Summer is nearly here and along with it comes long hours of special details placing officers amongst large crowds. Depending on the type of event, officers may be directing traffic in a traditional uniform, riding a bicycle, riding a motorcycle or suited up in protective riot gear and a gas mask.
In addition to any potential crowd activity that may endanger citizens and officers during summer events (traffic, intoxication, violent protestors, etc.), we have to concern ourselves with the fact that our personnel will often be working in direct sunlight, heat and humidity. Exertion, stressful situations, heat, dehydration and poor individual fitness can create a toxic combination that can result in preventable officer illnesses, injuries and even deaths.
The Medical Threat Assessment
The best way to predict, prevent and mitigate these situations is through the development of a medical pre-plan, often referred to as a medical threat assessment (MTA). Previously thought of as a tool reserved for tactical medics assigned to SWAT teams, an MTA works anytime officers are assigned to large scale events, elevated risk incidents or details occurring in difficult environmental conditions. The MTA helps identify potential hazards to your personnel, minimizes the chance of a preventable illness or injury and spells out a plan of action to respond to any illnesses or injuries that do occur. The assessment will also help identify points of contact for each supporting asset or organization.
If your agency has access to tactical medics, they should be able to advise you how to complete an MTA specific to your area, available medical assets and environmental threats. If not, the following will give you a very basic guide as to the points that an MTA should address.
- Medical facilities: Know where your local medical facilities are, the best routes for getting there based on time of day and traffic conditions, and which facilities are appropriate for different types of illnesses and injuries. Simply taking an officer to the nearest hospital may not be in the officer’s best interest.
- EMS response units: Understand what ground and air-based EMS assets will be available to you. Potential landing zones for an EMS helicopter may change depending on the time and day of the week based on population movements. Be aware of the level of training, certification and capabilities your local EMS services will bring and whether you will want to stage them before and/or during the event.
- Environmental threats: Check the weather forecast for anticipated temperature, humidity and precipitation. Anticipated wind speed and direction will be important for considering wind chills in cold weather, but are also important when planning for the possibility of chemical agent deployment. Possible severe weather events such as thunderstorms and tornadoes will significantly alter your plans, but even moderate temperatures can cause problems for officers engaged in physical activity or working for long periods in direct sunlight.
- Animal & plant threats: Determine if any potentially dangerous animals may be present in the area of operation, including domestic pets. Depending on the environment, mosquitoes or poisonous snakes may provide additional concerns of varying degrees. While a mosquito may not typically be thought of as immediately life threatening, they can cause discomfort at the least and potentially spread disease at the worst. Exposure to poisonous plants, such as poison ivy, can also cause distinct problems with exposure.
- Veterinary care: Talk to your K-9 and mounted units regarding any possible need for emergency veterinary care contingencies in the event that one of their animals are injured.
- Public works: Confer with local public works personnel to assist in determining whether any unidentified road hazards exist or what, if any, road closures should occur. Public works may also be able to assist with other support such as concrete barriers, barricades and temporary electrical power for incident command or officer support areas.
- Vulnerable populations: Identify nearby schools, day-cares, nursing homes or hospitals, which may be located nearby and may require special consideration or protection during operations in the area. These areas may also need to be taken into consideration when planning road closures or the deployment of chemical agents.
The MTA can also be used to identify the need for and availability of rest areas for personnel working the event. This includes secure areas for parking, equipment storage, meals, toilets and the ability to warm or cool officers depending on environmental conditions.
Provide your personnel with as much advance knowledge as possible regarding recommended uniform styles based on the threat assessment. Warm weather operations should permit the wearing of cooler uniform designs that include moisture wicking materials. Hats and sunglasses will also be important regardless of working in sunshine or overcast conditions. External body armor carriers will allow officers to release the sides for venting during rest breaks. I’m especially a fan of external carriers that permit load carrying features in order to improve weight distribution and pressure points on officers that cause unnecessary injury.
The Occupational Safety and Health Administration (OSHA) has recommendations posted on their website for personnel working in warm weather utilizing the “heat index.” The heat index was created by the U.S. National Oceanographic and Atmospheric Administration (NOAA) and is a valuable resource that assists in determining the severity of conditions based on both heat and humidity. Learn more here.
Ideally, your personnel would always be hydrating properly, regardless of assignment. Reality shows that many officers will not be concerned about hydration early enough and will find they are susceptible to heat-related illness if they consume their first bottle of water four hours into the operation. Proper hydration should begin at least 24 hours before a warm weather operation. Stress the need for them to drink water in lieu of beverages containing caffeine or alcohol.
Provide or encourage the use of backpack hydration bladders or the carrying of water bottles in cargo pockets. An officer who doesn’t carry water with him or waits until thirsty to take a drink will already be behind the hydration curve.
When taken to extremes, too much water consumption can also result in a serious medical problem known as hyponatremia or water intoxication. Consult with medical professionals in your region who are familiar with your working conditions and environment for appropriate fluid intake recommendations. Local fire departments can be a great resource regarding best-practices, as they are likely conducting firefighter rehabilitation operations during fire operations.
Be prepared to provide sunscreen, insect repellent, moleskin, non-emergency first aid supplies and basic over-the-counter medications for officers who need them. Encourage officers to carry personalized emergency medical information cards in the trauma plate pocket of their body armor so that information will be readily available concerning their allergies, medications, medical history and emergency contact in the event that any of them fall victim to an unexpected illness or injury.
After the MTA is completed, this pre-plan needs to be incorporated into your operational briefing of all personnel who will be involved. This briefing will advise personnel of any potential threats, recommended and required prevention methods and procedures for responding to any illness or injury. The briefing also provides your personnel with the opportunity to ask questions or make additional suggestions. Be sure to include support personnel and agencies in your medical briefing so there is no confusion as to anyone’s role or capabilities.
Once the operation commences, monitor environmental conditions and inform the incident commander regarding any changes in risk or officer status. The commander needs accurate information in order to ensure adequate staffing and officer health are maintained for the duration of the operation and your ongoing threat assessment will be of great assistance in accomplishing that goal. Be sure to have medical professionals checking in on officers periodically to monitor them for any changes. Officers can be stubborn and may not be willing to admit when they need rest, food or water. Be prepared to rotate officers out periodically.
Completing an MTA is not difficult, but it is often an overlooked tool that is designed to keep your officers healthy. We know that too many officers die from heart attacks. Unfortunately there are no statistics regarding the number of officers who suffer preventable heart attacks and survive, or suffer from preventable heat stroke, heat exhaustion or heat cramps while working extended operations in warm weather environments.
If you have tactical emergency medical support (TEMS) available, utilize their expertise to the fullest extent possible even on non-SWAT operations such as those mentioned above. If you don’t have TEMS available, talk to local EMS professionals and work with them to complete a medical threat assessment for any unique event or operation. Taking the time to predict, prevent and prepare for medical emergencies during such events will keep your personnel safer and more effective.