tactical EMS

[Luno]

@Mycrofft I think that there is a way to describe this that might make sense to you. As a tactical medic, on every team that I was assigned/cross loaded to, medical was a consideration in every mission, including training. I had complete medical records for each and every team member and base line resting vitals. Why you ask? Because it's a real pain in the posterior to realize that one of your guys is IDDM 12 hrs into what was supposed to be a 2hr mission. It sucks when you have a minor concussion and laceration from a slip and fall in training and only then you realize "MFKR is on coumadin." As the TEMS guy, you are basically the medical "mom" for the team. SWAT/ERT are also often tasked with protective missions, and this is where it emphasizes the need for a medical asset. You're evaluating your protectee's medical conditions and supplying that contingency planning to the mission commander, as well as keeping your guys operational.

As a tactical medic assigned with a team inside of NOLA with boots on the ground the first of september, 2005 and not leaving until october, medical planning was huge. This was also included in our plan and assessments for different missions including the decision to shelter in place during Rita. My team (medical) brought a unique skillset to the table without sacrificing mission readiness, or capability.

As a tactical medic, attached to various teams, medical preparedness was a huge factor in everything from training to executing missions. TEMS guy was there for everything from rolled ankles in training to oversight when suspects were restrained face down evaluating for respiratory difficulty/compromise to evaluation and training for Excited Delirium. The training for self-aid/buddy aid and what is now the principles of TC3 were all instructed by TEMS guy. IFAK checks pre mission were done, and decompression post mission was done by TEMS guy. TEMS guy was the one who made sure that if the risk warranted it, that there was some medic standing by in a rig making overtime for evacuation purposes.

As a tactical medic on protective missions, TEMS guy was the one who managed prophylactic medications and dosages when they were necessary. TEMS guy was the one that had to keep someone operational when you don't have another body to fill that slot. TEMS guy had a list of the protectee's medications and their entire medical history and was the liason between whatever prearranged hospital/care facility and the team should something go wrong.

I really believe that we are all of the same mindset, but are looking at things through different lenses. I have the unique perspective of us three, as I've been in the stack and I've been instructing the principles of TEMS for several years. However, I can absolutely agree that what both of you have portrayed as your perspective holds very little value as far as tactical medics usefulness.

Again to echo Vene, it is the product of a poor system, a misguided system that we can teach a couple of monkey tricks and expect amazing results. "Fire and EMS in the US operate the same way. Everyone wants the hard core all star pro. But most can't afford it. So they get some amateur to play dress up and do the best they can." Everyone wants to play, few understand the game, fewer can fulfill the role, and there are a remote few that are good at it.

And mycrofft, I don't dislike curmudgeons, I even have a friend who is a curmudgeon...

[mycrofft]

I was only thinking about the typical urban scenario (Bedford-Stuy or Compton on a Friday night after welfare checks are in and the local basketball team is humiliated...) and didn't think about taking the role of a military Ranger team but medical and with better knowledge of civilian ROE.

Yeah, that would be uniquely perfect (and rarely exercised, but apparently more frequently as time goes on). Much better than the adolescent scenario usually portrayed. Maybe I'm "feelin' ya" now?

[BSellers]

Originally Posted by Luno

I'm not gonna shoot. But what I am going to do is provide a little bit of a lens to help "that private" focus. When looking at any "cool guy" job, rather than focusing on how cool it is, how about looking at what unique skills or abilities that you can bring to your team.

How has your life brought you to the conclusion that you would be a good fit, or even what differentiates you from the next "cool guy" who wants the t-shirt? Do you bring a wealth of patient contact and clinical time, and working in environments that they work in? Do you even understand what they do, much less what your role would be, and how you're a good fit?

Are you physically fit? Because if you are in the stack, you will be carrying a standard load out, as well as medical gear, and expected to not only move well with the team, but when they're hurt, your work starts, so if your fitness level is the same as your team, you're anywhere near ready.

How is your planning/project management skills? You're going to need to be a constant resource for that commander, not only having an idea of how to stabilize prior to evac, planning the evac, coordination with local EMS and resources, contigency planning, risk assessments, but also medical assessments for your team prior to any activity.

How are your instructor skills? You need to be able to instruct a version of TCCC to your team, or whatever you feel that your team will need to be able to perform should you not be there or are incapacitated. You may have to brief local EMS on how your operations are conducted, hot/warm/cold zones, and how patients will come from your team to their transport.

How is your understanding of finances as they impact an organization, and balancing the needs/wants of a team, as it affects your plan as the medic? There are limited budgets for most teams, and everyone wants the latest "cool guy" gadget, can you adequately define why the IFAKs for your team need to take priority? Can you sell why the medical training you need to give your guys is more important than another round in the shoot house which everyone else wants to do? Can you convince your guys that it's important?

Do you have a solid understanding of what is going on with high velocity trauma, and the skills that are needed to stabilize it until your team can exfil the patient to transport?

What is your understanding of protective operations and how medical planning fits into the operational plan?

All these questions are things that I've learned the hard way. As a tactical medic, the title is cool and you can wear the t-shirt, the reality of what I've learned is that you are a worried mom, constantly planning, mitigating risk, juggling a bunch of balls, trying to keep bad things from happening, fighting for your team, stealing everything you can't get authorization to buy, training, researching, clinical rotations to keep your p/erishable skills fresh, and if you're not on a dedicated team (very few, even fewer with medics) all that, balanced with your regular job.

All that is after you've found a team that will work with you. There is no week long course that is going to teach you this job. Any EMT can find a podunk police department with a couple of fat guys in black and velcro with M-4s and tag along, maybe even get the patch. Being a proficient tactical medic is an entire world different...

Wow… somebody who gets it. If you don’t mind I would like to share your comments to several of our new applicants to our team.

[fortsmithman]

Here in Canada I think in Ontario Their tactical EMS is a division of the EMS dept. As well the one picture I saw of the medic he did not carry any firearms whatsoever.

[Luno]

Originally Posted by BSellers

Wow… somebody who gets it. If you don’t mind I would like to share your comments to several of our new applicants to our team.

By all means, I would like to correct one thing though,
"Are you physically fit? Because if you are in the stack, you will be carrying a standard load out, as well as medical gear, and expected to not only move well with the team, but when they're hurt, your work starts, so if your fitness level is the same as your team, you're anywhere near ready."

Should read,
"Are you physically fit? Because if you are in the stack, you will be carrying a standard load out, as well as medical gear, and expected to not only move well with the team, but when they're hurt, your work starts, so if your fitness level is the same as your team, you're NOT anywhere near ready."

I've told very good medics that they were too out of shape, too fat, etc... and to come back when they were fit. You can teach someone how to do something, you can't teach them to want to be there enough to make the sacrifices.

[MackTheKnife]

Originally Posted by ThatPrivate

It says student.

That it does.

[mycrofft]

Originally Posted by Luno

By all means, I would like to correct one thing though,
"Are you physically fit? Because if you are in the stack, you will be carrying a standard load out, as well as medical gear, and expected to not only move well with the team, but when they're hurt, your work starts, so if your fitness level is the same as your team, you're anywhere near ready."

Should read,
"Are you physically fit? Because if you are in the stack, you will be carrying a standard load out, as well as medical gear, and expected to not only move well with the team, but when they're hurt, your work starts, so if your fitness level is the same as your team, you're NOT anywhere near ready."

I've told very good medics that they were too out of shape, too fat, etc... and to come back when they were fit. You can teach someone how to do something, you can't teach them to want to be there enough to make the sacrifices.

Put them in the gear and a gas mask then run them through the confidence course and then make medical decisions rapidly. Don't even need to load them up. Most will quit then and there, some can't even stand being in a gas mask or a balaklava.

[kindofafireguy]

Disclaimer: I have no experience in tactical medicine, but I knew a few who were on the team in my last area.

Every one said that you are better served with a.) LE/MIL tactical experience and b.) SWAT training than with any TEMS course. More of the guys want to know they can trust you in a stack than how many intubations you've done.

Again, just what I've been told.

[Luno]

@Mycrofft, I'm gonna disagree with that approach... It's way too easy to kick the dog out of someone to try to make them quit, but the ones who stick it out, you might not want. It's incredibly harder to invest the effort in someone that will make them realize that they just aren't cut out for the field. You can smoke someone until they're puking, but it doesn't make them any better. And most of them, (myself included) would probably just walk away from a sophomoronic exercise, since it has very little to do with actual operations.