Making the Most of Police Partners

Police often arrive at emergency scenes before EMS providers. For that reason they can have even more opportunity than EMTs and paramedics to help certain patients—delivering quicker CPR and defibrillation for cardiac arrest, for example, and faster bleeding control in cases of trauma. When willing police partners assume certain small but time-critical portions of the emergency medical mission, the impacts on morbidity and mortality can be very positive. 

In other cases the levels of collaboration between emergency medical providers and law enforcement can leave something to be desired. And when things go really sideways, as recent high-profile cases have shown, people can needlessly die. 

What’s the secret to successfully harnessing law enforcement’s capabilities when cops arrive first to medical calls or police calls develop medical components? And can EMS systems help recreate the kind of success seen with police defibrillation and hemorrhage control in other areas now posing thornier challenges? 

“Just by the nature of how most 9-1-1 systems work, police will almost always beat ambulances to medical calls. And if you’re choking or in cardiac arrest, three minutes is forever,” says David Tan, MD, FAAEM, FAEMS, division chief of EMS and an associate professor of emergency medicine at Washington University in St. Louis, as well as medical director for the St. Charles County Police Department in Missouri. 

“There is no question that in communities where police have things like patrol CPR and AED programs, lives are saved. So I think we can build on those successes by saying, look, there is a tangible, measurable benefit to having a medically savvy police force. Not only is it good for the citizens we all serve, but it’s good for the police too. How many stories have we seen about officers collapsing in the station and saving each other? It’s a win-win situation.” 

The good news is that many modern police agencies recognize the value of officers who are “medically savvy.” The International Association of Chiefs of Police (IACP) cites data showing more than 80% of law enforcement agencies respond to medical emergencies, and around half provide some form of on-scene patient care.¹ The bad news is that half isn’t that many, and it may be a best-case calculation: A 2018 review of 2014 NEMSIS data found just 2% of patients received aid by law enforcement before medical responders arrived.²

Not all departments or officers may value medical priorities, but all have plenty on their plates. For many busy modern PDs, too much focus on medical matters is a luxury time and other responsibilities don’t afford. 

“One thing to understand about police officers is that of all professions, including medicine, they have to master a wider variety of topics than just about anyone,” says David McArdle, MD, FACEP, an emergency physician in Colorado and chair of the International Association of Chiefs of Police’s Police Physicians Section. “They have to know the law, about physical force, about driving, about firearms. And their training time is extraordinarily limited. So it’s frustrating, but in part it comes back to many police executives feeling their officers are so overwhelmed with other duties, [prioritizing medical interventions] just isn’t something they should do. 

“It’s a relatively easy sales pitch, but most places don’t want to go beyond tourniquets.”

Where It Works Well

Police defibrillation isn’t a new idea. Studies of its effectiveness began as far back as 30 years ago, when seven suburban departments joined together to evaluate how well it worked. Ten years later 96% of their surveyed officers agreed police AED use was beneficial to victims of cardiac arrest, and 89% agreed police AED use was appropriate.³ In all seven departments, a 2009 Prehospital Emergency Care summation found, “defibrillation [had] become integrated into the law-enforcement culture.” 

Other data shows police arrive to cardiac arrest calls before EMS more than half the time and reduce the average response time from 7.6 to 4.9 minutes,⁴ and AED use by law enforcement is associated with a doubling of survival rates in shockable out-of-hospital arrests.⁵ 

Organized efforts to teach and arm nonmedical responders for bleeding control owe much to recent decades’ terrorism and mass shootings that produced efforts like Stop the Bleed and the Hartford Consensus. Tactical care education and teams have proliferated, and most accredited police academies now have first responder components that encompass immediate care of the ABCs. Cops typically learn SABA, self-aid/buddy aid, and in the last 5–10 years have become more able to sustain lives in the initial minutes following major trauma. The IACP promotes direct pressure, tourniquets, and hemostatic agents for officers to aid the injured. 

Generally police are also more attuned to medical and behavioral issues and get more training on them than they used to. With increased recognition of excited delirium, they’ve become more aware of things like metabolic derangements and low blood sugar as potential causes for unusual behaviors. Says Tan, “Modern police departments have a much better understanding of the differential of altered mental status and certainly about trauma than they ever did, say, as recently as 10 years ago.”

Besides saving lives, McArdle says, growth in these areas helps police build trust at a time when officers could use some goodwill. 

“The medical care police officers can do is tremendously valuable, not just in reducing mortality and costs but also as far as enhancing the professional image of policing,” he says. “It shows we’re not just a bunch of knuckle-dragging killers, you know? It’s so important to do that. But most police executives just see it as, Well, the firefighters will do this. I don’t think we’re going to replace any fire department or EMS jobs, but I think we can hand the firefighters and paramedics a lot better patients to work with if we work as a team.” 

Where that “team” aspect is missing, people can die—think of recent well-publicized deaths like George Floyd and Elijah McClain. Those leave families grieving unnecessarily, generate anger toward police, and don’t reflect well on EMS systems that allow or are powerless to stop deaths in custody. (For an analysis of McClain’s case, which had significant fallout for both EMS and police in Colorado, see the accompanying article.) 

Optimizing the Interface

Your police colleagues can be great partners in saving lives if they are trained, resourced, and value the mission of doing so. You can’t force “medically savvy” on the unwilling or unable, but for the benefit of your patients, your own safety on scenes, and the safety of your law enforcement compatriots, it’s worth a bit of effort on a few levels:

• Develop relationships—Leaders have to buy in, but this is also important at the street level, where police and EMS bring different priorities and approaches to the same calls. “Talk to any EMS practitioner, and they’ll be able to tell you, ‘Oh, I know who Officer So-and-So is; they’re always very trustworthy and helpful,’” says Tan. “Unfortunately they’ll also be able to tell you who isn’t very helpful or can be a bit abrasive. That’s the one that you want to work on, because most of the problems result from some kind of misunderstanding or miscommunication.” Developing relationships in advance reduces that likelihood. 
• Practice—Train together for your active shooters and bus crashes for sure, but also consider occasional joint drills that pose more mundane cases like troublesome ExD patients or odd AMS and behavioral cases. Practice the quick-huddle strategizing and continuous interagency communications you’ll need on those scenes. Clarify how and when to transfer care and custody smoothly and how to help even criminal suspects promptly and effectively. 
• Outcomes and feedback—The NAEMSP’s position paper “Clinical Care and Restraint of Agitated or Combative Patients by Emergency Medical Services Practitioners,” updated in 2020 and cosigned by the NAEMT, NASEMSO, NEMSMA, and the American Paramedic Association, emphasizes the importance of quality assurance whenever EMS patients require physical restraint or pharmacologic management.⁶ It may be worth sharing or discussing specific cases with your police partners if they were handled well or could have been handled better. Evidence matters when you’re soliciting buy-in for their involvement in medical calls. 
• Keep a pulse—As a chief or medical director, stay active and involved at the field level—reading reports can only give you so much insight. Be clear about expectations and have leaders and trusted subordinates amplify key messages. If those side-by-side calls could be handled better by either side, leaders should know.  

References

1. International Association of Chiefs of Police. IACP Police Physicians Section, Emergency Trauma Care; www.theiacp.org/resources/training-key/667-emergency-trauma-care-part-i. 

2. Klassen AB, Core SB, Lohse CM, Sztajnkrycer MD. A descriptive analysis of care provided by law enforcement prior to EMS arrival in the United States. Prehosp Disaster Med, 2018; 33(2): 165–70.

3. Mosesso VN. Ten years of police defibrillation: Program characteristics and personnel attributes. Prehosp Emerg Care, 2009 Jul; 9(2): 186–90.

4. Myerburg RJ, Fenster J, Velez M, et al. Impact of Community-Wide Police Car Deployment of Automated External Defibrillators on Survival from Out-of-Hospital Cardiac Arrest. Circulation, 2002 Aug 27; 106(9): 1,058–64.

5. Weisfeldt ML, Sitlani CM, Ornato JP, et al. Survival after Application of Automatic External Defibrillators before Arrival of the Emergency Medical System. J Am Coll Cardiol, 2010 Apr 20; 55(16): 1,713–20.

6. Kupas DF, Wydro GC, Tan DK, Kamin R, Harrell IV AJ, Wang A. Clinical Care and Restraint of Agitated or Combative Patients by Emergency Medical Services Practitioners. NAEMSP Position Statement, October 2020; https://nasemso.org/wp-content/uploads/Clinical-Care-and-Restraint-of-Agitated-or-Combative-Patients-by-Emergency-Medical-Services-Practitioners.pdf. 

Sidebar: Police Medics

Some police departments, largely on the east coast, actually operate ambulance services, but few field actual EMTs. It may be time, McArdle suggests, for police medics.

“Police are usually the first responders to the scene and often the first victims,” he says. “I think we’re at a point where, as a medical subspecialty, we can consider the need for police medics. I’m not saying every cop needs to be a paramedic, but in Aurora and other recent cases, intervention with advanced medical skills by police may have produced a different outcome.” (Aurora cops likely saved some lives by transporting victims following the city’s 2012 theater shooting.) 

McArdle posed the argument in a 2020 letter to the Presidential Commission on Law Enforcement Reform.¹ He wrote: 

Much like the demonstrated value of the military special forces medic, I believe there is a critical need for the police medic to be embedded into patrol—not just for the treatment of battlefield wounds [but] the police medic should be able to address the unique medical issues common to law enforcement… Topics unique to the domain of the police medic include a variety of issues that may ultimately result in sudden death in custody. 

Such a position would respect the basic human needs of the injured suspect and help deescalate fraught situations. In Oklahoma City, McArdle noted, when EMTs were placed into patrol, it helped reduce use-of-force complaints by 30%. 

“They don’t even really need to be paramedics,” he adds. “They’ll do some of the same things paramedics do, but they won’t be responding to nursing homes at 3 o’clock in the morning to pick up septic patients, things like that.”

Critical care physician Mark Cannon, MD, went even further in a 2017 essay for the Peace Officers Research Association of California, arguing for law enforcement medicine as its own specialty.² Wrote Cannon: 

Developing the momentum to create a new medical specialty designed for law enforcement seems like a minimal effort when considering the volume of civilians killed and injured by groups like ISIS and the increase in ambush attacks on officers. 

References

1. McArdle DQ. The Need for the Police Medic to Be Embedded in Patrol. Letter to the Presidential Commission on Law Enforcement Reform, March 2020.

2. Cannon M. Law Enforcement Medicine: This Specialty’s Time Has Come. PORAC, 2017 Jan 10; https://porac.org/2017/01/law-enforcement-medicine-specialtys-time-come/.

John Erich is the senior editor of EMS World. Reach him at john.erich@emsworld.com.