POLICE Magazine

SEP 2018

Magazine for police and law enforcement

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10 SPECIAL REPORT H ACTIVE SHOOTER RESPONSE What you can do for the victims at the scene depends on your level of medical knowledge, your skill at treating trauma patients, and the tools available to you. But there are some relatively simple things tacti- cal medics can do with basic first- aid gear that can and will save lives. Hemostatic Bandages and Tour- niquets—If the blood flow is under pressure such as in a femoral artery wound, the normal clotting mecha- nism fails to stop the bleeding and the victim can bleed to death within a few minutes. Bleeding in the chest, pelvis, and abdomen is impossible to detect in the field and can result in a large amount of blood loss. Once the blood loss exceeds about 40% of the total blood volume, which is about five liters, an irreversible shock state begins and the victim dies. ere currently are many blood- clotting hemostatic bandages and tourniquet styles on the market. Readers are strongly urged to care- fully conduct their own investiga- tion to determine what is best for their agency. Recognizing and Treating the Sucking Chest Wound—One of the most serious of all penetrating chest injuries occurs when a bullet or a piece of shrapnel rips open a hole in the chest wall, entering the lung, causing it to collapse. e victim gasps for air, has extreme difficulty breathing, and frothy blood often bubbles from the wound. is is the sucking chest wound, and if not rec- ognized and treated promptly the victim will most certainly die. In this type of injury the chest cavity is no longer a sealed system and unrestricted air is allowed to rush through the wound in the chest wall and into the chest cavity during inhalation. is now-posi- tive intra-thoracic pressure system causes the lung on the affected side to collapse. Unless the hole in the chest wall is patched the lung is un- able to re-expand. e untreated collapsed lung re- sults in lack of oxygen in the blood and rapidly leads to loss of con- sciousness and coma. More bad things begin to happen with the shifting of the great vessels to the opposite side of the injury. Moments later, things get even worse when this pressure kinks off the large blood vessels returning all of the body's blood to the heart, resulting in decreased blood flow to the heart. After a few minutes the heart no longer pumps enough oxygenated blood, the body goes into irrevers- ible shock, and the victim dies. Sucking chest wounds require an immediate occlusive dressing or a commercially available vented quickly will save the victim's life. You could use a Ziploc sandwich bag, a large candy wrapper, or a piece of a plastic trash bag. A credit or ID card would even work once taped into place. Actually, any air- tight material will work quite well. Even with these interventions it is possible for the victim suffering from a sucking chest wound to de- velop a tension pneumothorax. is is another life threatening emergen- cy, and it will need to be released. Recognizing and Treating Ten- sion Pneumothorax—After pen- etrating trauma to the chest, air becomes trapped between the chest wall and the lung, otherwise known as a tension pneumothorax. A ten- sion pneumothorax is believed to cause about one-third of combat deaths from penetrating injuries to the chest. ese deaths can be re- duced or prevented with immediate recognition and treatment. e air escapes from the torn or lacerated lung and moves into the area between the chest wall and the lung called the pleural space. A major problem begins when the air cannot return to the lung and with each breath more and more air ac- cumulates in the pleural space. Essentially what has happened is the creation of a one-way-valve ef- fect. Progressive build-up of air pres- sure in the pleural space pushes the heart and the major blood vessels ex- iting and entering the heart to the op- posite side of the chest and obstructs TREATING the Victims TACTICAL MEDICS IN ACTIVE SHOOTER RESPONSE chest seal. Over the years there have been many suggested field expedi- ent dressings such as aluminum foil, duct tape, cellophane wrap- pers, and Vaseline gauze. In the real world it is probably most likely that when the moment arrives you will not have all your medical gear with you and a field expedient occlusive dressing will have to be improvised. Your ability to think and act Packing an abdominal wound on scene can stop a victim's bleeding until more advanced medical care is available. For severely injured victims to survive they need to get to a trauma center or other medical facility for surgery by any means necessary. PHOTOS: LAWRENCE HEISKELL

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