Rural officers need access to tactical medical training, and they need the support of their communities to get it. Regular citizens can play a major part in plugging the gap between living and dying in places far from backup, both literally and by applying positive pressure to help local leadership overcome resistance to lifesaving training.
Take this case, for example: In July 2016, a deputy was stabbed nearly a dozen times during a violent interaction on a remote Montana highway that ended when he finally killed his attacker. Solo patrol is standard outside of large urban departments, so he bled alone.
Two passersby happened on the scene and did their best to help. When backup arrived, the wounded officer was helped into a patrol car for the drive to the tiny, six-bed hospital in Malta (population 1915). There, the officer was stabilized and loaded onto a helicopter for the long flight to the nearest “big” hospital, in Great Falls.
The route to sophisticated trauma care looked a little like this, not counting the 30 miles or so to get to Malta in the first place:
A wounded officer in an urban setting can reasonably expect on-site aid from EMS or a SWAT medic, and transport to a Level I or II trauma center within minutes.
The evil flipside of all that empty beauty on a remote beat is that when rural officers get hurt, time and distance are the enemies of the Golden Hour. Add shortfalls in training and equipment, and both financial and cultural resistance to filling that gap, and rural officers are left to pay the price in blood.
A lack of training, equipment and leadership buy-in
Unlike the fire service, there are no nationwide safety standards for law enforcement, and it shows.
Kenneth Wise, a police chaplain and Tactical Combat Casualty Care/master SWAT instructor in Oklahoma, told me of a case that’s made the issue personal to him: a young officer who bled out from a gunshot wound on one of his first solo shifts.
“He had backup,” said Wise. “What neither officer had was a tourniquet or the knowledge to use it. Their department said it cost too much. It’s a liability, and there’s no reason for it. I’m trying to get as many rural officers as possible trained in this stuff.”
Wise went on to describe cultural obstacles that exacerbate financial constraints natural to small and rural agencies.
“The funding for some departments in this state is so low that IFAKs, tourniquets and training are out of the officer’s own pocket if they have them at all. What’s worse is resistance from chiefs and sheriffs who see that training as some sort of competition with their own officers, rather than as a resource. It’s leadership failure. They don’t want to admit ‘these things’ even happen in their communities. These are ‘Chicago problems’ or ‘New York problems, or ‘California problems’ – they’re not panhandle problems. That’s farmland. Can’t happen here. Except, it does.”
Bud Paine, director of Lifestar Rural EMS Solutions in Idaho, told me of similar barriers throughout his career in the intermountain west.
He develops interagency rescue task forces to blunt the adverse effects of distance for a medical response – including for SRT units dealing with risk in a rugged county bisected by a mountain range. Until his nonprofit began its work, officers had to wait for an air ambulance to access paramedic-level aid. But it hasn’t been easy.
“Many rural areas suffer from two distinct mindset flaws; that of, ‘that’s never happened here,’ and ‘that will never happen here.’ This has been directly responsible for unnecessary loss of life due to poor planning. The key is establishing cooperative training programs to enhance coordination,” said Paine. “In any rural area the county sheriffs in concert with county emergency managers, are responsible for all aspects that would affect establishing rescue task forces. Here in the west, that can often mean vast coverage areas, with limited resources and geographical challenges.”
Besides his decades of experience in fire and emergency medicine and dozens of certifications, Paine knows the personal cost of officers patrolling alone in remote places. A young EMT, Houston Largo, who worked with him in Arizona went on to become a Navajo Tribal Police Officer killed in the line of duty in 2017.
Paine, determined to fight for resources for his medics and the officers he works with, said, “The key is establishing cooperative training programs to enhance coordination. LEOs are naturally wary of working tactically with non-LEOs. Joint training allows parameters to be established so that all stakeholders are on the same page.”
Available solutions
Since the problem of accessing emergency medical help for rural officers seems so complex, I turned to EMS1 columnist Rob Lawrence, an expert in both civilian and military EMS. Is there any way to simplify this mess?
First, it turned out, I needed to understand the situation more clearly. Yes, time and distance are the enemies of the Golden Hour, and no, every problem cannot be solved with a helicopter.
Nevertheless, Lawrence explained, the Golden Hour isn’t the only consideration.
Some injuries are so grave that timely aid won’t make a difference. Most of the rest, especially penetrating wounds like stabbings and gunshot wounds, is what he described as “surgeon’s injuries”: you can’t fix them in the field, but you can buy a patient time to get to trauma care if you can just keep enough blood inside of them.
What’s required to make that happen given all the previously described obstacles?
First, the very basics: tourniquets and combat gauze carried by every officer, in the same place on every officer’s person, no excuses. Lawrence recommended that departments struggling with funding seek out grants to cover these baseline imperatives while more permanent solutions are worked out.
Second, training. It doesn’t have to be complicated to save a life, and it doesn’t have to be expensive.
FLETC offers exceptional training in tactical medical response for law enforcement and it’s free. They’ll even come to departments that can’t come to them; all they require is people and a place to hold the class. Again, no excuses.
If even that isn’t an option in the short term, Lawrence noted that Stop the Bleed classes are even more widely available, and also free. These have the added benefit of training for the general public.
To that end, Lawrence suggested developing a PSA explaining the basics of controlling bleeding and hands-only CPR for anyone within broadcast range. Remember the passersby who aided the deputy in Montana? Where officers work solo, with unreliable radio coverage, a passing logger or mail carrier is as likely to be first on scene as a professional first responder. Build the safety net wide, if you can’t make it deep.
Wise also remarked on the simplicity of the basics, saying that it was easier in some cases to get citizens to carry tourniquets than to get rural police departments to accept the idea.
“I have a 77-year-old farmer carrying one, and his 8-year-old grandbaby too. She wanted to know what I was teaching and grasped the idea in minutes. I gave her a tourniquet to carry, in case Big Pawpaw gets hurt.”
Farming is dangerous business, too.
Lastly, what about overcoming that cultural resistance?
Normalcy bias creates a powerful impediment to changing ideas and routines, with its smooth fiction of “those things never happen here.”
In this case, Lawrence advises taking a page from the firefighters’ book, saying “Firefighters are really, really good at getting what they need, whether it’s funding or changing laws. Unlike law enforcement, they don’t hesitate to say in plain language, ‘If you won’t do this one simple thing, people will die.’ It really is that clear. Law enforcement needs to get that message out. Just say it, just like that. People will die.”
For the lack of equipment and training, people will die. Cops have died. This isn’t a matter of finance and personnel, it’s a matter of life and death: a moral and ethical issue. Distance from backup and distance from trauma care are the perils of rural policing. The training and the equipment to make a difference already exist. It’s time to make sure access to them is the norm for rural officers, not the exception.
