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The Need for TEMS

The Pasco County, FL Sheriff’s Office was serving a search warrant on the drug suspect when the worst-case scenario happened. In September 2002, one of their own ended up fighting for his life. As the SWAT team’s battering ram plowed through the door of a trailer in Pasco County, a drug suspect unleashed a spray of gunfire that hit Corporal Gordon Larkin.

He hit the floor and began choking on his own blood. Still conscious, he could hear the officers around him charge past and shots being fired. As Larkin fought for his life, Peter Roehrig, a tactical medic, came to his aid. The potentially deadly bullet had lodged behind Larkin’s right eye on his optical nerve, creating irreversible nerve damage.

But with a tactical medic at his side, Larkin lived. He and Captain Rick Neal of the PCSO credit Larkin’s survival to the tactical medic. “If he wasn’t there, our guys would have been freaking out, plugging the hole with something,” said Larkin, laughing. Despite the jokes, Larking knows that if it weren’t for his agencies implementation of a tactical medic team, he may not be here today.

A SWAT team carries out the most dangerous missions of any police department, and with that comes a very likely risk that an officer will go down. Even in training situations, officers may experience broken bones or potentially deadly injuries. But more and more departments are training their medics to be prepared for care under fire, which they hope will reduce the amount of injuries officers receive and increase the likelihood an officer will live in the event of a serious injury.

Tactical Emergency Medical Support, or TEMS, is defined as the out-of-hospital medical support of law enforcement’s tactical teams during training and missions. These highly trained medical providers are able to maintain the health of the team’s members and provide immediate medical care to law enforcement officers, innocent bystanders and suspects.

TEMS goes beyond the care of traditional EMS employees. In the past, medical support for high-risk missions had been limited to EMS and fire rigs that usually waited a block or so away from the hot zone. Today, there is a new trend by many departments to put TEMS where they are needed most—in or near the hot zone.

And because of this, EMS workers are trained not only as a medic, but like a SWAT officer. TEMS are being taught much like a military medic, sometimes using the same manuals. They must understand how to take care of a victim under fire, not just when the debris settles.

TEMS: Sworn Or Not?

Two types of medics are used by SWAT teams, sworn-police officers with extensive medical training and EMS or fire medics who are not part of the police department. The term TEMS, however, infers medics who work extensively with the SWAT team. But this does not necessarily mean they have to be a sworn officer. In fact, many aren’t.

Building a TEMS team of one or the other has both advantages and disadvantages. For one, a sworn police officer who is a TEMS is more likely to be trusted by his teammates. For many police departments, there is a distrust of outside agencies and their lack of knowledge of police procedures and need for secrecy.

Many SWAT members look to the situation in Waco, TX as an example. There, an ambulance dispatcher and a paramedic informed the media beforehand that something was about to go down at Waco. This caused the Branch Davidians to gain knowledge of the impending raid, creating no element of surprise, possibly creating more deaths than what was necessary.

For departments that wish to have TEMS who aren’t police officers, this problem is solved by having the outside medics train regularly with the SWAT team, thus letting the TEMS get to know the SWAT team members and what is required of a SWAT team.

A major issue when creating a TEMS unit is figuring out who funds training, insurance and equipment for a TEMS team. This is much easier to figure out if the TEMS is a police officer, thus leaving it to the police department. When a TEMS team is created where members are from outside of the police department, there is a certain amount of confusion about funding. Who will buy their gear and pay for their training and time? There are no easy answers. Some may choose to split the bill while others may look for grants or donations.

The Kannapolis, NC Police have a written agreement between their agency and the local EMS that sets out the responsibilities and liabilities of each agency with regard to tactical medics. KPD provides body armor, radio, uniforms, and general tactical gear for the medic. The EMS agency provides the medical equipment and supplies, medical training, and insurance. The medic is paid by EMS for time spent training and deploying with the SWAT team.

Another issue, which boils down to the available time the TEMS has, is training. When any person is given two jobs, there can tend to be difficulty in keeping up with one field of expertise. Some argue that a police officer who also acts like a TEMS may not get the chance to stay on top of his EMS training. However, an EMS worker is being paid by his own department on a regular basis to stay on top of his medical training.

Armed Or Not?

A huge debate is raging in the TEMS community about whether or not TEMS should be armed. Sworn police officers who act as TEMS obviously want their guns at their side, but many don’t feel that a regular medic should have a gun. And then there is the issue of whether the expectations of an armed medic would change?

Lieutenant Curt Collins, of Littleton, CO Fire-Rescue, said that his TEMS team is made up of civilians, and they are not armed, but he says it comes down to a couple of simple reasons—certifications and money. He said his department believes that if you are going to be armed, you should go through a basic post academy. The TEMS would also need to qualify with their weapons and remain current with arrest control techniques.

“Now it comes down to finances and who will pay for the academy, the OT to cover shifts, and the qualifications,” Collins said. “With both departments cutting budgets, you can see where this expense may not be top on the list for either chief.” He also concedes that confusion plays a role in it as well. He asks if a TEMS is armed, is he then there for medical purposes or to act as a SWAT officer?

Mark Guimont, with the Upstate Carolina, SC Medical Center, is part of a small team trying to put together a TEMS unit for his local area. Their medics are unarmed, but Guimont would like to see that change. He said it isn’t that he sees the TEMS unit on the entry team, but being armed will make the TEMS feel more secure in a hot zone and not have to rely on the SWAT team for protection.

Some departments seem to play with both sides of the line. They may choose not to allow their non-police TEMS to carry a weapon but do require that they are trained on them. Raymond Coloson, with the Marion County, FL Fire-Rescue, says as a TEMS, he is required to qualify with all of the police department’s weapons, except the sniper rifle.

Sergeant Michael Card, with the Okaloosa County, FL Sheriff’s Department, explains that all of his TEMS are actual SWAT members, but they are only part-time law enforcement officers. Okaloosa’s TEMS go through basic SWAT school and are made “special deputies” by the sheriff. He said that if an officer or suspect is injured, the medics’ knowledge of weapons comes in handy so that they can make the scene safe by removing the weapon and storing it out of harm’s way.

They qualify on everything a normal officer would qualify on. However, Card said they are utilized in positions that would not put them in as much risk as a typical SWAT officer. “Our lives depend on their ability to provide medical assistance to us and any suspects injured,” he said. “It would not be practical to send them in the door first and get them injured.”


There is no standard for training when it comes to TEMS. Most departments decide what is best for their unit and their pocketbook. Some police departments require their TEMS to attend SWAT school with the new SWAT recruits as well as attend a TEMS school. One thing that seems to be a predominant necessity is having TEMS train with the SWAT team on a regular basis, thus brushing up their SWAT skills as well as keeping a good repertoire with the team.

National conferences were held in the early-1990s formally creating the TEMS community. Shortly after that, classes started popping up all over the country to provide this advanced training. The most widely known tactical medic class is Counter Narcotics Operational Medical Support (CONTOMS), which was introduced in 1990. Most classes and TEMS training groups that have sprung up since that time have instructors that are graduates of CONTOMS.

One Agency’s Advice

The Kannapolis Police Department has had a tactical medic for more than a decade. Chief of Police Paul Brown advises other agencies that want to get a tactical medic to do their homework up front. He advises departments to consult with established teams that are using SWAT medics and find out the nuts and bolts of what’s involved and to consult with attorneys and city/county administrators about any legal and administrative issues.

Brown said it is very important to do things right from the very beginning. “Don’t wait until you have something bad happen to start exploring the consequences,” he said. “There is no doubt that having a tactical medic on your team is a tremendous asset. However, the administrators of the agencies involved must have a sound understanding of the legal and operational issues involved so that they can protect the best interests of the medic as well as those of the agencies involved.”

He recommends executing written agreements between the agencies involved. His police department has a written agreement with the local EMS that sets out the responsibilities and liabilities of each agency with regard to tactical medics.

“I simply can’t imagine training or deploying without one at this point,” Brown said. “They have become an integral part of our tactical operations and a respected member of our team. I am constantly impressed by their courage and their willingness to voluntarily perform this role under the most dangerous and demanding of conditions.”

Pasco County Sheriff’s Captain Rick Neal spoke to the students of Rescue Training Inc. at a class in Orlando on his feelings about TEMS. “We all think you are heroes for what you do out there,” he told the room full of students. “You don’t know how important it is to have a medic at entry.” Captain Neal should know; because of a TEMS member, he still has Gordon Larkin on his SWAT team.

Another department that understands the necessity of TEMS not only for its own people but in aiding the general public is the Columbine Police Department (Co.) Collins said that the TEMS team was in the planning stage when two teens went through Columbine High School killing 12 fellow students and a teacher, as well as wounding 24 others.

“That event certainly confirmed the department’s belief in the need for a TEMS unit,” he said. Collins said that Littleton now has one of the largest TEMS team in the country with 15 members.

Christy Whitehead is a freelance writer/photographer based out of Jacksonville, FL. She worked for a time in public relations and has done freelance work for a daily newspaper for seven years. She can be reached at

Published in Tactical Response, Jan/Feb 2007

Rating : 9.2

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Not Exactly

Posted on : Oct 1 at 7:18 PM By Terrian

The lessons for this level of care were learned decades ago--WWll, Korea, and Vietnam. Applying military doctrine to civilian budgets isn't possible--well at least how it's being proposed. First off, you don't need to be a paramedic to save a life in the field. Good BLS keeps lives going. There are many factors to consider when providing statistics on lives saved. The return of the tourniquet, training everyone to use them and the increased ability to get people to field hospitals. The MCI plan that most medical responders use today is excellent. All officers should be trained on how to apply a tourniquet for themselves or their buddy. The firefighter should stay away until the scene is safe. And if the hostile doesn't kill himself, many do, within the first eight minutes, then killing him is the quickest way to get every wounded person care the quickest.


Posted on : Dec 10 at 7:19 PM By Joe

In military units with a similar job to SWAT, TEMS members first job is to put lead on target, only becoming advanced medics as soon as a member or opponent is down. This model has proven very successful in the sandbox and civilian agencies can learn a lot from the lessons already learned by our armed forces.

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