The purpose of care under fire is: To eliminate preventable death during contact in an active violent incident.

How do we improve the chances of a teammate’s survival during an active call which involves violence? I will point out a few critical elements in this article.

 First, let’s discuss if you are the officer who is hit by gun fire, shrapnel from an IED, stabbed, etc.

  • Return fire
  •  Attempt to move to cover
  •  Calm down, breath, focus on the location of the threat
  •  Try not to become pinned down
  •  Self-aid
  •  Weapons check
  •  Advise dispatch of your location
  •  Don’t yell out!! (This is actually still being taught by some instructors.)  Why would I advertise my location or ensure the shooter knows I’m wounded?! If I’m the shooter, I would immediately close in on you if you called out you were hit and down. 

We know from basic tactics that if you are being fired upon, MOVE, even if it’s only a foot, MOVE. Even if are you wounded, MOVE.

Ask any Infantryman about an ambush scenario and the answer should be the same: The best way to disrupt an ambush is to aggressively move toward it. Be Aggressive!

 Immediate intervention of the wounded officer is critical. Empirical evidence shows that over 70% of wounded officers will be cared for by another officer. This is why this topic needs to be included in all Firearms, SWAT and PPCT trainings.


This is a skill set just as an important as marksmanship at the range. Running an officer recovery scenario once a year is grossly inadequate.

All of the officers on my department carry the following items on their person:

  • CAT
  • Nasopharyngeal Airway (NPA) 28Fr
  • Compressed Combat Gauze
  • Vented Halo Chest Seal.

These items are carried in our pants cargo pocket. It sounds like a lot of gear, but it really isn’t nor does it cause a large “bulge” on your pant seam.



If there is a hole in the chest, seal it and look for an exit wound.

If there is a hole anywhere else, plug it.

It’s imperative, that all officers are proficient in the application of the chest seal, bleeding control and a tourniquet.

Practice continuously. Then, practice a second time with a tourniquet.

Practice in the dark, practice in low light, practice on yourself and practice on other people. Then, practice some more.

Airway Management should not be administered while in under fire. An NPA can quickly be inserted once the officer is moved to cover.

Every officer should know how to use this simple, yet, critical piece of equipment. Nearly 5% of combat deaths in Afghanistan occurred because of airway occlusion (blockage). Someone simply needed to open the airway or insert a basic airway to clear the problem.

The Cervical Spine (C Spine) should not be a concern unless the officer shows a neurological impairment like numbness or inability to move. Penetrating trauma to the spine usually occurs at the time of impact otherwise the hit is a clean miss of the spinal cord.

If a downed officer appears unresponsive and you notice a large amount of blood near them, they are probably already dead and a rescue under fire should not be attempted.

If a downed officer is killed and the fight is ongoing on the site, remove their: weapon(s), radio and ammo as one of you may need them. This ensures an assailant will not come across them later.

Remember when moving a downed officer to cover, the closest point of cover may be toward the threat. Aggressively moving forward may be your only or best option.

All officers should be proficient in techniques like Directed Fire and Bounding. The incident OIC should establish casualty collection points and types of wounded officer carries to ensure a positive outcome during downed officer recovery.

The best medicine during any Care Under Fire incident is Fire Superiority.

There are three stages of downed officer recovery:

Approach – The point officers leave cover to begin the extraction. Over watch is critical for the officers in the open.

Aid – The point where officers make contact with the downed officer. This is the most dangerous time for the recovery team. Don’t get tunnel vision on the victim. We don’t perform emergency care. We are simply here to recover the officer.

Extraction – The period of moving the downed officer to relative safety/cover.

All three phases should be performed quickly and quietly. Stealth and surprise is always our friend.

If the recovery team comes under fire during the recovery, it is usually best to continue, if possible, than to retreat and try again. Returning only gives the assailant more time to prepare for your 2nd recovery attempt.

In closing please remember: “When involved in a violent encounter, you will never rise to the occasion, you will fall to your level of training.”

 At the end of the day, it’s all about saving just ONE life.



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