An Introduction to K9 Tactical Emergency Casualty Care

The term operational K9s (OpK9s) refers to a distinct population of non-military federal and local law enforcement, force protection and SAR canines (aka K9s) that are placed in high-threat situations in support of various operations. Civilian OpK9s differ from military working dogs (MWDs) mainly due to the uniqueness that exists between a MWD operating under military-guided battlefield doctrine and a civilian law enforcement or SAR K9 serving in a noncombat, yet high-threat environment.

Some of the differences between the OpK9 and MWD include variances in the scope of practice and liability of medical providers; wounding patterns and prevalent mechanisms of injuries; available resources; and operational environment and associated hazards. Regardless the duty or discipline in which they are trained to perform, civilian OpK9s have, just like MWDs, repeatedly served as a force multiplier in the success of many noncombat (i.e., law enforcement, SAR and humanitarian) and combat (i.e., military) missions.

Ongoing military operations, escalating active shooter and terrorist events, and natural disasters have led to a significant increase in demand for these elite K9 operators throughout the world. Unfortunately, the increased utilization of OpK9s in tactical and high-threat environments has brought about an increased risk for line-of-duty injuries and deaths. As of May 2016, the K9 Officer Down Memorial Page (ODMP; www.odmp.org/k9) reported 12 LODDs for operational K9s in 2016; there were 26 in 2015. The OpK9 deaths for 2016 came from gunfire (6), being struck by vehicles (3), stabbing, drowning and asphyxiation (1 each).

Unfortunately these are just a few of the OpK9 deaths that have been reported on the K9 ODMP; there are more likely additional LODDs not recorded by the page.

Care in High-Threat Situations

Over the past couple of decades, casualty care for human tactical operators injured in high-threat environments has undergone a major paradigm shift.

On the military side, the implementation of Tactical Combat Casualty Care (TCCC) principles has been the most influential intervention for reducing fatality rates. For the civilian tactical, high-threat environment, escalating active shooter and terrorist events have fostered the emergence of tactical EMS (TEMS).

In 2010 the Committee for Tactical Emergency Casualty Care was formed with the intent of modifying military-doctrine TCCC principles learned from the battlefield into a set of best practice recommendations that could accommodate the operational and situational needs of the civilian law enforcement and TEMS community. These new principles became known as Tactical Emergency Casualty Care (TECC) and are available on the C-TECC website (www.c-tecc.org). Since its inaugural meeting in May 2011, C-TECC has made tremendous strides toward improving casualty care and prehospital survival rates for civilian high-risk situations.

Despite the impact OpK9s provide in safeguarding our society’s freedoms, large gaps in veterinary and K9 prehospital trauma care (e.g., standardized guidelines, funding, training, logistical resources, research, etc.) remain a challenge. In general, veterinary-specific out-of-hospital emergency medical services are not readily available for small animals. For the OpK9 in particular, licensed veterinary personnel do not often deploy as part of TEMS or SAR teams during high-threat situations. The implementation of human EMS services for injured OpK9s is hindered by issues such as EMS statutes regarding scope of practice as well as language in each state’s veterinary practice act (VPA) that defines the requirements for practicing veterinary medicine.

As a result, out-of-hospital point-of-injury care for these injured OpK9s remains grossly lacking. Often first responder care for injured OpK9s falls to the K9 handler or human TEMS medic. Unfortunately, few K9 handlers or EMS providers receive any training in even basic K9 first aid or trauma care. This lack of readily available on-scene veterinary care, in conjunction with the high prospect for sustaining life-threatening trauma, undoubtedly places OpK9s at higher risk for succumbing to their injuries.

Standardized Care

Another major gap hindering appropriate prehospital care for injured OpK9s was, until recently, the lack of standardized veterinary prehospital trauma care guidelines. Evidence in humans has shown that standardized trauma care guidelines are associated with improved survival and decreased complication rates. Even MWDs benefit from having the Department of Defense MWD Veterinary Service serve as an overarching entity for standardizing veterinary care protocols throughout the Armed Forces.

However, civilian OpK9s do not have one all-encompassing entity for developing or standardizing casualty field care. Instead, each individual civilian K9 unit and TEMS organization is left to develop and implement their own procedures and templates for training and providing care for the OpK9s they support. This lack of collaboration and unification for standardizing K9 tactical casualty care restricts the ability to develop best practice guidelines and jeopardizes the welfare of OpK9s injured in the line of duty. Although no current data evaluates the impact of standardized versus nonstandardized prehospital guidelines in veterinary medicine, it would seem reasonable that, similar to the human experience, standardization would result in improved survival rates for OpK9s.

The need for standardized prehospital guidelines applicable to the civilian OpK9 environment has fostered two major initiatives: the American College of Veterinary Emergency and Critical Care’s Veterinary Committee on Trauma (VetCOT) Best Practice Recommendations for Prehospital Veterinary Care of Dogs and Cats and the K9 Tactical Emergency Casualty Care (K9 TECC) working group.

In the March 2016 edition of the Journal of Veterinary Emergency and Critical Care, VetCOT’s Prehospital Subcommittee published its best practice recommendations for provision of prehospital care for companion dogs and cats. These are intended to be used by both paramedical and nonparamedical personnel primarily operating in nontactical environments. They are available for free at https://onlinelibrary.wiley.com/doi/10.1111/vec.12455/pdf. Although some consideration for the OpK9 is provided in VetCOT’s prehospital guidelines, they were not necessarily intended to take into account the constraints of providing prehospital care during a high-threat or tactical situation.

To fill the gap in standardizing out-of-hospital casualty care for OpK9s specifically tasked in high-threat or tactical environments, the K9 TECC working group was initiated in December 2014. The group’s intent is to develop best practice recommendations for eliminating preventable LODDs in OpK9s exposed to non-military high-threat environments. The working group consists of experts in tactical medicine, veterinary medicine, EMS/fire, SAR, military special operations and K9 handlers from various disciplines. K9 TECC blends evidence-based medicine with practical experience from users in the field to mold its final recommendations.

Similar to the human TECC principles, K9 TECC incorporates three dynamic phases of care: direct threat/hot zone, indirect threat/warm zone and evacuation/cold zone. Fundamentally the goals and principles for each phase of care are similar to those of human TECC; however, modifications are made to account for K9-related anatomical and physiological differences. K9 TECC principles remain flexible, not rigid, thus allowing TEMS units, LE agencies and SAR teams to adapt the principles to any particular operational task or situational threat. Since it’s modeled off human TECC, K9 TECC should be easily learned and applied by first responders. The first draft of K9 TECC guidelines is available on the K9 TECC website at www.k9tecc.org/resources.html.  

A Close Working Relationship

A major goal of the K9 TECC initiative is to bring awareness to the veterinary and EMS communities regarding the main challenges impeding appropriate and timely care for operational K9s injured in the line of duty. The desire is to invoke a collaborative initiative between the two communities to resolve these challenges and provide the best care possible to OpK9s. To do that, the K9 TECC working group advocates a cohesive working relationship between local EMS agencies and veterinarians.

A memorandum of understanding or agreement (MOU/MOA) may be drafted between the medical director of the EMS agency and the equivalent representative of the local veterinarian/veterinary treatment facility. This partnership fosters an avenue for establishing veterinary-specific procedural and medical protocols EMS providers may use to aid injured OpK9s. This will help mitigate some of the legal and liability issues that may surround such care. The MOU should outline a training program to educate and “certify” EMS providers on K9 anatomy, K9 first responder care and K9 TECC procedures. Overall the goal of this partnership is to ensure OpK9s are afforded timely and lifesaving prehospital care while minimizing the risk of legal reprisal to EMS providers.

Operational K9s are our companions, our teammates and our defenders. We owe them every opportunity to fight another day. K9 TECC hopes to bring together evidence-based medicine and user experience to devise leading-edge trauma care recommendations that may give these K9 heroes that opportunity.

K9 TECC Projects

The K9 TECC working group is working on several projects:

• Developing a trauma registry and electronic patient care record;
• Publishing informational papers;
• Developing best practice recommendations for prolonged field care;
• Fostering scientific research related to OpK9 prehospital trauma care; and
• Providing resources to facilitate the ability of first responders to provide appropriate and timely prehospital care to the injured OpK9.

A major task for the K9 TECC group is petitioning state veterinary and EMS regulatory agencies to adapt their veterinary practice acts and statutory EMS laws to legally allow human EMS paraprofessionals to render emergency aid to injured OpK9s. The working group has published two informational papers: Operational K9 Tactical Emergency Casualty Care (K9 TECC) Training and K9 Individual First Aid Kits (K9-IFAK) and Challenges Facing Prehospital Care for Operational K9s Injured in the Line of Duty. Find these at www.k9tecc.org/resources.html.

Please contact the K9 TECC working group at lee@k9tecc.org with any comments or questions.

Lee Palmer, DVM, MS, DACVECC, NRAEMT-T, WEMT, CCRP, is a board-certified emergency and critical care veterinarian who provides training in K9 Tactical Emergency Casualty Care (TECC) training to military, law enforcement and search and rescue (SAR) K9 handlers and civilian tactical EMS (TEMS) personnel. He serves as the veterinary medical director for K9 MEDIC and Tactical Medics International; a member of the American College of Veterinary Emergency and Critical Care’s Veterinary Committee on Trauma (VetCOT) Prehospital and Veterinary ATLS subcommittees; founding member and colead of the Committee for Tactical Emergency Casualty Care K9 TECC working group; advisory board member for the Committee for Tactical Emergency Casualty Care (C-TECC); a veterinary consultant for the USAF pararescue group; Veterinary Corps Officer, US Army Reserves; and an emergency and critical care consultant for the Veterinary Information Network (VIN).