# tactical EMS



## ThatPrivate (Jan 9, 2013)

I started paramedic school this pass Monday. I completed EMT-basic class in December. During my basic class my instructor talked about different career opportunities within EMS. Other then 911 the one that interest me the most is tactical EMS. I plan on taking a tactical medical operator course over the summer and get my TEMT certificate. My question is how do you find TEMS jobs? I plan on living in either Georgia, South Carolina, Maryland or Virginia and working primary 911 in a medium busy system (8-12 average call per shift). If anyone can help me out I would greatly appreciate it.


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## DesertMedic66 (Jan 9, 2013)

Check with the various police departments. They should be able to tell you if their swat medics are working police officers (aka have to get hired with PD) or if they outsource to ambulance companies/fire departments.


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## mycrofft (Jan 9, 2013)

See other threads and PM people identifying themselves as tactical medics and ask them personally!

Don't be afraid, we don't bite,


but Luno might shoot you if you make a sudden move.


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## Luno (Jan 10, 2013)

*Shot out...*



ThatPrivate said:


> I started paramedic school this pass Monday. I completed EMT-basic class in December. During my basic class my instructor talked about different career opportunities within EMS. Other then 911 the one that interest me the most is tactical EMS. I plan on taking a tactical medical operator course over the summer and get my TEMT certificate. My question is how do you find TEMS jobs? I plan on living in either Georgia, South Carolina, Maryland or Virginia and working primary 911 in a medium busy system (8-12 average call per shift). If anyone can help me out I would greatly appreciate it.



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...


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## abckidsmom (Jan 10, 2013)

What Luno said.  I wish all the people who identified a cool guy job they wanted to do would make such a great checklist of things they need to focus on to be successful in that role, and then actually applied themselves to acheiving those tasks.

I find that civilian tactical jobs (where you don't work in the law enforcement agency, but help them out) are as random as the calls coming in, and the ones who are going to be tapped for the job are not the young, gung-ho people, but the proven ones with years of experience and a lot of mellow in them.


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## Luno (Jan 10, 2013)

I <3 abckidsmom!


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## mycrofft (Jan 10, 2013)

"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. "

That's how you get called "Doc". Watch them for signs of hidden injury or illness (they will not want to "let down the team" or be "a sh$tbird), , and intervene when the powers that be try to cut your training or other preparedness issues.


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## ThatPrivate (Jan 10, 2013)

Luno said:


> 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?
> 
> ...



I'm currently in the military (PFC). I live the tactical environment. Yes I am physically fit I love ruck marches. I workout everyday at least 2 hours a day. I am beginning my paramedic career and I just wanted to learn about other type of paramedic work there is other then 911. My instructor said I would be a good fit for tactical paramedic work but I don't know where to begin looking for more information.


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## MrJones (Jan 10, 2013)

ThatPrivate said:


> I started paramedic school this pass Monday....



You started paramedic school this past Monday and you feel cocky enough to list EMT-Paramedic as your level of training? 

Outstanding.

:rofl:


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## ThatPrivate (Jan 10, 2013)

It says student.


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## MrJones (Jan 10, 2013)

ThatPrivate said:


> It says student.



Really?


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## Veneficus (Jan 10, 2013)

*cool guy jobs*

That was a great post by Luno. I just wanted to add something to it only partially related to the OP.

In order to get a cool guy job, you must first be a cool guy. 

It sounds stupid, but...

Most of the really desirable jobs, like tac med, require a proven track record. You have to be a known quantity. 

That requires experience, which is gained 2 ways.

1. High volume

2. Long time in

In some places you will see more patients in a year than some will see in 5, 10 or even a career. 

In any trauma environment, you need to have lots of experience before you are on the all star team so to speak. 

That means a lot of dealing with the less desirable aspects of the job until you are good at them.

As I often profess, all trauma is medical, and it is the toughest part of medicine. You have got to have your medical knowledge at a high level. Anyone can put on a tk or pack a wound, it is what comes next that will set the stage for success or failure. 

Be ready to spend a lot of time in school. I would also remind people, in order to be an emergency doc, you are looking at 3-4 years post grad training. To be a trauma surgeon, 7-9. Not saying that you want to be a surgeon, but it does show how much that needs to be learned I think.

Knowing who has what and what comes next. Again, anyone can say "send the patient to the level I." What if you have multiple patients, which multiple or the same level of acuity? If you flood 1 facility, you will overwhelm it and your people will suffer for it. 

As the medic, your circle is going to expand outside of your employer. You will deal with flight teams, hospitals, EMS, industrial health, etc. You will have to demonstrate your ability to all of them. So it will require not only knowledge, but people skills, and the ability to understand and work with their concerns. 

Nobody starts as the play maker.

There are many people with as much or more qualifications than you. You have to work your way in. That is a tedious process of often having to do things nobody likes or wants. If you are good at it, you get the chance to do something better. If you cannot be trusted with the mundane stuff, you will not be put in a position to do something important. 

As you succeed, and there will be failures, you will get more and more "cool guy" stuff to do. But it takes time and you have to be where the action is. 

Not trying to discourage you, but I would impress upon you that your goals are going to be a process bigger than simply applying for a job.


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## RocketMedic (Jan 11, 2013)

I would question the need for a tactical medic in most places. there isnt much need that cant be filled by a standard ems crew staging and CLS training.


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## Veneficus (Jan 11, 2013)

Rocketmedic40 said:


> I would question the need for a tactical medic in most places. there isnt much need that cant be filled by a standard ems crew staging and CLS training.



Easy overtime.

Easy overtime, my friend.


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## Handsome Robb (Jan 11, 2013)

For what it's worth I have a year and a half of EMS experience, tested for our TEMS team, did "exceptionally well" from what I was told and was passed over for the spot because of my lack of experience. 

You have to pay to play. I can't really say much more, Luno wrote out a great response. Like he said, there's a lot more to TEMS than just stacking up, breaking down doors and "taking names".  

It's department dependent but from my experience and talking with others TEMS is usually a division of the EMS agency and not the police department. Here, at least, you're a 911 medic first and a TEMS medic second. You work a regular street shift and rotate weeks being on-call for TEMS.

Finish medic school, get some medic experience under your belt and then start checking out the "cool guy jobs".


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## phideux (Jan 11, 2013)

I only know one guy that carries the T-Medic tag. His main job is not EMS, he is a police officer, assigned to the SWAT team, that is also a medic. A couple things I think are noteworthy, it's all about the experience. every member on that SWAT team is over 30, and has 10+yrs  under their belt on the force. Physically fit, no brainer of course. The guy with the medic patch on his back is pushing 50. I don't think you are gonna get out of medic school, take a TEMS class, and put on your swat uniform and roll. Spots on special teams like that are earned, not given.
Plus it's not the action all the time, super exciting job alot of folks think. 99.5 percent of his job is just routine, average, run of the mill police work.


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## Luno (Jan 11, 2013)

*Amazing....*



Rocketmedic40 said:


> I would question the need for a tactical medic in most places. there isnt much need that cant be filled by a standard ems crew staging and CLS training.



Please read the part about velcro and fat...   There is a lot that cannot be filled by a standard ems crew, and as another 68W you should know what cannot be accomplished by CLS training...


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## mycrofft (Jan 13, 2013)

Rocketmedic40 said:


> I would question the need for a tactical medic in most places. there isnt much need that cant be filled by a standard ems crew staging and CLS training.



I cannot tell you when a tactical medic would have been actually of use in my area, and I worked alongside LE for 22 years.


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## RocketMedic (Jan 13, 2013)

Luno said:


> Please read the part about velcro and fat...   There is a lot that cannot be filled by a standard ems crew, and as another 68W you should know what cannot be accomplished by CLS training...



There is no reason for most community police departments/sheriffs etc to spend the time and money to maintain a "tactical medic" when they could have a 911 truck staged at the corner 7/11 on a dedicated standby.

Obviously, the rural "let's hike 80 miles into the brush to go find some pot farmers" that you see on National Geographic is an exception, as is something full-time dedicated like Dallas SWAT or LAPD or other high-use/high-risk teams. Then it makes sense to dedicate a medic or team of medics to that unit. But for a lot of American agencies, I just don't see a real functional difference. 

Why does Edmond, OK need an armed tactical medic?

I'm thinking it's mission creep and warrior fantasies combined.


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## VFlutter (Jan 13, 2013)

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


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## Veneficus (Jan 13, 2013)

Chase said:


> 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.


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## Handsome Robb (Jan 13, 2013)

Chase said:


> 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.


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## Veneficus (Jan 13, 2013)

Robb said:


> 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.


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## Handsome Robb (Jan 13, 2013)

Veneficus said:


> 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.


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## ExpatMedic0 (Jan 13, 2013)

Veneficus said:


> 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.
> 
> ...



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


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## mycrofft (Jan 13, 2013)

Chase said:


> 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.


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## mycrofft (Jan 13, 2013)

Veneficus said:


> 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".


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## mycrofft (Jan 13, 2013)

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.


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## DrankTheKoolaid (Jan 13, 2013)

Chase said:


> 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


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## mycrofft (Jan 13, 2013)

*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".


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## DrankTheKoolaid (Jan 13, 2013)

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


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## RocketMedic (Jan 14, 2013)

Veneficus said:


> 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.
> 
> ...



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.


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## Veneficus (Jan 14, 2013)

Rocketmedic40 said:


> 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.


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## Luno (Jan 14, 2013)

mycrofft said:


> 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?


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## MrJones (Jan 14, 2013)

Luno said:


> 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?


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## mycrofft (Jan 14, 2013)

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.


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## Luno (Jan 14, 2013)

*Ok, I'll take the bait*



mycrofft said:


> 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.


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## mycrofft (Jan 15, 2013)

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?


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## Veneficus (Jan 15, 2013)

*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.


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## mycrofft (Jan 15, 2013)

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.


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## Luno (Jan 15, 2013)

*I think we see things the same but different...*

@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...


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## mycrofft (Jan 15, 2013)

*Tactical as in operating without safety infrastructure...never thought about that!*

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?


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## BSellers (Feb 15, 2013)

*Thank you.*



Luno said:


> 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?
> 
> ...



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.


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## fortsmithman (Feb 15, 2013)

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.


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## Luno (Feb 16, 2013)

BSellers said:


> 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.


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## MackTheKnife (Mar 5, 2013)

ThatPrivate said:


> It says student.



That it does.


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## mycrofft (Mar 6, 2013)

Luno said:


> 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,
> ...



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.


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## kindofafireguy (Mar 7, 2013)

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.


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## Luno (Mar 8, 2013)

@Mycrofft, I'm gonna disagree with that approach...  It's way too easy to kick the dog :censored::censored::censored::censored: 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.


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