TUCSON, Ariz. – Combat gauze and tourniquets form the foundation of what every Pima County Sheriff's Deputy calls an "IFAK" or "individual first aid kit."
Three years after a gunman killed six and injured 13 on the north end of the desert town, deputies like Gilbert Caudillo hardly need a reminder as to why the IFAK needs to be ready to go at all times.
"It was pretty overwhelming looking at that many people all down on the ground," Pima County Deputy Caudillo said while standing in the precise location he stood at on Jan. 8, 2011. "For a while, it was just me up here with all of these people. It was just a lot to take on."
Fortunately for him, Caudillo had been trained on how to use an IFAK six months prior to the shooting that nearly claimed the life of Congresswoman Gabrielle Giffords.
The kits – modeled after tools used by members of the military in Iraq and Afghanistan for years – made their way into the Pima County Sheriff's Office in June 2010.
"To not pay attention to the lessons [of the war] would have been malfeasance," Pima County Sheriff's Chief Byron Gwaltney said. "We assumed when we got the kits there might be a need for them some day."
Caudillo's training kicked in quickly the day of the shooting.
"It was like, 'hey, we have something to take care of these people,'" said the deputy and father of five.
With ambulances and paramedics kept at a distance during the first few minutes, deputies like Caudillo found themselves cut off from a more traditional medical response.
"If a scene is still dangerous, it it's still considered a 'hot' scene. It's difficult at best to get fire and EMS into that scene," Gwaltney said.
Doctors figure as many as three people owe their lives to the actions of the responding law-enforcement officers.
One of those now occupies the same congressional seat as the one Gabrielle Giffords once occupied.
"I was standing right beside Gabby," Congressman Ron Barber said, who was Gifford's district director at the time. "I saw out of the corner of my eye a young man with a gun in his hands – both hands – moving fast toward Gabby."
The gunman hit Barber twice, once in the face and the other in the leg. It was that leg wound that threatened to take his life due to substantial loss of blood. A doctor later told Barber a bandage used by a law-enforcement officer likely saved his life.
"He said that wound bandage saved my life, because it was able to at least slow the bleeding sufficiently so I didn't bleed out at the scene," he said.
"Bleeding to death is the No. 1 thing you have to worry about," Dr. Peter Rhee, a trauma surgeon who worked on multiple patients the day of the shooting at University of Arizona Medical Center said.
Dr. Rhee, a 24-year Navy veteran, helped the military devise what's known as "Tactical Combat Casualty Care."
To the battlefield casualty physician, transferring the lessons of T-CCC over into the civilian world made a lot of sense.
"In the military, the No. 1 killer of preventable death is bleeding to death," Dr. Rhee said.
In active-shooter situations, he said, law-enforcement officers will often – particularly at first – find themselves cut off from responding paramedics and firefighters.
"You think that an ambulance shows up at a shooting and can get into an area where a person is yelling for help, but the reality is police have got to secure the area first," he said.
It's precisely what happened to responding officers from the Aurora Police Department during the July 20, 2012 shooting inside the Century 16 movie theater. While records obtained by 9Wants to Know show more than a dozen ambulances responded to the scene, most of the critically wounded had to be taken to area hospitals in the back of Aurora Police cars.
An ongoing gag order in the criminal case prevents the Aurora Police Department from talking about the response.
But since the shooting, the Aurora Police Department has publically made it a goal to better train its officers in the use of such tools as combat gauze and tourniquets. Responding officers to the theater shooting had not undergone the training prior to the shooting on any large scale.
9Wants to Know contacted area police departments in an effort to better understand what tools are available to officers on the streets. Aurora hopes to train the vast majority of its officer in a modified T-CCC program by year's end.
Arvada has sent most of its officers through the training.
Boulder is looking at ways to finance the training. The Lakewood and Denver Police Departments have not undergone the training to any large extent.
Phil Carey runs Salida, Colo.-based Rescue Essentials and helps train police officers on medical response.
"We really need to change the way the nation responds to [mass casualty] types of incidents," he said. "Basically, law enforcement, as first responders, need to be able to render aid. In most penetrating injuries – arterial bleeders – we have about five minutes at most to render aid and save that person's life."
He calls it a paradigm shift.
Recently, Carey helped train more than two dozen law-enforcement officers from around the state in medical response to an active-shooter scenario. The training, held free of charge at Aurora Community College's Disaster Management Institute, was designed to be as real as possible.
"In the last 12 weeks, we've issued 600 [IFAK] kits," Eric Kazmierczak said.
Bending to the advice from their neighbors in the Pima County Sheriff's Department, the Tucson Police Department started training its officers on how to use tourniquets and combat gauze just this year.
It's all part of a national trend to better train law enforcement officers how to save lives.
Kazmierczak said its already paying off.
"In those 12 weeks, we've had at least 14 uses. Fourteen uses – one a week – is a bit more than I expected to see actually."
Wednesday, the Arvada Police Department honored one of its own who used a tourniquet to save the life of a man who had been severely cut by glass.
Carey said convincing police officers how to use things like tourniquets shouldn't be a tough sell. "The life you save just might be your own or your partners," he likes to say.
The training can be completed in a day or two. A tourniquet will run a department less than $40.
(KUSA-TV © 2014 Multimedia Holdings Corporation)