|Twenty-eight years ago the United States Special Operations Command collaborated with the Uniformed Services University on a biomedical research study that focused on the preventable causes of death on the battlefield and the way forward.|
The Commander of the Naval Special Warfare Command recognized the issues in combat casualty care after Operation Gothic Serpent (Black Hawk Down) spearheading the design of what we know today as the Tactical Combat Casualty Care guidelines widely practiced throughout all branches of the Department of Defense. Once adopted and battlefield proven, with alarming results, the Tactical Combat Casualty Care guidelines began working their way into the civilian public safety environment branded initially as Prehospital Trauma Life Support and now Tactical Emergency Casualty Care bridging the gap between battlefield and civilian tactical medicine. This bridge of education created a positive shift in preventable causes of deaths in the “field” for first responders but left one very important unanswered question, what about our K9 counterparts often injured in direct support of our tactical operations?
History Of The K9 Partner
In 1899 the first documented K9 training facility was located in Belgium and recognized as a world leader in canine training as the first and only site to provide this resource to all who sought it. In 1907 word traveled into New York and the Police Commissioner sent one of his top inspectors to observe and participate in the program making the New York Police Department the first to implement a training program in the United States. During the early years, the canine program was met with very little success ultimately making it a very short-lived program disbarring in 1918.
Between 1920 and 1940 canine partners and working dogs were unofficially used by private organizations and the military but were not revisited in the United States until after the Second World War when troops noticed England imbedded working dogs with their Units. In the mid-1950s what we know today as modern K9 programs began being readopted by law enforcement agencies throughout the United States.
Throughout the modernization of canine corps and the integration into the military and public safety setting training became longer and more dedicated to specific skills and duties held by the K9 partner such as narcotics, explosives, search and rescue, etc. with more one on one training between the handler and officer to create a lasting partnership between the two. Where we seem to have fallen short with training throughout history is the avenue of medical care for our K9 counterparts relying heavily on the hospital staff and local veterinarians to be available in the event something goes wrong.
In 2014 a working group was established with the intent of creating prehospital emergency care guidelines for K9s who become injured in the line of duty. The mission of the working group was not only to establish these guidelines but to educate the public on the need for standardized guidelines and education by all rescuers. While still not mandated for our K9 partners we owe it to them as responders and handlers to know how to render aid to them in the event they are injured while performing their duties.
Tactical Emergency Casualty Care for the Operational K9
In 2014 the K9 Tactical Emergency Casualty Care (K9 TECC) was established with the same principle background and viewpoints as the Committee for Tactical Emergency Casualty Care (C-TECC) and the Committee on Tactical Combat Casualty Care (CoTCCC) with the key difference being the type of patient the guidelines would cover. The K9 TECC initiative sought to raise awareness and develop an evidence-based approach to prehospital care for Operational K9s who become injured while performing their duties. As with C-TECC and CoTCCC, the K9 TECC initiative focused on the major preventable causes of death adopting and incorporating the phase of care model for immediate treatment of the Operational K9 (OpK9). This model is broken down into the three distinct phases of care: Direct Threat Care (DTC)/Hot Zone Care, Indirect Threat Care (ITC)/Warm Zone Care, and Evacuation (EVAC)/Cold Zone Care that mirror the guidelines produced by the human counterpart committees. Each phase suggests interventions and lessons learned based on the specific operation and tactical environment the OpK9 and Handler will find themselves in.
It is important to understand that the K9 TECC guidelines are established in the phase of care model to allow for any first responder to be able to undergo and understand this training, regardless of the amount of previous medical experience and skills held. The care guidelines are formatted in a way that various members of the team, first responding medical units, handlers, and others who may be involved in the OpK9’s care can function independently and stabilize the injured K9 until evacuation to a specialist can be accomplished. These phases of care and interventions can be practiced in almost any training scenario involving the OpK9 through the implementation of all hazards approach training scenarios and should be conducted outside of formal training regularly to ensure muscle memory for all providers and K9s.
When the time arrives that a K9 is injured in the line of duty the working group has established an acronym to assist the responder through their primary assessment. The acronym is M3-A-R-C-H2-P-A-W-S and it stands for:
*DIRECT THREAT CARE/HOT ZONE CARE*
- Move (Get off the “X” or out of the kill zone)
- Massive Hemorrhage: Direct Pressure or K9 Tourniquet
*INDIRECT THREAT CARE/WARM ZONE CARE*
- Massive Hemorrhage (Recheck and addressing unfound wounds) *should be done after any movement*
- Airway Management: Position head and advanced procedures
- Respiration: Chest Seal and Needle Decompression
- Circulation: Recheck for major bleeds and assess/address shock
- Head Injury
*EVACUATION/COLD ZONE CARE*
- Reassess M-A-R-C-H2
The initial phase of care known as the Direct Threat or Hot Zone is the medical treatment rendered to the K9 while the hostile threat is still present and can cause further injury to the OpK9. Treatment in this phase of care is very limited and rapidly changing depending on the tactical situation at hand and generally involves very little or no medical treatment. The goal in this phase is to keep all personnel safe and remove the injured from the hostile environment as quickly as possible along with stopping any life-threatening hemorrhage that may be visible. Equipment on hand is limited to what is carried either by the handler or the K9 on their kit and is generally referred to as an individual first aid kit (IFAK). The IFAK will vary by manufacturer but will carry tools essential in applying rapid lifesaving interventions in a compact pouch. Often during this phase of care, the best medicine is rapid extrication and tactical superiority, other interventions should be withheld until the warm zone or until the tactical advantage is gained.
The second phase of care begins once the provider and injured are rendered safe from the active threat in the area whether by threat elimination or movement to a safe environment. An important fact to remember about this phase is that it can return to the Direct Threat phase at any moment and the provider should be aware that treatment may have to be altered to ensure the safety of themselves and their casualty. Treatment during this phase is less limited than the first as the environment is much safer and equipment is not as limited as in the DTC environment. When providers have transitioned into this phase of care this is considered to be the time where they “make their money” when it comes to interventions and providing life-saving care to their casualties.
Once the provider is ready to evacuate the patient from the operational environment and to a higher level of specialty care they can begin their transition into the Evacuation or Cold Zone phase of care. This phase is situationally dependent and contains many variables that factor into the care rendered however, regardless of the variables the goal is still the same; ensure the casualty reaches the highest level of care as safely and quickly as possible. Medical treatments rendered during this phase are in preparation to transport the casualty and range from minor interventions that are not considered life-threatening but still important such as medications and splinting of fractures to vital signs and documentation. Remember, do not delay evacuation for treatments that can be rendered throughout the evacuation process!
K9 TECC Training and Advocacy
For years we have focused on the need for medical training geared towards the operational environment that can be delivered, understood and performed by any level of the first responder but have failed to consider our K9 counterparts when determining the answer. Prehospital providers receive no formal education when it comes to providing care for a K9 and very few formal classes are available, in the past we have relied heavily on transporting the injured as fast as possible to a local veterinarian who had an agreement with an agency and that has ultimately resulted in the loss of OpK9s from causes of death which can be prevented very easily through basic skills learned in a formal course and practiced during in-service training.
In 2021 we are starting to see more formal training spearheaded by private organizations to bridge the gap between the point of injury and definitive care for K9s along with customization and modernization of equipment tailored specifically to the K9.
My career in public safety has now run over 10 years and where we are today versus where we were in 2010 regarding K9 care is tremendous but I do believe we are still falling short in this area and we owe it to our K9 counterparts, our brothers and sisters, to continue to advance and advocate for more formal training for Emergency Medical professionals — in and out of hospital — and the development of more K9 point of injury equipment. In South Carolina, a Firefighter/Paramedic has led the initiative by developing formal training and protocols for Op9s. Shane Himes has worked with many local veterinarians, the Bureau of Emergency Medical Services in South Carolina, and Valkyrie Tactical Solutions to make a tangible product that will hopefully become the first prehospital protocols and formal training course for EMS in the State of South Carolina. I have had the pleasure of calling Shane a counterpart, coworker, and brother for many years now and encourage anyone who may have the opportunity to use K9 TECC to become the voice of advocacy in your department!