Tactical Medics... LEO's/ Not?

[traumajunky 5]

I have done some research on tactical medics around the country and wanted to know what others thought of them being sworn LEO's or not.

Why do you think they should/ shouldn't be, and what should their scope of practice include in their roles as such...

Thanks for your thoughts in advance.

[NJMedic 96]

What ever works for the local teams. I've been a tactical paramedic since 1990 for both a multi jurisdictional county team and a unit within the State Police. We train with both teams on a regular basis and dress in the same fashion as the team, with level III armor. Both teams are unarmed as far as the medics go. Nevertheless with are very familar with all the weapons, basicall to render them safe should an officer go down. We do shoot at the range and I as well as the medics all feel alittle odd when we shot better then the armed weapons.

Like I said it all depends on what works for the local departments.

[JJB531 652]

This is one of the top debates within the Tactical EMS community, and there are a few good arguements made on both sides as to which provider, a civilian EMT/Medic or a sworn Law Enforcement Officer, is better utilized to function as a TEMS provider. Each methodology has it's own pros and cons, and as NJMedic stated, it generally comes down to the individual team studying both options and going with the concept that is going to work for them. I'll try to give you some of the pros and cons of each concept.

Civilian EMS Providers as TEMS Providers

The Pros: Generally civilian EMS providers possess a stronger medical skillset then LEO's who are not regular practioners of prehospital emergency medicine. Prehospital medical providers are generally more comfortable and often more competent with providing prehospital medical care to individuals who are sick/injured. Because they already possess that skillset and that level of competency, medical training for experienced prehospital medical providers focuses on taking that knowledge of conventional prehospital medicine and applying it to an unconventional environment.

The Cons: One of the big cons is the liability of taking a civilian EMT/Medic and placing them in an austere, potentially violent environment where there is a higher likelihood of a violent encounter with an armed individual, which is completely the opposite of conventional EMS training and scene safety standards. The debate on whether to arm civilian providers is another that comes down to local jurisdictions and is an entire topic in it's own. Some civilian providers are an unarmed member of the team, leaving the medical provider defenseless in the event of a violent encounter. Generally these providers are offered basic firearms training and some range time to become familiar with the weapon platforms the tactical team they are supporting utilizes. Armed civilian providers generally attend some form of peace officer academy, similiar to becoming an armed auxiliary or part-time officer of the department they are working with. I could go on and on about this, but it's a whole different topic. One of the other big concerns for tactical teams is Operational Security (OPSEC). Generally tactical teams work under a heavy blanket of OPSEC so their operations remain covert until it is time for them to go operational. Usually the only individuals privy to an upcoming warrant execution are the members of the team. Even other sworn LEO's who are not associated with the tactical team are not made aware of the pending operation so the covert nature of the operation is not blown. Let's say the Tactical Commander contacts their civilian TEMS counterpart to advise them of the impending operation, and the civilian TEMS provider, who is not in the mindset of OPSEC, then posts all over his/her Facebook page about the "big hit" they're doing with the tactical team in the morning. This is a significant concern for tactical teams, and one of the reasons only certain individuals are privy to the details, even small details, of the impending operation. If the target of the hit is somehow tipped off, they can easily prepare for it, either by moving their operation to another location, or fortify their location and be ready to shoot it out with the team when they arrive.

Sworn Law Enforcement Officers as TEMS Providers

The Pros: Sworn LEO's assigned to Tactical teams are already trained in police tactics, weapon platforms, and are used to operating in an austere, violent tactical environment. Assigning a LEO to the stack provides the team with another gun; meaning another LEO who is an armed member of the team with arrest powers and all of the other powers provided to LEO's. One of the other pros is that LEO's in general have a slight amount of "distrust", and I use that term loosely, when it comes to individuals outside of the Law Enforcement community. By distrust I mean that you will often see LEO's associating with and hanging out with other LEO's, because of that mutual understanding of "the job". Now within the Law Enforcement community, LEO's assigned to Special Operations teams are a group within the group, and they often won't fully associate with other LEO's, even from their own department, the way they would with other members of their team. Now try taking a civilian, non-LEO TEMS provider, and placing them in the middle of this team and see how they're received. Every team is different, but it may take a while before they are welcomed into the team as a team member. A sworn-LEO provider also has earned some level of trust from the team simply because they're "on the job".

The Cons: Maintaining a strong skillset to be able to provide competent, complete, and correct medical care to a sick or injured individual. A LEO who does not regularly practice prehospital medicine will possess a weak skillset and be an incompetent provider, which is counter-productive to the operation. One of the other cons that can arise is confusion on the part of the LEO medical provider. Are they a TEMS provider first, or a Police Officer first?

There are just some of the basic arguements for which type of provider would be better suited for work on a tactical team as a medical provider. Obviously there is a whole lot more to be said for types of providers, levels and types of training, and so on.

[INIT915 1,119]

My agency does not use civilian medics, rather sworn personnel. Most of whom also practice actual/active EMS on the side.

I personally prefer it that way, but that's just me.

[JJB531 652]

As does my agency. Here in the Northeast, the concept of civilian EMS providers functioning as Tactical EMT's/Paramedics is not well received by most Law Enforcement agencies. Go down South or out West, and the reception is a little more welcoming. If you research you will find active, proactive, established civilian TEMS teams in Texas (Cypress Creek EMS who was featured on the front cover of a JEMS magazine and got a very informative write-up), Florida (Sunstar EMS and Jacksonville Fire Dept), Colorado (Denver Health Paramedic Division and Littleton Fire/EMS which was borne out of the Columbine School Shootings), Delaware (New Castle County EMS) just to name a quick few.

[Jybehofd 85]

i am not a tactical medic but i do work with the navy on my A job and have been trained on a couple of weapon platforms some very large. and its seems to be easier to learn then being a medic. Yes we can't enforce laws, but why can't they be a "swarn" person or consider a shooter in and only when the full team is formed and when needed based on the situation also. I am sure this is breaking 150 years of tradition or something, but i am not too sure how many medic would go in to a situation without at least a 9mm or something.

[JJB531 652]

i am not a tactical medic but i do work with the navy on my A job and have been trained on a couple of weapon platforms some very large. and its seems to be easier to learn then being a medic. Yes we can't enforce laws, but why can't they be a "swarn" person or consider a shooter in and only when the full team is formed and when needed based on the situation also. I am sure this is breaking 150 years of tradition or something, but i am not too sure how many medic would go in to a situation without at least a 9mm or something.

I'm a little confused by your post, but what I did get from it is the arguement that is made by a lot of Tactical EMS practicioners that "it's easier to train a medic to be a cop then it is to train a cop to be a medic". In my opinion, this does hold some level of truth. I've tried to keep my personal opinion about this topic to myself, but here it is (if anyone cares, lol).

First and foremost, if a Tactical Team is going to utilize a civilian EMS provider as their Tactical Medic (in the TEMS world the term "medic" is used to describe both EMT's and Paramedics), they have to select the right person. The individual needs to be put through the hiring process as if they were going for a job with the Law Enforcement agency they're going to be working with, including interviews, psychological exams, drug tests, background checks, etc. Secondly, they need to pass the SWAT physical/agility just as if they were trying out for the team as a regular LEO. Face it, not every LEO is cut out for the type of work that Tactical Teams perform. We like to think of Tactical operators as "the best of the best", true masters of the craft of high risk tactical operations. Experts in firearms control, marksmanship, and tactics. Individuals who can carry out specialized tactical operations that require such a highly motivated and skilled LEO. Civilian TEMS providers should be held to that same standard.

In regards to training, any civilian TEMS provider should attend some form of Law Enforcement training to attain a title similiar to peace officer status. In addition, all TEMS providers must attend some form of TEMS training to learn how to take the medical skills they already possess and apply it to the tactical environment, as well as learn those skills and methodologies they are not accustomed to which are specific to the field of Tactical EMS (i.e. remote patient assessments, medical threat assessments, barricade medicine, etc.)

You can't just take a civilian medical provider, throw a heavy vest and helmet on them, and call them a Tactical Medic. There needs to be a stringent, rigid set of standards and training before any civilian EMS provider can attain such a status. There needs to be written medical and operation protocols, continual joint training between the Tactical Team and the TEMS providers, training standards set forth by the agency, medical directors should be involved, etc.

Operationally, I don't necessarily believe in putting a civilian TEMS provider in the stack. I do agree that civilian TEMS providers, if properly outfitted with the necessary PPE (heavy vest, etc.), can be placed in the inner perimeter, staged at the point of entry. A civilian TEMS provider in the stack does nothing to benefit the Tactical Team; it's just another individual to get in their way of what they have to do. Tactical Teams have a mission, and that mission is carried out through speed, suprise, and violence of action. Sometimes more is not better, and this is one of thoses cases where unnecessary personnel running around the inside of a location can be more of a hinderance then a help. One of the main ideas of the TEMS program is to cut down on the time for an injured person to receive medical aide. Having your civilian medical provider staged at the point of entry, where they are not in the way of LEO's as they carry out their operation, but still close enough that they can be on top of an injured party in seconds, is not only effective, but ensures a higher level of safety for the TEMS provider.

Am I against civilian TEMS providers? No, as long as they follow the strict standards and guidelines I spoke of before. There are a hundred reasons why most LEO's are against the idea of civilian TEMS providers, and I don't disagree with them. There are liability concerns, safety concerns, OPSEC concerns, and so on. Neither way of thinking is right or wrong in my opinion. Both concepts can work, it's simply up to the Tactical Team to decide which is going to be the best means of providing tactical medical care. The only thing that I don't agree with is to shun away from civilian EMS providers simply because they're "civilians" and have no idea about law enforcement or combat. You know how many combat veterans are returning back from overseas and going back to their jobs stocking shelves at the local grocery or department store? These individuals have more combat experience then most LEO's out there. Keep an open mind. There are many civilian EMS providers out there with significant military experience serving multiple tours overseas. They're an untapped resource for such a program that should not be overlooked just because they're not an LEO.

Edited February 26, 2011 by JJB531

[joetnymedic 43]

i'd like to chime in here for a second also. as a former street medic. not to go against any medic who is tems, but i think if you are going to be a medic on a team that you should be armed with at least a pistol. i think that by placing someone who is unarmed out there, you are making them a liability as they can not defend themselves which would mean at least one other member of the team will have to watch over them. this leads to another issue. if the medic sees that a member of the team is in danger of being shot or taken out by the target can the medic take out the target without liability and how would that be percieved. granted the medic would obviouly have to be armed. another thing is there anything that says if the medic is treating a wounded team member and they are in danger of being shot that the medic can not take the wounded members weapon to defend them against further harm? i am not a tac medic, so thats the purpose for the questions as i'm sure other non tac medics would probably ask the same thing. i dont think anyone should be out there unarmed with a target on them

[JM15 386]

What qualifies someone to be a "tactical medic."?

[JJB531 652]

i'd like to chime in here for a second also. as a former street medic. not to go against any medic who is tems, but i think if you are going to be a medic on a team that you should be armed with at least a pistol. i think that by placing someone who is unarmed out there, you are making them a liability as they can not defend themselves which would mean at least one other member of the team will have to watch over them. this leads to another issue. if the medic sees that a member of the team is in danger of being shot or taken out by the target can the medic take out the target without liability and how would that be percieved. granted the medic would obviouly have to be armed. another thing is there anything that says if the medic is treating a wounded team member and they are in danger of being shot that the medic can not take the wounded members weapon to defend them against further harm? i am not a tac medic, so thats the purpose for the questions as i'm sure other non tac medics would probably ask the same thing. i dont think anyone should be out there unarmed with a target on them

The concept of arming civilian TEMS providers is a controversial one. Many civilians providers are working under there EMS agency who may not want the liability of there employees being responsible for and possessing firearms. With the majority of police involved shootings under so much scrutiny, imagine if we had civilian medics blasting people away. Secondly, if an armed perpetrator is able to get past the first 6 or 7 highly trained tactical operators in the stack, I highly doubt a medic with a 9mm is going to make much of a difference because Houston, We have a problem! There are tons of liability factors That would need to be addressed before arming a civilian EMS provider.

[JJB531 652]

What qualifies someone to be a "tactical medic."?

In some places, it's as easy as slapping on a patch that says tactical medic. Generally, most TEMS providers attend a TEMS course offered by private training organizations. Currently there are no set standards for a TEMS course curriculum, although most of the better courses follow the military's Tactical Combat Casualty Care (TCCC) guidelines. Tactical training depends on the department. Some departments do in the house training with their medics, others send it there medics to basic swat school or to a tactics class specifically designed for civilian TEMS providers.

[ny10570 745]

While training someone to be a medic is harder than than training someone to use a gun, a tactical medic doesn't need to be a full paramedic. They need to be a trauma medic. A blind airway, hemostatic dressings, and tourniquets are your primary tools. Have your civilian medic parked at a staging area so you can maintain your opsec and keep the most useful tool to a downed officer, rapid transport, available

[JJB531 652]

While training someone to be a medic is harder than than training someone to use a gun, a tactical medic doesn't need to be a full paramedic. They need to be a trauma medic. A blind airway, hemostatic dressings, and tourniquets are your primary tools. Have your civilian medic parked at a staging area so you can maintain your opsec and keep the most useful tool to a downed officer, rapid transport, available

I partially agree with the above statement. I do agree 100% that in the event of a downed LEO, airway/breathing control, hemostatics, and tourniquets are the basic tools a Tactical Medic will pull from his/her toolbox, and therefore a "trauma medic" is all that is really needed in this scenario. Realistically, a Tactical Medic doesn't have to be a paramedic, but can simply be a BLS provider. The only tool a BLS provider will not be able to utilize is advanced airway control techniques and needle decompression. The Tactical EMS provider might be a good application for the EMT-Intermediate level of training which is currently being discussed in another thread.

True Tactical Medicine is more about injury prevention and routine preventative maintenance then it is about providing care under fire. The true Tactical Medic is a useful resource for the Tactical Team to ensure that members are properly hydrated, medically able to continue a prolonged operation (just as we rehab and medically monitor firefighters between SCBA bottle changes), address even routine ailments and medical conditions that may affect Tactical Operators that can have an adverse affect on the outcome of an operation. Smaller tactical teams often have limited resources, so it doesn't help if your sniper is suffering from a case of diarrhea or even a simple headache. This is where the Tactical Medic comes in, to provide the sniper with some relief from any routine ailments he/she may be suffering from and to keep him/her in the game so their concentration and focus is on point in case they have to take that crucial shot.

My point is simply that the idea and concept of Tactical Medicine is not just the "glory image" of intubating a downed person while bullets are flying above. Realistically most Tactical EMS providers will spend more time answering questions about "why does it burn when I pee" or "hey, what's this rash look like to you?" rather then providing emergency medical care in a true tactical environment. This is where an experienced provider, and not just a "trauma medic" is more of an asset to the team.

[NWFDMedic 58]

As does my agency. Here in the Northeast, the concept of civilian EMS providers functioning as Tactical EMT's/Paramedics is not well received by most Law Enforcement agencies. Go down South or out West, and the reception is a little more welcoming. If you research you will find active, proactive, established civilian TEMS teams in Texas (Cypress Creek EMS who was featured on the front cover of a JEMS magazine and got a very informative write-up), Florida (Sunstar EMS and Jacksonville Fire Dept), Colorado (Denver Health Paramedic Division and Littleton Fire/EMS which was borne out of the Columbine School Shootings), Delaware (New Castle County EMS) just to name a quick few.

I beg to differ with this statement. Our TEMS program has been very well received right here in the Hudson Valley. Then again, our program is not one where the medics simply have a "patch thrown on their uniform" and they are required to undergo a good bit of training. (I'm not 100% sure of their standards as I'm not a member of the team.)

[JJB531 652]

I beg to differ with this statement. Our TEMS program has been very well received right here in the Hudson Valley. Then again, our program is not one where the medics simply have a "patch thrown on their uniform" and they are required to undergo a good bit of training. (I'm not 100% sure of their standards as I'm not a member of the team.)

I said the concept is not well received by MOST law enforcement agencies... Not all. Yours just so happens to be the exception.

[Medicone 14]

Just a few thoughts and a quick disclaimer; I currently operate as a career paramedic but previously was in law enforcement. While being involved in both fields, I have never been a “Tactical Medic” affiliated with an active team, although I have attended tactical medic training through several institutions in the northeast and southeast.

Tactical medicine provides some great advantages; both in a hot zone and perhaps even more so in the staging area/warm zone providing occupational health oversight and team monitoring. There is no need to go into the benefits of such a position as we all are well aware of them.

Some comments on TRAINING:

One of the biggest problems is that providers are under the assumption that completing some form of a TEMS course is sufficient to have them effectively participate on a team. I am constantly running into civilian (and some currently detached LEO) EMS providers (Paramedics, EMT-Bs,I,CCT) that say they are “Tactical Medics” because they took a TEMS course. All the TEMS courses (CONTOMS, HSS International, U.S. Training Center etc) provide a basic introduction to TEMS and some basic firearms instruction. They provide the mindset needed; but do not qualify someone to operate on a team (for the safety of the team, their safety and the safety of the general public).

Simply being able to manipulate, engage a target and render safe a firearm coupled with EMS training is not sufficient to make a TEMS provider ready to operate on a team.

ERT operators (LEO Officers) are highly trained in special operations. In additional to consistent firearms training, operators are educated in coordinated movements, tactics and procedures that make up a majority of the curriculum.

Someone previously mentioned that it is more desirable to have an active paramedic operate on the team because they are currently practicing. I agree with that principle, however, the same principle applies to the skills required of an LEO.

ERT operators train frequently; not monthly, but weekly. Movements need to effortless and second nature. Firearms must be readied, sighted in and used. To be a proficient ERT operator, just as a proficient Paramedic, your skills must be used constantly and maintained.

Some comments on PROFICIENCY/ACTIVITY

Being a proficient Paramedic comes down to having a solid education and being active to keep your skills up. NYC provides an excellent environment for Paramedics and EMS in general (coupled with a significant amount of BS). There are many voluntary hospitals that have per-diem staff members who can select from a plurality of locations to work ranging from the Bronx to Northern and Southern Manhattan. Paramedics who may be in a practical slump can select tours in busy areas to practice skills and procedures.

Unfortunately, as most EMS providers know, it is common to work 50-60 hours a week as a Paramedic to make a living.

LEOs also need to keep their skills up. Range days, team trainings and working the street are all part of a law enforcement career. With respect to LEOs on ERT teams, even more practice is necessary. Transitioning between carbines/pistols, non-lethal weapons, tactical reloads etc etc etc, ERT movements, room clearing…and then the legal aspects of entry and engagement. Distinct from EMS, most urbanized law enforcement agencies are primarily FT career based operators. Almost, if not all, ERT teams are comprised of full time LEOs.

DISCUSSION

While everyone should agree that it is desirable and necessary to have Paramedics and LEOs who are both proficient and active; that very concept presents and inherent conflict. There simply are not enough hours in the day to truly do both.

I know there are a lot of civilian Paramedics who really want to be on an ERT team (including myself), but we need to take a step back and think logically about what the job entails. It is not just attending a TEMS program and purchasing a drop holster and a chest rig. The job requires 100% dedication to the ERT team which includes maintaining proficiency at every skill that the LEO ERT member has as well. Teams by definition function as a group. Each member must be an equal participant and be predictable. This requires constant interaction. All dreams aside, without 100% dedication, an unnecessary risk is placed on the team and the public. Working 50-60 hours a week and an addition 20 hours per week plus deployments just is not possible anymore.

However, it is essential to have medical trained providers on the ERT team.

During deployments, 70-90% of the time, no medical interventions are necessary. However, when they are, they are generally trauma related requiring immediate intervention.

Many LEOs are also per-diem paramedics. It is possible for them to have a primary job on the ERT and have a per-diem job in EMS. To maintain their proficiency as a paramedic, or at least their skillset as it relates to traumatic injuries (GSW, hemodynamic comprise, IV/IO access, ETI, advanced airways, bleeding control; almost a NREMT-I curriculum will suffice), they have the ability to pick up tours in busy areas. I cant remember a time that a 12 Lead ECG or advanced medical case present/was treated in the hot zone. Not saying that it won’t happen, but the victim would be extracted in that case anyway; and complex aided case is not going to be treated with an active cqb scenario.

One of the important aspects of this is that the LEO/Paramedic can pick up shifts INDIVIDUALLY based on his schedule to maintain his skillset as a paramedic. He can select a busy bus in the BX for example or BK. A career paramedic does not have the ability to pick up a shift on the ERT without deploying the entire team. Fulltime LEOs are already on the team regularly and train with them as a group; practicing as a paramedic can be done per-diem to maintain proficiency. Several NYPD ESU members work per-diem for the hospitals and are very capable and proficient.

In summary, while it a civilian Paramedic may find it desirable to operate on a ERT team, while theoretically possible, it is far more efficient to simply train an existing LEO with EMT-I or EMT-P skills and require they maintain proficiency in their secondary capacity as a TEMS provider.

When 70-90% of the job is going to be LEO related proficiency, the remainder can be trusted to a proficient LEO TEMS provider who has the ability to stabilize the patient to allow extraction.

Just some thoughts, I do not mean to offend anyone. Best of luck with everyones endeavors!!

M1

[Guest alsfirefighter]

Overall I have enjoyed reading the comments. JJB..your spot on as usual. I have been very fortunate to be part of a team that was receptive to the concept at the start and very receptive over time and now they want to know which medic is walking in the door. While unarmed..good tactics, consistent training, strong policies and an understanding of limitations on both sides has lead to us being a solid partnership within the team and the guys trusting us as much as we trust them. While I personally believe that there is no reason after an excellent screening and selection process to be accepted on the team that tac medics should be given what is needed to have a pistol, fact is I'm very comfortable with how I operate being where we stage in the stack and other formations for various situations. Also there is no shortage of weapons if needed to protect myself or an officer on the team if need be. Again some concepts move slow and we live in litigation nervosa part of the country. Again good policy with the right people solve that issue.

Now...simply put...tactically trained EMS providers, meaning those who have been trained to operate in a hot zone, have been proven invaluable to increase the chances of survival for those in active shooter scenarios. Its not as simple as just getting someone out as the hot zone is much wider then that and treatment may need to be rendered by those wearing protective equipment and supported by armed officers. Case in point Dave Sanders, the teacher who survived his initial wounds only to succumb to his blood loss. It is quite ironic to me how law enforcement nationwide changed its tactics to handle active shooter scenarios to respond to the threat, yet many have not changed their relationship with EMS for those who may survive or increase survivability if they did. I've been fortunate to work with, train and lecture to law enforcement who some are very open to the concept, others doubt or just dismiss or think I'm nuts...but either way...its proven. In fact a USFA report post columbine recommends EMS agencies (of all types) to have members trained for such environments and since that fateful day in Littleton, CO...Littleton has the largest TEMS team in that nation.

But of course..things that have worked for years elsewhere won't work here. I can get an officer untrained in anything medical but CPR to an EMS call...but have cops who are more then glad to say they disagree with having someone like me as a tactical medic. I just laugh..and I am grateful the officers I work with on my team have always been vocal of their support of myself and my fellow TEMS members and I take pride in the mutual respect we have for each other.