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PubMedDate not supplied

Triage decisions of United Kingdom police firearms officers using a multiple-casualty scenario paper exercise.

INTRODUCTION: British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials. METHODS: Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials. Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored. RESULTS: The use of triage decision-making materials resulted in a significant increase in correct responses (p < 0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p < 0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better. CONCLUSION: It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.

Clinical Competence↗
PubMed2000

Alcohol sales to underage adolescents: an unobtrusive observational field study and evaluation of a police intervention.

AIMS: The aims of this study were to assess the ease with which adolescents in the United Kingdom are able to buy alcohol, to obtain information concerning vendors' perceptions of alcohol sales to adolescents, and to evaluate a police intervention intended to reduce underage alcohol sales. DESIGN, SETTING, SUBJECTS: An unobtrusive naturalistic field study was conducted in two urban locations. Pairs of 13- and 16-year-old boys and girls were trained to attempt the purchase of different types of alcohol (alcopops, beer, cider, wine, spirits) from four different types of retail outlets (corner shops, off-licence, public houses and supermarkets), under the supervision of a researcher and typically a parent. The assessment was repeated, with the omission of the 13-year-old boys, following a police intervention in one of the performance sites, consisting of warning letters and visits to vendors, and the issue of a small number of police cautions. A total of 62 underage confederates in all attempted 470 test purchases in phase 1 and 348 in phase 2. Between the two waves of test purchases a sample (n = 95) of the same vendors was surveyed by telephone. FINDINGS: In phase 1, sales resulted from 88.1% of purchase attempts by 16-year-old girls, 77% of attempts by 16-year-old boys, 41.6% of 13-year-old girls and 4.1% of 13-year-old boys. These figures were generally comparable across locations, alcohol types and outlet types. Refusals were more likely when another vendor was present. Eighty per cent of sales to 16-year-olds and 65% of sales to 13-year-old girls were made without challenge. "Prove-It" ID cards were requested in fewer than 12% of purchase attempts in both age groups. Overall, there was no evidence that the police intervention reduced sales of alcohol to 16-year-olds. There was a hint that the intervention may have caused a very short-lasting decrease in sales to 13-year-old girls, but this was contained within an overall increase in sales to this group. Alcohol vendors reported that they rarely encountered underage customers or refused sale though 90% of vendors said that if they became suspicious, they would request ID. Only two vendors believed that they were likely to suffer adverse consequences if they sold alcohol to minors. CONCLUSIONS: These data suggest that 16-year-olds, and girls as young as 13, have little difficulty in purchasing alcohol, and that there is little difference between different types of outlets in their willingness to sell alcohol to minors. Vendors perceive little risk in selling alcohol to adolescents. The fact that the police intervention failed to decrease sales suggests that vendors do not change their behaviour in response to the threat of legal action.

Adolescent↗
PubMed2001

Police attitudes toward people with intellectual disability: an evaluation of awareness training.

It is argued that more favourable police attitudes to people with intellectual disability (ID) are essential in meeting the police code of ethics, which stresses impartiality and respect for human dignity. The need to acknowledge and investigate the extent of support for eugenic attitudes in other key professionals who have a significant role in the successful inclusion of people with ID in community settings is discussed. The present paper reports on the evaluation of an awareness training event conducted by the Royal Ulster Constabulary in terms of the impact on attitudes towards people with ID held by police officers. The quasi-experimental design involved the measurement of participants' attitudes prior to and following awareness training, and the comparison of these data with a control group of participants who did not undertake awareness exercises. The Attitudes toward Mental Retardation and Eugenics (AMRE) scale was the instrument used to measure attitudes. Analysis identified the presence of varying degrees of support for the application of eugenic principles to people with ID. Furthermore, the results indicate that participation in the awareness exercise and subsequent discussions is associated with a significant reduction in support for eugenic-based attitudes towards people with ID by the police officers involved. Investment in training events which target attitudes towards people with ID can bring about a shift in reported attitudes. The importance of evaluating such awareness-raising exercises and their impact on police behaviour is highlighted.

Adult↗
PubMed1994

Police referrals to a psychiatric hospital: indicators for referral and psychiatric outcome.

Studies of police psychiatric referrals in the USA and the UK generally show these patients to be ill and in need of care. There are, however, no published Australian studies and such findings may not be validly generalised. This prospective study of consecutive police psychiatric referrals in Adelaide reports psychiatric assessment in 92 cases and observations by police in 69 of these, with no evidence of selection bias. The most common reason for referral was threat of self harm (28%). Mental illness was deemed to be present in 49% and the most common clinical description was "situational crisis" (29%). Schizophrenia was diagnosed in 18%. Clinicians viewed 19% of referrals as inappropriate. Increased relative odds for mental illness were associated with police accounts of psychotic symptoms, and decreased odds with threat of self harm and violence. Increased odds for admission were associated with language difficulties and damage to own property, decreased odds with threat to others, threat of suicide, and threat to self injury. There were 14 cases where possible charges were not being pursued: of these 7 were regarded as ill and 4 were regarded as inappropriate referrals. The rates of major disorders are lower than in other published work. It is proposed that this can be explained by relative ease of referral by police to psychiatry and flexible acceptance criteria.

Adult↗
PubMed2002

Organizational communication and the symbolic construction of police murder investigations.

This paper draws upon a range of empirical data to consider the ways in which police murder investigations are symbolically constructed, both within and outside of the police organization. It is argued that a range of communicative formats serve to produce the activities associated with police murder investigations in a way that serves to legitimate the police function to both members of the public and police officers alike. A particular emphasis is placed upon understanding the connections between informal and formal communications, and the instrumental and expressive objectives that variously underpin them.

Communication↗
PubMedDate not supplied

Future police operations and non-lethal weapons.

Society has entrusted the police with power and obligation to enforce law, maintain order and protect its members and the legal order of society. To be able to fulfil these obligations the police need credible means of countering threats against these values. Selecting the weapons, or rather use of force instruments, presents a multifaceted problem of balancing human considerations, judicial and societal requirements with tactical needs and technological possibilities. No matter what the incident is, a police-officer is expected to protect the innocent, him/herself, colleagues and the object persons and to cause no more harm than is justifiable and unavoidable. Unfortunately there is no safe use of force and in real life the only option available for resolving certain conflicts is some degree of force. Any weapon can be misused but most weapons have a legitimate use. Denying legitimate use, as well as allowing uncontrolled use, may lead to unnecessary suffering and loss of life. Technology is offering interesting alternative possibilities to the police and these must be considered with open eyes, bearing in mind that misuse, like torture, is not a property inherent to technology but an intentional behaviour of some people. Thorough research and fair and credible controls on police weaponry are needed to avert the possibility of misuse and to maintain trust.

Conflict, Psychological↗
PubMed1996

New York City police officers incidence of transcutaneous exposures.

Urban based police officers may be at high risk for the transmission of infectious disease. This study was undertaken to assess the incidence of needlestick and human bites to police officers based in an urban environment. A retrospective analysis of self-reported transcutaneous exposures and demographic information of police officers in the New York City Police Department (NYCPD) for 1992-93 was performed. Urine toxicology results of arrested individuals for 1990-91 was also analyzed. The transcutaneous exposure rate of NYCPD was 38.7 per 10,000. No differences occurred between males and females although officers between 20-29 years old had the highest incidence. The highest exposure rate occurred between 4-10 years of service. Greater than 60% of arrested individuals tested positive for potentially injectable drugs. Urban based police officers continue to have transcutaneous exposure incidents during their career. Widespread vaccination and continued education on universal precautions should be considered for all officers.

Adult↗
PubMed2004

Ill-health retirement: a survey of decision making by occupational physicians working for local authority fire and police services.

AIMS: To investigate the effect of qualifications, experience and service on ill-health retirement decisions made by police force and fire brigade medical advisers. METHODS: Doctors advising UK fire and police authorities attending a conference were given 16 case summaries from experienced fire and police advisers and asked to predict the outcome in terms of return to work or ill-health retirement. The answers were scored by assessing whether the outcome predicted by the participant agreed with the case setter. Correlation coefficients were calculated and a kappa coefficient was determined for assessing inter-participant variation. RESULTS: Forty-seven doctors attended, 44 participated and the responses of 39 (86%) were analysed. Over half the doctors participating had held their post for less than 5 years. The majority (>50%) agreed with the case setter in 11 case summaries and in five cases the agreement was strong (>75%). The majority disagreed in five cases, with < or =80% dissenting in three cases. There was wide variation in the inter-participant variation (kappa = -0.333 to +0.5) but the total agreed score correlated significantly (P < 0.05) with experience and service as a fire or police adviser (kappa = 0.33) and ill-health retirement agreement correlated significantly with experience (kappa = 0.49). There was no correlation between the level of qualification and total correct decisions. CONCLUSIONS: Whilst we found general agreement overall, our results suggest that there is inconsistency in ill-health retirement decision making by police and fire service medical advisers in certain cases. Experience appears to improve the likelihood of agreement in decision making.

Adult↗
PubMed1999

The role of the police power in 21st century public health.

The police power is the right of the state to take coercive action against individuals for the benefit of society. The companion article by Potterat et al., "Invoking, monitoring, and relinquishing a public health power: the health hold order," is a classic use of the police power in the control of a communicable disease, yet one that is increasingly controversial. Reaching an acceptable balance between the rights of society and those of individuals is the central issue facing public health in the next millennium, and the police power is at the center of this balance. This article reviews the constitutional basis of the police power, its historical use in public health, and the structural reasons why health departments preoccupied with personal health care cannot effectively use the police power to carry out public health enforcement.

Civil Rights↗
PubMed2004

Recurrent ventricular fibrillation in out-of-hospital cardiac arrest after defibrillation by police and firefighters: implications for automated external defibrillator users.

OBJECTIVE: To determine the prevalence and frequency of recurrent ventricular fibrillation (VF) in patients defibrillated by police and firefighters only and to determine its relation to survival. DESIGN: Retrospective observational study. SETTING: Out of hospital. PATIENTS: Individuals with witnessed VF arrest in the Rochester, MN, ambulance public service area who had defibrillatory shocks delivered by police and firefighters and return of spontaneous circulation with shocks only. MEASUREMENTS AND MAIN RESULTS: Electrocardiograms were recovered from data cards in automated external defibrillators used by police (n = 49) or firefighters (n = 18) to deliver shocks from December 1996 through December 2003 in the Rochester, MN, ambulance public service area. Patients with witnessed VF arrest were identified for recurrent VF after initial shock success (first one to three shocks). Both police and firefighters deployed automated external defibrillators delivering nonescalating 150-J biphasic truncated exponential waveform shocks (ForeRunner Automated External Defibrillator, Phillips/Heartstream Operation, Seattle, WA). Among 67 patients, 30 (45%) survived to neurologically intact discharge (overall performance category score of 1 in 29 patients and score of 2 in one patient). Twenty-nine patients (43%) regained spontaneous circulation with shocks only and 25 of 29 (86%) survived. VF recurred in 35 of the 67 patients (52%) while being cared for by police or firefighters. Of these 35 patients, no relation was found between the prevalence or frequency of VF recurrence and survival. CONCLUSIONS: VF recurrence is frequent, variable in time of onset, and unrelated to the performance of bystander CPR. The prevalence and frequency of VF recurrence were unpredictable and do not adversely affect survival. Thus, vigilance for recurrent VF is essential to ensure the survival of patients who are in the care of first responders, even after initial restoration of pulses with shocks.

Cardiopulmonary Resuscitation↗
PubMed1999

Globalization and the policing of protest: the case of APEC 1997.

The policing of protest at international events conflicts with the political and policing culture of the host nation. Previous research shows a trend toward softer, more tolerant styles of policing protest within various Western democracies. We present a case study of an exception: the repression of protest at an international event in which one Western democracy hosted rulers of less democratic regimes in a ritual celebration of economic globalization. We explore reasons why, in the face of protests about undemocratic regimes elsewhere, the Canadian government and police were willing to use blatantly undemocratic tactics popularly believed to be more characteristic of those other regimes. Implications are discussed concerning protest policing, economic globalization, the nation-state and social movements.

Humans↗
PubMed2006

Ethnicity and culture: thinking about 'police ethnicity'.

Research about the development of ethnic identifications within contexts of employment has been neglected, not least by proponents of 'new ethnicities'. Drawing on evidence from a two year study of Black Police Associations in the constabularies of England and Wales, this paper is concerned with the construction and sustaining of a particular notion of ethnicity, related to police employment. Black Police Association members have claimed a distinct experience of police employment related directly to their being 'black' and, therefore, an essentialism forming a boundary marking them off from white officers. 'Police ethnicity', however, is a strategic notion that is somewhat fragile and exclusive. The consequences of BPA definitions of being a black officer are explored. The paper ends with a consideration of the wider, intellectual consequences of researching ethnicity within employment.

Attitude↗
PubMed2006

Tackling alcohol related violence in city centres: effect of emergency medicine and police intervention.

OBJECTIVES: To identify correlates of alcohol related assault injury in the city centre of a European capital city, with particular reference to emergency department (ED) and police interventions, and number and capacity of licensed premises. METHODS: Assaults resulting in ED treatment were studied using a longitudinal controlled intervention, a three stage design during a three year period of rapid expansion in the night-time economy, when ED initiated targeted police interventions were delivered. A controlled ED intervention targeted at high risk night-clubs was carried out. Main outcome measure was ED treatment after assault in licensed premises and the street. RESULTS: Targeted police intervention was associated with substantial reductions in assaults in licensed premises but unexpected increases in street assault were also observed (34% overall: 105% in the principal entertainment thoroughfare). Combined police/ED intervention was associated with a significantly greater reduction compared with police intervention alone (OR = 0.61, 95% CI 0.40 to 0.91). Street assault correlated significantly with numbers and capacity of premises. Risk of assault was 50% greater in and around licensed premises in the city centre compared with those in the suburbs, although dispersion of violence to more licensed premises was not observed. CONCLUSIONS: Marked decreases in licensed premises assaults resulting from targeted policing were enhanced by the intervention of ED and maxillofacial consultants. Capacity of licensed premises was a major predictor of assaults in the city centre street in which they are clustered. City centre assault injury prevention can be achieved through police/ED interventions targeted at high risk licensed premises, which should also target the streets around which these premises are clustered.

Alcohol Drinking↗
PubMed2002

Association of seat belt use with death: a comparison of estimates based on data from police and estimates based on data from trained crash investigators.

OBJECTIVE: Estimates of any protective effect of seat belts could be exaggerated if some crash survivors falsely claimed to police that they were belted in order to avoid a fine. The aim of this study was to determine whether estimates of seat belt effectiveness differed when based on belt use as recorded by the police and belt use determined by trained crash investigators. DESIGN: Matched cohort study. SETTING: United States. SUBJECTS: Adult driver-passenger pairs in the same vehicle with at least one death (n=1689) sampled from crashes during 1988-2000; data from the National Accident Sampling System Crashworthiness Data System. MAIN OUTCOME MEASURE: Risk ratio for death among belted occupants compared with those not belted. RESULTS: Trained investigators determined post-crash seat belt use by vehicle inspections for 92% of the occupants, confidential interviews with survivors for 5%, and medical or autopsy reports for 3%. Using this information, the adjusted risk ratio for belted persons was 0.36 (95% confidence interval 0.29 to 0.46). The risk ratio was also 0.36 using police reported belt use for the same crashes. CONCLUSIONS: Estimates of seat belt effects based upon police data were not substantially different from estimates which used data obtained by trained crash investigators who were not police officers. These results were from vehicles in which at least one front seat occupant died; these findings may not apply to estimates which use data from crashes without a death.

Accidents, Traffic↗
PubMed2002

The police and mental health.

With deinstitutionalization and the influx into the community of persons with severe mental illness, the police have become frontline professionals who manage these persons when they are in crisis. This article examines and comments on the issues raised by this phenomenon as it affects both the law enforcement and mental health systems. Two common-law principles provide the rationale for the police to take responsibility for persons with mental illness: their power and authority to protect the safety and welfare of the community, and their parens patriae obligations to protect individuals with disabilities. The police often fulfill the role of gatekeeper in deciding whether a person with mental illness who has come to their attention should enter the mental health system or the criminal justice system. Criminalization may result if this role is not performed appropriately. The authors describe a variety of mobile crisis teams composed of police, mental health professionals, or both. The need for police officers to have training in recognizing mental illness and knowing how to access mental health resources is emphasized. Collaboration between the law enforcement and mental health systems is crucial, and the very different areas of expertise of each should be recognized and should not be confused.

Commitment of Persons with Psychiatric Disorders↗
PubMed2006

Rates of unemployment and incidence of police-initiated examinations for involuntary hospitalization in Florida.

OBJECTIVE: This study tested the hypothesis that contraction of regional economies affects the incidence of involuntary admissions to psychiatric emergency services by reducing community tolerance for persons perceived as threatening to others. METHODS: This hypothesis was tested with time-series analyses of the relationship between initial claims for unemployment in Florida between July 4, 1999, and June 28, 2003, and the weekly number of men and women presented by police to be examined for involuntary psychiatric hospitalization because of danger to others. The analyses controlled for admissions presented by mental health professionals because of danger to others and for admissions presented by police because of neglect or disability. RESULTS: When the analyses controlled for autocorrelation and other covariates, claims for unemployment insurance were significantly associated with the number of men presented by police for danger to others. During the study period, police presented 5,897 men for examination because of danger to others. Increased unemployment claims were associated with approximately 309 more men being presented for examination than expected from prior presentation rates and from the number presented by mental health professionals for danger to others and by police for neglect or disability. No such association was found for women. CONCLUSIONS: Consistent with theory, this study found that presentations for involuntary admission to psychiatric services increased after contractions in the labor market. Combining the methods of this study with econometric forecasting may allow providers to anticipate better the need for psychiatric services.

Adult↗
PubMed2006

Severity of intimate partner violence and occurrence and frequency of police calls.

This article evaluates whether female victims of severe physical, psychological, or sexual intimate partner violence (IPV) call police more often than other abused women. Abused women (431) reported frequency of contacting police (dependent variable), nature and severity of IPV experienced, and characteristics of themselves and their perpetrator (explanatory variables). A two-part regression model estimated likelihood of police contact among all participants and rate of contact among callers. Women with severe physical or psychological IPV or injury were more likely to call police than were other abused women. Among callers, women made 96% more calls if a weapon was involved, 58% more if they were severely sexually abused, and 40% more if they were severely physically abused. Women with children at home made 32% more calls. These results delineate the level and types of IPV and other characteristics of homes that make single and repeat calls to police.

Adult↗
PubMed2005

Police involvement in child protective services investigations: literature review and secondary data analysis.

This article examines the relationship of police and child protective services (CPS) coinvolvement to the outcomes of child maltreatment investigations. It reviews practice and empirical literature and conducts a secondary analysis of a national CPS data set. Most sources argue that coordination of the two agencies improves investigations and benefits children and families. Yet, sources also report friction between these agencies, interference with each other's job, and concerns that police involvement increases child removal. In the CPS case data, allegations were more likely to be judged credible when police also investigated and families were also more likely to receive various services. For neglect cases, multi-disciplinary decision making, but not police involvement per se, was linked to child removal. Across studies, police do not appear to hinder CPS effectiveness and may actually promote it. Their investigations should be coordinated in every community.

Child↗