tactical EMS

[Veneficus]

Apparently our SWAT team has a EM Physician who regularly works calls. I guess he got bored and wanted some adventure.

Or he recognizes having some level of onsite surgical capability will make more of a difference than some camo wearing yahoo with a TK and some quick clot.

 

[Handsome Robb]

Apparently our SWAT team has a EM Physician who regularly works calls. I guess he got bored and wanted some adventure.

The teams here have a pair of physicians that will respond to some call outs or go to trainings. Doesn't always happen but from my understanding it isn't totally unheard of to have them suited up and in the warm zone in the APC.

Definitely threw me for a loop during the TEMS testing when he ID'd himself as the SWAT MD and asked for a report and my triage, then made me explain why. Nothing different from giving a report to a trauma doc, just caught me off guard.

I agree it doesn't make sense for PD to pay to maintain a medic, plus how competent is that medic going to be if his primary job isn't EMS? Not saying it isn't possible, just looking at a different angle. Hence why the team here is all full time street medics with one flight medic, a pair full time EMS supervisors, a flight RN and TEMS is their "secondary" gig.

 

[Veneficus]

The teams here have a pair of physicians that will respond to some call outs or go to trainings. Doesn't always happen but from my understanding it isn't totally unheard of to have them suited up and in the warm zone in the APC.

Definitely threw me for a loop during the TEMS testing when he ID'd himself as the SWAT MD and asked for a report and my triage, then made me explain why. Nothing different from giving a report to a trauma doc, just caught me off guard.

I agree it doesn't make sense for PD to pay to maintain a medic, plus how competent is that medic going to be if his primary job isn't EMS? Not saying it isn't possible, just looking at a different angle. Hence why the team here is all full time street medics with one flight medic, a pair full time EMS supervisors, a flight RN and TEMS is their "secondary" gig.

Don't get me wrong, I think there are definately agenices that can make good use of a tactical medic. But those agencies are few.

I hold in the highest contempt some of these "tactical medic" courses. I have seen all manner of outright stupid, like practicing bagging patients in a variety of circumstances not coducive to medical care or life.

Every cowboy with a set of cammies and a black sam splint thinks they are the tactical combat medic. That they are going to teach "the youngins" how it is and how to do it.

But they don't seem to spend a lot of time on the realism of civilian tactical encounters. Like the spped and ease of evacuation.

In the "training" I had, not one time did they mention dragging somebody to cover or out of the line of fire before attempting care.

Sounds like that would be lesson #2.

Lesson #1 being the best first aid is to kill the other guy before he shoots you.

 

[Handsome Robb]

In the "training" I had, not one time did they mention dragging somebody to cover or out of the line of fire before attempting care.

:unsure: Really? That's pretty bad. I haven't even been through a formal certification course and I know that's absurd. You wont find me in a TEMS course either unless I get a spot the next time they test. Having the merit badge isn't going to make you any more desirable to the team...any team worth their salt is going to put you through their own course or pay to ship you off to a reputable program.

 

[ExpatMedic0]

Don't get me wrong, I think there are definately agenices that can make good use of a tactical medic. But those agencies are few.

I hold in the highest contempt some of these "tactical medic" courses. I have seen all manner of outright stupid, like practicing bagging patients in a variety of circumstances not coducive to medical care or life.

Every cowboy with a set of cammies and a black sam splint thinks they are the tactical combat medic. That they are going to teach "the youngins" how it is and how to do it.
you.

haha agree with this statement. I am sure there are some valid ones out there, but majority appear to me this way

 

[mycrofft]

Apparently our SWAT team has a EM Physician who regularly works calls. I guess he got bored and wanted some adventure.

I bet you a nickel it was a way for him to get a concealed carry permit. We had MD's and pharmacists becoming "deputy coroners" to do that one time.

 

[mycrofft]

Lesson #1 being the best first aid is to kill the other guy before he shoots you.

Preventive care. Like it.

If that's #1, then #0.5 is "Don't be there unless you have to; then, bring your own stack".

 

[mycrofft]

At work when a cell or pod had to be secured I'd stage at the closest exam room with medical gear and go in when they pulled the combatants out to separate cells. I'd also make sure my officers were ok (they were so amped up they twice overlooked some pretty significant wounds they had received).

Worst was when I wasn't there. Deputy slipped on OC spray over a polished concrete floor, had a severe concussion.

 

[DrankTheKoolaid]

Apparently our SWAT team has a EM Physician who regularly works calls. I guess he got bored and wanted some adventure.

Our main tactical medical oversite is provided by our trauma center medical director who is a very active gun toting SWAT member himself in the closest major area. He went through the same Tactical program as myself and the other tactically trained Paramedic in my area

 

[mycrofft]

Evidence based replies:

Show me the bodies. Show me the non-wartime actual use of tactical medics or MD's or rheumatologists or whatever in real missions, not rumors, not "war stories".

 

[DrankTheKoolaid]

If your an ACEP member read the Mar 2010 newsletter... Great story on the Swat MD I was talking about. Extremely active due to the number of methheads in the area

Fyi, if you go through a nationally recognized Tactical Medicine program and not just TCCC or whatever the latest catchphrase is to milk responders out of of their dollars is you can test out and be recognized through ACEP even as a MICP, RN, RT, PA or FNP

 

[RocketMedic]

Don't get me wrong, I think there are definately agenices that can make good use of a tactical medic. But those agencies are few.

I hold in the highest contempt some of these "tactical medic" courses. I have seen all manner of outright stupid, like practicing bagging patients in a variety of circumstances not coducive to medical care or life.

Every cowboy with a set of cammies and a black sam splint thinks they are the tactical combat medic. That they are going to teach "the youngins" how it is and how to do it.

But they don't seem to spend a lot of time on the realism of civilian tactical encounters. Like the spped and ease of evacuation.

In the "training" I had, not one time did they mention dragging somebody to cover or out of the line of fire before attempting care.

Sounds like that would be lesson #2.

Lesson #1 being the best first aid is to kill the other guy before he shoots you.

Two thumbs up- this is exactly what is taught at Ft. Sam. (And variations thereof, like "use your truck to push the disabled one out of the ambush, duh").

It was really, really hard to keep a straight face at orientation when the EMSA "tactical medics" were making their presentation about "on-scene trauma care". Their gospel would make sense on the frontier, with no other assets and no timely evacuation. Here? Pointless.

 

[Veneficus]

Two thumbs up- this is exactly what is taught at Ft. Sam. (And variations thereof, like "use your truck to push the disabled one out of the ambush, duh").

It was really, really hard to keep a straight face at orientation when the EMSA "tactical medics" were making their presentation about "on-scene trauma care". Their gospel would make sense on the frontier, with no other assets and no timely evacuation. Here? Pointless.

I have never been a military medic or corpsman.

I have never been to Ft. Sam

But I think I should start a tactical medic program and make buttloads of cash.

"There I was...Staring down the barrel of a supersoaker...When all of a sudden..."

I'll have to buy some cammies and a black sam splint though.

 

[Luno]

Show me the bodies. Show me the non-wartime actual use of tactical medics or MD's or rheumatologists or whatever in real missions, not rumors, not "war stories".

What exactly are you looking for?

 

[MrJones]

What exactly are you looking for?

Maybe evidence that "tactical medics" are more than just dudes who want to wear swoopy ninja gear and hang out with the shooters?

Or that tactical ems is more than just a term made up to justify dudes wearing swoopy ninja gear and hanging out with the shooters?

 

[mycrofft]

My archetype for a civilian tactical medic action is this: the medic/doc whatever wears entry gear and carries supplies to treat on scene or rapidly extract under threat or fire, and actually does this, repeatedly, not jut once in a career.

My non-archetype is all trained and dressed up but only stages or goes in after it is all over to treat and extract ASAP but not under immediate threat of or under fire. Or in front of a howling mob, active snipers, or whatever.

Not benchwarmers, and not peripherally involved, but where their trained and equipped presence in the hot area makes a difference in immediate care which could not be done by non-medically trained responders or trained responders without tactical training and equipage.

 

[Luno]

Ok, I'll take the bait

My archetype for a civilian tactical medic action is this: the medic/doc whatever wears entry gear and carries supplies to treat on scene or rapidly extract under threat or fire, and actually does this, repeatedly, not jut once in a career.

My non-archetype is all trained and dressed up but only stages or goes in after it is all over to treat and extract ASAP but not under immediate threat of or under fire. Or in front of a howling mob, active snipers, or whatever.

Not benchwarmers, and not peripherally involved, but where their trained and equipped presence in the hot area makes a difference in immediate care which could not be done by non-medically trained responders or trained responders without tactical training and equipage.

@Mycrofft... Alright you crusty curmudgeon, here goes my best shot... As a tactical medic and tactical medical instructor, and since apparently my last post didn't clear things up for you, let's try again.

Your "archetype" and "non-archetype" are an oversimplification, and akin to comparing a SEAL to the movie SEALs. Do the SEALs perform mission behind enemy lines, do they use snipers, do they insert via submarine? Well, we all know that answers to this, but that's about where the similarities end. Yeah, I know, you want "justification," but you're asking a preloaded question with 50cc of prejudice. I'm going to try to illuminate the difference between what you perceive and what should happen.
So, I guess to best tackle this, would be to question, is a Tactical Medic (or whatever the latest buzzword is for the position, but will be referred to as "TEMS" guy for the rest of this post) an asset to a team, and are they actually an asset, strictly used as an EMS provider or is there a separate skillset that provides the commander an asset whether they "suit up" or not?

The quick answer is if all they do is perform TC3/care under fire, then probably not. Are there circumstances that an advanced EMS provider can provide the difference between life and death for either the subject or the officers? Yes, is statistically large enough that the cost of the roll out of whatever tactical medic program country wide is practical? Probably not.

Now this goes into, what does the person attached/joined to a tactical unit bring to the table? Assuming that all things are equal for tactics, fitness, etc... The TEMS guy should be as specialized as your breacher, as your point man, as your radio/communications, as your commander, not a subtraction from the team, but a team member that has additional proficiencies.

Is medical planning necessary for operations? Is medical planning necessary for training? Does one have to have an understanding of how operations conducted to adequately advise the use of, let's say OC in a hostage rescue when a hostage has a known case of respiratory difficulties? Is there another specialist on the team that can step up and recognize the symptoms of cyanide poisoning? Much less the treatment? Now keeping in mind that not all SWAT/ERT missions are entries, there is alot more to the planning to the team than just the sexy, "bang, cross, button hook, clear." Protective missions, surveillance missions, negotiations, these all have a medical component and assessment that should be briefed to the commander prior to mission. This takes a far better understanding of the team and capabilities than a rig medic is going to bring on a rotational basis. This also changes on each individual mission, and the assessment of a non-TEMS guy is like a coach of a bunch of 7 year olds playing soccer trying to tell an NFL coach how to run defence.

Are we putting the "cool guy" stuff out there, and taking people who have no idea that there are enormous changes between missions even within the same department in charge? We are putting people in protective masks and having them bag simulated intubated patients in the dark without consideration of why they are in protective masks. IV sticks with night vision goggles, OD green sam splints, and more black and velcro than we know what to do with, but it all boils down to the same basics that we hit here over and over again. Lack of education and lack of understanding lead to a piss poor product, and that is what alot of the schools are turning out now. Even worse for "tactical EMS" because there is very little standard, and mission dynamics change so much that alot of what the TEMS guy needs is a solid understanding of how his team operates, then he can work his medical voodoo into the mix.

 

[mycrofft]

Gotcha. These strongly suggest a potentially important and very valuable role for medical knowledge. But have you seen it used? Has anyone here seen it used? (STATESIDE that is).

In military I've seen where medical is very important in ops planning, and we were included in the local sheriff dept's mass arrest/booking planning in 2003. Green Berets almost immediately had one or more people trained as their "doc" for each team; I think Rangers in WWII also had something like this.

My mind is open, but 22 years without seeing them used, and experiencing close-staging furnishing adequate benefits without the expense of "derring-do school", makes me curmudgeonly skeptical.



It's sad to think of fine talented brave and motivated people being all dressed up for this dance and no one invites them. Maybe the FBI, ATF or such use them more?

 

[Veneficus]

If I could just mediate a litte?

I agree 100% with Luno on what a tactical medic should be and should be doing.

I agree that there is tremendous value in that which certainly makes this provider worth easily more than non medical team members.

But, I must give Mycrofft his due.

I have sat in the truck getting paid OT to stage in the cold area. Even the TV news was closer than I was. I was paid to sit in class and figure out how to maintain a mask seal bagging Fred the head in all manner of nonsensical positions. I have seen all manner of "part time" wanna be SWAT teams from small local departments trying to "do the best we can" to imitate the people who make a living at it.

I would say there are far more of these "teams" then there are big city, FBI, secret government that runs the government, full time professionals.

But how is that any different from EMS or Fire?

I have met fire officers that have never performed an interior attack other than training.

I have met all manner of EMS provider who cannot efficently perform the skills they were taught in school.

But there is no shortage of schools and academies putting on a hardass paramilitary show.

TEMS is not its own monster. It is the new symptom of a larger disease. The idea that we can spend a few hours training people to do something very difficult and involved and armed with some technology, send them out to do the best they can. (which often sucks by any measure except how bad they were yesterday.)

But this is endemic in the whole of safety services in the US. Everytime I go to the airport in the US, I laugh at the TSA people. I swear somebody went down to unemployment asked everyone who didn't graduate highschool to raise their hands, and took everyone that did to guard the airport.

Of course with their minimal training they are given a set of hard/unbending rules to follow, which they do as best they can. Then to help we put what amounts to CT scanners in the airports.

Now every other country I have been to has professional security educated, trained, retrained, on all aspects of security. From detecting a threat to shooting people dead.

In the better airports, they are invisible. But they are there. Picking out the people who are about to cause trouble. Before it escalates.

These people cost a lot of money. For education, training, pay, benefits. Just like TEMS, EMS, Fire, etc. You hope you never need them.

Think of it from a military point, there are conscripts and there are professional soldiers. While they may wear the same uniform, they are certainly not the same.

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.

 

[mycrofft]

Because I don't want anyone to think I denigrate the entire idea, I am sure there are excellently trained tactical medics and teams, I am only asking narrowly if anyone has actually seen then doing their thing. Not staging closeby then going in when its over as I did in my scrubs with two deputies.

=================
Don't feel I'm picking particularly on "Tactical Medics" stateside. I had the following exchange with a best friend once:

FRIEND: "We've been going to a northern Mexican village every year on mission to teach them how to make hay bale houses".
CURMUDGEON: "Great! How many years have you been doing this?".
FRIEND: "Fourteen".
CURMUDGEON: "How many houses have they built by themselves?".
FRIEND: "Er, uh, ...none".

I still feel badly. We're still friends.