Introduction

“Medicine? For Special Agents? Really?” That is the response I received just a few years ago when I proposed the concept of training and equipping agents to provide trauma care at the federal level. I was working as a Special Operations Medic for a large federal agency. “You SRT guys might need that stuff but what do field agents need it for?” I eventually succeeded in having my program adopted nationwide after I pointed out that field personnel, unlike SRT, weren’t able to carefully choose the time and place of their encounters. SRT always plans to confront suspects with overwhelming force, an advantage in numbers and often has an ambulance on standby. Field personnel, on the other hand, are more often than not in pairs or alone with limited access to immediate medical response. In other words, field personnel (Patrol Officers) are the true tip of the spear in law enforcement.

In the time that I have been involved in tactical team operations, the inclusion of front line tactical medical personnel has become a reality. In fact, the National Tactical Officers Association has mandated the existence of a Tactical Emergency Medical Support (TEMS) capability as a required component of a certified tactical team. LAPD and LASO were some of the earliest adopters of this concept and agencies nationwide have followed suit. TEMS programs have shown their worth over the years and are currently an accepted concept. Now we must expand this capability to the Patrol Officer level as they are the one who can most benefit from it.

At the same time, one must understand the differences between training and equipping a motivated and specialized tactical unit versus line personnel. Working out those issues has taken years of thought, study, training course revisions and medical equipment advances. But the time is here.

Roadblock Arguments/Proposal for Success

1. “My officers aren’t medics. Let EMS deal with patients.” First and foremost, understand that this program is not intended to make police personnel primary medical providers. The costs and training burdens to do this would be insurmountable. As a tactical team medic, my yearly training and equipment commitments were tens of thousands of dollars and hundreds of hours. This program in no way supersedes the responsibilities of trained medical provider response. The purpose of this program is to bridge the gap between incident time and the arrival of EMS. It is in this five to ten minute window that an officer can literally save a life.

2. “My Academy already teaches First Aid/CPR.” Red Cross and the American Heart Association are great organizations who have a vested interest in pushing their programs concepts. They have large budgets and aggressive marketing campaigns. First Aid and CPR are great for civilian providers confronted with minor medical emergencies and cardiac patients. But these programs were not designed for law enforcement personnel and don’t realistically address penetrating trauma patients. In fact, I would argue that some First Aid training, such as the treatment of fractures and burns, is exactly what we should not be teaching law enforcement personnel. These are conditions to be handled by EMS. Calls for service regarding a medical patient will result in simultaneous arrival of EMS with police. EMS should be allowed to do their job. When will EMS not come to the scene immediately? In the exact types of situations that will result in the most vigorous police response. Shootings, stabbings, etc are the situations that we should be training for and those types of trauma patients are the ones not covered by First Aid and CPR courses.

3. “Liability.” Liability is literally the boogey man in the closet that, right or wrong, tends to drive many modern policy decisions. Agency attorneys will tend to default to this response when “police” and “medical” are mentioned in the same sentence and recommend against adopting a medical program. I would argue that the opposite is true. I view this training as a liability reduction program. Accepting that this program trains and equips personnel to take action only when a patient is experiencing a life threatening condition and trained medical providers are not present, what are your options? The options are clear, attempt to save the patient’s life or do nothing. The concept of Failure to Act/Failure to Render Aid is becoming commonly litigated. It has been successfully argued that putting personnel on the street with firearms and direction to confront law breakers makes it reasonably foreseeable that someone may be injured. How can we justify training our personnel to potentially take a life without preparing them to save one? Note that I am not only talking about treating fellow officers. This program teaches officers to actively treat civilians and suspects as well. But only when the tactical situation makes it safe to do so. Sound decision making should be as much a part of training as is the medical skills. Finally, when consulting with your agency attorney regarding this concept ask them if they would prefer to defend against a post use of force lawsuit where agency personnel did nothing for the patient versus a situation where, when safe to do so, the personnel attempted to aid the suspect or citizen.

4. “Community/Public Relations.” The concept discussed above actively addresses the issue of community/public relations as well. In this day and age of cell phone cameras and digital media, it is an inevitable fact that there will be documentation of any use of force incident that occurs in public. When those images make the front page of the local paper or (worse) the internet, would you rather see your officer standing over an injured suspect and staring at him or attempting to render aid? If the officer, as activists and lawyers often argue, “set out that day to kill someone” then why is he attempting to help him? How will the image of your officer rendering aid help in the aftermath? I think the answer is obvious.

5. “Terrorism/Active Shooter Response.” As stated previously, this course is as much about decision making as it is about physically rendering aid. Many agencies are currently addressing the very real possibility of active shooter/Mumbai style attacks domestically. The course should teach that elimination of the threat is the primary responsibility of law enforcement. Eliminating the threat is, in fact, a tactical medical act in that you are preventing additional casualties. Officers are taught that once the threat is eliminated there will be a lag in EMS response. This is the time frame in which they can make a difference by triaging patients, rendering immediate care and arranging for rapid transport of the most critically injured. It was clearly proven in the aftermath of the Gabriel Giffords and Fort Hood shootings that these actions save lives. This program purposefully dovetails with existing active shooter response training programs and supports their teaching. On the subject of terrorism response, agencies spend millions on gas masks and auto injectors to defend against potential chemical attacks. When was the last chemical attack domestically versus the last time someone was shot or stabbed in your area of responsibility?

6. “This will cost too much.” This program is not some theoretical venture designed around selling expensive equipment. Realize that we are talking about actual trauma kits containing the same components as used by military and tactical units. Not first aid kits containing band aids, insect bite lotions and cravats. By doing away with the first aid kits commonly found in police cars nationwide you could fund most of the equipment needed to institute this program. Additionally, those same first aid kits contain items that tend to suggest an officer should be treating medical conditions (minor injuries, bee stings, fractures) that they have no business treating. The equipment recommended by this program is ideal for grants, union/police association purchases and private donation funding. As opposed to buying items that could have potential blowback on the purchaser donating funds (a weapon) a trauma kit has a sole purpose – to save lives.

7. “Training Time.” Just like equipment costs, training time is a budgetary and logistical reality. Most officer level classes can be taught in one 8 hour segment containing both classroom and practical skills. The one day format is easily absorbed into regularly scheduled POST recertification schedules and Police Academy curriculums. Suggested retrainer time frame to refresh officers skills is every three years. It should also be noted that hands-on skill stations and scenario based training coupled with input from your tactics and survival skills instructors can allow these training hours to serve double duty as tactical training time.

Conclusion

I would proffer that the question isn’t why a program should be adopted but rather why wouldn’t it be adopted? The fact that it is the right thing to do for your officers and the public is only bolstered by the positive liability reduction and public relations aspects. The experience of our armed forces over the last ten years coupled with the resultant medical studies have provided incontrovertible evidence that lives can be saved through aggressive bleeding control methods and rapid transport.

Recommended Medical Item for Patrol Officers

Adequate training should be completed from a licensed professional before performing any first aid discussed in this article. This is not medical advice.