At the outset of this article, it is imperative to state that this author has no inside information, other than what has been made public in the press, with regards to the nature of the wounds suffered during the June 14th mass shooting at the Republican congressional baseball practice in Alexandria, Virginia, nor with regards to the treatment provided to the victims at the scene of the shooting.

As reported by news outlets, at 7:09 AM local time on June 14th, James Hodgkinson opened fire on the GOP baseball team as it practiced, firing over 50 rounds from a 7.62 caliber rifle (possibly an SKS) as well as a 9 mm handgun.  Two Capitol police officers — David Bailey and Crystal Griner — were wounded, as was Tyson Food lobbyist Matt Mika, congressional staffer Zach Barth, and U.S. Congressman Steve Scalise.

All of the victims suffered gunshot wounds to various locations on their bodies.  The shooter himself was killed by either the Capitol police officers or quickly-arriving Alexandria police officers, or a combination of both.

It is critical for the purposes of studying how to respond to these types of events — both tactically and medically — that the details are eventually released to the public, in some form and at a point deemed appropriate commensurate with the ongoing investigation.  Some details have already been released, including details of the actions on scene, and on the condition and wounding of various victims.  We should applaud the release of those details so far.

Military, fire, medical, and law enforcement professionals need to see descriptions of the wounds. They need to hear what treatments were provided in the field, during transport, and at the hospital.  They also need to be made aware of the medical outcomes that resulted.  Only in this way can these professionals refine their tactics, techniques, and procedures, to better handle such events in the future and save as many lives as possible.

Given what we currently know, the gunshot wounds inflicted on the victims were in the chest (multiple rounds into Mika), the left hip (pelvic area of Scalise), the ankle of Griner, and the leg of Barth.  It was unclear where Bailey was injured.  We also know that, according to Senator Jeff Flake’s own firsthand account of the incident, the wounded Congressman Steve Scalise — shot in the hip — lay bleeding on the baseball field for ten minutes while police returned fire and tried to neutralize the shooter.  Others applied an improvised tourniquet to the leg of Barth.

The above is a classic example of a “care under fire” scenario within the Tactical Combat Casualty Care (TCCC) curriculum.  What that means is that you are presented with wounded personnel that need immediate life-saving interventions, but you are still taking hostile fire and thus the care you can provide to the wounded is very limited. 

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TCCC teaches that while taking hostile fire, the primary consideration must be returning fire, and neutralizing the threat so that you can minimize the risk of additional casualties.  At the same time, you must attempt to move friendly casualties, via drag or carry, to cover and concealment.  Only then should treatment be administered. 

In addition to “care under fire,” TCCC differentiates between two other phases of care in a combat setting: “tactical field care” and “tactical evacuation care.”  In the tactical field care phase, medical personnel and their casualties are no longer under effective hostile fire, and more extensive care can be provided.  In the tactical evacuation care phase, the victims have been loaded onto an evacuation platform.  In this case, it would be an ambulance.  Even more extensive treatments are possible at this time.

Responding to these kinds of casualty situations in a way that combines both good “battlefield” trauma care with good small unit tactics is the essence of TCCC.  As noted, Barth was reportedly shot in the leg and an improvised tourniquet was applied, per press accounts.  While this is the correct idea, both military and civilian experience has shown that high-quality, commercially manufactured tourniquets are more effective at stopping life-threatening extremity bleeding than improvised tourniquets.  TCCC teaches it this way, as well.

Additionally, if Congressman Scalise was suffering significant external hemorrhage from his hip wound, a hemostatic dressing should have been applied with direct pressure to the congressman’s wound, since bleeding from wounds in the hip region cannot be effectively stopped with tourniquets.

If we apply the tactics recommended by TCCC to the shooting in Alexandria, one police officer could have laid down covering fire while another moved the wounded congressman — who was in the open — to cover.  There the police and bystanders could have begun to immediately treat the wounded man.

Additionally, for the multiple gunshot wounds to the chest of Mika, a vented chest seal should have been applied to treat it, if the wound resulted in an open defect in Mika’s chest wall – a so-called “open pneumothorax.”  The vent is important to prevent the development of a tension pneumothorax (a more dangerous condition) in the victim.

In a perfect world, where everyone is trained in TCCC, knows their role, and performs it flawlessly, that is how it would work.  Of course, the world is not perfect, and there will always be mitigating circumstances.  The goal should be to come to as close to perfection as possible in order to save the most lives.

And let us be clear: the responding officers are heroes and performed heroically.  Full stop.  So did the others on scene who provided the best care they were able to, given the circumstances.  None of those facts are in dispute.  The police officers present, specifically, likely saved 15-20 lives by their heroic actions.

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Again, it should be noted, this author does not know what medical interventions or tactics were used on scene, and in what order, beyond what has been reported in the press.  We all know press accounts are not always 100 percent accurate, to say the least. 

This article is in no way a negative judgment on the actions of the courageous and capable Capitol police officers on scene who were the first to engage the shooter.  This author was not there, nor does he have a definitive account of what happened.  Nor does this author know if the Capitol police are trained in TCCC or similar protocols, and whether they used them on scene.

Rather, the point here is that if the Capitol police are not trained in TCCC, or a similar curriculum, then they should be.  Such training would facilitate optimal performance in a similar future incident, and enable officers to provide the best care to the victims on scene before additional medical help can arrive. 

TCCC training would also facilitate the officers’ ability to return effective fire while attempting to move victims to safety.  The last 15 years of war have provided lessons learned in trauma care that must be applied in the civilian sector as well.  At the start of the recent period of war almost no U.S. forces carried tourniquets and no one had hemostatic dressings.  In 2017, no U.S. military combatant goes onto the battlefield without these essential items.  Police should operate in the same way, given the world we live in today.

Serving as a Capitol police officer in today’s world makes it likely that one will be faced with a situation requiring he or she to respond to an active threat and treat casualties in a virtual civilian war zone.  That is to say, during such an event one can expect multiple casualties, a continuous exchange of fire, and possible blast and/or blade injuries.  The Alexandria baseball field shooting is a perfect case in point.  Sadly, we can probably expect to witness more of these types of events in the future.

Again, just as this author does not know if the Capitol police on scene had received TCCC training, nor does he know if they were carrying Individual First Aid Kits (IFAKs), as many civilian police officers currently do throughout the United States.  If they do not, then they should, and those kits should include tourniquets, hemostatic dressings, chest seals, and other essential trauma equipment.  This will undoubtedly save lives.

Furthermore, the details of these repeated mass shooting events should be widely disseminated, and not hidden under the veil of an official investigation.  Such details can provide first responder and law enforcement professionals the opportunity to better refine the methods they will use to respond to them.  The details cannot be lost to secrecy or privacy as their examination is the only way that we can more effectively improve our response, and attempt to minimize the damage done in these terrible events.

(Photo courtesy of CNN)