LO082: EMS response to police use of force events: periods of personal and professional risk in prehospital care

Abstract

Introduction: This study provides an estimate of the number of EMS calls related to police use of force events that involve struggling, intoxicated and/or emotionally distressed patients. We hypothesized there would be under-reporting of EMS risk by paramedic agencies due to lack of standardized reporting of police events by EMS services and lack of a common linked case number between prehospital agencies in Canada. Methods: Data were collected during a multi-site, prospective, consecutive cohort study of police use of force in 4 Canadian cities using standardized data forms. Use of force was defined a priori and the application of handcuffs was not considered a force modality. Inclusion criteria: all subjects ≥ 18 years of age involved in a use of force police-public encounter. We defined risk to EMS as the presence of police- and/or paramedic- assessments of violent or struggling subjects on the scene. Three separate data forms (police-report of use of force, EMS encounter, and Emergency Department (ED) visit) were linked in the study by unique ID. When police-reported EMS was activated, investigators hand searched the EMS service reports at the relevant agencies for matching call sheets. Results: From Jan 2010 to Dec 2012, we studied 3310 consecutive public-police interactions involving use of force above simple joint lock application. Subjects were male (86%) with a mean age of 33 yrs; 85% were assessed by police as emotionally disturbed, intoxicated with drugs and/or alcohol or a combination of those. 45% were violent at the scene. Police-reported EMS attendance in 24% (809/3310) of use of force events, of which only 43% (349/809) of EMS run sheets were available. In events with violent subjects, EMS transported 51% to ED compared to 35% by police transport (chi=79.7, p=0.00). Conclusion: We identified periods of professional and physical risk to paramedics attending police use of force events and found that risk significantly underrepresented in EMS data. Paramedical training would benefit from policy and procedures for response to police calls and the violent patient, the majority of whom are struggling. A common linked case number in prehospital care would enable more specific quantification of the risk for EMS providers involved in police events.

A Comparison of Police Use of Force by Male and Female Officers in Canada: Rates, Modalities, Effectiveness, and Injuries

“…Consistent with previous findings (e.g., Hall & Votova, 2013), we found that the rate of police UoF incidents, as defined in the "Method" section, in the participating agency is very low (0.07%). with respect to UoF rates, two key findings emerged.…”

“…In Canada, it has been estimated that UoF is even more rare. Several reports have suggested that UoF occurs in about 0.10% of all police-public encounters in Canada (e.g., Baldwin et al, 2022;Hall & Votova, 2013), with lethal force occurring in about 0.001% of encounters (RCMP, 2022).…”

Stress-Activity Mapping: Physiological Responses During General Duty Police Encounters

“…The results of studies like ours can help inform the development and delivery of realistic and effective operational skills training that approximates real-world stress exposure. This evidence-based training approach is likely to be particularly important for improving performance in UoF encounters, which while low frequency (Hall and Votova, 2013; Baldwin et al, 2018), can result in tragic consequences and present substantial liability for officers and agencies (Braidwood, 2010; MacNeil, 2015; Dubé, 2016). It is also important to point out that studies like ours can also inform the development of SBT content, by informing agencies as to what sort of CFS and incident factors are occurring within their jurisdiction (e.g., if weapons are often accessible in CFS, that should be an element that is built into SBT scenarios).…”

Promising practices for de-escalation and use-of-force training in the police setting: a narrative review

“…Armstrong et al (2014) note that scenario-based training will be particularly important for use-of-force encounters, given the relatively low rate at which these encounters occur in real-life settings. Officers are unlikely to gain sufficient experience responding to use-of-force events from their day-to-day calls for service (Baldwin et al , 2018; Hall and Votova, 2013). Nonetheless, they must always be prepared to respond appropriately in case they do find themselves in a situation requiring the use of force, just as they must be prepared to effectively employ de-escalation tactics.…”