Patrol EMT Programs

pnwpopo

Newbie
Last summer, I got to attend a tactical medical course put on by Seattle PD for patrol coppers that culminated in an active shooter/mass-casualty exercise. It was great training, but one of my big takeaways was their neat program where they have patrol officers certified as EMTs.

I work in a moderately large agency (400ish), but we have low staffing and occasionally go to calls in areas without strong EMS/Fire support (e.g. a volunteer dept with the closest full-time spot being 20+ minutes away). I'm interested in other departments that have implemented a patrol EMT program and how it's gone for you.

Key points I'd like to know:
1. What kind of training/equipment/level of certification does your program have
2. What is the scope of the program
3. What kind of increased liability goes along with it
4. How is the program funded (grants?)
 

jBravo3

Regular Member
I just wanted to say that I really like the concept and I'd like to see this become the norm nationwide. I'd like to see every cop out there on patrol at least an EMT, and a BJJ blue belt for that matter, but I digress.

I know most of us landed at P&S primarily for the pew pew stuff, but medical, hands on abilities, and just the ability to empathize and talk to people is what the job really is at it's core. Not saying the gun stuff and shooting isn't important, but I feel like we as a profession could springboard forward and fix a whole lot of deficiencies, and build more trust within our communities, starting with just EMT certs and blue belts.

I've made an effort to put my money where my mouth is, and got an NREMT cert last year. Some other guys at my PD have done the same, and we've done it voluntarily and on our dime. I know that in the professional medical world (my wife is an ER RN, and my dad spent three decades in ERs as a DO), an EMT cert isn't a lot, but it's something.

After roughly 19 or 20 years of carrying a gun professionally, and being on scene at a lot of bloody problems (or other medical problems) that I didn't have solutions for, I knew I had to do something so I would stop feeling more or less like a helpless imbecile.

Some of those problems and situations have been hard to deal with in retrospect because of that feeling of helplessness - whether as a young, under trained Marine in combat, or an older, more experienced but still undertrained domestic cop in a back alley. It's a horrible feeling watching someone suffer, or having a crowd of people waiting for you to do something, when you don't know what to do.

We've come a long way with making TQs standard minimum equipment for patrol guys, and getting trauma kits in cars and on body, but EMT training and certs are the next step. In the current environment of cries to defund, this should be an easy sell for more funding, but I know it's not, because... reasons.

Sorry for the soap box, just wanted to say I really like the idea and concept of having EMT trained cops out there. Standing by for responses to the first post, and will be taking notes on anything noteworthy. As always, thanks all.
 

pointblank4445

Established
We were required to hold EMT license when I joined, and I held that for 8 years.

The problem we had with having the EMT mandate was training/certification. A little background in the IL system:

When I started, there was:
EMT-B (basic - couldn't push drugs)
EMT-I (intermediate - could push some drugs
Paramedic - obviously the top and required the most shadow/ER/ambo time (not something they could mandate for police)

The "I's" went away and there was only B's and Para's. Eventually they kept stacking on the mandates and requirements to where the B's more or less were nearing the levels of what the I's were. Keeping and maintaining the required meds and meeting the regular CE hours ultimately became an issue and we dropped back to "First-Responder" which is not really much lower than what I was originally trained at as an EMT-B. So in short, they kept moving the bar, and maintaining those creds was not feasible for the agency and the officers.

Since this time, we have fire respond to medicals as well and given our vicinity to hospital/ambulance/fire...the juice is not worth the squeeze as EMT's.

Where we have run into problems is in drug-related illnesses (primarily opioid) and the divide between the patient and you the officer (because you are still dressed as police...gun and all) despite what you say and the orange bag you hold. It causes problems. "Please tell me, you won't be in trouble...forget I'm a police officer...I just want to help"....does not fucking work.

And lets face facts. If we wanted to run medical calls...we would have been a paramedic....some of you weirdo's double and triple dip into fire and ambo...but most of us don't. With the relatively low frequency of serious medical calls, our training and experience does not lend to be good, experienced EMT's with a lot of "at-bats". Just one of the many "hats" we have to wear and generally it's mostly done half-assed. Gotta make room for that diversity/CIT/mental health/use of force/law update/sexual harassment/mandated reporter/Haz Mat/DHS/high risk stop/Blood borne pathogen/NIMs/LEADs....and whatever else continuing ed/recert is on my plate. :oops:

If I'm being completely honest, most of the ACTUAL stuff I've done on serious calls were things I learned long before in Lifeguarding CPR/AED/First Aid when I was a teenager or in the case of bleed/trauma in TCCC style training.
 

pnwpopo

Newbie
So in short, they kept moving the bar, and maintaining those creds was not feasible for the agency and the officers.

Since this time, we have fire respond to medicals as well and given our vicinity to hospital/ambulance/fire...the juice is not worth the squeeze as EMT's.

Where we have run into problems is in drug-related illnesses (primarily opioid) and the divide between the patient and you the officer (because you are still dressed as police...gun and all) despite what you say and the orange bag you hold. It causes problems. "Please tell me, you won't be in trouble...forget I'm a police officer...I just want to help"....does not fucking work.

And lets face facts. If we wanted to run medical calls...we would have been a paramedic....some of you weirdo's double and triple dip into fire and ambo...but most of us don't. With the relatively low frequency of serious medical calls, our training and experience does not lend to be good, experienced EMT's with a lot of "at-bats". Just one of the many "hats" we have to wear and generally it's mostly done half-assed. Gotta make room for that diversity/CIT/mental health/use of force/law update/sexual harassment/mandated reporter/Haz Mat/DHS/high risk stop/Blood borne pathogen/NIMs/LEADs....and whatever else continuing ed/recert is on my plate. :oops:
This is a perspective I'd be worried about too. I agree, there isn't a whole lot of reason to be injecting cops into medical calls without a real law enforcement component. So, question, do your local fire agencies also handle EMS? In our area, fire agencies are almost all paramedics as well and handle ambulance/involuntary committal stuff for us.

WA state passed a law several years ago that gives LE a legal duty to render first aid to anyone injured "at a scene controlled by law enforcement". https://app.leg.wa.gov/rcw/default.aspx?cite=36.28A.445 No real change; these are things we would be doing anyway, but the public felt better to put a statute to it apparently.

The biggest benefit I see to having patrol EMTs is to have heightened capability to treat seriously injured officers, suspects, or victims in a remote area. I'm really not super familiar with what kind of legal burdens come in on the fire/ems side, which is something I'm trying to learn about.
 

pointblank4445

Established
The biggest benefit I see to having patrol EMTs is to have heightened capability to treat seriously injured officers, suspects, or victims in a remote area. I'm really not super familiar with what kind of legal burdens come in on the fire/ems side, which is something I'm trying to learn about.
Yeah we now have a mandated aid by law requirement in our new LE reform bill too...

You are required to render aid commensurate with your level of medical training.

Our Fire can be EMT's or Para I believe and they respond to medicals. They don't do invol's though, that's ambulance or police.

I don't know how many GSW's you treat (I hope it's rare if ever), but becoming an EMT to treat that level of trauma is akin to going the police academy just to learn how to shoot a pistol. As I alluded in my previous post, you can get specific training for those events directly, and more often specific training will dig deeper than just the section the EMT portion covers. And like I said, the real serious stuff I've been involved with either medical or trauma was basic CPR/AED and or just knowing basic concepts of combat medicine (stopping/controlling/minimizing the bleed).

I'm probably over simplifying and looking at this through the lens of my generally negative experiences as an EMT, but mostly it's just being the harbinger of the inevitable choice: "ambulance or refusal form" and perhaps some O2 while we wait/get your vitals. Short of Narcan, oral glucose, nitro, or neb treatment...that's all I got for ya. I was literally giddy when I showed up to my first trauma call and a lady had slipped with pair of scissors and jammed them into her knee....super obvious what her injury/complaint is as was treatment.

IF you want to be an EMT...more power to you. It should NOT be mandated. I would rather more comprehensive trauma/first aid, CPR, AED be taught at more frequent intervals to police for critical incidents than to make them all sub-par EMT's. Anybody who thinks police should be humping med calls should be required to do ambulance/medical ride-alongs....
 

SmElly

Regular Member
Yeah we now have a mandated aid by law requirement in our new LE reform bill too...

You are required to render aid commensurate with your level of medical training.

Our Fire can be EMT's or Para I believe and they respond to medicals. They don't do invol's though, that's ambulance or police.

I don't know how many GSW's you treat (I hope it's rare if ever), but becoming an EMT to treat that level of trauma is akin to going the police academy just to learn how to shoot a pistol. As I alluded in my previous post, you can get specific training for those events directly, and more often specific training will dig deeper than just the section the EMT portion covers. And like I said, the real serious stuff I've been involved with either medical or trauma was basic CPR/AED and or just knowing basic concepts of combat medicine (stopping/controlling/minimizing the bleed).

I'm probably over simplifying and looking at this through the lens of my generally negative experiences as an EMT, but mostly it's just being the harbinger of the inevitable choice: "ambulance or refusal form" and perhaps some O2 while we wait/get your vitals. Short of Narcan, oral glucose, nitro, or neb treatment...that's all I got for ya. I was literally giddy when I showed up to my first trauma call and a lady had slipped with pair of scissors and jammed them into her knee....super obvious what her injury/complaint is as was treatment.

IF you want to be an EMT...more power to you. It should NOT be mandated. I would rather more comprehensive trauma/first aid, CPR, AED be taught at more frequent intervals to police for critical incidents than to make them all sub-par EMT's. Anybody who thinks police should be humping med calls should be required to do ambulance/medical ride-alongs....
This. You wanna be an effective first responder medically? Bleeding control, CPR, narcan w/training. Doesn’t need to be a 6 month EMT course.
 

The_Tacticallopath

Amateur
Forum Support I
I'm not a cop, but I am a paramedic.

My understanding is that there are small number of rural areas which employ trifecta LEO/Firefighter/paramedics. My understanding is that they rotate working in the specific roles to avoid the first issue I'll detail below. I know a few people who are trifectas coincidentally, and some of what I'm going to say is informed by them.

There are a few issues at hand here -

Role confusion - Different rules of conduct, confidentiality, and *very* different duties to act apply to an officer acting in the course of his duties to prevent/end/respond to crime vs an EMT in the course of those duties. These roles and duties may very well conflict with each other, and mixing roles can create real problems. There are potential 4th Amendment issues if gaining access under the guise of providing medical care results in the discovery of criminal activity, evidence, etc. HIPAA Confidentiality is its own animal. In summary, if the thought is that patrol officers are going to be empowered to flip a mental switch, pull a med bag from their trunk, and suddenly be an EMT on duty while still in their LEO uniform, that's a mess of a bad idea.

As far as the liabilities and such -

In short, EMT's work under delegated authorization from doctor titled as the Medical Director. Your officers would have to, after completing the EMT training and certifying through the National Registry, still then go through a training regimen approved by a Medical Director concerning the SOP's and Standard Delegated Orders that they've approved. You might get cooperation from a medical director in your area, but frankly it'll be roughly equivalent to onboarding with his EMS agency. That medical director will then be responsible for maintaining the proficiency and medical understanding of all of those officers who are, frankly, not going to be doing CME and putting the kind of attention into the medicine necessary. That sounds like a disaster waiting to happen.

Furthermore -

An EMT-Basic, without a paramedic partner, is of very limited utility. An EMT-Basic without a stocked med bag is of little more utility than a layperson. Those stocked med bags will be expensive assets with mostly one-time-use supplies that needs to be monitored and rotated as they expire. An EMT-Basic with a fully stocked med bag and no paramedic partner is still not much more useful in dealing with serious trauma than a limited-training layperson. Definitive treatment for serious trauma is a trauma surgeon.

In conclusion -

There's a *much* lower level of liability, much less complexity, much easier time training and keeping officers to the training standard, and no confusion of role issues if officers are simply put through an American Heart Association Basic Life Support course and an American College of Surgeons "Stop The Bleed" course. These are layperson level courses which would not require online/offline medical direction from a physician.
 

jBravo3

Regular Member
Great input and I can't say I disagree with any of the points made after I contemplate them. This especially:

"IF you want to be an EMT...more power to you. It should NOT be mandated. I would rather more comprehensive trauma/first aid, CPR, AED be taught at more frequent intervals to police for critical incidents than to make them all sub-par EMT's."

Yeah, you hit the nail on the head there I think. You're right, a mandate is too grandiose, but I'd like the training to be more common and offered by the agency as a training option maybe.

Most agencies in my area do not even maintain CPR or basic first aid certs, and I'd really like to see more emphasis placed on medical skills.

Ultimately, I guess I don't care about the cert in and of itself; it's the ability to provide basic aid that matters when it matters...and it's true that a piece of paper doesn't really guarantee anything.
 

pointblank4445

Established
Most agencies in my area do not even maintain CPR or basic first aid certs, and I'd really like to see more emphasis placed on medical skills.

That's sad and a long conversation about training and liability...

Said over and over and bears repeating:
Medical, firearms, combatives, driving, etc....all are skills that require more training and development than an agency can reasonably give...much less are WILLING to give. The burden of mastery is on the individual.

Granted, agencies could be a hell of a lot better about managing their expectations or doing more to support the learning process rather than doing half-assed blocks of instruction or online stuff just to check a box.

I've dogged my agency a bit here but I'll give them credit that over the years, they've been more than supportive of individual officers seeking training outside normal channels either in covering the days and not making the ofc burn time...up to and including paying tuition and travel per diem. Or if your timing and salesmanship is on point....all the above.
 

Doggiecop

Newbie
More emphasis on medical kits is easy. - see above -
Beg borrow trade for a kit, buy stuff too. I have a chubby blue fanny pack in the bottom of my patrol bag full of stop the bleed stuff. Made it my self, please don't expect your agency to provide "all" of what you need.
 

TCB

Amateur
The Patrol put me through EMT basic training and I’ve been Nationally Registered for the past 7-8 years...It’s an alternate duty for us. We often operate in fairly remote areas where there isn’t much EMS coverage, a lot of my calls are places where your local ambulance company will not go, air ambulances will not land and trying to get a search and rescue crew out can take a very long time. Most of the calls out in the mountains I deal with are severe dehydration and bad falls with all the related trauma head/leg/back/arm breaks. It’s usually a matter of stabilizing providing some basic treatment and carrying them out somewhere near a road or LZ for an ALS intercept. In town it’s nearly all breaks and lacerations from people coming off the Border Wall hard, the occasional “medical” call that usually just a hand off to a ambulance for transport (we are not allowed to transport) and out of shape people who think they are having a MI after getting chased down by one of our Agents. That stuff keeps us “in practice” for the real stuff (Agents in trouble) which is what I got the training for...our ATV guys get pretty messed up sometimes, MI’s, breaks, dehydration and the occasional trauma from fights.
Our Medical Director has given us a bunch of “advanced techniques” IV therapy, O2, superglottic airways & a couple more #comingsoon. Our BORSTAR Agents have some Medics on their rolls and they also have some more advanced protocols, during the summer they are doing 13 or so rescues a day in some areas, a lot of these would be body recoveries if they weren’t around. For my Agency the program works, my Station typically has 2-4 cross trained Agent/EMT a shift and is pretty typical nation wide. For a lot of the areas we work regular EMS response is a no go so we’re it...I think having the skill set is a bonus for a Police Officer who is motivated but most of the time with us most EMS calls are better left to someone who that’s thief full time gig. But it’s nice to have someone who can pretty much get anywhere in any situation and start treatment (think hot / warm zone situations).
 
Top