Alexander L. Eastman, MD, MPH, Deputy Medical Director and Reserve Police Officer, Dallas, Texas, Police Department, and Officer-at-Large, Police Physicians Section, IACP; and Jeffrey C. Metzger, MD, Medical Director and Reserve Police Officer, Dallas, Texas, Police Department, and Member, Police Physicians Section, IACP
aw enforcement is safer today than it was even as little as one decade ago. With strides in equipment, body armor, vehicle design, and safety tactics, to name a few, the profession has improved its ability to minimize officer injury and death. However, as the families of the more than 100 law enforcement professionals who died in the line of duty in 2009 will attest, the profession has not eliminated these risks altogether, and, hence, in this Year of Officer Safety at the IACP, it is imperative that officers be equipped with the knowledge and tools to mitigate and minimize the consequences of injuries when they occur. We can no longer afford to bury our heads and just strive for zero injuries. Until the profession achieves zero injuries, its members must prepare, and, to prepare, all must learn lifesaving skills. What has been limited historically to the tactical team medic or delegated to a civilian fire/rescue or EMS agency now must be delivered to the hands of each officer who has the potential for hostile contact. For this reason, the IACP presents the Saving Our Own (SOO) program and concept.
Saving Our Own: History
SOO is not a novel concept; it is simply a program designed to train police officers in simple, lifesaving techniques that have been proven effective. The delivery of this training to nonmedical providers is not new; early descriptions of a self-aid/buddy-aid (SABA) program exist. SABA, as a general concept, involves placing lifesaving skills and tools in the hands of people most likely to suffer injury. It takes trauma center concepts out of the hospital and moves them to the point of injury. These programs are a theoretical offshoot of the fact that when people are injured, the earlier care begins, the better the outcome.
While these concepts are indeed those that were born in trauma centers and field hospitals, the effectiveness of SABA programs and the SOO program is based on the simplicity and profound effectiveness of basic techniques. The techniques described below can be easily taught to police officers, soldiers, and anyone engaged in high-risk occupations.1
No group has learned more about the care of the injured over the last decade than our nation’s armed forces. It is said that one of the few good things that comes from war is improvement in the care of the injured warrior. Now more than ever, improvements learned overseas and paid for with American blood are being applied to the civilian trauma care environment. While a number of advances have revolutionized the care of the injured, none has served as a greater force multiplier from a medical standpoint than the delivery of lifesaving training and tools not just to the military medics, but to the warriors themselves. In reviewing the Joint Trauma Theater System (JTTS) that has saved so many lives during Operation Enduring Freedom and Operation Iraqi Freedom, Colonel Brian Eastridge, JTTS Director, has identified the delivery of SABA training and tools as the critical first link in the chain of survival.2
The SOO program and its core SABA techniques are based on sound science and the proven techniques known collectively as Tactical Combat Casualty Care (TCCC). Originally designed to address the profound failure of military medical doctrine in Mogadishu, Somalia, in 1993, TCCC developed into a set of tactically appropriate battlefield trauma care guidelines. Much of the content of these guidelines is geared toward interventions that can be taught to the troops, thereby multiplying the available number of individuals with medical training.
Since its introduction as a course in 1996, TCCC has been standardized from the war fighter/operator to the physician. Many civilian medical organizations including the American College of Surgeons Committee on Trauma (ACS-COT) and the PreHospital Trauma Life Support (PHTLS) program, as well as law enforcement and EMS agencies including the National Tactical Officers Association (NTOA) and the National Association of Emergency Medical Technicians (NAEMT), have adopted these guidelines for conducting operations in environments where injuries are likely. With the Department of Defense’s implementation of TCCC guidelines, U.S. forces have achieved the lowest percentage of individuals killed in action and the lowest case fatality rate in recent recordable history (1945–present).3 The TCCC recommendations were initially at odds with civilian pre-hospital guidelines being taught at that time, but the advantage of having battlefield trauma guidelines customized for the tactical environment was quickly acknowledged.
It is a common misconception in the civilian sector that TCCC guidelines are only applicable in a 360-degree military battle space similar to that seen in a war movie or in the middle of the streets of Iraq or Afghanistan. However, nothing could be further from the truth. The reality is that TCCC addresses optimal casualty care within a hostile environment. The average transport time to a medical treatment facility in Iraq can be less than one hour, which is not unlike situations that may be encountered in the United States. Weather, traffic, rural response, mass casualty, and ongoing tactical operations against active threats can contribute to longer transport times to definitive care in the civilian environment. Many also question the relevance of these guidelines due to the epidemiology of battlefield injuries compared with injuries likely to be encountered during civilian tactical operations. However, a gunshot wound that severs a police officer’s femoral artery is just as likely to cause death from blood loss as a shrapnel wound that severs a soldier’s femoral artery, and both are equally amenable to immediate lifesaving treatment.
Save Our Own: Key Concepts
The question then is which skills are applicable to the risks faced by the modern law enforcement officer. The skills that make up the core competencies taught in the SOO program are
- management of life-threatening bleeding/hemorrhage,
- basic airway management skills,
- wounded officer evacuation techniques, and
- basic understanding of TCCC concepts.
With the above training and skills, the law enforcement community can harness the simplicity of the SOO program and save the lives of officers who sustain injuries.
SOO is based on what was at the time a novel, statewide SABA training program in Texas, which followed the core competencies described above. To date, more than 500 Texas police officers have received this training. Bedford, Texas, Police Chief David Flory, a practicing paramedic, is the Tactical EMS Program Manager for the Texas Tactical Police Officers Association and a huge advocate for SABA training for law enforcement officers. According to Chief Flory, “SABA training is essential for the modern law enforcement officer. It teaches essential skills, every bit as important as defensive tactics, driving, and shooting.” In the Dallas, Texas, Police Department alone, three lives have been saved by the use of tourniquets on wounds suffered during patrol operations. These officers would have suffered worse consequences of their injuries through continuing hemorrhaging had these SABA techniques and devices not been applied. Because of its initial success, the state SABA course is presently being incorporated into active shooter training through the Advanced Law Enforcement Rapid Response Training Center based in San Marcos, Texas.
Perhaps the most critical component of the SOO program is hemorrhage control, since during any given shift, training in this area could help officers save their own lives or those of their partners. Of interventions that are possible in the field, with a basic amount of training, none has proven more effective than the immediate application of hemorrhage control techniques at the point of wounding.4 During SOO, these techniques are taught with both didactic and practical instruction. Several techniques including specialized pressure dressings that have been proven on the battlefield and tourniquet use are discussed. By the time officers complete the eight-hour SOO curriculum, they have more hemorrhage control training—and certainly more tourniquet knowledge—than most metropolitan EMS paramedics. After completing this single-day training and being issued a tourniquet that costs less than $30, officers are empowered with the ability to save lives.
Also included in the eight-hour SOO training block is a basic understanding of noninvasive interventions designed to maintain airway patency in an injured officer. Most often, these techniques involve placing the injured officer in what is known as the recovery position. Without placing any tubes or devices, an SOO-trained officer can help a critically wounded colleague maintain an airway most often in this position, and it is incredibly easy to learn. In jurisdictions that have chosen to add these additional airways skills to programming, law enforcement officers learn how to place nasopharyngeal airways—flexible nasal tubes to assist breathing—and even perform needle decompression on a fellow officer with collapsed lungs. While these skills are not included in the basic SOO package, it is clear that law enforcement officers, with no previous medical training, can learn these skills safely and effectively. After the SABA training, each SWAT officer in the Dallas, Texas, Police Department was issued an enhanced Individual First-Aid Kit (eIFAK). The contents of these kits are included in table 1.
|Table 1. Dallas Police SWAT—Enhanced Individual First Aid Kit (eIFAK) Contents|
- Modular bandage
- Combat application tourniquet
- Nasopharyngeal airway with lubricant
- 14-gauge 3.25-inch IV catheter for thoracic needle decompression
- Trauma shears
- Latex gloves
|Contents must be vacuum-sealed in pouch when issued to officers.|
Although listed as the third key component of the SOO program, knowledge of officer extraction techniques is critical for SABA training programs. One of the critical lessons learned from previous incidents is that the correct medical intervention at the wrong time or place can lead to serious consequences. To give students real-world training in this concept, several techniques are used. Officers are trained in methods of high-threat extraction, defined as the efficient movement of a wounded colleague from the point of wounding to a place where effective cover exists. It is behind this cover that the initial treatment principles described above are initiated. Several techniques including lifts, drags, carries, rope extractions, and other specialized actions are taught in this part of the one-day course.
Save Our Own: Conclusions
While law enforcement professionals strive to eliminate daily dangers through research, product development, and tactic development, today’s officers face unprecedented threats to their personal safety. Given this fact, the industry is left with no choice but to prepare these officers not only to face these threats with the tools to stop those that would do harm, but to mitigate the consequences of these encounters.
This year, the IACP intends to lead the way with a renewed focus on officer safety. Through a partnership between the IACP Police Physicians Section, the State Association of Chiefs of Police (SACOP), SafeShield, the Texas Tactical Police Officers Association, and several other organizations, IACP members hope to spread the word on this important project to every agency in the United States. While the profession strives to achieve zero injuries and illnesses, its members must be prepared when officers are injured. What they do when this happens will define the consequences for the officer, the agency, and the community. ■
1Frank Butler, “Tactical Combat Casualty Care: Combining Good Medicine with Good Tactics,” The Journal of Trauma 54 (May 2003): S2–S3.
2Brian J. Eastridge, et al., “Trauma System Development in a Theater of War: Experiences from Operation Iraqi Freedom and Operation Enduring Freedom,” The Journal of Trauma 61 (December 2006): 1366–1373.
3Brian J. Eastridge et al., “Impact of Joint Theater Trauma System Initiatives on Battlefield Injury Outcomes,” The American Journal of Surgery 198 (December 2009): 852–857.
4Ronald F. Bellamy, “Death on the Battlefield and the Role of First Aid,” Military Medicine 152 (December 1987): 634–635.
Please cite as:
Alexander L. Eastman and Jeffrey C. Metzger, "Saving Our Own: The Ultimate Officer Safety Program," The Police Chief 77 (June 2010): 18–20,
http://www.nxtbook.com/nxtbooks/naylor/CPIM0610/#/18 (insert access date).