Cops get narcan! I at least want a taser.
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Should Tactical Medics be armed?
- Thread starter CWATT
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Cops get narcan! I at least want a taser.
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bakertaylor28
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There's two ways of looking at this- depending upon how you define "tactical" medic- If one means within the sense of military service, it is illegal under international law for the medical corps of any country to be armed. The reason why is because medical units are automatically considered "non-combatants" and may not intentionally be fired upon, so long as they wear clear medical insignia.
If we're talking within the sense of civilian tactical operations, the issue gets blurred with a quickness. For starters, I am of the opinion that anyone whom carries a weapon should at least be credentialed as BLS and more importantly how to handle weapons-related injuries in the basic sense. (at least knowing what NOT to do- and this is coming from someone whom has responded to a gunshot call where someone tried to use SUPER GLUE as a clot activator.) - A great deal of BLS should be common sense- but oddly enough people these days seem to be lacking in that. Hence, cross training is always a good idea.
However, giving paramedics GUNS is not an answer to problems that SHOULD be under control by law enforcement. But, this depends upon how one defines "tactical medic" (as opposed to the majority of us) for purposes of civilian non-military use.
If we're talking within the sense of civilian tactical operations, the issue gets blurred with a quickness. For starters, I am of the opinion that anyone whom carries a weapon should at least be credentialed as BLS and more importantly how to handle weapons-related injuries in the basic sense. (at least knowing what NOT to do- and this is coming from someone whom has responded to a gunshot call where someone tried to use SUPER GLUE as a clot activator.) - A great deal of BLS should be common sense- but oddly enough people these days seem to be lacking in that. Hence, cross training is always a good idea.
However, giving paramedics GUNS is not an answer to problems that SHOULD be under control by law enforcement. But, this depends upon how one defines "tactical medic" (as opposed to the majority of us) for purposes of civilian non-military use.
bakertaylor28
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Cops with narcan really isn't the best idea, in my book, unless we train them when NOT to use it. I know of at least one case where a cop used narcan to try to counteract IV Tramadol. The result WASN'T good, to say the least.
bakertaylor28
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Under this definition- this is a situation where in all reality, this poses liability issues- because the courts will tend to define you as an adjunct to law enforcement if you in any way involve yourself with a tactical team such as SWAT etc. This means that effectively, Miranda will apply to you just as much as the rest of the team, and you might not be able to ask a patient the proper questions without placing a case in legal limbo.
VFlutter
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What was the result? Inappropriate Narcan administration shouldn't cause any harm is far outweighed by the much more frequent benefit from treating actual narcotic overdoes.
bakertaylor28
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Narcan in the presence of Tramadol is well-documented to cause seizures and more rarely status elipticus. It mimics TCAs in a lot of ways, yet also has opioid effects as well. The particular case in question resulted in status elipticus and consequential arrest.
DesertMedic66
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There are studies that are both sides of that fence. Some state it may cause the seizures to come on faster while others state there were less patients with seizures after Narcan admin. Let’s also not forget that seizures are a side effect of tramadol overdose.
VFlutter
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Based off a quick search I definitely wouldn't consider it "well documented" and as @DesertMedic66 said the literature is not conclusive. Correlation does not equal causation. Massive Tramadol overdoes are likely to seize and become apneic regardless.
The only study I could find that supports the claim that Narcan lowers the seizure threshold in Tramadol overdoes still states "The findings do not suggest that naloxone should be withheld, but that the potential for seizure should be noted and any forthcoming seizure dealt with. More research is needed to further define the factors that affect the seizurogenicity of naloxone in tramadol overdose."
http://eprints.arums.ac.ir/3741/1/Naloxone.pdf
But regardless even if that was the case a few rare incidents do not outweigh the benefits. Opioid overdoses are far more likely than Tramadol and most of the time we do not know what the patient overdosed on and commonly is polypharmacy.
The only study I could find that supports the claim that Narcan lowers the seizure threshold in Tramadol overdoes still states "The findings do not suggest that naloxone should be withheld, but that the potential for seizure should be noted and any forthcoming seizure dealt with. More research is needed to further define the factors that affect the seizurogenicity of naloxone in tramadol overdose."
http://eprints.arums.ac.ir/3741/1/Naloxone.pdf
But regardless even if that was the case a few rare incidents do not outweigh the benefits. Opioid overdoses are far more likely than Tramadol and most of the time we do not know what the patient overdosed on and commonly is polypharmacy.
Dustoff707
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Not 100% sure how TECC works but TCCC's first step is suppressing the threat before rendering any care to your patient. Can't do that if you're not armed. Another gun in the fight to end it faster to provide better care in a tactical field care situation rather than a care under fire situation where care is very limited is more desirable.
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Ok, I've gotta see this one... Please cite international law and applicability...
bakertaylor28
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Ok, I've gotta see this one... Please cite international law and applicability...
Luno, did you really just question that? NOTICE that I specifically restricted what I said to "military combat" situations:
"In 1864, sixteen European states adopted the first-ever Geneva Convention to save lives and alleviate the suffering of wounded and sick persons in the battlefield. As well as to protect trained medical personnel as non-combatants, in the act of rendering aid.
Chapter IV, Article 25 of the Geneva Convention states that: "Members of the armed forces specially trained for employment, should the need arise, as hospital orderlies, nurses or auxiliary stretcher-bearers, in the search for or the collection, transport or treatment of the wounded and sick shall likewise be respected and protected if they are carrying out these duties at the time when they come into contact with the enemy or fall into his hands." Article 29 reads: "Members of the personnel designated in Article 25 who have fallen into the hands of the enemy, shall be prisoners of war, but shall be employed on their medical duties insofar as the need arises."
According to the Geneva Convention, knowingly firing at a medic wearing clear insignia is a war crime.[2]
In modern times, most combat medics carry a personal weapon, to be used to protect themselves and the wounded or sick in their care.[3] When and if they use their arms offensively, they then sacrifice their protection under the Geneva Conventions. These medics are specifically trained.[4]"
Source: https://en.wikipedia.org/wiki/Combat_medic (internal references omitted.) I think that represents a good overview of that side of things. :-D
As for the other part of that, It's fairly basic constitutional law combined with the common law doctrine that "the hand of one is the hand of all", Therefore the paramedic whom engages in questioning of a person whom is subject to a criminal investigation could be considered subject to Miranda where that paramedic traveled to the scene as any part of any law enforcement team. This even extends
to more everyday situations we might encounter- if you ask an OD subject "what did you take" in the presence of a law enforcement officer, or you in any way tell the law enforcement officer what the individual took, you've violated that individual's fifth amendment right to have an attorney present before any questioning. Conversely, it doesn't violate the right so long as I take steps to remove the officer from the immediate area to prevent the officer from overhearing confidential information, and I don't tell the officer that confidential information.
We have to remember that EVERYTHING that comes out of the patients mouth is potential PHI - and handing PHI over to law enforcement without the required civil process WILL get you sued.
Medic27
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It's easy for the cops, have some common sense and they won't kill anyone with Narcan. Pinpoint pupils, there goes the Naxaloneeeee.
Now you got a pissed patient that ain't happy you saved his life. Lol, welcome to EMS.
Now you got a pissed patient that ain't happy you saved his life. Lol, welcome to EMS.
bakertaylor28
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Correlation doesn't equal causation, but yet where there's smoke there's fire. Interesting thought process, there.
SandpitMedic
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Wikipedia as a source... hmm.
Never thought of that
Never thought of that
bakertaylor28
Forum Lieutenant
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On second thought- when we consider the potential for opioid withdraw effects, yeah... why not? So long as I ain't the one who has to end up dealing with it. :-D And Just to think, the waive all started with Judy Garland dying on the porcelain God from a combination of bulimia and an overdose of seconal.
SandpitMedic
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If the answer is no, then they are not a tactical medic. You have to have the ability to be "tactical" not tacticool.
Period.
A vest and helmet does not make a tactical medic. It is the training in tactics, firearms, and medicine in combo that does make a tactical medic.
Period.
A vest and helmet does not make a tactical medic. It is the training in tactics, firearms, and medicine in combo that does make a tactical medic.
Medic27
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Dude around these parts if the patient is swinging his hands open handed, you just call fire. We let fire and LE deal with the ****. Because, I don't have too, Lol.
bakertaylor28
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Wikipedia as a source... hmm.
Never thought of that
Yeah it's a go to when your not in the mood to pull extensive research on the non-technical mundane, especially when your at least 90 per cent sure your right.
SandpitMedic
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90% huh? No need to investigate or research because you're so sure you're right...Not bad...
bakertaylor28
Forum Lieutenant
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Right....until said patient slaps the taste out of your mouth while in the back of your rig while your going down the street. Not much the LEOs are going to do about that, really.
