the tactical medic proposal for the development of a ... - NCRETAC

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Troy Osborne, EMT-P TEMS
Weld County Paramedic Services

• What is TEMS?
• Tactical Emergency Medical Support
• More than just a medical standby
• Medical providers that are specially trained and
equipped to operate in direct support of law
enforcement special operations teams

• The Law Enforcement Special
Operations community was
developed and specially trained
to handle unique threats.
• It is a life saving organization
that is called upon to handle
some of the deadliest incidents
faced by our safety forces today
• The Tactical Medic is an
indispensable element of the law
enforcement special operations
mission, and fits well within the
Police life saving goal

• “Bomb Teams” have existed for
hundreds of years. America’s
first full-time bomb team was
formed by the NYPD in 1903.
• Americas first official SWAT
team was formed by LAPD in
the 1967 in response to the ever
increasing number of major
incidents which quickly
overwhelm the capabilities of
conventional Law Enforcement.

• The Explosive Ordinance
Disposal or “Bomb Team”
consists of Officers trained in
mitigation of incidents involving
hazardous and/or explosive
devices.
• EOD is capable of working on
scene to render a device safe,
transporting a device for
explosive disruption and
investigating bombing
incidents.

• SWAT is comprised of Officers
trained in the use of special
weapons, close quarters battle
and unique tactical operations.
• SWAT teams usually consists of a
IC element, Breacher section,
Sniper section, perimeter team
and Entry / Arrest team.
• The SWAT team responds to
emergency call outs provides
high risk warrant service and
other special operations as
requested.

• The Tactical Medic may be…
• Armed
• Unarmed
• May be derived from
• Fire/Rescue
• Police
• Third Service EMS
• Military
• Various levels of qualification
• EMT-B, EMT-I, or Paramedic
• Military Medic, Corpsman or Pararescue
• RN, PA or MD

• To provide tactical casualty care to the victims of
violence at the point of wounding.

Same life saving goal, but a bit of a different approach
• Conventional EMS
• Scene size up
• Ensure a safe scene
• ABC’s of trauma care
• Emphasis on C-spine control
and airway management based
on DOT trauma standards
• Rapid infusion of large volumes
of IV crystalloids in an effort to
maintain SBP (Changing as we
speak)
• Evacuation to trauma center in
less than ten mins. Surgery
within the “golden hour”
• TEMS
• Remote assessment
• Suppress threats
• XABC of tactical casualty care
• Emphasis on aggressive
exsanguinating hemorrhage control
based on DOD trauma standards
• IV access with limited fluid
infusion allow for “permissible
hypotension”
• Evacuation to a trauma center when
situation/mission permit. Possible
need to provide extended field care

• Why do Tactical Medics dress like
ninja? Because form follows function.
• The Tactical Medic employs a wide
range of lifesaving equipment, some
familiar to conventional EMS some
unique
• Ballistic protective equipment, blast
protective ensemble, specialized load
bearing equipment, back packs, and
armored vehicles are all tools that the
Tactical Medic may employ to
accomplish his mission
• In addition to this specialized
equipment the Tactical Medic may
also employ the full range of ALS
hardware, medications and rescue
tools of conventional Fire/EMS.

Unified
Command
Law
Enforcement
Bomb / EOD
TEMS
Medical
Fire Rescue
Triage and
Transport
Fire
Suppression
Hazmat

• Many tactical operators only have rudimentary training in
emergency first aid.
• Operations within the unsafe scene are contraindicated for
the conventional EMS responder.
• It is tactically unsound to try to divert SWAT operators for a
medical mission while there is still an active threat.
• The gap in casualty care caused by the unsafe scene and the
extreme danger facing our officers and communities in
violent situations establishes the need for tactical medical
support.

• Emergency medicine is our
primary focus
• No role confusion
• Medical skills remain razor
sharp
• We bring our rescue expertise
to the Police operation.
• We possess the specialized
training that tactical
operations require
• We are able to go where the
police go

• In its most basic form TEMS dates back to ancient times.
• There has always been a need for field medicine and the
immediate care of wounded soldiers.
• Much of what modern medicine has learned about field
trauma care has come from the hard lessons learned during
armed conflict.
• Today’s Law Enforcement TEMS providers trace their
heritage back to the foundation laid by history’s special
operations forces medics.

• The Los Angeles County Sheriff’s
Department was the first to fully
integrate Medics into their SWAT
Team in 1970.
• Today Tactical Medicine has
developed into a highly
specialized and essential segment
of Law Enforcement.
• TEMS has become the
standard of care for emergency
medical response to violent
situations.

• Immediate on scene care can decrease preventable
death at the point of wounding
• Providing for the medical needs of innocents,
officers and suspects can improve the police
liability posture
• Tactical Medics are an internal asset not an outside
resource

• Failure to meet the standard of care
• Undue risk to Officers and public
• Deliberate indifference of a Government
Entity
• Abuse of power resulting in injury/death

• Team health management:
• Preventative evaluation
• Health and fitness education
• Monitoring Officer health issues
• Maintaining vaccination records
• Maintaining confidential medical
pre-plans
• HX
• Blood Type
• Allergies
• Current Medications
• Emergency contact numbers
• Religious preference
• Establish a baseline 12 lead ECG and
re-check semi-annually or PRN

• Planning:
• Pre-planning direct and alternate
routes to trauma centers.
• Planning for transport to
hospitals in MCI
• Requesting/Directing air
medevac
• Knowing the specific capabilities
of area hospitals
• Anticipating med-threats to
Operators
• Acting as a liaison with local
Fire/EMS resources
• Pre-deployment health checks

• Training:
• Planning for Police/EMS interoperability
• Rehearsal and development of special
rescue tactics
• Weapons familiarization
• Polishing medical capabilities
• Scenario training with teams
• Scenario training with external resources
• Planning for and drilling on worst case
scenarios to improve operational
capabilities
• Providing health education and training
in emergency first aid to police operators

• Operations:
• Monitoring Officers in inclement
weather
• Acting as the Tactical Commander’s
Conscience
• Medicine across the barricade
• Conducting remote physical
assessment
• K9 and SAR animal care
• Providing emergency decon
• Ensuring evidence is preserved
• Rapid extrication and CASEVAC of
the wounded when possible
• The highest quality ALS in places in
hostile environments
• OTC Medications for team issues

• According to the U.S. Department of Justice Uniform
Crime Report
• An average of 50-60 Officers are feloniously killed per
year
• An average of 18,000 others are injured as a result of
assaults that occurred in the line of duty.
• Tactical Officers sustain casualties at a rate of
approximately 30 injuries per 1000 Officer-missions.
• In addition to these morbid numbers the Police also lose
approximately 300 Officers per year to suicide.

• An estimated 90% of those who are killed in combat die in the
field, before reaching surgery
• 14% Catastrophic injury causing immediate death
• 60% Exsanguinating hemorrhage
• 10% Pneumothorax
• 6% Airway related problems
• A quick survey of these statistics reveal that nearly 80% of combat
fatalities are dying of treatable causes.
• The development of advanced body armor, and weapon systems
with incredible stand-off distance has helped prevent many fatal
injuries, but it has not completely eliminated the need for direct
mobile field medicine.
• In trauma time is everything. The purpose of the Tactical Medic is
to go where other medical assets cannot, to provide care under
fire, to save time, to save lives.

• To train hard
• To make a difference in
the lives of those that
they serve with.
• To keep innocents and
officers from dying
when wounded