References
A tactical analgesic option for Durham and Cleveland police firearms medics: the journey
Abstract
Background:
With an ever-increasing exposure to clinical situations, predominantly trauma, firearms medics at Durham and Cleveland police forces began to consider whether an increase in their scope of practice was needed; specifically, whether they could add analgesia administration to their clinical protocols.
Considerations:
The request was directed to the Tactical Medical Advisory Group (TMAG). This faculty comprises a clinical lead, emergency medicine doctors, military and civilian paramedics and tactical team medic (TTM) trainers. Analgesia in general was discussed, then potential analgesic agents were considered. The faculty agreed that the analgesic agent would have: to be available to all tactical team medics at all times, so should be highly portable); a minimal regulatory and training burden; a rapid effect with minimal side effects; and no conflict with prehospital medicine practice.
Implementation:
A 6-hour training course in methoxyflurane (Penthrox®) with summative assessments was designed and delivered by TMAG to all TTMs over a 4-week period. The chair of the TMAG agreed to be the signatory for the prescription-only medicine document and a standard operating procedure was drawn up. Sufficient stocks of methoxyflurane were then purchased and distributed across both police forces' armed response units, together with updated patient report forms, administration documents and feedback forms completed by TTMs after incidents.
During a strategic threat-and-risk assessment carried out by Durham and Cleveland police forces in 2008, the need was identified to provide immediate trauma care for authorised firearms officers (AFOs) and casualties in a ‘non-permissive’ environment; this is where support from healthcare providers cannot be provided for tactical reasons).
Cleveland and Durham Police Tactical Training Centre began providing specialised, trauma-based first aid training for AFOs. There was no agreed national standard for such a programme, which was termed the tactical team medic (TTM) course. This training followed established military doctrine by prioritising the assessment and treatment of catastrophic haemorrhage using military paradigms taken from recent conflicts and was more extensive than the Health & Safety Executive (HSE) emergency first aid at work training used in the police.
In parallel, the National Police Improvement Agency, in consultation with the Royal College of Surgeons (RCS) in Edinburgh's faculty of prehospital care, began to develop a first aid curriculum related to the firearms role and driven by trauma management, which would meet the needs of all firearms roles and operations. All AFOs in Cleveland and Durham constabulary attend the course to gain the TTM qualification.
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