A recent article in EMS1 by Jim Morrissey, a tactical paramedic for the San Francisco FBI SWAT team and founder of the Tactical Medical Association of California, lays out the changes that have occurred in the last decade when dealing with situations such as active shooters.
Due to what Morrissey perceives as a shift in doctrine where pursuit of an active shooter is sometimes done before SWAT team arrival and all tactical personnel are being provided with basic medical training, there is an increase in the inclusion of a dedicated tactical medic on SWAT teams and collaboration with local EMS and hospitals.
With this shift, says Morrissey, rescue task forces are becoming more prevalent. “A rescue task force is a trained, but hastily formed group of EMS medical providers (private and/or fire based) that partner with law enforcement on scene,” says Morrissey. “They will enter a newly secured area, such as an active shooter incident, to provide triage, emergent care and casualty extrication.”
Similar to tactical medics, rescue task force (RTF) team members correspond with local law enforcement during not only the active event, but also training and planning.
Although they receive body armor and helmets similar to tactical medics, RTF personnel continue to wear their daily uniform, as they arrive at the scene midway through their shift, says Morrissey.
Unlike in the past where emergency personnel worked out of a safe staging area removed from the action until the scene was secured, the RTF can intervene immediately.
Morrissey identifies four means of providing medical care during these situations:
a) Bystanders and victims providing care to each other before responders arrive.
b) Police remove victims to a safe EMS staging area.
c) Police secure the area and provide on the spot treatment for critical care.
d) Police bring in RTF medics under a force protection model.
“The RTF concept is becoming more widespread and adopted nationwide,” says Morrissey. “However, fire departments, local EMS providers and law enforcement need to collaboratively train, drill and develop procedures and protocols for this concept to be effective.”
Tactical medics, on the other hand, travel with the SWAT team and may be involved with all elements of the operation, including planning and briefing. Once on scene, the tactical medics can act as correspondents with the local EM to arrange an ALS ambulance stage. “The tactical medic is the logical liaison to the on-scene EMS assets that support law enforcement operations,” says Morrissey. “Typically, the tactical medic will have a face-to-face meeting with EMS units.”
The role of tactical medics can range from dispensing bandages and OTC pain medication to life saving support for police and emergency personnel and initial medical care for victims, bystanders and perpetrators, says Morrissey.
Sometimes, an existing member of the SWAT team may be sent for medical training, although Morrissey feels that “that may be a workable solution; however, it is unlikely those individuals have the medical experience and patient-assessment skills needed to be the best medical practitioner in high-risk, high-stress situations.”
He identifies the following models for incorporating medical contingency plans in law enforcement operations:
“Officer, agent or trooper medic
A sworn law enforcement officer has dual roles as an operator and medic; they have law enforcement powers and can certainly protect themselves from potential threats.
Agency contract
The law enforcement agency has a contract or memorandum of understanding with a local EMS agency to provide up-close medical care. Some agencies put these contracted medics through a reserve officer school so that they can be armed as police.
Individual contract
An individual or a team are under contract or memorandum of understanding with the law enforcement agency for providing medical coverage for SWAT missions and training.
ALS stand by
In this outdated model, there are no tactical medics attached to the law enforcement team, but police will stage a standard ambulance some distance away to respond to the scene after the scene is secured by law enforcement.”
For emergency personnel interested in more information, Morrissey recommends the NAEMT Tactical Combat Casualty Care (TCCC), Tactical Life Saver and the International School of Tactical Medicine, which offers a two-week program for medical professionals to work with law enforcement.
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