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"'Sometimes [the detainees] tell [the guards], 'we not locking in becuase its too hot,' Jackson says. Such refusal has often meant calling in the Emergency Services Unit, the jail version of a riot squad. REferred to as 'the turtles' by some detainees, the ESU is known to use extreme force when bringing people back to their cells"

This policy affects the insurance coverage for some populations, so that may impact how willing people are to be transported. The policy mostly deals with IMDs though, and those aren't as frequent for emergency responders, unless the individual was trying to harm themselves.

Membership is an ongoing thing, and other countries are notified when a country joins. They may sign treaties for safe nuclear use, but this is not required for initial joining. Since there is no "completion" of the program, there is no certificate.

This article appears to be cited in a variety of different publications, from papers on managing diabetes to aging.