While EMS agencies in the United States continue to deal with the COVID-19 pandemic and strain it puts on their systems, U.S. police departments are reporting the deadliest year since 1930.
According to the National Law Enforcement Officers Memorial Fund preliminary data, as of December 31, 2021, 458 federal, state, tribal and local law enforcement officers died in the line-of-duty in 2021. This is an increase of 55% from 295 killed in 2020. The past year has been the highest on record line-of-duty deaths since 1930, when 312 fatalities were recorded.
Of the 458 line-of-duty deaths in 2021, firearms related fatalities were the second leading cause of law enforcement officer deaths, the first being from the deadly COVID-19 pandemic that claimed 301 officers. Firearms related deaths represent a 38% increase over the same period in 2020.
“We know that mass casualty incidents don’t just occur in large cities anymore. Mass shootings and critical incidents are now popping up in small towns and rural setting,” Cumberland Police Department Chief Chuck Ternent said. “We always hope that the casualties will never outnumber the EMS crews, but sometimes it does.”
With the alarming number of injuries and deaths involving America’s law enforcement officers, EMS clinicians responding to these emergencies need to be prepared for the unique challenges they may be presented with.
Responding to a first responder shooting
Two officers in Frederick, Maryland, a city located about 50 miles west of Baltimore and Washington, D.C., along I-70 and I-270, were recently injured in a shooting.
“In a recent shooting in which two of our officers were injured, one bullet entered above the vest in the area of the neck and another officer was shot in the arm,” Frederick Police Department Deputy Chief of Police, Joe Hayer said. “All officers are issued tourniquets and bullet proof vests.”
“Responding to an injured law enforcement officer is a very high-stress situation,” Dr. Matthew Levy, DO, MSc, NRP, associate professor of emergency medicine and associate EMS fellowship director at Johns Hopkins University School of Medicine said. “Being up-to-date and current on treatment protocols and best practices, interventions for penetrating trauma are essential for all penetrating trauma patients.”
Following are 5 considerations for responding to an officer down call:
1. Rapid transport
Dr. Levy, the medical director for Howard County Department of Fire and Rescue, added for anyone that is shot and critically injured, on scene times should be kept to a minimum and rapid transport should be initiated to the appropriate facility.
The R Adams Cowley Shock Trauma Center in Baltimore, Maryland, accepts trauma patients from all over the state of Maryland, Washington D.C. and nearby states. The facility is Maryland’s primary adult resource center for trauma.
“Once care is initiated, we as the medical providers have to establish the appropriateness of care on site, extrication to fall back treatment area, triage of treatment, triage of transport and prior established trauma center destination,” Dr. Ryan Fransman, surgical critical care fellow at the R Adams Cowley Shock Trauma Center said. “In most cases, doing a full exposure of the patient after injury for initial intervention is unnecessary, time consuming and – in those actively hemorrhaging – can lead to rapid and pronounced temperature loss.”Dr. Fransman trained as a paramedic and registered nurse prior to becoming a physician.
“Beyond direct patient care itself, having a clear understanding of local practices, policies and expectations is very important,” Dr. Levy says. “If not already in place, establishing a working collaborative relationship with local law enforcement is an important first step.”
Dr. Fransman said that EMS professionals can expect different types of injuries when treating law enforcement officers, including penetrating life-threatening wounds.
“Overt external bleeding can get a tourniquet deployment and wound packing with limited exposure and – in those with known or suspected thoracic penetrating trauma – exposure of the anterior and posterior chest for hole assessment and occlusive dressing placement would be necessary and potentially lifesaving,” Dr. Fransman added.
2. Triage and treat
“Don’t be distracted or get overwhelmed by the presence of tactical equipment during your assessment,” Dr. Levy said. “Body armor can be removed by lifting it over the patient’s head. There is often also a quick-release present, but it not apparent, the shoulder straps can be cut with trauma shears.”
“Basic skills should take you a long way,” Ternent added. “There can be a moral and ethical dilemma for EMS when arriving on the scene with down fire, police and EMS workers, as well as a downed assailant, who is an (alleged) criminal.”
The correct decision is to always do triage and treat appropriately according to your protocols, Ternent added.
3. Evidence preservation
“Officers are setting priorities when responding to these incidents in terms of life safety for civilians and first responders, and incident stabilization to include scene preservation and security. Property conservation and security of evidence would come next,” Hayer added. “Sometimes, when law enforcement and EMS folks are responding to scenes, evidence can be inadvertently moved or slightly altered from the original event while providing care to victims.”
“While life-sustaining interventions are always paramount, EMS clinicians should try to minimize destruction of potential evidence,” Dr. Levy said. “This goes back to having an ongoing working relationship with local law enforcement.”
Documentation of the scene, surroundings and injuries in your patient care report is important in assisting the police during their investigation.
4. Tactical medic model
Tactical Emergency Causality Care is a course developed in 1996 by special operation forces. TECC provides guidelines, evidence-based and battlefield-proven methods to reduce deaths in tactical and trauma situations. The course is currently taught by the National Association of Emergency Medical Technicians.
Specialty tactical teams and appropriately trained police officers carry specialized equipment to treat injured officers, including tourniquets, hemostatic gauze, decompression needles, chest seals, scissors and a space blanket.
“All police officers have basic first aid and ‘Stop the Bleed’ skills,” Ternent said. “All of my officers carry BLS kits, ‘Stop the Bleed’ kits and a foldable litter in each vehicle. We provide care as soon as practical but understand stopping threats and securing the scene so EMS can work is our primary objective.”
Ternent added that when responding to shootings and mass casualty scenes, although not ideal, a paramedic can be paired with an officer to assist with treating a patient.
“At my department, I have tactical medics who are attached to my tactical team and train with them,” Ternnet said. “My tactical medics are there for the safety of my team members and will provide aid to anyone, including suspects if their skills are needed.
Cumberland Police Department’s tactical medics include physicians, nurse practitioners, paramedics and/or EMTs.
5. Scene safety awareness
Ternent said that in some situations, trained officers are trying to de-escalate the situation.
“Usually there is no mistake who is on the tactical team,” Ternent said. “Depending on the situation, the teams may be hidden out of sight, so their presence does not add to the anxiety of the suspect.”
Ternent said that it is important for tactical trained EMS personnel to be cognizant of how they are dressed, and tactical uniforms should not be part of the everyday uniform.
“I have seen EMS providers show up on scene and stand around in tactical clothing (like) that of the tactical team. If a suspect looks out a window or such and see what they perceive to be a tactical team when the police are trying to calm the suspect,” Ternent said, “it could exacerbate the situation.”
Drs. Levy and Fransman emphasized that concerns have been raised about managing an officer’s service weapon(s).
“If another law enforcement officer isn’t available to take possession of the weapon, don’t remove the weapon from the holster,” Dr. Levy said. “Rather, take off the entire duty belt. Unless you’re specifically trained and authorized in your EMS role, don’t attempt to clear or make safe a weapon.”
Hayer said both Frederick Police officers are recovering physically and mentally but have not returned to work.
This article, originally published in June 2022, has been updated.
