Tactical EMS a pointless waste of time and resources?

[sledogg1]

Took the course with FBI/Sheriffs dept in Grand Rapids Michigan great course but not used up here in NS.

[medic001918]

I'll give Tactical EMS the benefit of doubt for now, as it'd make sense to have EMS on standby for situations that have high risk in GSWs.

A question I'd ask is: Is there a difference in effectiveness among different levels of medical providers?

Having an ambulance on standby so they are there for immediate service and having them involved in the actual operation are two different things. Medicine shouldn't be practiced in a hot fire zone. The most appropriate action is to extricate the person (officer or civillion) to a safe zone for treatment. The only thing starting to do any form of treatment in the hotzone is run the risk of increasing the number of victims.

Seastrat, a well written first post. Kudo's to you. While being familiar with your medics is a benefit, and having them familiar with you as well. But you should be competent in the medics in your area in general. If you're not, or if there are issues with certain crews; then these are issues that need to be addressed between agencies. In my opinion (while lacking a great deal of knowledge in law enforcement), I can say that from a medical point of view, having a provider in the hot zone is not an effective use of resources. Extraction is the key to minimizing losses and damages. Any delay while in a hot zone is potentially adding to casualties.

Shane

NREMT-P

[DwayneEMTP]

seastrat, that was an amazing post!! And unheard of for a first post...Thanks for the info.

You know the reason I've never had any trouble making fun of TEMS (TOMS) is that they always sound like cavemen when they post...There was certainly nothing ignorant or macho about your post. You have made me pause and take another look...

I look forward to your posts in the future.

Dwayne

[FormerEMSLT297]

I think Seastrat hit the nail on the head. The idea of using tactical medics is simply this. Do you want an EMT (or P) running into a hot or warm zone without any type of training?... No you don't, so you train a team member or civilian medic to provide BLS or ALS care while in a potentially hostile environment.

The Tactical medic is also a PMT (Preventive Medicine Tech), like the navy corpsman who wraps or moleskins a marine company before a forced march, or provides basic NSAIDS or minor pain meds after the march.

The other thing that he mentioned is the LEGAL aspect. If a suspect gets shot, or injured seriously, the agency standard that most lawyers want to see is an immediate ability to provide care. If you dont have that and the suspect dies, the ambulance chasers will claim you faild to provide aid in a timely manner. So that an additional reason that the tactical medic is there....

As for any research papers I know of several instances where a tactical medic made a diference, so I would call for further research on the topic before we TRASH the tactical EMS concept.

Former

[seastrat]

I hope I didn't come across as trashing the "regular" EMS in my area (they are great) it's just that they don't see a ton of GSWs, and there is a varied level of experience on the average unit. We tend to pick "seasoned" medics who have worked in nearby big city systems and have seen tons of bad penetrating trauma. The day I get shot, I want the medic working on me to almost be bored with my injury she's seen it so many times. It would be a lot to ask a rookie medic to do well in a super high stress situation like that, especially if his unit was split and he was solo.

And as far as the security issue of sharing our info with the "regular" medics, we tend to be a little paranoid (not always a bad thing in our world), and we don't even always tell the local police what we are doing sometimes until minutes before we do it. Not that we don't trust "regular" cops & medics...but we don't trust them. We've executed on targets that involved both EMS personnel and local police officers, so we kind of tend to stick to ourselves with our info. Having TOMS on the inside just gives us the edge there, because we know we can trust "our guys:" we've backgrounded the hell out of them, we see them every month at training, and they are putting themselves in the risky places right along with us. Operational security is part of their "everyday" because they don't want to get hurt any more than any of us.

A couple of years ago we had patrol assist us when we executed a narcotics, gambling, prostitution and weapons search warrant on a night club that turned up empty when we got there...cigar smoke lingering in the room, drinks and cards on the table, one chair overturned, recently flushed toilets: you get the picture. Without revealing details, suffice to say Internal Affairs had their hands full with that one, and issued lots of subpoenas to cell phone carriers. Since then we collect cell phones from non-team personnel (including patrol cops and D.A.s) on senstitive ops before mission briefing starts. Our medics, on the other hand, keep their phones.

And you are 100% right about that Preventive Medicine Mission, Former Lt. Our guys do a full physical with our MD on every team member and file a baseline 12 lead on each guy. It's pretty personal: they ask about every hang nail you ever had and how many times you pee at night. The bonus is that when you have to make a trip to the ER, you have all the answers available. If you take one in the vest, there's a baseline EKG so you can see the changes from a cardiac contusion. Last year, they found a bundle branch block on of our guys he never knew he had. And with the advent of all this chem/bio stuff (we are now mandated to train for CBRN events), we know that there are two guys who are allergic to Cipro (so no anthrax for them), and one guy has a mild eye pressure issue (so cautious use of Atropine in him during the organophosphate event, because Atropine increases ocular pressure). No way we'd know any of that stuff about our guys without our medics, and indiscriminate use of one of those 2-Pam/Atropine autoinjectors kits might make one of our guys blind -- not exactly a "win" for us.

And since they maintain those records, we have them store all the emergency contact data, too -- they get pretty detailed there, too, & include info like where my wife works and what police department covers that area (and their number), so we can call them and ask them to send a car to get her & zip her out to the trauma center if the day turns out badly.

They also do rehab and 'fix" minor injuries that otherwise might take an operator off line. We have 34 guys which sounds like a lot, but really isn't if you have a barricade/hostage. We need every guy functioning 100% to do that job right (containment, sniper/observer, entry, rescue, etc.). A guy who maces himself accidentally might be done for the day -- but with our medics it's two drops of Tetracaine, a serious chops-busting and he's back in the game.

It's really just a lot of "little" stuff that will catch you off guard that our medics help prevent against.

[medic5880]

Seastrat - you do have some good points and I agree with much of what you have to say.

I have been a paramedic for more than 25 years... of which, I have participated in both training and operations of the tactical variety. This has included supporting a variety of operations to include: cannibas eradication missions, high risk warrant, barricaded subject (with and without hostages, EOD, VIP protection, and special event stand-by (national security events).

I offer the above not as a boast but as evidence of participation to the point of being able to make some informed judgments and decisions.

What I see as the biggest problem in tactical EMS is the the fact that the term itself has not been defined as a specialty and has a miriad of interpretations of baseline skills and competencies.

What I do see as beneficial with immediately measurable results is the esprit de corps and level of comfort found in Special operations teams with integrated EMS of any type. I also have personally seen a great deal benefit from the "tactical medic" performing pre-planning and or creating medical threat assessments for both training and actual missions. I imaging that most of the medics would agree that we tend to treat more during training than any other place... of course with the rare serious injury or incident being mostly within real missions.

For an off the wall comparison, I would suggest that having tactical medics is a lot like forcing all persons going to and from a doctors office from a nursing home to take a paramedic staffed and expensively equipped ambulance. Just because of the "what if? question.

I prefer to call tactical EMS the necessary and expensive evil resulting from good risk management. We must try to control our risk - especially when we know that there are missions that have moderate potential for serious injury.

[seastrat]

Medic 5880: I hear you that it costs a lot, (I do the budgets every year. All togeter the medics cost about $40k last year) and it may be sort of like taking an paramedic unit to & from the doctor's office for a distant "what if"...however from the law enforcement side, we look at it from the angle that we are potentially using some pretty heavy duty force, and the only reason we're using that force is to make the world a safer place. If we might create a serious problem for someone, we'd best have a pretty good plan to fix that problem. We're all about the safety of everyone involved (otherwise, why would we wait outside the single suicidal barricaded gunman's house trying to talk him out?)

I think an understanding of police "Use of Force" rules might help. Contrary to what many seem to think, in fact, we (the police) don't shoot to kill. We shoot to stop -- that is: shooting to stop the suspect from engaging in whatever criminal behavior they are involved in, where the use of deadly force is authorized & for which there is no more peaceful solution. Don't mix this up with "shoot him in the leg" thinking: if we pull the trigger, the behavior has to be bad enough that we are willing to kill. The reality is that aiming and accurately firing a gun is quite difficult under stress, so we only aim at "center mass of the target offered." (This means if I can see all of you I will aim in the middle of your chest. If I can only see your hand, I will shoot at the middle of your hand.) There are some small exceptions for snipers shooting at weapons to disarm suspects and taking out hostage holders, but 99.9% of the time the 1:Shoot to Stop, 2: Aim Center Mass, 3: Only Fire if You are Willing to Kill rules apply. We don't shoot to disable, but more importantly, we are never shooting with the intent to kill. We just want the badguy to stop what he's doing and we are out of other options, or our other options would clearly be ineffective. This not-shooting-to-kill thing is an important distinction.

What does this Use of Force stuff have to do with Tactical Medicine? The medics come into play as soon as that trigger press is released. The primary function of any team is to make an area safe for others. As soon as that suspect stops engaging in the behavior that earned him a gunshot wound, the responsibility of SWAT is to make the area safe even for the suspect. We are obligated to make the place safe for him by ensuring that he has adequate care. It may be expensive for us to bring high tech & high speed medics with us every time, but mere expense is an argument would also have you stripping my M-4 of its night vision scope just because the chances of my shooting someone at night are pretty low and I haven't had to do it yet. For that matter, I've never had to shoot anyone even with my pistol, so under the expensive-and-not-often-used argument, I'd probably have to ditch those, too. Actually, I'd have to ditch the guns before the medics: my medics treated a couple of dozen patients last year (a couple were even critical) and my team didn't even fire a single shot (well, except for that accidental discharge in the roll call room, but that's a story for another thread).

Since we rarely go to an assignment with less than 1,000 rounds of ammo total, we'd have a tough time asserting in court that we didn't have some idea that we might be involved in something where somebody got hurt. Plus, our average is that there is an injury or sudden illness on 1 out of every 3.5 missions or so, and a critical injury at least once per year. Clearly we should expect to need our medics when we head out. If we deployed without them, we'd be opening ourselves up almost no matter what the cost to have them tag along.

And considering that a jury will likely hold me highly accountable if I shoot a bad guy (or worse I miss and hit a good guy accidentally) and he dies without care from a GSW that he would have survived if he'd had rapid care & transport, I'm more than happy to see a chunk of my team budget going to protect, among other things, my financial assets from a needless lawsuit. "Surviving" a shooting means more than coming out the other end still breathing.

I'm confident that my medics stand ready to keep me safe beyond just keeping my blood pressure from falling below 120/80 if I spill some of my blood in the street. They'll also help keep my blood pressure from going over 220/180 by keeping me from the stress of getting sued if I spill somebody else's blood, too. And that's worth a lot to me.

[copamedic1]

I don't usually post articles, I'm better off reading them. I feel Ineed to chime in a little on this one.

I've been in ems for about sixteen years, the last ten as a paramedic, about that time ,I also gpt involved with our local police dept.,when they decided to assemble a swat team. We are a small town in rural mississippi, but we are a university town, so there a lot of ethnic diversity. to cut to the chase, I've been with most of the same guys since the onset, we have had a turn over, and new people come on board. I train tactically with the team, I know how to handle firearms of all types. I know my officers medical history as well as the family dr does. they know me and they trust me, I'm not the world's best medic, but to them I am. During training, it's like being a trainer for a sports team.

TEMS is probably over machoed, if that's a word. But the officers I work with like having me around.

[Dustdevil]

Plus five for a great post.

I think you just said more to put the job into true perspective than any of these shake 'n bake "tactical medic" schools ever do.

It's about TEAMwork and being there for your team. All that other GI Joe stuff is just television bollocks.

[Eydawn]

seastrat, thank you so much for teaching us about some of the realities of TEMS. I now know a LOT more than I did. Excellent. Sounds like the way TEMS should work... and I think it's a great thing that you weed out the hyper wannabees. I certainly wouldn't put ME in one of those situations... not the right personality type or maturity level yet.

Glad to have you on the forum!

Wendy

CO EMT-B

MI EMT-B