# Have you actually made tactical medical rescues stateside?



## mycrofft (Apr 30, 2011)

Here's the deal.  Tech schools are advertising to become a SWAT member with their one semester wonder courses, ditto EMT's, so folks are "graduating" with the expectation of becoming a "tactical medic" right off the bat. Others are being tagged to set up "tactical medic" programs or aspects to extant programs., because having "tactical medics" is "so _*hot*_!".

OK, let's hear from people who walk the walk:
IF you are officially tasked/employed as a "tactical medic" (e.g., a member of a stateside law enforcement or other legal paramilitary organization specifically tasked, trained and equipped to perform lifesaving measures during or immediately after an armed conflict including SWAT or other tactical teams), *and have actually performed this task*, please answer the following:
1. What is your average day like?
2.  Are you JUST a "medic" or a member of the team with additional duties?
3. What did you actually use to advantage in patient care? Have any equipment items proven to be without merit or just so many dustcatchers?
4. Is being a "tactical medic" worth it, or a waste of money and time?


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## Veneficus (Apr 30, 2011)

*repost of PM at request of OP*

My experience at one agency.

They had just started their tac team when I was there and we had some "tac medic" training and went to a few police drills. 

During the "operations" which we were paged off duty for or responded on duty to, our job was to get geared up in a black jumpsuit that said SWAT on the back with a helmet, no other body armor, no alice gear, etc. No weapon or even authorization to have one.

Once called, we parked the truck in the cold zone and sat and BSed with the cops stuck babysitting the perimeter while collecting overtime pay.

In the event of a casualty the Cops were to bring the casualty to us. (even after we had some BS training in trying to ventilate with a BVM is less than optimal conditions.)

Exciting wasn't it? I think the news crews were closer to "the action" than we were.

...Life and death


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## mycrofft (May 15, 2011)

*Judging from the responses I can make three divergent assumptions.*

1. The answer is NO, we do not have real life tactical EMT's.
2. The real ones are too busy dodging bullets and dragging casualties with IV's in their teeth.
3. They are tired of all this jackjawing.:huh:


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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.


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## mycrofft (May 16, 2011)

*Calling DrParasiite:*

1. Are they different than the rest of us somehow? All male, I presume.
2. Different pay or day to day duties?


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## WolfmanHarris (May 16, 2011)

Our medics that perform tactical duties do so as part of their larger area of responsibility in the Special Response Unit. (SRU)

SRU is made up of 16 (4 per platoon; 400 medics in the service total) Paramedics (12 ACP, 4 PCP). They are assigned to ride single medic in a response vehicle in one of our three districts. (The fourth is for covering vacations, sick time or may ride double if no one is off) 

Most of their time is spent jumping calls like any of our other response units unless needed for an SRU call.

The SRU handles tactical calls with PD ERU as well as bariatric calls, rescue support, MCI, deploying with the PD marine unit and deploying our Gator for more remote calls or incident trailers.

In the tactical role they train with the PD ERU and operate in the warm zone. They have full body armour but no weapons.

If they're utilized for a tactical call it is dispatched and coordinated via cell phone rather than radio, so we don't usually hear much about it. Chatting with one of our SRU guys yesterday though they get utilized for an SRU type call about 20 times of month of those a small percentage are actually tactical calls.

As far as pay goes they are at the same pay grade as our Captains. The unit has three female medics.

Pretty much our "tactical medics" exist to support various other operations. They aren't doing the takedown themselves, but by training regularly with the tactical team and being properly equipped they are a better resource for PD. They don't do the technical rescue, but by having training in it they are better equipped to support FD (which only has an FR level of medical training in Ontario) in their rescue operations and rehab. They don't take over the MCI calls, but they bring the resources and experience to the call to better support the regular crews in managing the scene. Ditto for bariatric calls. We continue to treat and manage the Pt. while the SRU sets up the lifting equipment, stretcher, winches, etc.


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## Luno (May 16, 2011)

#3 see jawjacking

Former tactical medic having worked with both civilian LEO and military contractor teams (stateside and overseas), and have assisted patients in line with my job description, however, not the kind you'd anticipate, not the "upside down, ETT placement, and chest tube placed on someone while aussie rapelling simultaneously firing my m-60 underwater."  But your run of the mill sprains, strains, broken bones, burns, hypo/hyperthermia, dehydration, taser removal, etc...   More to follow in the "why do we need this..." thread...


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## mycrofft (May 16, 2011)

*Thanks, folks, the wait was worth it!*

Any more?


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## DrParasite (May 17, 2011)

mycrofft said:


> 1. Are they different than the rest of us somehow? All male, I presume.


you presume wrong.  my FT job has 2 women on it, and my PT has one (out of 10 or so people).  Definitely more men than women, but nothing prevents a woman from doing the job.

I don't have the actual requirements in front of me (and I just checked my email, no luck their either), but it was basically be in good physical condition, be able to run a distance without getting too winded, be able to commit to the training, and some other stuff.  basically, you shouldn't having the 300 lb paramedics who can't walk a city block without stopping to take a break.


mycrofft said:


> 2. Different pay or day to day duties?


Same Pay.  they are EMS personnel, so they have routine EMS duties.  if a Tac assignment is requested, usually the TAC EMS unit is ready to go within the hour (I don't have the exact time), staffed by off the road personnel, field personnel whose truck is taken OOS during the mission, or off duty recall of close personnel.

to the best of my knowledge, no place in my state has a FT SWAT team, where the only thing the officers do is do SWAT operations.  the SWAT team personnel are either assigned to patrol units and have their SWAT gear with them, or they are FT SWAT people assigned to a SWAT unit that does more than just SWAT breaches (they handle violent EDPs, shootings/stabbings in progress, technical rescues, and they jump cool sounding calls just because they can), so they don't have a medic assigned full time.


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## mycrofft (May 17, 2011)

*Nearly parallel threads going .*

THe other asks the five W's.
Anyway, now that we have defined and described real tactial medics, and not the kids on the Cavalry Store catalogues of 1979, the next question would be about any special gear. Like opening my hall closet, I'm afriad to open this as stuff will come raining down I'm not anticipating.



*or mentioning the words "concealed weapon permit", "right to carry", "boots", "knife", or "fingerstick glucometry".h34r:


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## Arovetli (May 8, 2013)

Prior to going back to school I was a SWAT medic for a couple of years. I was primarily a patrol officer but pulled secondary assignment on the swat team, which was a part time program. There are a lot of variations state by state, where I was there was little formal recognition or regulation of Tactical medics by the state and we operated as close to NTOA guidelines as possible. In other states the POST commission (or comparable) is much more involved in specifying minimum standards. I was a medic for many years and going on the team was part of my employment deal, I was well connected and knew alot of people in the department so this aided me getting in.

My training was basic swat school a tccc course and a couple downed officer rescue classes and alot of training time with the team. We had a good solid training day per week and were on call 24/7. All this was in addition to patrol work. I got paid OT for call outs and training which was nice.

As an officer I was armed but opted to forgo a long gun, sidearm only. I had a couple different gear sets and would customize my load out based on the operational need. Plus all the guys carried IFAKs, so this aided the amount of medical gear onscene. I generally carried enough to care for two major traumas at once, and then any additional casualties would be treated by buddy aid/IFAK kits.

Generally I was in the back of the stack on the entry team and typically I broke off and set up shop in the first room entered, usually a living room. The team could continue movement and I could then be called forward or they could fall back and provide me security while I stabilized and rigged webbing sling/ prepared to fall back to the medical rally point. Ambulance was always on standby near the area.

I secured alot of prisoners and evidence, pulled security and the like freeing up the entry team guys to focus on what they needed to do.

On barricaded subjects/hostages I set up shop a few yards behind their positions, behind cover, with an eyewash/baby soap/water/oxygen station. Once gas was fired it was inevitable it would affect someone and they could move to me or I could move to them and get them squared away quickly.

Outside of medical duties I trained the team and the department on first aid, and was sort of a utility man on the team...since I wasn't fully commited to the assault team or sniper squad or command post, I filled in where needed.

In addition to typical medical gear I carried alot of OTC meds and caffeine pills, to pass out on the long standoffs. I never had a gsw but attended to alot of cuts and tear gas and gave out alot of Tylenol and Pepto bismol.

I did alot of amazing training, Live fire scenarios and the like. I trained with the team doing shooting drills so I improved my marksmanship.

It was a fun time and a great experience. IMO the classes are a waste of time outside of if you want to shoot and play pretend...unless they are state mandated and you already have a spot with or on the team, or have a likelihood of moving to the team within your agency.

Tactical teams are tight knit and you are not getting in unless you have a hookup. And the tactics they teach in the classes can be much different than what a team uses, there is alot of variation. 

Most of the classes advertised are just money makers for the people putting them on.
Don't label yourself a tactical medic unless you have been down range, so to speak...taking a class means nothing.

And as always, the best medicine is fire superiority.

Let me know if you have any other questions.

EDIT I apologize for poor grammar: blame it on the iPhone.


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## Arovetli (May 8, 2013)

Also, a key part of being truly integral to the team, as opposed to being a standby, is being a sworn LEO. There is simply too much liability, legality, procedure, and cultural issues going on unless you are sworn either as a regular or reserve officer, or some type of special deputization.

In thinking back, we hosted one of those tactical ems classes at our training center. A lot of EMS folks came, put on the gear, played around in the shoot house, etc. honestly, it was more of a show n tell.

As far as gear, I fell in love with the SWAT-T tourniquets. Cheap, lightweight and versatile. I could use em as TQs, pressure dressings, wrap em around iv bags for pressure. I think they are great. Aside from those I utilized alot of webbing and caribiners for quick rescue harnesses.

Morgan lenses were really useful.
Outside of that it was just alot of standard stuff.

Alot of planning, training, prophylaxis, coordinating, medical monitoring, record keeping. Good times.


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## Ace 227 (May 8, 2013)

Just like in the Army, it may be more beneficial to teach your regular line officers to treat basic extremity, pelvic, and thoracic trauma and how to properly evac the patient to a higher level of care, i.e, a waiting ALS unit versus teaching medics to be members of SWAT teams where ALS procedures really don't work under fire.

That being said, I also can appreciate embedding a medical asset with a unit as I have seen the benefits in the field.  Those were slightly more, austere, conditions than what a SWAT team would likely face though.


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## mycrofft (May 8, 2013)

*Excellent reply, a post in itself.*



Arovetli said:


> Prior to going back to school I was a SWAT medic for a couple of years. I was primarily a patrol officer but pulled secondary assignment on the swat team, which was a part time program. There are a lot of variations state by state, where I was there was little formal recognition or regulation of Tactical medics by the state and we operated as close to NTOA guidelines as possible. In other states the POST commission (or comparable) is much more involved in specifying minimum standards. I was a medic for many years and going on the team was part of my employment deal, I was well connected and knew alot of people in the department so this aided me getting in.
> 
> My training was basic swat school a tccc course and a couple downed officer rescue classes and alot of training time with the team. We had a good solid training day per week and were on call 24/7. All this was in addition to patrol work. I got paid OT for call outs and training which was nice.
> 
> ...



Any actual saves where a dedicated medic was really necessary?

(I was not a "tactical" medical guy, but would set up in close-by exam rooms when extractions or 10-15 breakups were needed. If you are their Doc, the team will accept you. Woe to the :censored::censored::censored::censored:ebird, though).


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## mycrofft (May 8, 2013)

Arovetli said:


> Also, a key part of being truly integral to the team, as opposed to being a standby, is being a sworn LEO. There is simply too much liability, legality, procedure, and cultural issues going on unless you are sworn either as a regular or reserve officer, or some type of special deputization.
> 
> In thinking back, we hosted one of those tactical ems classes at our training center. A lot of EMS folks came, put on the gear, played around in the shoot house, etc. honestly, it was more of a show n tell.
> 
> ...



So you were a tactical medic by description, or how? Civilian?  ANy actual saves which needed a tactical medic versus anyone else?

I hear you about being a sworn officer versus ancillary. If you "come to play", no stepping back and waving the red cross.


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## mycrofft (May 8, 2013)

Ace 227 said:


> Just like in the Army, it may be more beneficial to teach your regular line officers to treat basic extremity, pelvic, and thoracic trauma and how to properly evac the patient to a higher level of care, i.e, a waiting ALS unit versus teaching medics to be members of SWAT teams where ALS procedures really don't work under fire.
> 
> That being said, I also can appreciate embedding a medical asset with a unit as I have seen the benefits in the field.  Those were slightly more, austere, conditions than what a SWAT team would likely face though.



I think the delay aspect of field support (especially deployed military) is much higher than in an urban law enforcement event setting. Does any suburban or rural LE agency even HAVE a tactical squad with a medic? 

And in the boonies "the Doc" does as much for general health of his guys as anything else, if he's not screwing around. (See a lot of feet, right?).


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## Arovetli (May 8, 2013)

I was a paramedic, then joined the PD as a patrolman. Was on SWAT as a secondary assignment, primary assignment was to Patrol.

It is really dependant on the department, the ems systems, the politics....

A dedicated medic? I think of it more as a dedicated mindset. It helps when the main thing to concern myself was medical issues. So in briefing I was less focused on trying to predraw or guess at the layout of the house being raided, less concerned with the actual operation...more focused on the medical support of the operation.

Selecting a medical rally point, routes to the point, coordinating with the ambulance service, coordinating with helo coverage, we would put them on standby when we did a raid in a rural spot.

there are alot of advantages to having a dedicated medical guy, but i doubt it really makes or breaks anything routine. more of a SHTF and planning for SHTF guy.

SWAT is too often compared to the military, and they are way different animals. Integrating a medical asset into a swat team is much different that having a medic on the fire team but is a shooter first.

it is highly dependent on how the team operates and the local environment.

I never did any real rescues, no one ever got shot or severely injured. But we planned and trained for it. In scenarios it was incredibly useful to have a medical team member right there, becuase I could direct team tactics quickly based on the situation. much more fluid decision making process. i could quickly work with the stack leader to get the plan together and get it underway in seconds.

An in my case, not having a long gun was beneficial. I kept the gear on my person to a minimum, so I could move quicker, clear obstacles, go hands on with aggressive subjects.

In the aggresive vehicle assaults it was easy for me to grab and drag a subject out of the car, and I tackled, cuffed, and fought alot of people, which was easier without an M4 dangling from my neck. Since i was never commited to anything in particular, I could move to where I was needed without having to have someone relieve my position.

but, teams can make it all work in multiple ways, is it necessary? maybe not, but nice to have.

but it takes alot of medical expertise and law enforcement experience to really make it happen.

these rookie medics paying money for someones class are kidding themselves to think a little 911 experience and a piece of paper that says 'tactical' on it really prepares them or qualifies them for an integral role on a tactical team. IMO.

Also to add, I was a 'special operations' medic. I also supported bomb and dive squads.


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## Ace 227 (May 9, 2013)

mycrofft said:


> And in the boonies "the Doc" does as much for general health of his guys as anything else, if he's not screwing around. (See a lot of feet, right?).



Blisters and tick removal is about 90% of my job...


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## Masenko (May 10, 2013)

Arovetli, I probably have the urge to ask this from watching too many action movies, but when you set up your station behind cover

quote (idk how to use the quote buttons yet) :
On barricaded subjects/hostages I set up shop a few yards behind their positions, behind cover, with an eyewash/baby soap/water/oxygen station. 

do you take extra precautions to protect the oxygen from stray chaos? I don't even know if that's really a thing, but I keep thinking of the ending of Jaws


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## Arovetli (May 10, 2013)

Masenko said:


> Arovetli, I probably have the urge to ask this from watching too many action movies, but when you set up your station behind cover
> 
> quote (idk how to use the quote buttons yet) :
> On barricaded subjects/hostages I set up shop a few yards behind their positions, behind cover, with an eyewash/baby soap/water/oxygen station.
> ...



no just behind something stout or in a ditch. 
it is too bulky and usually stayed on the truck in a bag with spare supplies.
i did the forward rehab station thing a few times on long standoffs with alot of gas shot.


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## mycrofft (May 11, 2013)

People watch "Blackhawk Down" or read "On Call in Hell" and imagine daring heroic medical intervention done with one hand while firing with the other over a riot shield propped up in the middle of a free-fire zone.


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## rhstanford (May 17, 2013)

The Border Patrol has a large number of Agents trained as EMTs. They do patrol stuff until they are needed and then it is usually for treating an illegal alien who has been walking through the desert for sevral days in 100+ degree heat with no water. They give lots of IVs but see very few serious trauma calls. There is also the Search and Rescue team, but I think they have the same type of calls but they get to do more of the rescue stuff.


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## mycrofft (May 17, 2013)

These second duty deals are good, but what I've tried to explore here is the concept and the reality of medics who go armed and are in the thick of fighting in the USA (not in a war zone, on the streets or in a prison or similar).
I just don't see that it is a practicable paradigm.


I think such training is good so a medic going with the SWAT or similar team, but who is stationed a wee bit out of the way, knows what's happening, knows what NOT to do so she/he and the patient are safe, and in the extreme situation might be able to defend them...._*although it seems that doesn't happen either*_.

Authors and scientists have a saying about their work: "Kill your babies". Don't be afraid to discard paradigms proven wrong or happening as rarely as hens chewing steak.


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## epipusher (May 18, 2013)

Our swat medics sound similar to others posted. I am not a member but have friends that are. They go where the rest af the members go and are second to last in line during an entry or building search. They are unarmed as well but do go through weapons training incase of a "last man standing" situation. That is of course possible although it sounds like a good excuse to hit the range.


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## Arovetli (May 18, 2013)

one medic does not equal a swat team or police unit proficient in buddy aid/first aid/trauma care.

while im a fan of a swat medic, I'm also a huge fan of real medical training and ifaks for each officer. 

a properly applied tourniquet and homeboy ambulance patrol-car style are probably as effective as a solid medic on the team on overall trauma outcomes.

indeed, the majority of a medics functions are administrative and prophylactic, rather than truly life saving. more of a medical officer role.


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## mycrofft (May 29, 2013)

An example of tactical rescue in the military. GO to minute 17.http://www.youtube.com/watch?v=ho2VSLhZshA

Different?


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## RustyShackleford (May 29, 2013)

Real rescues by your definition happen so rarely domestically that the figures would be almost nil.  As I'm sure some of the other vets will attest to, we should be thanking our lucky stars we don't live in a place where it happens daily.  If people want to do these types of things their only option modern day is a trip to the sandbox.  In reality domestic tac medic duties is 99% training 1% operational.


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## DPM (May 29, 2013)

It sounds like it would be more beneficial (based on the testimony of those that have close contact or real life experience) to have Law Enforcement that is trained in TCC, rather than having an EMT or Medic with a little bit of SWAT training.

Thoughts?


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## mycrofft (May 29, 2013)

Given the rarity of situations where a specifically super-trained medic would be required to enter a hot area and treat; training people to scoop and scoot and basic tx seems better than a dedicated cadre of combat trained medics.


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## Tigger (May 29, 2013)

mycrofft said:


> Given the rarity of situations where a specifically super-trained medic would be required to enter a hot area and treat; training people to scoop and scoot and basic tx seems better than a dedicated cadre of combat trained medics.



Very few if any places have a fulltime tactical medic, I'm not sure where this dedicated cadre idea is coming for. If an agency wants to train street medics with a TCCC type course and have them on call, that seems fine to me. If the SWAT team wants to train a member with EMS experience, also fine.

What is the harm in doing either of these? I just don't understand what the issue is with the current models. Yes, rescues under fire will be exceedingly rare but that is obviously not the primarily roll, and no one is arguing otherwise.


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## RustyShackleford (May 29, 2013)

My system isn't perfect but I will just use it as an example.  We service a town of 1.2 million.  At all times we have two tems medics working.  They are ALS practicioners who deploy out of two different stations in different parts of town.  They have swat like jump suits on and operate out of SUV pru style suburbans.  If there is a tactical operation I'm town they are toned out.  They can also be toned out for chest pain calls etc involving high acuity for extra paramedics on scene for those type of calls and they can also pick and choose to assist trucks in their area of town with random calls.  This is the way things are done here and it seems to work well but in many ways the service I work for is ahead of the curve in certain areas.  Other Canadian services use ours as a model for TEMS services.  Its not perfect but from my point of view it works well.


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