Casualty Care for Law Enforcement: Saving Lives

By: Peter Pons, MD | Posted on: Apr 21, 2016

Bleed control

With the experience gained as a direct result of participating in war and the sad but deadly events involving active shooter incidents resulting in multiple casualties, the Hartford Consensus Group published a series of statements advocating for improved, coordinated and integrated response to these incidents in order to optimize victim outcome, with the focus being the rapid control of external hemorrhage.1-3  In addition, on a daily basis, there are victims of traumatic injury from a wide variety of other causes. 

The Hartford consensus group recommended that, in order to optimize the response to an active shooter event or other medical mass casualty incident, a continuum of care needs to be implemented that involves participation from not only the traditional emergency medical services (EMS) responders, but also the law enforcement officers arriving to the scene (often before EMS) as well as uninjured “bystanders” who can potentially serve as “immediate” responders.

To meet the training needs required to accomplish this important goal, the PreHospital Trauma Life Support (PHTLS) Committee of the National Association of Emergency Medical Technicians (NAEMT) in cooperation with the EMS Education Department of the Denver Paramedic Division developed and offer courses that address the educational needs of these two potential responder groups.  The Tactical Casualty Care for Law Enforcement and First Responders (TCC-LEFR) course is a one day program aimed at public safety responders to teach the basics of trauma care and hemorrhage control while operating at a potentially hazardous incident.  The Bleeding Control for the Injured (BCon) program is a 2 hour course for the citizen immediate responder that teaches how to recognize life-threatening bleeding and what to do to stop hemorrhage in a trauma patient. 

The TCC-LEFR course has already demonstrated the value of this type of education.4  In Denver, where the course originated, care provided by responding police officers who have taken the course has saved the lives of at least 11 trauma victims, 5 of them being fellow police officers who sustained gunshot wounds in the line of duty and the remainder being civilian victims of traumatic injury. 

The real value of this type of education can be summed up, not only by the number of lives saved, but perhaps best by the words of a police officer who was shot in the line of duty, treated by another officer who controlled his life threatening arterial hemorrhage, and who later stated that the training in hemorrhage control clearly saved his life and allowed him to return to his family. 

Knowing how to stop bleeding needs to become as widely taught and accepted as doing cardiopulmonary resuscitation (CPR) and public access defibrillation both of which have resulted in victims of cardiac arrest going home to their families.  We should do no less for victims of traumatic injury.  As was stated at a recent meeting of the Hartford Consensus Group, “The only thing more tragic than a death, is a death that could have been prevented.” 


  1. Jacobs LM, McSwain NE, Rotondo MF, et al., on behalf of the Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events. Improving survival from active shooter events: the Hartford Consensus. J Trauma Acute Care Surg 2013;74:1399–400.
  2. Jacobs LM. Joint committee to create a national policy to enhance survivability from mass casualty shooting events: Hartford consensus II. J Am Coll Surg 2014;218:476–8.
  3. Jacobs LM,Wade D, McSwain NE, et al. Hartford Consensus: a call to action for THREAT, a medical disaster preparedness concept. J Am Coll Surg 2014;218:467–75.
  4. Pons PT, Jerome J, McMullen J, Manson J, Robinson J, Chapleau W. The Hartford Consensus on Active Shooters: Implementing the continuum of prehospital trauma response.  J Emerg Med 2015;49:878-885.