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Starting a TEMS Unit from Scratch

Does your tactical team have a TEMS unit? If it doesn’t, it can, and it probably should. SWAT officers, despite their skills and equipment, are vulnerable to injury just like any other officer. What is different for tactical officers, though, is the types of injuries to which they are susceptible. Tactical officers put themselves in dangerous situations that can result in specific injuries best treated by a knowledgeable medical reactionary team.

While any responding paramedic is a welcome sight to an injured officer, being immediately treated by a team paramedic who has been standing by on the scene and who has the exact knowledge of what that officer has just survived would afford the injured officer a better medical outcome. Medical studies have proven that survival rates increase with immediate pre-hospital care by qualified personnel who can assess and manage trauma.

Because team paramedics typically train with the tactical team and are briefed before missions about possible threats, they become better equipped with medical and tactical knowledge. From a psychological standpoint, because they are official members of the team, they are also likely to have a personal relationship with their future patients. This relationship is more likely to foster a calming atmosphere for the injured officer, which is definitely best in an emergency medical situation.

Concerns When Starting a TEMS Unit

A SWAT paramedic for your team might very well have different duties from the SWAT paramedic in the next jurisdiction. You need to determine what the role of your TEMS unit will have. You can conduct an in-depth needs assessment to determine the specific jobs your TEMS unit will perform, but at the very least, you need to identify what your agency requires.

What medical status will your TEMS unit be required to have? Paramedic, EMT-1, EMT-2, RN, full medical doctor? Be aware of what each level of medical expertise entails. Just because you have an officer who moonlights as an ambulance driver, that does not make him qualified to treat wounded patients.

Will your agency only allow sworn law enforcement agents to act as SWAT paramedics and thus be armed? Will your SWAT medic be unarmed but allowed to be on the entry team? Will your TEMS unit be on secondary teams and only allowed to treat the injured after all the threats have been neutralized? Before you can establish a TEMS unit, you need to address these important issues.

Those are the easy questions because the harder ones involve paper, bureaucracy and lawyers. Some liability issues MUST be considered: Do you need to use city- or county-funded medical personnel, such as firefighter paramedics, or is your agency contractually obligated to use a certain local EMS company? What are the insurance liability and malpractice issues?

Let’s not forget about the financial aspect. Some agencies might be in a financial position to create the actual job title of “SWAT paramedic” and assume the person’s salary into their budgets. For an agency with a full-time SWAT team, that is more likely. For the majority of agencies with part-time tactical teams and who are increasingly dealing with budgetary restraints, the issue becomes iffy.

Is there a possibility you can have volunteer SWAT paramedics? Some teams “employ” certified paramedics that train and respond with tactical teams on their own time—the only thing they receive from the law enforcement agency is gear and affections (and a plaque and medal at the end-of-year banquet).

If your TEMS unit needs to be POST certified, can you recruit a civilian paramedic and have your agency pay for his certification? Or will the paramedic just receive the sponsorship of the agency but have to foot the certification cost individually?

You should also consider the chain of command. Will your TEMS unit answer directly to the SWAT commander or, if not employed by your agency, to the service that employs him? Will you use your TEMS personnel to assess medical hazards prior to a mission, and if so, what liability does that articulated opinion create? Once you have established exactly what role your unit will fill, you need to create a written policy outlining that role.

Finding the Right Candidates

Once the paper part of your TEMS unit is complete (not to mention the political wrangling that may ensue), the next part is the selection of candidates. Chances are fairly unlikely you have a sworn law enforcement officer who is also a paramedic who is also on your SWAT team. If you have that trifecta, your problems are solved. But for the most part, tactical teams need to recruit their own paramedics.

Experience on the streets will teach you who the quickest, most efficient and bravest paramedics are. Think about who you would want to be climbing out of that ambulance if you were hurt, and think about who you’d rather avoid. If there’s a paramedic who gets antsy whenever he has to navigate the scariest section of town, that person is probably not a good candidate for your TEMS unit. Similarly, if you encounter an EMT who has been affectionately termed a “groupie” or “wannabe,” that person is probably not the best bet either.

Some of the best SWAT operators are ones with prior military experience. Those with a military background are accustomed to the paramilitary workings of a tactical team, they’re usually not squeamish and, if allowed to be armed, they’re also not unfamiliar with the doctrine of protecting their patients. Because members of a TEMS unit could be allowed within the SWAT perimeter (and not staged in a “safe zone”), they should be outfitted in tactical gear (clearly marked as MEDICS) and could be expected to move with the team on missions.

Based on these expectations, it would be in the best interest of the tactical team to require its TEMS unit to meet and maintain the same physical qualifications and standards as the rest of the team. While not all tactical teams require their TEMS units to qualify on a physical test, some create a different set of standards that include more job-specific functions, like running and dummy-dragging skills, etc.

Again, because the specific role of your SWAT paramedic will be unique to your agency, your team and your needs, the qualifications will be dictated by those circumstances. Whatever qualifications you require for your medics, though, be sure to receive copies of their certifications and keep them on file. These should be updated just as you would update the training records of your team members.

Similarly, you should also require a background check with the requirement to notify the commander of any criminal infractions (including DUI) that have occurred after appointment to the team.

If you haven’t previously had an official TEMS unit associated with your team, you will have to educate your team members as to what to expect from the medics. While it is a great idea to have your medics present during training and re-qualifications to treat any injuries and/or dehydration issues, the team members should not come to rely on the TEMS unit as their personal physicians. While it would be perfectly acceptable to ask a team medic for an opinion on a minor issue while at training, calling them at 0800 on a Sunday morning for a quick anti-hangover IV would be wholly inappropriate.

TEMS Units as Instructors

Many tactical teams employ their TEMS units in a variety of ways, not just as medical responders. One such way is as a trainer. Your TEMS unit can offer a variety of training to your tactical team, such as how to administer “buddy first aid” on a mission or how to recognize the signs of dehydration during long training sessions. By involving your TEMS unit in your team training, they can identify potential medical hazards and offer medical / safety advice.

If you plan to incorporate the training role into the job description of your TEMS personnel, be sure to take that into consideration when selecting your team. Do they need to be instructor-certified or can you use them as subject matter experts and allow them to conduct training under another instructor’s certification? If they need to be instructor-certified, will your agency sponsor their training?

Authority of TEMS Units

The tactical medical personnel can actually be of great coordination assistance to the SWAT commander. Consider granting your TEMS unit the authority to arrange for all ambulance staging, communication with other emergency responders such as fire and other EMS, and communication with the local trauma center. This unloads some of the planning burdens of the tactical team leaders and could very possibly help the mission run more smoothly.

Remember that SWAT medics can also be used as medical documenters. They can provide written and photographic evidence of on-the-scene treatment not just of officers, but of suspects. When your team medics treat a suspect for minor lacerations and document it, it helps reduce your agency’s liability by warding off false injury reports.

While the establishing of a TEMS unit from scratch may appear to be daunting, with many high-liability issues and so many different TEMS models from which to choose, the fruits of your labor will be worth it. Once established, you will find your tactical medical unit to be indispensible…and hopefully just needed for the occasional band-aid or ankle wrap.

Cara Donlon-Cotton is a former course developer for the Georgia Public Safety Training Center and a recognized master instructor by GA POST. She can be reached at

Published in Tactical Response, Sep/Oct 2009

Rating : 9.8

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