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Who Saves SWAT?

SWAT takes on the toughest cases. Training and planning usually ensures the mission goes according to plan – a peaceful resolution. But when things go wrong, when shouts of “Officer Down” ring through the scene, it is up to TEMS to save SWAT.

Tactical Emergency Medical Support (TEMS) are the medically trained members of the SWAT team. They can be paramedics with limited law enforcement commissions, law enforcement officers with paramedic training, or health care professionals who remain unarmed. All these versions are in use throughout the nation, although the subject of which one is the best version remains up for friendly debate in the SWAT world. Regardless of where they come from, these medical professionals, trained in SWAT tactics and procedures, are there to provide care to officers, citizens and suspects injured during high-risk events.

In this time of budget cuts and layoffs, administrators may question the need for funding a team simply to stand by in case of an injury. Why not just ask for an ambulance after something happens? According to Corporal Doug Rickard, a Tactical Emergency Medic for the Southwest Washington Regional TEMS (SWWRTEMS) team, having medical professionals trained to function in a high-stress police environment can make all the difference to the SWAT team.

“They not only have medical people, they have tactically trained medical people,” he said. It is this tactical training, along with the ability to provide medical care without compromising the duties of the other SWAT officers that makes TEMS so effective. Fellow SWWRTEMS member and Clark County Deputy Jon Shields agreed, saying, “They know we are absolutely proficient at working around them. We are not foreign to what they are doing.”

But TEMS is more than just high-risk incident response for injuries. “When people outside the tactical community are asked to describe the roles and responsibilities of TEMS personnel, they usually envision emergency medicine representing 90 percent of the job when in actuality…it’s just the opposite,” according to Jim Etzin, Executive Director of the International Tactical EMS Association.

“TEMS provides unconventional medical support and expanded scope of care to the team that often includes aspects of occupational, preventative and sports medicine. It’s this comprehensive approach that makes them very similar to their military counterparts…the corpsmen, medics and para-rescuemen that serve within our special operations forces.”

In addition to caring for their own, agencies with TEMS medics also have someone who can respond to save suspects, assist with basic scene safety, provide care during training exercises and patrol, and function as a medical liaison and advocate.

TEMS Saving Suspects

While TEMS is most often thought of as saving officers, they also can make the difference between life and death for suspects who choose to engage the SWAT team. The Indianapolis Metropolitan Police Department TEMS team, founded in 1999, has been called upon to provide a variety of care for suspects according to SWAT Commander Tom Sellas.

In addition to treating those shot during apprehensions, the Indianapolis TEMS team, staffed by both by IFD and IEMS paramedics, successfully resuscitated two suspects found in respiratory arrest during warrant services. This TEMS team has been so successful that in one case a defense attorney who attempted to introduce his client’s injury into the trial abandoned the tactic when he found out how quickly and efficiently care was delivered.

TEMS Providing Scene Safety

The tactical training that TEMS members receive enables them to react safely in situations not necessarily found in a routine medical response. For example, think about the gear many law enforcement personnel wear and how unusual it appears to the uninitiated. How do they get the gun belt undone? How do they secure a weapon? Is the vest attached in front or in back? While there is no doubt medical professionals with no tactical training could figure it out, precious minutes could be wasted.

Add in the technical gear worn by SWAT officers and the stakes go even higher. Would an EMT feel confident he could remove a diversionary device from a SWAT officer without setting it off? “A TEMS provider familiar with SWAT’s weapons systems doesn’t have to wait for another operator to render a weapon safe. The medic or physician can do so without delay and consequently…deliver immediate care to the casualty,” Etzin said.

TEMS at Training

According to Rickard and Shields, training exercises can be more of a risk for officers than SWAT call-outs. “We’re talking about guys who practice blowing stuff up and shooting people,” Shields explained. “If you’re going to make a mistake, make it in training.” While training provides real-world experience, it can also lead to real-world injuries ranging from a sprained ankle after falling off an armored car to an accidental shooting. Shields recounts one incident in Vancouver, Wash., that demonstrates the benefit of having a TEMS unit close by.

The SWAT team was practicing explosive entries to breech a door. The members not involved in the exercise were 100 to 125 yards away, at a 30-degree angle opposite of where the shrapnel should land.

“It was a typical training exercise, a bunch of us standing around watching because it was going to be really cool,” he said. “The charge went off, the team made entry; everything looked good…when someone behind me yelled for a medic. I looked over and one of the Portland bomb techs was bent over at the waist and holding his mouth, which was bleeding fairly profusely.”

A piece of shrapnel from the blast had torn open the side of the officer’s mouth. While waiting for the ambulance, the TEMS team went to work controlling the bleeding, starting an IV, and providing pain medication. When he arrived at the hospital, doctors realized he had been hit by a pin that entered his cheek, hit his cheekbone, and lodged two millimeters from his carotid artery. While it appeared to be just a cut to his mouth, this could have been a life-threatening injury and having TEMS on scene could have saved his life.

When it comes to training, TEMS medics are not limited to just SWAT exercises. In Indianapolis, the TEMS team also provides support for the department’s Firearms Training Unit at patrol rifle schools, provides training for protective unit officers, and even standbys at K-9 training sessions in case of injuries to dogs or officers, according to Sellas.

TEMS as a Medical Liaison

As medical providers, TEMS members can stay with an injured officer as he journeys through the hospital system, communicating with doctors and nurses to provide immediate information on the officer’s medical history. As a result, the wounded officer is never without a member of his team by his side. For the family and law enforcement community, the knowledge that their loved one is never alone can provide great comfort in a stressful situation.

The TEMS medic can also provide a type of liaison service between the hospital and the law enforcement community. Hospitals are often limited by HIPPA regulations and policies in what information they can share and may have little patience with law enforcement administrators who demand information from them. “A TEMS provider can come in and say, ‘I’m the medic, or I’m the physician for this team, and if you don’t mind I can act as the liaison between your facilities personnel and my chain of command’,” Etzin said.

TEMS as Team Doctor

As the dedicated SWAT medic, TEMS members also function as medical advocates able to spot a physical or mental issue before it becomes detrimental. In Indianapolis, TEMS medics have identified illnesses ranging from asthma attacks to dehydration during routine assessments, including one potentially life-threatening situation affecting a SWAT recruit.

This proactive approach can do more than just catch sudden medical issues. Etzin refers to one incident in Akron, Ohio, when the TEMS physician doing routine SWAT exams found several members of her team had elevated levels of lead in their blood, possibly from years of indoor firearms training. As a result, the officers were referred for additional medical care and the agency made changes to its training program.

This interaction and advocacy builds a strong relationship between the TEMS medics and team members, which is vital when a mental health or critical-incident stress crisis arises. Instead of meeting a physician in a cold, impersonal office, officers with TEMS medics have someone to confide in who knows them and the issues they face on the job. “They have that trust, that interpersonal relationship, which other healthcare providers may not have,” Etzin said. The TEMS medic can then ensure the team member is referred for the necessary care.

TEMS and Hostage Negotiations

Hostage negotiators agree the longer they can keep a suspect talking, the better the chance of a successful outcome. But what if the hostage or suspect suffers a medical emergency or injury? In this case, having a medical professional who understands police tactics can be crucial.

When monitoring negotiations, a TEMS medic can provide information on the severity of an illness or injury to help determine if a crisis entry is necessary or if there is time to continue talking to the suspect. Take, for example, a report that a hostage has been shot. The automatic reaction by command may be an immediate rescue. But what if the hostage was shot in the toe? Is it still a crisis? What if the hostage is eight months pregnant? Does the team need to rush in to save her or is she safer staying put?

“The TEMS provider typically doesn’t become actively involved in crisis negotiation or suggest tactics. They’re simply going to provide medical intelligence to command officers so informed decisions can be made,” Etzin said.

TEMS on Patrol

Agencies with sworn officers who are also TEMS trained benefit by having units on the road who can provide another layer of help for citizens, saving those who are just in the wrong place at the wrong time. In December 2009, Shields, Deputy and TEMS medic Albin Boyse and Reserve Deputy and TEMS medic Wade Faircloth had just met for lunch while on patrol when the alert tones went out over the air. 9-1-1 had received a call of shots fired at the Bi-Lo Foods store just down the street.

Entering the store minutes later they found a clerk frantically trying to care for a fellow employee who had been shot multiple times. Recognizing there were not enough units to safely clear the scene, they grabbed the victim and backed him out of the store.

As arriving officers began to set up containment, Shields, Boyse and Faircloth, joined by Deputy/EMT Mark Butterfield, took the victim behind a concrete wall and began to assess his condition. “In the end we figured out he had been shot five, maybe six, times,” Shields said, including in the forehead, shoulder and back.

He also had defensive gunshot wounds to his hands. The team dressed the wounds, started an IV, and had him ready for transport when the ambulance arrived. “Seven minutes from the time that we actually got the call to 9-1-1, he was in an ambulance with a dressed head wound, an IV, a tourniquet and completely checked out head to toe to see how many holes he had,” Shields said.

Those seven minutes may have saved the victim’s life. Instead of waiting for the ambulance to arrive and then stage until the scene was secure, the TEMS medics were able to start treating him immediately. If they had not been on scene, the delay in help could have led to a much different outcome.

Funding TEMS

Funding a TEMS team in tough economic times can be a hard sell for many administrators, especially if the assumption is they are only there on standby for a worst-case scenario that may never happen. But the reality is TEMS is more than just an emergency response. Having TEMS provides someone who can respond to training accidents, act as a medical advocate, and serve citizens and suspects as well as officers.

“When I first started, a long time ago, we were always looked at as kind of the Doctor of Death,” Shields chuckled. “We’ve gone from that all the way to someone saying to me just recently, ‘our medics are like American Express, we don’t go anywhere without them’.” Nor should they.

Kelly Sharp is a partner in Workplace Consulting NW, LLC, which provides a variety of training and management classes. In addition, she has worked as a 911 training officer and dispatcher for 16 years. She can be reached at

Published in Tactical Response, Mar/Apr 2012

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