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Using data on ‘resistance-related’ injuries among officers to inform policy, training

Researchers are investigating the full spectrum of injuries that officers sustain while interacting, arresting, detaining, or pursuing suspects

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We know quite a bit about the circumstances around law enforcement officers’ on-duty deaths. We know much less about officers’ on-duty nonfatal injuries, which can involve significant medical costs, time away from work, long-term pain, and disabilities. [1]

The lack of a readily accessible comprehensive database has prevented researchers from examining the causes of nonfatal injuries among officers. And the classifying of these injuries in traditional injury coding schemas can also be problematic.

For example, an injury may get coded as being due to an “assault” when a suspect intentionally injures an officer; however, unintentional falls or sprains can also occur during these interactions, which are often not coded as “assaults” in traditional injury coding schemas. Because of this, it can be difficult for researchers to accurately assess officers’ injuries to determine if they are the result of an intentional assault or occur in a more indirect manner. This information is critical for providing better policies and training to reduce or prevent these injuries.

What the data says about resistance-related injuries

The National Institute for Occupational Safety and Health (NIOSH) published an article in the American Journal of Preventive Medicine to better define and understand the full spectrum of injuries that officers sustain while interacting, arresting, detaining, or pursuing suspects. These injuries were termed “resistance-related” injuries. [2]

Using injury data obtained from U.S. emergency departments (EDs) from 2012 to 2017, the study provides a national description of nonfatal, ED-treated injuries that officers sustained while interacting, arresting, detaining, or pursuing suspects. A unique case-finding methodology was used to specifically identify resistance-related injuries among officers. This involved reviewing all types of injuries to ascertain exactly how the injury occurred using details found in the medical report narrative.

The study found that an estimated 53% of officers’ ED-treated injuries were considered resistance-related. This study highlighted that officer–suspect interactions can lead to a wide range of injuries among officers and current injury classification systems are not equipped to categorize these resistance-related injuries in a way that is consistent and meaningful to law enforcement leaders. The main findings were:

  • About 303,500 law enforcement officers were treated in EDs across the nation for nonfatal injuries between 2012 and 2017.
  • The leading cause of the ED visits was violence/assaults (48%), transportation incidents (11%) and falls (11%).
  • Nearly 50% of falls and 31% of overexertion injuries, such as sprains and strains, were considered resistance-related.
  • The body parts most likely to be injured in a resistance-related injury were fingers and hands (25%), followed by upper extremities (22%) and lower extremities (20%).
  • The most likely diagnosis in a resistance-related injury was contusions or abrasions (35%), followed by strain or sprain (24%).

This research was the first to provide a national description of resistance-related injuries treated in EDs among U.S. law enforcement officers. Although intentional assaults are a concern for law enforcement officers and leaders, it is equally important to consider all injuries that occur when officers are interacting with suspects. Injuries resulting from falls or overexertion are often not coded as intentional assaults.

NIOSH is currently conducting additional research to better understand nonfatal injuries of law enforcement officers. Using the ED data as a springboard, a larger national study is taking place in which officers who have been injured are interviewed to obtain more detail than can be obtained from the ED medical record. The findings of this study should provide a better understanding of nonfatal injuries on a national scale, and will be vital for developing evidence-based policing strategies and tactics to reduce officer injuries. More information on the ongoing study can be found here.

Policy and training considerations

The examination of officers’ on-duty injuries points to important policy and training considerations.

The majority of resistance-related injuries were the result of direct assaultive action by a suspect. This supports the on-going need to develop officer skills and tactical knowledge to counter such actions. [3]

In addition, the finding that more commonplace injuries such as falls originate from officer-suspect interactions also bears important considerations for future training and policy. [4]

There may be value in officer training that includes holistic scenarios, in addition to working on individual tactics or the ability to identify assault cues. For example, a holistic scenario may include initial contact with a suspect, followed by a foot pursuit and then tactics to aid officers in physical struggle encounters. This creates a more realistic training approach setting where officers can negotiate the potential risk for falls, overexertion injuries and assaults in a single event that may be more reflective of the situations they face in the field.

This study also highlights the need for evidence-based de-escalation training. Some officer-suspect interactions provide little opportunity for de-escalation, but others evolve into confrontation and the use of physical force. [5] Although officers do not have complete control over every encounter, improving their social interaction and de-escalation skills can help reduce the potential for interactions to turn physical and, in turn, reduce an officer’s risk for injury.

This research also raises the question of the possible role that physical fitness plays in injury prevention for law enforcement. There is a lack of evidence-based approaches on how to maintain personal fitness for law enforcement officers. [6] A recent evaluation of a sports medicine model in a single agency reported that using an athletic trainer resulted in a 50% reduction in overall medical care costs and an 86% reduction in musculoskeletal injury-related medical care costs. [7] This model included the placement of a certified athletic trainer in the agency for clinical assessments, medical care, wellness education, injury rehabilitation, reconditioning and injury prevention. This single study found a connection between physical fitness and reduced injury risk, though more rigorous research is needed. Opportunities exist to improve officers’ rehabilitation and reconditioning post-injury, as well as improving overall physical fitness to prevent injuries from occurring in the first place.

Disclaimer: The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

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1. Bonnie RJ, Fulco CE, Liverman CT, eds. Reducing the Burden of Injury: Advancing Prevention and Treatment. Washington, DC: The National Academies Press, 1999.

2. Tiesman H, Konda S, Grieco J, Gwilliam M, Rojek J, Montgomery B. 2020. Resistance-Related Injuries Among Law Enforcement Officers: Addressing the Empirical Gap. Am J Ind Med, 2020 Dec;59(6):e231-e238.

3. Bureau of Justice Assistance, U.S. Department of Justice, Office of Justice Programs. BJA’s VALOR Officer Safety and Wellness Program trains over 50,000 officers. Washington, DC: Bureau of Justice Assistance, U.S. Department of Justice, Office of Justice Programs; November 20, 2018.

4. Hogan J. Recent incidents raise questions about foot pursuits. Post Register. July 26, 2019.

5. Alpert GP, Dunham RG. Understanding Police Use of Force: Officers, Suspects, and Reciprocity. Cambridge, United Kingdom: Cambridge University Press; 2004.

6. Lentz L, Randall JR, Gross DP, Senthilselvan A, Voaklander D. The relationship between physical fitness and occupational injury in emergency responders: a systematic review. Am J Ind Med. 2019;62(1):3-13.

7. Burke NC. Reducing law enforcement medical costs: utilizing the sports medicine model. Chantilly, VA: Fairfax County Police Department, 2014.

Hope M. Tiesman, Ph.D., is a research epidemiologist at the National Institute for Occupational Safety and Health (NIOSH). She received her Ph.D. in epidemiology at the University of Iowa where she was an occupational injury prevention fellow at the Heartland Center for Occupational Health & Safety. She has published extensively in the field of occupational injuries and worked with various occupations including the U.S. military, healthcare workers and police officers. She also serves on the International Association of Chiefs of Police Research Advisory Council. Her research interests include the prevention of workplace violence, suicide prevention, the occupational safety and health of police officers, and the scientific evaluation of workplace policies and programs.