arrival of fire/EMS assets, and that can be provided by the wounded officer and/or fellow LEOs on scene.
The medical requirements faced by LEOs under fire are somewhat analogous to the combat setting. Over generations of military conflict, U.S. forces have experienced incrementally decreased fatality rates as medical care was effectively brought closer to the battlefield (Goldberg, 2010).
The case fatality rate for combat casualties in the War on Terror in Afghanistan and Iraq is below 10% for the first time in history, down from more than 15% in Vietnam (Holcomb, 2006).
A substantial part of this improvement has been attributed to the concept of Tactical Combat Casualty Care (TCCC), developed by the US Special Operations medical community.
Aggressive, directed, point-of-wounding TCCC by non-medical troops in the form of self- and buddy-treatment, as well as continuity of TCCC by medical non-combatants represents significant enhancement in the initial echelons of casualty care.
As such, the InterAgency Board recommends two to four hours of medical training for LEOs, which includes the following:
– The concepts of TECC phases of medical care and the appropriate non-medical first responder application of TECC in relation to active threats. The primary objectives of this medical training are hemorrhage control maneuvers, airway and basic respiratory management, and identification and management of shock and hypothermia.
– Both didactic and practical elements should be included in TECC training for non-medical responders.
– Didactic training: TECC background and principles, equipment overview
– Practical training: Rapid physical assessment, basic airway management, use of commercial and improvised tourniquets, emergency compression bandages, hemostatic agents, vented and improvised chest seals, hypothermia prevention, and expedient lifts/moves/carries
Additional consideration for expanded TECC training should be given to the following, depending on the missions of the law enforcement entity and community emergency response configurations:
– Basic concepts of triage and mass casualty management
– Transport decisions: traditional fire/EMS transportation versus rapid transport via police or other non-medical vehicles (department, agency, region, or jurisdictional policy; state laws and regulations)
– Decisional authorities vary and may be impacted at the various layers of organizational government. These present legal hazards if they are breached.
– Integrated tactical operations with area fire/EMS agencies
– Familiarity with state trauma regulations as well as capabilities of local hospitals and regional trauma centers
– Standard precautions/principles of body substance isolation (BSI)
– Periodic skills and knowledge refreshers
– Scenario-based practical applications.
Additionally, the InterAgency Board recommends that an individual first aid kit, commonly referred to as an IFAK or “˜blow out’ kit, be issued to each officer trained in initial TECC medical care of the wounded.The contents of the kit should be chosen specifically for use by the non-medical law enforcement officers.The medical equipment and supplies in the kit do not need to meet military TCCC recommendations, but at a minimum must have evidenced-based proven efficacy when used at or near the point of wounding.
The LEO IFAK should include, at a minimum, the following:
– One commercially available windlass-style tourniquet
– One package of hemostatic gauze
– One roll of compressed cotton gauze
– One mechanical pressure bandage (e.g. ace wrap or other elastic bandage)
– One vented chest seal
– Non-latex gloves
Additional items for consideration include:
– One nasopharyngeal airway
– Small roll duct tape
– A pair of trauma shears
– A zippered bag with compartments or elastic straps holding IFAK contents in place.
The exterior of the bag should have multiple attachment points, allowing it to be mounted in a vehicle, on a backpack or on a duty belt.
