Again, too much time has passed since my last blog entry. The past 6 weeks has been a blur of conferences, training, and work. Not to mention the fact that when I'm home I'm burning the candle at both ends trying to get my house in shape to sell (a real challenge in our current soft economy, stimulus packages or not!).

You know how things seem to cluster together? In the ER, that's just a given... some days are "suture/laceration" day, or "chest pain" day, or "gunshot wound" day. But I experienced an unusual "topic cluster" over the past 6 weeks that has really got me wondering.

The topic that's clustering for me is this: how should we be training and implementing SWAT/tactical medics in America?

Example:  the active-killer situation that took place at the Van Maur department store in Omaha in December of 2007. At least one GSW victim was still alive when police officers deployed inside the "kill zone" (the active killer has already taken his own life, but LEOs could not possibly know that, of course). Emergency Medical Services personnel were forbidden by their protocols to enter the perimeter until the scene was declared "secure", however, so these victims were not extricated in anything resembling a timely fashion. This wasn't the fault of the EMS protocols, nor of the officers on the scene. But the situation highlighted the nature of the problem, and the terrible cost of our failure to address the issue.

I am aware of many other less-publicized situations where patrol officers, SWAT officers, or civilians were trapped in the "kill zone" with life-threatening injuries but were not extricated. SWAT officers are at the scene to fight, not render medical aid. Paramedics are at the scene to render aid, not to fight. If either fails to execute their primary mission responsibility, a greater disaster could result. It's crystal clear to me that what we need in every situation of this type is a third group of people: tactical medics.

The problem I'm finding is that there is no real consensus on what a tactical medic is, or what he should be able to do. And the more I dig into the issue, the more disturbed I become. But I probably need to backtrack to explain why I'm so disturbed.

As an ER physician, I am required to maintain my certification in various lifesaving protocols such as ACLS (Advanced Cardiac Life Support), ATLS (trauma), and so forth. This involves re-taking the standardized class and passing both written and practical examinations.  It wasn't always this way, but over the past 50 years or so the medical profession has policed itself into adopting and regularly updating these standards of care. The benefit is manifest: anyone who needs ER care for their heart attack or traumatic injuries anywhere in America can be assured that the doc taking care of them has met a national standard. Because of these proven standards of care, your chances of dying from a heart attack or injuries sustained in a motor vehicle collision are a fraction of what they were in the 1960's.

As the medical director of my county's ambulance services, I am aware of similar national certification standards for EMT's. Furthermore, we have national standards for fire & rescue, disaster preparedness, and so forth.

But when it comes to tactical medicine, things are a mess. And good people are dying because of it. So how do we clean this mess up? Well, I've got some ideas.

First thing: define the job/role of the tactical medic.  As far as I am concerned, the tac-medics' role is a blend of basic EMT and basic LEO jobs. It should be to enter the perimeter of an unsecured zone, pick up the injured person, and scoot out of there. "Scoop and run", a time-honored term in EMS circles. They aren't gonna start IV's, do CPR, apply splints & bandages, although they might apply a tourniquet or clear a blocked airway... something that can be accomplished in seconds, not minutes. The tac-medic's role is to get in and out of the hot zone with the patient and deliver him to fully-equipped paramedics outside the perimeter, who can then perform the critical life-saving maneuvers without being in danger of coming under fire. On the other hand, tac-medics shouldn't be expected to take a place in the entry stack or to try to extricate personnel under direct fire. The tac-medic's role is somewhere in the middle.

Second thing: define the skillsets needed by a tac-medic. A tac-medic doesn't need to have advanced paramedic skills, nor does he need to have the tactical mindset and weapons skills of a SWAT operator. But he needs to have a little bit from both sides of the fence. A tac-medic needs to be tactically aware enough to enter a danger zone without needlessly endangering his life or that of others. Because tactical situations are incredibly fluid, the tac-medic needs to be armed and trained enough to deploy his armament in defense of his own life and that of his patient if circumstances dictate. And the tac-medic needs sufficient medical skills to perform rapid life-saving maneuvers as needed. That's it.

I don't know about you, but it seems to me that this does not require the creation of a new profession. We cross-train our SWAT team members in basic lifesaving first aid--what I call "battle-aid"--and I know many jurisdictions cross-train paramedics in tactis and firearms. What we need, then, is to agree upon a standard of training and performance that can be met by both LEOs and EMTs who have the motivation to take on this unique role.

In my admittedly biased view, a reputable national organization needs to pick this problem up and run with it. For example, the highly successful Advanced Trauma Life Support program  for doctors was developed and promoted by the American College of Surgeons. Perhaps a body such as the National Tactical Officers Association (NTOA) should consider taking on the tactical medicine problem in a similar fashion.  

The problem is complex due to the mult-jurisdictional nature of law enforcement, but if EMS and Fire & Rescue have managed to come up with national standardization for their professions, why can't law enforcement do the same for tactical medics?

 

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Screen shot of Dr. Williams being interviewed by Police One TV