Ambulance UK June 2023

FEATURE
EMS to transport said patients sooner. Metropolitan AFOs were more
likely to be supported by regular response officers who could take over
patient responsibility of stable patients when AFOs were redeployed
urgently elsewhere. This is also reflected in the higher rates of firearms
deployments for metropolitan officers at 29% versus 3%, which is in
keeping with national statistics (2). Nationally, rural police response
times are slower than urban (7-10), and so this backup may arrive later
resulting in longer on-scene times in cases where D13 officers were
waiting to redeploy.
Penetrating trauma disproportionately affected metropolitan areas,
most notably WMP. This correlates with the WMP having the highest
national rates of Possession of Weapon offences (11). This contrasted
with the higher proportions of medical and mental health associated
incidents experienced by semi-rural forces. The D13 module has
a significant focus on Trauma compared to medical or psychiatric
pathologies (3).
Metropolitan officers were more frequently faced with life threatening
traumatic injuries such as external catastrophic haemorrhage and
penetrating chest trauma. Officers were confident in applying chest
seals where indicated, although there are inconsistencies in the results
for number of chest wounds versus chest seal/Nightingale Dressing TM
usage. Also, chest seals were not always used on penetrating
chest trauma due to other issues taking precedence, such as
ongoing catastrophic haemorrhage or management of scene safety.
Abdominopelvic wounds were not always easily amenable to field
dressings, and so officers sometimes used a Nightingale Dressing TM as
an alternative to minimise further contamination of an abdominopelvic
wound.
It would be challenging to apply the metropolitan/semi-rural categories
to all police forces in the UK, and so the wider generalisability of
these results is difficult to comment on. Furthermore, this report
includes PRFs from a mixture of firearms and PSU officers in unequal
proportions and does not analyse PRFs by the type of officer
attending, the ratios of which vary regionally. AFOs are more likely to
attend incidents involving knives and firearms, although there were
some instances of PSU officers managing stab wounds.
Some PRFs contained accounts from officers stating scene safety
concerns detracted from the medical care they were trying to provide.
Particularly true for AFOs, officers can find themselves in circumstances
where they must choose between stopping and treating a casualty
versus dealing with an ongoing threat. Increasing a police officer’s
medical skill set can further polarise this issue and leave officers at risk
from moral injury. Increasing the level of care that officers are able to
provide patients is a positive change, however it should not detract from
their primary role as police officers. This is where drop bags and zero
responders have an important role to play. Drop bags enable officers
to provide the necessary basic life-saving equipment to bystanders,
empowering them to become a zero responder and deliver immediate
care, while the officers manage the ongoing threat before returning
to the patient if appropriate. The 2017 Manchester Arena attack is an
example of where drop bags would have been particularly useful (13),
and they are being introduced to some forces.
Limitations
There are some limitations to this study. Although the 4 police forces are
divided into metropolitan and semi-rural categories, there is overlap in
the regions covered by each force; metropolitan forces have rural areas
and vice versa.
In some instances, there was a poor standard of PRF completion with
omissions in certain intervention tick boxes, only for the intervention to
then be described in the free text box.
Furthermore, it was not always clear when EMS services arrived.
Therefore there was sometimes ambiguity surrounding whether the
inventions indicated on the PRF were carried out by EMS or by police,
or whether interventions were omitted from the PRF by officers because
they did not carry them out or EMS carried them out instead – this
overlap was not always clearly defined.
It is assumed that all medical incidents attended by D13 officers in the 4
police force regions in 2021 were recorded on PRFs and that there were
no omitted incidents.
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AMBULANCE UK - JUNE
Further to these differences in job roles, there is also variation in the
level of medical training. The standards of medical training are defined
in Clinical Skills for Police Officers in Specialist Roles, a document
published by the Faculty of Prehospital Care (12). Medical training
is detailed in a modular format, from Module 1 (basic life support) to
Module 5 (Enhanced First Aid skills, equivalent to enhanced D13).
Module 2 is the minimum standard nationally for all officers. However,
the standard to which a police officer in a given role is trained can differ
nationally too. Analysis of how skill set versus interventions delivered
might account for some of the differences observed in this report.
Module 5 training is not limited to AFOs and PSU officers. Some forces
train officers in other specialist roles to Module 5 level, such as traffic
and surveillance officers. Such is the increasing burden of assaults and
penetrating trauma in rural areas that roads policing units are often
first on-scene. Traffic officers have a role to play in managing trauma
patients from RTCs too, and so it follows that they might benefit from
this enhanced level of medical training.
Conclusion
Metropolitan forces face a different patient burden compared to semirural
forces. Metropolitan forces experience higher rates of penetrating
trauma, mostly due to stab wounds, and subsequently higher rates of
extremity catastrophic haemorrhage and penetrating chest wounds.
Semi-rural forces have longer on-scene times and are more likely to
use resources other than a DCA to transport their patients. Semi-rural
forces also have higher proportions of medical and mental health-related
incidents.
Region-specific training with specific emphases could better prepare
D13 officers, particularly in areas relating to medical and mental health
incidents. However, officers need to be able to manage a wide range of
issues and so this should not detract from their trauma training. Officers
may also benefit from further guidance regarding patient transport and
continued collaborative training with EMS.
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