Law Enforcement Medicine: This Specialty’s Time Has Come

Does law enforcement need its own medical specialty? Mass shootings, terrorist attacks and unprecedented shootings of police officers in 2016 strongly support the answer yes.

MARK CANNON, M.D.
Cardiac Anesthesiologist, Critical Care Medicine Specialist

Anesthesia Service Medical Group; Sharp Memorial Hospital; University of California, San Diego; Chula Vista Police Department

In the early 1990s, specific training and certifications were being finalized for a new medical specialty called emergency medicine. Prior to the development of this new specialty, most emergency room doctors — for the previous 30 years — lacked specific education and training in emergency care. Today board-certified emergency medicine physicians are experts in trauma, prehospital care and all forms of medical pathology. The mass shooting in San Bernardino in 2015, as well as several other incidents in the United States, have highlighted physicians’ involvement in law enforcement and the discussions for the development of a new medical specialty: a discipline structured to operate in an austere and often violent environment that includes tactical operations, teamwork, mission planning and expertise in prehospital care related to the dynamics of explosive, high-energy wounds and other critical injuries. These discussions refer to a new specialty termed “law enforcement medicine.”

The events in San Bernardino introduced the world to Dr. Michael Neeki and the bravery, professionalism and expertise of law enforcement medical providers. Dr. Neeki is a civilian volunteer for the Inland Empire SWAT team, a special operations group that serves multiple cities in the county of San Bernardino. He has been integrated into the operations of this team and serves as the team physician. Dr. Neeki was one of the earliest first responders to arrive on-scene at the San Bernardino shooting. Because of his tactical capabilities, he was able to operate at ground zero and provide needed medical care within minutes. Dr. Neeki has been interviewed by dozens of news sources, including CNN, the Los Angeles Times and People magazine. He has become the face of law enforcement medicine.

Unknown to most of the general public, physicians have been involved in law enforcement tactical operations for decades. There are a handful of physicians in the United States who are actual police officers or sheriff’s deputies and fully trained SWAT officers, and they can operate in every capacity of a SWAT team. In addition to these physicians, many agencies have incorporated paramedics into their special response teams. The Los Angeles County Sheriff’s Department Special Enforcement Bureau (SEB) and Huntington Beach Police Department have done this for years. Captain Jack Ewell, Deputy Steve Doucette and Firefighter/Paramedic Ray Casillas are some of the most recognized and respected names in the tactical medicine community. This close-knit community also includes many physicians. Dr. Lawrence Heiskell is considered one of the grandfathers of tactical emergency medical support (TEMS). He has been rallying for TEMS for almost 30 years and was the founder of the first tactical medicine school in California. Currently, Dr. Heiskell, along with a group of TEMS experts and members of the California TEMS Initiative Council (CALTIC) are refining the education curriculum and training of tactical medicine for the California Commission on Peace Officer Standards and Training (POST). The final product will be mandatory law enforcement medicine training for all California law enforcement officers.

It will never be known if law enforcement physicians could have altered the final death toll in the terrorist attacks in Nice, Brussels, Istanbul and other cities in 2016,  but these world events have clearly shown a need for physicians on-scene in the increasingly dangerous world of law enforcement. Is there an organized precedence for physicians being trained to work in violent and austere environments? The answer is yes. The world of military special operations medicine has existed for years. The Green Berets, Delta Force and SEALs all deploy with combat-trained, battle-ready physicians.

The development of a new civilian medical specialty is never an easy or timely task. The creation of law enforcement medicine would necessitate an unprecedented partnership. If the specialty medical boards are to develop law enforcement medicine, they will be bound to partner outside of organized medicine to facilitate the education, training and expertise involved in tactical medicine. A collaborative effort between medicine and law enforcement would result in a physician prepared to function in a dynamic mass casualties incident. Only a new breed of physician would be interested in the physical challenges and rigors of law enforcement medicine, and law enforcement would have to realign their methods and traditions to accommodate physicians into the required education and training of tactical operations. While this group would not fit easily into the current field training of police cadets, the creation of law enforcement medicine is a must, and collaboration needs to drive this partnership. The result will be tactical operations with better medical care for today’s chaotic and brutally violent environment.

Several current medical specialties already provide the skill set to function in a tactical environment. Anesthesiology, emergency medicine and general surgery are disciplines that incorporate the knowledge, training and skills that law enforcement medicine would require. Physicians in these specialties are experts in acute traumatic evaluation and diagnosis, resuscitation and life-saving procedures. They routinely function as team leaders, directing health care team members in the management of a critically injured patient. Law enforcement medicine physicians would lead the paramedics and emergency medical technicians (EMTs) currently involved in the medical side of law enforcement and further build upon the team model. Conceivably, these medical teams would train together clinically in hospital settings, as well as in tactical special operations to assure their abilities to work at ground zero with enforcement teams seamlessly operating around them. The presence of the direct supervision of a law enforcement physician could allow the tactical paramedics and EMT to function at an unprecedented level, similar to a military special operations medic, all while safely functioning side by side with special operations law enforcement officers. The continuing work of the Physicians Section of the International Chiefs of Police (IACP) and the support of medical providers like the Hartford Group give further credibility to the creation of law enforcement medicine.

Developing the momentum to create a new medical specialty designed for law enforcement seems like a minimal effort when considering the volume of civilians killed and injured by groups like ISIS and the increase in ambush attacks on officers. Physicians do not typically seek to mix medicine and law enforcement, but the current involvement of physicians in tactical medicine leads to the belief that interest in the new medical specialty would grow quickly on the news of its development. The Department of Homeland Security and the State of California are often considered leaders in the advancement of law enforcement. Both are currently pursuing tactical medicine as an integral part of law enforcement training and operations. It makes sense that the Accreditation Council for Graduate Medical Education (ACGME) be invited to join in the advancement of tactical medicine to a new specialty. The existence of three current medical specialties with the needed skill sets makes this task seem inevitable.

In December 2015, a terrorist attack in Paris resulted in 130 people killed and over 300 injured. The tally in the March 2016 attack in Brussels was 34 killed and over 250 injured. Bastille Day, Nice: 86 people killed and 434 injured. June 2016: 49 people killed and 53 injured in the Orlando Pulse Nightclub shooting. And as of mid-December 2016, 64 U.S. law enforcement officers had been shot and killed in the line of duty. Would the outcomes of these events be different with the existence of a law enforcement physician and tactical medical team? The need for law enforcement medicine seems apparent.

About the Author

Dr. Cannon is a cardiac anesthesiologist with an additional board certification in critical care medicine. He is an adjunct associate professor at the University of California, San Diego (UCSD), director of Cardiothoracic Education and Training for UCSD anesthesiology fellows and U.S. Navy residents, and teaches incident response courses for the Department of Homeland Security. Dr. Cannon also serves as a Level I reserve police officer in Chula Vista, is a graduate of the L.A. County Sheriff’s Special Enforcement Bureau SWAT Academy and spent four years assigned to the Chula Vista SWAT team. In 2012, Dr. Cannon was honored for saving the life of a San Diego County deputy sheriff who had been shot and critically injured in the line of duty.