By Dennis R. Krebs
On a cold night only weeks before Christmas, a Baltimore police officer and his colleagues approached a suspicious vehicle. Shots rang out and the officer was struck in the abdomen. Bleeding heavily, he was hurriedly placed in the rear seat of a patrol vehicle and transported to a local hospital and trauma facility less than five miles away.
Similarly, Dallas officers were quickly transported to medical facilities in patrol vehicles when they were ambushed during a demonstration. Dallas Fire Department medics were unable to approach the scene due to active gunfire.
The number of officers shot has skyrocketed this year. In many cases, the downed officers were transported to medical facilities in departmental vehicles.
Rapid response
When an officer is severely injured, whether by gunfire or some other mechanism, decisions must be made expeditiously. Following our immediate attempts at emergency care – bleeding control and securing an airway – we quickly arrive at the point where the injured must be transported to the hospital. Generally, there are three modes of transport available: EMS, aviation or patrol vehicle.
In many cases, EMS is dispatched to the scene and the injured officer is transported to the most appropriate medical facility. Having those well-trained professionals, whether fully paid or volunteer, providing care to a critically injured officer is always the best option. However, EMS is frequently taxed with large call volumes and the ETA to the scene may be extended due to a lack of available units.
In some circumstances, the officer transported in a departmental vehicle may arrive at the hospital prior to an EMS unit’s anticipated arrival at the scene. Rural areas may be serviced by volunteer fire and EMS that are widely dispersed. In these situations LEOs might consider transporting in a patrol vehicle and rendezvousing with an EMS unit somewhere along the route to the hospital. Both the law enforcement and fire/EMS communication centers will need to coordinate the handoff.
Planning ahead
Events such as raids, where EMS or tactical medics are unavailable, allow time for planning which medical facility will be utilized in the event of an injury. Officers should also determine which vehicle will be utilized to transport an injured officer. The raid van is often the most appropriate choice. The driver of that vehicle should be aware of their responsibilities. In an emergency, the driver of the makeshift ambulance should be readily available with the keys to the unit in hand.
Figure 1 – A special operations mission in a rural area necessitated using a minivan as the transport unit. (Photo/Maryland State Police)
In addition, they should have the quickest route to the hospital already entered into a GPS or committed to memory. All officers should be acutely familiar with routes to hospitals from anywhere in their patrol districts. Variations for traffic conditions and time of day must also be anticipated. In addition, officers should be familiar with which medical facilities in their area are designated as trauma facilities.
All hospitals are not created equal. A 25-bed facility in rural Montana will not be as efficient at treating a gunshot wound as a trauma center in a major city. Although any medical facility should be capable of assisting with bleeding control and airway management, the injured officer may need a higher echelon of care that will only be available at the nearest trauma center. If the decision is made to run to a local hospital, have the communication center notify the facility you are on your way. Hospital staff can be prepared for your arrival and have a bed waiting at the emergency room doors. Provide communications with whatever patient information is available to include whether the officer is conscious, breathing, and if bleeding is controlled. In addition, provide the type of injury (gunshot, stabbing, or blast injury) and where it is located (head, chest, abdomen, extremity). Communications should forward all of the available information to the hospital where the officer is being transported.
Aviation assets
Rotor-wing aircraft have become a mainstay of rapid transport for the critically injured to trauma care facilities. Many police department aviation units perform a dual-role as law enforcement and medical transport. If the aviation asset is overhead performing their law enforcement role when an officer is severely injured, they can quickly land and switch to their medical transport responsibility.
Departments with single-role aviation units should determine whether they will transport one of their own when needed. If that asset is already on scene conducting a search for a suspect when an officer is shot, does it make sense to wait on another aviation asset with a longer ETA to the scene? Although some aircraft are small and space is at a premium, the rear seat of a patrol vehicle is equally, if not more, cramped.
Using a patrol unit
The decision is quickly made to place your injured partner into a patrol unit and race toward the hospital five miles away. The actual function of getting a wounded, near unconscious person into the rear seat of a cramped vehicle is not as easy as it may seem.
Figure 2 – Cramped rear seat of cage car. (Photo/Maryland State Police)
Many of us remember the image of four LEOs carrying an injured person from Norris Hall during the Virginia Tech massacre. When things go horribly wrong we may not have the luxury of utilizing four people to carry one of our own. Two officers should be capable of moving one of their downed partners.
The process begins with one officer kneeling behind the injured officer and reaching under their arms and grasping the wrists.
Figure 3 – One officer reaches under the arms and grasps wrists. (Photo/Maryland State Police)
An unconscious person’s body becomes totally limp. Merely grabbing the person under the arms will cause the arms to fly upward, increasing the probability of you dropping the injured party. Ensure you grab the wrists and control the upper body. This maneuver alone will allow you to drag an injured officer short distances. For longer distances, a second officer will place themselves between the injured officer’s legs facing their feet. Reach beneath the injured officer’s knees – not their ankles – and lift.
Figure 4 – The second officer reaches under the knees and lifts. (Photo/Maryland State Police)
Actually placing the injured officer in a patrol vehicle can be challenging; cage cars often have cramped rear seats and SUVs are high off of the ground. When the two officers carrying the injured approach the patrol unit, the person at the feet should step out from between the legs and place them on the seat of the vehicle.
Figure 5 – Place the injured officer’s legs on the rear seat of the unit. (Photo/Maryland State Police)
They will then enter the unit from the opposite side, grab the injured officer’s legs and pull them into the rear seat.
Figure 6 – An officer grabs the injured person’s legs and pulls them into the patrol vehicle. (Photo/Maryland State Police)
The other officer maintains control of the upper body.
Once the injured officer is completely inside of the transporting patrol vehicle they should be positioned on their left side.
Figure 7 – Injured officer is rolled onto their left side to facilitate drainage of fluid. (Photo/Maryland State Police)
A large concern for any internal injury is blood accumulation in the airway. If not corrected the patient could drown on their own bodily fluid. Positioning the injured person on their left side allows for drainage of those substances.
If there is any room available, get someone else in the rear seat with the injured officer. Again, this will be a challenge with cage cars. While in transit they can continually assess the injured officer and provide updates to the communication center. Most importantly, they can provide emotional support. Talk to the injured officer. Tell them they will survive. Even if they are perceived to be unconscious that supportive voice will provide needed encouragement.
The current threats are on every officer’s mind; each wanting to end their tour of duty and return home safely. One of the last things many officers want to discuss is one of their own being hurt or killed. Remember, having trained medics arrive on-scene to provide good medical care and transport to a trauma center remains your first option. Yet, we know that training for the worst can enhance our ability to efficiently deal with emergent situations. At roll-call, run through the scenario; see the complications of this means of transport first hand.
The only wrong answer in these situations is doing nothing.
About the Author
Captain Dennis R. Krebs (ret.): Dennis is retired from the Baltimore County Fire Department and former tactical medic with the Johns Hopkins Center for Law Enforcement Medicine. He is also the author of When Violence Erupts, A Survival Guide for Emergency Responders, and the Special Operations Mission Planning Guide.