The International Association of Chiefs of Police Conference was recently held in San Diego with thousands of law enforcement executives in attendance. The IACP Conference is one of the largest public safety conferences in the world and there were more than 600 vendors and organizations represented in the exhibit hall. T-Mobile for Government was an Industry Leader sponsor at this year’s IACP Conference and had one of the largest display booths on the show floor. That’s a good thing because the company’s newest emergency response SatCOLT vehicle was on display and open for attendees to take an inside look.

While T-Mobile has dozens of special response vehicles designed for disaster and special event response, the new SatColt is particularly impressive. Designed to go anywhere, it’s built on a Ford F550 chassis and is equipped with a full complement of T-Mobile hardware capable of providing voice, data and Wi-Fi services. It’s self-sustaining, with onboard power, dual masts and multiple backhaul options. Engineers have room to work while protected from the elements and there’s also capability for remote or autonomous operations. Many conference attendees took the opportunity to look inside the SatCOLT and see firsthand its potential to support emergency response operations.

To further demonstrate commitment and capability to first responders, T-Mobile hosted a well-attended workshop, Disasters and Major Event Planning – What You Need to Know Before, During, and After, that featured Nicole Hudnet, the T-Mobile Industry Segment Advisor for Emergency Response and a 27-year veteran of disaster deployments. Craig Martinez, National Public Safety Consultant for T-Mobile and a retired chief of police, co-presented with Ms. Hudnet and together they fielded numerous questions from a large audience.

T-Mobile is known for its mobile communication solutions and joined with several partners to provide demonstrations of game-changing capabilities in the areas of software analytics, drone response, 5G routers, and rugged computers. Judging by the level of engagement by IACP attendees, law enforcement decision makers are clearly interested in the force-multiplying potential that emerging mobile technologies can provide.

Perhaps the product demo that drew the highest level of interest from attendees was T-Mobile Direct Connect, a push-to-talk solution that leverages T-Mobile’s robust network to extend and bridge conventional LMR communications.

“The fact that we can provide eligible first responders with priority access and preemption for data helps ensure Direct Connect will meet the needs of front-line personnel,” said Scott Wiley, Senior Product Manager for Push-to-Talk at T-Mobile.

“Public safety can use Direct Connect to cost-effectively augment conventional radio systems by using a department radio paired with a device like the Cubic Vocality RoIP gateway,” Wiley explained. “And smartphones like the Samsung XCover6 Pro now feature a physical button on the side of the phone that can be programmed to provide functionality similar to a handheld radio.”

Overall, the 2023 IACP Conference was a great event and T-Mobile demonstrated it is clearly ready for prime time when it comes to supporting public safety operations. The company’s Connecting Heroes program, which helps ensure every eligible first responder agency has access to affordable wireless service, and their expanding collaboration with key public safety equipment and solution providers, has solidified their role in enhancing operational capabilities and improving safety for first responders.

Sponsored Content by T-Mobile for Government

Wildfires can be deadly and are one of the most dangerous challenges faced by fire service personnel. While these disasters were once limited to a specific season in a few trouble spots around the country, times have changed significantly, and now large portions of the country are impacted. In many areas, wildfires no longer have a season – they’re a year-round threat. Early detection – before a wildfire can spread – is critical and can mean a dramatic difference in the level of resources needed and the danger posed to firefighters. Artificial intelligence (AI) and 5G are bringing innovation to the fight.

In Boulder County, Colorado, an established and award-winning technology from a company called Pano is leveraging ultra-high-definition cameras and AI to provide early detection of wildfires before they become catastrophic events. The cameras, which are mounted on towers at high elevation locations, have 30x optical zoom capability and continually scan 360 degrees. Using AI, the incoming video is constantly searching the landscape for the first wisps of smoke. The technology can then identify the specific location or bearing, and alerts first responders within minutes of the first sighting of smoke. Boulder County Fire Manager Seth McKinney says the technology proved itself soon after the region began a three-camera pilot when an alert was triggered shortly after a  landscape worker inadvertently started a small fire. Although the worker quickly called 911, the fact that Pano had picked up on the smoke from the small fire demonstrated the system’s capabilities.

“About two months later, we had the Sanitas Fire,” McKinney said. “It started as a structure fire during red flag conditions with high winds – the [Pano] system keyed up on the smoke. As we were escalating our response, we were able to pull up images and it really helped in the coordination of resources.”

McKinney said the value extends beyond early detection of fires. “It’s not always about escalating a response,” he explained. “It can also mean that we don’t have a large number of personnel in an emergency response mode when it isn’t necessary. We are definitely detecting fires sooner, but there’s also a lot of value in the de-escalation. More than anything, it’s been able to help us recognize false alarms. Light patches of fog that come up after a rain storm - those often get called in as smoke,” McKinney said.

“When there’s an alert, I receive a text message and an email. It comes with a link to the web site and shows me exactly what the camera is detecting,” McKinney explained. “It’s a tool at my fingertips and I can share it easily. With additional training and partners, we can really fine tune our responses. It’s brought a level of situational awareness that you have in the field and made it available to managers, especially when combined with the radio traffic from dispatch.”

Kat Williams is the director of government development for Pano and she spent more than 7 years as a wildland firefighter, including time as a member of the Idaho Panhandle Hotshots. She knows firsthand the importance of time when it comes to wildfire detection. “The earlier we can identify a fire and provide solid intel, the [firefighting] efforts are more effective, and the firefighters are safer,” Williams said.

According to Williams, Pano does much more than identify a fire in its early stages. “We can provide a lat-long and this is incredibly important,” she said. “The specific location can be viewed on a phone or tablet and satellite photos can be overlayed. This helps to identify resources like water, roads, and old burn scars (retreat area for firefighters). This is the type of intel that is so valuable when you’re enroute to a fire.”

For Pano to provide early wildfire detection, huge amounts of information must be transmitted and quickly analyzed. Many of the Pano locations are wireless and 5G has proven particularly beneficial by providing better speed, increased capacity and helping to reduce latency. “Connectivity with 5G creates a better AI performance because we can analyze more frames and there is higher resolution per frame,” Williams explained. "And data-heavy features like looking at high-resolution video in near-real-time allows firefighters to see fire activity clearly from miles away.”

The State of Washington Department of Natural Resources (DNR) recently entered into a two-year pilot that will deploy 21 two-camera Pano stations. In a press release regarding the pilot, DNR Commissioner Hilary Franz noted that the Pano system will mean communities will have more time to act if evacuations are required. “When a fire is bearing down on your property, you don’t care how or when it started, you need to know that help is on the way right now,” Franz said.

All of the Pano stations in Washington will be operating on 5G provided by T-Mobile, which has the nation’s largest 5G network. Arvind Satyam, who is the chief operating officer for Pano, says the company is working closely with T-Mobile to leverage 5G connectivity. “We have a partnership with T-Mobile and 5G is so important because it allows us to capture higher resolution imagery which yields better results. Reliability, trust, resiliency – these are the things we think about when we think about working with T-Mobile,” Satyam said.

An IPSA Webinar, Targeting Wildfires with Technology, is scheduled for October 5, 2023, at 10 am Pacific/1 pm Eastern. Speakers will include Kat Williams and Seth McKinney (both quoted in this article) as well as Nicole Hudnet, T-Mobile Industry Segment Advisor, Emergency Response Team. Registration is open now and there is no cost to attend this IPSA webinar.

For more information: t-mobile.com/publicsafety and pano.ai

By Becky DePodwin

Hurricane season is just around the corner and while the seasonal outlook from Colorado State University outlines slightly below-average activity in the Atlantic basin, individuals and business should still take time now to evaluate their hurricane preparedness and response plan.

The Saffir-Simpson Hurricane Wind Scale estimates potential property damage of a tropical cyclone based on the storm’s maximum sustained wind speed. However, wind is just a single hazard out of many that pose a risk to lives and property when storms approach and impact land. During hurricane season, there are often headlines and news chyrons that say a storm has “strengthened” or “weakened” based on a change in category, but that change is only accounting for the wind and not the threat of rain, storm surge, or severe weather.

When putting together a plan, whether an individual/family hurricane preparedness plan, or a business continuity plan, it’s important to account for every hazard that may impact a location, as well as the large area over which those hazards can occur.

High winds? Storm surge? Inland flooding? Tornadoes? Power outage? Trees falling? While coastal locations have the highest likelihood of severe impacts, inland locations can still be significantly impacted by all potential hazards.

Flooding, storm surge

The deadliest hazard produced by a tropical cyclone is water. Past storms such as Harvey, Florence, and Joaquin have produced catastrophic and deadly flooding due to extremely heavy rainfall, with storms like Irene and Ida producing heavy rainfall that led to disastrous flooding well away from coastal locations. Inland flooding can pose a unique risk that may catch people living away from the coast off guard.

Hurricane Ian, in September 2022, produced a storm surge that was up to 15 feet above the normal water level. Flood waters can cause significant damage to infrastructure, with roadways washing out and structures becoming unstable. The rapid rise of fast-moving water as a storm is nearing landfall is what makes storm surge such a deadly hazard and why it’s imperative to comply with all evacuation orders.

Severe weather

Tornadoes are another dangerous hazard that tropical storms and hurricanes can produce, presenting a complicating factor in a preparedness and sheltering plan. Oftentimes, the threat for tornadoes in the outer bands of a storm can last for an extended period and given the transient nature of these spin-up tornado events, warning lead time can be reduced. With the possibility of flooding and tornadoes occurring in parallel, it’s crucial to have evaluated on-location sheltering options for both hazards and considered the opposing safety actions for each (below ground/interior room for tornado vs higher ground for flood).

Destructive winds

Last, is the threat of long-duration and damaging winds. Hurricane-force winds, which range from 74mph at the low end of a Category 1 storm to 157mph or higher in a Category 5 storm, can cause immense destruction to property. Manufactured buildings, tilt-up construction, and other mobile structures are at a very high risk of being damaged or destroyed and are not safe places to be during a storm.

Strong winds can bring down trees and powerlines, causing power outages as well as downed electrical wires that present a significant hazard to first responders and residents trying to navigate the immediate aftermath of a storm.

Additionally, rapid intensification (RI), an increase in maximum sustained winds of 30 knots in 24 hours, is a variable that needs to be considered when putting together a preparedness or continuity plan. All plans should assume and plan for hurricane intensification up to two additional categories. This will ensure individuals and businesses are not caught off guard by a storm like Hurricane Michael, which strengthened from a tropical depression to a Category 5 hurricane at landfall in just 72 hours. Equally important is timing. All preparations and/or evacuations should be brought to completion by the onset of tropical storm force winds.

Plan

A key part of putting a plan together is reviewing past weather events that have adversely impacted a location. Two resources that can assist with this are an insurance agent and a local emergency management agency.

Proper insurance is the best line of defense in ensuring an individual or business can minimize debt incurred during the preparation and recovery process, and insurance agents want to help policyholders mitigate their overall risk. Most homeowners’ insurance policies do not include flood insurance, so knowing a location’s flood zone information is key.

A local emergency management agency can provide information about flood zones, evacuation routes, how to receive localized emergency management alerts, past disaster data, and any other necessary information to guide the development of a hurricane preparedness plan.

Once the hazards are known, it’s time to ask the right questions to family members, a site safety specialist, or company management to ensure all possible scenarios have been considered and incorporated into a hurricane preparedness and response plan.

Last, to ensure a detailed plan can be properly executed in a high-stress situation, it should be vetted through an exercise that helps familiarize participants with the hazards, scenarios, and appropriate response actions.  

With an all-hazards approach, individuals and businesses can head into hurricane season knowing they are prepared for whatever the atmosphere may throw their way.

By Dave Mulholland

Each day, 9-1-1 telecommunicators handle stressful calls involving law enforcement, fire and medical incidents. Telecommunicators are trained to calm highly distressed callers and gather the appropriate information within structured protocols and processes. Their training and the protocols they use have been developed and refined over decades. Coupled with strong training and defensible protocols, telecommunicators have become experts in handling high-stress calls through repetitious use of both foundational elements. 

However, the 9-1-1 landscape has changed as acts of mass violence and other multi-caller/multi-victim high-threat incidents begin to increase. These acts have restructured in-the-field first response efforts.  Police officers now arrive and directly enter the area to engage the threat, no longer securing exterior perimeters and staging until sufficient resources exist for team entry into the incident. Trained fire personnel and medical personnel now enter hot zones rather than waiting for a scene to become secure before they enter to render aid.

Similarly, acts of mass violence impact traditional 9-1-1 response. Telecommunicators, as the first of the first responders, play a critical role in determining the nature and extent of the threat and supplying the in-field responders with information to end the threat. During an act of mass violence, it is likely that the 9-1-1 center will be quickly overcome with calls. Triaging these calls to gather the most pertinent information is paramount. To successfully do this, the telecommunicator may need to deviate from traditional practices such as gathering detailed information about injuries and providing emergency medical dispatch protocols.

Below are five tips to assist the 9-1-1 center in handling mass violence events.    

Tip 1: During an on-going act of mass violence, the highest priority is to gather information to stop the threat. Law enforcement first responders must be provided with as much information regarding the type of threat and information to help identify the attackers and their location. High-threat trained fire and rescue personnel need to understand the environment to make informed decisions on when and where to begin their response inside the incident. The dispatcher is informing these decisions.  Telecommunicators also help inform the response by identifying any additional information sources at the scene such as video feeds and determining if there are possible secondary threats at the scene.

Tip 2: It is essential that 9-1-1 lines be kept clear so that additional information may be obtained. This often requires truncating calls from victims and witnesses on the scene. It is hard to disengage with someone who is injured or next to someone who is seriously injured or dead. Calls must focus on stopping the threat, and until that happens, telecommunicators should not be triaging medical priorities or providing medical direction through emergency medical dispatch protocols. Jurisdictions could consider creating specially trained crisis personnel from other governmental departments (such as human services) who can be activated to communicate with callers during an active incident and provide direction and comfort to the callers. After the 9-1-1 telecommunicator obtains the necessary information from the initial call, the call be transferred to another phone bank staffed with these specialists. 

Tip 3:  As soon as it is clear that you have a mass casualty or significant active shooter event, mobilize Critical Incident Stress Management (CISM) or Traumatic Exposure Recovery Program (TERP) team members. When developing these teams, ensure that there are members not actively deployed as an event responder who can respond to on-going event to help begin help with stress management in the 9-1-1 center. Thus, the healing process can begin even as the incident is still ongoing. All 9-1-1 supervisors and managers must constantly communicate with and evaluate telecommunicators during the incident to gauge when they may be reaching breaking points. Be prepared to appropriately relieve an employee who may have reached maximum stress levels during the incident. A broken employee will not effectively contribute to incident resolution.

Tip 4: Train, train, train. As stress levels rise, thinking functionality begins to rely more on how the brain has been trained and conditioned to respond. The adage of you fight as you train is equally true in the 9-1-1 center. Telecommunicators must be trained on response to acts of mass violence, especially through repetitive simulation exercises. This will assist the telecommunicator in developing greater comfort to follow different protocols during a mass violence event. Time spent in continuous roll call and simulation trainings multiple times a year will reap large rewards should a mass violence incident occur.

Tip 5: Great efforts have been made to educate the public on responding to acts of mass violence, such as the “Run, Hide, Fight” educational campaigns. However, little has been done to educate the public on what information is important to relay when calling 9-1-1 during an act of mass violence or what to expect when calling. For example, the public should be prepared for the telecommunicator to quickly gather information regarding the active threat but not remain on the line to determine extent of injury or provide reassurance and medical direction. 9-1-1 centers should work collaboratively with their respective first responder agencies to expand education efforts to include communications with 9-1-1 during a mass violence incident.

The role of the telecommunicator is critical in responding to and resolving acts of mass violence. It is imperative to continually evaluate appropriate response to 9-1-1 calls during acts of mass violence through decomposition of prior events, adoption of best practices and lessons learned and development of new tactics and protocols in the 9-1-1 center. Telecommunicators prove their value in saving lives, providing hope to those in distress, and protecting first responders every day. Efficient handling of acts of mass violence amplify the telecommunicators critical role as part of the first responder team. 

By Gregory L. Walterhouse

What is benchmarking? Simply stated, benchmarking are points of reference from which measurements are made. There are several types of benchmarking, the first being corporate style benchmarking, predicated on the belief that superior results are the product of best practices that can be emulated from others. The second type is visioning initiatives whereby a vision is established leading to the creation of results-oriented targets. Visioning initiatives are like strategic planning. The third type of benchmarking, and the focus for this article is the comparison of performance statistics. In this type of benchmarking, an organization compares their own statistics to either national standards or data sets from other similar organizations.

Benchmarking can identify top performers within a data set and highlight relative strengths and weaknesses within an organization but does not identify best practices. However, there are some challenges to benchmarking. Relative to the public sector, the inconsistency in the ways that municipalities measure and report their data can make benchmarking challenging. Another challenge is turning benchmarking data into actions to improve service. This will require data-driven decision-making and transitioning from traditional models of service delivery to more innovative models, in other words, change, which is often difficult for some, particularly in the fire service to embrace.  

Another challenge is the interpretation of data. For example, a higher cost per incident rather than a lower cost may seem counter intuitive. Nevertheless, a city that has fewer incidents will have a higher cost, perhaps because prevention efforts receive more funding indicating a more efficient use of available funds. One report suggests that comparing one fire department to another may not be the most accurate metric due to different demographics and that comparing response service to prevention service within the same agency may provide a more accurate measure of efficiency.

Benefits of benchmarking
Several benefits can result from benchmarking. First, benchmarking helps develop standardized metrics against which a department can evaluate their performance. Second, benchmarking assists in developing performance expectations for the department. Next, benchmarking helps establish a culture of continuous improvement for fire departments and provides a basis for department administrators to identifying and correct performance gaps. As elected officials are becoming more data driven, benchmarking can provide the data needed to support budget and staffing requests, equipment purchases, and new or expanded programs. Benchmarking is also a useful tool when developing strategic plans.

National standards
The National Fire Protection Association “Standard (1710) for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments” provides national consensus standard metrics that departments can use for self-evaluation.

NFPA “Standard (1720) for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Volunteer Fire Departments” provides similar metrics for volunteer and on-call fire departments. Some examples of standardized metrics contained within the NFPA standards include alarm processing time, turnout time, travel time, total response time, staffing and more.

Another of several examples is NPFA “Standard (1410) on Training for Initial Emergency Scene Operations.” This standard provides required performance metrics for deploying hand lines, master streams, automatic sprinkler system support, and truck company operations. Bearing in mind that national standards are minimum standards of performance, comparing a department’s performance to similarly situated departments at the regional, state or national level may be more informative regarding efficiency of operations.

Data
Compiling a data set for comparison is complex, as well as time, and labor-intensive. Employing an existing data set will simplify the process of benchmarking.

One source is the ICMA that offers free open access benchmarking that is a software-neutral data set with over 20,000 data points that facilitates comparing local government performance metrics. ICMA’s benchmarking service focuses on key performance indicators, with corresponding definitions. Some examples of operational performance indicators for fire and EMS include total BLS and ALS responses, average response times, total expenditures for fire/EMS personnel and operations, percentage of residential fires confined to object or room of origin, and percentage of cardiac patients with pulsatile rhythms upon delivery to a hospital.

Demographic performance indicators include, residential population served, square miles served, median household income, percentage of population below the poverty level, percentage of vacant housing units, respondent ratings of fire service quality and more.

There are also performance indicators related to fire service human resources including, hours paid including overtime, sick leave hours used, turnover rates, and worker’s compensation days lost due to injury. 

Though less focused compared to the ICMA data set, the National Fire Incident Reporting System (NFIRS) at the U.S. Fire Administration offers a free data set of more than two million fire incidents annually. The data sets are available on CD by request and include categories of all incidents, fire incidents and fire and hazardous materials incidents. Though the data will facilitate a comparison to national data, it is not conducive to making comparisons to individual departments. Users of this data must also be aware that participation in NFIRS is not mandatory and therefore is not a complete census of all fire incidents and NFIRS is prone to reporting errors, though the National Fire Data Center performs internal quality checks to identify and correct errors. 

Third parties
With many departments struggling with reduce staffing and budget constraints, finding the time and resources to perform benchmarking can be challenging.

One solution is a benchmarking analysis performed by a third party. The Emergency Services Consulting International (ESCI), which is the consulting arm of the International Association of Fire Chiefs (IAFC), has teamed with ISO to produce the Community Fire Service Performance Review for Structural Fire Protection. This is a peer-review benchmark analysis that fire departments and municipalities can use to make comparisons. The review compares a department to 15-25 accurate peer organizations along with regional and national averages based on 32 data points. ISO compiles the points into four main sections: emergency communications, fire services, water systems, and community risk reduction. The focus of this third party benchmarking analysis is narrower in scope focusing on how departments can improve their ISO Public Protection Classification rating. 

Summary
In summary, benchmarking is important to the fire service. As data is increasingly driving decision-making in the public sector, comparing fire service delivery to both national standards and similarly situated municipalities is critical to providing cost effective and efficient service. Benchmarking identifies areas of needed improvement, strengths, and helps restore trust in government by using data to make decisions and uncovering innovative ways to elevate performance. Benchmarking also provides information that may lead to mid-course adjustments or terminating programs that are not producing intended outcomes. Data-driven decision-making leads to greater accountability and transparency, encourages continuous improvement and improves consistency.

By Gregory L. Walterhouse

Over the past year there have been calls for rethinking and reimagining policing in the United States. There have been calls for defunding thus de-staffing of law enforcement agencies, decriminalization of various offenses and completely abolishing police departments.

Unintended outcomes in law enforcement are often associated with human error, which is inevitable and is the difference between a desired or planned state and actual state. Since human error will occur countermeasures are necessary and Crew Resource Management (CRM) can provide such a countermeasure by helping to avoid errors, trapping errors when they do occur and mitigating the consequences of errors that are not trapped. 

What is CRM?
In short, CRM is a decision-making model for high-risk situations. CRM is a management system using all means available including equipment and personnel to improve safety.

• The first step is to recognize that a problem exists.

• Second, is to define the problem.

• Third, identify possible solutions to the problem.

• Fourth, take appropriate action to implement a solution.

The overarching goal of CRM is to identify human error and make necessary corrections before the error results in an accident. Some of the skills associated with CRM include coordinated two-way communication, decision-making, shared situational awareness, workload management, leadership and teamwork. The objective of CRM is to improve safety through training to optimize performance and the use of the team concept.

History
Due to increasing commercial aircraft complexity, and the rising number of accidents, most the result of human error, CRM was developed in 1980 in the airline industry. CRM was initially designed for flight crews, but eventually included flight attendants and air traffic controllers. At least one study found that joint CRM training sessions comprising both flight attendants and pilots together, increased positive teamwork behaviors, and broke down communication barriers in finding solutions to in-flight emergency scenarios. CRM has since been used in a number of industries including in maritime, railroads, health care including surgical and anesthesiology teams, the military, helicopter air ambulance operations, dentistry, pharmacy and firefighting.

Does CRM work?
As to the efficacy of CRM, one study found that in the health care industry, CRM resulted in a return on investment of between $9.1 and $24.4 million from avoidable patient safety events.

Another study found that surgical outcomes and safety culture improved after CRM was implemented in a pediatric surgical department. After CRM was implement in a hospital intensive care unit, a three year study found a significant reduction in serious complications and lower mortality in critically ill patients.

An additional study from health care found that CRM training of trauma resuscitation staff, resulted in improved behavior and communication, resulting in enhanced patient safety and by inference reduction of errors.

The United States Coast Guard reports a 74 percent reduction in injuries since implementing CRM.

From the fire service a series of workshops found that CRM was a worthy model to pursue for wildland firefighting.

Finally, a specific success story from aviation is the successful landing of U.S. Airways flight 1549 in the Hudson River which Captain Sullenberger attributed to both his experience and CRM training.

Law enforcement application
Law enforcement officers are called upon to continually make decisions. Often these decisions are high-risk, and must be made in complex high-stress situations. There are also instances where it is alleged that officers fail to intervene when a fellow officer allegedly violates a victim's Constitutional rights including the use of excessive force. It’s in these types of situations, and others, where CRM could help avoid or trap errors thereby reducing unintended consequences of law enforcement interactions with the public.

One author suggests that human error is often not a singular mistake, but a product of the environment the actor is working in. Granted, law enforcement officers at times must make split second decisions while other encounters with the public evolve over a matter of minutes lending themselves to application of CRM training. It is critical that first responders, including law enforcement officers, work as a team in these types of incidents, which is the cornerstone of CRM. Yet, CRM has not been widely implemented in public safety organizations including law enforcement.

CRM focuses on human factors being the source of errors as well as being the best source of avoiding errors. CRM can help law enforcement agencies mitigate undesired outcomes and unintended consequences by focusing on teamwork, communication and theoretical background knowledge. Team work competencies include, leadership, workload management and adaptability. Communication competencies include, professionalism, efficiency and reflection. Theoretical background knowledge includes, shared situational awareness and decision making, reducing human error and stress management.

One concern law enforcement may have with CRM is that it circumvents the traditional chain of command. However, this is not the intent of CRM. Rather CRM promotes team member input while preserving authority. This is consistent with the National Incident Management System (NIMS), under which all law enforcement agencies should currently be operating. Under NIMS, safety is the responsibility of all team members, where any team member regardless of rank, has the responsibility to clearly advocate their position if they disagree with an intended action. CRM builds and expands upon this concept. While this may require a culture change in some law enforcement agencies, it is a crucial change. A culture that supports the assertiveness of all team members regardless of rank or stature, to voice their concerns when they see something going wrong is foundational to implementation of CRM.

Summary
Abolishing, defunding, and de-staffing the police is not the answer. Reimagining and rethinking policing are vague concepts that fail to offer a solution. These are uninformed reactions by politicians and vocal special interest groups, many of whom are not supporters of law enforcement. Law enforcement administrators are best situated and informed to improve outcomes and minimize unintended consequences of interactions between law enforcement and the public. CRM offers a viable solution to avoid, capture and mitigate human error and minimize unintended outcomes of law enforcement interaction with the public. CRM needs to be implemented by all law enforcement agencies.  

By Brendalyn Val Bilotti

Tactical Medicine is a rapidly growing area in law enforcement. This focus on advanced pre-hospital medicine in a tactical or austere environment is the result of the current risks associated with law enforcement activities and the ever-growing war on terrorism. Furthermore, the Federal Bureau of Investigation has released the “2017 Law Enforcement Officers Killed and Assaulted” report online. This report states that 60,211 officers assaulted while performing their duties. They also reported that 46 law enforcement officers were feloniously killed in the line of duty, as well as an additional 47 law enforcement officers died as the result of accidents that occurred in the line of duty.

As TEMS (Tactical Emergency Medical Support) has grown in popularity, so have the number of programs offering instruction for this specialty. The challenge has been in the varied ways these programs are conducted. With a lack of a nationwide standardized competency-based program, such as is used with Pre-Hospital Trauma Life Support (PHTLS), the programs that do exist are producing a wide range of understanding, capabilities, and expectations of performance.

One of the most challenging areas of establishing consistent delivery of TEMS resources is the significant variation that TEMS providers come from. Due to the nature of the physical demands of the tactical environment as well as the increased risk to the provider, TEMS providers are almost always volunteers. They are physicians, physician assistants, nurses, paramedics and EMT's. The problem arises not just in their scope of practice and what they can do, but also the autonomy with which they are able to provide this support. A physician may act independently, but a nurse and physician's assistant need to operate under the auspices of a physician. Paramedics and EMT's can only provide care within the state guidelines, and must also be certified by the local county to provide this care.

Given the variation in what care is provided, the questions that individual departments need to ask include:

1. What competencies are required of each TEMS operator? The basis for most trauma care is adapted or adopted from The Committee on Tactical Combat Casualty Care, and The Committee on Emergency Casualty Care outlines the best practices for trauma care in a tactical environment. It is not all inclusive of all the needs of a law enforcement operation. In addition, the California Emergency Medical Services Agency (CAEMSA) and Police Officer Standardized Training (POST) have released a collaborative “Guidelines for Tactical Medicine.” It is from this position a course can be developed for all deputies, and from that course, advanced courses can quickly grow.
   
   
2. Medical equipment should each operator carry? As in any job, the tools you take with you dictate how much one can accomplish while completing the job assigned to you. To have impractical tools, impractical tools or the wrong tools not only inhibit but impedes mission completion. Therefore, deciding what tools a TEMS operator carries indicates how independent they are and how effective they are while providing medical care. Equipment including tourniquets, chemical hemorrhagic control agents, pressure dressing and airway support equipment all need to be evaluated.
   
   
3. How often should each TEMS operator be required to perform these skills in a training environment? Professional licenses and certifications have to be renewed every 2-6 years, depending on a provider’s level of training and licensure. No standard currently exists for tactical medicine. It is well documented that skill degradation occurs without practice, and this area needs to be addressed. Insight for this can be garnered from air ambulance programs, which have a broad scope of practice and regimented training schedules. This would include a focus on the non-medically trained patrol officer who is on the front line of any law enforcement activity, from a traffic stop to those whose job puts them at greatest threat, such as Explosive Ordinance Disposal (EOD) or Special Response Unit (SRU).

Licensing
Licensed professionals have a scope of practice defined and often limited by the licensing body. Example are the American Medical Association (AMA), California Board of Registered Nursing (BRN), and the CAEMSA as defined by Title 22 of the State of California, as well as the First Responder course which is a non-licensed certification whose scope of practice is defined by the United States Department of Transportation (DOT).

These licensing and certification bodies have standards of practice, assessments, procedures and tests that each level of licensure is required to prove competence in through written and skills testing — providing certification at each level: Tactical Emergency Medical Support (TEMS; for a contracted and trained EMT/paramedic/nurse, providing care under fire in the hot zone) and the Tactical Medical Doctor (TMD; for the physician serving as the tactical team's medical director and medical team leader). With these different and well-defined levels of care, both the tactical team leader, the medical team leader and all tactical team members have clear expectations of services provided at each level, thereby furthering legitimization of the TEMS and TMD providers and their integration into the tactical program and environment.

Training 
When inquiries have been made of law enforcement officers regarding the tactical medicine courses they have taken, one similar concern was voiced: programs seemed to be often geared toward medical personnel with no law enforcement or military background, and not toward experienced law enforcement officers. This subtle yet profound difference means that many program's curricula include topics such as weapons, tactics and range time. Officers stated they did not need nor want these topics because these were covered in their academies, SWAT schools and were governed by their specific agency's policies. Some programs did not delineate between licensed and not licensed students, and students attended classes in skills that they could never use.

Suggestions included the following:

• Develop a visionary and forward-thinking curriculum that approaches the topic of tactical medicine from the view of law enforcement officers.
• Law enforcement leaders need to be at the forefront in advocating for and ensuring that the expertise, training, and equipment to support our first line of defense is available.
• Law enforcement agencies need to define the qualification requirements for all officers.
• Periodic formal and informal meetings among law enforcement and medical leaders are essential for unit cohesion and clear communication before an incident.

The suggestions listed above provide a useful framework for creating a Tactical Medicine Program for law enforcement.

On a micro-level, this provides the law enforcement community an alternative to the currently available method of having an ambulance on standby unavailable to provide immediate casualty care, thereby delaying care to wounded officers, civilians or suspects.

On a global scale, this type of program provides incredibly valuable alternatives to current training programs that are tactical and weapons focused in training, and further providing a medically focused and competency-based program, as opposed to one based only in theory or one that his focused on licensed personnel with an advanced scope of practice.  It is essential to convey the importance of offering a quality standard based curriculum that includes a specific performance-based standard that is divided by the performance level of function.

The publication concluded with several additional recommendations. The following is a summary of several of the key recommendations provided for law enforcement:

• Law enforcement needs to learn more about the available resources of the communities they serve as well as the capabilities of other agencies involved in emergency response.
• Law enforcement leaders must develop relationships and networks with medical and EMS agencies before a crisis occurs.
• Law enforcement leaders must assure a strong institutional commitment to officer safety and providing resource allocation to provide the necessary skills and equipment.

The information in the publication was comprehensive and covered a breadth of information. This article covers just a few of the specific decisions that each agency must make. Just like corporate culture, each agency defines the roles and responsibilities of its officers, as well as expectations of basic training standards and operational expectations.

The information provided in this article is intended as a starting point for law enforcement and medical leaders to develop a collaborative, proactive and problem-solving approach to combat future knowledge deficits and ensure a well-trained and well equipped first line of defense.

This basic outline provides a solid starting point for developing a tactical medical program. As this program becomes developed and the instructor cadre solidifies, a program can be expanded to teach all law enforcement self-aid and buddy aid. These skills reduce the severity and long-term impact of the line of duty injuries.

An individual who has completed a Tactical Medicine training program may or may not be competent to perform any number of medical procedures. Issues such as licensure, state and county laws, and the broad background that TEMS operators come from, beginning at the certified First Responder, including licensed personnel such as EMT's, paramedics and nurses, and ending by encompassing the physician level make the solutions complex. Currently, a certificate is not a validation of competence. It is this gap that should be addressed and with current movements toward standardization. In the article “Tactical Medicine-Competency-Based Guidelines” the framework to develop a standardized program is outlined.

It is from this launching point that a program can be used to develop a program. With slight modification, it can be offered to other affiliated public safety agencies, such as fire departments, the county contracted ambulance provider. A program is unique in the provision of medical care in the tactical environment geared towards experienced law enforcement officers and experienced medical providers.