Police officers should provide CPR in traumatic arrest?

[Hamhock]

http://www.nytimes.com/2016/09/27/o...=WhatsNext&contentID=WhatsNext&pgtype=article

This was written by an EM-trained (or perhaps EM trainee) physician about traumatic arrest in the field.

I don't even know where to begin, so I will leave it open to the rest of you guys...

I wonder if he discussed the "opinion" piece with his chair before seeking publication in the NYTimes.

HH

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[BAM!]

Well, WE all know this, but to reiterate, first the cops need to make sure the site is secure. That means searching/disarming the guy to make sure he doesn't unload one on you while you're performing first aid. This is actually one of the first parts of First Aid --> making sure the scene is safe. Then call for ambulance, which they are doing. Then if you want them to do stuff like applying pressure/stop bleeding, you'll need to equip them with a lot more PPE than a pair of gloves. Hepatitis blood stains still show up on navy blue uniforms.

As for the CPR part. We all know this is controversial. Does it help in traumatic arrest? Should you focus more on stopping the bleeding vs assisting/pushing all the blood out of the body? To me, it doesn't make intuitive sense to do CPR because the problem is blood loss, not necessarily a damaged heart like in an MI. But we all do it because that's what we do in cardiac arrest and it looks silly to just watch someone die without doing CPR. Action looks better than inaction.

I understand the academic drive to publish / create a name for yourself. But maybe you want to run this op-ed piece by some trauma surgeons first before catering to the liberal media?

 

[WilcoWorld]

On the one hand, I would like to see police get better training at CPR and to see every squad car carrying an AED.

On the other hand, this case is a terrible example of the positive impact such training could have. If anything, this case highlights the fact that we ask too much of police already, and that they should spend more time training in conflict resolution and non-lethal means of gaining physical control - not on being EMT-extenders.

Googling the author - he appears to be an EM resident who is working on a FOAM presence. I suspect people could see that as a positive or a negative, depending on their perspective.

 

[Arcan57]

http://www.nytimes.com/2016/09/27/o...=WhatsNext&contentID=WhatsNext&pgtype=article

This was written by an EM-trained (or perhaps EM trainee) physician about traumatic arrest in the field.

I don't even know where to begin, so I will leave it open to the rest of you guys...

I wonder if he discussed the "opinion" piece with his chair before seeking publication in the NYTimes.

HH

I think focusing on the CPR part of things isn't the right approach but I think that it's not unreasonable to have police know how to put on a tourniquet or hold direct pressure after a scene has been secured. If nothing else, the post-shooting scene of a group of officers standing over a handcuffed,dying person watching them bleed to death while they talk amongst themselves is horrible PR. Hell, if the idea of a police officer being trained to render aid to a suspected criminal offends your sensibilities bill it as training in case a fellow officer gets shot or stabbed.

 

[DrDrummer]

I think focusing on the CPR part of things isn't the right approach but I think that it's not unreasonable to have police know how to put on a tourniquet or hold direct pressure after a scene has been secured. If nothing else, the post-shooting scene of a group of officers standing over a handcuffed,dying person watching them bleed to death while they talk amongst themselves is horrible PR. Hell, if the idea of a police officer being trained to render aid to a suspected criminal offends your sensibilities bill it as training in case a fellow officer gets shot or stabbed.

This has been done in Houston, by Dr. Holcomb and colleagues, who distributed CAT tourniquets to all officers. Hopefully they are infrequently being used, but when they are I have no doubt they will save lives.

CPR is unlikely to be an effective intervention in traumatic arrest. The author could have taken advantage of this platform to make that more clear. Tourniquets, direct pressure, etc. seem like they may be worth encouraging but as everyone else has said, tough to do in many situations. CPR in "excited delirium syndrome" related arrests, on the other hand...

 

[gro2001]

I think it's totally appropriate and not asking the police to much to expect them to attempt to provide aide to someone they just shot. Yes, sometimes that will be impossible until they have established the scene is safe. Yes, calling for an ambulance takes priority over providing the aide. But when there are multiple officers present it should be possible to do several things simultaneously.

Is CPR specifically going to help in traumatic arrest? Probably not. But they should do something (pressure, maybe tourniquets, heck... maybe even CPR). Not doing anything after you shot someone is not acceptable.

 

[alpinism]

If I were his PD I'd be so pissed right now...

Ignoring the fact that the author (current NYU EM resident) likely has very little experience with traumatic arrest, he still should know better. Regardless of his personal opinions on police providing first aid after a shooting, CPR in traumatic arrest has never been proven to be beneficial and is not currently the standard of care by any means. In fact most experts would agree that it likely does nothing for patients while also delaying or interfering with other time sensitive life saving procedures. Hell, here's the exact quote from the ATLS manual - "closed heart massage for cardiac arrest or PEA is ineffective in patients with hypovolaemia"


Traumatic arrest = HOTT mnemonic
http://blog.ercast.org/no-cpr-trauma-arrest/

(The best part of the NYT article is that Swaminathan is actually one of the aPDs at the author's residency program)

 

[InternistDO]

I know from when I worked EMS that Philadelphia police had an policy where they would transport penetrating trauma victims to the hospital in the back of their squad cars rather than wait for the medics. As I recall, the trauma centers endorsed the idea (because of improved outcomes) enough that it became official policy a few years ago. There's a study around the internet somewhere. No CPR though, just scooping and running.

While it's not CPR, it is an example of the expanding expectations of police when it comes to medical stuff.

 

[WilcoWorld]

I know from when I worked EMS that Philadelphia police had an policy where they would transport penetrating trauma victims to the hospital in the back of their squad cars rather than wait for the medics. As I recall, the trauma centers endorsed the idea (because of improved outcomes) enough that it became official policy a few years ago. There's a study around the internet somewhere. No CPR though, just scooping and running.

While it's not CPR, it is an example of the expanding expectations of police when it comes to medical stuff.

It also reminds me of that scene in Training Day...

 

[Tenk]

CPR on a gunshot traumatic arrest is about as useful as voodoo magic.

 

[deleted109597]

So, there's a lot about this on FB and Twitter as well. Suffice it to say that some of the vocal members of that program are against any discussion of anything being wrong about it. They blame the title and any discussion about CPR on the editor of the NYT. They ignore the fact that many cops in fact do have medical training.
Basically they're acting like internists that diagnose something a day after we admit them. This is simply monday morning quarterbacking of the police, from a place that thinks all guns are bad (and I'll agree, most are).
The guys and girls at Temple are getting ready to release a paper on use of police transport for GSW. This is probably the only thing they can do after IFAK or CAT. Doing CPR for "public appreciation" will simply risk cops lives (imagine them trying to do that when the hordes bum rush them), and in the end, will make them lose in court when the lawyers show that in fact, it's worthless and that they should be doing something else.
I won't have my SWAT guys do it, no matter how much public pressure there is. We need to teach the public, and apparently some residents better.

 

[carbonizedeyesockets]

There is no doubt the law-enforcement duties should be the first and foremost responsibility of police officers. But, there is NO REASON they should not be trained to perform CPR and use an AED when appropriate. I have worked as paramedic in communities where PD carried AEDs, oxygen, and basic first aid supplies. Those officers were trained to do CPR and they often initiated CPR and first aid prior to EMS arrival. They were a huge asset to the EMS system, and to their communities. Many of these officer involved shootings have a single "suspect" and multiple officers on scene. It is not unreasonable for 1-2 officers to initiate CPR, even if for traumatic cardiac arrest as a result of police actions (if anything it shows they did something to try and save the person, even if we as medical professionals know it will likely be futile). As has been demonstrated time and time again, many officers just stand around and wait for EMS. Though I imagine it has happened, I don't know of any situations where police during the course of performing CPR on a victim of an OIS were attacked or did not have enough officers available for crowd control (we all know that every available officer will respond, whether they're actually needed or not). Sorry (not sorry), but I have higher expectations of police. Our soldiers are expected to provide medical treatment to enemy soldiers when indicated, and there is no reason to expect less of police officers.

 

[InternistDO]

The guys and girls at Temple are getting ready to release a paper on use of police transport for GSW. This is probably the only thing they can do after IFAK or CAT. Doing CPR for "public appreciation" will simply risk cops lives (imagine them trying to do that when the hordes bum rush them), and in the end, will make them lose in court when the lawyers show that in fact, it's worthless and that they should be doing something else.
I won't have my SWAT guys do it, no matter how much public pressure there is. We need to teach the public, and apparently some residents better.

Penn (I think) did one a few years ago

https://www.ncbi.nlm.nih.gov/pubmed/21166730

 

[carbonizedeyesockets]

I won't have my SWAT guys do it, no matter how much public pressure there is. We need to teach the public, and apparently some residents better.

In an era when SWAT is wayyyyy over-used for no-knock raids and too frequently raids the wrong house and too frequently kills or injures someone that is completely innocent, you want them to not act at all? *facepalm*

 

[alpinism]

There is no doubt the law-enforcement duties should be the first and foremost responsibility of police officers. But, there is NO REASON they should not be trained to perform CPR and use an AED when appropriate. I have worked as paramedic in communities where PD carried AEDs, oxygen, and basic first aid supplies. Those officers were trained to do CPR and they often initiated CPR and first aid prior to EMS arrival. They were a huge asset to the EMS system, and to their communities. Many of these officer involved shootings have a single "suspect" and multiple officers on scene. It is not unreasonable for 1-2 officers to initiate CPR, even if for traumatic cardiac arrest as a result of police actions (if anything it shows they did something to try and save the person, even if we as medical professionals know it will likely be futile). As has been demonstrated time and time again, many officers just stand around and wait for EMS. Though I imagine it has happened, I don't know of any situations where police during the course of performing CPR on a victim of an OIS were attacked or did not have enough officers available for crowd control (we all know that every available officer will respond, whether they're actually needed or not). Sorry (not sorry), but I have higher expectations of police. Our soldiers are expected to provide medical treatment to enemy soldiers when indicated, and there is no reason to expect less of police officers.

The police should be transporting these patients to the nearest hospital ASAP, not screwing around on scene doing CPR or waiting for EMS. If there's an ALS unit nearby they can also head in their direction and transfer care on the way to the hospital. No one is suggesting that the police do nothing or just stand around and wait for EMS. What we are saying is that having LEOs perform CPR on shooting victims is not beneficial and likely hurts patients by wasting time and delaying transport to the hospital.

 

[deleted109597]

In an era when SWAT is wayyyyy over-used for no-knock raids and too frequently raids the wrong house and too frequently kills or injures someone that is completely innocent, you want them to not act at all? *facepalm*

No. I hold them to the same standards as my EMS.
Doing something isn't the answer. Doing the right thing is.

 

[evilbooyaa]

I think the main thing to expect from police officers once they shoot somebody (and the scene is clear and safe for the officers) is to provide some amount of monitoring and caring for the person they just shot.

I can most likely guarantee that if a police officer was shot instead of a civilian, the other officers would have been doing something, anything, rather than just standing around waiting for EMS without even checking on the person who was shot.

I think it's common decency that even if you shoot someone for a legitimate reason, you should clear them of weapons to ensure that you will be safe, then try SOMETHING to keep them alive. Not necessarily saying CPR is the answer in this case, but at least some direct pressure to something bleeding would be better than just standing around.

 

[carbonizedeyesockets]

Ok, so ultimately we do agree that the police should act in some way to help the person who was shot. They should not stand and simply wait, which apparently is the common practice. Whether CPR, which I agree is not ideal for trauma arrest, or rapid transport without CPR when transport time is short, something more should be done. However, not all PDs are comfortable w/ transporting (apparently this is only done in a handful of cities, and evidence is not conclusive that it is better than EMS transport), and nor are all EMS' okay with letting PD transport.

In terms of police performing CPR in cardiac arrest due to penetrating trauma, I get that this is usually futile. However, lets face it, medicine does things that are futile every day in order to make someone feel better (family, pt., and/or medical team). In a perfect world, we would not do this. We would love to not have to do those sorts of things ever again. But, we are all subject to external pressures. I don't think police officers have anything to lose by initiating CPR. If anything, they have something to gain even if its one less thing to be chastised for by the public. And as someone else pointed out, police would certainly attempt resuscitation on one of their own. I'd like to see a physician look an officer in the face and tell them that they shouldn't do CPR on one of their fellow officers under similar circumstances. With that essentially being the case, I do not see how we can tell officers to not render aid to a "suspect" when we know that they would render aid to one of their own.

 

[deleted109597]

However, not all PDs are comfortable w/ transporting (apparently this is only done in a handful of cities, and evidence is not conclusive that it is better than EMS transport), and nor are all EMS' okay with letting PD transport.

Um, who cares if EMS is ok with it. If they aren't there, they don't get to make the decision. EMS probably isn't ok with STEMIs driving to the ED. They don't get to fix that problem, as it's not theirs to fix.

I don't think police officers have anything to lose by initiating CPR. If anything, they have something to gain even if its one less thing to be chastised for by the public. And as someone else pointed out, police would certainly attempt resuscitation on one of their own.

So, yeah, there is pretty conclusive evidence that PD transport (or homebody ambulance) is better than EMS. It's time to fixing the problem, not time to stabilizing.

I'd like to see a physician look an officer in the face and tell them that they shouldn't do CPR on one of their fellow officers under similar circumstances. With that essentially being the case, I do not see how we can tell officers to not render aid to a "suspect" when we know that they would render aid to one of their own.

I have done that, and if you want, I'll record it next time so you can stop talking out your ass. We aren't telling them to not render aid. Not doing CPR=/= not applying pressure, tourniquets, or the like. Sure, not every department/agency does this, but don't paint them all with the same brush.