Episode 10 – Dana Vilander: Tactical Medicine and Ropes Work in Modern Tactical Teams

Jon Becker: My name is Jon Becker.

For the past four decades, I've dedicated my life to protecting tactical operators. During this time, I've worked with many of the world's top law enforcement and military units. As a result, I've had the privilege of working with the amazing leaders who take teams into the world's most dangerous situations.

The goal of this podcast is to share their stories in hopes of making us all better leaders, better thinkers, and better people.

Welcome to The Debrief!

My guest today is Dana Vilander. Dana spent 32 years with the Los Angeles County Sheriff's Department, working 26 of those years in the elite Special Enforcement Bureau, or SEB, first as a K9 for four years, then as a SWAT operator for four years, and finally as a tactical medic with emergency services division for 18 years.

Because of his unique experiences and very broad skillset, Dana has trained with and provided training to some of the most elite military and law enforcement units in the world, working in tactical combat casualty care, as well as rural operations, vertical access and rope, and high angle rescue work.

Dana, thanks so much for joining me today on The Debrief!

Dana Vilander: Thanks for having me, Jon!

Jon Becker: First, let's kind of walk through your career path because it's kind of a unique one. You've worked kind of both sides of the tactical world. So why don't we go back to the beginning?

Dana Vilander: Oh, to the very beginning, yeah. Okay, well, that's a good one. In college, I actually met a PJ who just got. Now, this is in the late seventies, and we discussed it and it really fascinated me what PJ's were doing at that time. I don't know if he was in Vietnam or not, but he inspired me to delve into it. And when I went to the recruiter's office, it wasn't the pathway that they have today where they have a pipeline to prepare you for the testing and stuff like that. So that part of it didn't appeal to me, but it was always in the back of my mind.

So in 1982, I enlisted in the Air Force reserve as a security policeman. And what's interesting is in that unit was an LA sheriff's deputy. There were a number of deputies and police officers that were in the unit. And that deputy at the time just happened to be Jack Ewell.

Jon Becker: Oh, man!

Dana Vilander: So that's where we met. Was in the air force reserve back about 1982/83.

Jon Becker: It's like saying, yeah, I met this guy named Babe Ruth, and he's like, hey, you want to hit baseballs?

Dana Vilander: Yeah. So he encouraged me to apply to the sheriff's department set me up on a ride along in Firestone park with Vic Rodriguez and his partner. I believe it was John Hogue, who died a few months after that in a shooting. But I was really happy. I wanted to do that. So chose the sheriff's department. I applied to LAPD, Long Beach PD, Sheriff's department, all at the same time. The sheriffs picked me up first, and I'm glad they did. I had a blessed career while working patrol. Had some interaction with the special enforcement Bureau, but not a lot.

But I knew that was where I wanted to go because when I initially came on the department, they had a unit called the emergency Services detail, which was essentially a civilian equivalent of the PJ's. So I was in the reserves until 1990. May of 1990, I tested for SEB itself, SED for the SWAT side, and I was encouraged to try out for canine as well. So I tried out for K9 during that time. Saddam Hussein invaded Karoit in August of 1990. And if I had still been in the reserves, I probably wouldn't have got to the special enforcement Bureau.

So it was kind of fortuitous that I got out in May because the unit did go to Kuwait. And K9 picked me up in January 91 and went through SWAT school, got the K9, had countless operations like you do as a K9 handler. And some years, it was about four years, I went over to the SED. So the SWAT side. John Ajay, who passed in 1998, he and I did a body swap. He wanted to come over K9. I wanted to go to SWAT. That was one of my goals, was to go to SWAT and worked my way up through the teams. I was actively involved in the sniper program, entry team member.

And in 1998, I tested again for the emergency services detail, or ESD, and was chosen to go there. So in 1998, went through paramedic school, which is the first thing you have to do. And from there, mountain rescue training and then dive training and spent the next 18 years there. Hoist operator, crew chief on air rescue five, and search and rescue, medic, recovery diver, SWAT medic.

Jon Becker: So talk – maybe for those that don't know, La sheriff's ESD. Kind of give us a thumbnail sketch of the unit of.

Dana Vilander: So when I got there, it was an 18 man unit. You had three sergeants, 15 deputies, deputy paramedics. So everybody had to go to paramedic school. And you had all this training and experience. And at the time, we would have five guys on a shift, basically. So you had two in air five working as helicopter rescue medics.

And then the other guys were on the ground driving Angeles crest, Azusa Canyon to Hunga Canyon. You know, you were up in the mountains and if a SWAT activation happened, then you just drive out of the mountains to wherever the SWAT activation was. And so you worked intimately with the volunteer search and rescue teams for LA county and you pretty much were busy all the time. They had a unique schedule. It was a 72 hours on schedule, three days on, six days off.

And I can remember the longest shift I had was 70 hours of being awake for 70 hours, just going from call to call to call, which is great.

Jon Becker: So I think one of the things that's unique about ESD is it's got this multi mission profile. Right? Like, how do those missions silo out? Give me like the kind of, you know, they've got a rescue, obviously, search and rescue mission. What else does ESD do?

Dana Vilander: Well, the tactical medics on every SWAT operation and SWAT operations basically were the king. So if you were – Well, if you're actively involved in a search and rescue mission, say on the ground, they would just have to call guys in to cover the SWAT mission. But if you were just out patrolling, like I said, on Ansar's crest or something like that, and a SWAT mission came in, you'd have to respond to the SWAT call.

And that was pretty much the primary function because when I first got there, if you think about warrant services and some of the barricades where the entry team wants to pull the front door, the front hardened door off the house, it was ESD that would do that. We had the only truck that had a huge boat cleat on the front of the truck and somebody would go up with the big fish hook like this, with the cables attached and hook them to the front door.

And then we would tie it off real fast and then drive back and pull the door off the house. And that was one of our missions for barricades. But more particularly on the warrants, the early morning warrants, that was a real common thing we were used for. And then we're there, obviously, as medics.

Jon Becker: But then there's also a dive component to ESD. Right?

Dana Vilander: Right. So the history of ESD. Let me do that real quick. So the special enforcement bureau or the special enforcement details started in 1958. It was basically like a saturation patrol team of guys. You had to be over 6ft to be in the unit at the time. So real policemen. So it was a gun squad? Yeah, pretty much.

So in 1966, Sheriff pitcher started, created the emergency services detail. And the job was to have active duty deputies up in the mountains on search and rescue missions. And the unit with Frank Waldron was the sergeant and the, basically the founder of the unit. They picked up the recovery diving.

So anybody that goes missing, any object evidence, anything like that, planes in the ocean, if they need to be recovered, it was ESD's job to dive on those things. So typically it was in lakes, pitch black water, no visibility whatsoever for evidence and dead bodies.

Jon Becker: Feeling your way around.

Dana Vilander: Feeling your way around. Exactly. But we would also be out at Catalina, around Catalina island, and then also around San Clemente island. So San Clemente island is actually a piece of LA county and the waters around it. You know, you have a lot of active scuba divers, fishermen, things like that. So if a scuba diver went missing or died off of San Clemente Island, ESD would do the scuba dive death investigation of that, which they still do today. They do all the dive accidents or dive death investigations out of the special ESD.

Jon Becker: So, I mean, that's a pretty, especially for a law enforcement unit, that's a pretty broad skill set. You've got a dive component, you've got, you know, ropes and high angle rescue combined with tactical, you know, combat casualty care.

Dana Vilander: Right.

Jon Becker: All in, all in one unit.

Dana Vilander: Right. So it does take a lot, but luckily, I mean, retraining, constant training, but luckily, like with, let's just say, air rescue five, you're using all of those skills on an almost daily basis. When you, when you load the helicopter, you have your dive gear, you have your medic gear, you have your rope rescue gear, and you have your SWAT gear that all goes in the helicopter and goes with you wherever you go.

The only thing you don't have is tanks because tanks are rather heavy, you know, and so they. But those are staged around the county. So if a dive came up with the operation, you'd change into your wetsuit while flying to the, to pick up your tanks or flying to the dive scene and just make it happen like that.

Jon Becker: So a big component of ESD is kind of the tactical medic thing early in your career. Talk to me about what that was like. What was the, you know, at some point, TCCC becomes a thing, right? Prior to that, what was the strategy?

Dana Vilander: That's a good question, because there's a real good history of SEB in a book. I don't know if you've seen it by John Coleman, but the history of that is there. And basically, in the ESD were more like first aiders than anything. Else. They started going to paramedic school in the early seventies when La county initiated the first paramedic institute. So they were getting the paramedic training, but still they were doing basic, more like basic first aid. They could do IV's and things like that.

So when they integrated with sed in, I want to say it was 1970 to 71, they were still kind of in a first aid mode. Roll into the eighties. There's a lot of doctors around the country who were interested in the tactical world, and rich Carmona was one.

Jon Becker: Rich Carmona, eventually surgeon General Rich Carmona.

Dana Vilander: Yes, that rich Carmona out of Pima County, Arizona. He has an interesting career. So the development of, and they called it TEMS, or tactical emergency medical skills at the time was still more like first aid. You could do your paramedic skills, but the tactical component really hadn't gotten hold yet. So fast forward to 1996. I'm sorry. So, 1989, NTOA and Rich Carmona and SEB, they hosted the first actual NTOA Tems course in the country.

And then next year, it was held in Pima county in 1990. So those are kind of the beginnings right there. Through the early nineties into about the time I came into the unit, they started a tactical EMT program, but it was still kind of a medic, first aid kind of a course.

Jon Becker: Yeah, not a lot of it. It's MT.

Dana Vilander: We're not moving. We're not there. To the TCCC yet. Yeah, TCCC, as a concept started in 1996 with…

Jon Becker: Black Hawk down.

Dana Vilander: Well, 1993 was Black Hawk down, Battle of the Red Sea, and 18 dead and 73 wounded. And Frank Butler, John Hagman. And then there was another doctor out of the military with the last name of Butler. They wrote this paper, and what they did was they did a retrospective studies back to World War 2, Korea. What are the patterns of injury? What are the patterns of preventable death?

And when they looked at what happened in Mogadishu, they're saying that there was a correlation there so that you could die from getting shot in an extremity within two to three minutes if nothing is done for it. And my first EMT class back in 1978 at college, tourniquets were forbidden. You never put it. If you put a tourniquet on that limb, you're gonna lose that limb.

Jon Becker: Yeah.

Dana Vilander: So you just…

Jon Becker: Yeah, I remember that.

Dana Vilander: You just didn't put a tourniquet on. And what these doctors advocated was tourniquets, pressure dressings, wound packing, things that were not in the normal world like you see today. We'll stop the bleed. So it was revolutionary in 1996. There was only one military unit that actually adopted it back then, and that was when Stanley McChrystal was the colonel. The regiment commander of the 75th Ranger Regiment instituted it. They have a great program to this day, but it was still slow to pick up in the rest of the military. In the civilian world, there was still no knowledge of this other than the fact, unless you saw the paper itself, the tactical.

Jon Becker: Yeah. I mean, nobody carried tourniquets. No ambulances, didn't have tourniquets. It was not a thing. Right? And when you say preventable death, if my understanding is correct, what you mean is if we had had basic life saving capability, that person survives, for instance, they bleed out from an injury that you could stop the bleeding with.

Dana Vilander: Right. So if you want to look back at some of the old first aid training manuals from EMT classes, from colleges, whatever it is, when they're talking about. What's the common acronym for first aid?

Jon Becker: ABCs.

Dana Vilander: ABCs, right. Airway, breathing, circulation. Well, in those manuals, if you actually go back and look at it, it will say in there, and by the way, if the person is bleeding severely, stop the bleeding first before you address anything else. But that was completely glossed over when.

Jon Becker: It was like, oh, put a little pressure on it.

Dana Vilander: Oh, yeah, elevation.

Jon Becker: Yeah, yeah. Elevate it and put pressure on it. He's missing a foot. Lots of pressure.

Dana Vilander: So that was what they did was they brought this to light, that this was good. Let's go up a few years. 2001, Operation Enduring Freedom, Afghanistan. Even the military special units didn't really follow TCCC at that point. Early on getting into Iraq, 2003, 2004, it still wasn't being taught pretty much to most of the medical community within the military. Special operations started to get that training and they started to get things like live tissue training to do it.

But what was the problem with all of the training that the military is getting and these doctors identified, that was the training. If you took advanced trauma life support, say, as a course, as a doctor, as a medic, whatever you went to advance, it's based on being in a hospital. And you have every resource in the world when you're a hospital.

But when you're on a target house, on a SWAT operation, or on a military operation, you could be hundreds of miles away from something. Or even in La county, if you're in the high desert, you could be 60 miles from a trauma center. And what do you have as your medical supplies? Usually it's going to be in a backpack or even smaller if you're a team without, say, a dedicated medicine, you may have an individual first aid kit.

Jon Becker: Yeah, but even, I mean, IFACs even was not a thing.

Dana Vilander: Not a thing. Right.

Jon Becker: Like people might have a boo boo kit. Yeah, but they weren't carrying.

Dana Vilander: Yeah. Bandaids, some gauze, Cobans, maybe ace wraps, something like that.

Jon Becker: Yeah, but they weren't carrying IFACS.

Dana Vilander: Right.

Jon Becker: Or tourniquets or compression bandages or any of the stuff that now we regard as kind of de rigueur.

Dana Vilander: Right. When I got to ESD in 1998, I was given a Harper pack is a back pack, and you filled it up basically with the gauze, the wraps, the things like that. Not even chest seals at the time. You'd have Vaseline gauze to create a three sided occlusive dressing if you had a chest injury or abdominal evisceration or something like that. So that came later.

1998, when I got there, aeromedic school, like I said, dive school, mountain rescue school, got on the helicopter, started flying, and then it was about that time we started to see a transition in the guys from the unit, the older guys that were retiring, and then more guys were coming in with Iraq and Afghanistan. You started to see how the tourniquet started to take hold because they had to, because all the blast injuries that were happening in Iraq, I mean, it was pretty much a lot of catastrophic injuries. And the early tourniquets that they had was the Cat tourniquet by North American rescue about 2004, Tachymeter Solutions Ross Johnson developed. He was a special forces medic, developed the soft tea.

Jon Becker: Soft tea, yeah.

Dana Vilander: And that was, those were basically the two basic tourniquets. Two, go to tourniquets on the market at the time, and there were others out there. You had the NATO tourniquet. You had different people doing different things. But those are the two basic tourniquets. I was fortunate enough in 2000 to be flying air five when two PJ's from a special tactics squadron on the east coast came out to fly on air five with us. And I maintained contact with one of them, Mike. And through the years, he guided me towards military courses.

And one of them that he guided to me is John Hagman, one of the writers of the teacher proceed paper. His company, Deployment Medicine International. They were doing live tissue training for the military, and I was lucky enough to get into one of those courses. And that's when I saw the tourniquets that were out there.

And when you're working on something that's bloody. You have dirt and everything else going on. It makes a big difference when you're trying to turn, as opposed to you and I sitting here and applying a tourniquet to your arm or to your leg. With live tissue training, there's real blood, there's real dirt, there's a lot of things going on. And so you can see how these tools work in that environment.

Jon Becker: So when is okay. So tourniquets start to come in. TCCC begins to really take hold of the military.

Dana Vilander: In the military, yes.

Jon Becker: And at what point is the March acronym developed? Is that as part of the initial launch of TCCC?

Dana Vilander: March was. Yes, MAR. Originally it was MAR, and then CH came later, but it was, yeah. Massive hemorrhage, airways and then respirations or breathing. So it wasn't ABC reversed because the C in March is still circulation, but you're dealing with shock, and you're dealing with any additional injuries that you may come across. But massive hemorrhage was the big one. Like you said, if your foot's missing and you've got blood squirting out, you need to stop it. And direct pressure and even putting a constricting band isn't going to work. You need a tourniquet that you have to stop the bleeding.

Jon Becker: When did we figure out that? Because I remember as a kid, my brother was hit on his motorcycle when he was really young, had a compound fracture of his femur, would have bled out, severed femoral artery, and a med student from USC came by and improvised a tourniquet and shut the bleeding off.

And I remember the discussion about, they're gonna cut his leg off and it's gonna cost him his leg. And, you know, when did we figure out that that was just not true?

Dana Vilander: It was the data coming out of the war, Operation Iraqi Freedom. Also, the Israelis had experience with tourniquets, and they found that you could safely have a tourniquet on for two to 4 hours, was the timeframe. The Israelis actually had an experience with a guy having a tourniquet on for 11 hours with no nerve damage, no loss in sensation, anything like that.

So it was that experience at the military being the driver of this program in the beginning, that that's where they said, yeah, these are safe. And it was about 2005, 2006, ESD. We continue to funnel guys into these live tissue courses.

So those concepts came with us, and we started teaching, actually, a TCCC program in about 2006. I want to say right before the NTOA conference in LA, we were already going down that path, and we started to do some. Just some kind of familiarization classes out at patrol stations about the march algorithm and doing things. And you would hear patrol guys would come up and say, why aren't they teaching this to us in the academy? So that was back then, which they do now, probably nationwide, they're doing that.

Jon Becker: I think so. I think most places now we've kind of developed that people are carrying IFACs. If there is a silver lining to the Afghan and Iraq wars, it is the massive expansion of TCCC knowledge and understanding of hemorrhage control. And the devices that work, the devices that don't work, you know, they were obviously born of tragedy. But there are a lot of police officers that are alive today because TCCC was pushed down.

Dana Vilander: Absolutely, absolutely. Police officers, citizens, and then even suspects. So the fact that it's out in the police community, it's great for everybody. There's that video of an Oklahoma officer that was shot just recently, making contact with a guy this close. When the suspect pulls out a gun and starts shooting at him, he gets hit in the leg. He follows the TCCC principles. He runs the COVID. There's a vehicle there. While he's still engaging the guy as the suspect.

Jon Becker: Yeah, I remember this one.

Dana Vilander: Did you see that one? Yeah, yeah, yeah, it's a great one. And then he comes back out to see where the suspect is. The guy's running away. So he pulls his tourniquet out and applies it to his leg, continuing to communicate on the radio. Did a fantastic job.

Jon Becker: Yeah, he really did.

Dana Vilander: And that's what you see. You look at LAPD saving their own, also putting him on citizens downtown when they were having some of the riots and things like that. A police officer. Yeah, it's for him. But in that moment, you see a lot of police officers will apply it to the citizens or the suspects.

Jon Becker: Yeah, I mean, you see suspects that are surviving, that have been, you know, engaging police and getting shot, and the team is rescuing the guy with their own medical gear. You know, it strikes me that it's kind of good all the way around.

From your experience, how do we maintain this? Like, it's – We've had this big spike, and the 35 years I've done this, you'll see things come into favor, and then you see them go out of favor, and, you know, it's like we build a capability, and then it gradually attrition takes it down and we go, oh, my God, we have to do this. We start over again. If you're an agency, how do you maintain this capability of TCCC, you think?

Dana Vilander: That's a good question. It takes somebody at the agency, whether it's an appointed person or somebody takes it on themselves, which you see that a lot of agencies, a guy just takes on a project and he owns that project, but they need to have some sort of manager said that the training continues and more importantly, the budget for the equipment. Well, budget for the equipment and the training, because training is money as well.

Jon Becker: Yeah, sure.

Dana Vilander: But definitely on the equipment side. I think as far as state of the art when it comes to the devices and all the techniques and things like that, I think we're probably there for a while, but it's just maintaining that budget so that supplies are replenished. You evaluate your training program and. And then what are you giving the guys in their IFACS, in their first aid kits?

Jon Becker: So let's dissect that a little deeper. So first, starting with the training, what, in your opinion, how many different levels are there of training here? Like, obviously we want first aid training, TCCC training for patrol officers, SWAT teams, probably a little higher level. SWAT medics. How do you dissect that in an agency? Take a middle sized agency, 500 officers. How many different levels of expertise would you try to implement?

Dana Vilander: Oh, I would keep it at maybe just two levels. So, like, for the SWAT team, because SWAT teams train more regularly than I think patrol officers do. So a one to two day program every year for patrol is fine? Well, I wouldn't say fine because I would obviously want it better.

But I think – And on the SWAT side, every quarter, they should have a day at least. You look at the initial training, usually you're talking about, you go through the TCCC program, then you're showing them the tourniquets. Everybody goes to the tourniquets. I think the next phase is that putting them into the training operational mode where they're coming upon casualties and having to deal with them. And SWAT teams are pretty good at doing that, too.

Jon Becker: Yeah, it's interesting. One of the things that we're seeing emerging with a lot of the teams we're working with is kind of a, for lack of a better term, like a three tiered approach where you've got IFACS for individuals, you have a team medic who is carrying a backpack and has other levels of equipment and then kind of a third tier of equipment, which is really mass casualty care. Right. It's throw bags. It's, you know.

Dana Vilander: Right, right.

Jon Becker: What are your thoughts on that?

Dana Vilander: I agree with it. We had bigger backpacks in our armored vehicles. For calls. We would have rope access equipment in our bearcats, and then we would also have the bigger ones for the mass casualty. And it makes sense to have the mass casualty stuff because you are going to be. You look at San Bernardino and as the team makes entry and you have 30 casualties on the floor, you know, what do you do?

And, you know, the companies in ours done a very good job of it. Tac Meds has done a good, I'm sure, safeguard medical. They all have these mass casualty bags where you can just drop a kit as you go, roll a person in the recovery position so they don't die an airway death, but then people coming in will see an IFAC next to them or something like that, or a throw kit that's down on the ground next to the casualty. Absolutely.

Jon Becker: Yeah. I think one of the things that came out of San Bernardino is there are a lot of people that are alive today that would have died had there not been a tactical medic or medics who had the ability to quickly look at somebody and just put them in a recovery position. They're unconscious, they're having a hard time breathing. Just rolled them into a recovery.

Dana Vilander: And that's the thing that should go out, even to patrol, because who's going to be first on scene? A lot of times.

Jon Becker: Almost always.

Dana Vilander: Luckily, at San Bernardino, the teams were training just down the road. So they were on scene like that. On a normal MCI, normal active shooter with multiple people down, it's going to be patrol. Just like the active duty procedures have changed from Columbine, where we're going to wait outside and wait for the SWAT team, to now, if you're a lone officer, you're supposed to go in there and address this guy and eliminate the threat if you can. So that's a quantum leap from where we were 25 years ago with Columbine.

Jon Becker: So, Dana, why don't we start with individual gear? Talk to me about an IFAC. What? What should be in an IFAC.

Dana Vilander: So an IFAC is actually designed for you. It's not for you to take off and use what you have in your kit on somebody else. So it's. It's designed and the commercial kits that are out there. So you'll have, typically, you'll have a tourniquet, you'll have one or two chest seals, preferably two chest seals, which we can talk about.

And then you have a gauze, whether hemostatic gauze or just regular gauze. And then you're going to have some sort of a compression wrap. You could have scissors, you could have gloves. You could have a casualty card in it to make notes if you wanted to. But that's typically what you see in a knife. AC.

Jon Becker: So why don't we walk through the components, starting with a tourniquet? Two major tourniquets are still kind of cat and soft tea. Right?

Dana Vilander: Right. Yeah. There's some really good ones from other ones. Like I said, safeguard medical. Some other companies have all come out with good tourniquets that are all committee on TCCC approved.

Jon Becker: Okay, so is that kind of the industry standard? Like, look for something that's committee on TCCC approved?

Dana Vilander: Yes.

Jon Becker: That's the good housekeeping seal, as it were. Okay, and then what about gauze?

Dana Vilander: Well, back up to tourniquets just for a second. So for a SWAT guy, he should have a tourniquet where somewhere on his plate, carrier, vest, whatever it is, where he can get to it with either hand. Because if he shot in his left arm or shot in his right arm, you have to be able to reach it with either hand. And then in the IFAC, you should probably have a second tourniquet. Cause you could get shot more than once, and you might have to treat yourself that way.

Jon Becker: Yeah, we just actually just embedded into one of our play carriers now. A tourniquet into the bottom of the vest, where it's just at your stomach. It's there all the time, and that's the – I use this for you. What do you think about the idea of locating IFACS and tourniquets and those kinds of things on, especially with SWAT cops putting it someplace that everybody knows where it is on a guy.

Dana Vilander: There's philosophical differences on that. It's something that I think it's a good idea. If everybody has their IFAC in one place, everybody knows where to go to for that. If I come on John, and John has his IFAC on his right shoulder, and I go to look for it down where everybody else has it, you're just delaying care.

Our job is to keep every drop of blood in them. So you're just having that seconds delay if you have to find the guy's IFAC or whether it's in his cargo pocket or whatever it is. I like the idea of having him located the same.

Jon Becker: And does it make sense for a team to use the same IFAC and the same gear? Because, you know, you'll see teams where everybody has the same gear, and you'll see other teams where everybody has individual gear. What are your thoughts on that?

Dana Vilander: They have individual gear because they're having to buy it themselves, and that's an issue. Right? So if you're gonna do something like that, everybody on the team should know what's in each, each person's IFAC, and then you have to pull it out and show them how to use. If you have a different iFAC or a different tourniquet than everybody else, you better show everybody how to do it. Cause you might be unconscious and they have to apply your tourniquet on you.

Jon Becker: And you said a second ago, like, we need to keep every drop of blood in their body. Talk to me about the significance of that.

Dana Vilander: Right. So if you go back to MAR from the original TCCC paper, tourniquets stop the bleeding. The second part of massive hemorrhage that they identified, and they were kind of throwing it out to industry that – If you think about the one ranger that died in the movie, Ranger Smith, the PJ or the SF medic, he's trying to clamp his artery because it was way up high in a pelvic region. Right? Couldn't do it. Couldn't clamp it. And he ends up bleeding out as a result of that.

So what they put out there in the TC paper was, we need a hemostatic agent embedded in the gauze so that it can be packed into a wound. So, blood stopping agent, commercially made by a number of companies now, but it's embedded in the gauze, and you're going to pack the wound just like you would with normal gauze.

Jon Becker: So that's like sea locks. And, you know, there are variety of things.

Dana Vilander: HemCon. Combat gauze.

Jon Becker: Yeah, variety of things. But you're not only packing gauze, you're packing in a clotting agent, basically.

Dana Vilander: Essentially, yes. Depending on what the chemistry is on how it's going to affect the clouds, how it's going to create clouds.

Jon Becker: What is it? Give me more there on that.

Dana Vilander: Yeah, so the one that is from. I'm sorry, Z-Medica, the combat GOS. So originally there was Hemcon or something like HemCon, which is a derivative from seafood. Sea life casings.

Jon Becker: Yeah, like shell.

Dana Vilander: Shellfish, which doesn't have any. It creates a clot at the site. So with combat gauze, what it is, it works on the clotting factor within your body. So it's – I forget the name off the top of my head right now for the agent that they're using, Kaolin. They're kind of a kaolin based agent that they use, and it works on the actual clotting factors. To build a clot at the site.

Jon Becker: To force the body into building the clot.

Dana Vilander: As opposed to creating, say, a plug.

Jon Becker: Got it. And so I've heard conflicting arguments on using hemostatic gauze, that doctors don't like it. It complicates cleanup and all that. And then I've heard the exact opposite, that, no, it doesn't matter. It stops bleeding immediately. That's the right answer.

Dana Vilander: Well, that's a really good thing to bring out, because when you're teaching. Stop the bleed to civilians now, and that's where we're at in society today. This all came from TCCC. But when you're talking to civilians, you say, put anything in that wound that you can possibly put into it. T shirt, a sock, underwear, anything. Dirt, grass. Stuff it in that wound if you have to, if that's all you have available to try to stop the bleeding.

So to say that there's an argument from doctors that a hemostatic agent embedded in gauze is a problem. Yeah.

Jon Becker: So when you're doing that right, when you're shoving gauze, you're shoving a sock, you're shoving whatever. What are you really trying to do?

Dana Vilander: You're trying to get in here so that you're pinching the artery down, packing it as tight as you possibly can to keep it that way, and then you're going to wrap it with a compression wrap to keep it right there.

Jon Becker: Is the goal at that point to cause the blood to clot, or is the goal to both pinch the artery down?

Dana Vilander: Both.

Jon Becker: Got it.

Dana Vilander: Cause you might not be 100% successful in pinching that artery, but you're gonna pack that wound as tight as you can.

Jon Becker: Because, again, we're just trying to retain every bit of blood we possibly can in the body. So going forward with an IFAC tourniquet, some form of gauze.

Dana Vilander: Right. Compression wrap.

Jon Becker: Compression wrap, which is, how are we gonna use a compression wrap, typically?

Dana Vilander: Like an ace wrap or coban or something like that? You're going to bring it round, tight. As tight as you possibly can.

Jon Becker: Again, creating compression. Compression on the wound site. Yeah, got it. So that's an individual first aid kit.

Dana Vilander: Right. I'm sorry we skipped over the chest seals. So when I started to create an occlusive dressing, you had petroleum gauze, and you would use tape to create that three sided occlusive dressing over a hole in the chest. What industry did was they created chest seals using a gel substance, hydrogel kind of a substance that it would stick. If you think about normal first aid tape that you have in the house or the white first aid tape that you have if you're sweaty or if you're a hairy man.

Jon Becker: Doesn't work.

Dana Vilander: It's not going to work. Well, the creation of, through industry of these chest seals, it will stick, and then they all have. Now. So you had a three sided occlusive dressing so that air could escape if it needed to. Now, they all have vents in these chest seals so that all you do is have to put the chest seal over the wound and it should vent on its own.

Jon Becker: And the intent is to maintain the vacuum integrity of the chest.

Dana Vilander: Right. We don't want air coming in. We don't want any more air even exiting an injured lung into the chest cavity that can't escape. But we don't want any air coming in from the outside also.

Jon Becker: Got it. Okay, so that's individual first aid kit.

Dana Vilander: Right.

Jon Becker: Let's move up to a team. What do you think the best methodology for a team to carry their gear? Everybody's got an IFAC, I'm assuming to start, and then each of the tactical medics then is going to carry a secondary backpack.

Dana Vilander: Right. Yeah. So when we were doing SWAT operations, warrant service or barricaded suspect or whatever, I had a small pack, but I had four additional tourniquets. I had more hemostatics, more gauze, more chest seals, and then some of the diagnostic stuff that you would need, like a pulse oximeter, things like that.

Jon Becker: So then when we're talking about a mass casualty event and these mass casualty bags, it's basically a series of throw bags. It's a series of little individually packed. What do you see is in those individual throw bags?

Dana Vilander: Tourniquet chest seal, if they can afford it. You don't see chess seals often in those, in those casualty kits. But I would say chest seal, hemostatic if you can afford it. Remember, hemostatic started about the dollar 50 range. So if you're a small, small agency, you know, you put 20 kits together, that's $1,000. What's in your budget?

Jon Becker: Just in hemostatic gauze.

Dana Vilander: Just in hemostatic.

Jon Becker: As opposed to like, z gauze or rolled gauze, which is…

Dana Vilander: Rolled gauze is a dollar and a half. Yeah. So you'll see rolled gauze, usually a space blanket. Try to keep them warm, which is part of the h in March. Chest seal be good. If not a chest seal, they'll have the petroleum gauze in it, also compression wrap.

Jon Becker: Okay. And so the methodology being, if you have a mass casualty. Now you can hand out these throw bags, which then allows one medic to direct bystanders, helpers, people working on themselves. The idea being to scale the medic.

Dana Vilander: Right.

Jon Becker: Yeah, that makes sense.

Dana Vilander: And a lot of them, you'll see like up to 20 of these throw kits in there.

Jon Becker: What is your recommendation? Like if an agency starting a program or starting a tactical paramedic. Tactical medic program, what's your recommendation as to where they go for training? What do you see as the best resources?

Dana Vilander: There's good training agencies or training companies around the United States. I think one of the best ones, if you looked at it, was strategic operations down in San Diego. They're nonstop teaching the military in TCCC procedures, both out of hospital and in hospital, what they have down there at their location. But they're also into the TECC program, so they're teaching a lot of police fire on the exact same techniques.

Jon Becker: What's the difference between TCCC and TECC?

Dana Vilander: That's a good question. So TCCC is military focused. The word combat, some people, not in the military or not in the SWAT world, thought that might be sound offensive. I think we all know that a gunfight is a gunfight. Combat is combat. But they removed it so that fire departments would be probably more amicable fire departments and others and the general public knowing that you have a TECC, tactical emergency casualty care as opposed to tactical combat.

Jon Becker: So before we wrap this up on TCCC stuff, is there anything else you think that teams should or individual operators should be thinking about or looking at?

Dana Vilander: I think one of the things is have realistic training. Following up on your training question, have realistic training and put your casualties, when you're doing this training in unique positions, and just remember the guidelines are, you know, direct fire, you're return fire, get to cover first, you know, address the gunfight, and then address the casualty when you can. If he can't be taken care of himself.

Jon Becker: Yeah, it's interesting! One of the things that you'll see in training is people go, that's unrealistic. That's an unrealistic scenario that a casualty would be stuck on a roof, or it's an unrealistic scenario that a casualty would be stuck behind a bookcase.

And if we've learned anything through our lecture series, and if we've learned anything just through the debriefs we've done through this show, you ask yourself, as the story evolves, could it get worse? Oh, it can't get worse. And then it gets worse, and then it gets worse again. And then it gets worse again.

And it's just, you know, you see these circumstances where it just gets perpetually worse. And the training seems, you know, training seems to fall into these patterns of like, oh, okay, well, Dana's gonna be our test guy. He's in the middle of the room, on the floor and the suspect is already dead.

And, you know, I just did an interview with Buddy Brown from York County, South Carolina. The suspect is under a deck. He shot three guys, he's killed one and he's given up. And he's 30 ft from you. And two of your guys are bleeding you to death. What do you do? And so it's like when you talk about real estate training and you ask Buddy, he said, we never trained for that. We never thought the guy would give up. Now the guy's throwing his gun out, he's hands up.

So now you're holding at him. But are you dealing with him? Are you dealing with your guys? How are you getting the guys out? You know, buddy himself is a big guy. They had a hard time carrying him. They kept dropping him, I think. What would you recommend in those training iterations? What are the things that people need to think about when they're designing a training scenario?

Dana Vilander: Well, first off, I would say every time you do team training, you put casualties into it. The more often you include casualties in your team training. You know, particularly for the part time teams that maybe get once a month or twice a month, every time you do entry training, you should be putting casualties in there because exactly what buddy was saying, you never train for that. If you never train for that scenario, how will you react?

And there's that old saying, you don't rise to the occasion. You revert to your lowest level of training or highest level of training, whichever that way that went. But if you have never even thought about this before, this concept that I could have a casualty with a suspect right here, what am I going to do? And that's what you need to put into your team training. You have to put that in.

The military is really good at doing that, invoking casualties. And through the courses that we have, we do that a lot. So the guys get used to that. Not get used to it from the standpoint of that, you know, if that's one of their friends, you know, they're going to be. They wouldn't be upset about it. But it's – No, it's an immediate action drill.

Jon Becker: Yeah.

Dana Vilander: Right.

Jon Becker: That's a really good way to put it. It's an immediate action drill where you've. You have conditioned the team that when this happens, we do this. And, you know, as you said in all the debriefs that I've attended over the years, that's exactly what happens. Everybody defaults to the level of their training. And so I like that idea.

One of the things that you and I have talked about and is kind of a logical extension of where we hear is ropes work, and using ropes work specifically to evac people to move them to do whatever. Why don't we start just with kind of Dana's thumbnail sketch of history of rappelling in SWAT. It all goes back to the SWAT TV show and guys swinging through windows, but give me kind of your take on it. Yeah.

Dana Vilander: So ropes haven't been used a lot in tactical situations other than in the, let's just say, the suicidal jumper type of a situation. But go back in history, everybody's familiar with the princess gate, the iranian embassy, storming by the SAS, going through the windows. And I think that's what everybody's opinion is of rappelling and rope work. When I got to the team, we had to rappel in SWAT school.

And I think just about every SWAT school probably has a repelling segment, but I think it's more of just a hoo ya, more of a confidence drill. Yeah, something like that. And I think they're missing out on seeing the other applications. If your snipers are elevated, you know, how are they getting up there if they – If there's not a ladder, if there's not a stairwell, if they're. If they have to get down in a hurry.

So in addition to rappelling, though, for the. For the ropework side of SWAT, most teams don't. Don't do it. You know, like I said, they have the suicidal jumper considerations where negotiator be out there. And there's. There's very few teams that are actually doing that. I know San Diego is doing that. LAPD does that. ESD handles that at the special enforcement Bureau.

And I'm sure New York, NYPD and I'm sure agencies around the country are doing that. But it's an interesting thing. When you talk about doing a tactical rope access course with teams, and they're from small towns, they say, oh, well, we only have two and three story buildings, so I don't need to worry about that. And if I could just tell a quick story in a conversation with an LAPD officer, was they had a crazy guy on top of a restaurant. He's compliant, but they got to get him down. Fire department won't help him help them because he's a suspect.

Jon Becker: He's a crazy guy.

Dana Vilander: Yeah. So they have to get up there on their own. They get down there on their own. So they use a dumpster to climb up on top of the roof, handcuff the guy, he's compliant, and then they have to get him down, and they kind of drop him to the dumpster, and then he rolls and falls on the ground. Basically. They thought they did a great job until they watched the body camera footage of that.

So the question was, how could we do that? And there's simple, inexpensive tools in the rope world to do stuff like that, like webbing or short pieces of rope, but you have to learn those techniques, too. Going back to the training for the medical side, you have to understand what's potentially out there that you could do, and then you need to see how you can do it. So not what to do, but how you can do things using different pieces of equipment.

Jon Becker: Yeah. And I think it goes back to the team having as broad a skill set as they possibly can. Right. Like, it's. I think part of the challenge with a modern SWAT team is there's so many different domains of knowledge that are required.

And, you know, you see teams where they try to maintain that knowledge for everybody. You also see teams where they build cadres. And that seems to be kind of the emerging strategy is that Dana's the rope guy, John is the medic guy, and you can take the team to a deeper level. What's your opinion on that?

Dana Vilander: No, I agree with that because are you going to be the drone operator? Are you going to be the aerial drone operator? Are you going to be the ground drone operator? Are you the planner for the hit that you're going to do? Because you could just keep going and going and going. Right?

Are you the weapons instructor for the team and you have all these responsibilities, or if everybody does that, I agree. Having a cadre. Cause they can be specialists then. And for some of these skills, you definitely want specialists to keep everybody on the team safe. And then in the liability side of it, they're protecting the team and liability also.

Jon Becker: Yeah. You know, we're hearing. I'm hearing more and more from teams that they've kind of given up the idea of tactical rappelling, where they're going to do the princess gate, swing down to the window and all of that. And so you'll hear like, well, why do I need ropes? Why do I need repelling? Talk to me about some of the reasons and some of the applications that you see for ropes work in a modern tactical environment.

Dana Vilander: Sure. I mean, again, getting a sniper up into position, that's really common here in LA because they have the academy awards, they have all these things. It's real. Even at Sofi Stadium now with the Rams and the Chargers over there, ESD is up on the rafters all the time. You have protesters that go up there. So not necessarily on the SWAT operational side of it, but that's a specialty that somebody on the department has to have, and it's not going to be the fire you sar guys, particularly if these are suspects.

So the team needs to have that capability for those type of incidents. So if you go to the fifth and main hostage rescue with LAPD, you know, that developed so quickly because the suspect was acting erratically and violently. And then they did the dual explosive breach on that because it happened that fast. And what they would have done, talking to the team, the climbing team leader over there, if they had had the time, they would have sent guys down on ropes, whether it's to breach a window, whether it's to put a diversion outside, throw a drone in, whatever it is.

So there's definitely some uses for it. I think what teams aren't seeing is also that if, let's just say the suspect sets a fire below you, you're two or three stories up, and now you have a fire that goes below. That's to get started by the suspect below you, or they light off the natural gas pipe, and now you got natural gas filling the house and you're two or three stories up. Are you going to run down the stairs or do you want to just go out that window that's right there?

So there are escape techniques that are out there similar to what firemen use and train at on a regular basis. But I think SWAT teams should know that because you just never know what's going to happen below you as well.

Jon Becker: And also, you know, there's the whole. To tie it back into the TCCC conversation, there's also like, if one of your guys gets injured in an elevated position, you've got to get him down.

Dana Vilander: Right.

Jon Becker: Right. Or a suspect, you know, it's. I mean, you're probably a little less concerned with the suspect, but, you know, if. If somebody gets injured in an elevated position and you can't bring fire in, what do you do?

Dana Vilander: Right. Or just think about being on the fourth or fifth floor, one of your guys is down.

Jon Becker: Yeah.

Dana Vilander: I mean, are you gonna. It's gonna take a few guys. Cause with equipment and everything else, you're gonna be fairly heavy. But how many, how long will it take you to get the guy down to the ground floor as opposed to breaking out a window, attaching a rope to him? Cause he's got some sort of a rigging belt or something. And then just dropping him to the ground? Not dropping him, but lowering ground, which could be done in about 25 to 30 seconds.

Jon Becker: Yeah, no, it makes a lot of sense. I think it's trying to articulate to teams why they need to maintain this other capability. With regard to gear for a team, what would you recommend a team carry with them?

Dana Vilander: I think everybody should have at least a rigging belt on. Not a. Not just a velcro belt or something. You need something like what Aardvark put out with the belt system that you guys have, where you can actually put a rigging style belt or a rated belt like from Misty Mountain or something like that, that can be integrated into a harness if you needed to, but you can rappel off of that.

And that is the first place with two carabiners. I think every operator on an entry should have 25 to 30 ft of one inch tubular webbing. Because you can escape yourself. You can use it to open doors. You can create a harness with it. There's a variety of uses to use with one inch tubular webbing. That's what everybody should have.

An agency that I work with quite often just did that after I did some training with them on what the possibilities with webbing are. And I'm not trying to sell my classes, I'm just saying those are the possibilities that are out there. But you should have a roping team guy you were talking about, special. You should have a specialist and he should have a rope that, depending on the size of the building, is that you can get down at least 100 ft, if not more.

And then he would have the ability to anchor the rope, send the rope out, and then have a carabiner or device that the agency, the team wants to use so that everybody can bail out again, this is more of the bailout mode for about three pounds weight. Really not that much money. You could have a kit that is fully capable to do whatever you want to do with it.

Jon Becker: That somebody just carries in a backpack. And that's where it sits.

Dana Vilander: Yeah.

Jon Becker: With a rope stuck on a vest.

Dana Vilander: Right.

Jon Becker: And even from a rope standpoint, it doesn't have to be, you know, 716 inch kern metal rope. It can be smaller.

Dana Vilander: Right. So technology obviously has come a long way even in the rope community. What the PJ's use is an eight millimeter rope by sterling. I know a North American rescue has a new eight millimeter rope. So 8 millimeters is down there in size where you would like to be because 100 ft weighs maybe about three pounds as well. And it's very compressible when you're carrying it.

Jon Becker: So Dana, obviously these domains require a lot of expertise. What's the best way for people to get a hold of you and to learn about the programs that you're running?

Dana Vilander: So we have a website, it's and we offer about 14 different courses. The majority of them that we have are California post approved. So I thought it was important to get the state's buy in for the SWAT community and for the law enforcement community in general to see that we have an approved program and guys will get the credits necessary for them when they take the classes.

Jon Becker: Are there any resources or websites you'd recommend? Do you have Dana's reading list or website list?

Dana Vilander: I really don't. I ponder that a lot. I do a lot of just the research myself. But on the rope side of it though, there's definitely, if you looked at on YouTube, not rescue craft. Well, there is rescue craft on YouTube, but also element rescue. Sean McKay, he does great videos, explains things very well. A lot of the techniques that we teach are the techniques that he's teaching and that's a good YouTube resource.

On the tactical medicine side, North American rescue has some really good content on their website and also on their instagram they have a NAR doctor. They have some really good content going out updating people on things that are happening regularly.

Jon Becker: Well, we'll link to all of that in the show notes and make it easier. We'll also link to your website.

So Dana, thanks so much for joining me today! You taught me a lot.

Dana Vilander: Thank you, Jon!