Law enforcement agencies and out-of-hospital emergency care

History of Racial Discrimination by Police Contributes to Worse Physical and Emotional Quality of Life in Black Americans After Traumatic Injury

BACKGROUND

Black Americans are more likely than their White counterparts to experience traumatic injury and worse functional outcomes. Unfair police treatment has been identified as one specific form of racial discrimination potentially driving these deleterious outcomes. The aim of the investigation was to better understand the relationship between experiences of discrimination by police and trauma-specific quality of life outcomes, including PTSD symptom severity, in Black Americans following traumatic injury.

METHOD

Traumatically injured Black American adults (N = 53) presenting to a level 1 trauma center completed a measure of police and law enforcement discrimination at baseline, and quality of life and PTSD were assessed 6 months later.

RESULTS

Stepwise regressions results showed more frequent discrimination by police and law enforcement significantly predicted lower emotional and physical well-being 6 months after injury. Further, more frequent police discrimination resulted in more severe PTSD symptoms by 6 months after injury.

CONCLUSIONS

Findings underscore that following an injury not specifically related to discrimination by police, patients' historical, negative police experiences contributed to worse physical and emotional recovery in the present. These findings, in unison with prior investigations, reveal the need to consider patients' history of negative police experiences as a social determinant of health in their recovery.

Immediate Medical Care Rendered by US Law Enforcement Officers after Officer-Involved Shootings - An Open-Access Public Domain Video Analysis

BACKGROUND

After officer-involved shootings (OIS), rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEOs) after lethal force incidents.

METHODS

Retrospective analysis of open-source video footage of OIS occurring from February 15, 2013 through December 31, 2020. Frequency and nature of care provided, time until LEO and Emergency Medical Services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board.

RESULTS

Three hundred forty-two (342) videos were included in the final analysis; LEOs rendered care in 172 (50.3%) incidents. Average elapsed time from time-of-injury (TOI) to LEO-provided care was 155.8 (SD = 198.8) seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO versus EMS care (P = .1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (P < .00001).

CONCLUSIONS

It was found that LEOs rendered medical care in one-half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.

A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States

Study Objectives Law enforcement is increasingly viewed as a key component in the out-of-hospital chain of survival, with expanded roles in cardiac arrest, narcotic overdose, and traumatic bleeding. Little is known about the nature of care provided by law enforcement prior to the arrival of Emergency Medical Services (EMS) assets. The purpose of the current study was to perform a descriptive analysis of events reported to a national EMS database.

METHODS

This study was a descriptive analysis of the 2014 National Emergency Medical Services Information System (NEMSIS) public release research data set, containing EMS emergency response data from 41 states. Code E09_02 1200 specifically identifies care provided by law enforcement prior to EMS arrival.

RESULTS

A total of 25,835,729 unique events were reported. Of events in which pre-arrival care was documented, 2.0% received prior aid by law enforcement. Patients receiving law enforcement care prior to EMS arrival were more likely to be younger (52.8 [SD=23.3] years versus 58.7 [SD=23.3] years), male (54.8% versus 46.7%), and white (80.3% versus 77.5%). Basic Life Support (BLS) EMS response was twice as likely in patients receiving prior aid by law enforcement. Multiple-casualty incidents were five times more likely with prior aid by law enforcement. Compared with prior aid by other services, law enforcement pre-arrival care was more likely with motor vehicle accidents, firearm assaults, knife assaults, blunt assaults, and drug overdoses, and less likely at falls and childbirths. Cardiac arrest was significantly more common in patients receiving prior aid by law enforcement (16.5% versus 2.6%). Tourniquet application and naloxone administration were more common in the law enforcement prior aid group.

CONCLUSION

Where noted, law enforcement pre-arrival care occurs in 2.0% of EMS patient encounters. The majority of cases involve cardiac arrest, motor vehicle accidents, and assaults. Better understanding of the nature of law enforcement care is required in order to identify potential barriers to care and to develop appropriate training and policy recommendations. 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):165-170.

Law enforcement-applied tourniquets: a case series of life-saving interventions

Although the epidemiology of civilian trauma is distinct from that encountered in combat, in both settings, extremity hemorrhage remains a major preventable cause of potential mortality. The current paper describes the largest case series in the literature in which police officers arriving prior to emergency medical services applied commercially available field tourniquets to civilian victims of violent trauma. Although all 3 patients with vascular injury arrived at the receiving emergency department in extremis, they were successfully resuscitated and survived to discharge without major morbidity. While this outcome is likely multifactorial and highlights the exceptional care delivered by the modern trauma system, tourniquet application appears to have kept critically injured patients alive long enough to reach definitive trauma care. No patient had a tourniquet-related complication. This case series suggests that law enforcement officers can effectively identify indications for tourniquets and rapidly apply such life-saving interventions.

Video self-instruction for police officers in cardiopulmonary resuscitation and automated external defibrillators

INTRODUCTION

Police officers often serve as first responders during out-of-hospital cardiac arrests (OHCA). Current knowledge and attitudes about resuscitation techniques among police officers are unknown. Hypothesis/problem This study evaluated knowledge and attitudes about cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) among urban police officers and quantified the effect of video self-instruction (VSI) on these outcomes.

METHODS

Urban police officers were enrolled in this online, prospective, educational study conducted over one month. Demographics, prior CPR-AED experience, and baseline attitudes were queried. Subjects were randomized into two groups. Each group received a slightly different multiple-choice test of knowledge and crossed to the alternate test after the intervention, a 10-minute VSI on CPR and AEDs. Knowledge and attitudes were assessed immediately before and after the intervention. The primary attitude outcome was entering "very likely" (5-point Likert) to do chest compressions (CC) and use an AED on a stranger. The primary knowledge outcomes were identification of the correct rate of CC, depth of CC, and action in an OHCA scenario.

RESULTS

A total of 1616 subjects responded with complete data (63.6% of all electronic entries). Randomization produced 819 participants in group 1, and 797 in group 2. Groups 1 and 2 did not differ significantly in any background variable. After the intervention, subjects "very likely" to do CC on a stranger increased by 17.2% (95% CI, 12.5%-21.8%) in group 1 and 21.2% (95% CI, 16.4%-25.9%) in group 2. Subjects "very likely" to use an AED on a stranger increased by 20.0% (95% CI, 15.3%-24.7%) in group 1 and 25.0% (95% CI, 20.2%-29.6%) in group 2. Knowledge of correct CC rate increased by 59.0% (95% CI, 55.0%-62.8%) in group 1 and 64.8% (95% CI, 60.8%-68.3%) in group 2. Knowledge of correct CC depth increased by 44.8% (95% CI, 40.5%-48.8%) in group 1 and 54.4% (95% CI, 50.3%-58.3%) in group 2. Knowledge of correct action in an OHCA scenario increased by 27.4% (95% CI, 23.4%-31.4%) in group 1 and 27.2% (95% CI, 23.3%-31.1%) in group 2.

CONCLUSION

Video self-instruction can significantly improve attitudes toward and knowledge of CPR and AEDs among police officers. Future studies can assess the impact of VSI on actual rates of CPR and AED use during real out-of-hospital cardiac arrests.

Being first on the scene of an accident--experiences of 'doing' prehospital emergency care

Prehospital emergency care includes the care and treatment of patients prior to them reaching hospital. This is generally a field for the ambulance services, but in many cases firemen or police can be the ones to provide the first responses. The aim of this study was to describe and understand experiences of being the first responder on the scene of an accident, as described by policemen, firemen and ambulance staff. A lifeworld perspective was used in four different traumatic situations from southern Sweden. The data consisted of 13 unstructured interviews with first responders. The phenomenological analysis showed that experiences of being the first responder on the scene of an accident is expectations of doing a systematic course of action, dressed in the role of a hero, and at the same time being genuine in an interpersonal encounter. This entails a continuous movement between 'being' and 'doing'. It is not a question of either - or, instead everything is to be understood in relation to each other at the same time. Five constituents further described the variations of the phenomenon; a feeling of security in the uncertainty, a distanced closeness to the injured person, one moment in an eternity, cross-border cooperation within distinct borders and a need to make the implicit explicit. This finding highlights the importance of using policemen and firemen in doing life support measures while waiting for the ambulance staff, and would in turn increase the importance of the relationship between the different professionals on the scene of an accident.

Ten Years of Police Defibrillation:

OBJECTIVE

In 1992,a study to evaluate the effectiveness of police defibrillation was initiated in seven suburban police departments. This paper describes the characteristics of those programs and the attitudes of chiefs and officers ten years after the commencement of that study.

METHODS

A 32-item survey instrument including questions on department demographics, defibrillation program characteristics, and attitudes was mailed to the chiefs. A separate 25-item survey was developed to assess officers' attitudes; a non-management officer distributed and collected these surveys anonymously. Responses are reported descriptively.

RESULTS

All seven chiefs and 78% of the officers completed surveys. Police arrive prior to emergency medical services on 80% or more of calls, with a mean +/- standard deviation response interval of 3.1 +/-1.7 minutes. All departments identify a program coordinator and six a medical director; three departments have a quality-improvement program. Five departments have liability coverage for the use of an automated external defibrillator (AED), and no department reported any liability-related problems. Five of the chiefs and 82% of the officers disagreed or strongly disagreed that liability issues are a concern or a source of hesitation in using the AED. Ninety-six percent of the officers agreed or strongly agreed that police AED use is beneficial to cardiac arrest victims. All seven police chiefs and 89% of the officers agreed or strongly agreed that AED use by police is appropriate.

CONCLUSIONS

In these seven police departments with ten years of program experience, defibrillation has become integrated into the law-enforcement culture. Liability issues are not a prominent concern of chiefs or officers. Police chiefs and officers in these departments continue to support police-based defibrillation programs.

More than medical treatment: the patient's first encounter with prehospital emergency care

A common feature of emergency care services is the short, fragmented encounters with great demands for rapid treatment and efficiency. The aim of this study was to describe and understand the patient's first encounter with prehospital emergency care as experienced by the patient and the first responders. A lifeworld perspective was used in four different traumatic situations. The data consisted of 18 unstructured interviews with patients and first responders. The phenomenological analysis showed that the concept of lifesaving means more than just upholding vital functions. The patient needs to retain his/her identity by means of a communicative contact, to be confirmed in the lived encounter and to recapitulate the elapsed time of the unexpected event in order to regain a state of equilibrium. Five constituents further described the variations of the patients' first encounter; the encounter with the helpless injured body, the confirming existential encounter, the encounter while waiting, the lived encounter and the recapitulated encounter. This finding highlights the importance of a new understanding about empowering the patient with narratives throughout the whole caring process. There are also implications for educating personnel and students in emergency care about the first encounter with the patient in emergency care where the senses, the time and the narrative are essential elements that are unique for each person.

The role of law enforcement agencies in out-of-hospital emergency care

BACKGROUND

A key component of out-of-hospital emergency care is the rapid response of trained providers with appropriate medical equipment. In some communities, law enforcement agents function as first responders to accomplish this goal. The purpose of this national survey was to assess the proportion of law enforcement agencies that provide medical care to determine the extent of care they provide, to identify how many use AEDs, and to assess the attitudes of agency leaders regarding their roles as medical first responders.

METHODS

Eight hundred agencies were selected at random from a national database of 43,000 agencies available through the National Public Safety Bureau (Stevens Pt, WI). These agencies were sent a 19-question survey either by US mail or telephone.

RESULTS

Four-hundred and fifty-four (57%) surveys were returned, and 420 (53%) were available for use after exclusion criteria were applied. Eighty percent of law enforcement agencies respond routinely to medical emergencies and 39% of these reported they deploy AEDs. Thirty-one percent of all law enforcement agencies are equipped with AEDs, a ten-fold increase from 2.6% reported in a previous national study in 1997. Funding issues were the most common reasons cited for not using AEDs. Approximately 75% of respondents agreed that law enforcement agencies should provide initial emergency medical care and indicated that officers in their agency would be willing to receive additional training to accomplish this.

CONCLUSION

Based on this survey, law enforcement agents often serve as medical first responders. Nearly three quarters of responding agencies felt this role was appropriate. AEDs are now deployed much more frequently than indicated by a previous national study, but still less than one-third of law enforcement agencies carry AEDs as part of their standard response equipment.

Future shock: automatic external defibrillators

PURPOSE OF REVIEW

This review provides a practical overview of the performance capabilities of automatic external defibrillators (AEDs), and of advances in technology and dissemination programmes for these devices.

RECENT FINDINGS

Arrhythmia analysis by AEDs is extremely reliable in most settings (sensitivity 81-100%, specificity 99.9-97.6%). Accurate detection of arrhythmias has also been demonstrated in children, leading the US Food and Drug Administration to approve the use of several AEDs in children aged 8 years or younger. Factors that potentially may reduce the quality of arrhythmia detection are the presence of wide complex supraventricular tachycardia and location of an arrythmic event near to high-power lines. AED use by professional basic life support providers resulted in increased survival in the prehospital setting. However, provision of AEDs to nonmedical rescue services did not result in universal improvement in patient outcome. Public access defibrillation programmes have led to higher rates of survival from cardiac arrest. The role of AEDs in hospitals has yet to be elucidated, although in-hospital mortality from ventricular arrhythmias has been shown to decrease following AED deployment.

SUMMARY

Given the correct setting, AEDs can ensure that defibrillation is not limited by lack of medical knowledge or difficulties in decision making. However, event-related variables and operator-related factors, that are yet to be determined, can significantly affect the efficacy of automatic external defibrillation.

Feasibility of public access to defibrillation

Immediate defibrillation is the single most effective therapy to reverse ventricular fibrillation cardiac arrest today. The once physician-only skill of defibrillation has entered mainstream society and is saving the lives of many sudden cardiac arrest (SCA) victims in a variety of settings. The automated external defibrillator (AED) and the concept of public access defibrillation (PAD) are a result of collaborative efforts between the American Heart Association (AHA) and medical manufacturers. Today, airports, airlines, casinos, cruise ships, and other public venues have modernized their first aid kits to include an AED. The success of these programs has ignited a trend in public safety and subsequently marketed the worth of AEDs in the home. Although optimal placement of AEDs remains uncertain, PAD is showing great promise in reducing the death rate from SCA. The lay public, both trained and untrained, is emerging as the next level of emergency care responders able to use a defibrillator.

Automated external defibrillators and first responders: a satisfaction survey

PRIMARY OBJECTIVE

Automated external defibrillators (AEDs) are used with increasing frequency in the United States by first responders (FR) such as police officers (PO) or firefighters (FF). However, FR satisfaction with use of AEDs has not been investigated. We hypothesized that FR satisfaction is comparable with that of paramedics (PA) and that, among those who have defibrillated with AEDs, those who have restored a pulse before PA arrival have a higher level of satisfaction than those who have not restored a pulse.

MATERIALS AND METHODS

A 21-item questionnaire with closed answers was sent to FR and PA in four communities. Each answer was scored 0, 1 or 2. A score between 10 and 16 correlated with the highest satisfaction level.

RESULTS

276 out of 311 questionnaires were returned (89%). Two hundred and eleven respondents (35 PA, 70 FF and 106 PO) had used an AED and 99 FF and PO had restored a pulse before PA arrival. The satisfaction level of PO, FF and PA was high as demonstrated by the scores: 13.26, 13.07 and 13.39, respectively. Use of AED and pulse restoration resulted in higher scores than those of groups who had been trained only and who had not restored a pulse.

CONCLUSION

FR demonstrated a high level of satisfaction with using AEDs, and also had a favorable attitude toward implementation of AED use. Restoration of a pulse was clearly a factor responsible for a higher satisfaction. This positive attitude should encourage further implementation of early defibrillation programs in non-medical first responder settings.

Chain of survival: differences in early access and early CPR between policemen and high-school students

Immediate activation of the emergency medical service (EMS) and cardiopulmonary resuscitation (CPR) increases the incidence of return of spontaneous circulation and the number discharged from hospital. The American Heart Association (AHA) and the European Resuscitation Council describe CPR as an ordinate sequence of eight steps. The objectives of this study were to assess the general knowledge of EMS and CPR and to analyse the retention of the CPR steps 2 months after a Basic Life Support (BLS)-course conducted according to AHA standards. We studied two populations from the same geographical area, law enforcement agents (LEA), since they are often the first to intervene, and high school students (HSS) since they are more likely to participate in such courses. HSS were more responsive and receptive than LEA. In order to increase the retention of the sequence of CPR steps, the number of steps should be reduced and refresher courses should be included in training programmes. Early access and early CPR are still not completely effective in the geographical area studied.

Automatic external defibrillators: changing the way we manage ventricular fibrillation

OBJECTIVE

To discuss recent developments in automatic defibrillation and to review the evidence that first-responders equipped with automatic external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest.

DATA SOURCES

MEDLINE search from 1966 to 1999 (articles in English only) and examination of bibliographies.

STUDY SELECTION

Published studies of out-of-hospital cardiac arrest and first-responders equipped with AEDs. Studies had to have a control group and to report survival to hospital discharge from ventricular fibrillation (VF).

DATA EXTRACTION

Six studies met the selection criteria (two prospective randomised trials, two prospective controlled trials, and one cohort study and one retrospective study, both with historical controls).

DATA SYNTHESIS

A random effects meta-analysis of odds ratios for survival from VF.

CONCLUSIONS

Meta-analysis suggests that equipping first-responders with AEDs increases the probability of survival to hospital discharge after out-of-hospital cardiac arrest (odds ratio, 1.74; 95% CI, 1.27-2.38; P < 0.001). However, most of the studies lacked sufficient power to draw definitive conclusions. Until the impact of wide deployment of AEDs is fully understood, first-responder defibrillation in Australia should only occur as part of coordinated multicentre research studies.

Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest

OBJECTIVE

To determine the feasibility of police officers providing defibrillation with automated external defibrillators (AEDs) and to assess the effectiveness of this strategy in reducing time to defibrillation of victims of out-of-hospital sudden cardiac arrest.

METHODS

This was a prospective, interventional cohort study with historical controls conducted in 7 suburban communities in which police usually arrived at the scene of medical emergencies before EMS personnel. All adult patients who suffered cardiac arrest before EMS arrival and on whom EMS personnel attempted resuscitation were enrolled. Police officers who were trained to use and equipped with AEDs during the intervention phase were dispatched simultaneously with EMS to medical emergencies. Police were instructed to use the AED immediately on determination of pulselessness. Outcome measures were the difference between control and intervention phases in interval from the time the call was received at dispatch to the time of first defibrillation and in rate of survival to hospital discharge for patients initially in ventricular fibrillation.

RESULTS

EMS personnel attempted 183 resuscitations in the control phase and 283 during the intervention; of these, 80 (44%) and 127 (45%), respectively, involved patients with initial ventricular fibrillation rhythms. Mean time to defibrillation decreased from 11.8+/-4.7 minutes in the control phase to 8.7+/-3.7 minutes in the intervention phase (P<.0001). Survival to hospital discharge of patients in ventricular fibrillation did not differ between phases (6% control versus 14% intervention, P=.1). When police arrived before EMS personnel, shock administered by police compared with shock administered by EMS was associated with improved survival (26% [12/46] versus 3% [1/29], P=.01). Logistic regression analysis revealed AED use was an independent predictor of survival to hospital discharge.

CONCLUSION

In 7 suburban communities, police use of AEDs decreased time to defibrillation and was an independent predictor of survival to hospital discharge.