Over the last 6 months, Dr. Matthew Sztajnkrycer, a “SWAT doc” from Minnesota, has exposed some 150 officers to this stressful and revealing training exercise:
A patrol officer, answering a domestic violence call, is shot down as he exits his unit. Officers responding to 911 calls from the scene observe him slumped in a seated position behind his car, not moving. To reach him, they must leave cover and cross more than 75 feet of open ground. The unlocated gunman potentially still controls the kill zone.
What should they do?
Overwhelmingly, what they do, Sztajnkrycer has found, is take immediate action that puts them at great risk but does not necessarily benefit the wounded victim.
“A downed officer raises very primal emotions,” he says, “due to the simple fact that he or she is your colleague, your friend—and, in fact, might one day be you. The desire of most officers is to get out there and bring their colleague safely home.”
What Sztajnkrycer wants to convey are the advantages of making a rapid “calculated analysis” of such critical situations, not with the impossible goal of eliminating all risk but to more coolly weigh the hazards and benefits of immediate action so that a “reasonable decision” about what to do can be made.
“When dealing with injuries under conditions of active threat, it is important to understand that medical needs are simply another tactical consideration and do not necessarily take precedence over other tactical priorities,” Sztajnkrycer explains.
Quoting from a military medical journal, he says that to successfully do what is best for both a wounded officer and would-be rescuers, you need to keep in mind that “good medicine can be bad tactics, and bad tactics can get everyone killed and cause the mission to fail.”
Sztajnkrycer, a technical advisor to the Force Science Research Center at Minnesota State University-Mankato and a consultant in emergency medicine at the prestigious Mayo Clinic, serves as medical director for a municipal police department and as a tactical medic for a city/county SWAT team in Minnesota. With half a dozen years of SWAT involvement on his resume, he ran the “realistic, dynamic” downed-officer scenario as training for his own officers, as well as for tactical operators and street officers elsewhere, incorporating several variations.
In one version, the victim officer was “obviously dead,” with simulated brain matter spilling out of his protective face mask. Other times, he was “shot” in the leg, able to freely move his upper body and communicate with responding officers from cover behind his patrol car. Sometimes the suspect exhibited no presence, and sometimes he attacked rescue teams with paintball or airsoft ammo from predictable or unexpected locations as they approached or tended to the victim officer.
Generally, arriving officers showed the same instinctive, dangerous response across all versions: to rush to the downed officer and bring him to safety—even in instances where evidence clearly suggested he was already dead.
“Even SWAT operators who were trained as combat lifesavers, knowledgeable of the basics of tactical medicine, still hurried up to the downed officer. On several occasions, responding officers incurred injuries of their own in doing so,” he says. “Old habits die hard.
“Even when not under stress, the decision-making process of our brain is frequently illogical, emphasizing wants over needs. In the setting of a critical incident, mental processes are further altered. Adrenaline levels are high, there is a desire (if not always a need) to help, and time keeps ticking away, increasing the level of stress and the perceived need to do something.”
Sztajnkrycer did not conduct the exercises as a scientific study, but the startling results nonetheless have prompted him to make some trenchant observations on how responders to an officer down in a hot zone can better manage their actions so that risk “is reduced to acceptable levels.”
Here, drawing from a paper Sztajnkrycer has recently written and from an exclusive interview he granted to Force Science News, we present highlights of his suggestions. The paper itself, “Risk Reduction in Officer Rescue: A Scenario-Based Observational Analysis of Medical Care,” can be accessed in full on the Force Science News Web site (Click here to read it).
3 RISK PHASES
“If you’re making an entry with a SWAT team and someone next to you gets shot, that’s a very different situation from the scenarios I ran,” Sztajnkrycer explains. “If you’re right next to an officer who goes down, it’s usually much easier to grab him and move him to safety ASAP, rather than retreat without him and try to rescue him later. Doing the latter converts the SWAT situation into the very training scenarios I ran for the officers.”
If, however, a rescue can’t be effected instantly for some reason or if you and others arrive after an officer is already down, you are then challenged by 3 phases of risk, so long as there’s still a potential active threat:
- The Approach-Risk Phase exists for the time and distance required for you to penetrate into the kill zone from your last point of cover and concealment to the downed officer.
- The Aid-Risk Phase consists of the time you spend “in the hot zone, under threat of effective fire, assessing the downed officer and performing preliminary care. This phase is high risk because any suspect is now aware of the rescue attempt, the team is relatively static, and situational awareness is easily lost while focusing on the injured officer,” Sztajnkrycer writes.
- The Extraction-Risk Phase covers the time and distance necessary for you to “return the downed officer to a position of relative safety, where further medical aid and definitive evacuation can be performed.”
Sztajnkrycer stresses that the threats inherent in these phases should not be taken on automatically by would-be rescuers. Instead, pause a few moments to break the tunnel vision of immediate rescue, to calculate the risk-benefit ratio of each phase, and to identify possible threats and safe areas before launching into action.
“If you know an officer is down, the suspect probably also knows,” Sztajnkrycer says, “and he may have a plan for what he’ll do when a rescue is attempted.” Keep in mind that “the most appropriate medical care may actually be threat neutralization.”
First, try to determine in “a rapid yet organized fashion” if you are actually dealing with a downed-officer rescue—or a body recovery. “The reduction of risk favors getting more information, rather than rushing forward,” Sztajnkrycer told Force Science News. Yet across his scenarios, “no team attempted remote assessment,” aside from one team that simply called out to the downed officer before entering the hot zone.
Since hands-on assessment isn’t possible, look for indirect signs of life, such as spontaneous movement, spontaneous chest rise, exhaled breath on a cold day. Exposed brain matter from head wounds strongly suggests fatality, although such wounds have proven survivable in many cases.
In the absence of a tactical medic who might use binoculars to assess the victim, employ a sniper and his scope, Sztajnkrycer suggests. “Snipers are more observational than regular officers. They’re attuned to looking through a scope and providing real-time intelligence in great detail that can be translated into medical intelligence.”
Bluntly stated, if the downed officer is judged to be dead “no further time pressure exists,” Sztajnkrycer writes. “There is no longer a patient with the potential to deteriorate. The situation can hopefully be resolved and allow for dignified recovery of the body” later, when it’s safe to do so.
In an effort to encourage a more rational approach over the primal urge to “do something” even in hopeless cases, some teams make a pact among themselves not to advance if a member is shot in the head and brain matter is exposed, Sztajnkrycer notes. “They don’t want their friends to risk an attempted rescue just so they can lie in a coma for the rest of their life. It’s an honest and reasonable subject to discuss ahead of time.”
With an officer who appears to be alive, you need to determine if he is “sick” or “not sick,” to use emergency room jargon. “Sick implies that the officer is critically injured and will die in the next 15-20 minutes,” Sztajnkrycer explains. “Not sick means that while injured and in need of medical treatment, the officer can survive for at least that long; in other words, you can do nothing for awhile. This decision is critical from a tactical standpoint, because a sick patient requires immediate action,” whereas a non-sick victim allows for more flexibility.
Sztajnkrycer writes: “If the officer is awake and able to move, order the officer to initiate self-aid as appropriate, while awaiting rescue. Unfortunately, many people equate being shot with being helpless or dead, something frequently reinforced in training. Nothing could be further from the truth.
“Once injured, some officers may simply shut down. Forcefully remind them that they need to fight, that they are not to give up. If the injury has easy emergency treatment, such as applying pressure to a wound to decrease bleeding, tell them to do that. Depending on their injury, they may be able to provide cover for the rescue team. They certainly should be asked to provide intelligence on the situation, thereby keeping them engaged and actively involved in their own survival.”
When a rescue attempt is deemed mandatory, “take a few moments to survey the scene one last time,” Sztajnkrycer urges. “Scan the area for potential cover, concealment, and threats (debris, secondary devices, suspects). Determine the best approach to the casualty. Plan the best route of return with the downed officer, given that several guns will now be off-line and extra weight will be present.”
Your speed, decisiveness, and tactical preparedness will be critical. In Sztajnkrycer’s scenarios, the average time to cross the 25-meter distance and reached the downed officer was just under 21 seconds.
Even accounting for lag time in the suspect’s response to your actions, “this is still ample time to significantly injure or kill several members of the rescue team,” he writes. “A semi-automatic AK-47 clone can fire 30 rounds in approximately 5 seconds.”
In Sztajnkrycer’s exercises, the average time rescue teams spent in the kill zone under actual or potential “fire” was about 50 seconds, with the longest time being 2 minutes 11 seconds.
Some of those precious moments, in his opinion, were consumed by administering medical treatment that was unnecessary or inappropriate. “Trying to bandage extruded brain matter was one example,” Sztajnkrycer says. “Examining the downed officer all over for possible injuries like you’d do a car-accident victim was another.”
While tactical officers “worked better as a group and approached in a tactically more solid manner,” when they reached the downed officer and tried to render care they tended to be “out of their element, the same as regular officers.” Even when the victim was confirmed dead, “teams frequently continued forward with body recovery rather than simply retreating quickly. By locking into a rescue mind-set, and therefore extracting the body,” officers expanded their time in the hot zone at the mercy of an attacker by nearly 27 seconds.
In a high-threat situation, kill-zone medical care should be “extremely limited,” Sztajnkrycer cautions. Some observers advise avoiding any treatment in the hot zone, with the focus “solely on extrication,” thereby minimizing exposure and risk. Sztajnkrycer believes the only kill-zone medical care should be “control of life-threatening hemorrhage, achieved through the rapid use of a tourniquet.”
As a general rule, tourniquet placement “should take no more than 7-10 seconds.” Yet in the training scenarios, the average time required was more than 56 seconds; the best time was 37 seconds, the worst over 2 minutes. “You’d never send someone into a free-fire zone without teaching them how to reload a weapon, yet officers are sent out not knowing how to use a tourniquet,” Sztajnkrycer says.
“The hot zone,” he notes dryly, “is not the place to use any equipment for the first time.”
Sztajnkrycer suggests that pre-designating a rescue aid officer will save time and cut risk. That officer “will know that he/she can focus on the downed officer in relative safety, as the other officers maintain situational awareness.” Most important, the aid officer can expedite care “by having a medical preplan, including having the tourniquet out and readily available. If you know what you’re going to be doing beforehand, you’ll do it quicker than if you try to make it up on the fly.”
Removing a downed officer took nearly 50% longer on average than approaching him, in Sztajnkrycer’s tests, in part, at least, because of the encumbrance of a victim who was unable to assist in movement.
“To minimize risk,” Sztajnkrycer writes, “an appropriate extraction route, with suitable points of cover, should be determined” before initiating the rescue. “The goal of this phase may not be to remove the officer to a point of definitive safety.” It may be safer to move him “to a position of relative safety,” where additional care can be rendered and emphasis can be placed on neutralizing the threat.
Sztajnkrycer points to 2 “common failures” that can heighten extraction risk if not tended to tactically:
- Package separation, where officers carrying or supporting the wounded officer become isolated from those providing protection and situational awareness. A combination of factors, including adrenaline surge during the closing phase of rescue, often causes the carrying group to outpace the cover group, leaving the carriers exposed with limited defensive/offensive options. The larger the distance to be covered, the greater the risk of package separation.
- Simply reversing back along the approach route. “There may be safer, alternate routes, including those that provide better cover,” Sztajnkrycer writes. “Additionally, teams tend to turn around and face in the direction they are extracting. In so doing, the team faces weapons and protective equipment (e.g., ballistic shields) forward toward relative safety, while leaving flanks and rear exposed.”
Knowing how to rapidly assess and rescue a downed officer “is a mission-critical element in law enforcement,” Sztajnkrycer emphasizes. And not just for specialized tactical operators. “ ‘Hasty’ rescues are now often viewed as patrol-level responses,” he states. Every officer must understand that they may one day find themselves as the first medical responder in these events.”
When your time comes, you need to know that while “rescues remain high-risk,” with knowledge and diligent practice “there are ways to modify the risk involved in your favor.”
A note from Dr. Bill Lewinski:
“This article and the one prior (“Can this ‘uniform response’ defeat suicide bombers?” transmitted 10/23) both spotlight a basic yet critical concept worth noting,” says Force Science Executive Director, Dr. Bill Lewinski.
“Each piece focuses on officers’ responses to situations to which they are unaccustomed and for which they are generally untrained. Not surprisingly, those responses are less than effective at resolving the challenges these officers faced, be that confronting an attack or treating a wound.
“It is important to remember that this inefficiency is not reflective of an inherent inability for these officers to perform well,” he continues. “Rather it’s the result of their inability to tap into the knowledge, skill and confidence that comes from relevant training.
“As we discuss in our Force Science classes, it is important that officers be trained to the degree that they develop automatic motor programs and decision making models that allow quick analysis, great decision making and then appropriate action or reaction. They should be trained to the level that their response option decision-making is timely and informed and they should be accustomed to controlling the psychological and physiological reactions to stress that can jeopardize an officer’s ability to perform well…or sometimes at all.
“Ultimately,” Lewinski says, “their training should result in a high level of confidence in their ability to successfully handle these types of situations, thus helping to avoid confusion, panic and response paralysis.
“Remember that the findings of these two articles do not reflect the quality of the officers involved. These are good officers. What they do reflect is the importance of providing training that arms them with the knowledge, skill and experience to perform as they must in these types of scenarios.”