In addition to hot and humid weather, summer often brings compressed outdoor training schedules for many agencies that may be unable to effectively train outside during severe winter months. Regardless of geographic region, training outdoors in summer heat invites opportunities for officers to suffer medical emergencies related to overexposure to heat and sunlight. A quick check of the Officer Down Memorial Page (odmp.org) reveals multiple, recent examples of incidents that resulted in line-of-duty deaths:
• Inspector Timothy Charles Barnes, North Carolina Division of Motor Vehicles License and Theft Bureau, E.O.W.: July 28, 2010. Age: 38. Inspector Barnes died as the result of heat stroke shortly after completing physical training and collapsing at the North Carolina Justice Academy.
• Officer Rogerio Rene Morales, Davie (Fla.) Police Dept, E.O.W.: Jan. 13, 2011. Age: 27. Officer Morales died after suffering heat stroke while participating in tryouts for his agency's SWAT team on a 77-degree day. He was participating in the tryouts when he suddenly collapsed.
• Border Patrol Agent Jeffrey Ramirez, E.O.W.: Sept. 15, 2012. Age: 25. Agent Ramirez suffered symptoms of heat stroke during a defensive tactics training exercise in Laredo, Texas, on a day where temperatures were above 90 degrees. He was transported to a hospital after he began to feel ill. He was treated for dehydration and released. After failing to wake up the following morning, he was transported back to the hospital where he remained on life support until passing away several weeks later.
It's difficult to know if these cases were preventable, but they certainly illustrate the need for all officers, and especially trainers, to be aware of the signs and symptoms that may indicate one of your students or co-workers is suffering from a heat-related illness. Note: For additional information on preventing training-related deaths, see the March 2013 Law Officer article, "Good Training Gone Bad."
Heat-Related Illnesses
Heat-related illnesses result from dehydration and over-exposure to sunlight and heat. The chance of suffering from heat cramps, heat exhaustion and heat stroke are all increased as temperatures and exertion levels increase. Age and the use of caffeine, alcohol and some medications are also contributing factors. In addition, the wearing of dark clothing and heavy gear make it more difficult for the body to cool itself.
Heat cramps are the first stage of heat-related illness, and as such are a critical red flag, even though they're not an immediate, life-threatening emergency. The prevention, early recognition and treatment of heat cramps will help prevent more serious heat-related illnesses from developing.
• Signs and symptoms: Muscle cramps, dehydration, muscle spasms, nausea/vomiting, weakness, profuse sweating.
• Treatment: Move patient to a cool environment. Provide sips of electrolyte-containing sports drinks or cool water. Consider EMS response if patient's condition worsens or does not improve.
Heat exhaustion does not require extreme high temperatures, despite popular belief. Heat exhaustion can occur during moderate temperatures when combined with overexertion and dehydration.
• Signs and symptoms: Pale skin, profuse sweating, low blood pressure, headache, weakness/fatigue, thirst, rapid/shallow breathing, muscle cramps.
• Treatment: Move patient to a cool environment. Loosen or remove clothing. Elevate the patient's legs. Call EMS or transport to hospital immediately.
Heat stroke is an immediate life-threatening emergency that can occur in extreme cases. If left untreated, a heat stroke victim will ultimately go into cardiac arrest and die. Heat stroke occurs when the body can no longer cool itself.
• Signs and symptoms: Little or no sweating, skin possibly hot/red/dry, altered level of consciousness, rapid/shallow breathing, increased body temp, general weakness, rapid pulse, dilated pupils, collapse, nausea/vomiting, shortness of breath.
• Treatment: Move patient to a cool environment. Remove clothing. Call EMS with advanced life support (ALS) capabilities. Cool the patient immediately with air conditioning, fans and ice packs to armpits, groin and neck.
Cardiac Emergencies
According to the Officer Down Memorial Page, heart attacks were the third leading cause of line-of-duty deaths among law enforcement officers in 2013 behind deaths related to vehicles and gunfire. Almost half of the heart attack deaths in 2013 involved officers who were 32 years old or younger. Officers engaged in unmonitored physical training activities in warm weather conditions have an increased risk of experiencing a cardiac emergency regardless of the physical health of the officer, though obviously those in poor health may be more susceptible than those in good health.
• Signs and symptoms: Crushing, sharp or dull pain in the chest that may radiate into the shoulders, arms, jaw or back; numbness or tingling, particularly in the left arm; pressure or discomfort in the chest; sweating; nausea or feeling of indigestion; and shortness of breath or feeling of a racing heart.
• Treatment: Direct the patient to a position of comfort, either sitting or lying down; encourage the patient to take slow, deep breaths and monitor closely for any change in condition. Call EMS. Obtain as much information as possible regarding the patient's medical history, allergies and medications to provide to EMS. If the patient becomes unresponsive, check for breathing and a pulse. If no pulse or breathing are present in an unresponsive patient, begin CPR and automated external defibrillator (AED) procedures.
Preparedness
Although recognizing the symptoms of heat-related illnesses is important, prevention is even better. Make sure your officers drink water frequently and liberally apply sunscreen. Some officers fail to bring their own water and sunscreen, so trainers should bring extra. Make sure you have recently updated your training in CPR and the use of AEDs. Ensure you have an AED available when you train.
In addition, complete a medical threat assessment (MTA) prior to training events, just as your SWAT team's tactical medics might do prior to a preplanned tactical operation. Your MTA should include identification of possible threats based on the type of training and the environmental conditions officers will be training in. The MTA should also include treatment and transport procedures in the event of a medical emergency during the training session.
Below 100 Application
The five tenets of Below 100 apply to situations other than those involving gunfire or vehicles. At least four of the tenets can be directly applied to warm-weather training events.
• Watch your speed. Don't rush with regards to planning, training or following safety procedures. Make sure you are taking frequent water breaks while training in warm weather and ensure students are hydrating sufficiently.
• Wear your vest. Body armor has been proven time and again to save lives in more than just officer-involved shootings on the street. Many agencies require body armor to be worn during firearms training, but trainers should set the example for students by wearing it during all types of training. Even the best of firearms instructors using the finest of ammunition, targets and firearms have seen the occasional unintentional discharge, catastrophic failure or ricochet that causes bullet fragments to strike students or instructors. Avoid preventable injuries by wearing your other "armor" such as your eye and ear protection. Even a billed cap and long pants are important to shield yourself from sunlight and provide limited protection from hot brass and ricochets.
• WIN—What's Important Now? Follow commonly accepted safety procedures. Clearly define your learning objectives for each class. Brief your students on the emergency plan. Closely monitor your students for signs of heat-related illness or injuries. Know when to alter, postpone or delay scheduled outdoor training due to extreme heat or humidity. Strike a balance between the need to train officers in a variety of weather conditions versus the risks to their safety. Remember to monitor instructor health as well. They may be outside training all day, while students may only be rotating through two- or four-hour training blocks.
• Remember: Complacency kills! Instructor certifications, SWAT training or rank do not create an impenetrable shield around you and your students. Just because you haven't experienced a problem yet, doesn't mean you won't. We use multiple layers of safety procedures and equipment to minimize risk in the event any of those protective layers fails. As a trainer, you have a responsibility to your officers to train safely and to be prepared for a variety of medical emergencies that may arise during training.
We like to focus on high-profile, traumatic injuries that can be addressed with a variation of tactical combat casualty care (for more, see the May 2014 issue of Law Officer). In the process, we sometimes forget about the greater likelihood of less dramatic, but equally deadly, heat-related illnesses during training. The longer you train officers, the closer you are to such a situation occurring on your watch. Take steps to prevent a problem, and be ready for when that day arrives.
