Years ago when Dr. Joe Nakagawa was among area physicians invited to get involved with the local SWAT team he made the commitment and stuck to it. That led him along a path to becoming a reserve officer and finally stepping away from his emergency room role to become a fulltime police officer. Now he leads the tactical medicine program at the Hawthorne (CA) Police Department.
Nakagawa, 48, graduated from medical school at University of California, Los Angeles, where he completed his residency and training in emergency medicine. He first started working in an emergency room 17 or 18 years ago. About 15 years ago Nakagawa signed up to assist the SWAT team, but soon learned other doctors were not as free to participate when needed.
“Our experience was that doctors in general can be unreliable and have other priorities. It's hard to get them out there,” Nakagawa said. “So, I started training the SWAT guys to be basically like ad hoc medics to provide some medical care. This was before tactical medicine and TCCC (Tactical Combat Casualty Care) was a thing in the law enforcement world. So that model was pretty successful.”
Nakagawa explains the 20 or so officers on the SWAT team became highly trained, including some who certified as EMTs, but the other officers of the department did not receive such training. To remedy that, the Hawthorne Police Department Tactical Medicine Program (TacMed) grew past the boundaries of just the SWAT world.
“Instead of just having a few highly trained guys, we thought the model should be we train everybody with a little bit of something, which is exactly the TCCC model that ended up getting adopted by law enforcement,” says Nakagawa. “So since then, we've trained up all 100 officers plus basically all our civilians and teach TCCC with tourniquets, wound stoppers, CPR, and first aid, so they're all pretty highly trained almost up to EMT level.”
After working closely to train Hawthorne officers for several years, Nakagawa’s interest in police work grew. As a result, he completed the reserve academy and became a reserve officer for Hawthorne. He wore that hat from 2009 to 2020, but then wanted more.
“Then as our program got bigger and bigger and I liked it more and more I decided just to go full time here at Hawthorne, so I got hired on as a patrol officer,” he says.
Initially, he started just like most officers — working patrol shifts — but remained involved with TacMed. Now as the police department’s medical director he mostly is focused on TacMed, which has grown and expanded through memorandum of understandings (MOUs) to provide training to several surrounding cities.
“I'm also board certified in emergency medical services. So, it's kind of nice to have someone who's in the medical world and knows EMS to be able to represent law enforcement interests to the EMS and fire world in California,” he says.
He admits his nickname at his department is “Doc” but that is fine with him. The doctor-turned-cop has a hand in both worlds, law enforcement and medicine. He even finds the two professions are alike in some ways.
“I keep telling people that emergency medicine, which is what I used to do, is very similar to law enforcement in that it’s really problem focused. You're sent to a problem to take care of the problem and move on to the next. It’s rewarding, because in both fields you get to go home at the end of the day and you feel like you did something,” he says.
The cop doc still works typically one shift a week in a hospital emergency room. His hospital coworkers were not surprised when he stepped away to become a police officer fulltime since he was working as a reserve officer while still at the hospital fulltime for many years.
So, why did the emergency room leave the hospital to become a cop?
“One, I just enjoyed law enforcement and I enjoyed being on patrol. But, also, there was so much going on here at Hawthorne that it was really difficult to do what we were doing and not have someone who's full time administering the program and being there. With our TacMed program we do a lot of training, a lot of education, we provide a lot of medical care out there in the community and so all that has to be overseen by basically a doctor,” he says.
In California TCCC is more commonly known as Basic Tactical Casualty Care (BTCC). Whichever term is used, one of the key components is learning to stop bleeding.
“That’s been the thing that kills people the fastest. People think you're going to die from not breathing, but you're going to die from bleeding out much, much faster. You're talking about one or two minutes sometimes,” says Nakagawa. “So, if we can teach our guys out there to put on the tourniquets, pack the wound, and stop the bleeding immediately we save a lot of lives.”
Every patrol officer at the Hawthorne Police Department is equipped with a full medical loadout with multiple tourniquets, Quick Clot gauze, chest seals, airways, AEDs, and some basic medications so they have all the tools they'll need, Nakagawa says. In addition, some officers carry tourniquets on their duty belt or elsewhere. For a smaller police department of slightly less than 100 officers, having a medical director is unique. Most times a medical director is on staff at fire or EMS departments and only at larger police departments.
“I would say in LA County, we're probably the only department outside of LAPD and the sheriff's department that has a medical director and even with those guys it's not a full-time medical director who's there all the time like we are here,” he says.
Nakagawa recently received the South Bay Medal of Valor Distinguished Service Award. The South Bay Medal of Valor Committee is an organization that hands out awards to fire and police employees across the region who performed above and beyond the call of duty during the course of the year. Nakagawa humbly says he has done nothing special and the recognition must have been for his ongoing effort to train officers.
As he talks of the days prior to officers being properly trained and prepared to handle medical emergencies, Nakagawa terms the difference as a sea change.
“Before, what we found was when cops showed up at a medical call — because sometimes we get dispatched to fire calls to save babies who aren't breathing or people with full cardiac arrests — our guys would just circle the block and wait for the fire engine to show up because they didn't know what to do. So, what we've done is we've kind of changed that mindset and the culture and given them the knowledge and the tools to be able to actually do something. So those guys are first in. They run up the steps with the medical bags, saving babies’ lives,” explains Nakagawa.
One incident that shows the advantage of training patrol officers in life-saving skills sticks out in Nakagawa’s mind. A young girl had fallen into a hotel swimming pool. Both fire and police were dispatched, but officers were first to arrive on the scene.
“We were there for at least five to seven minutes before the fire department showed up and our guys were doing CPR, hooked up to the AED, and were doing chest compressions. We revived her basically, and saved her life,” Nakagawa says.
At Hawthorne there are now four paramedics and 20 EMTs, but the TacMed program will continue to grow and expand. Nakagawa says the department will be sending additional officers to paramedic school. Plus, there is another big step in the works.
“We're actually in the process now trying to get our program certified by the county to be an official EMS provider, just like a fire department. Then we'd like very much to push out this knowledge to everybody, not just the few departments close to us, but people across the county, across the state, and even maybe nationally, so they can benefit from a lot of what we're doing,” says Nakagawa.
Although the TacMed program now impacts the community and other agencies, the reason the Hawthorne Police Department first wanted to provide more medical training to officers is rooted in an accident that injured one of its motorcycle officers in 2007.
“We went all the way from our station to where the motor went down, which is 10 to 15 minutes away, and they still hadn't loaded up, they hadn't gone to the hospital, and really nothing was being done for him. So, we wanted to be able to provide medical care ourselves and actually do something instead of being at the whim of other agencies. So that's one of the impetuses of starting this program,” explains Nakagawa.