Into battle with no medical services
Based on the fact that the police have direct access to the advanced trauma capacities of the army, I regard their relative excess mortality after injury as a result of challenges inherent in the police’s own pre-hospital practice.
The time immediately after a trauma, «the golden hour», is crucial for the patient’s survival (3). In Afghanistan, the police operate in an environment where external medical support/reinforcement cannot be counted on. Pre-hospital medical preparedness in the police force thus depends on solid medical competence and the availability of basic medical equipment among all police officers.
Police training in Afghanistan encompasses eight weeks at a «basic patrolman course», including half a day of first-aid training (personal communication, Colonel Dr Fazekasof the Hungarian Defence Force and head of ANSF Medical Development Branch of ISAF Regional Command North). In addition, according to Afghan guidelines, each police officer should be issued with personal medical equipment/first-aid kit (tourniquet, pressure bandage and nasopharyngeal tube). However, actual first-aid skills and access to medical equipment in the Afghan army have not been systematically investigated.
My observations of the medical training provided during the «basic patrolman course» made me doubt whether this course was suitable for providing the police students with necessary basic first-aid skills. Moreover, a considerable proportion of the police officers with whom I later spoke in Mazar-e Sharif stated that they had never undergone any kind of first-aid training, despite the fact that they had recently completed the «basic patrolman course», and none of those whom I spoke to reported having access to personal first-aid equipment. During ISAF’s half-yearly public health conference in Kandahar in the autumn of 2013, I heard of similar experiences from the other regions of Afghanistan.
The Afghan police operate in a very violent environment. There is reason to assume that a large number of Afghan police officers are exposed to a risk of violence on a daily basis, without having real access to basic medical preparedness. Such absence of medical services carries an unacceptably high human cost, and also serves to render the police force less robust.