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Tactical Medicine
ESSENTIALS
SECOND EDITION

John E. Campbell, MD, FACEP

Lawrence E. Heiskell, MD, FACEP, FAAFP

Jim Smith, MSS, NRP, FABCHS, CPC, CLEE

E. John Wipfler III, MD, FACEP

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assumes no responsibility for, the correctness, sufficiency, or completeness of such information or recommendations. Other or additional safety measures may be required under particular
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standards of care required in any particular situation, because circumstances and the patient’s physical condition can vary widely from one emergency to another. Nor is it intended that this
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23 22 21 20 19 10 9 8 7 6 5 4 3 2 1
BRIEF CONTENTS

Section 1 Elements of Tactical Medicine

Chapter 1 History and Role of the Tactical Medical Provider
Chapter 2 Safety and Wellness of the Tactical Medical Provider
Chapter 3 Tactical Team Fundamentals
Chapter 4 Equipment of the Tactical Medical Provider
Chapter 5 Weapons Handling and Firearms Safety
Chapter 6 Unconventional Weapons and Criminal Tactics
Chapter 7 Medical Intelligence
Chapter 8 Medical Response to Active Assailant Mass Casualty Incidents
Chapter 9 Operational Tactics
Chapter 10 Tactical Team Activations

Section 2 Assessment and Management of Injuries

Chapter 11 Patient Assessment in the Tactical Environment
Chapter 12 Controlling Bleeding
Chapter 13 Basic Airway Management
Chapter 14 Advanced Airway Management
Chapter 15 Shock Management
Chapter 16 Extraction and Evacuation
Chapter 17 Ballistic, Blast, and Less-Lethal Weapons Injuries
Chapter 18 Torso Injuries
Chapter 19 Head, Neck, and Spine Injuries
Chapter 20 Extremity Injuries
Chapter 21 Soft-Tissue Injuries
Chapter 22 Environmental Emergencies
Chapter 23 Medications in the Tactical Environment
Chapter 24 Weapons of Mass Destruction
Chapter 25 Hazardous Materials and Clandestine Drug Labs
Chapter 26 Challenges in Tactical Medicine
Appendix A K-9 Management
Appendix B TEMS Forms
Appendix C Defensive Tactics
Appendix D Law Enforcement Education for Tactical Medical Providers (TMPs)

Glossary
Index
CONTENTS

Section 1 Elements of Tactical Medicine

Chapter 1 History and Role of the Tactical Medical Provider
Introduction
The History of Tactical Emergency Medical Support
Civilian Emergency Medical Services
Law Enforcement Overview
The History of SWAT Units
The Beginnings of TEMS Units
Roles Within the SWAT Unit
Roles and Responsibilities of the Tactical Medical Provider
Bilateral Command
Command Systems: LIMS and NIMS
Tactical Medical Provider Training
Tactical Medicine Curriculum
Law Enforcement Training for Tactical Medical Providers
Unit Training
Hazardous Materials Training
Bloodborne Pathogens Training
Continuing Medical Education

Chapter 2 Safety and Wellness of the Tactical Medical Provider

Introduction
Health and Wellness
Preventive Medicine Principles
Wellness for the SWAT Unit and TEMS Unit
Diet and Nutrition
Exercise
Personal Hygiene Considerations
Sleeping Habits
Stress Management
Downtime
Spirituality
Hobbies and Interests
Maintenance of Lasting Personal Relationships
After Critical Incidents
CISM Controversies
Patient Confidentiality
Radio Reporting

Chapter 3 Tactical Team Fundamentals

Introduction
Mission Goals
Types of Incidents Requiring Activation
Weapons and Tools
Forcible Entry Tools
SWAT Explosive Breaching Considerations
Less-Lethal Weapons
Close-Range Impact Weapons
Electronic Control Devices (ECDs): The TASER® ECD
Compressed-Air Technology
Extended-Range Impact Projectiles
Noise-Flash Distraction Devices
Less-Lethal Chemical Agents

Chapter 4 Equipment of the Tactical Medical Provider

Introduction
The Tactical Medical Provider Uniform
Additional Insignia
Extreme Weather Garments
Cold Weather Gear
Warm Weather Gear
Tactical Personal Protective Equipment
The Ballistic Vest
The Ballistic Helmet
The Balaclava
Eye Protection
Hearing and Ear Protection
Gloves
Medical Protective Gear
 Kneepads
Hydration Systems
Gas Mask or Air-Purifying Respirator
Flashlights and Illumination Tools
Essential Emergency Medical Gear: A Four-Level System
Level 1
Level 2: Medical Vest with Utility Pouches, Belt, and Thigh Packs
Level 3: Tactical Medical Backpack
Level 4: Tactical Medical Advanced Life Support Kit
Additional BLS Trauma Management Kit
Tactical Medical Supplies
Tactical Compression Bandages
Tactical Tourniquets
Improvised Tourniquets
Clotting Agents, Hemostatic Bandages, and Hemorrhage Control
Chest Seals for Penetrating Chest Trauma
Chest Decompression Devices
Airway Devices
Automated External Defibrillator
Oxygen Tanks
Stretchers and Extraction Gear
Field-Expedient Decontamination Equipment
Personal Dosimeters
Additional Equipment to Consider

Chapter 5 Weapons Handling and Firearms Safety

Introduction
Firearms Overview
Handguns
Long Guns
Firearm Caliber
Ammunition
Firearms Training
Handgun Safety
Choose the Right Weapon
Practice
Securing a Firearm
Downed SWAT Officer Firearm Security
Suspect Firearm Security

Chapter 6 Unconventional Weapons and Criminal Tactics

Introduction
The Human Body and Mind
Criminal Tactics
Criminal Suspect Weapons Issues
Edged Weapons
Firearms
Types of Conventional Explosives
Secondary Explosive Device Threats
Booby Traps

Chapter 7 Medical Intelligence

Introduction
Medical Planning for Safe Training
Law Enforcement Training Injuries and Deaths
Hot Weather Considerations
Cold Weather Considerations
Additional Environmental Threats and Prevention
Cross-Agency Training
Medical Planning for Incident Sites
Special Event Planning
Planning for Medical Support During a Mission or Training
Nutrition, Hydration, and Sleep Factors
Preventive Care and Support
Rehabilitation Stations
Medical Records
Medical Plan
Medical Intelligence
Medical Threat Assessment
Postmission Medical Planning

Chapter 8 Medical Response to Active Assailant Mass Casualty Incidents

Introduction
High-Threat MCIs
Active Assailant Incidents
Five Tiers of Medical Response
The Threats
Rapid Response and Extraction Times
Body Count per Minute
Law Enforcement Response
Rapid Reaction Teams
EMS and Fire Medical Response to AAMCIs
Rescue Task Forces
Primary Objectives of Medical Responders
Firefighters and EMS Personnel Integration with LEOs
Concepts and Goals for RTF Medical Personnel
The Hartford Consensus
Chapter 9 Operational Tactics
Introduction
Activation
SWAT Unit Activation
TEMS Unit Activation
Callout Formation
SWAT Officer Data Cards
Medical Threat Assessment
Personnel Tracking
Tactical Plan Development
Immediate Action Drills
TEMS Unit Staging
Perimeters and Zones at Callouts
Staging of the TEMS Unit in the Tactical Environment
Positioning of EMS Transportation
Entry for the Tactical Team
Indications for Dynamic or Stealth Entry
Entry Team Operations
The Stack Formation
Stairs Tactics
The Pie Tactic
Clearing Rooms: Entry and Egress
Victim Restraint
TEMS Operational Procedures
Recognition of High-Threats and Threats
Cover and Concealment
Quick Peeks
Light Tactics
Sound and Light Discipline
Using Other Senses to Maintain Situational Awareness
Covert Communications
Radio Communications
Mission Completion
Post-Mission Debriefings

Chapter 10 Tactical Team Activations

Introduction
Variety of SWAT Missions
Tactics
Emotionally Disturbed Persons
Tactics
Active Shooter Scenarios
Tactics
Escaped Fugitive or Suspect
Tactics
Mass Gathering Events
Tactics
Riots
Tactics
Downed SWAT Officer or Bystander in an Exposed Position
Tactics
Executive Protection
The Role of the TMP
Tactics
High-Risk Prisoner Transport Medicine
Tactics

Section 2 Assessment and Management of Injuries

Chapter 11 Patient Assessment in the Tactical Environment
Introduction
Scene Safety
360-Degree Situational Awareness
Partners-in-Safety
Safety When Treating Suspects
Tactical Patient Assessment: Call-A-CAB ’N Go Hot
Call
A: Address Threats
CAB: Circulation, Airway, and Breathing
‘N: Neurologic Status Check
Go
Hot
Patient Assessment During Evacuation
SAMPLE History
Secondary Assessment
Remote Assessment Medicine
Barricade Medicine
Triage
Mass-Casualty Incident
SWAT Assessment Triage

Chapter 12 Controlling Bleeding

Introduction
Identify Hemorrhage
Sources of Bleeding and Characteristics
Hemorrhage
Hemorrhage Treatment
 Principles of Tourniquet Use
Junctional Tourniquets

Chapter 13 Basic Airway Management

Introduction
Causes of Airway Obstruction
Manual Maneuvers
Head Tilt–Chin Lift Maneuver
Jaw-Thrust Maneuver
Basic Airway Adjuncts
Nasopharyngeal Airway
Oropharyngeal Airway
Ventilations
Mouth-to-Mouth Ventilation
Mouth-to-Mask Ventilation
The Bag-Mask Device
Suctioning the Airway

Chapter 14 Advanced Airway Management

Introduction
Airway Obstruction
Orotracheal Intubation
The Sellick Maneuver
The Intubation Procedure: Visualized (Oral) Intubation
Patient Intolerant of the Endotracheal Tube
Single Lumen Airway
King LT Airway
Laryngeal Mask Airway
i-gel Supraglottic Airway
Digital Intubation
Nasotracheal Intubation
Surgical and Nonsurgical Airways
Open Cricothyrotomy
Needle Cricothyrotomy
Rapid-Sequence Intubation

Chapter 15 Shock Management

Introduction
Hypovolemic Shock
Treatment for Hypovolemic Shock
Treatment Goals
Treatment Steps
IV Therapy and Hypovolemic Shock
IV Administration
IV Troubleshooting
Intraosseous Infusion Administration

Chapter 16 Extraction and Evacuation

Introduction
Extraction
Self-Extraction
Overview of Manual Extraction Techniques
Patient Handling
General Rules for Rescuers
Dragging
Manual Carries
Evacuation
TEMS and EMS Interface
CASEVAC Versus MEDEVAC
Communicating with Civilian EMS and Hospitals
Air Medical Evacuation
Preparing a Landing Zone

Chapter 17 Ballistic, Blast, and Less-Lethal Weapons Injuries

Introduction
Ballistics
Types of Ballistic Wounds
Assessment and Management of Ballistic Injuries
Ballistic Vest Removal
Blast Injuries
Tissues at Risk
Assessment and Management of Blast Injuries
Law Enforcement Bomb Technician
Less-Lethal Weapons Injuries
Close-Range Impact Weapons
Extended-Range Impact Projectiles
Noise-Flash Distraction Devices
Less-Lethal Chemical Agents
Compressed-Air Technology

Chapter 18 Torso Injuries

Introduction
Load-and-Go Injuries to the Chest
Penetrating Wounds and Major Blunt Trauma to the Chest
 Complications of Penetrating Wounds and Major Blunt Trauma to the Chest
Load-and-Go Injuries to the Abdomen
Blunt Trauma
Penetrating Trauma
Pelvic Fracture

Chapter 19 Head, Neck, and Spine Injuries

Introduction
Load-and-Go Injuries to the Head, Neck, and Spine
Head
Neck
Spine
Treat-Then-Transport Injuries
Eye
Ear
Nose
Oral Injuries

Chapter 20 Extremity Injuries

Introduction
Load-and-Go Injuries to the Extremities
Amputation
Femur Fractures
Open Fractures
Complications of Extremity Injuries
Treat-Then-Transport Injuries
Closed Fractures
Sprain
Strain
Dislocations

Chapter 21 Soft-Tissue Injuries

Introduction
Load-and-Go Injuries
Thermal Burns
Electrical Burns
Treat-Then-Transport Injuries
Closed Wounds
Open Wounds
Bite Wounds
Subungual Hematoma
Fungal Skin Diseases
Contact Dermatitis
Friction Blisters

Chapter 22 Environmental Emergencies

Introduction
Cold Exposure
Hypothermia
Local Cold Injuries
Heat Exposure
Heat Cramps
Heat Exhaustion
Heatstroke
Lightning
Stabilizing Care
Bites and Envenomations
Spider Bites
Hymenoptera Stings
Snake Bites
Scorpion Stings
Tick Bites
Poisonous Plants

Chapter 23 Medications in the Tactical Environment

Introduction
Medication Considerations
The Five Rights of Medication Administration
Medication Administration in the Tactical Environment
Over-the-Counter Medications
Prescription Medications
Reporting the Use of Medications to Command Staff
Pain Medications
Antibiotics
Pain Medications in the Tactical Environment
Meloxicam, Acetaminophen, and Ibuprofen
Morphine
Fentanyl
Nausea Medications in the Tactical Environment
Ondansetron
Ketamine
Medication Storage

Chapter 24 Weapons of Mass Destruction

Introduction
Chemical, Biologic, Radiologic, and Nuclear Threats
Chemical Terrorism/Warfare
Biologic Terrorism/Warfare
Nuclear/Radiologic Terrorism
Scene Safety for the TMP
Secondary Device or Event (Reassessing Scene Safety)
Chemical Weapons
Blister Agents
Pulmonary Agents (Choking Agents)
Nerve Agents
Metabolic Agents (Cyanides)
Biologic Agents
Viruses
Bacteria
Neurotoxins
Other Biologic Toxins
Nuclear Weapons
What Is Radiation?
Sources of Radiologic Material
Nuclear Energy
Nuclear Weapons
Radiologic Dispersion Device
How Radiation Affects the Body
Response
Suicide Bombings
Response

Chapter 25 Hazardous Materials and Clandestine Drug Labs

Introduction
Hazardous Materials
Classifications of Hazardous Materials
Protective Equipment for Hazardous Materials Incidents
SCBA and the Tactical Environment
Clandestine Drug Labs
Clandestine Drug Lab Considerations
Rapid Decontamination

Chapter 26 Challenges in Tactical Medicine

Introduction
Challenges of Treating the Restrained Patient
Excited Delirium
On-Site Screening Examination for Suspects
Crime Scene Considerations
Preserving Evidence
Physical Signs of Death
Special Considerations

Appendix A K-9 Management

Police Dog Emergency Medical Gear
Preparing for Police Dog Emergencies
Canine Tactical Assessment
Call-A-CAB ’N Go Hot
Circulation
Airway and Breathing
Load–and–Go
Pain Management
Fractures
Heat Emergencies
Poisoning

Appendix B TEMS Forms

Appendix C Defensive Tactics

Introduction
Principles of Self-Defense
Winning a Confrontation
Fight or Flee
Self-Defense Moves
Combat Physiology
Hormones and Nerves
Blood Vessels
The Brain
The Heart
The Eyes
The Ears
The Gastrointestinal and Genitourinary Tracts
The Skin
Restraint Devices and Techniques
Weapons and the TEMS Unit
Firearms
Batons
OC Spray
Illumination Tools
Knives
TASER and Other Conducted Electrical Weapons
Appendix D Law Enforcement Education for Tactical Medical Providers (TMPs)
Introduction
The Role of TMPs
Training Limitations
TMPs and Law Enforcement
Tactical Medical Curriculums and Training
LEO Competency Requirements
TMP Self-Defense at the Tactical Scene
Armed TMP Elements
Suggested Competency Requirements
Weapons Safety and Skills
Knowledge of Laws and Liabilities
Police and SWAT Topics
Emergency Medical Service (EMS) Scope of Practices
Summary

Glossary
Index
AUTHOR BIOGRAPHIES

John Emory Campbell, MD, FACEP Dr. Campbell passed away in 2018. Dr. Campbell was an excellent physician, innovator, pioneer, and
teacher with many outstanding achievements.
Dr. Campbell was known worldwide for his innovative and groundbreaking work in developing prehospital trauma education. In 1982, Dr.
Campbell founded the Basic Trauma Life Support (BTLS) program. It was the first course and curriculum dedicated to prehospital trauma
assessment and trauma care worldwide. He taught, alongside Colonel Jim Smith (his future co-author), and conducted the first BTLS course
in August of 1982. He wanted to teach paramedics the principles of advanced trauma life support (ATLS) to improve the care provided to
trauma patients. He partnered with the Alabama Chapter of ACEP to publish the first BTLS textbook in 1982. Basic Trauma Life Support has
since been renamed to International Trauma Life Support (ITLS) to better reflect its scope and mission, and it is now a global organization
offering 15 types of trauma courses and teaching over 30,000 students annually in over 40 countries.
“John did not set out to be an EMS leader,” said ITLS Editor-in-Chief Roy Alson, PhD, MD, FACEP, who has served on the editorial board
alongside Dr. Campbell for many years. “Thirty years ago, he developed a new trauma course and said, ‘Why aren’t we teaching this to
EMS?’ Along the way, he convinced countless doctors, nurses, and EMS, fire, and police personnel to share his vision. The legacy John
leaves is measured in the lives saved by those who have been ITLS trained. He will be missed.”
Dr. Campbell had a lifelong interest in the military and supported law enforcement throughout his life. Dr. Campbell, Chief Jim Smith, Dr.
Lawrence Heiskell, and Dr. John Wipfler worked together with over 120 contributors and reviewers to generate the first comprehensive
textbook on tactical medicine, Tactical Medicine Essentials, which was copyrighted and published in 2012. Endorsed by the American
College of Emergency Physicians, Dr. Campbell was able to contribute his extensive experience in the public safety prehospital arena to this
textbook. The first edition has sold over 6000 copies and is used in tactical medicine education worldwide. Dr. Campbell’s legacy lives on not
only in the form of ITLS, but also in the form of Tactical Medicine Essentials, Second Edition, written by his three co-authors.

Lawrence E. Heiskell, MD, FACEP, FAAFP Dr. Heiskell is the founder and medical director for the International School of Tactical
Medicine, the first and only state and federally approved tactical medicine school approved by the California Commission on Peace Officers
Standards and Training (POST) and the United States Department of Homeland Security (DHS). Dr. Heiskell is residency trained and board
certified in emergency medicine and family practice and has been a practicing emergency physician for more than 32 years.
Prior to attending medical school, Dr. Heiskell spent 5 years with the United States Antarctic Research Program and served on three
expeditions to Antarctica and the South Pole. He was awarded the Congressional Antarctic Service Medal in 1979. He has 29 years of
experience as a SWAT team physician beginning as a reserve deputy with the Kern County Sheriff’s Department in Bakersfield, California.
He is currently a reserve police officer and tactical physician with the Palm Springs Police Department in Palm Springs, California.
Dr. Heiskell served on an 18-agency member tactical medicine coalition under the auspices of the California Commission on Police
Officer Standards and Training and California Emergency Medical Authority (EMSA) to create the State of California Tactical Medicine
Operational Programs and Standardized Training Recommendations.
He is a graduate of Riverside Sheriff’s Office (RSO) SWAT School, National Tactical Officers Association (NTOA) School, Heckler & Koch
SWAT School, and the Federal Bureau of Investigation (FBI) SWAT School. Dr. Heiskell has lectured extensively in the United States and
abroad on tactical emergency medicine and has published over 70 articles and other publications on tactical medicine topics.
Dr. Heiskell has provided special operations emergency medical support for the FBI, Drug Enforcement Administration (DEA), and the
Bureau of Alcohol, Tobacco, and Firearms (ATF).

Colonel Jim Smith, MSS, NRP, FABCHS, CPC, CLEE Colonel Smith currently serves as the public safety director for a rural community in
the United States. He has more than 45 years’ experience in public safety as a certified police chief and has served as a bureau commander
in a metropolitan police agency supervising an FBI certified bomb squad and a clandestine laboratory entry-assessment team, 911 center
serving more than 30 agencies, responded more than 300 bomb/incendiary incidents, and more than 100 clandestine laboratories. Smith has
served as the public safety coordinator for a university with multiple campuses. Smith has developed several classes for the university
environment addressing clandestine laboratories, emergency management, WMD, and crisis management. He has been a practicing
paramedic for more than 45 years and is a certified fire instructor. Smith has a master’s degree in science in safety from the University of
Southern California and a bachelor’s degree from Troy University. He has served as a paramedic in the tactical setting for many years and
teaches classes in this arena. Smith served as a task force officer on a federal joint terrorism task force and as a senior health physics
technician and radiochemist at an operating nuclear power facility for several years. He has written several textbooks including subject matter
on bombs and bombings, response to WMD events, EMS operations in the WMD setting, and crisis management. He also serves as a peer
reviewer for several textbook publishers and professional journals, and he has more than 100 peer-reviewed articles published. Smith has
conducted research on explosion and fragment suppression leading to the production of specialized equipment and a patent issued for the
process. Smith teaches criminal justice, homeland security, and terrorism classes for the University of Phoenix and Troy University.

E. John Wipfler III, MD, FACEP Dr. John Wipfler is a board certified attending emergency physician and a Clinical Professor of Emergency
Medicine at the University of Illinois College of Medicine. In medical school, he joined the armed forces starting in 1985 and retired at the
rank of Major, U.S. Army Medical Corps (Res) after 14 years of service. In 1994 as an academic emergency physician, he obtained training
and additional military experience (Panama, multiple military bases) and started volunteering as a tactical physician for several SWAT teams
in the Midwest. Gaining valuable experience over the past 25 plus years, he continues to serve as tactical physician and TEMS medical
director for three SWAT teams and multiple law enforcement agencies in central Illinois.
Since completing his internship in surgery and residency in emergency medicine, he teaches and practices medicine with the Department
of Emergency Medicine at OSF Healthcare Saint Francis Medical Center, a Level I Trauma Center in Peoria, Illinois. Dr. Wipfler co-founded
the first tactical EMS unit in the state of Illinois, the Special Tactical Assistance Trauma Team (STATT) in 1998. He is a sworn LEO, a
Sheriff’s Physician who has been involved in tactical operations for more than 220 SWAT callouts. The STATT Tactical EMS unit (five
physicians, one nurse, two paramedics) supports three law enforcement tactical teams: Central Illinois Emergency Response Team (CIERT),
Illinois Law Enforcement Alarm Services team (ILEAS region 6/7), and the Peoria City Police Department Special Response Team (SRT). He
also supports callouts and/or training with the United States Secret Service for regional presidential motorcade escorts, United States
Marshals Service (SOG), and the Drug Enforcement Agency (DEA). He has flown SOG helicopter missions with the United States Marshals
Service Special Operations Group during high-risk prisoner transport.
As a certified firearms instructor who is also qualified expert in pistol, small-bore rifle, and high-power rifle marksmanship, Dr. Wipfler
routinely teaches firearms safety classes integrated with tactical medicine principles. He is certified by the Illinois State Police, and along with
his wife they have taught over 10 concealed carry courses. He has completed multiple military and civilian tactical/medical courses, including
the Chapman Academy (Basic and Advanced Pistol, Tactical Rifle), Combat Casualty Care Course, Counter Narcotics & Terrorism
Operational Medical Support (CONTOMS), Radiation Emergency Assistance Center/Training Site (REAC/TS) radioactive injury management
course, Heckler & Koch Basic and Advanced Tactical EMS courses, United States Army Medical Research Institute for Infectious Disease
(USAMRIID) Chemical and Biological Warfare School, Insights Training, and Strike Tactical Solutions close quarters combat courses.
Dr. Wipfler was instrumental in starting and served as medical director of the Region 2 RMERT disaster response team in central Illinois,
and has deployed on multiple real-world disasters including several large tornado strikes with mass casualties. Dr. Wipfler served with 12
others on the founding executive council for the sole state-wide disaster response agency in Illinois, the Illinois Medical Emergency
Response Team (IMERT). He served for 5 years as medical director of Life Flight, and has served as a flight physician for hundreds of air
medical rescues and transfers.
He has coauthored textbooks on emergency medicine and firearms safety, written chapters for textbooks—including the tactical medicine
chapter in the International Trauma Life Support (ITLS) text—as well as multiple tactical medicine and research papers. Dr. Wipfler lectures
internationally (Japan, Taiwan, Hong Kong, others) and teaches tactical medicine, disaster preparedness, bioterrorism/WMD response, and
advanced emergency ultrasound at the University of Illinois College of Medicine.
In 1999, Dr. Wipfler developed one of the first emergency medicine residency program tactical medicine elective rotations in the world.
This is a 2-week training session that over 90% of the EM residents at UICOMP/OSF St. Francis Residency Program complete during their 3-
year training program. Many have graduated and moved on to new communities where they now serve as tactical physicians throughout the
United States.
As the co-chair of the Illinois Tactical Officers Association (ITOA) tactical EMS committee, he has been involved in expanding TEMS in
the Midwest and instructing Tactical EMS with the Chief Jeff Chudwin and the ITOA and other law agencies, and he has co-chaired the
annual ITOA Tactical Medicine Conference for 6 years. He gained valuable experience by teaching with Dr. Heiskell at the International
School of Tactical Medicine in California for many years.
In 2005, Dr. Wipfler was asked by officials with the Department of Homeland Security to serve with an 18-agency member tactical
medicine coalition in California, representing the Illinois Department of Public Health Tactical Medicine Committee. This California committee
worked with the California Commission on Police Officer Standards and Training and California EMS Authority (EMSA) to create the State of
California Tactical Medicine Operational Program and Standardized Training Recommendations, approved in March 2010.
He continues to engage in firearm competition, 3-gun matches, advanced pistol courses, and other training, which help keep his skills
sharp. Dr. Wipfler recently competed in the 2018 U.S. National Patrol Rifle Competition in Novi, Michigan (LE only), where he scored in the
top 9 shooters of over 100 law enforcement officers. For hobbies, he enjoys scuba diving, fishing, and continues to engage in mountaineering
with friends and family, having summited the Matterhorn, Mount Rainier, Mount Shasta, Mount Baker, Long’s Peak, Hallet’s Peak, and
others. He and his wife are blessed and very proud of their six children and many travels and family adventures they have shared together.
When he initiated one of the first tactical medicine teams in the Midwest, he began teaching EM residents about tactical medicine. At that
time, in 1999, there was no formal textbook of tactical medicine, and so he was honored to serve as the lead author and join with three
trusted friends (Chief Jim Smith, Dr. Heiskell, and Dr. Campbell) to assemble a textbook that gathered the input and expertise of over 120
seasoned professionals in prehospital and tactical medicine, fire, law enforcement, disaster response, military operations, and other talented
individuals. Many members of the ACEP Section of Tactical Medicine were able to provide valuable expert input. The resulting textbook,
published by Jones & Bartlett Learning, was endorsed by ACEP, and is now used to help educate students internationally. This new second
edition was enhanced even further by additional expert reviewers and with updated information. Dr. Wipfler considers it a true honor and a
privilege to medically support the brave men and women in blue and camo uniforms.
ACKNOWLEDGMENTS
Special Thanks
The authors would like to extend a very special thanks to the following individuals who generously gave their talents, time, and extensive
knowledge to the formation and enhancement of this book:

Glenn A. Bollard, MD, FACEP

Past-Chair and Past Section Development Coordinator, Tactical Emergency Medicine Section
American College of Emergency Physicians
Special Certification, Forensic Medicine and Ballistics
Meadville, Pennsylvania

Martin Greenberg, MD, FACS

Chief, Section of Hand Surgery, Illinois Masonic Medical Center
Clinical Assistant Professor of Orthopedic Surgery, University of Illinois
Chair, EMS Advisory Council TEMS Committee
Tactical Physician, South Suburban Emergency Response Team (SSERT)
Reserve Police Officer, Village of Tinley Park, Illinois
Chicago, Illinois

Michael R. Meoli, Firefighter, EMT-P, Tactical Paramedic, SOC (SEAL)

Tactical Paramedic Firefighter, Special Trauma and Rescue (STAR) Team
Mobile Medical Strike Team, Paramedic Field Training Officer/Preceptor
San Diego Fire and Rescue Department
Special Warfare Operator Chief (SEAL)
Special Operations Command (SOCOM) Advanced Tactical Practitioner (ATP)
Casualty Assistance Calls Officer (CACO)
Tactical Combat Casualty Care (TCCC) Instructor/Trainer
Command Fitness Leader (CFL), US Navy Reserve SEAL Team 17
Coronado, California

Reviewers
Paul Abdey, Dip IMC RCS (Ed), Paramedic
Tactical Medicine Unit Manager
Kent Police
Maidstone, Kent, United Kingdom

Jeff W. Adams
Lieutenant (ret), Special Response Team Commander
Peoria Police Department
Peoria, Illinois

Amado Alejandro Baez, MD, MSc, MPH, FACEP, FCCM

Professor and Vice-Chair for Operational Medicine
Director, Center for Operational Medicine
Department of Emergency Medicine
Medical College of Georgia, Augusta University
Augusta, Georgia

James Bender, BS, EMT-P, HEM

Tactical Paramedic
Healthcare Emergency Manager
Medical Horizons Consulting
Washington, Illinois

Sean Benson
Firearms Tactical Advisor, Bronze Commander, and Trainer
Firearms Training and Development Unit
Rotherham Police Station
Rotherham, South Yorkshire, United Kingdom

Neil P. Blackington, EMT—Tactical

Deputy Superintendent, Commander, Support Services Division
Boston EMS
Boston, Massachusetts

Brandon Bleess, MD, FACEP

Medical Director, Life Flight
Attending Emergency Physician, Department of Emergency Medicine
Clinical Assistant Professor of Emergency Medicine
University of Illinois College of Medicine
Tactical Physician, Special Tactical Assistance Trauma Team (STATT)
Deputy Sheriff, Woodford County Sheriff’s Office
Peoria, Illinois

William P. Bozeman, MD, FACEP, FAAEM

Associate Professor, Director of Prehospital Research
Wake Forest University, Department of Emergency Medicine
Winston-Salem, North Carolina

Walter J. Bradley, MD, MBA, FACEP

Physician Advisor, Trinity Medical Center
Medical Director, Illinois State Police Tactical Response Team
Medical Director, Tactical Medicine Team, Moline Police Department
Moline, Illinois

David W. Callaway, MD, FACEP, MPA

Professor, Emergency Medicine
Chief, Division of Operational and Disaster Medicine
Department of Emergency Medicine, Carolinas Medical Center
Chair, Section of Tactical Medicine, American College of Emergency Physicians
Charlotte, North Carolina

Dale Carrison, DO
Professor of Emergency Medicine
Chair, Department of Emergency Medicine
University of Nevada School of Medicine
Las Vegas, Nevada

Matthew Clark
State Registered Paramedic
Police Specialist Firearms Officer
United Kingdom

Keith F. Collins, NREMT-P, CIC

Tactical Medic
Rotterdam Police Department
Rotterdam, New York

Jeff Chudwin, JD
President, Illinois Tactical Officers Association
Chief of Police (ret), Olympia Fields Police Department
Olympia Fields, Illinois

Michael Colvard, DDS, MS, M O Med RCSEd

Associate Professor of Oral Medicine and Diagnostic Sciences
Director, Disaster/Emergency Medicine Readiness Training Center
University of Illinois at Chicago
Chicago, Illinois

John H. Cottey II, MD

Emergency Physician
University Medical Center Brackenridge
Austin, Texas

John Croushorn, MD, FACEP

Chair, Department of Emergency Medicine, Trinity Medical Center
Tactical Physician, Federal Bureau of Investigation
Major, United States Army Medical Corp (vet)
Birmingham, Alabama

W. Scott Crowley, BA, EMT-P

EMT Program Director
Phoenix College
Phoenix, Arizona

Fabrice Czarnecki, MD, MA, MPH

Director of Medical-Legal Research, The Gables Group, Inc.
Attending Physician, Emergency Department, St. Joseph Medical Center
Towson, Maryland

Tony Damiano
Tactical Medic
Polk County Sheriff Department
Bartow, Florida

Andrew Dennis, DO, FACOS, DME

Trauma Surgery/Burn Surgery/Critical Care
The Cook County Trauma Unit, Cook County Hospital
Cook County Sheriff’s Police Hostage and Barricade Team
Chairman, Department of Surgery, Chicago College of Osteopathic Medicine of Midwestern University
Medical Director/Team Surgeon/Police Officer
Cook County Sheriff’s Police Department, Emergency Services Bureau
Northern Illinois Police Alarm System Emergency Services Team, Des Plaines, Illinois Police Department
Chicago, Illinois

Raffaele DiGiorgio, NREMT-P, UK HPC Registered Paramedic

Owner
Global Options & Solutions
Knoxville, Tennessee

Chris Dinsdale
Senior Lecturer, Prehospital Medicine
Tactical Medicine Specialist
Sheffield Hallam University
Sheffield, South Yorkshire, United Kingdom

Franco Dillena
Training Officer
Miramar Police Department
Miramar, Florida

Steve Erwin, BS, NREMT-I, Tactical EMT-I, EMSI

Program Manager, Emergency Medical Service
Louisiana Department of Health and Hospitals
Baton Rouge, Louisiana

Alexander L. Eastman, MD, MPH

Deputy Medical Director, Police Officer, Tactical Physician
Dallas Police Department
Assistant Professor of Surgery, Division of Burns, Trauma, and Critical Care
University of Texas Southwestern Medical Center
Dallas, Texas

Michael Eby, MD, FACOG

Chief, Surgical Critical Care, Jerry L. Pettis Memorial Veterans Affairs Medical Center
Loma Linda, California
Tactical Physician/Reserve Officer, San Bernardino Police Department
San Bernardino, California

Richard C. Frederick, MD, FACEP

Vice Chair, Department of Emergency Medicine, OSF Saint Francis Medical Center
Clinical Associate Professor of Surgery, University of Illinois College of Medicine
Tactical Physician, Special Tactical Assistance Trauma Team (STATT)
Auxiliary Deputy Sheriff, Peoria County Sheriff’s Office
Peoria, Illinois

Mark Griffeth, EMT-P

Manager, Facilities Division, Medical Programs
Illinois Law Enforcement Alarm System (ILEAS)
Urbana, Illinois

Russell J. Graham, BA, AAS, EMT-P

Staff Sergeant

Stephen Grasso, BA, EMT-P

Battalion Chief/SWAT Medical Team Leader
Lauderhill Fire-Rescue
Lauderhill, Florida

Joseph R. Haake, MD, FACEP

Tactical Physician, Carbondale Police Department
Emergency Physician, Southern Illinois Healthcare
EMS Medical Director, Southern Illinois Regional EMS
Captain, U.S. Army Reserve, 303rd Field Hospital
Carbondale, Illinois

David Halliwell, MSc Paramedic, FIFL, MIFPA

Head of Education
South Western Ambulance NHS Trust
Bournemouth, Dorset, United Kingdom

Brendan E. Hartford, EMT-Tactical

SWAT Team Training Coordinator, Chicago SWAT
Chicago Police Department
Chicago, Illinois

George Z. Hevesy, MD
Chair, Department of Emergency Medicine
Attending Emergency Physician, OSF Healthcare Saint Francis Medical Center
Clinical Associate Professor of Emergency Medicine, University of Illinois College of Medicine
Tactical Physician (ret), Special Tactical Assistance Trauma Team (STATT)
Auxiliary Deputy Sheriff (ret), Peoria County Sheriff’s Office
Peoria, Illinois

John Holschen, EMT-P, Tactical Paramedic

United States Army Special Forces Medical Sergeant (ret)
Heiho Consulting Group, LLC
Bothell, Washington

Matthew N. Jackson, MD, FACEP, FAAEM

Medical Director for Pre-Hospital and EMS, OSF HealthCare System
EMS Medical Director, Region II, PAEMS
Attending Emergency Physician, Department of Emergency Medicine
Clinical Assistant Professor of Emergency Medicine, University of Illinois College of Medicine
Tactical Physician, Special Tactical Assistance Trauma Team (STATT)
Deputy Sheriff, Woodford County Sheriff’s Office
Peoria, Illinois

Joshua Jeffries, EMT-P, Tactical Paramedic

Firefighter and Paramedic, Morton Fire Department
Private Security Specialist
Prehospital Educator – PAEMS
Tactical Paramedic, STATT TacMed Team
Police Officer, Washington Police Department
Instructor, TacMed Essentials LLC
Morton, Illinois

Neil Jones
Firearms Instructor
Tactical Firearms Unit
Sussex Police
Lewes, Sussex, United Kingdom

Sean Johnston, EMT-P, Tactical Paramedic

SRT - Special Response Team Tactical Officer
Peoria Police Department
Peoria, Illinois

Thomas M. Kamplain, Jr, MS, NREMT-P, Tactical Paramedic

Director, EMS/Fire Science
DeKalb Technical College
Covington, Georgia

Shane Knox, MSc, HDip-EMT

Advanced Paramedic
Training and Development Officer
HSE-National Ambulance Service College
Ballinasloe, County Galway, Ireland

Terry G. Kaufman
Tactical Medic, Lafayette Police Department
Manager, Flight Safety, Petroleum Helicopters, Inc.
Lafayette, Louisiana
Jacqueline E. Krajecki, RN, BSN, MSNA, EMT-LP, CEN, CCRN, CFRN, CRNA
Certified Registered Nurse Anesthetist
The Anesthesia Group of Sarasota
Sarasota, Florida

Austin Lamb, MD, FACEP

Attending Emergency Physician, Department of Emergency Medicine
Clinical Assistant Professor of Emergency Medicine
University of Illinois College of Medicine
Tactical Physician, Special Tactical Assistance Trauma Team (STATT)
Deputy Sheriff, Woodford County Sheriff’s Office
Peoria, Illinois

Gordon L. Larsen, MD, FACEP

Medical Advisor, Technical Rescue/Zion National Park Search and Rescue Team
Attending Emergency Physician, Southwest Emergency Physicians, Dixie Regional Medical Center
St. George, Utah

Justin M Lemieux, MD
Clinical Assistant Professor, Stanford Emergency Medicine
EMS/Disaster and Tactical Medicine
Medical Director/Field Physician San Mateo Regional Tactical EMS
Instructor, International School of Tactical Medicine
Medical Team Manager FEMA US&R CA-TF 3
Mountain View, California

Christopher J. Loscar, NREMT-P

St. Clare’s Hospital MICU
Dover, New Jersey

Mark A. Lorenz, MD, AAOS

Orthopedic Surgeon, Hinsdale Orthopaedics
Clinical Associate Professor, Loyola University Medical Center
Hinsdale, Illinois

David Q. McArdle, MD
Attending Emergency Physician, Georgia Emergency Associates, South East Georgia Medical Center, Brunswick, Georgia
Occupational Medicine Physician, Defense Support Systems LLC, Greenville, South Carolina
Federal Law Enforcement Training Center, Glynco, Georgia
Reserve Officer/Tactical Physician, University of Colorado Police at Boulder, Colorado
Affiliate Faculty Department of Criminology & Homeland Security, Regis University, Denver, Colorado
President, TacMedMD LLC
Medical Director, ColoradoSTAR
Centennial, Colorado

Kevin J. McCollin, MBA/HCM, NREMT-P

Director of Emergency Medical Services
Dugway Emergency Medical Services
Dugway, Utah

Lt. Craig McElhaney, NREMT-P

SWAT Medic
Miramar Fire-Rescue
Miramar, Florida

Tom McGarey, MA Ed, BSc

Paramedic Tutor
Regional Ambulance Education Centre
Northern Ireland Ambulance Service
Belfast, County Antrim, Northern Ireland

Sean D. McKay, EMT-P, Tactical Paramedic

Instructor, Tactical Medicine
Operational Rescue
Associate, Asymmetric Combat Institute
Taylors, South Carolina

Rick F. Miller, MD, FACEP

Director (ret), Pediatric Emergency Medical Services, OSF Saint Francis Medical Center
Clinical Associate Professor of Emergency Medicine, University of Illinois College of Medicine
Tactical Physician (ret), Special Tactical Assistance Trauma Team (STATT)
Deputy Sheriff (ret), Peoria County Sheriff’s Office
Peoria, Illinois
Alan Moore
Paramedic and Registered Nurse
London, England, United Kingdom

Jesse Munk, EMT-P, Tactical Paramedic, IDPH-LI

STATT Tactical Paramedic
Woodford County Sheriff’s Deputy
Instructor, TacMed Essentials Basic/Advanced
FLETC Tactical Medicine Instructor
EMS Shift Supervisor
HazMat, Rope operations, Vehicle Machinery Tech
Bloomington Firefighter
Bloomington, Illinois

Keith Murray MD, FAWM, FACEP

Emergency Medicine Physician
Medical Director Pittsburgh SWAT
Medical Director University of Pittsburgh SERT
Pittsburgh, PA

Wren Nealy, Jr, EMT-P, Tactical Paramedic

Director of Special Operations, Cypress Creek Emergency Medical Services
Lead Instructor, Tactical Medical Operational Support Course
Houston, Texas
Deputy Sheriff and SWAT Assistant Team Leader, Waller County Sheriff’s Office
Hempstead, Texas

Bohdan (Dan) T. Olesnicky, MD, ABEM, ABIM

Director of EMS, Eisenhower Medical Center Instructor, International School of Tactical Medicine
SWAT Physician, Palm Springs Police Department SWAT Palm Springs, California

Kevin Olver
Police Tactical Firearms Trainer
Cleveland and Durham Police Tactical Training Centre
Stockton-on-Tees, Cleveland, United Kingdom

Brian P. Pasquale, MPH, NREMT-P

SSG (ret), 68W_W1, USSOCOM-SOF-Paramedic
Co-founder
Tac-Med LLC
Collegeville, Pennsylvania

William F. Pfeifer, MD, FACS

Clinical Professor of Surgery, Rocky Vista University College of Osteopathic Medicine
Associate Clinical Professor of Surgery, University of Colorado Health Sciences
Mile High Surgical Specialists
Denver, Colorado

Jason R. Pickett, MD, EMT-P/T

Assistant Professor, Division of Tactical Emergency Medicine
Department of Emergency Medicine, Boonshoft School of Medicine
Wright State University
Major, USAR Medical Corp
Kettering, Ohio

Scott Plantz, MD, FAAEM

Associate Clinical Professor
Department of Emergency Medicine
Mount Sinai Hospital
Chicago, Illinois

James P. Phillips, MD FACEP

Assistant Professor of Emergency Medicine
Fellowship Director and Chief, Disaster and Operational Medicine
George Washington University Hospital
Senior Fellow, Center for Cyber and Homeland Security
Elliot School of International Affairs
Washington, District of Columbia

Guadalupe (Wally) Quintanilla, EMT-P, AAS

TEMS Team Leader, South Suburban Emergency Response Team
Corporal, Posen Illinois Police Department
Posen, Illinois
Engineer/Paramedic, Orland, Illinois Fire Protection District
Orland Park, Illinois

Colleen S. Ragon, RN, MSN, CEN, CFRN

Tactical Nurse, Special Tactical Assistance Trauma Team (STATT)
Central Illinois Emergency Response Team (CIERT)
Peoria Police Special Response Team (SRT)
Illinois Law Enforcement Alarm System (ILEAS) Region 6 Team
Auxiliary Deputy Sheriff, Peoria County Sheriff’s Office
Flight Nurse Specialist, Life Flight, OSF Saint Francis Medical Center
Peoria, Illinois

David Rathbun, EMT-P

Los Angeles County Sheriff, Special Enforcement Bureau (ret)
Tactical EMS Chair, National Tactical Officers Association
La Canada, California

Lee Raube, DO
Attending Emergency Physician, Department of Emergency Medicine
Clinical Assistant Professor of Emergency Medicine
University of Illinois College of Medicine
Tactical Physician, Special Tactical Assistance Trauma Team (STATT)
Deputy Sheriff, Woodford County Sheriff’s Office
Peoria, Illinois

Nicholas R. Reinhart, DO, FACEP

Medical Director/EMS Medical Director
OSF Healthcare Saint Elizabeth Medical Center
Ottawa, Illinois
Attending Emergency Physician
Department of Emergency Medicine
OSF Healthcare Saint Francis Medical Center
Clinical Assistant Professor of Emergency Medicine
University of Illinois College of Medicine
Tactical Physician, Special Tactical Assistance Trauma Team (STATT)
Deputy Sheriff, Woodford County Sheriff’s Office
Peoria, Illinois

John Rigione, EMT-P

President
Emergency Medical Solutions, Inc.
Bangor, Pennsylvania

Hector Roman, AS, EMT-P, Tactical Paramedic

Hospital Corpsman 1st class (FMF)
Advanced Tactical Training, Inc.
Coral Springs, Florida

Malcolm Q. Russell, MBChB, DCH, DRCOG, MRCGP, FIMC RCS(Ed)

Managing Director
Prometheus Medical Ltd.
Hope-under-Dinmore, Herefordshire, United Kingdom

Navin Sharma, RN, BSN, CEN, EMT-P, Tactical Paramedic

Police Officer (ret)/Tactical Paramedic-RN
Instructor, Tactical Emergency Medicine
Vancouver, Washington

Daniel Smiley, EMT-P

Chief Deputy Director
State of California Emergency Medical Services Authority
Sacramento, California

Andrew Smith
Medical Emergency Response Team Paramedic
Royal Air Force
Chippenham, Wiltshire, United Kingdom

William Smock, MS, MD, FACEP, FAAEM

Professor, Department of Emergency Medicine
University of Louisville School of Medicine
Police Surgeon, Louisville Metro Police Department
Tactical Physician, Floyd County, Indiana Sheriff Department
Another random document with
no related content on Scribd:
 It must have been about the beginning of May—just at
the time when the lilac on the bush near Granny Robin's
window was in full bloom—that a very strange thing
happened. The children had seen nothing more of the light
in the church since the Sunday when they had called Mr.
Robin to see it, and they were beginning to despair of ever
seeing it again. Yet still, when Sunday evening came, they
climbed on the flat tombstone, and looked in through the
window, hoping against hope that it might appear, and that
they might be able to prove the truth of their story. But as
the days grew longer and lighter, it became more and more
unlikely that any one who might happen to be in the old
church would require a light until long after Audrey's and
Stephen's bedtime.

But it so happened that one Sunday night, Aunt

Cordelia told Audrey that when she left church, she was
going to see a friend of hers who was ill, and who lived on
the other side of the river, almost two miles away. This
would take her a long time, as the friend might require her
help when she arrived, and in that case it would be late
before she was home.

Audrey was in alone, for the rain was falling fast, and
she and Stephen had not been together all day. The little
girl sat for some time by the window, watching the rain
which was beating mercilessly on the old tombs, and
covering the grave of the two grandchildren who died young
with the tiny blue blossoms of the forget-me-not which
Stephen had planted there.

It was a long, dreary evening, and it seemed as if it

would never come to an end. She would have liked to have
gone to church with Aunt Cordelia, but she was not allowed
to go in the evening. Once a day was enough for little girls,
Aunt Cordelia said.
 After a time it grew so dark that Audrey thought she
would go to bed, but then she remembered that she had
had no supper, and that Aunt Cordelia would not like her to
help herself to any. If it had only been fine, and she could
have been with Stephen, she would not have minded how
long Aunt Cordelia had been away; they would have been
so happy together that the time would have seemed short
to both of them.

As she was sitting at the window, she suddenly

remembered the strange light, and she wondered if it was
burning. It was dark enough for any one to need a light,
and if it was to be lighted at all that night, she felt sure it
would be already burning. It was still raining fast. Audrey
could hear it beating against the window, and there was not
even light enough for her to see the crooked old tombstone
which stood only two yards from the house.

A great longing came over the little girl to run across

the churchyard to the other side of the old church, and to
peep in at the window. Would Aunt Cordelia be angry if she
came home and found her out? She did not think she would
be, if she told her how very long the time had seemed to
her. Besides, she would not be five minutes away, and she
would know for certain whether that strange light was
burning or not.

Aunt Cordelia's old mackintosh was hanging behind the

kitchen door, and Audrey took it down, and wrapping it
round her, she opened the window and crept cautiously out.
It was so dark that to any one else, it would have been
impossible to cross the churchyard, full as it was of rough,
uneven stones, some of which were half buried in the long
grass, without either stumbling over them or falling against
them. But Audrey knew every inch of the churchyard, and
she could find her way about it by night more easily than a
stranger could have done so by day.

So the little figure, in her long waterproof cloak, went in

and out amongst the old tombstones in safety, and at
length reached the wall of the church. Feeling her way by
means of it, she passed under the east window on her way
to the flat stone on the other side of the church.

But just as Audrey was turning the corner, she stumbled

over something which was lying on the ground, and fell
forward with her head against the flat tombstone. What
could it be? There was no grave close to the wall, and she
had felt quite safe in walking there. Audrey sat up and
rubbed her head, and wondered more and more what had
made her fall. It was very dark at this side of the church,
for a thick yew tree overhung the flat tombstone, and
Audrey could distinguish nothing whatever.

She thought Stephen must have left something on the

ground when he had been playing there the day before; and
she was just going to climb upon the stone that she might
look for the light, when she heard close beside her a
strange noise. It seemed to be a moan, or the cry of some
creature in pain; and Audrey thought she must have
stumbled over some wounded cat or dog, which must have
crept under the church wall to die.

Wrapping her cloak tightly round her, she climbed down

from the stone, and felt with her hand on the grass below.
To her utter horror and astonishment, a voice spoke to her
as she did so.

"Is any one there?" said the voice.

Audrey was trembling so much that she could not

answer the question.
 "Is any one there?" said the voice again.

"Yes," said Audrey fearfully, "I'm here; Who are you?"

"You needn't be scared," said the voice, "I'm only old

Joe." And then he gave another groan, which went straight
to Audrey's little heart.

"What's the matter with you?" she said. "Are you ill?
Have you hurt yourself?"

"I'm dying, I think," said the voice faintly.

"I'll fetch somebody," said Audrey, getting up from the

stone; "I'll bring Mr. Robin."

"Oh no," said the old man in a louder voice, "don't tell
of me. I didn't do nobody any harm—don't fetch anybody;
don't thee now—they'll lock me up if they come!"
 "I'LL FETCH SOMEBODY," SAID AUDREY.

"Mr. Robin won't lock you up," said Audrey; "he's very
kind is Mr. Robin."

He made no answer to this, so Audrey did not speak to

him again, but at once began to creep past him. She was
still trembling so much that she could hardly stand, but she
managed to make her way back to the old houses, though
not so quickly as she had come.

She stopped at Granny Robin's window, and knocked on

the pane. Mr. Robin opened it.
 "Why, Audrey," he said, "what are you doing at this time
of night—and all wet and dripping, too?"

She could hardly tell him what she wanted, for her
heart was beating so fast with the fright she had had; but
she begged him to come with her, and to come at once, and
to bring a candle with him.

CHAPTER X
Old Joe

MR. ROBIN climbed out of the window, and taking

Audrey's hand in his, he told her to guide him to the place
where she had heard the voice. She led him in and out
amongst the tombstones; as far as the east window of the
church. Then, when they were sheltered from the wind and
the rain under the church wall, he lighted his candle, and
they went round the corner to the north side of the old
building.

There, on the grass under the yew tree, lay an old man,
so small, so thin, so shrivelled, that he looked no bigger
than a boy twelve years old. His hat had fallen from his
head, and his untidy grey hair hung upon his shoulders, and
round his neck was a board on which was written the one
word—"Blind."

The old man's eyes were closed, and he took no notice

of them as they bent over him. Mr. Robin took hold of his
hand, and it was cold as ice; then he felt his threadbare
clothes, and these were wet through with the rain, and so
was his old red scarf, which he had untied, and which was
lying beside him on the grass.

"I think he is dying, Audrey," said Mr. Robin gravely.

But just then the old man opened his eyes, and said in
a trembling voice—

"Don't tell of me—don't let them lock me up! I didn't do

no harm to nobody."

"We'll take him to the fire," said Mr. Robin. "Go and get
Stephen's father to help me, Audrey; he'll be in by now."

Very gently the two men carried him through the

churchyard, whilst Audrey went before them with the
candle. They took him into Mr. Robin's house, and put him
in Granny Robin's arm-chair before a blazing fire. Then
Audrey went to tell Aunt Cordelia, and to ask her to come
and help them.

The kettle was soon boiled, and they gave him some hot
tea, and then the colour came back a little into his ashen
face, and he said—

"Thank you. I'm better now. You won't tell of me—will

you?"

"What is there to tell?" asked Mr. Robin.

"You won't tell of me sleeping in the old church. I don't

do no hurt to anybody."

Mr. Robin and Stephen's father looked at each other.

 "So you sleep in the old church, do you?" said Mr.
Robin.

"Yes," said the old man. "I've slept there about a year
now. You won't tell of me, will you? I've nowhere else to go
but to the house, and I don't do a bit of harm—not a bit I
don't."

"How do you get in?" asked Granny Robin.

"Through the vestry-window," he said. "It hasn't a lock

on it. But I couldn't climb up this afternoon; I turned faint
and dizzy-like. I fell down quite stupid, and when I came to
my senses it was raining fast; I thought I was going to die—
I did indeed."

"Then that was the light we saw in the church—me and

Stephen!" cried Audrey.

"Did you see it?" said the old man piteously. "Don't tell
of me—don't!"

"How do you get your living?" asked Granny Robin.

"I sit under the railway-bridge and play my fiddle," said

the old man. "I must have dropped my fiddle, I think," he
said, as he felt for it with his trembling hands. "It'll be on
the grass outside somewhere; and I get a few coppers—a
very few coppers indeed. They buy me a bit of food, but
I've none left for lodgings—not a penny, I haven't."

"So you sleep in the old church! Isn't it very damp?"

asked Aunt Cordelia.

"Not in the pulpit," said the old man. "I curl away in the
pulpit, and put my head on an old cushion—it's snug up in
the pulpit. Don't tell of me—now don't, there's good folks!"
 "But what do you want a light for?" said Mr. Robin
gravely.

"Just to eat my supper by," he said. "It's so dark in

there. I feel lonesome when I'm eating my supper. I put it
out as soon as ever I've done."

"Then you're not blind!" said Stephen's father, holding

up the board which had been hanging round his neck.

"No," he said; "I wear that because they give me more

coppers if I do. I haven't very good sight; it's dim-like, but
I'm not so blind as all that."

"Oh dear, oh dear!" said Mr. Robin. "This is a very sad

story."

"Don't tell of me—" said the old man, whimpering like a

child, "don't tell of me!"

"We must think what's to be done," said Granny Robin;

"we'll talk it over to-night."

"And you may sleep on this sofa till morning," added Mr.
Robin. "We are trusting you very much by letting you stay
under our roof; but we can't turn you out in the rain. You
won't disappoint our trust, will you?"

"No, I won't, sir," said old Joe; "and thank you kindly,
sir!"

He turned so faint after this, that they were obliged to

lift him on the sofa and to cover him with a thick shawl. And
then, when the others were gone, and Mr. and Mrs. Robin
were alone, they talked long and earnestly together about
what was to be done with old Joe. He was evidently a poor,
ignorant old man, with no idea of right or wrong, and as
dark in his soul as a heathen in Africa. Yet perhaps God had
sent him to them that they might lead him into the
Kingdom of Light, and if so, they ought not to send him
away.

So in the morning, after they had given him some

breakfast, they talked to him about it.

"We have an empty room at the top of the house," said

Mr. Robin, "where you may sleep, and we'll put a mattress
for you to lie on, if you'll do two things to please us, and if
you'll keep your word about them. First, you must promise
me you'll never go into the old church again—if you do, we
shall feel it our duty to tell of you; and next, you must let
me put that lying board of yours at the back of the fire. If
you'll do those two things, old Joe, we'll give you a shelter
and welcome."

"And you'll not tell of me?" said the old man.

"Not as long as you keep your word," said Mr. Robin.

So old Joe stayed on. His illness seemed to have been

brought on by exposure and by want, and after a few days'
quiet, he seemed almost himself again. Then he was never
to be seen in the daytime, for wet or fine, he went to play
under the railway-bridge; and he found that he received
quite as many pence as he had done when he had that lying
board round his neck.

But in the evening, just as it was growing dark, he

climbed over the wall on the opposite side of the
churchyard, and came creeping through the graves up to
Granny Robin's window. Here he rapped three times, and
when they had let him in, they took him to the kitchen fire,
that he might warm himself before going up to bed.
 Audrey and Stephen would often come in to talk to him,
as he sat holding his thin, wrinkled hands to the blaze.
Audrey felt him her special charge, and often said that Old
Joe belonged to her, for she had found him first.

"How was it we only saw your light on Sunday?" she

asked him one day.

"Because I was in earlier that night," he said. "I came

later on week nights; I was afraid of folks seeing me; but I
didn't think as anybody would be about the old church of a
Sunday night."

"I'm so sorry for you, old Joe," said little Stephen,

laying his small hand on the shrivelled one of the old man.
"I wonder if you are one of the Children of Light?"

"I'm afraid he's not," said Audrey gravely.

"Oh, but you must be!" said little Stephen. "You'll be so

happy if you are."

"I never heard tell of them," said old Joe.

"They are the people who belong to Jesus," said

Stephen; "and He will make you one of them if you ask
Him. Will you ask Him, old Joe?"

"I've been a bad, wicked old man," said Joe. "I don't
suppose He would have anything to do with such as me."

"But He loves you," said little Stephen—"doesn't He,

Audrey? And He died for you, old Joe. Won't you ask Him to
take you into the Kingdom of Light?"

"I haven't said a prayer since I was a little lad and went
to Sunday-school," said old Joe—"not for sixty years or
more. It's too late for me to begin now."

"No, it isn't too late," said Audrey. "It's never too late to
begin to pray."

"You must begin to-night, old Joe," said Stephen. "Put

your hands together—so—now say after me, 'O Lord, take
my sin away, and make me a Child of Light. Amen.' You can
remember that prayer—can't you, old Joe?"

"I think I can," said the old man.

"And you can say it when you're out under the railway-
bridge, can't you?" asked Audrey.

"I think so; I'll try," said the old man humbly.

"Oh, I'm so glad!" said little Stephen. "'I do so want you

to be one of the Children of Light."

CHAPTER XI
The Hot Summer

AFTER this Audrey and Stephen had many a talk with

old Joe, in the evening, about the Kingdom of Light. He kept
his promise, and said the little prayer; and Granny Robin
said that she felt sure that it was being answered—he was
so humble, so sorry for his sinful life, so anxious to walk as
the Children of Light ought to walk.
 It was touching to see his love for the children. He had
been so long without any one to care for him, that it was a
new life to him to be amongst kind, friendly faces, and all
the love of his poor old heart went out to them. As the
evenings grew long and light, he followed them about the
churchyard, helping them to water the graves, and to cut
down the long grass at the foot of the stones.

But if old Maria happened, by any chance, to come into

the churchyard to show the old building to a stranger, he
always hid behind a bush until she was out of sight. He
seemed to fear that, by some means, she would know how
often he had spent the night in the pulpit, and would speak
to him about it.

Stephen and Audrey were very pleased to find that old

Joe had watched the swallows with as much interest as they
had done. He told them that he had liked to have their
company in the deserted church, and that when he woke
early in the morning he had loved to hear them twittering
overhead, and to watch them flying in and out of the broken
pane in the east window. There were young birds in the
nest now, and Audrey and Stephen spent a great part of
every day in looking in through the window, and in watching
the parent birds feeding them.

And Granny Robin, when she heard of it, said that it

reminded her of a verse in the Book of Psalms:

"'The swallow hath found a nest for herself, where she

may lay her young, even Thine altars, O Lord of hosts,
my King and my God.'"
 And she taught Audrey and Stephen a little hymn,
which she told them to say to themselves as they peeped in
at the swallows—

"'Happy birds that sing and fly

Round Thine altars, O most High;
Happier souls that find a rest
In a Heavenly Father's breast.'"

That was a hot summer in the old city. The elderly

people said it reminded them of the summers when they
were young, which they always declared were far hotter
than the summers of their old age. The city lay on a great
plain, and the scorching rays of the sun seemed to strike
down upon it, with nothing to break their power. The old
walls helped to shut out even the faintest breath of air
which might be stirring outside; and as day after day and
night after night went by, and no cool refreshing showers
came, the atmosphere in the narrow streets of the city
became close and stifling, and it was difficult to work by day
or to sleep by night.

Every one felt the influence of the weather in one way

or another. Aunt Cordelia felt it, and it affected her temper,
and made her more hard than ever on Audrey's pinafores.
Granny Robin felt it, and sometimes was so weary that she
laid down her knitting, and sat with folded hands dozing in
her chair by the window. Stephen's father felt it, and was
obliged to climb out of his window and take his stool and
tools under one of the churchyard trees.

Audrey felt it, and sat wearily in the close atmosphere

of Miss Tapper's academy, and longed for school to be over,
that she might get back to Stephen. But the little boy felt it
most of all. The flowers on the two graves were drooping
with the heat, in spite of all the careful watering they
received. And Stephen, the frailest flower of all, was fading
also, in spite of the tender care and love of his father.

No one thought much of it at first. It was the hot

weather, they said, which made him so quiet, and which led
him to lie for hours together on a rug which his father
spread for him under the lilac bush, unable to play, too
weary even to look at pictures, too weak and tired to do
anything but watch the swallows flying backwards and
forwards, and round and round, as they looked for food for
the little birds in the nest. It was the hot weather, they felt
sure, which had taken away his appetite, and which had
made him look even more thin, and pale, and fragile than
he did before.
 "GRANNY ROBIN, I'VE COME TO TELL YOU A SECRET."

They were all very good to him. Aunt Cordelia would

come to her window with a little cake fresh baked from her
oven, to tempt him to eat. Audrey would spend all her spare
time in reading to him and trying to amuse him. Granny
Robin would let him climb inside her window, and lie on her
knee for hours together; whilst his father would do anything
and everything that he thought would cheer and brighten
the child whom he loved so dearly.

But although they were all so kind to him, although they

all felt that he suffered far more from the intense heat than
they did, still none of them were very anxious about him.
They had been so long accustomed to his being weak and
fragile, that it did not strike them as strange that he should
be so completely exhausted by the weather; and they
hoped and believed that when cooler days came his
strength would return, and that he would be what he had
been, and would do what he had been able to do before the
hot weather set in.

It was old Joe who saw most clearly, in spite of the

dimness of his sight for other things, that little Stephen was
fading away. The evenings were long and light now, and the
old man and the children spent more time together than
before. The two graves were covered with flowers, and old
Joe had taken Stephen's place in helping Audrey to water
them and to take care of them. Stephen was too weak even
to lift his own little can. But Joe would carry him in his arms
to look at them, and to smell the roses which were growing
on a little rose-bush, which he had given him to plant on
the grave of the two grandchildren.

Yet tears would often come into the old man's eyes as
he looked at the child. He had had no one to love him or to
care for him till the children had found him, and now one of
them was going to leave him.

"Joe," said Stephen to him one day, "you'll take care of

the grave for me if I go away."

"Yes, Stephie, yes, to be sure I will," said the old man,

as he wiped away the tears which would come in his eyes.

But he never asked him where he was going, or when.

He knew, and Stephen knew, that the Child of Light was on
his way to the Home of Light, where darkness cannot come.
He could not help speaking of it that night, when Mr. Robin
brought him his supper, that he might eat it under the lilac
tree.

"The little lad's going fast," he said, with a sob.

"What little lad? Not Stephie!" said Mr. Robin.

"He is, though," said the old man; "and what's more, he
knows it hisself."

It was only old Joe's fancy, Mr. Robin said, when he

mentioned it to his wife, but still he did think Stephen's
father should let a doctor see him.

Stephen's father was spoken to, and at once went off

for the best doctor in the old city. But the doctor told them
just what the old man had told them before—that Stephen
was going fast. He might pick up a bit if cooler weather
came, but he would never outlive the summer, he said.

Stephen had heard the doctor's words, and leaving his

father and Mr. Robin together, he crept away to Granny
Robin's window.

"May I come in and sit on your knee, Granny Robin?" he

said.

"Yes, my little darling," said the old woman, as she felt

for the window, that she might help him in.

"Now we're cosy," said Stephen, as the old woman laid

aside her knitting and took him in her arms.

"Granny Robin, I've come to tell you a secret."

"What is it, Stephie?"

"I'm going to die young, Granny Robin."

 "Oh, I hope not, my dear child!" she said, as she
stroked his little thin face.

"Yes, the doctor said so," said Stephen gravely. "And

you said it was a good thing for the two grandchildren,
Granny Robin."

"Yes, it will be a good thing for you, Stephie," she said;

"but oh, what shall we do without you? Whatever shall we
all do without you?" And Granny Robin broke down at this,
and sobbed as if her heart would break.

"Never mind," said little Stephen—"don't cry! I'm a

Child of Light, you know; and it will never be dark in the
King's Garden—will it, Granny Robin? And won't it be nice
when you, and father, and Audrey, and old Joe come there
too?"

Granny Robin dried her eyes; she would not grieve the
little lad by her tears. And there was Audrey to be
comforted—poor little Audrey—who had come in crying and
full of sorrow.

"I'm so tired," said Stephen presently, with a long, deep

sigh.

Audrey called his father, who lifted him out of Granny

Robin's arms, and carried him to his little bed.

"Father," he said, as he was undressing him, "carry me

to the window, please."

"Why, Stephie, it's getting dark," he said. "What did you

want to see?"

"I always look out before I get into bed," said the child.
"I always have a peep at the grave of the two
grandchildren. Yes—there it is; isn't it pretty, father? I
wonder if any angels are looking at it now, and if they see
you and me up here? Shall you plant any flowers on my
grave? You will, won't you? I do wish I could be buried here,
under the window."

"My little lad, my own darling little lad!" sobbed the

father, as he laid him on his pillow.

The next day Stephen seemed better than he had done

for weeks before, and they all felt cheered and comforted,
in spite of the doctor's words. He walked about a little, and
sat under the lilac bush, and even helped Audrey to water
the graves.

"Maybe he'll get better after all," said Mr. Robin

hopefully. "Doctors do make mistakes sometimes."

But old Joe shook his head.

"The candle flickers up a bit afore it goes out," he said

gravely.

CHAPTER XII
White Robes

THE summer passed away, the hot, tiring weather

departed, and cool winds began to blow over the
churchyard. The leaves on the trees were changing colour,