An Open Letter from ACEP’s Tactical and Law Enforcement Medicine Section

I watched the traffic stop video of Tyre Nichols with an all-too-familiar mix of revulsion, sadness, and anger. Officers beat him brutally and once he is in custody, fail to render aid. Other recent cases, such as the deaths of Earl Moore, Jr., belittled by medics before being restrained prone on the stretcher, and of George Floyd suffocated under the knee of Derek Chauvin while other officers stood by, are examples of particularly callous disregard for the rights, health and safety of citizens during police contact. In-custody deaths sow division between our police and the citizens they are sworn to serve and protect.

These examples and similar cases expose a fundamental lack of recognition of medical emergencies and the need for acute interventions to alleviate risks of preventable injury and death. We must put a stop to the egregious failures we continue to see on the news. As emergency physicians and the clinical conscience of prehospital medicine, we have a responsibility to help make that happen. Though I sincerely doubt anything would have changed the outcome from the protracted and deliberate attack on and withholding of care from Mr. Nichols, our advocacy now could prevent future similar deaths.

Medical oversight of EMS is part of the core curriculum of emergency medicine. The recognition of EMS Medicine as a subspecialty of emergency medicine shows clearly that prehospital care standards are directly created by our expertise. This promotes best practices and evidence-based care for the millions of patients treated each year by EMS, while creating ongoing quality assurance and improvement.

According to the United States Department of Justice, every year close to a quarter of the U.S. population have contact with the police. Initiated by citizens, police officers, or some other factor, these interactions revolve around criminal activity, traffic accidents, calls for law enforcement aid, and medical emergencies, among a myriad of other societal incidents. While most law enforcement officers are trained in basic first aid, CPR, and AED use, many lack a more formalized medical skill-set to recognize and address significant illness or injury.

Though many private and government agencies offer tactical medical training (designed to optimize treatment in the austere environment) there is no broad consensus on what that training best entails. To summarize: despite often being the first point of patient contact in medical and high-threat emergencies such as overdoses, shootings, domestic violence, and mass casualty events, law enforcement officers have limited medical training, often with little to no medical oversight.