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Training SWAT Medics
In the past decade, there have been incidents all over the country where police and victims have bled out because help was not able to get to them due to the danger of the situation. In a 1999 incident, two officers in Cobb County, GA, Sgt. Reeves and Officer Gilner were killed in a hostage situation, and another officer was wounded. Medics were there but were unable to do anything to help the officers until the police cleared the area.
Because of this incident and others, the role of rescue personnel began to change, and the concept of SWAT medics was initiated. In the last three or four years, fire and rescue paramedics and EMTs (who are both being called “medics” for the purpose of this article) are now taking an active part in SWAT callouts and as members of Immediate Response Teams (IRT).
The thinking behind the SWAT medic concept was that medics were on the scene anyway, so why not put them on the SWAT team so they would be right there if there was an injury? Plus, this immediate care would lead to a higher survival rate. Liability issues pertaining to appropriate and expedient care for the bad guys as well as the team were also a concern.
The fire chiefs at Clearwater, FL Fire & Rescue thought it was so important for medics to accompany the Clearwater, FL Police SWAT teams that they offer a Tactical Emergency Medical Support course for those paramedics and EMTs who wish to become tactical medics.
Medical personnel from other fire departments take the course as well because Clearwater Fire & Rescue is part of a countywide Closest Unit Response system. Under this system, the units closest to the incident respond, whether or not it is in their jurisdiction. Because the medics from other fire departments may be working together at a scene, it is helpful for them to train together so they are all on the same page.
SWAT medics are unlike other paramedics and EMTs both in their training and in their demeanor. They must be high performance, competitive individuals because high stress and physical fitness are part of the job. Their spot on the team is earned through extensive tryouts, not awarded. SWAT medics must be able to function under physical and mental stress (simulated in training by pushups, running the obstacle course, etc.) and still deliver life-saving medical procedures quickly and accurately.
Tactical Emergency Medical Support Course
The qualifying course for a tactical rescue technician was taught in a cooperative effort between the fire and police departments. Coursework reflected earlier Counter Narcotics and Terrorism Operational Medical (CONTOMS) concepts, with the addition of the latest Tactical Combat Casualty Care (TCCC) curriculum. SWAT medics in Clearwater must also attend a separate SWAT School along with new SWAT recruits.
Day 1—Among the topics discussed on the first day were the role of the tactical medic, liability issues, tactical triage (the sorting and allocation of treatment to patients according to a system of priorities designed to maximize the number of survivors), and the mission-specific equipment that must be taken to a callout. Equipment needed at an active shooter incident might be different from that needed at a hostage situation. And the equipment needs to be pared to the bare minimum since the medic will be carrying his bag for long periods of time and may be going through narrow spaces.
Tactical medicine is more like combat medicine than that practiced by the fire department in everyday emergencies. There may be penetrating injuries and wounds with massive bleeding. For this reason and with collaboration with Navy Captain Frank Butler (the special operations command surgeon), the emphasis of the day was placed on the latest TCCC guidelines.
If an officer is down, he needs to be removed from the situation quickly. The medics need to have a rescue plan formulated before going in. Where is the closest cover? Where will they take the officer? Where is the extraction point? Where is the rallying location for regrouping? Tactical medics must work closely with SWAT during incident planning and the execution of those plans, as well as during training so they are up to speed with communications and actions as they discover their strengths and weaknesses.
Day 2—A physician assistant from a local hospital explained the uses of sutures: how different ones work, how long they work, and which ones to use with different kinds of wounds. Suturing is not something paramedics usually do in their day-to-day lives but might need to know in a tactical situation. The medics then practiced field-expedient suturing. A banana was chosen as the “patient” because it has several layers, the outer one tougher than the inside, much like human skin.
A member of the Clearwater Police Department SWAT team discussed the relationship between law enforcement and tactical medics, stressing how they must train as a tactical unit and create cohesiveness so under stress they will work like a machine.
The tactical medic with an Immediate Reaction Team (IRT) operates in close proximity to the entry team, but about 20 seconds behind it. It handles everything behind it so SWAT doesn’t lose ground. With plans already in place, it can accomplish a coordinated rescue.
The objectives of IRT are to decrease death and disability of law enforcement and civilians, increase awareness of new extraction/rescue techniques in tactical operations, and make available preplanned rescue strategies. Concepts from Lt. Col. Dave Grossman like stress inoculation and stimulus response are emphasized in IRT. They are integrated into all of the scenarios.
A discussion of the limitations of body armor and ballistic shields followed, as well as how shields can be used in officer rescue. During a high-risk warrant, the first 6 feet inside the door are the most dangerous, and if one officer is shot, typically another one will be also. For this reason, the IRT should be in close proximity to the entry unit, but should be considered a separate element.
Medics must master tactical triage and overcome their natural instinct to stop and treat the first injured officer they come across. This is because the duty of IRT is to help SWAT complete its mission (LIE—locate, isolate and eliminate the threat). Eliminating the threat is the first priority for team safety.
That evening, IRT drills allowed the team to explore different avenues of rescue. These were high stress scenarios in the dark, with the medics under fire from hidden adversaries with paintball guns. They were taught stacking behind a shield so they could rescue a downed officer. Many of the scenarios were done in almost complete darkness—some in a field and some in a building. If a team member was shot, he had to be rescued, too. The idea was to inoculate them continuously with enough stress that they won’t shut down in a real situation.
Day 3—Fourth Generation Warfare was the topic of the first lecture. The kinds of injuries most tactical medics—as well as other paramedics—will face have changed radically in the last few years. Terrorism is the reason, and it will be coming to this country.
In 1989, military writer William S. Lind wrote about a new kind of warfare that was emerging, one in which the goal of the enemy would be to collapse a country internally instead of destroying it. They would do this by using nontraditional and guerilla tactics. They would have no uniforms to identify them, be highly maneuverable, have no definable battlefields or fronts, and blur the distinction between the military and civilians. And, because they were a nongovernment group, there would be no political entity with which to make peace. Police and medics will find themselves in situations different from what they have experienced in the past, and they must be prepared.
Tactical medics must also care for another member of the SWAT team—the team’s K-9. Dogs can become injured as they perform perimeter control, search and rescue, suspect tracking, and other duties. The medics learned how to handle an injured dog by approaching slowly, speaking calmly and utilizing the K-9’s handler in its treatment. Some of the K-9 emergencies they might need to treat are heat stroke, exposure to toxic chemicals, such as insecticides, and drugs, snake bites, fractures, and gunshot wounds.
They also learned how to provide medical support to team members during extended operations. For example, they might encounter sunburn, heat injuries, and dehydration caused by temperature and humidity as well as dark clothes, helmets and body armor.
Day 4—The medics participated in hands-on scenarios while being shot at by bad guys armed with paintballs and Simunition. In one daytime scenario, the medics had to deal with 17 role players. Because the primary duty of a tactical medic is to act as medical support for the police department, they noted patient locations and conditions but continued on with the team. A team leader questioned the walking wounded as they left the building under their own power.
Using hand signals and remote assessment, the medics communicated with each other as they moved from cover to cover. One injured person was bleeding badly from a leg wound. They dragged him to cover and applied a tourniquet.
The medics were also taught to search a patient for weapons by imagining that their hands were covered with powder and they were applying it to the patient’s body. In that way, nothing would be missed. Had they not found the weapon concealed on one of the victims, he would have opened fire on them.
After dark, two other scenarios were conducted. One was a hostage situation, and the other the rescue of a bleeding individual in a totally dark house. In this scenario, security was provided by the tactical element—the police. Medics crawled into the house and along the floors until they located the patient. No lights were used at all, even when treating the patient, because of an Israeli incident in which two tactical physicians were shot.
In that incident, the light from a laryngoscope (a lighted, fiber-optic instrument used to see into the throat) gave away their positions. In this training scenario, the medics applied a tourniquet once they found the bleeding spot and carried the patient to a waiting van. At this point a mannequin replaced the patient and medical care such as IV administration and airway management took place.
Day 5—One of the duties of SWAT medics is to keep the team healthy. Members may become dehydrated while on a callout. Signs of dehydration include muscle tenderness and stiffness, joint pain, rapid heart rate, confused mental state and fatigue.
Methods of decontamination of patients were also discussed because sometimes patients need to be decontaminated before being put into a closed container like an ambulance or a helicopter. If, for example, they were exposed to OC gas and not decontaminated, the gas might also affect the pilot or driver.
SWAT members were generally athletes when they were young, so many of them bring previous injuries to the job. A sports medicine doctor spoke about sprains, lacerations, concussions and dislocations, and demonstrated the application of elastic bandages.
Tactical medics must also attend a separate SWAT school. Even though they are unarmed while performing their jobs, it is thought that they should also know how to fire a weapon in case they or the person they are rescuing come under fire and they must defend themselves.
While law enforcement has developed ways of removing an officer or other victim from a dangerous situation, fire/rescue must do the same thing. The use of a drag device to pull a rescued officer along the ground to safety was developed for fire department use but has now been adapted to police rescues.
In addition to being quicker, some newer drags allow those SWAT team members rescuing an officer to have both hands free to fire their weapons. In addition, this drag technology saves the rescuing personnel from the back injuries that can result from carrying the wounded officer, and also prevents additional injuries to the rescued officer himself.
Infrared cameras have been used extensively in fires to find victims in smoke-filled rooms. Now they have been adapted to police work and are being used to find perpetrators in dark backyards and hidden areas.
When the paramedics initially began to work with the police department, one concern was the sensitivity of the information and how it would be controlled. How could the medics be on the scene of a SWAT callout, yet have the location of that callout remain secure? The problem was solved in Clearwater by having only one or two contact individuals at the fire department. Once they are notified of a callout through a secured paging system, the tactical medics meet at the firehouse, are given the location, and drive there in unmarked vehicles.
Financial considerations should be shared between the fire department and the police. SWAT medics dress very much like SWAT, and must wear ballistic vests, helmets, etc. In Clearwater, the police department supplied these.
The concepts of Tactical Medics (SWAT) and Immediate Response Teams bring medics closer to the action, and training such as that received by tactical rescue technicians is giving them the tools to do their jobs. When a SWAT team is accompanied by individuals with “Medic” or “Rescue” printed boldly on their uniforms, they know the tactical medics are there, prepared to save their lives.
Jim Weiss is a retired lieutenant from the Brook Park, OH Police Department and a frequent contributor to Tactical Response. Mickey Davis is a Florida-based journalist. They may be reached at JWEISSemail@example.com and MDavisFLAfirstname.lastname@example.org.
Published in Tactical Response, May/Jun 2006
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