Longitudinal Assessment of Emergency Responders' Attitudes Toward People Who Overdose and Naloxone Following an Overdose Education Training

BACKGROUND

In addition to teaching overdose recognition and response, overdose education and naloxone distribution (OEND) trainings for emergency responders aim to improve trainee attitudes toward people who use drugs and toward naloxone. This study examines the training effectiveness long term, as well as the extent to which improvements are dependent on profession type or recent experience administering naloxone.

METHODS

A total of 774 emergency responders, consisting of law enforcement officers (LEOs) (n = 624, 81%) and emergency medical service (EMS) personnel (n = 150, 19%), attended OEND trainings and completed surveys immediately prior to ("pre") and following ("post") the training, as well as 6 months later ("follow-up"). Survey items assessed attitudes toward people who have overdosed, naloxone-related risk compensation (ie, "enabling") beliefs, and whether participants had administered naloxone since attending the training. Multiple regression and estimated marginal means were used to evaluate changes in scores.

RESULTS

Emergency responders showed improved attitudes (pre = 2.60, follow-up = 2.45, P < .001) and risk compensation beliefs (pre = 2.97, follow-up = 2.67, P < .001) 6 months following the training. Follow-up scores differed by profession, with LEOs endorsing worse attitudes (difference = 0.55, P = .013) and more risk compensation beliefs (difference = 0.67, P = .014) than EMS. In addition, having recently administered naloxone predicted more negative attitudes (EMS: difference = 0.55, P = .01; LEO: difference = 0.54, P = .004) and risk compensation beliefs (EMS = 0.73, P = .006; LEO = 0.69, P = .002) at follow-up.

CONCLUSION

Six months after an OEND training, emergency responders' attitudes toward people who overdose, and their risk compensation beliefs remained improved. However, LEOs had more negative follow-up attitudes and beliefs compared to EMS. Emergency responders who had administered naloxone had worse attitudes and beliefs at follow-up than those who had not. Of note, our sample evidenced sizable attrition between pre and follow-up assessments, leaving room for selection bias. Future studies should investigate how to mitigate negative effects of administering naloxone on attitudes toward those who overdose, and belief that naloxone is "enabling."

Emotional Eating and Cardiovascular Risk Factors in the Police Force: The Carolina Blue Project

There is an association between emotional eating and cardiovascular disease (CVD) risk factors; however, little is known about this association in the police force. This study explores the associations between emotional eating and CVD risk factors in law enforcement officers in North Carolina. Four hundred and five officers completed The Emotional Eating Scale, and 221 of them completed the assessment for CVD-related markers. Descriptive statistics, Pearson's correlation, and multiple linear regression analyses were performed. Emotional eating in response to anger was significantly positively associated with body weight (β = 1.51, t = 2.07, p = 0.04), diastolic blood pressure (β = 0.83, t = 2.18, p = 0.03), and mean arterial pressure (β = 0.84, t = 2.19, p = 0.03) after adjusting for age and use of blood pressure medicine. Emotional eating in response to depression was significantly positively associated with triglycerides (β = 5.28, t = 2.49, p = 0.02), while the emotional eating in response to anxiety was significantly negatively associated with triglycerides (β = -11.42, t = -2.64, p = 0.01), after adjusting for age and use of cholesterol medicine. Our findings offer new insights to address emotional eating and lower CVD risk in law enforcement officers.

Cardiovascular risk, social vigilance, and stress profiles of male law enforcement officers versus civilians

This study examined the cardiovascular disease (CVD) risk profiles of male law enforcement officers (LEOs) and civilians. CVD risk profiles were based on data collected using traditional objective (e.g., resting BP, cholesterol), novel objective (e.g., ambulatory BP) and self-report measures (e.g., EMA social vigilance). A subset of male LEOs (n = 30, M age = 41.47, SD = 8.03) and male civilians (n = 120, M age = 40.73, SD = 13.52) from a larger study were included in analyses. Results indicated LEOs had significantly higher body mass index [BMI], 31.17 kg/m2 versus 28.87 kg/m2, and exhibited significantly higher trait and state social vigilance across multiple measures, whereas perceived stress was higher among civilians. Findings highlight the need for future research examining CVD risk associated with occupational health disparities, including attributes of individuals entering certain professions as well as experiential and environmental demands of the work.

The Relative Burden of Occupational Injuries and Illnesses in Firefighters: An Analysis of Washington Workers' Compensation Claims, 2006-2020

Firefighters face many hazards on the job and have a high rate of work-related injuries and illnesses (WRII). We analyzed Washington workers' compensation claims from 2006-2020 to characterize WRII in firefighters compared to law enforcement officers and "all other" workers. There were 9187 compensable claims for firefighters, 7801 for law enforcement officers, and 586,939 for "all other" workers. Nearly 40% of claims for firefighters were work-related musculoskeletal disorders (WMSDs). The claim rate per 10,000 full-time equivalent (FTE) firefighters was 716.4, which is significantly higher than that of law enforcement officers (510.0) and "all other" workers (163.2). The rate per 10,000 FTE of WMSD claims was also higher in firefighters (277.0) than in law enforcement officers (76.2) and "all other" workers (57.6). Additional WRII among firefighters commonly included being struck or caught in objects, slipping or tripping, and exposure to caustic or noxious substances; and amongst law enforcement, transportation accidents and violence. Medical costs and time-loss days per claim were lower for firefighters and law enforcement than for "all other" workers. Common tasks associated with WMSDs in firefighters included lifting and transporting patients, using specific tools and equipment, and physical training. WMSDs stand out as an area for prevention and intervention activities.

Ready, willing, and able: California college campus law enforcement officers' respond to the opioid overdose attitudes scale

BackgroundCollege campus police departments are providing law enforcement officers the authority to administer naloxone, the antidote to opioid overdose. This study explored the competence, concerns, and readiness among college campus-based law enforcement officers in Northern California to administer naloxone in case of an opioid overdose on campus.

METHODS

Using a quantitative, cross sectional design, law enforcement officers from seven Northern California college campus-based police departments were recruited for this study. Participants completed sociodemographic information and the Opioid Overdose Attitudes Scale (OOAS) electronically.

RESULTS

Forty law enforcement officers completed questionnaires. Findings suggested officers were ready and willing to assist opioid overdose victims, had sufficient naloxone administration training, and were not concerned with consequences of precipitating withdrawal symptoms or harm to a student after administering naloxone.

CONCLUSIONS

College campus-based law enforcement officers had positive attitudes regarding handling opioid overdose situations and felt mostly comfortable administering naloxone.

Test-Retest Reliability and Minimum Difference Values of a Novel and Portable Upright Row Strength Assessment in Probation Officers

Upper body (UB) strength is important for occupational tasks and injury prevention in law enforcement officers (LEOs). Portable, reliable, and cost-effective assessments are needed to examine UB strength among LEOs in field settings. The purpose of this study was to examine the test-retest reliability and minimum difference (MD) values of a novel and portable isometric upright row assessment in probation officers. Thirty certified probation officers (18 women; age = 38.9 ± 9.0 years, body mass = 98.8 ± 27.1 kg, stature = 171.4 ± 14.0 cm) volunteered for this investigation. Testing occurred on-site across two sessions (2-5 days apart). Participants stood upon an aluminum plate with a chain attached to a handle and dynamometer. They grasped the handle with a pronated grip, two cm below the umbilicus, and performed three isometric maximal voluntary contractions. Intraclass correlation coefficient (ICC2,1), standard error of the measurement (SEM), and MD values were calculated. Results indicated no significant systematic error (p = 0.080) across sessions. The ICC2,1, SEM, and MD values for UB strength were 0.984, 27.20 N (4.1% of the mean), and 75.38 N (11.3% of the mean), respectively. These data suggest this isometric upright row assessment is a reliable, portable, and cost-effective measure of UB strength to assess and monitor LEOs in field settings.

Health, Safety, and Wellness Concerns Among Law Enforcement Officers: An Inductive Approach

Background: Although studies have assessed the impact of occupational risk factors on the health of law enforcement officers (LEO's), few have involved (LEO's) as informants in ways that allow their points of view to be heard directly. Thus, the objective of this study is to explore the occupational health, safety, and wellness (OHSW) concerns of (LEO's). Methods: (LEO's) working in Quebec, Canada were invited to answer an open-ended question regarding their OHSW concerns. Using a multi-stage content analysis, the collected answers were analyzed and coded by two members of the research team to identify the most recurrent concerns of (LEO's). Findings: Five themes relating to the OHSW concerns of (LEO's) were identified, namely, the work schedule, occupational stress, work equipment, workplace health promotion, and operational risks. Furthermore, our analyses highlighted differences in the concerns of (LEO's) based on their level of experience and sex. Conclusions/Application to Practice: This study addresses a gap in the literature on the OHSW concerns from the perspective of (LEO's). Overall, our results support that the work schedule and occupational stress associated with law enforcement are the two most recurrent concerns of (LEO's). Thus, the results of this study further stress the need for police organizations to implement strategies and policies, which could mitigate the deleterious effects of these hazards on the overall wellness of (LEO's).

Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research

BACKGROUND

The public safety sector includes law enforcement officers (LEO), corrections officers (CO), firefighter service (FF), wildland firefighting (WFF), and emergency medical services (EMS), as defined in the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health (NIOSH). Across these occupations, shiftwork, long-duration shifts, and excessive overtime are common. Our objective was to identify research gaps related to working hours, sleep, and fatigue among these workers.

METHODS

We used a scoping review study design that included searches of MEDLINE, Embase, CAB Abstracts, Global Health, PsychInfo, CINAHL, Scopus, Academic Search Complete, Agricultural and Environmental Science Collection, ProQuest Central, Cochrane Library, Safety Lit, Homeland Security Digital Library, and Sociological Abstracts using a range of occupational search terms and terms related to working hours, sleep, and fatigue.

RESULTS

Out of 3415 articles returned from our database search, 202 met all inclusion criteria. Six common outcomes related to working hours, sleep, and fatigue emerged: sleep, fatigue, work performance, injury, psychosocial stress, and chronic disease. Nearly two-thirds (59%, n = 120) of the studies were observational, of which 64% (n = 77) were cross sectional and 9% were (n = 11) longitudinal; 14% (n = 30) of the studies were reviews; and 19% (n = 39) were experimental or quasi-experimental studies. Only 25 of the 202 articles described mitigation strategies or interventions. FFs, LEOs, EMS, and WFFs were the most studied, followed by COs.

CONCLUSIONS

In general, more longitudinal and experimental studies are needed to enrich the knowledge base on the consequences of long working hours, poor sleep, and fatigue in the public safety sector. Few experimental studies have tested novel approaches to fatigue mitigation in diverse sectors of public safety. This gap in research limits the decisions that may be made by employers to address fatigue as a threat to public-safety worker health and safety.

Effects of the Task Complexity on the Single Movement Response Time of Upper and Lower Limbs in Police Officers

Police officers occasionally encounter belligerents resisting or even physically assaulting them without or with objects. The self-defense or legal utilization of use of force to disable the offender from harming an officer or others may depend on a single movement speed of hands and legs. This study investigated the effects of task complexity on a single movement response time of the upper and lower limbs in police officers. The sample consisted of 32 male police officers aged between 23 and 50 years. They performed a single movement as fast as possible with their upper and lower limb in three incrementally more complex tasks. In the first task, participants acted on a light signal and with their dominant limb they had to turn off the signal as fast as possible. In the second task, on the light signal, participants could turn off the light with free choice of the upper limb in a hand task or lower limb in a leg task. In the third task, participants had to turn the light off with the right limb if the light turned red and with the left limb if the light turned blue. The BlazePod device was used to assess the movement response time. The results show that there was a significant effect of task complexity on the single movement response time of the hand (F = 24.5, p < 0.001) and leg (F = 46.2, p < 0.001). The training of police officers should utilize specific and situational tasks to improve movement response time by improving the redundancy in decision-making processes during work-specific tasks of different complexity.

Perception of Law Enforcement Officers on Preventing Road Traffic Injury in Vanuatu: A Qualitative Study

Background: Road Traffic Injuries (RTIs) cause approximately 1. 35 million deaths annually, and is the leading cause of death among people between ages 5 and 29. Law Enforcement Officers (LEOs) deal with Road Traffic Collisions (RTCs) and have contact with RTI victims at a daily basis, they possess an excellent perspective on preventing RTI. This study aimed to explore LEOs perceptions on risk factors and preventive measures of RTI in Vanuatu. Methods: This study employed qualitative methods that used Focus Group Discussions (FGDs) to gather data from 25 LEOs between October 14th and November 30th, 2020. Self-identified Ni-Vanuatu LEOs who have been serving for over 6 months and residing at the study setting were included in this study. Purposive sampling was used to recruit study participants from three municipalities in Vanuatu. A semi-structured open ended questionnaire was designed to guide the FGDs. Data obtained were sorted out using thematic analysis processed with some preconceived themes based on theory, and also allowing the data to determine new themes. Results: Data saturation was reached from conducting 5 FGDs with 25 LEOs who were traffic officers and municipal wardens. Five main themes and sixteen subthemes were generated from the study. The main themes include driving and alcohol, the challenges to effective enforcement, barriers to effective care and support for RTI victims, measures for road traffic control and promoting road traffic safety. The respondents perceived that addressing resources issues and the legislations on road traffic control act and vehicle regulation act will enhance prevention of RTI. Conclusion: This study explored the risk factors of RTI and the barriers to effectively prevent RTI in Vanuatu. The study also generated suggestions of a combination of road traffic control measures that could be implemented to prevent RTI. Future research should look at effective strategies of preventing RTIs in resource deficit settings.

The Relationships Between Reduced Alcohol Use and Decreased Burnout Following Mindfulness-Based Resilience Training in Law Enforcement Officers

Objective: This study is a secondary analysis of data collected in an earlier clinical trial of mindfulness-based resilience training (MBRT) (ClinicalTrials.gov registration number 02521454), where the MBRT condition demonstrated a significant reduction in self-reported burnout and trend-level reductions in alcohol use in law enforcement officers (LEOs). Given that MBRT is not designed to be a substance use intervention and does not contain explicit substance-related content, this study sought to clarify these findings by exploring whether improved burnout mediates reduced alcohol use. Method: Participants (n = 61) were sworn LEOs (89% male, 85% White, 8% Hispanic/Latinx) recruited from departments in a large urban metro area of the northwestern United States, and were randomized to either MBRT (n = 31) or no intervention control group (n = 30) during the trial. Results: MBRT group assignment predicted reduced burnout (b = 0.43, standard error [SE] = 0.14, p = 0.004), which subsequently predicted reduced alcohol use (b = 1.69, SE = 0.81, p = 0.045). Results suggest that reduced alcohol use was indirectly related to a reduction in burnout post-MBRT. Conclusion: Given that MBRT does not explicitly address substance use, these findings were interpreted to suggest that officers in the training acquired a new set of coping skills to deal with the operational and organizational stressors of police work.

Perceptions of opioid and other illicit drug exposure reported among first responders in the southeast, 2017 to 2018

BACKGROUND

Opioid use has risen dramatically in recent years, and its illegal use puts first responders at risk when intervening in overdoses. Synthetic opioids, like fentanyl with a potency 50 to 100 times greater than morphine, pose a great risk and accidental exposure via ingestion, inhalation, mucosal, or percutaneous routes, can potentially lead to fatal outcomes. Anecdotal media accounts in early 2017 of accidental occupational opioid exposure among first responders generated a national concern.

METHODS

To identify first responders' recollections, beliefs, and concerns about possible occupational exposure to opioids and other drugs, researchers in Kentucky, Virginia, Mississippi, and Georgia administered an emailed, anonymous convenience sample survey.

RESULTS

A total of 5955 surveys were analyzed with 15% of respondents reporting they believed they had been exposed to opioids, and of those, less than 1% reported experiencing health effects from perceived exposure. Over half (51%) of respondents reported being "very or somewhat concerned" about developing health effects from exposure to opioids. Half of respondents reported being unaware of Centers for Disease Control and Prevention (CDC)/National Institutes for Occupational Safety and Health (NIOSH) guidelines for preventing occupational-related opioid exposures.

CONCLUSIONS

Only a small fraction of first responders believed they had experienced symptoms related to opioid exposure in overdose response calls, but half were concerned about potential exposures and half were unaware of the educational guidance on prevention available. The high level of concern regarding potential exposure warrants the need for the development and or enhancement of targeted educational training interventions and further dissemination of pre-existing training interventions to ensure first responders have the knowledge and understanding of occupational opioid exposures and minimize stress associated with the potential rare exposures.

Detecting the Relationship between the Stress Levels and Perceived Burnout in Law-enforcement Officers during the COVID-19 Outbreak: A Cross-sectional Study

The present study aimed to determine the effect of burnout and stress levels on law enforcement officers' perceptions and behaviors to emphasize the need for adequate attention and care in these individuals during the COVID-19 outbreak. The research group of this cross-sectional study conducted in July-August 2020 was formed by the law enforcement officers. The Perceived Stress Scale (PSS), Burnout Measure-Short Version (BM-SV) and a personal data form prepared by the researchers were used in the study. Data were analyzed using the IBM SPSS Statistics 16.0 software package program. The PSS scores were higher and significant in the group whose working hours were not increased due to the COVID-19 pandemic and they thought that there was a decrease in crime rates and did not need psychological support (p ≤ .05). The PSS scores were higher and significant in the group who took the warnings about COVID-19 into consideration, were afraid of contracting the virus, did not care about the progress of the epidemic and used the mask correctly. Additionally, the BM-SV scores were higher and significant in the group who stated that they were not afraid of contracting the virus (p ≤.05). A comprehensive crisis prevention and intervention system including epidemiological monitoring/observing, screening, referral and targeted interventions should be established to reduce the perceived level of stress and burnout in law enforcement and prevent further mental health problems.

The Role of Law Enforcement Officers/Police in Drug Prevention within Educational Settings-Study Protocol for the Development of a Guiding Document Based on Experts' Opinions

The United Nations Office on Drugs and Crime—World Health Organization International Standards on Drug Use Prevention—reflects the value of safe, nurturing and supportive social institutions around the lives of youths to benefit from the prevention of risky behavior extending beyond individually-developed resilience for healthy adolescent development. Schools are valuable social institutions to this effect and school safety and adolescent health outcomes can be threatened by drug use and violence. As such, collaborative, multi-level, evidence-based, developmentally sensitive, substance use prevention programs are imperative. The International Standards, in their latest version, did not reflect specific evidence of law enforcement officer-based programs with effect on drug use prevention, including in school settings. Nevertheless, the collaboration between law enforcement agencies and school-based substance use prevention programs continue to be the focus of research and policy. In this project, we aim to explore in more detail the role of law enforcement in preventing substance use in schools. We use mixed methods, including three phases: (i) scoping review on the best practices for effective law enforcement in school-based drug and crime prevention; (ii) interviews with experts, using the Delphi method, in substance use prevention and training law enforcement in school-based drug prevention; and iii) developing guidelines for law enforcement based on the findings. Initially, we identified a total of 17 papers that were categorized in four categories based on their results (negative or null effect n = 11 studies, positive effect n = 1 study, mixed effects n = 4 studies and indefinite conclusion n = 1 study). However, the authors of the studies with negative or null effect did recommend being cautious about these results due to the respective studies’ methodological limitations. The actual and perceived roles of police are largely unclear and/or variable. Therefore, clear outlines regarding law enforcement’s role within schools are crucial as one study showed that an officer’s role influences how they respond to student conduct. A secondary emergent theme from this review indicates that there is potential for positively impacting a youth’s perceptions of police through collaborative and engaging school-based programs. Currently the project is gradually moving to Phase II, where we are identifying the key experts based on scientifically published peer reviewed and grey literature/guidelines to investigate elements that make the role of law enforcement officers in school-based prevention more effective. Given the frequency with which policy makers around the world request information about the role of law enforcement in effective prevention efforts, guidelines on their roles within schools is a gap that needs to be filled. Such efforts would improve drug prevention in schools and better orient law enforcement’s role in drug prevention within educational settings.

Despite Low Obesity Rates, Body Mass Index Under-Estimated Obesity among Russian Police Officers When Compared to Body Fat Percentage

In some countries, obesity rates among police officers are higher than the general public, despite physically demanding jobs. Obesity rates based on body mass index (BMI) may lack accuracy as BMI does not directly address body composition. Since data are lacking for obesity rates among Russian police officers, this study documented and compared officer obesity rates to the adult Russian population and compared the accuracy of body mass index (BMI) for obesity classification to two direct measures of body composition. Moscow region police officers (N = 182, 84% men) underwent height, weight, waist circumference (WC), and body fat percentage (BF%) bioelectrical impedance measurements during annual medical examinations. BMI-defined obesity rates were 4.6% for men and 17.2% for women, which were >3 and >1.8 times lower than Russian adults, respectively. WC-defined obesity rates were similar to BMI (3.3% for men and 10.3% for women), but BF%-defined obesity rates were much higher (22.2% for men and 55.2% for women). Although obesity rates were lower than those found among police officers in other countries, BMI alone was not a particularly accurate method for classifying weight status among Russian police officers.

Relations Between Frequency and Volume of Leisure-Time Physical Activity and Body Composition in Police Officers

Purpose: Leisure-time physical activity (LTPA) has always been very important for the maintenance and improvement of body composition. Thus, the aim of this study was to examine if the frequency and volume of LTPA (F-LTPA and V-LTPA) were related to indices of body composition in police officers. Method: A physical activity questionnaire was used to collect data from 346 male police officers regarding their F-LTPA and V-LTPA. They were divided into four groups relative to the frequency, and four groups relative to the volume of LTPA, labeled as inactive, seldom active, moderately active and very active for each LTPA indicator. Percent body fat (PBF), skeletal muscle mass (PSMM), skeletal muscle mass index (SMMI) and body fat mass index (BFMI) were assessed. Correlation analyses investigated associations and multivariate analysis of variance analysed the differences between body composition and LTPA, with significance set at p < .05. Results: The F-LTPA correlated (p < .001) to PBF (r = -0.306), BFMI (r = -0.289), PSMM (r = 0.309) and SMMI (r = -0.138, p = .010). The V-LTPA correlated (p < .001) to PBF (r = -0.370), BFMI (r = -0.348), PSMM (r = 0.311), and SMMI (r = -0.106, p = .049). The differences that occurred between more and less active police officers, whereby those who were very active had lower values of PBF and BFMI and higher values of PSMM and SMMI regardless of the frequency and volume of LTPA. PBF and PSMM were more affected by LTPA than SMMI and BFMI. Conclusions: F-LTPA and V-LTPA were considered important for police officers, whereby F-LTPA was related to muscle and V-LTPA to fat parameters of body composition.

Health effects from unintentional occupational exposure to opioids among law enforcement officers: Two case investigations

Recent increases in the rate of drug overdose-related deaths, the emergence of potent opioids such as carfentanil, and media reports of incidents have raised concerns about the potential for work-related exposure to a variety of illicit drugs among law enforcement officers (LEOs), other emergency responders, and other workers in the United States. To characterize the risk associated with unintentional occupational exposure to drugs, we retrospectively investigated two incidents that occurred in 2017 and 2018 where LEOs were exposed to opioid and stimulant drugs and experienced health effects. We interviewed five affected LEOs and others. We reviewed records, including emergency department documentation, incident reports, forensic laboratory results, and when available, body camera footage. Multiple drug types, including opioids and nonopioids, were present at each incident. Potential routes of exposure varied among LEOs and were difficult to characterize with certainty. Health effects were not consistent with severe, life-threatening opioid toxicity, but temporarily precluded affected LEOs from performing their essential job duties. While health risks from occupational exposure to drugs during law enforcement activities cannot currently be fully characterized with certainty, steps to prevent such exposures should be implemented now. The creation and implementation of appropriate controls plus education and training are both important to protecting first responders from these hazardous agents. To more fully characterize potential exposures, timely prospective toxicological evaluation of affected responders is recommended.

Effects of Tactical Emergency Casualty Care Training for Law Enforcement Officers

OBJECTIVE

This study evaluated how Tactical Emergency Casualty Care (TECC) training prepared law enforcement officers (LEOs) with the tools necessary to provide immediate, on-scene medical care to successfully stabilize victims of trauma.

METHODS

This was a retrospective, de-identified study using a seven-item Fairfax County (Virginia USA) TECC After-Action Questionnaire and Arlington County (Virginia USA) police reports.

RESULTS

Forty-six encounters were collected from 2015 through 2016. Eighty-four percent (n=39) of the encounters were from TECC After-Action Questionnaires and 15% (n=7) were from police reports. The main injuries included 13% (n=6) arterial bleeds, 46% (n=21) mild/moderate bleeds, 37% (n=17) large wounds, 20% (n=9) penetrating chest wounds, and 13% (n=6) open abdominal wounds. One-hundred percent of officers reported success in stabilizing victim injuries. Seventy-four percent of officers (n=26) did not encounter problems caring for a patient while 26% (n=9) encountered a problem. Ninety-seven percent (n=37/38) answered Yes, the training was sufficient, and three percent (n=1) indicated it was OK.

CONCLUSION

This is the most comprehensive study of TECC use among LEOs to date that supports the importance of TECC training for all LEOs in prehospital trauma care. Results of this study showed TECC training prepared LEOs with the operational tools necessary to provide immediate, on-scene medical care to successfully stabilize victims of trauma. Continuing to train increasing numbers of LEOs in TECC is key to saving the lives of victims of trauma in the future. RothschildHR, MathiesonK. Effects of Tactical Emergency Casualty Care training for law enforcement officers. Prehosp Disaster Med. 2018;33(5):495-500.

Beyond rescue: Implementation and evaluation of revised naloxone training for law enforcement officers

OBJECTIVE

This study describes the implementation and evaluation of revised opioid overdose prevention and education of naloxone training for law enforcement officers (LEOs) that added: (1) a recovery testimony and (2) the process for deputy-initiated referrals postnaloxone administration.

DESIGN AND SAMPLE

Evaluation regarding the naloxone training included a pre- and postopioid overdose knowledge surveys (N = 114) and subsequent 1-year postnaloxone training outcomes.

RESULTS

Pre- and posttest scores for all knowledge outcome measures were statistically significant (p < .001) with favorable comments pertaining to the recovery testimony. Out of 31 individuals who received naloxone, 6 individuals (19.4%) continue to be in treatment or received some treatment services. The most common symptoms reported were unconsciousness/unresponsiveness (40.5%), abnormal breathing patterns (24.3%), and blue lips (16.2%). The majority of the calls (65.6%) were to a residential area, and the time for naloxone revival ranged <1-10 min (M = 3.48; SD = 2.27).

CONCLUSION

As nearly 20% of individuals sought treatment after a LEO-initiated referral, it is recommended that other agencies consider the referral process into the training. Future research will investigate the impact of the recovery testimony in reducing the stigma of addiction.

Shiftwork and decline in endothelial function among police officers

BACKGROUND

Our objective was to assess the influence of shiftwork on change in endothelial function.

METHODS

This longitudinal study was conducted in 188 police officers (78.2% men). Shiftwork status (day, afternoon, night) was assessed objectively using daily Buffalo, NY payroll work history records. Brachial artery flow-mediated dilation (FMD) was assessed using ultrasound. Mean change in FMD% between 2004-2009 and 2010-2015 was compared across shiftwork using analysis of variance/covariance.

RESULTS

Overall, mean FMD% decreased from 5.74 ± 2.83 to 3.88 ± 2.11 over an average of 7 years among all officers; P < 0.0001. Effect modification by gender was significant. Among men (but not women), those who worked day shifts had a smaller mean (±SE) decrease in FMD% (-0.89 ± 0.35) compared with those who worked the afternoon (-2.69 ± 0.39; P = 0.001) or night shifts (-2.31 ± 0.45; P = 0.020) after risk factor adjustment.

CONCLUSIONS

Larger declines in endothelial function were observed among men who worked afternoon or night shifts. Further investigation is warranted. Am. J. Ind. Med. 59:1001-1008, 2016. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

The prevalence of metabolic syndrome among law enforcement officers who responded to the 9/11 World Trade Center attacks

BACKGROUND

Law enforcement officers (LEOs) experience high rates of cardiovascular events compared with the general US population. Metabolic syndrome (MetS) confers an increased risk of cardiovascular disease and all-cause mortality. Data regarding MetS among LEOs are limited.

METHODS

We sought to determine the prevalence of MetS and its associated risk factors as well as gender differences among LEOs who participated in the World Trade Center (WTC) Law Enforcement Cardiovascular Screening (LECS) Program from 2008 to 2010. We evaluated a total of 2,497 participants, 40 years and older, who responded to the 9/11 WTC attacks.

RESULTS

The prevalence of MetS was 27%, with abdominal obesity and hypertension being the most frequently occurring risk factors. MetS and its risk factors were significantly higher among male compared to female LEOs, except for reduced HDL-cholesterol levels.

CONCLUSIONS

MetS is a rising epidemic in the United States, and importantly, approximately one in four LEOs who worked at the WTC site after 9/11 are affected. Am. J. Ind. Med. 59:752-760, 2016. © 2016 Wiley Periodicals, Inc.

Childhood Adversities and Resistant Behaviors Toward Law Enforcement Officers in a National Sample of State and Federal Inmates

An overwhelming body of literature points to a relationship between experiencing adversity during childhood and later violence in adulthood. This study addresses a gap in existing research by testing of the impact of four prior childhood adversities on resistant behaviors toward law enforcement officers. A four-level ordinal dependent variable measuring passive resistance, verbal resistance, police action resistance, and physical resistance was created using data from the nationally representative, 2004 Survey of Inmates in State and Federal Correctional Facilities. A generalized ordinal logistic regression model tested the effects of childhood adversities on resistant behaviors toward law enforcement officers. Physical victimization during childhood and adulthood predicted resistant behaviors toward law enforcement officers above and beyond the effects of prior victimization during only childhood and only adulthood. This study found a strong association between prior physical victimization, foster care involvement, and resistant behaviors after adjusting for demographic, situational, and criminal background variables.

Mortality of a Police Cohort: 1950-2005

BACKGROUND

The authors conducted a retrospective cohort mortality study on police officers from 1950-2005.

METHODS

Standardized Mortality Ratio (SMR) analyses were conducted separately for white male (n=2761), black (n=286), and female (n=259) officers.

RESULTS

Mortality from all causes of death combined for white male officers was significantly higher than expected (SMR=1.20; 95% confidence interval (CI) =1.14-1.26). Increased mortality was also seen for all malignant neoplasms combined (SMR=1.32; 1.19-1.46), all benign neoplasms combined (SMR=2.50; 1.08-4.93), and all diseases of the circulatory system combined (SMR=1.11; 1.02-1.19). The elevated mortality for all malignant neoplasms was primarily due to statistically significant excesses in cancers of the esophagus, colon, respiratory system, Hodgkin's disease and leukemia. Black officers had lower than expected mortality from all causes (SMR=0.45; 0.18-0.92) while female officers had elevated all-cause mortality (SMR=2.17; 1.12-3.79).

CONCLUSIONS

Findings of increased risk for malignant neoplasms should be replicated and studied in relation to measured risk factors.

Cancer incidence among police officers in a U.S. northeast region: 1976-2006

Police officers are exposed to occupational hazards which may put them at increased risk of cancer We examined the incidence of cancer in a cohort of 2234 white-male police officers in Buffalo, New York. The study population was followed for 31 years (1976-2006). The incidence of cancer, ascertained using a population-based tumor registry, was compared with 9 US regions using the Surveillance Epidemiology and End Results (SEER) program data. Four hundred and six officers (18.2%) developed cancer between 1976 and 2006. The risk of overall cancer among police officers was found to be similar to the general white-male population (standardized incidence ratio [SIR] = 0.94, 95%, confidence interval [CI] = 0.85-1.03). An elevated risk of Hodgkin's lymphoma was observed relative to the general population (SIR = 3.34, 95%, CI = 1.22-7.26). The risk of brain cancer, although only slightly elevated relative to the general population (SIR = 1.61, 95%, CI = 0.73-3.05), was significantly increased with 30 years or more of service (SIR = 2.92, 95%, CI = 1.07-6.36). Incidence ratios were significantly lower than expected for skin and bladder cancer Police officers were at increased risk of Hodgkin's lymphoma overall and of brain cancer after 30 years of service.