# For argument's sake: given, that there IS a need for "tactical EMT's" stateside...



## mycrofft (May 15, 2011)

Given, that there IS a need for "tactical EMT's" or "EMS" stateside, how would it be defined?

When would it be needed?
Who would it be? (Agencies, and what sort of training).
Where would it be used?
What would the scope of practice be? Expected types of injuries under what circumstances?
and WHY...why would such a corps or branch of practice be neccessary, given existant resources and tactical practice (i.e., no noncombatants into a hot zone).
I have my prejudices, let's see if they match others' or are unseated. Open to all, but please try to keep it grounded and no shin kicking (use PM for that).


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## bigbaldguy (May 16, 2011)

I suppose it would be needed in situations like the Columbine shootings where people need to be treated but the scene is large and difficult to "clear". I imagine the agency that makes the most sense would be law enforcement as these individuals would be going into active shooter situations. As for scope of practice I imagine it would not have to be terribly comprehensive since if tactical medics are going in chances are they are going to be getting these people out of the hot area as quickly as possible not treating on scene. 

In short I suppose the best choice for this would be police officers cross trained in bls.

Just my humble opinion


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## DrParasite (May 16, 2011)

I am NOT a tactical medic.

my agency DOES have tactical medics, and they are used with the city SWAT team during SWAT operations. They are either EMTs or Paramedics. They are usually FT employees of EMS, and are detailed to the PD when they have an operation. No Firearms are given out, but full body armor is issued. they are typically the last in in the line of SWAT guys, or they stay at the door until the shooting stops.

my part time agency also has Tac Medics. they are all paramedics, and more often than not FT somewhere in the department (or formally full time). We do this for both the county and the central regions of the State Police.

I also know of two towns near me that have Tactical EMTs that support their town SWAT teams, which are comprised of EMTs who are employed by EMS and detailed out for SWAT ops.. but that's all I know about them is that they exist

the medics are NOT law enforcement, they are only there in case a LEO gets injured during an operation.

TAC medics ARE NOT for columbine for active shooter situations.  they support the officers on Tac teams,in case they get shot.  and maybe to help a bystander once all the officers are safe and the situation is contained.   One your active shooter has been contained by LEO, than send the medics in to help the injured.  

all TAC medics must meet the same physical requirements as LEOs, and they often train side by side with the LEOs.  They are part of the team, they (typically) do not help civilians until the situation is contained.

BTW, most of the time a tac medic's job is pretty boring, just like a SWAT officer.  things go as planned, no one get shot, the bad guys go down without a fight.  but when you have a 6 man SWAT team go in and two get shot, you want the medic there to treat the injured while the other 3-4 go after the bad guy.


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## Handsome Robb (May 16, 2011)

There are tactical medics here through the 911 agency. They support the local SWAT teams as well as FBI, DEA, US Marshals, any government agency that is making an entry in our area. They are all Paramedics that work FT on 911 rigs. They are crosstrained as a member of the team and make entry as the last man on the line, with a sidearm only and extra medical gear.  They've been toned out ~100 times in the last two years, but also participate in every training exercise the SWAT teams participate in.


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## jjesusfreak01 (May 16, 2011)

We don't have a lot of Tac medics here, but all of our county medics are trained in how to maneuver within active shooter type scenes to extricate patients in semi-secured areas.


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## mycrofft (May 16, 2011)

*DrParasite, question:*

but when you have a 6 man SWAT team go in and two get shot, you want the medic there to treat the injured while the other 3-4 go after the bad guy. 
I get the ratonale (I sort of consulted with my sheriff dept when they put their CIRT together about it)  but do they *actually* do it?
Luno raised a good point in an allied post, the majority of injuries will be stuff like sprains and lacerations from falls etc. In one response I was on an officer had a two inch deep impact lac in his posterior upper arm and didn't  know it; on one I was off during, a deputy slipped in OC overspray on a concrete floor, hit his head and was off duty over a year with sequelae.


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## Luno (May 17, 2011)

*Is the arguement regarding tactical medics just a misunderstanding of the job?*



> but when you have a 6 man SWAT team go in and two get shot, you want the medic there to treat the injured while the other 3-4 go after the bad guy


Please tell me that you're kidding...  In an insecure environment, you don't want to lose a fully functional team member from the stack, if you've lost one to some unfortunate injury, you don't want to lose 2+ because if I was the medic, I'm not working without a secure perimeter, or at least 360 security...  Besides, you don't want to take people away from the fight...  

Okay, but I digress, this thread and the similar threads have been amusing to say the least, especially the conjecture and opinion from people who might know people who might have done this...  Okay, first for mycroft...  Is there a requirement for specialized training for EMS personnel to operate in non-standard environments... Well, I'll counter that to not train personnel causes an undue risk to the mission, not only in the uber-cool world of black and velcro, but the overwhelming issues that I've seen with any sort of specialized EMS work, whether SAR, Ski Patrol, Remote, Jungle, Dive, and even Tactical, is that you're already involved or have some sort of familiarity and skill in that world prior to being EMS in that arena.  Just like a 120hr course does not make an effective EMT, and a 12 week, or even a 4 year paramedic course does not make an effective paramedic, a whiz/bang "tactical" super cool, SWAT/ERT/Tactical Medic course does not make you an effective tactical medic.  When I used to instruct tactical medicine for a group out of California, the joke was always it's TACTICAL medicine, if you don't know tactics, then you're just medicine, which is useless in that environment.  You become a risk, not a value add.  
But on to the questions....


> When would it be needed?


During all training, chalk talk/walk, mission planning, hostage negotiations, and with all assaults, high risk warrants, vip protection, etc... basically all use of the tactical unit


> Who would it be? (Agencies, and what sort of training).


It needs to be someone with a LEO or MIL background, preferably a full time EMS provider, and if not a full time officer (think public safety officers), then a reserve or special commision due to liability regarding use of force


> Where would it be used?


see "when would it be needed"


> What would the scope of practice be? Expected types of injuries under what circumstances?


Scope of practice would be adequate with Paramedic, but with these additional special emphasis points 
-environmental
-Haz-Mat
-psychological/counseling
-command and multi-agency interface
-preventative and sustainment med


> and WHY...why would such a corps or branch of practice be neccessary, given existant resources and tactical practice


I think the answer to this question, is how could it not be neccessary, given existant resources and tactical practice.  I can see how it could be rationalized that the suspect can lay there, after being shot, while you drag them to the nearest ambulance 10-15 min away, but I don't see that even the most jaded officer could say the same about their partner.  

I've been on teams where I've had to counsel regarding suicide, divorce, infidelity, substance abuse, not to mention just regular mission stressors, and had to keep people with extensive psychological issues that were emerging, together until we could get them to help.  I've been the trainer, teaching the team on self and buddy aid, helping them to learn their equipment.  I've been in the planning for missions, setting up and coordinating back up medical aid and evac, consulting on environmental concerns, haz-mat, and how long the team should be able to be functional without having to give them a break, or rehydration time.  Doing health screening regularly for the team, and keeping both command and the team appropriately updated with their limitations.  The part of being the medic that was most important to me was the I was the one that knew the guys, knew them better than anyone else on the team, and I needed every ounce of that information to help them in their job, and to help the team accomplish the mission.

In my opinion, and apparently very long winded post, the tactical medic is an essential part of the team, not as an additional entity, but as an integrated entity, however it is far more important that the medic is a much bigger contributor to the team, than just another street paramedic...


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## beandip4all (May 17, 2011)

ye$, there i$ a need for tactical emt$ here $tate$ide $o that they can wear their expen$ive tactical gear

and no, deeming thing$ "tactical" i$n't ju$t a marketing ploy to rai$e price$ on plain old gear and $ell more cool $tuff at all!!



posted from my tactical phone with the light of my tactical flashlight while snuggled in my tactical sheets and wearing tactical pajamas


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## usafmedic45 (May 17, 2011)

As someone who has PTSD in part due to being dumb enough to volunteer to accompany sheriff's deputies (the county I was working in didn't have a tactical team, let alone tactical medics) looking for wounded at the back of a house while there was an active shooter situation at the front/side of the house, I would like to point out that those who seek out this sort of thing for the "cool" factor are either messed up in the head (takes one to know one) or too immature to ever actually get a spot on a team (thankfully).  To this day, loud noises make me hit the deck.  I actually gave myself a bloody nose at work a couple of weeks back after dropping reflexively onto a concrete floor when someone dropped a glass container on the floor which exploded with a loud "BOOM".  

There is a role for dedicated, trained and sufficiently mature individuals to work in these situations but they are thankfully infrequent in nature.

The best advice to newbies:  Be careful what you wish for, you just might get it is.


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## medicdan (May 17, 2011)

One of my friends is a member of a fairly large SWAT department. The majority of the day (or week) or an urban SWAT team is not spent on high level raids, but executing drug arrests and warrants, on standbys for suicidal or homicidal persons, and training. I see no problem with training one or more of the members in strong BLS, and having an (ALS) ambulance on standby for high-level raids.


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## mycrofft (May 17, 2011)

*I think the Rangers approach was/is the best in some ways.*

GOOD: "organic capacity" means everyone has some training and carries some personal medical stuff, but the dedicated "medic", who doesn't even _claim_ to be immune under Geneva Convention, has taken the concentrated training. The "Doc" humps his own gear, the medical gear, and maybe some additional belt ammo and water.
BAD: the original training scenario in Nam was that the "medic" became seasoned under fire . Little hard if you got rotated in just as the former medic was DEROS'ed home or taken out before you got there, no overlap orientation.
LUCKY: Again, the majority of injuries and problems are going to be minor ortho, or mild to moderate from falls, or equipment accidents (mild to serious). 
I really appreciate the input from the members and wish this could be stickied on the top of this section.


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