Trauma patients who received blood products were at high risk of hypocalcaemia. Aggressive management of these patients with intravenous calcium during transfusion may be required.

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Background. Since 2007 Durham and Cleveland Firearms Police have trained a small number of firearms police officers to an enhanced level of first aid qualification. This article reviews the history of this programme, the patient report forms submitted during the period 2013-2016 and analyses the types of incidents attended. Methods: 66 PRFS were interrogated and analysed from a four-year period between Jan 2013 and Dec 2016. There was a marked increase in PRFs submitted during that time. Over half the casualties were male, resulting from assault (15) 21%), road traffic collisions (14)19%) and deliberate self-harm (14)19%). The most frequent medical interventions were wound dressing and direct pressure, airway manoeuvres and Oxygen therapy. On-scene times with patients prior to handover to NHS staff ranged from 0->60 mins. 0-20 minutes (22), 20-40 minutes (15), 40-60 minutes (10) and >60 minutes (1). Discussion: This data shows that the TTMs provide a useful medical response often arriving before other medical provision is on scene. Despite the primary role being to respond to firearms trauma, officers have dealt with a range of medical scenarios and provided a range of interventions.

Background: With an ever-increasing exposure to clinical situations, predominantly trauma, firearms medics at Durham and Cleveland police forces began to consider whether an increase in their scope of practice was needed; specifically, whether they could add analgesia administration to their clinical protocols. Considerations: The request was directed to the Tactical Medical Advisory Group (TMAG). This faculty comprises a clinical lead, emergency medicine doctors, military and civilian paramedics and tactical team medic (TTM) trainers. Analgesia in general was discussed, then potential analgesic agents were considered. The faculty agreed that the analgesic agent would have: to be available to all tactical team medics at all times, so should be highly portable); a minimal regulatory and training burden; a rapid effect with minimal side effects; and no conflict with prehospital medicine practice. Implementation: A 6-hour training course in methoxyflurane (Penthrox®) with summative assessments was designed and delivered by TMAG to all TTMs over a 4-week period. The chair of the TMAG agreed to be the signatory for the prescription-only medicine document and a standard operating procedure was drawn up. Sufficient stocks of methoxyflurane were then purchased and distributed across both police forces' armed response units, together with updated patient report forms, administration documents and feedback forms completed by TTMs after incidents.

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