Arterial bleeding or other hemorrhaging caused by a bullet or blast injury can lead to irreversible shock and death within a few minutes if an injured cop or civilian doesn't receive aid immediately.

We've recently learned these hard lessons in Afghanistan and Iraq. Control bleeding first. Then prevent the onset of shock to save lives. Active shooter scenarios quickly come to mind when discussing penetrating trauma that can sever limbs. Training law enforcement to handle this type of injury and others in the field is critical to our life-saving mission.

In Vietnam, the critical time to stabilize and transport a patient to a field hospital became known as the "golden hour." More than 40 years later, we've updated it to "the golden quarter hour."

Why should we embed a tactical EMS (TEMS) in a SWAT team or even patrol? Law enforcement EMTs are not only important during field operations. Police training accidents are responsible for more injuries to officers that field operations. After all, a rescue squad with an ambulance may not always be readily available. Your location may be isolated, and traffic in many locales is a constant impediment to quick arrival.

Mass casualties that occur at an incident such as the Boston Marathon bombing can overwhelm EMT resources. And because the area of operation is still hot, non-law enforcement personnel are usually not coming into the scene. It's not only a matter of minutes; seconds can make the difference in patient survival.

Hemorrhage, tension pneumothorax, and airway compromise can be treated early with minimal equipment and rudimentary techniques. A simple cellophane wrapper from a pack of cigarettes was used to treat a sucking chest wound in Vietnam, when nothing else was available. We have to train cops to use the equipment and life-saving methods, just as we train field personnel in the use of deadly force.

A great of example of the successful use of SWAT EMTs occurred in Tucson, Ariz., on Jan. 8, 2011. An active shooter opened fire at a political event in the parking lot of a shopping mall. U.S. Rep. Gabrielle Giffords was severely wounded.

Pima County Sheriff's deputies responded, took the shooter into custody and immediately put their EMT training to work in dealing with 19 wounded and dying victims. They triaged, treated, and stabilized the victims by the time fire and rescue personnel arrived on the scene when the area had been secured. Everyone involved agreed the deputies had saved a lot of lives that day. 

SWAT-trained EMTs have been in place with some teams for several years now. More are needed to come online.

What about patrol? They're the true first responders. More and more agencies issue tourniquet kits to patrol and other street personnel. The Lafayette (La.) Police Department recently trained all of their sworn personnel in the use of tourniquets and issued the kits to each officer.

When responding to violent events such as an active shooter, after we've neutralized the threat, we can extend our life-saving abilities by managing and treating the damage done by the perpetrators.