A research team headed by a certified Force Science Analyst has explored an important concern that may be overlooked in typical field-medicine training for LEOs: How much extra stress is inflicted on an officer who needs to apply a tourniquet to a severely injured colleague?
This question was investigated recently in Scottsdale, AZ, with the help of 236 police volunteers.
The study, believed to be the first of its kind, was headed by Force Science grad Todd Larson, a retired Scottsdale PD lieutenant who is now director of the Simulator Training Lab operated by the HonorHealth medical services network. The HonorHealth Trauma Dept. partnered in the research, and Force Science instructor Dr. Matthew Sztajnkrycer, an emergency medicine specialist with the Mayo Clinic, consulted on the project as a subject-matter expert.
Of the volunteers, all sworn personnel with Scottsdale PD, 85% were male, mostly in the 21-40 age range, with nearly 75% on the job for 15 years or less. Five per cent reported getting no regular exercise; the others followed a fitness routine from one to five or more times a week.
A minority (28%) had been in the military, had military medical experience (2%), and had been “deployed in a war-type setting” (14%). Less than 10% reported other prior medical experience.
About half had received some tourniquet training, and most reported a mid-level confidence in their ability to properly apply this potentially life-saving device.
First in Larson’s study, Air Force registered nurses took the participants’ blood pressure and pulse to establish baselines. Then after 45 minutes of lecture and videos on tourniquet use and a practice session, the officers were paired for live, stress-inducing scenarios. Some participants were fitted with heart monitors.
Sitting in a patrol car, the teams one at a time hear radio traffic of a hot call, an active shooter in progress. An unseen officer responds, gets into a gunfight, and calls out that he is hit in the leg. Then his radio goes quiet.
When the test officers rush to the scene, they enter a shoot-house made up like a drug store/pharmacy. Immediately inside, they’re assailed by gunfire (safety blanks from training guns) and battle to incapacitate the attacker. Once he’s down, they search for and find the wounded officer, bleeding profusely.
This “officer” is, in fact, a “high-fidelity simulator,” a highly sophisticated, computerized medical training manikin that can produce a stunning array of human qualities. Among other things, it can breathe, talk, register heart tones and a palpable pulse, bleed, and respond to treatment.
In this case, the injured “officer” speaks briefly, then “passes out, in shock.” One officer from each team must apply a tourniquet to stanch the dangerous hemorrhaging, while his partner provides cover and conducts radio communication.
After the scenario, the participants’ vitals were checked again.
“We found statistically significant physiological differences between officers who had to manage the tourniquet and those who simply provided cover,” Larson told Force Science News. “Both had come under ‘gunfire’ that simulated a life threat and, of course, that boosted their stress levels. But the act of providing emergency medical care with the tourniquet added an additional layer of stress on top of that. The physiological effect on the tourniquet officer’s body was very high.”
The average heart rate for cover officers, for example, rose from 78 bpm before the scenario to more than 98 bpm afterward, an increase of about 26%. But for tourniquet officers, the increase spiked by nearly 40%, up from about 77 bpm to more than 107. “Those wearing heart monitors spiked to nearly 200 beats per minute in some cases,” Larson says.
Likewise, his team found that tourniquet placers on average had statistically significant elevations of blood pressure beyond what the cover officers experienced.
Larson points to three major correlations in the findings:
- Age: Older officers tended to “perform better” (i.e., “showed less physiological stress”) than younger officers;
- Tenure: Those with 10 or more years of service performed better;
- Medical experience: Those who had prior medical experience (including military medical) performed better.
“An officer over 50 years old with 20-plus years on the job who has prior medical training appeared less impacted by physiological stress during tourniquet application,” Larson summarizes.
Confidence level going in, incidentally, proved to have “no correlation to actual stress reaction or performance,” Larson says.
HonorHealth researchers and Dr. Sztajnkrycer will be mining the research data for other relevant information, Larson says. Meanwhile, Larson offers these observations on the findings in hand:
“When we add a medical component to an officer’s responsibilities in a high-stress situation, we have to recognize that we are significantly increasing that officer’s physiological load and that his or her human performance may be degraded as a result.
“We can’t just hand an officer a tourniquet and say, ‘Use it when you need it.’ There must be training and practice, and not just one-time training either. And just like in shooting situations, we can’t expect that officers are always going to make perfect decisions when their body is under stress.
“Tourniquet proficiency is important. There are many critical situations in today’s world that just won’t wait until EMS arrives. Officers need to be prepared to stop serious bleeding on themselves, on partners, and on civilian victims. You never know when that moment is going to hit.”
Case in point: Shortly after participating in Larson’s research, one of the officer volunteers received an urgent “subject with a knife” call. “A male subject had sliced an artery in cutting his arm to the bone with a bread knife,” Larson says. “He was starting to pass out when the officer arrived.
“The officer applied a tourniquet and stopped the bleeding. Without that, the subject absolutely would have died.”
For more information, Todd Larson can be reached at: Todd.Larson@HonorHealth.com. HonorHealth plans to pursue publication of this research in a professional journal. The initial findings will be presented at the Emergency Medical Services Odyssey Conference on June 9 in Phoenix.