Blog

Classes & Communications

Friday, 02 October 2009 18:19

I recently conducted a TAS "Shooting With Xray Vision for Civilians" class in Saukville, WI. Attendance was sparse (something a lot of independent instructors have been noting during the current economic downturn) but a surprisingly large number of cops were in attendance. Because of the small class size, we had a very interactive time together, with plenty of Q&A and discussion around the room. We'll be holding another one of these classes in the New Year, again in Saukville.

I am in discussions with a top-drawer trainer who works for a federal agency and is a first-rate instructor at one of our nation's finest independent training facilities... regarding the possibility of conducting a 2-day Tactical Treatment of Gunshot Wounds class in the Milwaukee area. If it comes together, we will be opening the class up to local LE personnel to fill a maximum class size of 25. This class is designed primarily for tactical team/SWAT operators who want to know more about how to effectively treat trauma in the tactical (hot zone) environment.

Communications:  we've added a lot of new members to this site in the past few weeks, which is great. Unfortunately, I have not been able to notify several of you that your membership/login has been activated because your agency email addresses are spam-blocking my emails. I suggest that anyone registering with tacticalanatomy.com use a non-agency email address when they register.

Tactical Medics: When Are We Going to Fix This Problem?

Tuesday, 14 July 2009 12:43

Again, too much time has passed since my last blog entry. The past 6 weeks has been a blur of conferences, training, and work. Not to mention the fact that when I'm home I'm burning the candle at both ends trying to get my house in shape to sell (a real challenge in our current soft economy, stimulus packages or not!).

You know how things seem to cluster together? In the ER, that's just a given... some days are "suture/laceration" day, or "chest pain" day, or "gunshot wound" day. But I experienced an unusual "topic cluster" over the past 6 weeks that has really got me wondering.

The topic that's clustering for me is this: how should we be training and implementing SWAT/tactical medics in America?

Example:  the active-killer situation that took place at the Van Maur department store in Omaha in December of 2007. At least one GSW victim was still alive when police officers deployed inside the "kill zone" (the active killer has already taken his own life, but LEOs could not possibly know that, of course). Emergency Medical Services personnel were forbidden by their protocols to enter the perimeter until the scene was declared "secure", however, so these victims were not extricated in anything resembling a timely fashion. This wasn't the fault of the EMS protocols, nor of the officers on the scene. But the situation highlighted the nature of the problem, and the terrible cost of our failure to address the issue.

I am aware of many other less-publicized situations where patrol officers, SWAT officers, or civilians were trapped in the "kill zone" with life-threatening injuries but were not extricated. SWAT officers are at the scene to fight, not render medical aid. Paramedics are at the scene to render aid, not to fight. If either fails to execute their primary mission responsibility, a greater disaster could result. It's crystal clear to me that what we need in every situation of this type is a third group of people: tactical medics.

The problem I'm finding is that there is no real consensus on what a tactical medic is, or what he should be able to do. And the more I dig into the issue, the more disturbed I become. But I probably need to backtrack to explain why I'm so disturbed.

As an ER physician, I am required to maintain my certification in various lifesaving protocols such as ACLS (Advanced Cardiac Life Support), ATLS (trauma), and so forth. This involves re-taking the standardized class and passing both written and practical examinations.  It wasn't always this way, but over the past 50 years or so the medical profession has policed itself into adopting and regularly updating these standards of care. The benefit is manifest: anyone who needs ER care for their heart attack or traumatic injuries anywhere in America can be assured that the doc taking care of them has met a national standard. Because of these proven standards of care, your chances of dying from a heart attack or injuries sustained in a motor vehicle collision are a fraction of what they were in the 1960's.

As the medical director of my county's ambulance services, I am aware of similar national certification standards for EMT's. Furthermore, we have national standards for fire & rescue, disaster preparedness, and so forth.

But when it comes to tactical medicine, things are a mess. And good people are dying because of it. So how do we clean this mess up? Well, I've got some ideas.

First thing: define the job/role of the tactical medic.  As far as I am concerned, the tac-medics' role is a blend of basic EMT and basic LEO jobs. It should be to enter the perimeter of an unsecured zone, pick up the injured person, and scoot out of there. "Scoop and run", a time-honored term in EMS circles. They aren't gonna start IV's, do CPR, apply splints & bandages, although they might apply a tourniquet or clear a blocked airway... something that can be accomplished in seconds, not minutes. The tac-medic's role is to get in and out of the hot zone with the patient and deliver him to fully-equipped paramedics outside the perimeter, who can then perform the critical life-saving maneuvers without being in danger of coming under fire. On the other hand, tac-medics shouldn't be expected to take a place in the entry stack or to try to extricate personnel under direct fire. The tac-medic's role is somewhere in the middle.

Second thing: define the skillsets needed by a tac-medic. A tac-medic doesn't need to have advanced paramedic skills, nor does he need to have the tactical mindset and weapons skills of a SWAT operator. But he needs to have a little bit from both sides of the fence. A tac-medic needs to be tactically aware enough to enter a danger zone without needlessly endangering his life or that of others. Because tactical situations are incredibly fluid, the tac-medic needs to be armed and trained enough to deploy his armament in defense of his own life and that of his patient if circumstances dictate. And the tac-medic needs sufficient medical skills to perform rapid life-saving maneuvers as needed. That's it.

I don't know about you, but it seems to me that this does not require the creation of a new profession. We cross-train our SWAT team members in basic lifesaving first aid--what I call "battle-aid"--and I know many jurisdictions cross-train paramedics in tactis and firearms. What we need, then, is to agree upon a standard of training and performance that can be met by both LEOs and EMTs who have the motivation to take on this unique role.

In my admittedly biased view, a reputable national organization needs to pick this problem up and run with it. For example, the highly successful Advanced Trauma Life Support program  for doctors was developed and promoted by the American College of Surgeons. Perhaps a body such as the National Tactical Officers Association (NTOA) should consider taking on the tactical medicine problem in a similar fashion.  

The problem is complex due to the mult-jurisdictional nature of law enforcement, but if EMS and Fire & Rescue have managed to come up with national standardization for their professions, why can't law enforcement do the same for tactical medics?

223/5.56 Duty/Defense Ammunition Selection

Sunday, 21 June 2009 22:15

I must apologize to Members and other readers of this site for my inattention to the site of late. June has been a heavy month, with two major conferences to attend/speak at, as well as a lot of demands on my time at work. How is it that when the economy goes sour, people start doing more things that land them in my Emergency Department? Is it something akin to the full moon?

Inquiring minds want to know!!!

Anyways, enough whining... Today I was notified by my great friend Dr. Gary Roberts that I had been referenced on an internet gun forum. The writer, who has apparently taken one of my classes or heard one of my lectures, ascribed to me certain expertise in "terminal ballistics" that he felt superseded the ballistics testing done by the FBI.  I hastened to set the record straight... I have never claimed to know more than those jello junkies at the FBI ballistics labs!!! They do good work down there in Quantico, and better yet, they freely share it with the rest of us. 

But I must state explicitly here (as I do in all my classes) that I am NOT a terminal ballistics expert, nor do I do much terminal ballistics testing myself. I rely heavily on the bench testing done by people like Dr. Gary Roberts in this area. My expertise is much more in the area of terminal effects, i.e., showing people what the anticipated effects of their well-targeted rounds might be. As such I train people where to shoot the bad guys, and via my trauma medicine background, what kinds of effects one can expect when a person is shot in one of the major zones of incapacitation.

The problem, as you may be aware if you've attended one of my classes, is that in gunfights our opponents rarely stand up to us foursquare with their guns at the hip and let us shoot them in the high mediastinum. In many, many gunfights I have in my files, the offender presented LEOs with a bladed or crouching or some other contorted stance which bears no resemblance to qualification and training targets. Shot placement suffered accordingly as the LEOs in question had no training on these "non-traditional" presentations. As Dr. Roberts has so ably pointed out on many occasions, the problem your bullets have to solve may require much, much more than 12 inches of penetration.

Example: in the 1986 FBI Miami gunfight, bank robber and murderer Michael Platt shot Agent Ed Mireles in the right (dominant) forearm with a round of 5.56. This round shredded Mireles' forearm and permanently disabled him. However, the bullet failed to penetrate through the arm and into Mireles' torso. As such, Mireles was able to continue, using his nondominant hand with both his Remington 870 and his S&W revolver, and ultimately put the final bullets into Platt that finished the fight.

If Platt's rifle had been loaded with a bonded-core or partition-style bullet designed for deep penetration even through intermediate barriers, Mireles likely would have been much more seriously injured, if not killed.

In my medical experience and in my big game hunting experience, penetration is a good thing. I have not been greatly impressed with the terminal effects (not to be confused with terminal ballistics, BTW) of most frangible rounds on human/live animal targets. Tthis does not include, of course, small varmint game such as prairie dogs and woodchucks. I have little faith in the incapacitating effect of any round's temporary cavitation effect, whether it be a handgun or rifle--50 BMG being a possible exception. What counts in gunshot wounds is, quite simply, what vital organs has the bullet penetrated/perforated, and how catastrophically. On the other hand, I've not been impressed with the terminal effectiveness of the deep penetration afforded by our military 62 gr steel-tipped armor-penetrating ammo, which is too often a remote-control cordless drill.

The clear answer is that for general patrol/defensive rifle duty, we want a round that both expands well and penetrates deeply, while maintaining reliable functionality and accuracy. This is the ideal.

That being said, and no disrespect intended to any of the runners-up, my personal and professional 5.56 ammunition choices based on the recommendations of true experts like Dr. Roberts--and my own experience on live animals and tissue simulants--tend to run along the lines of Federal TRU 55/62gr bonded, Black Hills/Nosler Partition 65 gr, and Winchester JSP 64 gr. These rounds will defeat intermediate barriers and will penetrate deeply through tissue, and will work accurately in barrels from 1:7 through 1:10. All of these rounds have an excellent record in OIS's over many, many years, and as such I have no reservation in recommending them.

ILEETA Report: Features of the Active Killer

Saturday, 09 May 2009 14:06

I recently attended the annual conference of the International Law Enforcement Educators and Trainers Association (ILEETA) in Wheeling, IL. As it has been since I first attended in 2005, it was an outstanding meeting.

I had the privilege of sitting on the "Panel of Experts on Use of Deadly Force", moderated by Massad Ayoob. As usual, this was a lively discussion forum with a lot of good input from the panel and from the floor. One of the most interesting topics brought up was and update from Ron Borsch on his research into the features of "active killers".  Ron manages the South East Area Law Enforcement (SEALE) Regional Training Academy in Bedford, OH, and has been researching features of active killer incidents for a number of years.

Ron believes the "active shooter" term commonly used by the media and by law enforcement is inaccurate, pejorative and prejudicial against law-abiding firearms users, and potentially dangerous to law enforcement personnel. As he correctly points out, a law-abiding citizen shooting trap or punching holes in targets on his back 40 is an "active shooter": he is actively shooting, and doing so completely within the limits of the law! Ron quite reasonably argues that  the term "active shooter" needs to be replaced by "active killer", because the latter term conveys the essence of the deranged murderer and his actions in two succinct words. I agree. We need to get the message out to fellow LEOs and to the media that this terminology needs to change.

Borsch defines an active killer as a mass murderer (4 or more victims are intentionally murdered in the same episode and location) whose acts take place in no more than 20 minutes. This definition encompasses every active killer event since Charles Whitman's rifle rampage at the University of Texas in 1966, and including the Columbine High School horror, among others. Borsch has analyzed almost 100 incidents. Borsch's research shows that the modus operandi of active killers has remained consistent through time, and this knowledge has shaped his training for LEOs.

Borsch's research reveals a number of critical features of active killers. First, they almost always act alone (98% of cases). Second, their primary objective is to produce as high a body count as possible in a short period of time; they commit as many as 8 murders/attempted murders per minute during their rampages. Borsch relates this high rate of killing in his metaphoric "stopwatch of death": the active killer knows that police will respond, and he has only minutes to cause as many deaths as possible. The active killer fears police, or in fact any form of armed resistance. When police or armed citizens show up, the active killer takes his own life in 90% of incidents. Active killers are "dynamic and quick" (average duration of attacks post-Columbine is less than 8 minutes), almost never take hostages, and they do not negotiate. In 80% of cases active killers have used long guns (rifles or shotguns), and 75% of active killers bring multiple firearms to the scene. 

Borsch has used his data to formulate a training program and policy template that encourages the first responding officers to an active killer call to make immediate entry to the location. As Borsch states, "The incident may well be over by the time police arrive. But with some of these subjects attempting as many as 8 murders a minute, we don't have the luxury of waiting for backup before entering. These are extraordinary events that warrant an extraordinary response."

Borsch's training emphasizes the first responding officer making rapid entry into the location, with weapon(s) out and ready for immediate deployment. The active killer is unlikely to return fire on police officers, but also is highly unlikely to respond positively to verbal warnings or to negotiate. Officers need to be prepared to shoot immediately when the subject is encountered. Since active killers are increasingly resorting to wearing body armor, responding officers should be aware that multiple upper torso/head shots may be required to stop the carnage. A patrol rifle/carbine or shotgun is the preferred LEO entry weapon.

Borsch cites the recent actions of officer Justin Garner, who earlier this year responded to an active killer call at a nursing home in North Carolina, as an exemplar. By the time Garner entered the building, the subject had murdered 7 elderly residents and a nurse in a matter of only a few minutes. Garner encountered the subject as he was reloading his shotgun. Garner terminated the encounter with one shot to the subject's upper chest with his service sidearm.

Of significant note, Borsch's study reveals that only 6 active killer incidents have been successfully terminated in progress by LEOs. Most successful terminations were the product of courageous action on the part of private citizens, most often unarmed. However, it should be noted that nearly every active killer incident on record in the USA has occurred in so-called "gun-free" or "zero weapons tolerance" zones such as shopping malls, office buildings, and schools. It should come as no surprise to most of us that these zones are highly attractive to the active killer, as he is more likely to be able to execute his high body count plan than he would be in, say, a police station or gunshop!

More on the absurdity of "gun-free" zones, particularly schools, to follow in my next blog article.