Fig. 1. Hearing and eye protection for firearms training. From left to right: electronic earmuffs, wraparound eyeglasses, custom silicone earplugs, two different types of foam earplugs

Hearing protection can be provided by earmuffs and earplugs, which are graded by the noise reduction rating (NRR). The NRR typically ranges from 21 to 27 dB for reusable earplugs, 28 to 33 dB for foam earplugs, and 17 to 31 dB for earmuffs (see Fig. 1 ). Officers should wear earplugs and earmuffs during firearms training, to maximize hearing protection. Electronic earmuffs amplify noise up to a threshold level (around 80 dB) and help to hear commands on the range. Electronic earmuffs are recommended for frequent shooters, including firearms instructors and tactical team members, in conjunction with earplugs. Custom-made silicone earplugs are available and are preferred by some shooters for their comfort. Officers should be careful about hearing protection when shooting indoors or when shooting short-barreled carbines.

The main purpose for headgear and clothing for shooters is comfort, but these items also could increase safety. Casings ejected by firearms are hot and could burn and distract shooters. A baseball cap or a hat with a wide brim should be used. Long pants and long sleeves offer protection against hot brass and the environment. Warm clothes are indicated if shooting in a cold environment, because most range training is fairly static. Officers may choose to wear ballistic vests during firearms training.

A first aid kit should be readily available on each range. At the minimum, a kit should contain the following items:

Police agencies should develop policies to address medical emergencies that may occur on the range. Besides accidental gunshot wounds and backsplash, other possible medical emergencies at a police firing range include blunt trauma (falls); environmental injury (hypothermia, heat exhaustion, bee sting, poison ivy); cardiac disease, especially during intense physical training; and other general medical emergencies. Firearms instructors should have some first-aid training. Ideally, an EMT should be on staff. Ranges commonly are located in remote areas. Access to emergency medical services (EMS) can be an issue, and its procedures, such as when and how to call for a medical evacuation helicopter, should be addressed in advance. Several means of communication should be available to call for help. The location of the nearest hospitals and trauma centers should be known.

Simulation training with firearms

Most of the recent training deaths of officers occurred during simulation training. Simulation is a valuable part of the training: It allows officers to experience realistic fights during force-on-force scenarios. During simulation training, firearms are rendered safe and are used to shoot blank or marking rounds or are kept empty for dry firing. Blank rounds create a concentrated blast of hot gases that can be deadly at close range. Police officers have been injured seriously by blank rounds in training; however, most accidental shootings in training happen when a loaded weapon is brought in by mistake. Typically, an officer leaves the training area and loads the gun. He or she returns to the training environment, forgetting that the gun is loaded. Another common mistake happens after the end of the simulation exercise, when the guns have been loaded. An officer asks a question about the exercise, and the instructor offers to do another demonstration of the technique, forgetting that the gun is loaded.

Law enforcement agencies should implement strict guidelines to prevent these tragedies. No live weapons and no live rounds should be present in the training area. Training officers should go through a simulation instructor's course. Safety officers should search officers for live rounds and weapons and possibly use metal detectors. Firearms should be inspected immediately before the exercise by the safety officer and the student to make sure that the firearms are loaded with training rounds. The training area should be closed, and no interruption should be allowed. Students and instructors are notified when training is completed and when they can have access to live weapons, for example: No more practice, no more demonstration, you now carry live weapons.

Real firearms should be avoided whenever possible, unless they are fitted with special devices that allow only blanks or marking rounds to be fired and are marked with a special color (usually red). Real firearms should not be used for dry firing during simulation and should be replaced with dummy guns for exercises that do not require shooting. Officers should wear hearing and eye protection if guns are fired. Groin, throat, and neck protection is mandatory if marking rounds are used. Ballistic vests are recommended. A medical kit, similar to the range medical kit described earlier, should be available. Instructors should be trained in first aid and have plans and communication means to contact EMS.

Defensive tactics training

Defensive tactics is the art of empty-hand combat. Law enforcement officers use defensive tactics to control (restraint techniques) and disable subjects (impact techniques) and to defend themselves when attacked (blocking, falling, and rolling techniques). Firearm retention and disarming, knife defense, handcuffing, and impact weapons usually are added to the defensive tactics curriculum. Wall padding and mats with no gaps between them can reduce injuries in defensive tactics. Shoes should be worn while working on mats. Live weapons should be avoided whenever possible and replaced with dummy weapons. Plastic guns and knives are preferred during more dynamic exercises. Dummy aluminum guns and knives might be preferred in other training exercises, because they feel more realistic and are less likely to break, chip, or cause lacerations.

Handcuffing training uses real, metallic handcuffs. It can be painful and could cause nerve damage. Overly tight handcuffs have been found to cause temporary and permanent neuropathies [4,5]. To prevent nerve damage, wrist neoprene support bands could be used, and handcuffs should not be too tight.

Simulation training in defensive tactics lets officers experience the stress of a real fight and shows them how to apply successful techniques under realistic conditions. To achieve this goal, officers playing the attackers wear special protective suits (Fig. 2) . Commercial training suits are generally not appropriate for full-contact fighting and need to be modified for added protection and mobility; however, there have been improvements in these suits (P.J. Messina, personal communication, 2003). Training suits have to provide protection against impacts, adequate mobility, and peripheral vision while minimizing dehydration and heat exhaustion. At the Modern Warrior Defensive Tactics Institute, training suits are supplemented with ice packs on the chest, on the back, and around the neck to prevent heat exhaustion. Additional support is added to the back of the neck to prevent whiplash injuries while preserving the mobility of the neck. Officers playing the attackers should have special training and frequently should rest and hydrate during simulation training. They also should wear mouth guards. Several monitors are needed to direct the fight, keep the officers safe, and check the protective equipment. The floor, walls, and dummy weapons should be padded. The trigger guard of the dummy guns should be removed to prevent finger injuries. To keep the fight realistic, the officers do not wear protective equipment. The duration of a fight should be limited to 60 seconds. Code words should be used to stop the fight if anybody observes a safety risk. At the Modern Warrior Defensive Tactics Institute, more than 10,000 officers have been trained in simulated confrontations during the past 15 years. Only one attacker had a significant injury that required medical attention. It is interesting to compare this rate of injury to the findings described in an article by Minor, Rudnick, and Plumstead elsewhere in this issue. The low rate of injury at the Modern Warrior Defensive Tactics Institute can be explained by the use of equipment, selection of the attackers, and use of safety procedures. The training suits are modified to offer the best protection and mobility. The attackers are experienced defensive tactical experts who are trained in simulation confrontations. Their training includes a complex obstacle course, which they have to complete with the training suits. A safety briefing is given before the fight. At least three instructors monitor the fight and the equipment for safety issues. The attackers work in two shifts, allowing one group to rest and hydrate while the other group fights with an officer.

Fig. 2. Simulated fights. Three attackers with protective suits fight with an officer.

 

Other training

Other dangerous training activities include high-speed driving and the use of explosives and distraction devices. Some agencies use helmets during driving exercises. Distraction devices, or flash-bangs, create a loud noise and a bright light when they explode. They are used by tactical teams. Several officers experienced severe upper-extremity injuries when distraction devices exploded while still held by the officers. When deploying distraction devices or explosive charges, the entire procedure should be supervised step by step by a safety officer. Typically, the trainee announces loudly each step to make sure that none is missed. Officers should wear flame-resistant gloves that are made of leather and Nomex (DuPont, Wilmington, DE). Flame-resistant Nomex uniforms also could be used. Medical kits and fire extinguishers should be readily available during driving, explosive-, and distraction-device training.

Accidental shootings

Between 1992 and 2001, 29 officers died from accidental shootings in the United States [1]. Nine officers died from accidental shootings during training, 18 officers died in  crossfires, mistaken for subject, and firearm mishaps,  and two officers died in unknown circumstances. Mistaken-identity shootings happen when off-duty or plainclothes officers draw their firearms without obvious police identification. Other officers perceive them as suspect with a gun and might shoot if they seem to be a threat. Several procedures can be implemented to decrease the risk for mistaken-identity shootings. Some police departments issue bright orange armbands with police markings for plainclothes officers to be identified when necessary. Clothing with several concealable pull-down police identification flaps is available. An appropriate procedure for plainclothes officers is to hold their badge or identification above the head and turn it back and forth and to state who they are. This approach is helpful when holding a suspect at gunpoint to prevent mistaken-identity shootings when responding uniformed officers, possibly from a different agency, arrive on the scene.

Home firearm safety is a critical issue for law enforcement officers who have families, especially for officers with young children. Each year, children of law enforcement officers are killed or wounded with the firearms of their parents. Children as young as 2 years old can shoot and kill themselves with a handgun [6], and a 3-year-old was able to pick up a pistol and shoot and kill his father, a police officer [7] . Every law enforcement agency should teach home firearm safety programs to its officers. If the firearms are not directly under the control of the officer or a trusted adult, they should be secured in a locked safe and not just hidden [8] . The ammunition could be locked in a separate location. Weapons that are not used for a long time may be disassembled partially. Officers may want to keep a loaded gun available for personal and home defense while at home. A quick access safe, with only four or five buttons, is a recommended method of keeping the home defense gun. The officer, however, should be in the area immediately surrounding this type of safe, as children might open it given enough time. Children also should be educated about firearm safety. The Eddie Eagle GunSafe Program of the National Rifle Association teaches the following steps if a child finds a gun: stop, don't touch, leave the area, and tell an adult [9] . Officers should talk to their children about firearm safety in a way that is appropriate for their age. Children could have access to the unloaded firearm under the direct supervision of the officer or a trusted adult to decrease their curiosity and demystify guns.
Police weapons [Return to Article Outline]

Each issued weapon raises several concerns, including safety for the public, safety for the officer, effectiveness, and training. Nonlethal weapons have to be assessed for the injuries that they could cause to suspects.

The design of firearms tends to be universal, but modifications are sometimes necessary for specific classes of users. Law enforcement organizations use handguns and long guns (shotguns, carbines, rifles, submachine guns). Excessive recoil should be avoided by selecting proper calibers and ammunition. Some agencies are replacing shotguns with carbines, because officers complained of the recoil created by the shotgun. Although shooting technique and ammunition could mitigate perceived recoil, officers usually perceive carbines as being more user friendly. Female and small-sized officers may need different handguns with smaller grips and shorter trigger reach [10] . Grip-strengthening exercises seem to help the shooting abilities of female and small-sized officers (P.J. Messina, personal communication, 2003). The stocks of most shotguns and rifles are too long for police work and need to be shortened, even for average-sized men (J.S. Farnam, personal communication, 2003). Night sights are self-luminous tritium inserts that are imbedded in the regular sights of a firearm. One study found that night sights improved shooting accuracy in low-light conditions [11]. Night sights are recommended for handguns and long guns.

Nonlethal weapons include pepper spray, batons, TASER (Thomas A. Swift's electric rifle), and nonlethal rounds (Fig. 3) . Pepper spray and other chemical agents are discussed more fully in an article by Czarnecki elsewhere in this issue. The TASER is an electrical immobilization device that shoots probes into a suspect. Different models and brands exist. The probes stay connected to the weapon by a high-voltage insulated wire, which transmits electrical pulses to the suspect. The Advanced TASER M26 (TASER International, Scottsdale, AZ) is probably the most common TASER unit used by law enforcement. Although TASERs are not a solution for each violent situation, a sheriff's office found that, since the TASER was issued 3 years ago, injuries to deputies during arrest situations have dropped by 88% [12].

Safety and protective equipment

Medical kits

Officers should have access to a medical kit at all time. They should receive enough first aid training to be able to use issued medical kits and to protect themselves against blood-borne pathogen exposures. Advanced emergency medical training is desirable. In some agencies, every officer is a certified EMT. More and more agencies issue automated external defibrillator to regular patrol officers. Officers should obtain training in tactical medicine (eg, how to treat penetrating trauma on themselves or their partners) while operating in an unstable tactical environment.

Officers should carry a tourniquet at all times and be trained in its use. Tourniquets are safe if used properly, especially if left on an extremity for less than 1 hour [13,14] . They are effective and easily placed in less than 30 seconds. Once placed, both hands of the wounded officer are free to continue the fight. In military special operations, it is recommended that the only medical intervention while under fire should be to stop any life-threatening external hemorrhage with a tourniquet. It is recommended that military special operation forces carry a readily available tourniquet at a standard location on their uniforms. Tourniquets alone could save 60% of all the preventable deaths from combat trauma [14].

A personal medical kit, carried by each officer, could include one tourniquet, two trauma dressings, two rolls of conforming gauze, and one pair of latex or nitrile gloves. A more comprehensive medical kit should be carried in the police car. In special circumstances, such as a search warrant or tactical operation, a large medical kit should be available. Additional items, depending on the level of medical training of the officers, may include: advanced life support supplies and medications; additional tourniquets, trauma dressings, and rolls of conforming gauze; dressing materials, including nonadherent dressings, tape, bandage strips, cohesive bandage, elastic wraps, adhesive bandages, gauze pads, and safety pins; pocket mask; oropharyngeal and nasopharyngeal airways; splints; space blanket; EMT shears; cold compresses; acetaminophen; ibuprofen; aspirin; antibiotic ointment; saline drops; antiseptic solution; alcohol gel.

Infection control

Infection control involves the use of gloves and eye protection. A spitting mask is a mesh bag that is placed around the head of a suspect to prevent the biting of or spitting at the officer. Alcohol-based gel can be used when water and soap are not available. It is recommended to carry alcohol-based gel in every police car. Bio-Safe Antibacterial Skin Protectant (Bio-Safe Enterprises, Milwaukie, OR) acts like a liquid glove. It is applied on the skin and dries, creating a bactericidal barrier for several hours.

Ballistic vests

Soft ballistic vests (or body armor) have been available to law enforcement officers since 1973. Modern body armor is more comfortable, lighter and more flexible than ever. It is made with synthetic fibers: Kevlar (DuPont, Wilmington, DE), Spectra (Honeywell, Morristown, NJ), or Zyloflex (Toyobo Co., Ltd., Osaka, Japan). More than 2500 officers have been saved from serious injury or death by ballistic vests [15].

The National Institute of Justice (NIJ) standard 0101.04 rates soft body armor in three main categories: IIA, II, and IIIA (from weakest to strongest protection) [16] . Level IIA armor protects against 9-mm full metal jacketed round nose bullets, with nominal masses of 8.0 g (124 gr [grains]) impacting at a minimum velocity of 332 m/s, and against 40 S&W caliber full metal jacketed bullets, with nominal masses of 11.7 g (180 gr) impacting at a minimum velocity of 312 m/s. Level II armor protects against 9-mm full metal jacketed round nose bullets, with nominal masses of 8.0 g impacting at a minimum velocity of 358 m/s, and against 357 magnum jacketed soft point bullets, with nominal masses of 10.2 g (158 gr) impacting at a minimum velocity of 427 m/s. Level IIIA armor protects against 9-mm full metal jacketed round nose bullets, with nominal masses of 8.0 g impacting at a minimum velocity of 427 m/s, and against 44 magnum jacketed hollow point bullets, with nominal masses of 15.6 g (240 gr) impacting at a minimum velocity of 427 m/s. Level III and level IV are rigid body armors that protect against rifle rounds.

Level II armor should be suitable for most police officers. Level IIIA armor should be issued to officers who are involved in high-risk operations, such as warrant service, hostage rescue, and protective details. Ballistic vests can be improved by fitting a trauma plate (usually 8x5 inches) on the chest. Trauma plates can be soft and made of the same material as the ballistic vest, or rigid and made of ceramic or metal. Trauma plates offer level IIIA, III, or IV protection.

It seems that no type of body armor has failed in the streets. Most ballistic vests consistently stop handgun rounds beyond their ratings. Between 1992 and 2001, 19 officers died from gunshots that penetrated their body armor. They incidents involved rifle rounds. An officer who is shot while wearing a ballistic vest is likely to experience benign blunt trauma to the chest. There is no reported case of death from blunt trauma caused by handgun rounds. A death from traumatic aortic dissection was reported when an officer was shot with a rifle while wearing soft body armor. It is recommended that officers go to an emergency department as soon as possible if they are shot while wearing a ballistic vest. A chest x-ray should be performed, because pulmonary contusion has been reported (C.J. Holliman, MD, personal communication, 1999).

Ballistic vests have been known to fail during tests. It is recommended that police departments conduct their own tests on new vests and on vests that randomly are taken from officers in the field. Improper storage (creating folds), high temperature, and corrosive chemicals could decrease ballistic capabilities. The exact lifespan of ballistic vests is unknown, but some manufacturers recommend changing vests every 5 years.

Puncture-resistant vests are available with or without ballistic protection. They are recommended for correction officers, who are more likely to be assaulted with improvised knives or picks rather than firearms. Puncture-resistant vests are regulated by the NIJ standard 0115.00 Stab Resistance of Personal Body Armor.

Gloves

Police officers wear gloves for different reasons. Latex gloves protect against bodily fluids. Compared with latex gloves, nitrile gloves are more resistant to puncture and chemicals and are less allergenic. Powdered latex gloves should be avoided. Leather gloves are used for general hand protection and can be lined with Kevlar or Spectra for increased resistant against cuts. Many tactical operators prefer flame-resistant flight gloves, which issued by the US Air Force, with thin leather palms, Nomex backs, and long cuffs. Gloves can be worn for protection against the cold. If gloves are worn routinely, officers should shoot with and without the gloves during firearms training.

Eyeglasses

Officers can wear prescription eyeglasses and sunglasses. OSHA mandates eye protection when the eyes are exposed to flying particles or caustic liquids [14] . It is recommended that officers wear safety eyeglasses that comply with the ANSI Z87.1-1989 standard during high-risk operations, such as warrant service and tactical operations. Prescription eyeglasses and sunglasses worn on patrol should be as safe as possible and have unbreakable lenses. Another article by Good and Taravella in this issue offers a detailed discussion of vision issues in law enforcement.

Helmets and shields

Helmets are issued for ballistic protection, riot control, and special vehicle operation (motorcycles, bicycles, snowmobiles). The NIJ standard 0104.02 establishes rules for riot helmets and face shields, defining peripheral vision, impact attenuation, penetration resistance, and retention system. Ballistic helmets are used during tactical operations. Ballistic shields are used during warrant service and tactical operations and can be issued to patrol officers. Shields require special training. The NIJ standard 0108.01 regulates ballistic-resistant protective materials, including helmets and shields. A level IIIA material, probably the most common, stops a 44 magnum round fired from a pistol and a 9-mm round fired from a submachine, at given velocities.

Other equipment

The remaining equipment of police officers includes uniform, headgear, boots, or shoes, duty belt, duty belt accessories, and radio. Duty belt equipment typically includes handgun, handcuffs, flashlight, latex gloves, baton, radio, and pepper spray canister (Figs. 4 and 5) . Holsters contain one of several retention devices to prevent criminals from taking the gun from the officer. Between 1992 and 2001, 594 officers were slain with firearms, and 46 (7.7%) were killed with their own weapon [1] . In the 1970s and early 1980s, about 20% to 25% of officers who were slain with firearms were killed with their own weapons. Better-designed holsters and firearm retention training have helped to decrease the number of officers who are killed with their own weapons. Some modern rigid plastic holsters may not allow the drawing of the firearm from unusual body positions (eg, while on the ground). New holsters should be tested to make sure that officers can draw from any position, including with the nondominant hand. Holsters designed for men may not fit female officers because of difference in hip size. Duty belts and holsters are discussed more fully in the last part of this article.

Fig. 4. Duty belt for tactical officer. Thigh holster and thigh magazine pouch are shown.