Advanced first aid skills for police officers in specialist roles: the ‘why’
Faculty of Pre-Hospital Care
A lot of the time, when we think about clinical skills, we focus on the ‘how’ and whilst, as part of our ethical considerations, we do consider the ‘why’, do we apply that to our structures and organisations too? Understanding the ‘why’ gives us a point of reference or a context for our decisions about the ‘how’.
Those of you outside policing who have followed some of the papers and updates to come out of the Faculty in the last three or four years, or have seen the news posts about the Faculty’s involvement in police casualty care, may have paused to ask yourself why the police need anything beyond ‘normal’ first aid. Whilst to some it may seem to be common sense given the situations frontline police officers encounter, others may perceive this is as a mission creep into the realms of healthcare professionals.
Since the formation of the first public police force in 1829 officers have been responsible for protecting life, and despite the introduction of first aid training in 1878 and the provision of police ambulance services from 1878 through to the late 1940s (there’s probably another blog entirely in our history), it isn’t actually documented anywhere that the police have a specific responsibility to give first aid to the public. It is accepted that we have a core duty to save life, but where do we draw the line?
There are several relevant pieces of legislation and police policy that compel the police to provide first aid training and equipment.
Firstly the Health and Safety (First Aid) Regulations 1981 state that employers should ensure that they have provision for “adequate first aid to employees that are injured or become ill”. Whilst, as mentioned previously, police officers are not legally-speaking employees, the Police (Health and Safety) Act 1997 specifically extended all health and safety legislation to include police officers. As such, the police are obliged to provide first aid for injured and ill officers, and as the Regulations make no exemptions or even mention of special circumstance, this not only applies regardless of the environment or the officers’ whereabouts, but the level of first aid must be risk assessed to that specific environment – meaning training and kit have to be relevant to the risk faced.
Under the Health and Safety at Work Act 1974, organisations are also obliged to ensure that their work does not expose the public to risk. When legislators drafted the original 1974 Act, their mindset was such that they wish to protect the public from falling items on street-side construction works, or unguarded railway crossings, not to the policing of a riot where the use of batons, horses and protected vehicles will inevitably pose a risk of harm. It is however, incumbent upon the police to minimise that risk, ideally to avoid it, but certainly to mitigate through the provision of first aid in those circumstances where the insult itself cannot be avoided.
Under the Human Rights Act 1998, every citizen has a right to life. This was originally taken to mean that the State, which has a duty to uphold human rights, was not permitted to take the life of a citizen, except in very specific circumstances i.e. a negative obligation, an obligation not to do something. By extension the Act also created positive obligations, when the State must act to uphold rights, rather than simply refrain from breaching them. In the case of the ‘right to life, when the State (in our case, the police acting as an arm of the State), use force on a citizen e.g. shooting them, or using a baton on them, in circumstances where this action may take their life, there is a duty then to attempt to save their life once the threat has passed.
These three laws have influenced police policy and procedure, and thus have been incorporated into the service’s Authorised Professional Practice, our national ‘best practice’. Commanders (i.e. senior police officers responsible for the planning and execution of a given operation) must consider “the health and safety implications for officers and members of the public who may be affected by police action”, embedding both the 1974 and 1981 health and safety legislation in policy. Likewise, the 1998 Act is reflected in that fact that police must “ensure that assistance and aid are rendered to any injured or affected persons at the earliest practicable opportunity”.
Aa review of the police response to the 2011 summer disorder which generated Ten Key Principles Governing the Police Use of Force, which the review itself noted are applicable in all police uses of force, not just those in disorder. One of the principals includes “the availability of adequate medical expertise to respond to harm caused by use of force”.
There is an international element to be considered too, which adds nothing to our domestic and policy requirements, but certainly cements what we do in an international context. The Basic Principles on the Use of Force and Firearms by Law Enforcement Officials, adopted by a United Nations Congress in 1990, provides that where the use of force and firearms is unavoidable, police officers should “ensure that assistance and medical aid are rendered to any injured or affected persons at the earliest possible moment”.
Whilst specialist medical capabilities may exist in some areas, who may be able to operate to some extent in high-risk policing environments, the duty is on the police to look after its own and those who they impact. Were the police able to discharge their first aid responsibilities to the ambulance service then so would every workplace, office and industrial site!
Through the application of international obligation, domestic human rights legislation, domestic health and safety legislation, and the police’s own national guidance for operations and planning we can see why some police officers operating environments where there is a higher risk of being injured or of causing injury, have to have an advanced level of first aid training.
The most common role associated with the advanced level of first aid training is that of firearms officer, which you may have heard called D13. However, subject to other national role profiles or local risk assessment, many other departments have the same level of training, and in some cases their training may be even more advanced. This includes public order (riot) medics, marine and underwater search officers, working at height teams, surveillance officers and, in some forces, dog handlers and roads policing officers. As an aside, D13 only relates to firearms training but more of that later.
Police forces may consider other elements of first aid, considering the needs of the public and extending beyond ‘normal’ first aid provisions, these lay outside of their obligations which may have consequent liability or legal issues for officers acting outside of their statutory duty requiring careful consideration.
Whilst specialist medical capabilities may exist in some areas, who may be able to operate to some extent in high-risk policing environments, the duty is on the police to look after its own and those who they impact. Were the police able to discharge their legal first aid responsibilities to the ambulance service then so would every workplace, office and industrial site! This is the ‘why’ for advanced first aid skills for police officers in specialist roles.
As is well-documented in the papers and updates that have been produced by the Faculty, as well as published papers from other sources, there is a clear by-product of these specialist officers’ advanced first aid capability. Despite the ‘why’ an overwhelming amount of their first aid interventions are on members of the public who they come across during the course of the routine duties and outside of their specialist environments. This is commendable, and has undoubtedly saved lives, but as it is not the primary ‘why’ it means that careful consideration is needed as to how these interventions impact on the ‘what’ and the ‘how’ when it comes to governance of training content and equipment selection.
Nick
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