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Police deaths in New York and London during the twentieth century.

OBJECTIVES: To describe the incidences and causes of occupational police deaths in New York City in the United States and Greater London in the United Kingdom during the twentieth century. To assess the relation between overall societal violence and violence directed toward police officers in these metropolitan areas. DESIGN AND SETTING: Ecological study of New York and London from 1900 through 1999. MAIN OUTCOME MEASURES: Intentional and unintentional occupational police mortality rates for New York and London were estimated for each decade. The general population homicide rates of both New York and London were assessed for their correlation with their respective intentional occupational police mortality rates. RESULTS: During the 20th century, 585 police officers in New York and 160 police officers in London died while participating in law enforcement activities. New York had markedly greater intentional police mortality rates compared to London throughout most of the 20th century, but these differences decreased significantly by the end of the century. Intentional gunshot wounds comprised 290 police deaths in New York, but only 14 police deaths in London. In New York, gun shot wounds (both intentional and unintentional) accounted for more occupational police deaths (51.6%) than did all other injury mechanisms combined. In London, motor vehicle collision was the most common cause (47.5%) of occupational police death. There were no apparent correlations between the general population homicide rates and intentional police mortality rates in either New York (r(2) = 0.05, 95% CI -0.77 to 0.81) or London (r(2) = 0.34, 95% CI -0.61 to 0.89). CONCLUSIONS: During the 20th century, both intentional and unintentional occupational police mortality rates were significantly greater in New York compared to London. These differences are likely from several socioeconomic, cultural, and occupational factors. The declines in police deaths in New York during the latter part of the 20th century indicate that at least some measures taken by the New York Police Department have been successful at significantly reducing the incidence of both intentional and unintentional police deaths.

Accidents, Occupational↗

The impact of routine traffic encounters that include procedural justice on police perceptions.

OBJECTIVES: Despite procedural justice in police-citizen interactions being widely studied, there is limited research regarding police perceptions of these interactions. This study addresses this by exploring police perceptions of two different types of random breath test (RBT) - standard and procedurally just - in an experimental trial. Officers were asked to report on whether they believe that their RBT interaction with drivers and riders changed behaviour, developed more positive perceptions of police and resulted in slower travel. Additionally, they were asked if they thought that the RBT interaction took too long. METHODS: This study was a six month randomised control trial with two operational conditions: a control condition with a standard (n = 18 days) and an experimental condition with a procedurally just (n = 17 days) RBT. Police officers completed post-operation surveys (n = 80). RESULTS: Police officers incorporating the principles of procedural justice into RBT had limited impact on officer perceptions. However, those officers who were more open to innovation believed that the interaction would result in more positive perceptions of police. Police officers who believed that their RBTs with motorcycle riders would make a difference perceived that the riders would both change their behaviour and travel more slowly after the interaction. There were no differences in perceived interaction length by police officers across both conditions. CONCLUSIONS: This study has shown that police officer openness to innovation has an important role to play in police officers having more positive perceptions regarding the outcomes of RBT interactions. As such police organisations should undertake activities, such as training, to improve innovation. The lack of perceived differences in RBT length between standard and procedurally just interactions suggests that these enhanced interactions can be implemented without concerns that police officers believe that they 'take too long'.

Humans↗

Adult victims of sexual assault: acute medical response and police reporting among women consulting a center for victims of sexual assault.

BACKGROUND: The medical response to adult sexual assault should comprise: the collection of forensic evidence, the treatment of injuries, and follow-up counselling. In the past, victims of sexual assault reporting directly to the police may not have received this total medical care. The Copenhagen Center for Victims of Sexual Assault at Rigshospitalet, Denmark offers a 24-h service. Medical treatment and psychosocial follow up is offered independent of police reporting. The aim of this study was to assess whether adult sexual assault victims who reported to the police differed from those who did not report to the police. METHODS: Using clinical records, sociodemographics, characteristics of the assault, and type of preventive medical treatment received were obtained for 156 consecutive women consulting the Copenhagen Center (March 1st to December 31st 2000). Comparisons between characteristics of victims who reported to the police or not were determined. RESULTS: Ninety-four (60.2%) of the women reported to the police. Women who sought services within 24 h of the assault, had experienced use of force, were subjected to assault outdoors, and among whom nongenital injuries were observed were more likely to report to the police (p < 0.05). However, in the multivariate model these associations fell below significance, and only the type of perpetrator remained significantly related to police reporting. The adjusted odds ratio for police reporting when the perpetrator was a friend was 0.4 (95% CI 0.17-0.94). There was no statistical difference between the victims who did or did not report to the police to request prophylactic antibiotics or emergency contraception. CONCLUSION: Observed injuries and requests for prophylactic antibiotics or emergency contraception were not influenced by whether the woman did or did not report directly to the police. Hence the need for medical treatment appears to be similar in the two groups, and available specialized care for victims of sexual assault should not be restricted to those who immediately report to the police.

Adolescent↗

Homeless people's trust and interactions with police and paramedics.

Although the health impact of patients' trust in physicians has been well documented, less is known about the possible health effects of trust in police or paramedics. Homeless people frequently interact with police officers and paramedics, and these experiences may affect their health and future willingness to seek emergency assistance. We examined homeless people's self-reported interactions with police and paramedics in Toronto, Canada, and their level of trust in these emergency service providers. In a sample of 160 shelter users, 61% had interacted with police in the last 12 months, and 37% had interacted with paramedics (P = .0001). The proportion of subjects who expressed willingness to call police in an emergency was significantly lower than those willing to call paramedics in an emergency (69% vs. 92%, P = .0001). On a Likert scale ranging from a minimum of 0 to a maximum of 5, trust levels were lower in police than in paramedics (median level 3 vs. 5, P = .0001). Among shelter users, 9% (95% confidence interval [CI], 5% to 14%) reported an assault by a police officer in the last year, and 0% (95% CI, 0% to 4%) reported an assault by a paramedic. These findings showed that homeless people have much lower levels of trust in police than paramedics. Reports of negative interactions with police are not uncommon, and homeless people's perceptions of the police may pose a barrier to seeking emergency assistance. Further research is needed for objective characterization of homeless people's interactions with police officers and the potential health implications of low levels of trust in the police.

Adult↗

Section 136, The Mental Health Act 1983; levels of knowledge among accident and emergency doctors, senior nurses, and police constables.

OBJECTIVES: Section 136 of the Mental Health Act 1983 empowers the police to detain those suspected of being mentally ill in public places, and convey them to a place of safety. In practice, accident and emergency (A&E) departments are often used. The authors assessed levels of knowledge of section 136 between A&E doctors, senior nurses, and police constables. METHODS: Doctors and senior nurses in all (A&E) departments in the Yorkshire region were asked to complete a multiple choice tick box type questionnaire, as were police constables from the Humberside Police Force. RESULTS: 179 completed questionnaires were returned, of which 16 were completed by consultants, 14 by SpRs, 24 by SHOs, 33 by senior nurses, and 92 by police officers. Some 24.1% of A&E staff and 10.9% of police failed to recognise that a person has to appear to be suffering from a mental disorder to be placed on a section 136; 40.2% of police did not know that section 136 is a police power; 55.2% of A&E staff and 14.1% of police incorrectly thought that a person could be placed on a section 136 in their own home; 43.75% of consultants and 50% of SpRs did not consider A&E departments to be a place of safety; 49.4% of A&E staff and 29.3% of police thought that patients could be transferred on a section 136. Only 10.3% of A&E staff and 22.8% of police had received any formal training. CONCLUSIONS: The knowledge among A&E staff and the police of this difficult and complex piece of mental health legislation is poor and requires action through formal education and training. This study not only reflects the levels of knowledge within the groups, it may also reflect the different perceptions of each group as to their role and duties within section 136 of the Mental Health Act 1983.

Emergency Service, Hospital↗

Recording of community violence by medical and police services.

OBJECTIVES: To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police. METHODS: Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located. RESULTS: Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0). CONCLUSIONS: Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0-10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection.

Adolescent↗

Assault cases in Maiduguri metropolis: A comparative study of police and accident and emergency units' records.

BACKGROUND: Information on the incidence of assault cases such as armed robbery, fights and house burglaries in most Nigerian cities are usually based on data collected from police records with little or no attempt to tap medical sources of information. OBJECTIVE: The aim of this study was therefore to compare the rate of recording of assault cases in the Maiduguri metropolitan area by the police at the Maiduguri central police station and the Accident and Emergency unit (A and E) of the University of Maiduguri Teaching Hospital. Possible reasons why assault victims report or do not report to the police before seeking for treatment was also investigated. METHOD: All victims of assault who attended the A and E unit of the hospital over a one year period (2002-2003) were interviewed and relevant data collected in a prepared form. Findings were compared with the record of assault cases within the same period at the Maiduguri central police station. RESULT: 185 patients presented at A and E with body injuries due to assault during period of study. 108 (58%) informed the police before attending hospital, out of which majority (38.9%) claimed an 'instinctive reaction to do so' as the reason for informing the police. A significant proportion (61%) of those that did not inform the police claimed that the feeling that 'nothing will come out of it' as the reason. Only 41% of cases reported to the police were recorded. There was a tendency by the police to record cases where gun was used or the victim was a female. CONCLUSION: The true picture of violence in most Nigerian cities can better be assessed by collecting data from both the relevant A and E department as well as from the police. The need for the populace to develop confidence and trust in the police cannot be overemphasised.

Accidents↗

Occupational medicine for policing.

A wide variety of medical conditions may be associated with police work. Unlike other occupations where a specific link can be traced between an exposure or an action and a specific pathology, the link between police work and disease is more problematic. The medical conditions which seem to be associated with police work are all conditions for which numerous other risk factors are identifiable. These risk factors include physical inactivity, poor nutritional practices, cigarette smoking and alcohol overuse. While it is undoubtedly desirable to minimise these risk factors in any patient population it is imperative, given the increased risks among police personnel, that aggressive attempts he undertaken to reduce cumulative risks. The physician plays an important part in this process by screening for specific conditions associated with police work, by educating the police officer about increased risks and by encouraging lifestyle choices that will reduce risk. It is also important that the physician encourages the use of personal protective equipment where appropriate. Periodic health assessment of police officers by a physician knowledgeable about police work should include education about the risks associated with the occupation and about methods to reduce risk. The physician should also enquire about exposures to violent or dangerous occurrences and should include assessment for possible emotional sequelae of such exposure. Operational procedures designed to reduce risk of violence and to improve police officer safety and survival are appropriate but are not in the normal realm of the physician. The question of whether a medical condition may be attributable to the occupation of policing is liable to produce strong emotions. When a police officer becomes ill there is an understandable desire on the part of other officers and, often, on the part of the public, to attempt to demonstrate a connection between the occupation and the illness. In line with this tendency several US states have policies in place to unquestioningly accept atherosclerotic heart disease among police officers as 'occupationally induced' for pension purposes. This leads to situations where the scientific evidence may be at odds with the political agenda of individuals and groups participating in the determination. This review will examine the evidence for a number of medical conditions. Specific occupational exposures, such as lead exposure among ballistics specialists, or chemical exposure among forensic laboratory workers are addressed elsewhere. Biohazard risks will be addressed in a later review.

Journal Article↗

Ethics and the police surgeon: compromise or conflict?

Police surgeons play an important role in the British criminal justice system. Professionally located between the two worlds of medicine and the law, they face ethical dilemmas which derive from the dual nature of their role. The development of the police surgeon service has seen the emergence of three further dualisms within the police surgeon role. These are the forensic-therapeutic divide, the specialist-generalist division, and the issue of dependence or independence with regard to the police. These internal dualisms are discussed and their implications explored. Attention then turns to a consideration of three issues which demonstrate the nature of the ethical dilemmas facing the British police surgeon: the particular articulation of the (police) doctor-patient relationship, the matter of consent, and the subject of confidentiality. Both these ethical issues and the nature of the police surgeon role are explored through the primary analysis of survey and interview data collected from a national sample of police surgeons and police services, and the secondary analysis of key documents on the police surgeon, the paper concludes that specific ethical guidance is needed to address the forensic aspects of the police surgeon role.

Confidentiality↗

Critical incident exposure and sleep quality in police officers.

OBJECTIVE: Police officers face many stressors that may negatively impact sleep quality. This study compares subjective sleep quality in police officers with that in control subjects not involved in police or emergency services. We examined the effects of critical incident exposure (trauma exposure) and routine (nontraumatic) work environment stressors on sleep quality after controlling for the effects of work shift schedule. METHODS: Subjective sleep disturbances were measured by the Pittsburgh Sleep Quality Index in police officers (variable-shift workers, N = 551; stable day-shift workers, N = 182) and peer-nominated comparison subjects (variable-shift workers, N = 98; stable day-shift workers, N = 232). The main predictor variables were 1) duty-related critical incident exposure to on-line policing and 2) work environment stress related to routine administrative and organizational aspects of police work. RESULTS: Police officers on both variable and stable day shifts reported significantly worse sleep quality and less average sleep time than the two corresponding control groups. Within police officers, cumulative critical incident exposure was associated with nightmares but only weakly associated with poor global sleep quality. In contrast, the stress from officers' general work environment was strongly associated with poor global sleep quality. Sleep disturbances were strongly associated with posttraumatic stress symptoms and general psychopathology. CONCLUSIONS: A large percentage of police officers report disturbances in subjective sleep quality. Although the life-threatening aspects of police work are related to nightmares, the routine stressors of police service seem to most affect global sleep quality in these subjects. These findings may have implications for health and occupational performance.

Adult↗

Providing automated external defibrillators to urban police officers in addition to a fire department rapid defibrillation program is not effective.

OBJECTIVE: The aim of this study was to determine if providing automated external defibrillators (AEDs) to urban police officers would increase the proportion of patients with out-of-hospital cardiac arrest (OOH-CA) who were discharged alive from the hospital. METHODS: This prospective, controlled study was conducted in a city with about 332,000 persons. The EMS system included paramedic ambulances and fire department based first responders equipped with defibrillators, but police officers did not respond routinely to medical emergencies. Between March 1997 and February 1999, all OOH-CAs in four police districts were identified and followed until death or hospital discharge. All 35 police cars in one police district were provided with AEDs, and all police officers in that district were trained in CPR and the use of AEDs. Police and fire first response units were dispatched simultaneously in district 3 (intervention group). Fire first response was dispatched without police in districts 2, 4, and 5 (control group). RESULTS: A total of 645 OOH-CAs occurred over the 2 years. Sixty-two were outside of the study area. Two did not have accurate address information to determine the police district. Of the remaining cases, 154 (27%) occurred in the intervention district and 427 (73%) were in the control area. Survival to hospital discharge was similar; it was 11/154 (7.1%) in the intervention and 16/427 (3.8%) in the control districts (odds ratio=1.98; 95% CI 0.90--4.36). Survival to hospital discharge for witnessed OOH-CA events occurring prior to EMS arrival and found to be in ventricular fibrillation or ventricular tachycardia was 4/27 (15%) in the intervention area and 9/73 (12%) in the control area (odds ratio=1.2; 95% CI 0.4-4.4). CONCLUSION: Equipping police cars with AEDs in an urban area where the fire department-based first response system also carries defibrillators did not improve the hospital discharge survival rate for victims of OOH-CA.

Automation↗

Stress in the Norwegian police service.

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.

Adaptation, Psychological↗

From conversion to coercion: the police role in medication compliance.

This paper examines the role of the police in supporting community based mental health services for the chronically mentally ill in a mid-sized midwestern city. Cooperation between the police and mental health system, as reflected in training and procedural agreements for emergency evaluations and hospitalization, achieves the conversion of the police to a medical model view of mental illness which stresses the importance and effectiveness of medication compliance so that the police will act upon this belief in their handling of the mentally ill. However, police recognition of the limits of the medical model and organizational change impacts upon cooperative police practices. Police experience conflict over the assumed therapeutic goals of community treatment and the important gatekeeping function community mental health systems perform under deinstitutionalization. Erosion of the police belief in the effectiveness of community mental health, and the resulting change in practices, may provide an important, yet partial, counterbalance to the control exerted by the medical model. The availability of police authority to assure compliance, or in some cases to reinforce the consequences of non-compliance with medication, raises questions about police-mental health relationships that are too cooperative.

Antipsychotic Agents↗

Police involvement in pediatric prehospital care.

One hundred fourteen emergency medical services agencies and 76 police chiefs throughout the United States were prospectively surveyed to ascertain the current utilization of police personnel within the prehospital care system. More than three fourths (77%) of the surveys mailed were completed. Respondents indicated the following: (1) a majority (92%) of police personnel were trained in cardiopulmonary resuscitation and basic first aid, (2) only half (57%) of police were trained in moving or transporting patients, and (3) few (36%) police were provided ongoing training in emergency pediatric medical skills. In spite of this, police were reportedly present at calls activating emergency medical services systems between 24% and 69% of the time, and the majority of these were trauma related. Police chiefs surveyed indicated that their officers played a large role in medical management prior to arrival of emergency medical services personnel; 87% would initiate cardiopulmonary resuscitation and 93% would begin basic first aid. Sixty-one percent of police chiefs indicated that officers would occasionally "scoop and run" with a critically ill child rather than await emergency medical services arrival. The data indicate that, right or wrong, police personnel are actively involved in their prehospital care system at present. In many instances, their help may be needed. Further thought should be given toward defining an exact emergency medical services role for police personnel and toward providing adequate initial and ongoing basic medical training for these individuals.

Allied Health Personnel↗