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Public Safety Column
The IPSA's Public Safety Column is an opportunity for our members and corporate sponsors to provide thought leadership articles about all topics facing public safety.
The articles we publish are not necessarily the views of the IPSA, rather they are opinions shared by each contributor.
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By Heather R. Cotter, Executive Director
The International Public Safety Association reached out to a few member to get their perspectives on emerging lessons learned and considerations related to the COVID-19 pandemic specific to continuity of operations, safety and mental health. The article contributors include:
Q: What are you seeing related to the COVID-19 pandemic, specific to COOP, safety and/or mental health?
Poon: As organizations at all levels are finding their key resources are limited and personnel may be unavailable due to the COVID-19 pandemic, now is the time for everyone to review and reassess their essential functions so that the resources that are available can be applied in efforts that will be most beneficial to your organization.
FEMA has various tools to support continuity-related planning to include the Business Process Analysis and Business Impact Analysis User Guide. This guide supports the development, review and validation of essential functions by taking you through the steps of conducting a Business Process Analysis and Business Impact Analysis. This and other useful continuity-related tools and information can be accessed in the FEMA Continuity Resource Toolkit.
FEMA also have online trainings through the Emergency Management Institute, and the most relevant ones now are:
An Introduction to Continuity of Operations: IS-1300
Introduction to Continuity of Operations Planning for Pandemic Influenzas: IS-0520
And the Continuity Guidance Circular is also available in the Resource Toolkit as our foundational document that has basically outlined how much of national resilience depends upon everyone in the whole community having continuity plans. Continuity isn’t limited to government or any specific sector.
Steiner: COVID-19 is requiring us to rethink our normal response to our routine emergencies. Protect yourself and your personnel right away as part of your initial scene safety. It is important to remember that people can be asymptomatic and still be contagious. Even people who are showing symptoms may not be forthcoming with that information about their symptoms in fear of being labeled (stigmatized) or denied entry into a place.
We are treating runs as though the patient has COVID-19 by protecting ourselves right away wearing surgical masks, eye protection, gloves and other PPE as needed. We are also placing masks on all our patients to provide an additional level of protection. We are sending one medic in to evaluate the patient and determine the proper level of PPE and care. We are even trying to get the patients to meet us at the front door, lobby or outside when possible to help limit the potential exposures.
Greco: The mental health field is seeing resiliency, strength and courage through this difficult time. We continue to see first responders struggling with existing stress that is being compounded by this crisis.
Q: What else should organizations be thinking about and addressing?
Greco: We need to start looking at physical and mental wellness during and after this crisis. And not just in our first responders, but for our doctors, nurses and other medical professionals. I am concerned about the rates of acute stress disorder and PTSD. I would ask that organizations begin to look at wellness efforts now and plan for taking care of their people after this event. This is critical to help mitigate burnout, compassion fatigue and PTSD.
As Chair of the IPSA’s Mental Health & Wellness Committee, I am proud to serve with a terrific group of first responders and medical and mental health professionals. IPSA has several resources available on their website including infographics depression, PTSD, suicide, family and officer wellness. I encourage agencies and individuals to download and distribute these free resources.
Steiner: The well-being and mental health of your personnel and their families during this difficult time needs to be near the top of every leader’s mind. Plus, the economic impact the COVID-19 pandemic is having on both the public and private sectors; many individuals and companies are experiencing financial stress. It is going to be a long road to recovery.
Poon: This event is really highlighting how important it is to have good continuity plans in place. Even though we are not activating plans in the traditional sense, or relocating operations, we are using the strategies and capabilities we have developed over the years to maintain functions and services. We need to focus on four continuity planning factors:
The IPSA will continue to reach out to its stakeholders during and after the COVID-19 pandemic. We promise to continue to share the information we receive from our multidiscipline network so we can all learn from one another. Afterall, our vision is for a stronger, more integrated public safety community capable of an effective joint response to all public safety incidents. Together we are stronger.
IPSA COVID-19 Webpage
IPSA Mental Health Infographics
IPSA FEMA COOP Webinar Recording
IPSA Webinar Recording: Burnout - Staying Out of the Red Zone
10 tips for emergency responders, healthcare providers for managing stress during the COVID-19 crisis
"The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) issued guidance on how covered entities may disclose protected health information (PHI) about an individual who has been infected with or exposed to COVID-19 to law enforcement, paramedics, other first responders, and public health authorities in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule.
The guidance explains the circumstances under which a covered entity may disclose PHI such as the name or other identifying information about individuals, without their HIPAA authorization, and provides examples including:
When needed to provide treatment;
When required by law;
When first responders may be at risk for an infection; and
When disclosure is necessary to prevent or lessen a serious and imminent threat.
This guidance clarifies the regulatory permissions that covered entities may use to disclose PHI to first responders and others so they can take extra precautions or use personal protective equipment. The guidance also includes a reminder that generally, covered entities must make reasonable efforts to limit the PHI used or disclosed to that which is the "minimum necessary" to accomplish the purpose for the disclosure.
"Our nation needs our first responders like never before and we must do all we can to assure their safety while they assure the safety of others," said Roger Severino, OCR Director. "This guidance helps ensure first responders will have greater access to real time infection information to help keep them and the public safe," added Severino.
The guidance may be found at: https://www.hhs.gov/sites/default/files/covid-19-hipaa-and-first-responders-508.pdf "
By Andrew Devine
Editor’s Note: This article is reprinted with permission from the Mesothelioma Guide.
The U.S. Fire Administration (USFA) and the National Institute for Occupational Safety and Health (NIOSH) have teamed up to study the causal relationship between firefighting and diseases such as mesothelioma. The study found that firefighters have a substantially higher risk of developing mesothelioma than the general population.
Firefighters are a group of people that have one of the more notable risks for developing mesothelioma. These risks aren’t hard to imagine when considering the amount of debris and toxins released into the air when an older building burns down.
The smoke and dust generated from these fires are likely to contain unsafe levels of asbestos. When structures are on fire and when they collapse, asbestos fibers present in the structure become airborne.
There are also unforeseen risks that firefighters serving prior to the 1970s may have incurred. Such a risk is the use of asbestos in the protective materials worn by firefighters prior to this period. Since the risks of asbestos were not widely known, it seemed logical at the time to manufacture helmets, coats and pants with fire-resistant asbestos.
While firefighters today have protective equipment, such as masks and respirators, it is not always a requirement for them to use the equipment. This obviously puts firefighters at risk of exposure if asbestos is present.
Study backgroundThe idea behind the study was to create a more conclusive understanding of the occupational risks of firefighting and developing cancer. By increasing the number of participants in the study, researchers hope to back up previous studies with a more scientifically significant analysis.
The study consisted of nearly 30,000 career firefighters who served between 1950 and 2009 in San Francisco, Chicago and Philadelphia.
While the research does not consider factors such as smoking, personal health and consumption of alcohol, they did determine that firefighters are twice as likely to develop mesothelioma compared to the general population.
This was the first study ever to identify higher rates of mesothelioma among firefighters in the United States. It also found that firefighters have a higher rate of developing several other types of cancer.
The study is projected to have a second phase in which researchers will look at the occupational history of the firefighters in this study to gain more specific information about the relationship of firefighting and the development of cancers like mesothelioma.
9/11: A recent example of asbestos risks for firefightersOne of the most infamous asbestos exposure risks for firefighters were those who served at Ground Zero on 9/11. The lower floors of the Twin Towers were coated in tons (estimated between 400 and 1,000 tons) of asbestos that was released into the air when the buildings collapsed.
The dust cloud resulting from the collapse swamped lower Manhattan, engulfing skyscrapers and people. Those without respirators were sure to inhale the toxic dust.
A study released a year after 9/11 by the American Thoracic Society highlighted the risks associated with asbestos exposure for firefighters at Ground Zero.
Although the study wasn’t speculative about firefighters developing mesothelioma in the future, it determined there was a significant amount of asbestos released in the air after the collapse.
The study did, however, determine that firefighters at Ground Zero had immediate respiratory side effects, including pleural effusions and pleural thickening. These are serious symptoms, which illuminate the risks firefighters must face.
There isn’t any event comparable in magnitude that posed risks to firefighters quite like 9/11. However, it does go to show that firefighters responding to calls involving buildings containing asbestos face an inevitable risk of being exposed to dangerous levels of asbestos.
Why is this study important?The study released by the USFA and NIOSH is important for many reasons, but one reason stands out in relation to mesothelioma: awareness. Knowing that firefighters have two times the risk of developing mesothelioma than the average American is powerful information.
This is information that can be used to help protect firefighters from unseen, airborne risks such as asbestos. It may also encourage firefighters who are tempted to remove their respirators to protect themselves.
Many people are still unaware of the potential threat of asbestos exposure. The toxic fibers are regulated in the U.S., but they still aren’t banned. Firefighters, especially, need to be aware of these risks.
About the AuthorAndrew Devine is a contributing writer for Mesothelioma Guide. He has developed an interest in educating patients and their families on everything from new treatments to what to expect after diagnosis.
Submitted by the Fairfax County Department of Public Safety Communications, Fairfax County, Virginia
In cooperation with Fairfax County’s Health Department, Fire and Rescue Department Medical Director, and Police Department Safety Officers, the Department of Public Safety Communications in Fairfax County (Virginia) have added the following questions to all calls:
If any of the below criteria are met, for any call, click the INFECTIOUS DISEASE button and list the criteria in CAD.
Medical pre-arrival instructionsKeep the patient/subject isolated. Do not allow anyone to come in close contact with him/her.
Return to chief complaint card
Start with chief complaint card/information gathering. Enter call for dispatch according to EMD protocol or event type.
Law enforcement pre-arrival instructionsDirect the involved subject(s)/parties to come outside, to exit the residence/office to meet the responding officer. (Our goal is to meet the involved subject(s) outside in open air to help minimize exposure).
Provide pre-arrival instructions. Screen for Coronavirus – ask questions in any order.
Screen for Coronavirus – ask questions shortly after event entry. Return to line of questioning.
IPSA COVID-19 Webpage
By Lieutenant (Ret.) Joseph “Paul” Manley, IPSA Board Member
In the United States, an increasing number of law enforcement officers, firefighters and EMS providers have been ordered into 14-day quarantine at home or in-quarters after exposure to a COVID-19 positive patient.
As of March 18, 2020, we are aware of 25 Kirkland firefighters and two police officers; four King County EMS paramedics, including two interns; 77 San Jose firefighters; six Reedy Creek Florida firefighters; nine Albany County deputy sheriff’s; and five FDNY EMS providers who have been ordered into quarantine. There is a high likelihood additional personnel will be reported as in-quarantine, quarantine completed or released from quarantine in the days ahead.
Kirkland, Washington cases
More than two dozen first responders were quarantined for possible exposure to the coronavirus after they responded to a nursing home where numerous people have tested positive.
The City of Kirkland issued a press release that confirmed 25 Kirkland firefighters and two Kirkland police officers have been placed under quarantine “out of an abundance of caution” after they were exposed to the virus at a nursing home.
Kirkland Fire Station 21 was shut down to house the first responders under quarantine who cannot, or do not, want to go into home quarantine for fear of infecting family and friends. Neighboring fire departments will be providing additional support as one-quarter of the 100 sworn members of the Kirkland Fire Department remain under quarantine.
King County, Washington cases
EMTs working for American Medical Response Company (AMR) in King County, Washington were not informed when they transported a patient with COVOID-19 symptoms.
San Jose, California cases
The San Jose Fire Department placed 77 firefighters under quarantine after four of the department's members tested positive for the coronavirus.
Reedy Creek, Florida cases
Reedy Creek Improvement District, the city-state that acts as Walt Disney World’s governmental agency, reports that seven firefighters and EMTs have been put under quarantine due to coronavirus.
Albany County, New York cases
According to Sheriff Apple, an Albany County Sheriff's deputy tested positive for COVID-19. The deputy, who was assigned to the judicial center, is recovering and has minor symptoms. The positive diagnosis forced the county to quarantine nine other deputies, putting a staffing strain on the department.
New York, New York casesJohn Knox, former FDNY Fire Marshal, dies of coronavirus complications. Additional FDNY members have also tested positive for COVID-19.
This news is highly illustrative of the dangerous role that our first responders play each and every day. Despite the ongoing risks associated with this virus for first responders, their families and their friends, they are all absolutely dedicated to protecting their communities with the services they need during these uncertain times.
About the Author
Paul Manley is a 30+ year public safety professional and adjunct faculty member at Endicott College in Beverly, MA. Paul is the Founder of Risk Mitigation Technologies, LLC and a retired Police Lieutenant and Executive Officer for the Nahant, Massachusetts Police Department. Paul has a Master’s Degree in Criminal Justice Administration from Anna Maria College and is a Board-Certified Homeland Protection Professional (CHPP). Paul is honored to be a Board Member of the IPSA.
IPSA COVID-19 webpage
By Nicholas Greco, M.S., BCETS, CATSM, FAAETS, IPSA Mental Health Committee Chair
Emergency responders and healthcare professionals have stressful jobs due to the type of work they perform. During a crisis, such as the COVID-19 pandemic, these professionals may start to feel overwhelmed and have higher levels of stress. While they may be physically prepared to respond to a higher volume of public needs, it is important for them be mindful of maintaining their mental health and overall well-being.
Here are some quick and useful tips for emergency responders and healthcare providers to reduce stress:
About the Author
NICHOLAS GRECO IV, M.S., B.C.E.T.S., C.A.T.S.M., F.A.A.E.T.S., is President and Founder of C3 Education and Research, Inc. Nick has over 20 years of experience training civilians and law enforcement. He has directed, managed and presented on over 350 training programs globally across various topics including depression, bipolar disorder, schizophrenia, verbal de-escalation techniques, post-traumatic stress disorder, burnout, and vicarious traumatization. Nick has authored over 300 book reviews and has authored or co-authored over 35 articles in psychiatry and psychology. He is a subject matter expert for PoliceOne/Lexipol and Axon as well as a CIT trainer for the Chicago Police Department and the the State of Illinois. Nick is a member of the International Law Enforcement Educators and Trainers Association (ILEETA), IACP, IPSA, and CIT International, as well as Committee Chair for the IPSA Mental Health Committee. Nick can be reached at email@example.com
Public safety agencies and organizations across the globe are becoming increasingly smartphone-centric. In a recent webinar hosted by the International Public Safety Association, panelist Dale Stockton said, “When you consider the sheer utility and overall functionality, [smartphones] have become the tech equivalent of the proverbial Swiss Army knife.”
It is this undeniable agility that has agencies thinking of smartphones as more than just a device for calls and text messages. When paired with secure, intuitive software apps and ruggedized accessories, smartphones enable agencies to operate more efficiently, maintain real-time situational awareness and increase first responder safety.
However, there are always challenges for agencies looking to adopt new technology, especially when it is equipment issued at an individual level. Luckily, the webinar panelists had plenty of tips and suggestions for overcoming these common objections to smartphone (and tablet) adoption.
“We don’t have the budget.”Funding is always a challenge for public safety organizations when it comes to acquiring and implementing new technologies. However, it is a challenge that is easier to overcome when those technologies can play multiple roles in the emergency management process and strategy.
According to webinar panelist Luke Stewart, “When it comes to investing in the right equipment, scalability is the most important factor.” This means investing in multi-purpose devices that have long-term value.
Many tablets now have cellular connectivity. Drones provide a great visual advantage, but they can also be used for extending coverage when towers are down. Free and low-cost apps like ATAK provide top-to-bottom mapping and messaging functionality for command-level decision makers and individuals in the field.
For agencies still in need of funding support, grant programs are also a great place to start. Websites like grantsoffice.com provide a complete listing of available opportunities for emergency and mobile communications, including some recently released by the Department of Homeland Security.
“We don’t have time for training.”Even with the funding for devices in hand, some agencies will delay adoption in fear of the eventual implementation and roll out. Fortunately, smartphones are one piece of equipment that’s easily understood due to their consumer use.
For this reason, the panelists recommended that public safety agencies select mobile apps that are intuitive and quick to learn. That way, agencies can focus their training and policy on end-user specific courses, knowing that various stakeholder groups like law enforcement, fire departments, rescue teams, EMS and NGOs won’t be leveraging the app features in the same way.
The panelists also recommended that public safety organizations consider training events that stress operating conditions, such as working in the dark or even putting phones in airplane mode to simulate a loss of service.
“Smartphones easily break during operations.”There is a major concern that smartphones typically cannot survive fires, major downpours, or even just constant use. Investing in the latest ruggedized equipment can help ensure that public safety organizations get the most out of their devices. This gear doesn’t need to break the bank, either: various military-grade cases are available on the market and can sell for less than $60, and fireproof pouches are available as low as $17.
The panelists also encouraged public safety agencies to look for device models that already come ruggedized or built with physical durability in mind. For example, Stewart explained how goTenna Pro radios are built to meet IP68 ratings, and offer flexible antennas and ruggedized Deployment Kit carry options for more demanding deployments.
“We don’t have reliable cell service.”But what about the durability of the network itself? Public safety professionals often find themselves in dead zones or even highly congested areas that impact connectivity. Agencies in rural communities or those with unreliable cell coverage may question the utility of a smartphone if it can’t be used all the time.
This is where mobile mesh networking devices can play a role in your agency’s mobile strategy. Mesh networking radio devices pair with smartphones via Bluetooth or USB and allow teams to communicate even when WiFi, cell and satellite are unavailable. This means that agencies can maintain real-time team tracking and critical text-based messaging when responding to any emergency, even when cell towers and other fixed infrastructure has failed.
About the AuthorNatalia Kossobokova is the Executive Editor of The Last Mile and the Content Marketing Manager at goTenna. She spearheads the development of global marketing content which includes thought leadership content and other marketing projects. She has over 10 years of experience working in the government communications industry. Natalia graduated from the University of Maryland with a Master's degree in Business Administration.
Webinar: How to build a comprehensive mobile first strategy for emergency management
Tech Series Spotlight: Hoverfly on tactical advantages of using tethered drones
Why communications infrastructure is key to community disaster resilience
Top 10 apps for emergency response teams
Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The outbreak first started in China, but cases have been identified in a growing number of other areas, including the United States, per the U.S. Centers for Disease Control and Prevention.
The CDC has released information on several aspects of COVID-19. Examples include:
These are free resources available to the emergency responder community. We highly encourage you to read and share them with your departments, colleagues and social media.
By Sarah Guenette, IPSA Mental Health Committee Member and Learning & Development Manager, CCS Safety Champion, Calgary Community Standards
A strong support network is critical for first responders to maintain good mental health. Spouses/partners play a key role in this. Spouses are likely to notice early warning signs that their loved one is possibly struggling with a mental health issue, organizational stress, or cumulative stress symptoms such as burnout, compassion fatigue or morale injury. For spouses to be aware of potential warning signs first responder couples should establish effective communication techniques built on trust, honesty and respect.
The nature of first responder work and the culture that goes with it tends to isolate its members. They are often unable or unwilling to share details of their work with their spouse. This is due to the requirement for confidentiality, but also the desire not to inflict vicarious trauma on their loved ones. It can be challenging for the partner at home to know that their spouse has another life when they put on their uniform. Spouses must accept this fact and learn techniques to manage any resentment or mistrust that comes with it.
To cope with this, it’s helpful to get to know the other supportive people in the first responder’s life – spouses should get to know their first responder’s partner and attend functions such as Christmas parties to get to know teammates and supervisors. The first responder should encourage this. Knowing the other members in a spouse’s support network will help to build the trust.
After a busy shift or following a stressful event, first responders often require some time alone to decompress when they get home. Due to the separation between their work life and their home life, it can be challenging for them to quickly move out of the first responder mindset and into the husband/wife/father/mother mindset. Until they have made that shift into their “at home” roles, conversation will be unproductive and potentially lead to conflict.
However, the first responder needs to understand that their spouse and family need them, and they cannot isolate themselves at the expense of that. It is a good strategy to set a time limit for decompression time and let the spouse know how long is needed (ex., “I just need 20 mins and then I’ll be back”). The spouse then knows that they will have an opportunity to reconnect and talk after the first responder has destressed from the events of their shift.
An early warning sign of potential stress problems is too much isolation. If a first responder is distancing themselves from their spouse, family and friends on a regular basis or for long periods, the spouse should talk to them and, if applicable, seek advice on how to handle the situation. Spouses might suggest accessing support services offered by the agency such as peer support, chaplaincy or psychological services. These services are also often available to family so couples should research what their specific agency offers.
First responders are trained to keep their emotions in check and will sometimes resist opening to their spouse for fear of losing control or showing weakness. This can lead to unhealthy coping techniques such as distancing/social isolation, alcohol use or drug use. First and foremost it is important for them to know that showing emotions and opening up to their spouse is safe. The spouse should reassure them that it is a safe place where they will not be judged and that they will support and advocate for them.
Active listening is a skill that should be practiced by both the first responder and the spouse to ensure there is open and respectful communication. Without active listening a person can quickly start to feel undervalued and start keeping things to themselves.
It is important to note that when a first responder is in a decompression phase, they probably won’t be able to actively listen. They need to be fully focused and engaged in the conversation. Trying to get them to actively listen before they are ready will prove frustrating for the spouse.
Active listening is not just hearing what the person is saying but focusing on what they are saying. When a first responder opens to a spouse there are four areas that the spouse should be concentrating on:
Active listening can also entail asking clarifying questions and summarizing back to the speaker what they said to ensure it was heard correctly.
Empathy and appreciation
Empathy and intentional appreciation are critical in any relationship. Making these a priority contributes to strong communication. Each person in the relationship needs to feel that they are valued for what they contribute.
Since first responders work shift work and need time to decompress, spouses may feel resentful that they are “doing nothing” while the spouse has been managing the home and family alone during the shift rotation. As mentioned above, an understanding of the need for decompression time is important as is establishing limits on it. Likewise, the first responder needs to have an appreciation and empathize with their spouse who has stressors in their role too.
If the first responder is never contributing that could be an early warning sign and should be discussed, especially if they are sleeping a lot and appear to be lethargic or have stopped taking an interest in activities they previously enjoyed.
Critical incidents, crisis stress response and occupational stress injuries can all affect a first responder. Spouses should take the time to research the stressors of first responder life and be attuned to early warning signs. First responders too should try to be self-aware and let someone know if they are concerned about themselves.
Critical incident stress is “A state of cognitive, physical, emotional and behavioral arousal that accompanies the crisis reaction…If not managed and resolved appropriately, either by oneself or with assistance, it may lead to several psychological disorders”. First responders may take a while to talk about a critical incident. It’s important for those around them to be patient and be on the lookout for warning signs (increased alcohol use, lethargy, social isolation, hypervigilance).
It is recommended to take a three-step approach to deal with any critical stress symptoms:
There is no relationship more impactful to one’s mental health than that with a spouse. Given the stressors of the job, first responder marriages can be challenging. Having strong and respectful communication strategies is key to ensuring that the first responder and spouse are both willing to be open about stressors they are encountering and be committed to staying mentally healthy together. Spouses need to be aware of first responder culture and the specific stress responses inherent in it. Understanding can prevent resentment and frustration and help them to be proactive in supporting their loved one.
Most importantly, if a first responder is struggling with stress, addiction or another form of mental health concern, they must feel comfortable to talk about it. The spouse is the main source of support in accessing additional resources. Investing time in forging strong communication skills, trust and appreciation is the best investment that can be made to create a lasting and loving first responder relationship.
Sarah Guenette, M.A., is the Learning & Development Manager for Calgary Community Standards. Sarah has a background in 9-1-1 and was a call evaluator, dispatcher and operations manager for over 10 years. She has overseen the Psychological Health and Safety portfolio for Calgary Community Standards since 2013 and is passionate about creating and maintaining a healthy workplace for employees. Sarah is also a proud first responder spouse to a Calgary Police Service Officer.
IPSA Infographic: Support for First Responder Spouses
IPSA Infographic: Staying Healthy Together in First Responder Couples
Webinar: Your Strength Keeps You Safe
Webinar: Heroes are Human Too - Depression, PTSD & Suicide
Webinar: Fighting addiction in EMS/Healthcare
By Brendalyn Val Bilotti, IPSA TEMS Committee Member
Tactical Medicine is a rapidly growing area in law enforcement. This focus on advanced pre-hospital medicine in a tactical or austere environment is the result of the current risks associated with law enforcement activities and the ever-growing war on terrorism. Furthermore, the Federal Bureau of Investigation has released the “2017 Law Enforcement Officers Killed and Assaulted” report online. This report states that 60,211 officers assaulted while performing their duties. They also reported that 46 law enforcement officers were feloniously killed in the line of duty, as well as an additional 47 law enforcement officers died as the result of accidents that occurred in the line of duty.
As TEMS (Tactical Emergency Medical Support) has grown in popularity, so have the number of programs offering instruction for this specialty. The challenge has been in the varied ways these programs are conducted. With a lack of a nationwide standardized competency-based program, such as is used with Pre-Hospital Trauma Life Support (PHTLS), the programs that do exist are producing a wide range of understanding, capabilities, and expectations of performance.
An individual who has completed a Tactical Medicine training program may or may not be competent to perform any number of medical procedures. Issues such as licensure, state and county laws, and the broad background that TEMS operators come from, beginning at the certified First Responder, including licensed personnel such as EMT's, paramedics and nurses, and ending by encompassing the physician level make the solutions complex. Currently, a certificate is not a validation of competence. It is this gap that should be addressed and with current movements toward standardization. In the article “Tactical Medicine-Competency-Based Guidelines” the framework to develop a standardized program is outlined.
“Licensed vs. non-licensed."
One of the most challenging areas of establishing consistent delivery of TEMS resources is the significant variation that TEMS providers come from. Due to the nature of the physical demands of the tactical environment as well as the increased risk to the provider, TEMS providers are almost always volunteers. They are physicians, physician assistants, nurses, paramedics and EMT's. The problem arises not just in their scope of practice and what they can do, but also the autonomy with which they are able to provide this support. A physician may act independently, but a nurse and physician's assistant need to operate under the auspices of a physician. Paramedics and EMT's can only provide care within the state guidelines, and must also be certified by the local county to provide this care.
Given the variation in what care is provided, the questions that individual departments need to ask include:
1. What competencies are required of each TEMS operator?
The basis for most trauma care is adapted or adopted from The Committee on Tactical Combat Casualty Care, and The Committee on Emergency Casualty Care outlines the best practices for trauma care in a tactical environment. It is not all inclusive of all the needs of a law enforcement operation. In addition, the California Emergency Medical Services Agency (CAEMSA) and Police Officer Standardized Training (POST) have released a collaborative “Guidelines for Tactical Medicine.” It is from this position a course can be developed for all deputies, and from that course, advanced courses can quickly grow.
2. Medical equipment should each operator carry?
As in any job, the tools you take with you dictate how much one can accomplish while completing the job assigned to you. To have impractical tools, impractical tools or the wrong tools not only inhibit but impedes mission completion. Therefore, deciding what tools a TEMS operator carries indicates how independent they are and how effective they are while providing medical care. Equipment including tourniquets, chemical hemorrhagic control agents, pressure dressing and airway support equipment all need to be evaluated.
3. How often should each TEMS operator be required to perform these skills in a training environment?
Professional licenses and certifications have to be renewed every 2-6 years, depending on a provider’s level of training and licensure. No standard currently exists for tactical medicine. It is well documented that skill degradation occurs without practice, and this area needs to be addressed. Insight for this can be garnered from air ambulance programs, which have a broad scope of practice and regimented training schedules. This would include a focus on the non-medically trained patrol officer who is on the front line of any law enforcement activity, from a traffic stop to those whose job puts them at greatest threat, such as Explosive Ordinance Disposal (EOD) or Special Response Unit (SRU).
Licensed professionals have a scope of practice defined and often limited by the licensing body. Example are the American Medical Association (AMA), California Board of Registered Nursing (BRN), and the CAEMSA as defined by Title 22 of the State of California, as well as the First Responder course which is a non-licensed certification whose scope of practice is defined by the United States Department of Transportation (DOT).
These licensing and certification bodies have standards of practice, assessments, procedures and tests that each level of licensure is required to prove competence in through written and skills testing — providing certification at each level: Tactical Emergency Medical Support (TEMS; for a contracted and trained EMT/paramedic/nurse, providing care under fire in the hot zone) and the Tactical Medical Doctor (TMD; for the physician serving as the tactical team's medical director and medical team leader). With these different and well-defined levels of care, both the tactical team leader, the medical team leader and all tactical team members have clear expectations of services provided at each level, thereby furthering legitimization of the TEMS and TMD providers and their integration into the tactical program and environment.
When inquires have been made of law enforcement officers regarding the tactical medicine courses they have taken, one similar concern was voiced: programs seemed to be often geared toward medical personnel with no law enforcement or military background, and not toward experienced law enforcement officers. This subtle yet profound difference means that many program's curricula included topics such as weapons, tactics and range time. Officers stated they did not need nor want these topics because these were covered in their academies, SWAT schools and were governed by their specific agency's policies. Some programs did not delineate between licensed and not licensed students, and students attended classes in skills that they could never use.
Suggestions included the following:
The suggestions listed above provide a useful framework for creating a Tactical Medicine Program for law enforcement.
On a micro-level, this provides the law enforcement community an alternative to the currently available method of having an ambulance on standby unavailable to provide immediate casualty care, thereby delaying care to wounded officers, civilians or suspects.
On a global scale, this type of program provides incredibly valuable alternatives to current training programs that are tactical and weapons focused in training, and further providing a medically focused and competency-based program, as opposed to one based only in theory or one that his focused on licensed personnel with an advanced scope of practice. It is essential to convey the importance of offering a quality standard based curriculum that includes a specific performance-based standard that is divided by the performance level of function.
The publication concluded with several additional recommendations. The following is a summary of several of the key recommendations provided for law enforcement:
The information in the publication was comprehensive and covered a breadth of information. This article covers just a few of the specific decisions that each agency must make. Just like corporate culture, each agency defines the roles and responsibilities of its officers, as well as expectations of basic training standards and operational expectation.
The information provided in this article is intended as a starting point for law enforcement and medical leaders to develop a collaborative, proactive and problem-solving approach to combat future knowledge deficits and ensure a well-trained and well equipped first line of defense.
This basic outline provides a solid starting point for developing a tactical medical program. As this program becomes developed and the instructor cadre solidifies a program can be expanded to teach all law enforcement self-aid and buddy aid. These skills reduce the severity and long-term impact of the line of duty injuries.
It is from this launching point that a program can be used to develop a program. With slight modification, it can be offered to other affiliated public safety agencies, such as fire departments, the county contracted ambulance provider. A program is unique in the provision of medical care in the tactical environment geared towards experienced law enforcement officers and experienced medical providers.
Brendalyn "Val" Bilotti directs training operations as the Alameda County POST MASTER Instructor including training needs assessments for 3K public officials, curriculum design, review and consulting, and ensuring regulatory compliance. Some of her key accomplishments include: Served as a Chair for the California Tactical EMS Advisory Subcommittee, Command Staff on search assignment, and the URBAN SHIELD Medical Branch Chief responsible for the oversight, care, treatment & transport of 250 SWAT officers; conducted site risk assessments to project medical needs in a large-scale Homeland Security/Disaster exercise for 280 participants across 792 miles and 7 countries achieving 99.5% success in providing all medical care onsite; and established a competency-based Tactical Medical Program for Law Enforcement officers including tourniquet training to prevent death by extremity hemorrhage achieving 98% successful placement on all extremities within 20 seconds.
California Tactical Casualty Care Training Guidelines (2017)
IPSA InfoBrief: TECC v TCCC
IPSA InfoBrief: Legal Aspects of Tactical Emergency Medical Support
Webinar: K9 Tactical Emergency Medical Support
Webinar: TEMS 101 - What you need to know to get a program started
Webinar: TEMS - Remote Surrogate Medical Care
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