Self-Applied First Aid
Photos Eric Dickinson
If you don’t have a trauma dressing, your bare hand can provide direct pressure, too. Photos Eric Dickinson
You can also try lying on the wound to use your body weight to provide pressure.Photos Eric Dickinson
Pressure-points can also control blood loss. For injuries to an arm, apply pressure to the brachial artery by pushing fingers between the bicep and the upper arm bone.Photos Eric Dickinson
For leg injuries, apply pressure to the femoral artery by pressing against the pelvic area. The femoral artery can prove difficult to pinch off; if so, try placing a baton, shotgun butt stock or other object of similar length against the area.Photos Eric Dickinson
A magazine or baton can make an effective windlass for your tourniquet.Photos Eric Dickinson
A magazine or baton can make an effective windlass for your tourniquet.Photos Eric Dickinson
FEATURED IN TRAINING
I think most officers would agree that the thought of seeing your own blood rapidly exiting an ugly looking wound is one of the most disturbing images you hope you never see. Yet with all the great strides made in officer-survival training and equipment over the past 25 years, first aid seems to have been glossed over or entirely ignored by many academy and in-service training programs, which instead focus on real officer survival topics, such as firearms and defensive tactics.
Modern SWAT teams often have tactical emergency medical support (TEMS), and individual tactical operators may carry personal trauma kits, but most patrol officers don t have the load-bearing capability for the kinds of medical supplies carried by tactical officers and combat soldiers. Patrol officers may be lucky to have a decent first-aid kit in the trunk of their car. Injury during an off-duty incident further limits the amount of supplies available to injured officers when they need it the most.
Although some type of basic first-aid training may take place in the academy or during in-service training, it rarely focuses on treating oneself in law enforcement scenarios. In the recent Hollywood movie Shooter, the main character performs some remarkable self-care on himself after being shot, including making and administering his own IV solutions. This makes for interesting Hollywood fantasy, but it s an unrealistic portrayal of self-applied first aid at any level.
Officers need realistic training in self-applied first aid regardless of jurisdiction. Rural and small-town law enforcement officers may face extended response times for backup and EMS, as well as lengthy transport times to an appropriate hospital. Likewise, officers in large metro areas may find themselves unable to call for help due to radio-signal interference from large structures or delayed responses due to traffic congestion.
It s time we recognize the importance of self-applied first-aid to officer survival. This article will not provide an all-inclusive list of techniques and concerns, but it should serve as an overview of the basic issues an average officer should be taught to handle.
Imagine you ve just had the fight of your life. You believe you are alone except for the 250-lb. drug-crazed maniac with a gun now lying motionless several feet away. First things first: Take a couple slow, deep breaths. Calmly get on the radio and get the cavalry coming. Be brief. Give as much vital information as possible while keeping in mind that you may not have time to talk for long. You re tired and hurt, and there may be additional threats out there. If nothing else, broadcast your identification and location.
Ask yourself several questions: Is the suspect down? Are there more hostile threats? Are you ready for them if they come or if the suspect suddenly attacks again? Where are you at exactly? Should you move to a different location for better cover, better distance from any possible threats or to be seen by incoming units? What route should incoming units take to get to you?
To quote Lt. Col. Dave Grossman (ret.), The fact that you are alive to know you are shot is good! You may not have even realized that you were injured due to the adrenaline and stress of the altercation you were just involved in.
During your self-assessment, calm yourself and check yourself for injuries. Are you OK? Can you move all your extremities?
For the most part, remembering your ABCs from CPR and basic first-aid training will get you through.
A Is for Airway
If you can talk or breathe, your airway is open. Tip your head back to keep the airway open. If you feel you may vomit, lie down on your side in the recovery position to avoid choking or taking vomit into your lungs in the event you pass out.
B Is for Breathing
Take slow, deep breaths. Autogenic breathing techniques may be referred to by different names (e.g., combat breathing, tactical breathing, etc.), but they are all essentially the same. Inhale through the nose for a four count, hold for a four count. Exhale through the lips for a four count, hold for a four count. Trainers such as Gary Klugiewicz, Ken Good and Dave Grossman have been teaching these techniques to officers for years as a way to calm the mind and control the body during high stress encounters. As you breathe, be aware of any abnormal sounds, pain or sensations.
C Is for Circulation
If you re conscious, you have a pulse. Your autogenic breathing will help to slow your heart rate. Check yourself from head-to-toe visually and physically, if possible, to identify any injuries. Do you have any external bleeding, pain, tenderness, swelling or deformities? Of these, external bleeding is one of the most serious, but it s also one of the easiest for the average officer to assess and treat with limited training and supplies. Remind yourself that your odds of surviving a traumatic injury in the United States are excellent due to the quality of our EMS and hospitals.
If left uncontrolled, life-threatening blood loss could lead to death. There are three types of external bleeding. Recognition of these types will help an officer to better understand the severity of an injury and what steps may be most effective in stopping or slowing it:
1. Arterial bleeding is the most difficult to control. It may spurt out of the wound at high pressure with a pulsating rhythm. It s bright red due to its high oxygen content.
2. Venous bleeding is dark red due to its poor oxygen content. It tends to flow in a steady stream from a wound site. It s easier to control than arterial bleeding due to its lower pressure. It s more common than arterial bleeding due to the proximity of veins to the surface of the skin.
3. Capillary bleeding is easily recognized by dark red blood oozing from the wound site. It s very easy to control and may not even require active control methods for clotting to occur. It commonly occurs with abrasions.
There are four basic bleeding control techniques that should be instinctive for all officers whether they are treating themselves or others. All of the following techniques can be performed immediately with items the typical officer may have at hand.
You probably perform this basic technique automatically when you get a minor cut or a bloody nose. Protective gloves are obviously desirable when treating others, but don t worry if you can t get your gloves on before applying pressure to your own wound.
As the name implies, press against the wound in order to close the affected vessels and assist in clotting. A trauma dressing of some sort is great, but if you don t have one, use other items, such as clothing, a ticket book or your bare hand. Once in place, don t remove the dressing or risk destroying any clots that have formed. If blood soaks through the dressing, place another dressing over the first and continue to apply pressure. You might even lie on the wound so your body weight puts pressure on the injury, as depicted in the classic Calibre Press video, Surviving Edged Weapons.
If possible, let gravity do some of the work for you. Raise the affected area above the level of the heart while simultaneously continuing to apply direct pressure. This technique is not recommended if there is an obvious or suspected bone fracture in the affected area.
Pressure-point techniques are typically reserved for use as a supplemental bleeding-control method. Pressing the affected artery against the bone may help control bleeding from the extremities, but it s difficult to perform for longer than a few minutes. For injuries to an arm, apply pressure to the brachial artery by pushing fingers into the area between the bicep and the humerus (i.e., the upper arm bone). For injuries to the legs, apply pressure to the femoral artery by pressing against the pelvic area to the right or left of the groin. Due to the strength of the blood flow through this artery and its depth beneath other tissue, you must apply significant pressure to stop the blood flow. You may find this technique very difficult to perform on your own femoral artery due to the angle and pressure required.
As an alternative, try to locate the artery and place a baton, shotgun butt stock or other object of similar length against the area. Grab the object 2 3 feet above your leg and pull the object down against the artery to slow blood flow.
A tourniquet may be appropriate when other control methods fail or when circumstances do not allow an officer to focus complete attention to their injuries. A lull in the action with active hostile threats in the area may give the officer little time for self care. It was Jesse Ventura who first coined the term, I ain t got time to bleed. If you re involved in an ongoing violent confrontation, you may not have time to bleed either. A tourniquet may provide the quickest response and easiest maintenance for severe bleeding so you can get back into the fight.
You can leave a tourniquet in place for up to two to three hours before you risk losing the limb. This is ample time for officers in most scenarios to reach an appropriate medical facility. In addition, the tourniquet does not require irrigation of the wound like some hemostatic agents that may further delay medical procedures. If possible, note the time you applied the tourniquet. You can do this can by simply writing the time on the affected limb in blood or with a pen.
A wide material, such as a belt, is preferable to prevent the tourniquet from cutting into the skin, but shoelaces or plastic, flex-type restraints have also worked successfully. If necessary, tighten the tourniquet around the affected limb by securing a makeshift windlass and turning it until the bleeding stops. A baton, pistol magazine or other similar item might make a good windlass.
The application of cold temperatures to an injured area cannot be overlooked, although it s typically not as effective at bleeding control as the previous four techniques. An officer waiting for EMS in the winter may find snow and ice can provide effective, supplemental bleeding control. By applying the snow or ice to the wound for 15-minute periods with five- to six-minute intervals between, the vessels will constrict, slowing the blood flow and limiting the chances of cold injury to the area. This technique may also make surgery and recovery of the affected area easier by reducing swelling.
Uncontrolled blood loss results in the onset of shock prior to death. It occurs when not enough oxygen is delivered to the body s tissues. A patient in shock is a patient who is circling the drain unless they get medical intervention very quickly. Officers must recognize signs and symptoms of shock and basic measures to prevent its onset.
If you are in or near shock, you may experience rapid, shallow respirations, extreme thirst, restlessness, changes in mental status, a rapid, weak pulse, anxiety, and pale, cool and moist skin. In order to prevent or treat shock, maintain an open airway, deal with any breathing issues and prevent further blood loss. Elevate your legs 8 12 inches if there is no concern of injury to the pelvis, head, chest, abdomen, neck or spine. Keep yourself warm, and practice calming techniques while reassuring yourself that you will be all right.
Self-applied first aid is just as important to officer survival training as firearms and defensive tactics. Officers must receive regular refreshers in basic first aid, self-care and how to provide that care with limited resources. Odds are good an injured officer may not be able to reach the first aid kit in the patrol car when they really need it.
Don t fight like a tiger during the confrontation only to give up on yourself while waiting for EMS. Your job is not finished just because the confrontation is over. Practice these techniques until they become just as instinctive as reloading your pistol from slide lock. Try to incorporate them into scenario-based training.
To quote Grossman again, Do not expect the combat fairy to come bonk you with the combat wand and suddenly make you capable of doing things you have never rehearsed before.
Goold G, Vahradian S: Basic First Response. Upper Saddle River, NJ: Brady/Prentice Hall, 1997.
Limmer D, O Keefe MF, Grant HD, Murray RH, Bergeron JD: Emergency Care, 9th Edition. Upper Saddle River, NJ: Brady/Prentice Hall Health, 2001.
Thank you to Sergeant Larry Hahn (ret.) of the Waterloo (Iowa) Police Department and Ben Schloss, an NREMT-P with Lifeguard Air Ambulance at St. Luke s Hospital in Cedar Rapids, Iowa, for their input into this article.