Return
to Home Page
Many of the advances taking place in emergency
medical care are a direct result of military medicine. Lessons learned
by physicians and medics in the armed forces are tailored for use by civilian
care providers.
In much the same way, police agencies adapted
the techniques of combat to control of high-risk situations in their jurisdictions.
Special Weapons and Tactics (SWAT) teams have been in place in many American
cities since the 1960s.
A method for police confronting well-armed
individuals was developed following the urban riots of the early sixties.
Los Angeles Police and other departments began using police officers specially
trained in paramilitary techniques and special weapons to address these
issues. Many of these techniques were borrowed from the military's Special
Operations groups.
What the law enforcement community failed
to do at that time was follow the military's lead in providing medical
support to their tactical teams. Most services were provided by the local
ambulance services who were understandably hesitant to enter an area that
was not well controlled.
The SWAT officer is a very valuable resource
and is not easily replaced. When a unit is dispatched, a group of highly
trained individuals is placed in a very dangerous situation. It is impossible
to pull someone off patrol and call them a sniper. Further, most teams
do not have much redundancy. Finding methods of keeping the members healthy
and safe helps the team perform more efficiently.
Armed services combat teams have long had
medical support. Only recently have programs been developed to give police
agencies similar emergency back-up.
"When I first joined the team, there was no
medic assigned to our tactical force," noted Lt. Eugene Melanson, commander
of the U.S. Park Police SWAT team. "We used to rely on local medical services,
the same people you would get by calling 911. "
Over the years, many metropolitan departments
developed some type of medical capability within their tactical units.
Some trained police officers as medics while others schooled emergency
medical technicians in the workings of an entry team.
However, there was still controversy over
what needed to be taught to these responders. To address this the Uniformed
Services University of the Health Sciences (USUHS) teamed up with U.S.
Park Police (USPP) and others to work toward a consensus. The resulting
58-hour course known as Counter Narcotics Tactical Operations Medical Support
(CONTOMS) was born. Those who completed the school receive the designation
of Emergency Medical Technician-Tactical (EMT-T).
"In November of 1989, we recognized the need
for special training in tactical medicine," said Joshua Vayer, director
of the CONTOMS Program at USUHS. "We joined with the Special Forces branch
of the Park Police to explore the idea of a standardized curriculum. Roughly
nine months later pilot testing was completed and the first EMT-Tactical
class was run."
The need for this type of training was reinforced
soon after discussions began. When Park Police Sgt. Rick Preston had a
heart attack and died during a training session, it brought home to many
on the team their vulnerability.
"An EMT was present and started CPR on Sgt.
Preston immediately, said Melanson. "Although my officer died, it impressed
upon us the need to have competent emergency medical care with the team,
not five blocks away at the staging area."
Initially Vayer and others began to look at
the types of behaviors and skills that would be needed to properly train
a person to be an EMT-T. There was very little consensus on what should
be taught and how to teach it.
"As we began to work on this program, we came
to realize that there were few teams with medical support as part of their
operations," said Vayer. "EMS crews were usually standing by a few blocks
away. There was no agreement on what they should be taught to help the
teams and stay out of trouble."
Initially, the participants looked at how
lessons learned from military medicine could be transferred to civilian
law enforcement.
"When we first started working on this idea,
I went to some military maneuvers near Quantico, VA," said Melanson. "I
was impressed by the amount of medical support that came along with the
combat groups. I also realized that there were similarities between the
two types of operations and their hazards."
"Sometimes we forget how dangerous our job
is," he continued. "We bring explosives, high powered rifles, and chemical
agents to a scene. It is only common sense to bring along specialized medical
support."
The mechanics of medical care are essentially
the same in tactical operations as in other settings. The complicated part
of SWAT EMS is the environment in which the care is provided and the decision
making processes an EMT has to use.
"If all you do is decide if someone is alive
or dead, that is pretty easy," said Vayer. "If adequate evaluation means
you put yourself at very high risk, then it is a harder decision."
Participants learn to do rapid and remote
assessment. Vayer described it as an algorithm that helps an EMT decide
how much of a risk should be taken to effect a rescue. Often this has to
be done from the last point of concealment and cover.
"Before the start of SWAT medic training,
the criminal had to be dead or arrested before the EMS could move in to
treat any casualties," noted Capt. Sebastian Wong, a paramedic with the
San Francisco Department of Public Health and a member of the city's SWAT
team. "They were not trained to give treatment under fire, so staging often
occurred a block or two away. If a femoral artery was nicked, half the
victim's blood volume could be lost while they moved up."
Having medical support on the team means immediate
care is available when injuries occur. Without SWAT medics, the scene has
to be secured before EMTs can move up from their staging areas and begin
to work on the patients. Now care is available within seconds instead of
minutes.
Most EMT and paramedic training is based upon
the logical assumption that you will be in a relatively controlled and
safe environment. That makes sense since most practices are structured
that way. In a SWAT environment that is not often the case and new, specialized
skills have to be developed.
One new skill taught is delivering care under
fire or in severe environments. By using both classroom and laboratory
instruction, those enrolled in CONTOMS are subjected to many of the same
stressors they would see in the field.
"The SWAT teams work under a lot of conditions
that are not faced by even the most seasoned street medic," noted Melanson.
"One minute you may be treating a patient in the dark hall of a building
and the next working on someone with firearms, explosives and loud noises
all around."
The course includes classroom and practical
applications in the field every day. Thursday there is an all-day exercise
that culminates in a real-time simulation lasting four to six hours.
The participants are given a scenario and
they are expected to carry it out. Practical exercises use tear gas, blank
ammunition, and concussion grenades to make it as real as possible.
"We would love to be out every day doing real
missions but that is not the most effective way to do teach the material,"
noted Vayer. "To get the information across, a good part of the day is
spent in the classroom. Those skills are reinforced during the practical
exercises."
Another focus of the program is managing the
health of the team, making the EMT-T responsible for preventive medicine
and injury control.
Teams usually get ready only to wait for hours
until a drug buy is made or hostage negotiations break down. The equipment
adds about 10 degrees to a person's heat load and the wait is often in
the back of a closed van. There is also a physical training component that
may result injury.
"Our view is that the EMT-T has responsibility
for the team's health and safety at all times," said Vayer. "The medic
should be with them during training, briefing and deployment."
The EMT-Tactical has an impact on the team
in areas other than the treatment of catastrophic injuries. Getting a SWAT
member back on the line from a muscle sprain or small cut is also an important
part of the medical services to the team.
A person who goes through CONTOMS is taught
how to complete a medical threat assessment of the situation. It is then
their responsibility to make suggestions to the team commanders on what
resources are needed to minimize these dangers.
The EMT-T looks at the intelligence reports
to help the commanders know how the medical aspects of the situation may
alter their plans. For instance, the medic sees that the laboratory they
are going to raid contains a certain type of chemical that regular gas
masks do not protect against. They would then tell the team leader this
so that appropriate gear could be issued.
The trained medic also brings his or her expertise
on the medical community's resources and how to activate them if needed.
Few police officers have these skills and knowledge.
Under certain situations, the medic may need
to alert the trauma unit of their situation. If a narcotics laboratory
is to be raided, the tactical medical officer would consult with the emergency
physicians on what kind of chemical injuries expected and how they should
be handled in the field and the hospital.
"Their job is to go through the entire system
and pick out problems that are potential threats to the health and safety
of officers, criminals and civilians," stated Wong. "Once identified, they
develop plans to deal with the medical problems that may surface."
Treatment of an injured person is often only
part of the medic's responsibility. When working with a prisoner or bystander,
preservation of evidence must also be considered. Knowing what is useful
and who to contact after discovery, is not within the scope of a normal
EMS practice.
Another aspect of training stressed at CONTOMS
is "assessment across the barricades". If a hostage or criminal becomes,
medical support should assess and possibly even direct treatment from a
remote location.
"A hostage negotiator knows about as much
about medical treatments as the medic knows about successfully talking
a person into giving up," said Wong. "If you have a SWAT medic available,
they can provide some form of medical counseling to the criminal and simultaneously
pick up information that might be helpful to the negotiator."
Medical support for tactical operations has
a positive effect on the moral of the unit.
"This shows the men on the team that they
are important and supported," said Melanson. "They can focus on their mission
knowing that, if anything does happen, the best medical support possible
is immediately available."
The selection process for the law enforcement
officers is very demanding and rigorous. The method used to appoint the
medical support should be too.
"You cannot let everyone wanting to join the
program become a SWAT medic," noted Wong. "They need to be a very mature
and psychologically stable team player. The life of each member is interdependent
with the others. `Ricky Rescue' or John Wayne types may get somebody killed
in this environment."
In addition the EMT or paramedic needs to
be highly skilled and experienced in medical matters. Often, decisions
will need to be made immediately and without being able to consult with
the hospital base station.
Minimum requirements for admission to CONTOMS
include certification at the EMT level. The student must be associated
with a bona fide public safety organization and sponsored by a law enforcement
agency with counter- narcotic responsibilities. Finally, a recommendation
form must be filled out by the applicant's supervisor.
Vayer stressed that entrance into the course
is very competitive; they receive two applications for every slot available.
A documented need for the training weighs heavily in the admission decisions.
Other criteria include prior training demonstrating interest and expertise
in the area and current affiliation with a SWAT program.
There are no specific fitness requirements
for admission to the program. However, there is strenuous exercise involved
in the program. There is also exposure to irritant agents such as tear
gas, smoke and pyrotechnics during field exercises.
"You cannot just take a police officer out
of a patrol car and make them a SWAT team member," said Melanson. "Likewise,
a medic must be highly trained and qualified. Medical support of tactical
operations requires a special person."
To
see other articles