August 08, 2017

When I saw this brilliant video I immediately felt the need to share it with the TacMed community for a variety of reasons. First of all however I would like to state that I think this is an incredible piece of policing, coupled with a life-saving intervention under extreme duress. Any comments that I make in this article are by no means intended as criticisms, they are simply observations that are well illustrated in the footage. Every observation that I make is something that I myself have been guilty of in the past in tactical medical situations when the adrenaline was pumping.

The video depicts two Las Vegas Metropolitan Police Officers initially involved in a car chase that turns into a brief foot pursuit followed by a shootout after the suspect opens fire. In the ensuing gunfight the suspect sustains multiple close-range pistol gunshot wounds, one of which induces an arterial bleed in his right upper thigh which, left untreated, would have certainly resulted in exsanguination and death from blood loss within minutes. The two police officers rapidly render the scene safe, restrain the suspect, and transition from an offensive response to a life-saving tactical medical response in a matter of seconds. A Combat Application Tourniquet is applied and the arterial bleeding is stopped.

The video credit belongs to the PoliceNetwork Youtube channel:

The first point I would like to make is the importance of familiarity with your equipment, and the critical requirement for repetitive Reality Based Training (RBT), or training as you’re going to fight.

When learning any new skill, there are four levels of integration during its acquisition (Grinder cited in Murray 2006, p. 25):

  • Unconscious Incompetence
  • Conscious Incompetence
  • Conscious Competence
  • Unconscious Competence

Put simply, this translates as follows:

  • You don’t know what you don’t know
  • You know what you don’t know and can’t do it
  • You can do it, but have to think hard about it
  • You can do it on autopilot

To illustrate the importance of programming the correct skills into an operator in any field, I would like to quote from an outstanding reference in Warrior Science Deadly Force Encounters (Artwohl 1997) surrounding experiences of Law Enforcement officers during gunfights:

“…under sudden life-threatening stress, individuals will likely exhibit behaviour based on past experiences that they will automatically produce without conscious thought. This means [that there is a necessity to] not only [train] officers in appropriate tactics but also [to provide] sufficient repetition under stress so that new behaviours will automatically take precedent over any previously learned, potentially inappropriate behaviours that they possessed before becoming an officer”.

The video above shows the two police officers displaying Unconscious Competence with their handguns. They have excellent muzzle control throughout, and it can be observed that when the initial officer requires a magazine change, he does this without hesitation and achieves a clean reload in a matter of seconds without the slightest shaking of his hands. He has clearly practiced his weapon drills repeatedly in RBT scenarios in order to achieve this level of competence during a situation where his life is at threat, his adrenaline is pumping, and his heart rate is likely near maximal. Contrast this with his subsequent application of the arterial tourniquet, which he is clearly familiar with, however I would assess is operating at a Conscious Competence level with the device. I need to stress here again that I am not criticising this officer’s performance, however it can be seen that he needs his full concentration to apply the device. His fine motor skills are failing him slightly, and he appears to apply the tourniquet correctly initially before doubting himself, removing the device, and then reapplying it and tightening it with assistance from his partner. The whole application takes a shade over 40 seconds, which under the circumstances is outstanding, and as stated above, unquestionably life-saving.

The second point to draw out of the video is the lack of personal protective equipment use by the officers. Naturally the application of an arterial tourniquet to a significant arterial bleed is time critical, and it may be that the officer made the conscious choice to not burn time applying gloves before intervening. Furthermore the likelihood of contracting a blood-borne virus through intact skin of the hands is probably very low. That said, should either of the officers in this video had any open wounds on their hands, which could very possibly occur in the mayhem of the depicted scenario, the lack of glove use would put them at risk of contracting any blood borne virus that the suspect may have had. In the context of a suspect who has just led the police on a car chase, before opening fire, it is not unrealistic that they may be an intravenous drug user, and potentially carrying Hepatitis C or HIV. As stated repeatedly throughout this article, I am not criticising the responding officers, and the time taken to try and apply a set of latex gloves on sweaty, shaking hands would have been significant in this situation, resulting in a significant and potentially fatal further blood loss from the suspect’s wound. On many occasions when responding to bleeding soldiers from my own element in tactical scenarios I didn’t waste the time applying gloves, rather consciously choosing to engage in medical management more quickly and expose myself to the casualty’s blood. That said, we were all regularly screened for blood-borne viruses, and I was confident that the exposure was low risk. When treating foreign nationals or partner force soldiers from countries we were operating in, I would always take the few seconds to apply gloves before exposing myself to blood or body fluids. It’s a judgement call, but having the gloves available, and ideally colocated with your medical equipment serves as a reminder to apply them in the heat of the moment, and allows a split-second conscious decision to be made to take the time to apply them or not.

The final point I would like to make is the importance of all first responders carrying, and being well trained in the application of arterial tourniquets. It is not beyond the realms that any general duties police officer or ambulance officer could find themselves in the very situation that is depicted in the video. It may not be a gunfight, it could be quite easily be the result of a motor vehicle or industrial accident. Without immediate access to an arterial tourniquet, and sufficient training to apply it effectively under duress, it would have been extremely difficult, if not impossible, to save the life of the suspect in the video.

For anyone interested in learning more about Reality Based Training principles and applications, grab yourself a copy of the Murray’s Training at the Speed of Life. The definitive textbook for military and law enforcement Reality Based Training (full reference below). Those interested in learning more about arterial tourniquets for first responders might want to check out TacMed’s Ebook on the subject. Click here for a link containing an overview, a video description of the book by the author, and a link to a free chapter.

In conclusion, to the officers from the LVMPD wearing the body cameras goes my full respect. Your composure under fire, and then compassion and competence in saving the life of the very man who just opened fire on you is nothing short of remarkable. I truly hope you never have to buy a beer at a bar again!

As always, questions and comments are welcome. dan.

References

Artwohl, A, Christensen, LW 1997, Deadly Force Encounters: What cops need to know mentally and physically to prepare for and survive a gunfight, Paladin Press, Boulder, CO.

Murray, K 2006, Training at the Speed of Life. The definitive textbook for military and law enforcement Reality Based Training, Armiger Publications, Gotha FL.