This article is based on research conducted as a part of the CA POST Command College. It is a futures study of a particular emerging issue of relevance to law enforcement. Its purpose is not to predict the future; rather, to project a variety of possible scenarios useful for planning and action in anticipation of the emerging landscape facing policing organizations.
The article was created using the futures forecasting process of Command College and its outcomes. Managing the future means influencing it — creating, constraining and adapting to emerging trends and events in a way that optimizes the opportunities and minimizes the threats of relevance to the profession.
By Captain Edward Falkenstein
Imagine a bustling city of a million souls, a tapestry of diverse lives and stories. Here, in this microcosm of society, law enforcement grapples with the daunting challenge of understaffing amid a rising tide of in-custody incidents, echoing a troubling national trend. As the Prison Policy Initiative highlighted, the United States witnessed a peak in jail deaths in 2018, its highest number since 2000, with suicides and drug-related fatalities at the forefront. [1]
Our story begins with an arrest — a scenario all too familiar, yet about to unfold differently thanks to a groundbreaking technological leap: health-monitoring wearables. This innovation isn’t just a gadget; it’s a guardian.
Our tale weaves through the life of a habitual offender whose brush with death becomes a testament to the transformative power of these devices, turning a potential tragedy into a beacon of hope. During his latest arrest, as the handcuffs closed around his wrists, they did more than restrain him; they started monitoring. Integrated into the handcuffs was a health wearable device, silently observing his vital signs. As the officer escorted him, a subtle alarm from the device alerted about an irregularity in the offender’s heart rate. Acting swiftly on this notification, the officer called for medical assistance, averting a potential emergency.
In our city, the intersection of law enforcement and public health has long been a complex, often contentious battleground. This suspect, a career criminal with a history of drug offenses and petty crimes, personifies the challenge. Traditional policing methods focused more on control than care, have repeatedly failed to address the underlying health issues that plague individuals like him. This cycle of arrest, incarceration and release, punctuated by preventable tragedies, calls for a transformative approach.
Once at the jail, the narrative of his custody took a turn. As part of the intake process, he was fitted with another wearable, this time integrated with his identification band. This device continuously monitored all his vitals, unveiling health concerns that had previously gone unnoticed. The data gathered offered critical insights, allowing for timely medical interventions and a tailored approach to his care while in custody.
This failing is not unique to our city. Cases like George Floyd in Minnesota or Manuel Ellis in Washington highlight the tragic outcomes of inadequate health oversight and excessive force. Ellis’ death, partly due to restraint methods compounded by health issues, echoed the national outcry for change and mirrored the global outrage sparked by similar incidents. [2]
In this context, our city’s law enforcement faces a daunting task. Traditional approaches, emphasizing control over care, have resulted in a cycle of incarceration and release, marred by preventable health-related incidents. This necessitates a paradigm shift toward integrating health-monitoring technologies, prioritizing the well-being and safety of those in custody.
The crossroads: Enforcement versus care
Today our law enforcement stands at a crossroads. Despite advancements in technology, the tools at our disposal for health monitoring remain insufficient. Officers are trained to restrain and control, but not necessarily to identify or react to medical emergencies. This gap in capabilities and training has often led to tragic outcomes, further eroding public trust.
There are many potential benefits to equipping law enforcement officers as medical first responders, especially in cases of cardiac arrest, opiate overdose or severe bleeding. [3] The integration of tools like automated external defibrillators (AEDs) in law enforcement vehicles could significantly decrease response times and improve survival rates in medical emergencies. Expanded medical training in advanced emergency skills, such as the application of tourniquets, clotting agents and nasopharyngeal airways, is becoming increasingly crucial to train recruits in law enforcement academies. Such training would be pivotal to save lives in cases of penetrating trauma and other emergencies.
These insights point to an urgent need for a systemic change. The integration of health-monitoring technologies and advanced medical training for officers is not just a luxury but a necessity. This approach can bridge the current gap, ensuring that officers are not only enforcers of the law but also protectors of life, equipped to respond effectively to health crises in the line of duty.
The future of care
In an ideal future, every officer would be equipped with the tools to not just enforce the law but also protect life in its most vulnerable moments. Picture our suspect, now under the watchful eye of health-monitoring wearables. These devices, seamlessly integrated into handcuffs and jail bracelets, serve as silent sentinels, continuously analyzing vital signs and detecting any signs of distress.
As we envision the future of law enforcement and custodial care, the integration of health-monitoring wearables stands at the forefront. These devices are transforming health care, offering real-time monitoring of vital signs like heart rate and rhythm, potentially revolutionizing the way we approach medical care of prisoners. [4] The implementation of such technologies in law enforcement aligns with the growing trend of utilizing advanced medical devices to enhance the safety and well-being of individuals in custody.
In Cobb County, Georgia, the jail is using medical monitoring wristbands to track inmates’ health, aiming to reduce custodial deaths. [5,6] The wearables, developed by Black Creek Integrated Systems, have been used since summer 2022 on about 75–80 inmates in the medical wing. Designed similarly to a smartwatch, these devices are crimped onto each inmate’s wrist and monitor heart rates. Despite facing technical issues like water penetration disrupting service (which are being resolved by the manufacturer), the devices have shown their efficacy by recording critical incidents, including the death of an inmate. They are currently limited to the medical wing, but there are plans for potential expansion within the facility if the technical issues are resolved.
In San Diego County, the sheriff’s department faces scrutiny for its disproportionately high in-custody death rate. A review of these deaths suggests many could have been prevented with timely intervention and adequate staffing. [7]
Now the San Diego County Sheriff’s Department is conducting a pilot program to deploy health wearables for monitoring the most medically vulnerable inmates. [8] Such programs reflect a proactive approach to custodial care, prioritizing health and safety, not just incarceration.
Captain Kyle Bibel’s insights from the pilot program reveal the multifaceted challenges encountered in the practical application of these wearables. [9] Despite the initial promise, the program, which involved around 20 high-risk inmates, faced significant obstacles. Bibel notes that the jail’s infrastructure, particularly its thick cement walls, posed severe connectivity challenges for the Wi-Fi or Bluetooth-dependent devices. Additionally, the logistical aspects, such as the time-consuming nature of equipping and maintaining the devices and the difficulty in finding willing inmate participants, highlighted the complexities of implementing wearables in a real-world setting. These insights underscore the need for not only technological advancements, but also adaptable strategies tailored to the unique environments of different custody settings.
The experience in Benton County, Arkansas, as shared by Lieutenant Tyler Ross, presents a different perspective. [10] Their program, operational for about two weeks at the time of the interview, has been used for six inmates who were either detoxing or had prior health concerns. Ross highlights the system’s 24/7 monitoring capability by deputies, health care providers and jail administration. The health monitors, made of hard plastic attached to the inmate’s wrist, are robust and have proven to be tamper-resistant. Ross notes that the program costs about $80,000 a year, covering 55 wearables and the necessary monitoring equipment. This initiative, even in its early stages, has shown promise in its operational functionality, staff reception and budget feasibility. It reflects a growing trend of adapting wearable health technologies in various custodial environments.
Local media noted the sheriff’s office’s use of wearable devices for inmates with medical conditions or undergoing detoxification, highlighting how these devices can alert staff to medical emergencies, facilitating immediate response. [11] Computer science experts echo this approach, emphasizing the potential of wearable health devices in monitoring and diagnosing various medical conditions, thereby advancing the capabilities of health care in custodial settings. [12]
Conclusion
These initiatives mark a significant step toward a future where law enforcement is not just about enforcing laws but also about safeguarding the health of those in custody. By integrating these advanced health-monitoring wearables, law enforcement agencies can ensure a higher standard of safety and care, potentially transforming the narrative of custody into one of compassion and protection. This technological leap, backed by comprehensive training and policy support, can bridge the gap between law enforcement and health care, paving the way for a more humane and effective approach to in-custody care whether on the street or incarcerated.
References
1. Wang L. Rise in jail deaths is especially troubling as jail populations become more rural and more female. Prison Policy Initiative. June 2021.
2. Glenn S. ‘Can’t breathe’: Tacoma police restraint of Manuel Ellis caused his death, medical examiner reports. Tacoma News Tribune. February 2021.
3. Renga S. Law enforcement officers as medical first responders can save lives. EMS1. August 2015.
4. Bayoumi K, Gaber M, Elshafeey A, et al. Smart wearable devices in cardiovascular care: Where we are and how to move forward. Nature Reviews Cardiology. March 2021.
5. Riggall H. Sheriff rolls out medical monitoring wristbands to curb jail deaths. Corrections1. June 2022.
6. Westenberger B. Personal communication. 2023.
7. Nott JE. Unending ‘crisis’ in San Diego county jails: Hundreds dead, millions in legal payouts. Prison Legal News. November 2022.
8. Davis K. San Diego jails’ most medically vulnerable inmates to get health monitoring devices under sheriff’s program. Los Angeles Times. October 2022.
9. Bibel K. Personal communication. 2023.
10. Ross T. Personal communication. 2023.
11. Neal T. Benton county sheriff’s office using bands with sensors to monitor inmates. Arkansas Democrat Gazette. January 2022.
12. Iqbal SMA, Mahgoub I, Du E, et al. (2021.) Advances in healthcare wearable devices. NPJ Flexible Electronics, 5:9.
About the author
Edward Falkenstein is a law enforcement professional with 23 years of experience, currently serving as a captain in the El Dorado County Sheriff’s Office. He holds a Bachelor’s degree in Political Science from Chico State University and a Master’s degree in Criminal Justice from Arizona State University. Edward is an alumnus of the Sherman Block Leadership Institute, Senior Management Institute for Police (SMIP) and POST Command College Class 71.