HCMC NETWORK FEATURE: Medical training for law enforcement

A motor vehicle collision (MVC) on a snowy rural highway or a remote farm accident.  A hostile scene, unsafe for ambulance personnel to enter.  A violent and out-of-control individual who may be sick, intoxicated, or in autistic crisis.  A call to a private residence for a cardiac arrest or a call to a nursing home for a person who has shortness of breath.  Who responds?  Law Enforcement Officers (LEO’s) are often first on the scene to a wide range of 911 calls, particularly in communities where they are designated First Responders.  They respond to medical and behavioral emergencies in public and private settings, from residences, nursing homes, and schools to crime scenes and other challenging and potentially hostile environments that may be too hazardous for Emergency Medical Services (EMS) personnel to immediately access.  Special training is needed and EMS Education at HCMC has responded with a unique program, Tactical Emergency Medicine Peace Officer (TEMPO)™, specifically designed for law enforcement personnel.  

TEMPO is designed as a comprehensive educational opportunity to train LEO’s for effective response to a wide range of calls, both medical and behavioral, in diverse settings and conditions.  No other course in the region offers the combination of staff expertise, state-of-the art facilities, mobile training options, customized courses, and unique skills- and scenario-based curricula for high quality profession-specific emergency medical training.  From the Meeker County Sheriff’s Office and the Metropolitan Transit Police to police departments in Minneapolis, Edina, Eden Prairie, and Minnetonka, diverse law enforcement groups across Minnesota have signed on for TEMPO training and give it high marks.

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TEMPO training goes beyond typical classroom formats to train participants in challenging conditions for emergency care of civilians, fellow officers, and themselves, using real-life scenarios specific to law enforcement calls.  It builds on the standard First Responder training that all MN LEO’s receive around the time of their first training academy experience.  Training in stress-simulated situations requires officers to react and perform in difficult conditions, preparing them for effective response within a range of peaceful and hostile settings and in favorable and adverse conditions.  Skills tests and scenarios are conducted indoors and outdoors in all weather conditions, in daylight and darkness, with visual, auditory, and tactical distractions.  Skill repetition drills and applications in modified stress environments are designed to build muscle memory and close reactionary gaps.  Participants train wearing duty gear, including body armor, gunbelts, weapons made safe, and/or hazardous materials (hazmat) gear (Photos 1-7) so that they are familiar with how it feels to perform during a normal duty situation.

TEMPO courses address a variety of medical, traumatic and behavioral emergencies.  Depending on individual agency needs and requirements, the courses can be customized to focus on specific areas from unknown medical or trauma situations, chest pain, cardiac arrest, penetrating wounds, emergency childbirth, chemical suicide, and carbon monoxide poisoning to safe management of combative individuals, who may be in autistic crisis, mentally ill, intoxicated, or otherwise impaired (Photos 8-12).

Stress-inoculating scenarios build on lectures, demonstrations, and skills practice, training officers to render emergency aid in challenging situations often based on actual law enforcement calls.  For example, training on hemorrhage control is reinforced by a scenario requiring response to a hostile scene and tourniquet application with limited vision (Photos 13 a-e).  Skills training in automatic external defibrillator (AED) use, adult and infant high-performance CPR, airway management, and spinal injury management is tested by application in challenging field settings and scenarios (Photos 14-16).  Lectures on Excited Delirium Syndrome, prevention of arrest-related deaths, and training in “emotional rescue” techniques for autistic individuals in crisis are augmented by scenarios involving safe management of violent and out-of-control individuals (Photos 17a-b).   Additional TEMPO subjects not typically found in EMS refresher coursework include training on medical liability and appropriate use of aeromedical EMS resources (Photo 18).

TEMPO training was started in 2008 and now includes EMT-Refresher, First Responder-Refresher, and customized courses designed to meet needs specific to diverse law enforcement agencies.  Courses may be held at the South Metro Public Safety Training Facility in Edina, which offers state-of-the-art indoor and outdoor facilities.  Courses are also fully mobile and have been taught outstate, tailored for local law enforcement need and work environments across Minnesota (Photos 19a-b).  Detailed planning, staging, and de-briefing of participants enables the TEMPO team to address key learning points, incorporate feedback, and optimize learning opportunities (Photos 20a-c).  TEMPO instructors have also worked with departments across Minnesota to provide tactical medical kits, which are carried by LEOs for rapid personal use on the scene of emergencies (Photo 21) (Read This is Real World Stuff for more details).

The TEMPO team is equipped with a unique skillset in both law enforcement and emergency medicine.  Medical Director Dr. Jeffrey Ho is an emergency physician at HCMC, a fully sworn deputy sheriff with the Meeker County Sheriff’s Office, and a former firefighter.  He is internationally known for his research on Excited Delirium Syndrome, use-of-force and custodial arrest physiology, arrest-related death, and physiological effects of TASER devices and other law enforcement tools and weapons.  TEMPO Program Coordinator Rob Snyder is a paramedic with over 15 years of experience and extensive training in public safety and tactical emergency medicine, including domestic preparedness/hostile events response, prevention of in-custody deaths, and advanced hazardous life support.

Skilled TEMPO instructors bring a wide background in medicine/EMS, law enforcement, military service, and public safety (Photo 22).  Ryan Kelly is an Army combat medic with law enforcement background; Shayna Kiwus is a paramedic and a Hennepin EMS Education specialist; Andy Sherek is an OR nurse, paramedic, and former Anoka County dispatcher; and Jim Ingham is a paramedic with Northfield Hospital EMS and was previously in the U.S. Army Police Corps.  Dr. Paul Nystrom is an emergency physician, with previous experience as active duty in the U.S. Navy, including Dive Medical Officer and Undersea Medical Officer training and work with the Navy SEALs in San Diego, the Chula Vista SWAT team, and the Drug Enforcement Agency.  He is currently a junior faculty member at HCMC in the Department of Emergency Medicine and is completing his MN law enforcement academy training for LEO licensure.

Response to TEMPO courses has been enthusiastic.  Minneapolis police and fire departments have trained all personnel in basic tactical EMS principles, CPR, and combat casualty care.  Police departments in Edina, Eden Prairie, Minnetonka and Meeker County have made TEMPO EMT and First Responder refresher training mandatory for all patrol officers.   Eden Prairie Police Chief Rob Reynolds notes that officers from his force have described the TEMPO course as “one of the best and most important trainings they have attended.”  Edina Police Department’s Sgt. Kevin Rofidal (the 2009 training officer responsible for initially sending his personnel to a TEMPO course) reports that “salty” veteran officers are excited by training specific to their work settings.  After taking the course himself, Sgt. Rofidal made TEMPO the EMS training standard for officers in his department (Read more in This is Real World Stuff).

Edina Police Chief Jeff Long credits TEMPO’s real-life scenarios for “taking classes beyond that clean, pristine setting in which officers have been trained for so long.”  Meeker County Sheriff Jeff Norlin notes the value of TEMPO training for law enforcement officers in rural settings; “TEMPO training has a law enforcement twist, with outside dangers…When you’re working in a rural area, you’re tossed into the mix of a lot of different things, with help a long ways out.”  Meeker County Chief Deputy Brad Lindgren agrees, describing TEMPO training as “cutting-edge, top of the line training,” that is applicable in diverse settings. “Tourniquet training, for example, is valuable not only for officers wounded by gunfire, but also for trauma in farm accidents and MVC’s (motor vehicle collisions).”

Metro Transit Police officers also rate TEMPO training highly.  The department currently sends all officers to TEMPO First Responder refresher courses and will make the course required training in the future.  Sgt. Mario Ruberto, a former veteran HCMC EMS paramedic, reports that Metro Transit officers describe the TEMPO course as “straight up the best medical training that they’ve ever been to” and praises its benefits for officers working across the eight-county jurisdiction of the Metro Transit Police, which spans rural and urban areas.  “In Minneapolis and St. Paul we have major trauma centers within blocks of where we might go down.  But a wounded officer could be up in Sherburne County, far from a major trauma center, so learning effective use of tourniquets and chest seals is very valuable.”  Sgt. Ruberto says that participants have told him that “going through training that put them in scenarios under duress really solidified the training and impacted them as far as what they learned.  They felt competent in getting that tourniquet on for themselves or for a partner, and they knew what a chest seal was, how to apply it, and how important it is to get immediate care.”  (TEMPO training with the Metro Transit Police and the Roseville Police Department was recently featured in a TPT program, “Redesigning MN: Margin of Safety,” aired on August 17, 2012).

The Meeker County Sheriff’s Office has had extensive experience with TEMPO training and personnel.  Dr. Ho’s expertise is based on over 20 years as an HCMC emergency physician and over 7 years as a sworn Meeker County Sheriff’s Office deputy.  His dual credentials have enabled a unique collaboration between the two agencies.  The TEMPO team has conducted multiple trainings in Meeker County since 2008 and has developed tactical medical kits for the department (Photo 23).  TEMPO development has been richly informed by actual calls to which Dr./Deputy Ho and others have responded.  For instance, a recent Meeker County call requiring stabilization and helicopter evacuation of an MVC victim with multiple trauma provided the basis for a multi-agency training scenario conducted during a September 2012 two-day TEMPO course in Meeker County for the sheriff’s office (Photos 24a-e), including Jeff Norlin (Sheriff), Brad Lindgren (Chief Deputy), Mike Hirman (Former Sheriff), and 22 deputies. Collaboration following Dr. Ho’s response to a call from an autism educational facility resulted in a 2012 case report published in Prehospital Emergency Care and development of a TEMPO law enforcement autism awareness training module, which has been modified and utilized in trainings with diverse law enforcement groups across the state.

A medical direction agreement between the Meeker County Sheriff’s Office and HCMC yielded an award-winning research project and publication of a peer-reviewed clinical article on simulated “use of force” law enforcement encounters (see Police Chief, October 2012).  Both HCMC and Meeker County have found this medical direction partnership to be beneficial to the citizens of greater MN and are committed to continuing this going forward.

Members of the TEMPO team also lecture and train personnel through outreach education across Minnesota.  In February 2012, Dr. Ho trained Kanabec County public safety personnel on management of Excited Delirium Syndrome through the HCMC Trauma & Critical Care Speakers Bureau, which sends speakers to venues across Minnesota.  Rob Snyder has assisted with numerous trainings on tactical emergency medical techniques during hostile event response, from the Arrowhead EMS conference (January 2012) to instruction for students from Minneapolis, Willmar, and Hutchinson in the HCMC/Ridgewater College Paramedic Program (Photo 25).

To date, over 2200 men and women from more than 25 police, fire, and sheriff’s departments across Minnesota have participated in TEMPO EMS refresher courses and customized tactical emergency medicine courses, from Anoka, Brown, and Cass Counties to Polk, Ramsey and Washington Counties (see list below).  Customized courses have provided specialized training to park and transit police, hazmat teams, corrections officers, water and mounted patrol officers, National Guard members, and SWAT teams.

The TEMPO team is now fielding requests from out of state agencies as the popularity of the TEMPO training concept and curriculum is growing.  They are currently conducting TEMPO training for railroad police officers near Chicago, Illinois.  Word of the quality and popularity of TEMPO training has begun to spread, as LEOs from out of state have attended training, some from as far away as Texas. A goal of the TEMPO team is to grow the ability to teach these courses to all Minnesota LEO’s as well as LEO’s from other states.  According to Dr. Ho, “Educated and effective emergency medical care by LEO’s to citizens in need should not be a function of geographic boundary. HCMC is an internationally known leader in emergency medical care and I would like to see the TEMPO program contribute significantly to that reputation.”

Law enforcement officers are grateful for the unique instructor skill set and hands-on, law enforcement-specific TEMPO training format, which equip them to provide better emergency care to community members, to fellow officers, and to themselves when they are wounded.  Chief Long of the Edina Police Department commented that, “If you look at the data on police officers killed in the U.S., it’s not just in larger cities.  Many officers are killed in small towns and suburbs like Edina,” where officers remember the near-fatal shooting of Officer Mike Blood in 2000 at an attempted bank robbery.  TEMPO course evaluations document great appreciation by participants.  One Eden Prairie police officer wrote, “I know I can better serve the public and my partners with this training.”  Numerous participants called it the best EMS training they’d ever had, with one officer adding, “So thankful to have HCMC have my back.”

TEMPO participants have come from more than 25 departments in 10 Minnesota counties:

Anoka County: Ramsey Police Department

Brown County: New Ulm Police Department

Cass County: Walker Police Department

Crookston County: Sheriff’s Department

Dakota County: Hastings Police Department; Dakota County Sheriff’s Department

Hennepin County: Brooklyn Park Police Department; Deephaven Police Department; Eden Prairie Police Department; Edina Police Department; Golden Valley Police Department; Hennepin County Sheriff’s Department (Patrol Deputies, Water Patrol, Hennepin Crime Lab Deputies, and Special Operations Unit/WMD team); Minneapolis Police Department; Minnetonka Police Department; Minneapolis SWAT Team; Minnetrista Police Department; Rogers Police Department; Roseville Police Department; Three Rivers Park Police

Isanti County: Isanti Police Department

Meeker County: Meeker County Sheriff’s Office (patrol deputies, dispatchers, mounted patrol, reserves and corrections officers)

Ramsey County: Mounds View Police Department

Washington County: Cottage Grove Police Department; Woodbury Police Department

TEMPO trainings with multi-county, state and federal agencies

Multi-county: Metro Transit Police (8 Minnesota counties, 85 cities)

State agencies: Wisconsin: Pierce County and Pepin County Sheriff’s Departments; South Dakota: Vermillion Police Department; Texas: U.S. Marshall’s Office, Paint Rock, Texas

Federal agencies: TSA Air Marshals; U.S. Immigrations and Customs Enforcement (ICE)

Multiagency training in Scottsdale Arizona: (participating agencies) U.S. Military Police, Yuma AZ; Phoenix Police Department; Arizona Department of Public Safety; Scottsdale Arizona Police Department; Maricopa County Sheriff’s Department

 

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