# Tactical medic protocols?



## ccfems540 (Jul 19, 2010)

Can anyone send me copies of your current tactical medical protocols?  My department is starting a SWAT medic program and we are starting from scratch.  Also, what are the requirements to qualify to become a team member.  We are considering CONTOMS as a starting point.


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## akflightmedic (Jul 19, 2010)

1. Extract patient from scene
2. If bleeding do A or B or Both.
    A. Apply Celox
    B. Apply tourniquet
3. If not breathing...Ventilate with BVM
4. If tension pneumo is present, decompress AFFLICTED side
5. Insert King LT when able
6. Insert IV if needed
7. Hand off to Local EMS for transport who is staging down the road

Consider C-spine but a scoop and soft collar are just as good these days and will be the next wave of future EMS changes.


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## mycrofft (Jul 25, 2010)

*Protocols are like navels..except it doesn't take a plastic surgeon to change 'em.*

1. Look for multiple affected unmarked victims.
1.a. If seen , move upwind and uphill and call for fans.


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## MrBrown (Jul 25, 2010)

Our Special Emergency Response Team uses the standard Clinical Procedures.


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## ExpatMedic0 (Jul 25, 2010)

ccfems,
one of my partners at work helped start the SWAT medic program here in Portland Oregon way back when. Hes retired now, reverted his medic to basic and only works doing event stand by part time with me... but feel free to PM me your email and I can pass it along if you like.


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## LondonMedic (Jul 26, 2010)

*TACTICAL MEDICAL PROTOCOL V.1*

1. Dress all in black.
2. Wear aviators.
3. Eat donuts.
4. Err, that's it.


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## MrBrown (Jul 26, 2010)

LondonMedic said:


> *TACTICAL MEDICAL PROTOCOL V.1*
> 
> 1. Dress all in black.
> 2. Wear aviators.
> ...



Only Brown may wear aviators, what with having a suitable degree and base of experience 

"...yes good morning its Westpac Rescue, mile and a half south for entry direct Auckland City Hospital, not above 1,500; ... hang on"
<CLICK>
"...yes good morning its Dr Brown speaking from the helicopter emergency medical service, we're about eight minutes away from you ...."


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## Melclin (Jul 26, 2010)

LondonMedic said:


> *TACTICAL MEDICAL PROTOCOL V.1*
> 
> 1. Dress all in black.
> 2. Wear aviators.
> ...



Haha.

I was going to be more diplomatic: What exactly is the role of a "tactical medic". What more do you need other than first aid? Presumably they all have first aid certs anyway (or whatever your equivalent is) if they're coppers. 

TMP V1.2 : After you finish your doughnut, position airway, arrest bleeding, drag pt to the care of someone who isn't a copper.


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## Afflixion (Jul 26, 2010)

Haha, seems easy correct? yeah now try doing all that with rounds flying overhead and the adrenaline making your fine motor skills go out the window... don't poke fun at tactical / combat medicine unless you've been there.

With that out of the way, your protocols are going to very from region o region, as do regular EMS protocols. No one online could give you any except their own, Your level of care is only semi-affected by the cert you hold because I doubt your going to be lugging around a geezer squeezer if your a paramedic. Most of it is penetrating trauma that you will see which is unlike civilian ems where most trauma they see is blunt. Yes, most of it is hemorrhage control and splinting and such, if not close to 80-90% of it.


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## Melclin (Jul 26, 2010)

Afflixion said:


> Haha, seems easy correct? yeah now try doing all that with rounds flying overhead and the adrenaline making your fine motor skills go out the window... don't poke fun at tactical / combat medicine unless you've been there.



I'm not having a go at the military medics, that's a different matter. We are talking about police right? Training to be medics? We're talking about "scope of practice" for coppers. I'm having a go at the idea of making it more complicated than it needs to be. What "scope" do they have? They already have first aid certs, what more do they need?

I would have thought that the obvious problem of how hard those skills are to perform under fire is a good reason not to complicate those first aid basics with some BS about spinal immobilization and trying to get coppers to do anything other than get a pt to the care of someone who knows what they're doing.


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## ccfems540 (Jul 26, 2010)

Melcin-  You need to do a little research.  You have no idea what a tactical medic is.


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## FF-EMT Diver (Jul 26, 2010)

Melclin said:


> I'm not having a go at the military medics, that's a different matter. We are talking about police right? Training to be medics? We're talking about "scope of practice" for coppers. I'm having a go at the idea of making it more complicated than it needs to be. What "scope" do they have? They already have first aid certs, what more do they need?
> 
> I would have thought that the obvious problem of how hard those skills are to perform under fire is a good reason not to complicate those first aid basics with some BS about spinal immobilization and trying to get coppers to do anything other than get a pt to the care of someone who knows what they're doing.



No Buddy we're talking about Bona fide EMS Professionals going into the line of fire with the Police and treating them and anyone else that may get harmed in the apprehension of violent criminals, We have standard protocols that are followed in the line of fire and that is the discussion at hand.

As was stated due some research BEFORE you do a lot of off hand commenting.

And if I'm taking your post out of context accept my apology and I look forward to your explanation.


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## Melclin (Jul 26, 2010)

ccfems540 said:


> Melcin-  You need to do a little research.  You have no idea what a tactical medic is.



Yes I know, the idea is quite foreign to me. And it doesn't make a great deal of sense for the reason I put forward. Hence my original question:



Melclin said:


> What exactly is the role of a "tactical medic". What more do you need other than first aid?



With some googling I have seen how scarily paramilitary that whole world appears to be, how oddly fragmented law enforcement is in America and I was also reminded how much EMS seems more conceptually aligned with emergency services than with healthcare. My question was originally why do you need anything more than first aid. I saw the curriculum for a few courses and it was basically an extended first aid course (with the exception of surgical cric and chest decomp and I would still question the wisdom of that, but I can't really be arsed arguing about it), so it makes more sense now. I had this absurd picture of you trying to teach police how to be health care professionals, but I see how its not that, so I'll tag out.


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## mycrofft (Jul 26, 2010)

*Tactical Medics...four is five.*

Tactical medics arise administratively from two directions: the uncommon need to retrieve live victims from dangerous areas during potentially contested areas, and the success of organic medical support in armed forces during war (e.g., Green Berets). It is fueled by fears of liability if civilian caregivers enter the area, and the testosterone swollen nature of young LE's into the whole TAC thing. (Worked LE for twenty years, so please don't question my personal observaton based upon experience). The macho (for both genders) is necessary, but not for program decison making.

As it is, taken overall, SWAT has proven to be very poor at catching and arresting people, very good at standing around behind cars and specialized vehicles staring at buildings allegedly holding suspects, and setting up cordons/traffic blocks.

"Tactical Medics" can't practice the out-of-bounds stuff battle medics do in war zones, they mostly wear armor and wait for their boss to wave them in then drag unstablized people to "safer ground" when often the bad guys are already gone. The image is inflated, that is ok, but the strutting and warrior macho are wearing to everyone else.
See reply #1.

PS: Law Enforcement people train up as medics pretty much as well as non-LE's, but the questions about medical control and etc. are usually brushed aside. Are there legal standards posted by *medical authority* anywhere?


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## FF-EMT Diver (Jul 26, 2010)

Melcin I see your new post, disregard the smart tone in my post.

Again our officers are trained in first aid, some are 1st responders and all carry IFAKS on their armor and are familiar with using on themselves and teammates.


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## Melclin (Jul 26, 2010)

mycrofft said:


> "Tactical Medics" can't practice the out-of-bounds stuff battle medics do in war zones, they mostly wear armor and wait for their boss to wave them in then drag unstablized people to "safer ground" when often the bad guys are already gone. The image is inflated, that is ok, but the strutting and warrior macho are wearing to everyone else.
> See reply #1.



Now I know I said I'd tag out, but this is exactly what seemed to me to be the case. I just figured I didn't understand it because I'm in health care, perhaps I still don't but its nice to see someone who knows better share that view.

EDIT >> FF-EMT Diver: It seems perfectly fine to have them be FRs or whatever, but I had this picture of some copper getting a a couple of days of training and then sitting there trying to RSI a bloke, when he really should have just taken him to an actual healthcare professional.


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## mycrofft (Jul 26, 2010)

*Addendum*

I respect the professionalism and potential courage these folks have, but the basis is medical provision in a civilian world, not something akin to the fiction on TV.


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## Chimpie (Jul 26, 2010)

Melclin said:


> EDIT >> FF-EMT Diver: It seems perfectly fine to have them be FRs or whatever, but I had this picture of some copper getting a a couple of days of training and then sitting there trying to RSI a bloke, when he really should have just taken him to an actual healthcare professional.



Being able to leave an active scene is not always possible.


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## FF-EMT Diver (Jul 26, 2010)

Melcin I see where you are coming from....And some teams do not have any medics and in their case the guys either secure the area and bring in EMS when scene is neutral or bring their guys out to EMS.

Mycroft I'm not sure how SWAT is in your area but it must be different than here, The medics here are on the entry team and SWAT in our area does a good bit of arresting and very little standing around looking cool.....Also all that I am familiar with have a medical director that has sat down with the lead medic and designed a set of "special Protocols".


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## FF-EMT Diver (Jul 26, 2010)

Chimpie said:


> Being able to leave an active scene is not always possible.



Good point Chimpie and one that I meant to bring out, We carry enough gear in a backpack (Blackhawk Stomp II) that we can treat in position if necessary.


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## mycrofft (Jul 26, 2010)

*FF-EMT Diver, good! You have some "on the ball" folks there.*

Speaking nationally, though, SWAT is often like other law enforcement programs to assuage the civilians and the hotdog administrators. Our local PD has a SWAT, but also each officer is trained and has the armor, and sometimes the weapon (usually an AR-15 or equiv) is in the trunk. Response time is low, and often the situation is over before the stack in their tank has to actually set up shop.

The "active area" is an interesting concept also, being a function of policy minus political and financial realities.

Not to say if I were the one "pinned down" in a firefight, that I would decline tactical care !!  But how often are people really "pinned down"?

IS there a national assocition of tactical medics, is it medically or paramilitarily oriented, and do they set standards?


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## FF-EMT Diver (Jul 26, 2010)

I must say I agree with you there.

Very rare are the " pinned Down" occasions.

Not really as far a a National organization for Medics.
For all Tac officers it is http://ntoa.org/site/

And the guidelines that most everyone goes by are the TCCC material.http://www.naemt.org/Libraries/PHTLS%20TCCC/TCCC%20Guidelines%20091104.sflb

I will also point out that if you google National Association of Tactical Medics you will find a website to a training organization in Ga. I have been to their class and they do have a good class but they are NOT a national authority on tactical medicine.


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## MrBrown (Jul 26, 2010)

We have the Specalist Emergency Response Team (SERT) made up of selected Intensive Care Paramedics.

Thier role is to go to strange incidents like high angle rescue or help the Fire Service extricate people who have gotten stuck some place.  They also support the Police Armed Offenders Squad and Special Tactics Group as well as the New Zealand Special Air Service (our elite tier 1 special forces).

... and they get to dress in Green Nomex and repel out of helicopters B)


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## LondonMedic (Jul 26, 2010)

I don't get it. I can appreciate that as a European I don't work in a country where I'm likely to encounter an armed, hostage-taking national supremacist twice a week - these are maybe once in a career events.

However, I do not understand how it can be cost-effective for every other township or county to have a SWAT team replete with tactical medics (+/- their own weapons) on standby in such a way that they can be used safely and in a timely manner.

What training to EMTs need other than to remain behind something solid (or a police officer) until the rounds stop flying? Lots of people on this forum discuss scene safety - why does it suddenly change here?

We're used to the concept of the expectant triage category, why does that not apply?


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## MrBrown (Jul 26, 2010)

LondonMedic said:


> I don't get it. I can appreciate that as a European I don't work in a country where I'm likely to encounter an armed, hostage-taking national supremacist twice a week - these are maybe once in a career events.



The following spring to mind

1993 Bishopgate Bomb
Paddington Rail Crash
7/7 

We have SERT for things like this (not just Police AOS/STG support) in that they are "specialist" emergencies which need out of the ordinary logistical and medical support by people who support the Fire Service get people out from underneath trains or down from buildings or things like that.

They can also support the Police Armed Offenders Squad or the SAS if need be, which is a growing percentage of thier work.

SERT are however, not just for that purpose.

Does the LAS not have some sort of capacity to provide specialist medical support to weird incidents?

Then again, the UK Police are unarmed, but then again ... ours are supposed to be too!

.... and since WHEN is the UK part of Europe? I thought you guys had detatched out of embarrasment and just sit there doing your thing and let the Contentialers do thier thing


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## LondonMedic (Jul 26, 2010)

MrBrown said:


> The following spring to mind
> 
> 1993 Bishopgate Bomb
> Paddington Rail Crash
> 7/7


I would have let you have Dunblaine.

From what I understand, the three incidents you give examples of aren't a speciality of most US tactical medics (and they're almost once in a career events - although I know one man who went to two of them).



> Does the LAS not have some sort of capacity to provide specialist medical support to weird incidents?


It does as it happens; http://www.londonambulance.nhs.uk/calling_999/who_will_treat_you/hart.aspx
I'm not overly convinced. 



> .... and since WHEN is the UK part of Europe? I thought you guys had detatched out of embarrasment and just sit there doing your thing and let the Contentialers do thier thing


I was only using Europe as an example of a part of the world which isn't full of meth fuelled, gun owning, mentalists.


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## mycrofft (Jul 26, 2010)

*No, but you have had and will have more "martyrdom heroes" as time goes on.*

(That's Al Jazeerah talk for sucide bombers).
It would be instructive to see the British and other European portocols to compare with ours.

I just thought of a scene where special training and equipment could be of use...post-explosion incidents where secondary "devices", unstable environment, possible fire, possible UXO (unexploded ordinance), and trigger happy troops are all involved.


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## LondonMedic (Jul 27, 2010)

mycrofft said:


> (That's Al Jazeerah talk for sucide bombers).
> It would be instructive to see the British and other European portocols to compare with ours.
> 
> I just thought of a scene where special training and equipment could be of use...post-explosion incidents where secondary "devices", unstable environment, possible fire, possible UXO (unexploded ordinance), and trigger happy troops are all involved.


And only one or two victims?

Or do we need to send the entire department to this reputable looking company.


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## matt202 (Jul 27, 2010)

I really think that before you start deciding on what the skill set should be with regard to the police tactical teams and whether or not there is a need for any thing more than basic first aid you should look at the average time delay from injury to hands on by the ambulance service. 

In the UK there has been a number of documented cases, most recently in Cumbria, where is has been more than two hours.

If I were shot it would be nice to get some sort of pain relief in that time frame.


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## Melclin (Jul 27, 2010)

matt202 said:


> If I were shot it would be nice to get some sort of pain relief in that time frame.



Hahaha, pain relief? In American EMS? :blink:


Welcome to the forum


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## ExpatMedic0 (Jul 28, 2010)

Unless you live in the sticks there are serious crimes everyday. I live in a city of only 1 million(including the metro area) in a city with a fairly low crime rate and we use are SERT teams on a fairly regular basis. Our SERT medics are on call and also work full time as Paramedics for the fire department, but every city has a different system. Some city's like Detroit have a full time SWAT team.
A wounded suspect recently died in Portland because SERT was not called earlier... No one could enter the hot zone and the suspect bled to death waiting for a tactical medic to arrive for 45 minutes.

The teams are not just used for hostage situations.... there also used for barricaded armed suspects, suicidal armed suspects, and even a lot for drug raids. 
Saying they do not need a medic is kind of silly ,like saying the army does not need infantry line medics.


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## Shishkabob (Jul 28, 2010)

LondonMedic said:


> I don't get it. I can appreciate that as a European I don't work in a country where I'm likely to encounter an armed, hostage-taking national supremacist twice a week - these are maybe once in a career events.



And I as an American can appreciate that I have rights that Europeans do not have.



We win.






Anyhow, Dallas PD actually has Tactical Physicians, and already have atleast one save credited to them.  Granted they did the same things a Paramedic could, but still BA none-the-less.

http://www.tacticalmedicine.com/files/webarticle4.pdf


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## matt202 (Jul 29, 2010)

schulz said:


> Unless you live in the sticks there are serious crimes everyday. I live in a city of only 1 million(including the metro area) in a city with a fairly low crime rate and we use are SERT teams on a fairly regular basis. Our SERT medics are on call and also work full time as Paramedics for the fire department, but every city has a different system. Some city's like Detroit have a full time SWAT team.
> A wounded suspect recently died in Portland because SERT was not called earlier... No one could enter the hot zone and the suspect bled to death waiting for a tactical medic to arrive for 45 minutes.
> 
> The teams are not just used for hostage situations.... there also used for barricaded armed suspects, suicidal armed suspects, and even a lot for drug raids.
> Saying they do not need a medic is kind of silly ,like saying the army does not need infantry line medics.



Schulz,

Are your SERT medics armed for their own protection?

Regards

Matt


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## ExpatMedic0 (Jul 30, 2010)

Matt,
I am not sure, let me ask the guy who founded it I work with. Ill get back to you when I find out. I know this policy vary's from department to department


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## ExpatMedic0 (Aug 6, 2010)

Sorry it took so long, he got back to me and No, none of our SERT medics are armed.


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