By Brian L. Springer, David Q. McArdle, Fabrice Czarnecki, and Alexander L. Eastman
espite improvements in tactics and equipment, as well a number of safety initiatives and programs, 2011 was a deadly year for law enforcement officers. According to the National Law Enforcement Memorial Fund, for the first time in 14 years, officers killed by firearms outnumbered deaths from traffic-related causes.1 In addition, other law enforcement lives continue to be claimed by motor vehicle collisions, heart disease, and falls. These profoundly tragic deaths occur not only out on the streets, but also in the relatively secure confines of training. Adequately addressing this problem requires a multifaceted response. Officer safety begins with the individual and is augmented through the support of fellow officers, administration, and the community at large. To provide guidance on medical aspects of officer safety, a group of dedicated professionals have emerged: law enforcement physicians. In its relative infancy, law enforcement medical support is an umbrella concept that encompasses preventive medicine (wellness programs and occupational medicine), self-aid/buddy-aid, first responder/first provider, and Tactical Emergency Medical Support (TEMS). Its purpose is to enhance officer and public safety, reduce departmental liability, and prevent or mitigate officer disability. The IACP Police Physicians Section believes that law enforcement medicine is a unique entity with its own set of guiding principles. It has the potential to be life saving and career preserving when LEOs are faced with the darkest hours of their career: a devastating injury or illness.
Despite the recognition that law enforcement officers are needlessly lost to injury and illness, the harsh reality of the situation is that we lack a solid grasp on the best practices for law enforcement medicine. While several studies mentioned later in this article look at how LEOs get injured—what specific injuries lead to the most damage and devastation to our personnel—there is a dearth of good scientific data to answer this question. The authors are left interpolating from their military colleagues.
A specific example is injury sustained from firearms. Most law enforcement selfaid/buddy-aid programs, as well as most TEMS programs, are based upon the U.S. military’s Tactical Combat Casualty Care (TCCC) system. Created to address shortcomings in military medicine brought to light during the Battle of the Black Sea in Mogadishu, Somalia, TCCC was designed for a military environment, and its use (as well as other tactical medical protocols based on military data) in the civilian realm has not been scientifically validated. The National Association of Emergency Medical Technicians (NAEMT) Prehospital Trauma Life Support curriculum grew from original recommendations of the TCCC Committee—but is designed for training EMS personnel, not LEOs.
Military gunfights on the battlefield and law enforcement deadly force confrontations on the street may sometimes seem similar, but preliminary research indicates that the patterns of injury are not. TCCC has proven its worth in the combat setting, but in the civilian environment it generates questions: Are the treatment priorities of military wounds appropriate for LEOs? Is the equipment fielded by military ideal for LEO injury? This equipment is not inexpensive and takes up weight and space on an officer’s tactical vest or duty belt. Efforts are under way to make such equipment more compact and affordable, but these costs still must be considered.
Currently, there is no single database that captures LEO injury data with sufficient detail. While never designed to address injury in detail, the Federal Bureau of Investigation’s Law Enforcement Officers Killed and Assaulted (LEOKA) database has been used by some to try to extrapolate useful information. Analyzing 10 years of LEOKA data from 1998 to 2007, Sztajnkrycer et al. attempted to identify “preventable” causes of death: injuries where immediate intervention through self-aid/buddy-aid or by a tactical medic would have saved the officer’s life. Out of 341 line-of-duty deaths occurring within 1 hour of felonious assault, excluding blunt trauma (such as being beaten with fists, kicks, or a blunt object or weapon) the authors deemed 123 cases “preventable.” Almost three-quarters of those were injury to the chest; this differs considerably from military data, where the most common preventable cause of death is injury to an arm or leg. Another study, the IACP’s Reducing Officer Injuries: Developing Policy Responses shows several different patterns of injury.2 This study, the first of its type, captured all injuries from a sample of eighteen law enforcement agencies from around the country. While there were no fatalities during the study period, two clear trends emerged. First, that fitness and wellness play a large role in both injury rates and time to recovery, and, second, that nearly 18 percent of injuries sustained in confrontation placed the injured officer at risk for extremity hemorrhage.
Unfortunately, LEOs continued to be injured during training as well. In their analysis of the National Tactical Officers Association Police Training Fatality Report, Bollard and Metzger found an increase in the number of training-related deaths annually during 2008–2010.3 They presented their findings at the 2011 IACP Conference in Chicago.4 The greatest number of deaths was due to medical causes, such as presumed myocardial infarction (heart attack) leading to collapse and cardiac arrest. Gunshots, motor vehicle crashes, and falls also remain significant causes of death.
There has been a recent surge of interest in medical training for law enforcement. While this interest originated among SWAT and other branches of law enforcement special operations, every officer with public contact or the potential for conflict must be able to care for themselves or their partner until help arrives. TEMS, the provision of tactically appropriate trauma and emergency medical care that originated with SWAT in the 1960s and 1970s has continued to evolve. Yet while TEMS is geared towards specialized, high-risk units, recent active shooter events in Aurora, Colorado, and Tucson, Arizona, have demonstrated a clear need for every officer to be trained and well-versed in a number of life-saving techniques. Because of the unique environments in which LEOs operate, they cannot be dependent on traditional EMS and rescue to come to their aid.
The IACP Police Physicians Section has been actively discussing the future direction of tactical first aid for police officers. LEOs continue to be killed in training and in the line of duty. While there is not clear evidence that the military medical model is optimal, it can be assumed that medical intervention as soon as possible will mitigate complications of injury and reduce officer deaths.
As a part of the IACP’s overall focus on LEO safety, the IACP Police Physicians Section continues to explore best practices for law enforcement medicine. Over the next year, the section will be specifically looking at wellness programs, tactical first aid (selfaid/buddy-aid, first responder/first provider), and TEMS. The goal of this endeavor is to enhance officer and public safety, reduce departmental liability, and prevent or mitigate officer disability. In order to make meaningful progress, the section proposes the following:
1. Define the scope of the issue through better data collection and through collaboration with other specialty organizations. There are numerous data sets available, and these should be carefully assessed for what they can teach us about LEO injuries and fatalities and what can be done do to prevent them. The shortcomings of these data must also be examined, and the information necessary to review what interventions have been previously attempted must be collected. For instance, law enforcement must turn a critical eye toward medical information LEOs have been taught in the past, what they are being taught now, and what effect this might have had on saving lives. This scope should be inclusive of all medical risks faced by law enforcement, not just felonious assault but also blunt trauma (that is, injury from motor vehicle crashes or falls) and complications of heart disease. Other organizations have similar interests, and collaboration with them can ensure the problem is defined completely, and the needs of all officers are being met.
2. Determine the essential medical skills for LEOs. Once the scope of injury and illness is better understood, competencies can be defined that are appropriate for all levels of LEO. For instance, skill sets for patrol officers may differ from those assigned to investigative or high-risk assignments (SWAT, narcotics, etc.). Training officers (both FTOs and at basic training) will need to pass on this information in a practical, accessible format. Chiefs and other administrative officials will need to understand how to integrate medical training into their departments, and ensure that officers are provided with appropriate equipment that functions in today’s environment of severely restricted budgets.
3. Recommend the training necessary to ensure LEOs master and retain this knowledge and skill set. Providing a knowledge base is not simply enough. The best methods for teaching and retaining that knowledge must be ascertained and integrated into LEO practice. A one-time block during basic/recruit training will not be sufficient. Ongoing training and familiarization with acute interventions likely will be necessary, though optimal time and methodology have not yet been determined. Most likely, training in law enforcement first aid will need to be viewed like firearms or fitness qualification, and carried out in a regular annual or more frequent format. Additionally, as the officer’s role changes over time, training should be tailored to ensure that the officer’s needs are met. Program development and ongoing supervision should be done with the assistance of a local physician familiar with the principles of law enforcement medicine. The recent IACP Training Keys on emergency trauma care can also help departments to implement a law enforcement-specific first aid program.5
4. Consider the potential financial costs, harm/benefit, and legal ramifications of such practices. Equipment and training expenditures will need to evolve with lessons learned from law enforcement medical support data. Police officers are not going to replace the emergency medical providers in their communities. Instead, they should be equipped with basic medical skills that can be used to save their own lives and those of another injured or ill officer. An added benefit would be that these skills could be applied to assist an injured bystander or even suspect. Such training should not distract the officer from other critical training, but should be complementary. Any medical equipment carried by an officer must be affordable, easy to use, effective, and must not interfere with performance of their day-to-day duties.
As noted, there is still much to be done. The end results of this endeavor will be enhanced knowledge and safety for LEOs, a worthwhile and achievable goal. The IACP Police Physicians Section stands ready to assist departments in developing this important capability. ♦
1National Law Enforcement Officers Memorial Fund, “2011 Officer Fatality Statistics,” http://www.nleomf.org/facts/officer-fatalities-data/2011-law-enforcement-fatalities.html">http://www.nleomf.org/facts/officer-fatalities-data/2011-law-enforcement-fatalities.html (accessed September 25, 2012).
2Adrienne Quigley and Alexander Eastman, “Officer Down: How Does It Really Happen? The IACP Reducing Officer Injury Pilot Study—Results, Trends, and Officer Safety Recommendations” (presentation, IACP 2011, Chicago, Ill., October 22, 2011).
3National Tactical Officers Association, Police Training Fatality Report, July 2012, http://ntoa.org/site/images/stories/pdf/TrainingFatalitiesReport2012.pdf (accessed October 26, 2012).
4Glenn A. Bollard and Jeffrey C. Metzger, “A Retrospective Study of Law Enforcement Training Deaths: New Paradigms for Prevention” (presentation, IACP 2011, Chicago, Ill., October 22, 2011).
5IACP Training Keys 667, 668, 669 “Emergency Trauma Care,” parts I–III, purchasing information is available at http://www.theiacp.org/tabid/452/Default.aspx (accessed October 12, 2012).
|Brian L. Springer, MD, EMT-T, FACEP, Director, Wright State University–Division of Tactical Emergency Medicine, Dayton, Ohio; David Q. McArdle, MD, FACEP, Medical Advisor, Rocky Mountain Tactical Team Association, Vice-Chair; IACP Police Physicians Section, Medial Officer Health Office, Federal Law Enforcement Officers Training Facility; and Clinical Instructor, Department of Emergency Medicine, Georgia Health Science University, Southeast Georgia Health System, Brunswick, Georgia; Fabrice Czarnecki, MD, MA, MPH, FACOEM, Medical Director of Public Safety Medicine, Northwestern Memorial Physicians Group, Chicago, Illinois; and Chair, IACP Police Physicians Section; and Alexander L. Eastman, MD, MPH, FACS, Lieutenant and Deputy Medical Director, Dallas, Texas, Police Department; Chief of Trauma Surgery at Parkland Memorial Hospital; Assistant Professor of Surgery, University of Texas Southwestern Medical Center; and Officer-at-Large, Police Physicians Section|
Please cite as:
By Brian L. Springer et al., "Law Enforcement Medicine: Core Concepts from the IACP Police Physicians Section," The Police Chief 79 (December 2012): 76–77.