This website is funded through a grant from the Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice. Neither the U.S. Department of Justice nor any of its components operate, control, are responsible for, or necessarily endorse this website (including, without limitation, its content, technical infrastructure, and policies and any services or tools provided).

Are you carrying what is necessary should you find yourself in a critical incident requiring immediate medical attention? Download this list, check your equipment with the list, and share with other law enforcement officers to make sure that you and your fellow officers are prepared!

These two methods differ on how they are fed. To explain further, below is a comparison of how they differ in tooth engagement, chip evacuation, cutting forces, cutter wear, and cooling.

Plainmilling

A go bag is necessary to rapidly deploy medical equipment, ammo, and supplies within the perimeter of a critical incident.

This roll call training is designed to reduce officer injuries and deaths through discussion and demonstration of the types and placement of medical equipment that should be carried by law enforcement officers.

The VALOR Program’s casualty care curriculum and resources are based off the TCCC model. TCCC approves certain brands in the market based on rigorous research and testing on the products, ensuring that they are only endorsing products that will be reliable and effective in the field. Therefore, though there are other products on the market, VALOR features only TCCC-approved products in the toolkit.

Always ensure that an unconscious person has an open airway to his or her lungs. One way to ensure an open airway is to use a head-tilt, chin-lift technique, lifting the tongue from the back of the throat. The unconscious person can also be shifted to either side so that his or her tongue will not block the airways.

Another distinction we have to learn about these two milling approaches is that the resulting chips separate from the work part differently. The chips during a back milling process are thrown in an upward motion, while in the down milling process, the chips separate in a downward direction. This means that in up milling, chips tend to accumulate at the cutting zone and may choke or be carried with the cutting edge during the milling operation, resulting in a compromised surface finish. On the other hand, in down milling, chips vacate the workpiece easily without much interference with the cutting. That’s why down milling is deemed to be more suitable for chip management.

This publication provides photos and instruction on how to use hemorrhage control medical supplies such as tourniquets, gauze, and bandages.

Up milling and down millingwhich is better

The Casualty Care Resource Clearinghouse is your one-stop-shop for all VALOR casualty care resources. All the resources available on the other pages can be found here as well as a multitude of others. Check out the Clearinghouse for videos, posters, articles, and more.

Facemilling

Relating to the entry and exit of the cutting tool in both approaches, their cutting force for both milling methods also varies. The cutting force in back milling starts from zero to maximum, while for down milling, it begins from maximum to zero. Because of the way the material is cut in a down milling operation, relatively low power consumption can be attained for CNC milling.

Purchase them in bulk from a vendor that supplies TCCC-approved tourniquets: Combat Application Tourniquet (CAT) Gen 7; Combat Application Tourniquet (CAT) Gen 6; Ratcheting Medical Tourniquet, Tactical (RMT - T); SAM Extremity Tourniquet (SAM - XT); SOF Tactical Tourniquet, Wide (SOFTT - W); Tactical Mechanical Tourniquet (TMT); TX2” Tourniquet (TX2); and TX3” Tourniquet (TX3).

Below are various roll call drills to utilize in your agency or to practice on your own. There are detailed instructions and required materials provided for each drill. Practicing these vital casualty care practices could save your life, the life of a fellow officer, or a civilian!

Since back milling cuts in an opposing direction, it experiences higher friction, resulting in a higher chance of wearing the cutter edge. While in down milling, tool wear is relatively minimized because it cuts the material in the same direction as its feed.

Endmilling

In CNC milling, both down and back milling offers an advantage on a given situation and application. Described below are their benefits and on what circumstances are they best used on:

Do you have any drills that you or your agency use to practice casualty care principles? Email us your drill at casualtycare@valorforblue.org to help a fellow officer or agency with their casualty care training!

The VALOR Officer Safety and Wellness Program (VALOR Program) has been provided by the Institute for Intergovernmental Research® (IIR) since VALOR’s inception in 2010.

The best method to treat hypothermia is to prevent it. When the body’s temperature lowers and hypothermia occurs, the body’s ability to clot blood diminishes. Keep patients warm, even in warm or hot environments.

This online scenario is designed to increase the capacity of law enforcement personnel to implement mitigation techniques used to deal with major hemorrhage secondary to injuries caused by gunshot and/or knife wounds, etc.

Conventionalmilling

Due to the opposite cutting direction of back milling, the chips load on the teeth at their minimum. This means that as a tooth engages with the workpiece, the width of the chips increases from zero to maximum. While in down milling, a tooth of a cutting tool starts to cut a chip of material from maximum to zero as each tooth engages with the workpiece.

● It has a reduced load from the cutting edge resulting in lower tool wear and longer tool life. ● It produces a smooth surface finish because of its cutting approach (thick to thin) ● It generated lower heat than that of back milling. ● It requires a less critical work holding fixture. ● It has better chip evacuation.

The three most important factors to consider when acquiring a tourniquet are cost, durability, and Tactical Combat Casualty Care (TCCC)-approved.

In addition to this, the back milling cutting force is directed to the opposite side, having a tendency to lift the workpiece from its clamping. On the other hand, the cutting force in down milling is directed downward, so it secures the clamping of the work part, decreasing the chances of the work part from being pulled out.

Also called up milling. This approach is known as the conventional way of milling that involves feeding the work part against the direction of the cutting tool’s rotation, causing an upward cutting force. Here, the cutting tool is forced against the work part as it engages, producing relatively high friction, and in turn, produces a higher amount of heat. In up milling, on the contrary to down milling, the cutter starts to subtract the minimum material until it gradually cuts the maximum material as it rotates.

Advantagesanddisadvantages ofup milling and down milling

Back or up milling is the traditional way of milling back when machines were not yet equipped with backlash eliminators. The opposing forces in this approach remove errors that a machine backlash may cause.

Threat suppression Hemorrhage control Rapid extrication to safety (get off the "X")Assessment by medical personnelTransport to definitive care (hospital)

Ideally, to ensure an excellent surface finish, it is essential to consider having the lowest possible chip thickness at the end of the cut. This is why back milling is preferred for roughing processes, and down milling is preferred for finishing operations.

Experts use countless CNC milling techniques in making the most out of their CNC machine depending on the size, shape, feature, and material of a part being machined. One of these techniques employed in the machining industry is the utilization of different cutting approaches, namely down milling and back milling. Using the right type of cutting approach for a specific application plays a significant role in making your machining successful. To set everything first into perspective, below are the definitions of each one:

Unless otherwise indicated, drill sheets were created by the National Association of Emergency Medical Technicians. VALOR instructor and tactical paramedic David Dunafan has created the VALOR drills. All of the roll call drills have also been reviewed by Dr. Jonathan Sheinberg, cardiologist and lieutenant on the Cedar Park Police Department.

As time went by, the technology behind the CNC milling machine has evolved, backlash eliminators are integrated within their mechanisms, enabling machinists to use down milling in their processes.

This federal, multidisciplinary first responder guidance translates evidence-based response strategies from the U.S. military’s vast experience in responding to and managing casualties from IED and/or active shooter incidents and from its significant investment in combat casualty care research into the civilian first responder environment. In addition, civilian best practices and lessons learned from similar incidents, both in the United States and abroad, are incorporated into this guidance.

What isup milling

With all these advantages, there are still things to be cautious about in down milling. These are machine backlash and the deflection of both the cutter or the work part.

Down milling and back milling is a different approach used in providing CNC milling services, both offering an advantage in a given situation or application. The fundamental distinction between these two is their cutting and feed direction. In down milling, the material is provided in the same direction as the cutting tool rotation. On the other hand, in back milling, the material is fed in the opposite direction as the cutting tool rotation.

These documents present tactical medicine material that may conflict with conventional civilian emergency medical services (EMS) practices. Routine civilian EMS care is not designed to address care for victims in situations where rescue personnel are exposed to an ongoing threat of violence. These documents are specially designed for law enforcement officers who will be the first responders to situations that require balancing both tactical and medical issues.

Since the filming of this video the Tactical Combat Casualty Care Committee updated their list of recommended tourniquets to include the following: Combat Application Tourniquet (CAT) Gen 7, Combat Application Tourniquet (CAT) Gen 6, Ratcheting Medical Tourniquet -Tactical (RMT-T), SAM Extremity Tourniquet (SAM-XT), SOF Tactical Tourniquet – Wide (SOFTT-W), Tactical Mechanical Tourniquet (TMT), TX2” Tourniquet (TX2), and TX3” Tourniquet (TX3). Since the filming of this video, Chief David Flory has retired from Hot Springs Arkansas Police Department and is now a Senior Research Associate for the Institute for Intergovernmental Research, and a lead instructor for the VALOR Program

Threat suppression Hemorrhage control Rapid extrication to safety (get off the "X")Assessment by medical personnelTransport to definitive care (hospital)

Improper technique when performing drags and carries of someone wounded in the field can create a delay in care, an increase in the time personnel are exposed on the X, or worsen an injury.

This milling approach is preferred for dealing with the rugged demands of rough cutting a work part with tough and brittle materials (e.g., hardened, cast, or forged). In addition to its roughing application, machinists tend to set their cutting approach to back milling when cutting thin-walled and extended surfaces. The reason for this is that deflection is minimized because of the opposing forces while cutting.

Climbmilling

This online training is designed to review the Tactical Combat Casualty Care-recommended tourniquets and demonstrate to officers how to apply each of these tourniquets on themselves and others to prevent major blood loss.

Where gunfire is still occurring or is likely to start again, threat suppression is the best “medicine.” If you become a victim, you are of no help to the situation. Make sure to always “get off the X” in a hot zone to ensure tactical advantage and safety.

You are limited to what you can carry on you while on-duty. Choose equipment wisely and carry the most critical pieces of equipment you may need to stay prepared for a critical incident at any moment.

Your VALOR session will expire in 60 seconds. If you are still working in VALOR, please press the Continue button to extend your session.

To render effective medical aid, you must have the proper equipment and know how to use it. This requires regular training with your trauma care equipment. Utilize the resources on this page to assist you and your agency with consistent and realistic casualty care training to ensure you are prepared for any critical incident!

● Down milling is a preferred process when a smooth surface finish is desired, while back milling is for when it is for roughing purposes. ● Down milling has better heat generation, lower load, and better chip evacuation. ● Back milling is a good process when it comes to minimizing machine backlash and deflection.

Where gunfire is still occurring or is likely to start again, threat suppression is the best “medicine”. If you become a victim, you are of no help to the situation. Make sure to always “get off the X” in a hot zone to ensure tactical advantage and safety.

Always ensure that an unconscious person has an open airway to his or her lungs. One way to ensure an open airway is to use a head-tilt, chin-lift technique, lifting the tongue from the back of the throat. The unconscious person can also be shifted to either side so that his or her tongue will not block the airways.

During a critical incident, where is your tourniquet? It is too late to go back to your patrol car or agency. Download, print, and share this poster to remind yourself and your fellow officers to always have their tourniquets on them!

Also known as climb milling. This approach involves feeding the work part in the same direction of the cutting tool’s rotation, resulting in a downward cutting force. The cutter engagement with the work part at its entry will cut the maximum material and then gradually reach zero as the cutter rotates. Having the same direction for the feed and the cutting tool rotation develops lesser resistance between the cutter and the workpiece. This could mean lesser heat generation during the machining process.

You are limited to what you can carry on you while on-duty. Choose equipment wisely and carry the most critical pieces of equipment you may need to stay prepared for a critical incident at any moment.

The best method to treat hypothermia is to prevent it. When the body’s temperature lowers and hypothermia occurs, the body’s ability to clot blood diminishes. Keep patients warm, even in warm or hot environments.