On September 7, 2013, an off-duty Chicago police officer named Kenneth Walker was working security at a public housing project when he got into a scuffle with a visitor—and shot him. “He’s bleeding from the chest, it’s probably critical,” Walker told a 911 dispatcher.
The operator told Walker to cover the wound and keep the man calm. But Walker made no move to help him, security video shows, even as blood began to pool on the sidewalk. Neither did any of the officers who soon arrived on the scene. Instead they stood over Marlon Horton as he gasped for air.
It took more than five minutes for fire department medics to arrive. They took Horton to a hospital, where he was pronounced dead.
It’s impossible to know what might have happened if Walker had bent down to stanch the bleeding, but emergency first aid can be the difference between life and death. And all too often, officers are not providing it, even when department rules say they should, according to an investigation by Type Investigations and The Marshall Project. Officers are often working with limited training, vague policies, and few consequences for inaction, our reporting found.
To understand how officers are trained in first aid and when they are required to provide it, Type Investigations and The Marshall Project reached out to police departments in the country’s 50 largest cities. Most departments said they give first aid training to police recruits and half of them said they require officers to provide aid whenever possible.
Yet there is wide variation in how the policies are written and enforced. In Memphis, Tennessee, officers must provide aid only to individuals they “exercise control over,” generally meaning anyone they’ve stopped. In San Diego, on the other hand, police are specifically instructed to offer first aid to all civilians, even when there is no discernable breathing or pulse.
In Chicago, where Horton died, the rules are far less clear. Police there are trained in CPR, portable defibrillator use, and wound care. But when asked about when police are required to use first aid training, a department spokesman responded, “Not applicable.” In Chicago police and fire are dispatched together, he wrote, so emergency medical personnel are on scene.
There’s no national database tracking these incidents, but our investigation found at least 32 cases since 2010 in which police officers delayed or failed to offer emergency first aid to people who subsequently died from their injuries. In roughly half of these cases, the officers involved remained on the force.
Some of these deaths have become well-known: Philando Castile, Eric Garner, and Freddie Gray all died from injuries suffered during encounters with police, prompting questions about whether officers on the scene could have saved them. So did George Floyd, whose killing by a Minneapolis police officer, Derek Chauvin, kicked off unprecedented protests nationwide.
Advocates for police reform say the lack of accountability in departments’ first aid policies is indicative of a deeper problem. Not only should police avoid excessive force, they argue, officers should make every effort to save lives, especially ones they’ve put at risk.
For some in law enforcement, it’s not a simple proposition. Historically, police departments have followed an unwritten policy of focusing on law enforcement duties and leaving first aid to firefighters or paramedics. Medical training is often cursory at best and rarely addresses the difficulty of transitioning from using force to providing aid, leaving many officers feeling unprepared to render help.
Yet expectations about police actions are starting to expand. There are still no national standards for first aid training, said Tracie Keesee, co-founder of the Center for Policing Equity, which uses a data-driven approach to police reform. “What there is, though, is a recognition industry-wide that you have a duty to do something,” she noted.
When that duty goes unfulfilled, she added, communities are left with questions. “They want to hear whether it’s training, lack of training, no policy, or whether or not you, as a human, have value for life.”
Medical experts say the first moments after a traumatic injury often determine whether a person survives. With every minute that passes, the efficacy of any intervention decreases; even a three-minute wait for an ambulance can be too long.
In 2010, Carmen Torres, drove her SUV against traffic on a one-way street that led to the now-closed Long Island College Hospital in Brooklyn, New York. Her 11-year-old daughter, Briana Ojeda, was having an asthma attack. When a police officer, Alfonso Mendez, blocked her car, Torres asked him to give CPR to her daughter. A witness said that Briana’s lips were blue, but Mendez refused to help. “I didn’t feel safe putting my hands on someone without actually knowing what I’m doing,” he later testified.
Briana Ojeda died from the asthma attack and Mendez was suspended from the force. Her family sued the city, the New York Police Department, and Mendez in 2010, alleging that Mendez should have assisted her, but the case was dismissed because there is no legal right to medical care from police unless a person is officially detained.
In 2017, Governor Andrew Cuomo signed Briana’s Law, which requires NYPD and state police officers to receive CPR training at the police academy and to get retraining every two years.
But that type of training doesn’t always translate into action in the field, police explain. For one thing, the Houston Police Department told us, officers have to ensure that a crime scene is safe before they can start giving aid. “Once treatment begins, officers may quickly lose any tactical advantage due to the fact they will be kneeling or crouched and/or have their attention diverted,” Police Administrator Melissa Cummins wrote in an email.
Allegations of police neglect across the country
In 2013, police officers tried to arrest Barrington Williams for selling illegally discounted trips on the subway. He ran, and officers eventually caught him. Handcuffed and gasping, Williams told them he had asthma. They rolled him on his side, but did not provide any first aid, and he died. The city paid Williams’ mother a $2.6 million settlement earlier this year.
Fort Worth, Texas
When police pulled over Alisha Trevino and her boyfriend in 2015, she swallowed a small baggie of meth. As she sat in the back of the police cruiser, Trevino vomited twice and began convulsing, but officers thought she was faking. She became unresponsive. Officers radioed for an ambulance to come on a “slow roll”—meaning no lights or sirens—because they still thought she was faking. It took 15 minutes to arrive; Trevino’s heart stopped on the way to the hospital.
San Jose, California
On July 4, 2016, a cousin called 911 when he found Anthony Nuñez, an 18-year-old, bleeding from the head after a suicide attempt. When police arrived, they said Nuñez came to the door and pointed a gun, which a witness later disputed. Two police riflemen stationed across the street shot Nuñez. Officers handcuffed him and cleared the house before allowing paramedics to approach. He was pronounced dead at the scene. His family sued, alleging the officers used excessive force and denied Nuñez medical care. A federal jury awarded the family $2.65 million in damages.
In November 2013, police responded to a call about a disoriented man holding a knife. He was Jason White, a 31-year-old Iraq war veteran whose family said he had returned from deployment extremely traumatized and fearful, and had taken to carrying knives for protection. White tried to flee, but police approached him and shot him during the encounter. Though White collapsed, the closest officer fired two more shots. One officer rolled White onto his stomach and handcuffed him; none attempted to provide first aid. The ambulance arrived fifteen minutes later, and White was pronounced dead.
Police out on routine patrol tried to arrest Freddie Gray because he ran when he saw them. After a brief chase, officers caught and handcuffed him. According to the police, he asked for his inhaler, a request they ignored. After making a stop, the officers loaded Gray into the police van on his stomach, head first, without buckling him into a seat belt. The van made three more stops before arriving at the station; in that time, Gray suffered a severe spinal cord injury. He was taken to a hospital, where he later died from his injuries.
St. Paul, Minnesota
In the summer of 2016, Diamond Reynolds broadcast a live video on her Facebook page of the moments after a police officer shot her boyfriend, Philando Castile, during a traffic stop in a suburb of St. Paul. The dash cam from the police cruiser shows that the officer who shot Castile never gave him first aid. Other officers, who arrived three minutes after the shooting, pulled Castile from the car and started chest compressions until an ambulance arrived a couple minutes later. Castile died from his injuries.
No federal law mandates that officers provide first aid directly, and the courts have been reluctant to examine the issue. A case involving Jason White, a 31-year-old Iraq war veteran in mental distress who was shot and killed in 2013 by police officers in Columbus, Ohio, was appealed all the way to the U.S. Supreme Court last year. A circuit court had ruled that if officers call an ambulance, they’ve met their responsibility to act. The NAACP Legal Defense Fund disagreed, and urged the Supreme Court to intervene. The high court opted not to hear the case, leaving the lower court ruling intact.
The loved ones of people killed in encounters with the police often file lawsuits based on the Fourth and Fourteenth Amendments—which guarantee the right to be free from excessive force and to receive adequate medical care while detained by law enforcement.
Requiring officers to provide first aid after using force is essential to improving the relationship between the community and police, said Christy Lopez, a professor at Georgetown Law who served in the civil rights division of the Department of Justice under the Obama administration, which used the federal courts to demand local police reforms.
Lopez pushed for those court consent decrees to include the first aid requirement, but says under Trump, enforcement of these reforms faltered. She still thinks first aid should be a priority for effective police reform, both to “minimize the harm of the use of force” and “to signify to officers the sanctity of life must be central to policing—no matter who the individual is or what they have done.”
Even with the right policies on the books, police training can be lacking. The United States has some of the world’s shortest training requirements to become a police officer—just 6 months of training for a recruit in Los Angeles, for example, versus two to three years of training in London.
Often, officers’ only training in first aid happens during their time at the academy. Of the 50 departments we contacted, 37 said they provide first aid training to recruits, but only 20 among them said they offer refresher courses, and only 14 departments require officers to attend them. Most didn’t answer the question. Seven departments didn’t respond to our outreach at all, even after we filed public records requests.
The Tulsa Police Department is an outlier in its approach to first aid, providing 32 hours of training and a specialized unit of officers who are also licensed paramedics or EMTs. Anthony First, who oversees the department’s medical training program, says he saw the department’s 2014 initiative to equip officers with the overdose-reversing drug naloxone as an opportunity to go beyond the first aid basics required by the state. Collaborating with local colleges, First implemented a new approach based on military-style emergency first aid, known as tactical combat casualty care. All officers now go through a training program that includes the sights, sounds, and smells they may encounter in an emergency situation.
“Every second our officers try to remember what they learned five years ago, that’s more red blood cells the patient loses and the closer to death they are,” First said, explaining the goal of the training is to make the first aid response automatic.
“We can’t afford to have you think about it,” he added. “Just do it.”
Since the updated training program began, First said, Tulsa officers have been involved in at least 400 incidents where they saved or profoundly impacted the outcome of a critically injured patient. He also says that his officers routinely use some component of this training several times a week.
Shortfalls in training can easily lead to harm. In the fall of 2014 rookie NYPD officer Peter Liang was patrolling the darkened stairwell of a Brooklyn public housing building when he was startled by a noise and fired his gun. He did not realize he had hit someone, but soon found Akai Gurley, who lay bleeding, struck by a bullet that had ricocheted off a wall and into his chest.
Liang and his partner did not attempt to provide aid, instead stepping around Gurley and his girlfriend, Melissa Butler, and continuing down the stairs, prosecutors said. So Butler, coached by an emergency operator speaking to her neighbor, performed CPR on Gurley until an ambulance arrived. He died from his injuries.
At Liang’s subsequent trial for manslaughter, he admitted that he did not feel qualified to perform CPR, even after going through training as a recruit. Testimony from his partner and a police academy classmate revealed a cheating scandal in the NYPD academy, where officers were certified in CPR despite never practicing on a dummy or even opening the textbook.
The first aid instructor was ultimately placed on administrative duty and the department conducted an investigation into the training of Liang’s cadet class. According to news reports, the department retrained more than 5,000 officers as a result of the scandal.
The question of how police handle the fallout from their own use of force has particular resonance in Black communities. Research has shown that police violence is a leading cause of death for young Black men in America, who are more than twice as likely to be killed by police than white men. So Black people are far more likely to be the ones who suffer if police don’t know—or don’t use—first aid.
Images of police officers inflicting grievous harm and then failing to help their victims invoke a long history of racial violence. In Ferguson, Missouri, after Darren Wilson shot 18-year-old Michael Brown, he and other officers left Brown on the asphalt in the August heat, in plain view of his family and friends.
Better policies and training aren’t enough to change the psychology of policing or the systemic racism that often undergirds it, said Philip Stinson, a professor of criminal justice at Bowling Green State University in Ohio who studies police use of force.
“We’ve got to deal with the institutional racism,” Stinson said. “We can’t train our way out in a four-hour training session of the fear that cops have of Black men, of Black boys.”
The killing of Floyd, a Black man accused by a shopkeeper of using a fraudulent twenty-dollar bill, showed what is at stake. Chauvin, who has since been fired by the Minneapolis police department, used a department-sanctioned chokehold as he tried to arrest Floyd, kneeling on his neck for nine and a half minutes.
The department’s policy on the use of this kind of force is clear: If at any point in the use of this restraint an individual becomes unconscious, the officer should immediately call for emergency medical services, and “check airway and breathing—start CPR if needed.”
Yet bystander videos and body camera footage show that Chauvin continued to hold his knee on Floyd’s neck, ignoring Floyd’s cries of “I can’t breathe” as well as the cries of bystanders. Even when a woman identified herself as an off-duty firefighter and urged Chauvin to check the pulse and breathing of the motionless Floyd, the officer remained kneeling.
Switching gears after a use of force can be challenging for officers, says Frank Straub, director of the Center for Mass Violence Response Studies at the National Police Foundation, which researches police practices. Still, he notes, there’s no adequate explanation for Chauvin’s behavior. “Until help arrives, they have to flip that switch and switch modes completely,” he said. “Some officers under some circumstances can do that incredibly well. And other officers don’t have the ability to do that because of the overwhelming nature of what has just happened.”
For Walker, the Chicago cop who shot and killed Marlon Horton, that switch never happened. He would not comment on the shooting. But in his deposition for the lawsuit filed by Horton’s family, Walker told attorneys that he tried everything in his power to avoid firing. “Don’t misread this situation,” Walker testified he pleaded with Horton. “I’m going to put you down.”
Walker admitted he did not try to help Horton, testifying that he was not trained by the Chicago police to provide first aid directly. He said he knew that he had to call 911 and request an ambulance.
His boss, then-police Superintendent Garry McCarthy, defended Walker’s actions in a press conference.
“At the end of the day, the officer called 911 to report what had occurred, which is providing medical assistance,” McCarthy said. “Comforting someone who you were just in a life and death confrontation with is not an easy thing to do.”
Ultimately, the city settled with Horton’s family for $900,000 in 2019. Walker faced no discipline for the incident, according to research by the Citizens Police Data Project, and is still a Chicago police officer. A spokesperson for the department declined to comment on its response to the incident.
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Other cities are starting to rethink—and reform—the way their officers respond to medical emergencies. Tucson Police Chief Chris Magnus said that departments need to broaden the scope of what they consider competent policing to include more than just tactical and firearm proficiency and, most critically, hold officers accountable for meeting that updated standard.
To change the culture of a department, he said, “you normalize and create expectations about other aspects of what professionals do in a situation.” The idea of saving lives, for example, Magnus said, “that becomes part of what a professional does.”
The Tucson police department was recently tested on this issue when three officers failed to help 27-year-old Carlos Ingram-Lopez, a suspect in custody who was restrained face down for 12 minutes even as he began struggling to breathe. Though the county attorney’s office declined to prosecute the officers, they no longer work for the police department. The three resigned, but Magnus said the department would have been justified in terminating them because “they violated policy and training.”
Despite the lack of consistent policies and training among police departments, Daniel Harawa, who petitioned the Supreme Court to hear Jason White’s case as a lawyer with the NAACP Legal Defense Fund, sees a way forward.
There is a constitutional basis for requiring police officers to provide aid, said Harawa, who runs an appellate clinic through Washington University in St. Louis. But the question of police officers’ responsibility to provide first aid after using force has not been as robustly explored in case law, he said, as issues like excessive force or a prisoner’s right to medical aid.
“There is no other person that can use violence in the way that police officers are allowed to use violence to do their jobs,” he said, and that means officers must also be able to pivot and provide aid when required. The federal government has started tracking officers’ use of force to hold them accountable, he said; it should also track what they do in the moments after using force.
For now, however, officers will continue to find themselves in life-or-death situations that demand a quick response. For Magnus, there’s no question—the highest priority of every police department should be the sanctity of life.
“If you have a police department where that isn’t the case,” he said, “I think you have a real problem.”
Research assistance by Mary Retta. Taylor Elizabeth Eldridge is a Knobler Fellow at Type Investigations.