As twin bombs detonated near the finish line of the Boston Marathon, police officers, firefighters and emergency medical technicians heroically rushed into danger to save lives. The first responders found that they were dealing with devastation on a massive scale but utilized everything available to help those that had been critically injured. One of the actions taken by a number of first responders was the application of makeshift tourniquets to victims who were in danger of bleeding to death from their injuries. Those actions were reportedly responsible for numerous victims surviving long enough to reach a Trauma Center where surgical interventions were able to save their lives.
The decision to apply those tourniquets was not widely reported, but as we look back now, it is a perfect example of the evolution of an evidence-based practice that can have impact on the lives of police officers and those we have sworn to protect.
Before my career in law enforcement, I worked in the EMS field in some of the most challenged cities in New Jersey. Traumatic injuries were all too common, and we treated them with the best of our conventional training at the time. I was familiar with the tourniquet as a tool of last resort and confess that I never even considered it in my fight to save lives due to its reputation for significant damage to limbs and tissue and an increased risk of death. That perception was recently changed when my agency joined the ranks of others around the nation in an effort to deploy commercially available Combat Application Tourniquets (C-A-T) to every police officer. The training was simple, the delivery was clear, and the officers in my agency immediately saw the value of carrying the devices. Within a few days, we had the first use of the device when we stopped an assault victim from hemorrhaging after a knife attack, and we now consider the C-A-T a critical piece of equipment. The value of the program is clear with unknown numbers of people saved each year through the deployment of these live-saving tools. In fact, since deploying tourniquets as part of a self-aid/buddy-aid (SABA) program in 2013, the Tuscan, Arizona police department reported that over 50 civilian lives had been saved.
These success stories and the thousands more taking place every day were born out of sacrifice. In the early 2000’s, as our armed forces deployed to conflicts in Iraq and Afghanistan, roadside bombs and improvised explosive devices began to inflict terrible injuries upon our brave servicemen and women. As those injuries disproportionately affected external limbs, tourniquets began to be deployed to stop hemorrhaging and save lives. Medical researchers from the U.S. Army Institute of Surgical Research were presented with a unique opportunity to study the effects that tourniquets had on everything from survival rates to collateral damage and discovered that a century of conventional wisdom did not ring true. Despite years of believing that tourniquets should only be used as the last resort, the research showed that they could safely stop blood loss with minimal adverse effects, thereby greatly increasing the number of soldiers who would survive beyond arrival at the first aid station. As a result of that extensive research, C-A-T’s became a standard tool used to save lives throughout the military and have now found their way into the world of the domestic emergency responders.
This story provides an excellent starting point for a discussion on the benefits and evolution of evidence-based practices and their applicability for policing. For centuries, the simple tourniquet had been ignored as a life saving tool based upon research results from the early 1900’s. Once a modern, rigorous evaluation was conducted however, we found that the technology had now evolved to the point where the tourniquet was once again an extremely viable piece of equipment. As a result of those studies, policy is beginning to change and more and more police agencies are successfully deploying C-A-T’s to save the lives of police officers and civilians. It strikes me that so many practices in policing fit this mold. Ingenious police officers will always improvise and find ways to achieve the mission, but without rigorous evaluation and study, we are doomed to continue using ineffective practices or risk not learning about those practices that work.
Those Boston first responders saved lives on their own, but we should ensure that we continue to evolve as a profession and learn from their efforts.
Stuart Greer is a Lieutenant with the Morristown (NJ) Police Department. His emergency services career began as an Emergency Medical Technician in the cities of Irvington and Newark before being selected for appointment as a Police Officer in 1998. During his time in uniform, he worked through every assignment in the Patrol Division including a foot post, bicycle patrol, traffic safety unit, and as a field-training officer. In his current assignment, Lieutenant Greer serves as the Commanding Officer of the Criminal Investigations Unit with direct responsibility for managing all Detectives, the Anti-Crime Unit, and the Property & Evidence Unit. In addition, he serves as Public Information Officer, Training Coordinator, and as an Internal Affairs Supervisor.
Lieutenant Greer earned a Bachelor of Arts degree in Justice Studies from the College of Saint Elizabeth (Morristown, NJ), a Master of Studies (MSt) in Applied Criminology and Police Management at the University of Cambridge (UK), and is currently working towards a Master of Public Administration at the Wagner School of Public Service at New York University. Lieutenant Greer is a founding member of the American Society of Evidence-Based Policing and currently serves on the Executive Board of the organization.