One of our core responsibilities as prehospital medical providers is to offer care and assistance to not only the general public, but also to those who assist and protect us in the field: law enforcement officers. Despite the risk of injury that most police officers face in their daily line-of-duty work, they don’t often receive good medical instruction on self care and buddy aid. As a result, they too represent a medically underserved population that EMS providers are in an excellent position to assist.
Although most police officers receive some medical instruction during their training at a law enforcement academy, no federal or state standard governs the level of training required or the frequency with which refresher courses must be offered.1
Without such standards, there’s a wide variety in the medical skill sets of officers within and between law enforcement agencies. Some officers may have a deep understanding of medical care, while others may know very little. With all they do to provide scene safety for us to do our work, it simply makes sense that we should return the favor.
The Problem
Although tactical emergency medical services (TEMS) is defined as medical support for police and law enforcement officers, it has traditionally focused on high-risk special weapons and tactics (SWAT) units. By concentrating resources on only these relatively small units, however, we’re making a strategic mistake: The majority of injuries in law enforcement are borne by the street level officer, not the tactical operator.
The Department of Justice/Federal Bureau of Investigation’s Law Enforcement Officers Killed and Assaulted database reported that 57,268 police officers were assaulted in 2009, with more than 95% of those assaults occurring against officers in non-SWAT assignments.2
These assaults resulted in more than 15,000 injuries and 48 deaths. Of those officers who sustained fatal injuries, only five were involved in tactical/SWAT scenarios. Therefore, although focused “SWAT medicine” offers an exciting opportunity to provide direct care in the high-risk tactical setting for officers and perpetrators, targeting medical instruction toward the larger population of non-SWAT officers who sustain a greater number of injuries may be the smarter move.
Law Enforcements Needs
The inherent danger of law enforcement work puts officers at risk for motor vehicle accidents, ballistic injuries, stab wounds and orthopedic injuries. It follows then, that the street level officer needs training in the basics of first aid, including hemorrhage control, airway and pneumothorax management, and sprain/fracture treatment. And with police officers often representing the first persons on the scene of an emergency, it also makes sense to instruct them on the use of automated external defibrillators.
Unfortunately, like other public agencies, most law enforcement groups are currently operating on tight budgets. As a result, the knowledge and supplies to provide immediate casualty care should be easily obtainable at low cost and provide as much “bang for the buck” as possible.
Care items should be readily portable so they can be carried on, or easily reached by, the police officer at work. These items should be both durable and survivable to minimize expiration and turnover of supplies. As EMS providers, it’s important that we take the time to teach each officer how to use these materials, taking care to provide enough depth to make the concepts understandable without making things too technical.
Today, all U.S. military soldiers entering combat do so with standardized individual first aid kits (IFAKs) that have proven success in improving survival after injury on the battlefield. Our department felt that similar success could be achieved in the civilian sector by issuing kits to our street level police officers.
The Nashville Experience
In Nashville, every police officer is required to undergo annual in-service training on a topic of the leadership’s choosing. At the request of our local law enforcement agency, we built a modern day “first aid” program and taught that program once a week for five months to the entire roster of approximately 1,400 active duty officers.
In each weekly course, we taught the same lecture and practical skill session using a PowerPoint presentation and training kits that modeled the IFAKs that we then issued to each officer. We covered the following topics:
>> The airway, breathing, circulation, disability and exposure assessment of first aid;
>> Basic airway opening, including jaw thrust and head tilt/chin lift;
>> CPR;
>> Lacerations and bleeding;
>> Dressing application;
>> Tourniquet use;
>> Ballistic injuries and wound considerations;
>> Blunt-force injuries;
>> Burn injuries;
>> Management of impaled objects; and
>> Extraction and evacuation techniques.
To practice their skills with real-time feedback, we gave the officers an opportunity to apply bandages and tourniquets and treat mock sucking chest wounds. At the conclusion of the course, each officer was issued an IFAK with all contents stored neatly in a single modular lightweight load-carrying equipment pouch.
It contains 6″ Israeli battle dressing, a tourniquet, a triangular bandage, stretch and sterile gauze, petrolatum gauze, medical shears, medical tape, personal protective gear (e.g., shield, gloves) and a Mylar rescue blanket.
Cost was a key consideration for us. We were able to obtain the materials above and supply each of the 1,400 officers with a complete kit at an individual unit cost of $56.80. The funds used to pay for the purchase of these materials came from a Department of Homeland Security Metropolitan Medical Response System grant.
Outcomes
It’s important to note that we didn’t certify the officers as first responders after the course was completed. The purpose of our pilot project was to primarily train the officers in specialty techniques to care only for themselves and their partners.
The course was also not long enough to certify the officers to the first responder standard and wasn’t designed to teach them to provide care to the general population. That’s what their original academy training is designed to do. What we were able to achieve, however, was the instruction of a large population of public safety officers who are at high risk for frequent injury in a very short period of time.
There’s no doubt that in the care of the critically injured trauma patient, two concepts hold true: 1) every second counts and 2) care at a Level I trauma center is associated with improved patient outcomes. We believe our program will allow officers to provide earlier care, which will lead to improved outcomes when injuries occur.
Conclusion
As the experts in prehospital emergency care, EMS has a duty to improve flaws that can be fixed easily in our systems. This low-cost, high-impact program for law officers presents us with a real opportunity to improve patient outcomes by designing some direct lectures on specific topics and interspersing hands-on skill sessions.
EMTs, paramedics and EMS physicians can and should teach their jurisdiction’s law enforcement officers how to deal with the immediate health threats of such injuries as sucking chest wounds, exsanguinating hemorrhages and airway obstructions.
With the use of public, private or government funds, officers can be equipped with life-saving emergency supplies for very little money per officer. By preparing a standardized lecture and practical skills series that can be taught by EMTs, paramedics or physicians, there’s a real opportunity to improve outcomes for an underserved population that does so much to make our own jobs as safe as possible.
Author’s Note: The previous statements represent the views of the authors and not necessarily the view of the Department of Defense or its respective components. JEMS
References
1. Sztajnkrycer MD, Callaway DW, Baez AA. Police officer response to the injured officer: A survey-based analysis of medical care decisions. Prehosp Disaster Med. 2007;22(4):335—341.
2. Department of Justice Federal Bureau of Investigation. 2009. Law Enforcement Officers Killed and Assaulted. In Federal Bureau of Investigation. Retrieved March 8, 2011, from www2.fbi.gov/ucr/killed/2009.
This article originally appeared in May 2012 JEMS as “Partners in Crime: EMS provides a training program for local law enforcement.”
