EXECUTIVE SUMMARY AND DECISION
As a result of four separate incidentsi related to auto-lock, trigger finger manipulation holsters [Blackhawk SERPA CQC Level II holsters (ii) (low wall)], the Federal Law Enforcement Training Center (FLETC) requested that a study be conducted to identifY any common causative factors unique to this holster design. The study was assigned to Firearms Division (FAD) at FLETC-Glynco with assistance from the FLETC Field Training Directorate (FTD). A subsequent companion study of the Blackhawk SERPA CQC Level II Holster (high wall) was also conducted which resulted in similar findings.
The scope of both holster studies was devised to identify any safety related problems unique to the deactivation of the retention device while drawing and presenting the firearm. This testing included the following components:
a review ofthe current FAD curriculum;
review of FAD Standard Operating Procedures (SOPs);
an interview of the student involved in the FLETC-Glynco accident; a search to identify and verifY other outside incidents within the firearms training community;
and psycho-motor skills testing(iii) of the process of drawing a weapon from the auto-lock trigger finger manipulation holster.
The participants completed written feedback critiques at the conclusion oftheir session. Also, there was limited video recording of certain portions of the testing.
SUMMARY OF FINDINGS
The conclusions and results gathered from the analysis of holster testing and participant feedback was captured in separate reports at the completion of both the studies.
~ Duress is experienced by the shooter when draw-stroke steps are executed out of order. This sequencing error can then initiate a cascading series of failures (iv). This series of failures is first recognized by the shooter as an inability to draw the firearm from the holster.
• This inability is caused by:
o The tension caused by the upward pressure of the draw stroke occurring prior to the
deactivation of the retention mechanism.
o Unless deactivated prior to the draw action, this feature "locks" the pistol in the holster.
Once locked, the shooter experiences a greater amount of duress.
o The shooter then tends to use more force in an effort to remove the weapon from the
holster and tends to transition from digital-pad to digital-tip pressure which causes the
trigger finger to bend. Also, the associated increase in grip pressure causes all of the
fingers of the strong hand to flex, further increasing the flex or bend of the trigger finger.
o When the firearm is finally removed from the holster, this bend in the trigger finger
positions the finger proximal to the trigger or on the trigger.
~ The feedback from the majority of the FAD staff' that participated in the study indicates that a holster that requires multi-tasking of the trigger finger or that has a release mechanism closely proximal to the trigger is potentially problematic by increasing the risk of an inadvertent discharge. Subsequent review of the studies by the FLETC FTD SMEs also concluded that proximity of the finger to the trigger creates an inherent safety risk.
~ The proctors that administered the testing are all SMEs (vi) from the FLETC Basic and/or Advanced Firearm Training Programs and. The recommendation provided by these SMEs regarding the use of this style holster range from "hesitant to recommend the use of" to "should not be used in training. "
~ The frame by frame review ofthe video from the intern/CITP student portion of the psychomotor skills testing indicates that during approximately 25% ofthe draw strokes the shooter's trigger finger was proximal to the trigger and approximately 13% ofthe draw strokes began out of sequence (low wall study).
~ The interview with the CITP student involved in the training accident on December 13, 2011,
revealed that the curriculum and presentation of that curriculum was appropriate and complete.
The student indicated that he experienced a sequencing error and discharged his weapon.
~ An informal survey was conducted of commercial and private firearms training facilities. Several responses included; this style of holsters can be used but must have the release mechanism disabled, or cannot be used at a facility.
Based upon the known facts, SME observations and both holster study findings, the FLETC submits the following training decision:
~ The FLETC is restricting the use of level II retention, auto lock-trigger finger release style holsters during all firearms training on FLETC firearms ranges. Holsters that possess a single retention release mechanism that is located proximal to the trigger area of the firearm are problematic and pose a safety hazard. Holsters that include additional release mechanisms (level III retention) should be evaluated for suitability prior to use on FLETC firearms ranges. This restriction will be classified as a "local range rule" which the FLETC has used in the past to improve safety practices during firearms training at all FLETC training sites.
(i) The first incident, an Unintentional Discharge (UD), occurred on July 20, 2010, at FLETC-Glynco. This incident was the result
of the shooter's jacket becoming entangled in the holster during the process of re-holstering the pistol. The three most recent
incidents were apparent Negligent Discharges (ND) and occurred on October 27, 2011, at FLETC-Cheltenham, on December 13,
2011 , at FLETC-Glynco and on March 30, 2012, at FLETC-Cheltenham. All of these ND's resulted in self-inflicted injuries.
(ii) The Auto-Lock Trigger Finger Manipulation Holster has been available commercially since 2006. It is available for most
models of pistols and revolvers. This holster is available in both left and right hand models. As a retention holster, this design
protects and retains the firearm as designed. The holster is designed with an auto-lock system that securely holds and "locks" the
firearm in the holster when the firearm is inserted. There is no need to manipulate any portion of the holster to secure the
firearm. The release for the retention mechanism is located on the exterior of the holster on the outboard side, in the area of the
trigger/trigger guard ofthe firearm. To operate the release the shooter establishes his/her strong-hand grip, extending and
straightening the index finger (trigger finger). The shooter then applies digital-pad pressure with the trigger finger to the "release
button". This action deactivates the retention device allowing the shooter to draw and present the firearm.
(iii) This testing consisted of a series of draw stroke drills that commenced with 4 second facings and were reduced incrementally to
.75 seconds. These skills were conducted both strong-hand (two-hand) and support-hand (one-hand).
(iv) A cascading series offailures is best described as non-sequenced, repetitive actions that place the shooter in danger of
experiencing a Negligent Discharge.
(v) This group consisted of 49 FAD instructional staff members (FLETC staff and Partner Organization (PO) representatives) with
approximately 294 years of instructional experience.
(vi) These SMEs possess 120 years of active firearms training experience. They are the Lead Instructors with program oversight
for the following programs: CITP, UPTP, LMPT, RSITP, SSTP, LERTP and FITP