Year: 2009

Christmas is almost here, and soon we will be bidding goodbye to 2009. Good riddance, I might say, given the events that have transpired in the past year. I am reminded of the ancient Chinese curse: "May you live in interesting times".

For we are, indeed, living in interesting times. In 2009 we’ve seen the United States federal deficit increase exponentially as a runaway tax-and-spend Congress has plunged us into unprecedented debt. We have seen our economy teeter on the brink of collapse (and some say we’re still teetering…). We have watched as Korea and Iran race to develop nuclear weapons and delivery systems while our do-nothing President apologizes to the World for the "bad behavior" of the United States. And that same President somehow managed to nearly-simultanously escalate the war in Afghanistan and collect a Nobel Peace Prize.

Pandemic H1N1 Influenza ran amok in 2009, causing more panic than anything else, although the death toll was not insignificant. The federal government is about to take over the health care system in the United States; given the government’s record of creating runaway bureaucracies such as the Veterans Administration and the Social Security Administration (either of which could be the poster child for poor service and rampant inefficiency) I am gravely pessimistic about the future of health care in America.

But amid all this gloom and doom, I have to admit there have been some great moments for me in 2009. Despite tight training budgets, we were able to conduct almost as many Tactical Anatomy classes in 2009 as we did in 2008. More cops attended TAS courses in 2009 on their own dime than in any previous year, which tells me two things: first, that this training is needed in the law enforcement community, and second, that there are a lot of dedicated trainers out there who will stop at nothing to make sure their people get the best training they can find. To all those dedicated instructors, I want to say thank you, and don’t give up doing what you do. Officers’ lives depend on you.

I wish all of you a very Merry Christmas, and a happy and safe New Year. Here’s hoping 2010 turns out to be a great year.

Several people have contacted me to let me know that they are having problems registering for the November "Shooting With Xray Vision" class and/or the "Tactical Treatment of Gunshot Wounds" class to be held in the first week of November at Nashville.

I am at a loss to explain these problems, as some folks have registered with no difficulty at all. It may be a server-to-server communication problem, and my webmaster is looking into it.

If anyone is having difficulty using the website registration, you can mail your information (name, email address, snailmail address, telephone number, and agency, along with a check or money order for your tuition to: Tactical Anatomy Systems LLC, P.O. Box 183, Ripon, WI, 54971. I will email confirmation of receipt of your registration when I get it.

Doc

I recently conducted a TAS "Shooting With Xray Vision for Civilians" class in Saukville, WI. Attendance was sparse (something a lot of independent instructors have been noting during the current economic downturn) but a surprisingly large number of cops were in attendance. Because of the small class size, we had a very interactive time together, with plenty of Q&A and discussion around the room. We’ll be holding another one of these classes in the New Year, again in Saukville.

I am in discussions with a top-drawer trainer who works for a federal agency and is a first-rate instructor at one of our nation’s finest independent training facilities… regarding the possibility of conducting a 2-day Tactical Treatment of Gunshot Wounds class in the Milwaukee area. If it comes together, we will be opening the class up to local LE personnel to fill a maximum class size of 25. This class is designed primarily for tactical team/SWAT operators who want to know more about how to effectively treat trauma in the tactical (hot zone) environment.

Communications:  we’ve added a lot of new members to this site in the past few weeks, which is great. Unfortunately, I have not been able to notify several of you that your membership/login has been activated because your agency email addresses are spam-blocking my emails. I suggest that anyone registering with tacticalanatomy.com use a non-agency email address when they register.

Again, too much time has passed since my last blog entry. The past 6 weeks has been a blur of conferences, training, and work. Not to mention the fact that when I’m home I’m burning the candle at both ends trying to get my house in shape to sell (a real challenge in our current soft economy, stimulus packages or not!).

You know how things seem to cluster together? In the ER, that’s just a given… some days are "suture/laceration" day, or "chest pain" day, or "gunshot wound" day. But I experienced an unusual "topic cluster" over the past 6 weeks that has really got me wondering.

The topic that’s clustering for me is this: how should we be training and implementing SWAT/tactical medics in America?

Example:  the active-killer situation that took place at the Van Maur department store in Omaha in December of 2007. At least one GSW victim was still alive when police officers deployed inside the "kill zone" (the active killer has already taken his own life, but LEOs could not possibly know that, of course). Emergency Medical Services personnel were forbidden by their protocols to enter the perimeter until the scene was declared "secure", however, so these victims were not extricated in anything resembling a timely fashion. This wasn’t the fault of the EMS protocols, nor of the officers on the scene. But the situation highlighted the nature of the problem, and the terrible cost of our failure to address the issue.

I am aware of many other less-publicized situations where patrol officers, SWAT officers, or civilians were trapped in the "kill zone" with life-threatening injuries but were not extricated. SWAT officers are at the scene to fight, not render medical aid. Paramedics are at the scene to render aid, not to fight. If either fails to execute their primary mission responsibility, a greater disaster could result. It’s crystal clear to me that what we need in every situation of this type is a third group of people: tactical medics.

The problem I’m finding is that there is no real consensus on what a tactical medic is, or what he should be able to do. And the more I dig into the issue, the more disturbed I become. But I probably need to backtrack to explain why I’m so disturbed.

As an ER physician, I am required to maintain my certification in various lifesaving protocols such as ACLS (Advanced Cardiac Life Support), ATLS (trauma), and so forth. This involves re-taking the standardized class and passing both written and practical examinations.  It wasn’t always this way, but over the past 50 years or so the medical profession has policed itself into adopting and regularly updating these standards of care. The benefit is manifest: anyone who needs ER care for their heart attack or traumatic injuries anywhere in America can be assured that the doc taking care of them has met a national standard. Because of these proven standards of care, your chances of dying from a heart attack or injuries sustained in a motor vehicle collision are a fraction of what they were in the 1960’s.

As the medical director of my county’s ambulance services, I am aware of similar national certification standards for EMT’s. Furthermore, we have national standards for fire & rescue, disaster preparedness, and so forth.

But when it comes to tactical medicine, things are a mess. And good people are dying because of it. So how do we clean this mess up? Well, I’ve got some ideas.

First thing: define the job/role of the tactical medic.  As far as I am concerned, the tac-medics’ role is a blend of basic EMT and basic LEO jobs. It should be to enter the perimeter of an unsecured zone, pick up the injured person, and scoot out of there. "Scoop and run", a time-honored term in EMS circles. They aren’t gonna start IV’s, do CPR, apply splints & bandages, although they might apply a tourniquet or clear a blocked airway… something that can be accomplished in seconds, not minutes. The tac-medic’s role is to get in and out of the hot zone with the patient and deliver him to fully-equipped paramedics outside the perimeter, who can then perform the critical life-saving maneuvers without being in danger of coming under fire. On the other hand, tac-medics shouldn’t be expected to take a place in the entry stack or to try to extricate personnel under direct fire. The tac-medic’s role is somewhere in the middle.

Second thing: define the skillsets needed by a tac-medic. A tac-medic doesn’t need to have advanced paramedic skills, nor does he need to have the tactical mindset and weapons skills of a SWAT operator. But he needs to have a little bit from both sides of the fence. A tac-medic needs to be tactically aware enough to enter a danger zone without needlessly endangering his life or that of others. Because tactical situations are incredibly fluid, the tac-medic needs to be armed and trained enough to deploy his armament in defense of his own life and that of his patient if circumstances dictate. And the tac-medic needs sufficient medical skills to perform rapid life-saving maneuvers as needed. That’s it.

I don’t know about you, but it seems to me that this does not require the creation of a new profession. We cross-train our SWAT team members in basic lifesaving first aid–what I call "battle-aid"–and I know many jurisdictions cross-train paramedics in tactis and firearms. What we need, then, is to agree upon a standard of training and performance that can be met by both LEOs and EMTs who have the motivation to take on this unique role.

In my admittedly biased view, a reputable national organization needs to pick this problem up and run with it. For example, the highly successful Advanced Trauma Life Support program  for doctors was developed and promoted by the American College of Surgeons. Perhaps a body such as the National Tactical Officers Association (NTOA) should consider taking on the tactical medicine problem in a similar fashion.  

The problem is complex due to the mult-jurisdictional nature of law enforcement, but if EMS and Fire & Rescue have managed to come up with national standardization for their professions, why can’t law enforcement do the same for tactical medics?

 

I must apologize to Members and other readers of this site for my inattention to the site of late. June has been a heavy month, with two major conferences to attend/speak at, as well as a lot of demands on my time at work. How is it that when the economy goes sour, people start doing more things that land them in my Emergency Department? Is it something akin to the full moon?

Inquiring minds want to know!!!

Anyways, enough whining… Today I was notified by my great friend Dr. Gary Roberts that I had been referenced on an internet gun forum. The writer, who has apparently taken one of my classes or heard one of my lectures, ascribed to me certain expertise in "terminal ballistics" that he felt superseded the ballistics testing done by the FBI.  I hastened to set the record straight… I have never claimed to know more than those jello junkies at the FBI ballistics labs!!! They do good work down there in Quantico, and better yet, they freely share it with the rest of us. 

But I must state explicitly here (as I do in all my classes) that I am NOT a terminal ballistics expert, nor do I do much terminal ballistics testing myself. I rely heavily on the bench testing done by people like Dr. Gary Roberts in this area. My expertise is much more in the area of terminal effects, i.e., showing people what the anticipated effects of their well-targeted rounds might be. As such I train people where to shoot the bad guys, and via my trauma medicine background, what kinds of effects one can expect when a person is shot in one of the major zones of incapacitation.

The problem, as you may be aware if you’ve attended one of my classes, is that in gunfights our opponents rarely stand up to us foursquare with their guns at the hip and let us shoot them in the high mediastinum. In many, many gunfights I have in my files, the offender presented LEOs with a bladed or crouching or some other contorted stance which bears no resemblance to qualification and training targets. Shot placement suffered accordingly as the LEOs in question had no training on these "non-traditional" presentations. As Dr. Roberts has so ably pointed out on many occasions, the problem your bullets have to solve may require much, much more than 12 inches of penetration.

Example: in the 1986 FBI Miami gunfight, bank robber and murderer Michael Platt shot Agent Ed Mireles in the right (dominant) forearm with a round of 5.56. This round shredded Mireles’ forearm and permanently disabled him. However, the bullet failed to penetrate through the arm and into Mireles’ torso. As such, Mireles was able to continue, using his nondominant hand with both his Remington 870 and his S&W revolver, and ultimately put the final bullets into Platt that finished the fight.

If Platt’s rifle had been loaded with a bonded-core or partition-style bullet designed for deep penetration even through intermediate barriers, Mireles likely would have been much more seriously injured, if not killed.

In my medical experience and in my big game hunting experience, penetration is a good thing. I have not been greatly impressed with the terminal effects (not to be confused with terminal ballistics, BTW) of most frangible rounds on human/live animal targets. Tthis does not include, of course, small varmint game such as prairie dogs and woodchucks. I have little faith in the incapacitating effect of any round’s temporary cavitation effect, whether it be a handgun or rifle–50 BMG being a possible exception. What counts in gunshot wounds is, quite simply, what vital organs has the bullet penetrated/perforated, and how catastrophically. On the other hand, I’ve not been impressed with the terminal effectiveness of the deep penetration afforded by our military 62 gr steel-tipped armor-penetrating ammo, which is too often a remote-control cordless drill.

The clear answer is that for general patrol/defensive rifle duty, we want a round that both expands well and penetrates deeply, while maintaining reliable functionality and accuracy. This is the ideal.

That being said, and no disrespect intended to any of the runners-up, my personal and professional 5.56 ammunition choices based on the recommendations of true experts like Dr. Roberts–and my own experience on live animals and tissue simulants–tend to run along the lines of Federal TRU 55/62gr bonded, Black Hills/Nosler Partition 65 gr, and Winchester JSP 64 gr. These rounds will defeat intermediate barriers and will penetrate deeply through tissue, and will work accurately in barrels from 1:7 through 1:10. All of these rounds have an excellent record in OIS’s over many, many years, and as such I have no reservation in recommending them.

I recently attended the annual conference of the International Law Enforcement Educators and Trainers Association (ILEETA) in Wheeling, IL. As it has been since I first attended in 2005, it was an outstanding meeting.

I had the privilege of sitting on the "Panel of Experts on Use of Deadly Force", moderated by Massad Ayoob. As usual, this was a lively discussion forum with a lot of good input from the panel and from the floor. One of the most interesting topics brought up was and update from Ron Borsch on his research into the features of "active killers".  Ron manages the South East Area Law Enforcement (SEALE) Regional Training Academy in Bedford, OH, and has been researching features of active killer incidents for a number of years.

Ron believes the "active shooter" term commonly used by the media and by law enforcement is inaccurate, pejorative and prejudicial against law-abiding firearms users, and potentially dangerous to law enforcement personnel. As he correctly points out, a law-abiding citizen shooting trap or punching holes in targets on his back 40 is an "active shooter": he is actively shooting, and doing so completely within the limits of the law! Ron quite reasonably argues that  the term "active shooter" needs to be replaced by "active killer", because the latter term conveys the essence of the deranged murderer and his actions in two succinct words. I agree. We need to get the message out to fellow LEOs and to the media that this terminology needs to change.

Borsch defines an active killer as a mass murderer (4 or more victims are intentionally murdered in the same episode and location) whose acts take place in no more than 20 minutes. This definition encompasses every active killer event since Charles Whitman’s rifle rampage at the University of Texas in 1966, and including the Columbine High School horror, among others. Borsch has analyzed almost 100 incidents. Borsch’s research shows that the modus operandi of active killers has remained consistent through time, and this knowledge has shaped his training for LEOs.

Borsch’s research reveals a number of critical features of active killers. First, they almost always act alone (98% of cases). Second, their primary objective is to produce as high a body count as possible in a short period of time; they commit as many as 8 murders/attempted murders per minute during their rampages. Borsch relates this high rate of killing in his metaphoric "stopwatch of death": the active killer knows that police will respond, and he has only minutes to cause as many deaths as possible. The active killer fears police, or in fact any form of armed resistance. When police or armed citizens show up, the active killer takes his own life in 90% of incidents. Active killers are "dynamic and quick" (average duration of attacks post-Columbine is less than 8 minutes), almost never take hostages, and they do not negotiate. In 80% of cases active killers have used long guns (rifles or shotguns), and 75% of active killers bring multiple firearms to the scene. 

Borsch has used his data to formulate a training program and policy template that encourages the first responding officers to an active killer call to make immediate entry to the location. As Borsch states, "The incident may well be over by the time police arrive. But with some of these subjects attempting as many as 8 murders a minute, we don’t have the luxury of waiting for backup before entering. These are extraordinary events that warrant an extraordinary response."

Borsch’s training emphasizes the first responding officer making rapid entry into the location, with weapon(s) out and ready for immediate deployment. The active killer is unlikely to return fire on police officers, but also is highly unlikely to respond positively to verbal warnings or to negotiate. Officers need to be prepared to shoot immediately when the subject is encountered. Since active killers are increasingly resorting to wearing body armor, responding officers should be aware that multiple upper torso/head shots may be required to stop the carnage. A patrol rifle/carbine or shotgun is the preferred LEO entry weapon.

Borsch cites the recent actions of officer Justin Garner, who earlier this year responded to an active killer call at a nursing home in North Carolina, as an exemplar. By the time Garner entered the building, the subject had murdered 7 elderly residents and a nurse in a matter of only a few minutes. Garner encountered the subject as he was reloading his shotgun. Garner terminated the encounter with one shot to the subject’s upper chest with his service sidearm.

Of significant note, Borsch’s study reveals that only 6 active killer incidents have been successfully terminated in progress by LEOs. Most successful terminations were the product of courageous action on the part of private citizens, most often unarmed. However, it should be noted that nearly every active killer incident on record in the USA has occurred in so-called "gun-free" or "zero weapons tolerance" zones such as shopping malls, office buildings, and schools. It should come as no surprise to most of us that these zones are highly attractive to the active killer, as he is more likely to be able to execute his high body count plan than he would be in, say, a police station or gunshop!

More on the absurdity of "gun-free" zones, particularly schools, to follow in my next blog article.

 

I’m sorry about the gaps in my blog entries so far this year… 2009 has been an extremely busy year for me on several fronts. In addition to my clinical duties in my ER–which have been greater than usual due to an ER doc shortage–I’ve had significant admin duties as ED Director, plus I’m trying to get a concussion assessment program implemented for our local schools’ athletic departments. That, in addition to some big changes at home, have kept me away from the computer.

I had to order a reprinting of the Tactical Anatomy Instructor Manual in February. This caused some delays in shipping to some of you, which I apologize for. Unfortunately, my office staff consists of me, myself, and I… and one of us failed to notice the dwindling inventory. But we have received the new books, and will re-commence shipping tomorrow, (3/16/09). Our inventory of Tactical Anatomy T-shirts also bottomed out in February. Re-printing of the t-shirts has been complicated by some minor design changes that needed to be made, which is going to delay availability until early April at the earliest. I ask anyone who has t-shirts on backorder to watch this blog page… I think I’ve got everyone’s orders safely tucked away in a file folder, but if you are backorder and don’t receive a shirt within a week of seeing the "available" announcement here, give me a shout.

I’m pleased to announce that I have been invited to join the Waupaca County Sheriff’s Department as Medical Officer and Special Deputy. Sheriff Brad Hardel and Chief Deputy Al Kraeger have asked me to provide training for the department in "Shooting With X-ray Vision", which I am eager to do. (I have this thing about making sure that the LEOs who patrol where I live/work are as highly trained as they can be.) I will also be joining WCSD’s SWAT team and providing them with battlefield medic training, as well as being available for SWAT call-outs. This means I’m going to have to purchase a hi-capacity .45 ACP sidearm to match the Department’s new SIGSAUER P220’s. Those of you who have shot with me know how much of a hardship it’s going to be for me to switch from .40 S&W to .45 Auto!  <evil grin>

Recent speaking engagements here in Wisconsin (including the semi-annual LEOTA meeting in Green Bay last month) have pushed me to try to schedule "Shooting With X-ray Vision" classes for both law enforcement and civilian personnel in the latter half of 2009. We will be offering a 2-day Advanced class for LEOs in conjunction with Milwaukee P.D. some time in the fall, and we may also run a 1-day Basic class at Milwaukee County Sheriff’s Department as well. After the success of the first Civilian class we held last November, there has been a groundswell of interest from civilians in Wisconsin, Iowa, and Illinois for another 1-day Civilian class. Timing is everything here, but I’m looking probably at early September for this class, to be held somewhere north or west of Chicago. Al Grossman of Tactical Shot Training will be hosting the class, and as soon as I have more information on where and when the class will be held, I’ll get the registration process set up here at tacticalanatomy.com.

Feedback on classes is vital, folks. Please email me with questions, or make comments here on the webpage if you want to see more training programs, etc. I’m open to suggestions.

 

Doc

 

Last week I had the opportunity to pay a visit to the Firearms Training Unit of the City of Milwaukee Police Department. I have had the privilege of working with Sgt. (newly promoted to Lieutenant) Jim "Mac" MacGillis and his instructor staff on a number of occasions over the past 4 years. All of the fulltime instructors have taken my Tactical Anatomy training, with four officers having completed my 2-day Advanced Instructor Development course last year.

Milwaukee PD’s officers have one of the best hit ratios of any large police department I am aware of. Moreover, their success rate in Officer-Involved Shootings (OIS) has been extremely positive (for the officers, anyway). Mac and his staff have used some innovative training methods to really ensure that MPD coppers can put their 180 gr Gold Dot Hollow Point bullets where they count. This training has involved the use of a great training/qualification target that encourages good shot placement in real life, effective use of the IES MILO computer simulator, shooter problem diagnostics programs, force on force training, and so on. This is one switched-on department when it comes to firearms training.

They’ve now developed a new inservice program for veteran officers that is strongly based on the 3D anatomic targeting skills contained in Tactical Anatomy Systems’  training. They’re using many of the Powerpoint slides from my Tactical Anatomy Instructor Manual, with some really good slides of their own making (that I intend to "borrow" for my upcoming talks at ILEETA and IALEFI!). Then they take to the firing range, where they’re using remote-controlled robotic movers with Tactical Ted-type 3D targets mounted on them. Mac and his staff run the trainees through progressively more difficult targeting problems, individually and as two-man "buddy teams" (see members-only section for more discussion of this).

"When they come in and see what we want them to do, most of our coppers are pretty nervous," Mac says. "But by the end of the training they know they can hit where it counts from any angle, on moving targets, and while moving themselves. They leave here with a huge boost of confidence in their ability with their handguns."

It’s a huge boost of confidence for me and for Tactical Anatomy Systems, too, because this marks the first time a metro police department has officially made Tactical Anatomy a major part of its firearms training program. I feel pretty good about this, as MPD’s adoption of my training means that by the end of the current training cycle every one of MPD’s patrol officers  will have learned 3D target organ visualization and will be able to put their bullets where they are critically needed when the fecal matter hits the rotating cooling device. Milwaukee’s excellent OIS record can only get better with this extra training. In fact, there has been one OIS by a TAS-trained MPD officer already, and it was an unqualified success: one shot at 40 feet ended the fight instantly and permanently.

Next week I am going back for a second visit, and I’m going to actually take the 4-hour block of training from Mac and his staff alongside the class of MPD officers. I’ll be posting photos and (hopefully) video of the training in the Members Only section.  

Tactical medicine has become a buzzword in the law enforcement community in the past few years… but like many new concepts, it means different things to different people. Depending on who you take the class from and where, the curriculum can vary enormously, and the quality of the instruction can be anything from cutting edge to dull and disinterested.

Tactical Anatomy Systems^TM is offering our basic (4-hr) Battlefield Trauma Care class in conjunction with our Advanced Instructor class in Nashville on March 11. This class was developed over several years taking into account my training and experience as a certified Emergency Physician, EMS Medical Director, and after taking the tactical medicine classes offered by colleagues around the country. I am not too pround to say that as a physician I have learned a huge amount of field medicine from guys with basic medic training who have had to use their training under enemy fire.

The terms "tactical medicine" and "tactical emergency medical services" bug me… I don’t think they really tell the listener/reader what the course or discipline is about. I like "battlefield trauma care" (BTC)  or "combat trauma care" because they speak to the crux of what most of us in the TEMS field are trying to do: train non-medical personnel how to do the necessary things to survive combat trauma during the firefight and immediately thereafter.

So what does Tactical Anatomy ‘s  BTC training consist of? To be honest, it depends on how much time you allot for training, and what the level of skill and training the class has going in. My most basic BTC class is a 4-hour block that covers the basic principles of field treatment of gunshot wounds, edged weapons wounds, and blast trauma, with hands-on practical exercises in using the basic survival tools that every soldier or cop should have on hand in a violent confrontation. If we have a more advanced group with more time, we’ll go into more advanced scenario-based training incorporating simulated wounds and simulated-fire and live-fire environments. 

The next scheduled Battlefield Trauma Care class (4-hr block) on our books will be held in Nashville on March 11, 2009. Tuition is $145 and includes a basic trauma kit for each trainee. Register by clicking the caddy button below and following the instructions (credit card), or if you wish to pay by check or department purchase order, contact me through the "Contact" button on this website and I’ll email you the info you need to sign up.  

{simplecaddy code=BTCNashville}

 

 

Anybody want to buy a Chrysler 300M Special Sport?