Tactical Medical Response Initiatives4/19/2009 8:50:00 AM By Met Clark EMT-P Tactical
Charlie Bunn RN, CEN Tactical
The Tactical Medical Response Initiatives©, developed by Tangent Edge, are guidelines for the civilian and combat medic to incorporate into their training and decision-making process. The medic, in general terms, may find a host of challenges in today’s Global War On Terrorism (GWOT). The environment is the determining factor that sets the stage on when, where and how the medic will employ medical skill sets to save lives. This should not be confused with routine medical calls and is indeed a specialized field with different medical approaches as well as medical philosophy.
The Tactical Medical Response Initiatives© is a stand alone component to civilian tactical medicine. The prevalent thought among public safety administrators focuses on two factors that will govern the response of the tactical/SWAT medic. These factors include legal and liability issues. The tactical/SWAT medic, in most states, can conduct operations legally with law enforcement. This allows medics to carry a weapon in the line of duty for SWAT operations; however, liability issues create an air of hesitancy on the part of the medic due to sponsoring agency’s reluctance to assume responsibility for the medic’s actions.
If the medic uses lethal force without proper accreditation or training, legal prosecution, and/or criminal charges may be filed. Agencies may also be in dispute as to which organization is responsible for the medic’s training. Medic training may consist of a multiple certifications such as SWAT/tactical medic school, SWAT school, and mandate training. An agency’s budget may not allow for medics to be active members of a SWAT team or allow for time spent away from their original assignment. Oftentimes, the medic will come out-of-pocket for expenses incurred for training as well as deployment with SWAT operations.
The Tactical Combat Casualty Care (TCCC) is the military doctrine and program for medics in combat and pre-training for combat. Civilian tactical medicine schools often teach medics the three components of the TC3. These components may or may not be applicable to the environment in which the civilian tactical medic may be operating.
The three components are:
1. Care Under Fire
2. Tactical Field Care
3. Casualty Evacuation
Care Under Fire This is the most dangerous and technically difficult phase for the medic. Some agencies place medics with the entry team; some preposition them in the hot or warm zone. Tactical Medics should be located in the hot zone in order to be able respond quickly to injury. Some departments feel that the medics should not be armed, a proposition that reduces the effective fire power of the team. Armed medics should complete the same firearms training required of all Special Operations officers on their department. This prevents use of force questions and fully integrates the medic with his team mates.
The First Tactical Medical Response Initiative© is Risk Management/mitigation. This is the application of specific environmental skills and training that include patient management and effective rescue skills while in the hot zone. When out of harm's way, the medic may then begin providing definitive care to the injured. In dealing with injured team mates the medic may assume that they (teammates) are otherwise healthy and victims of injuries that are bleeding. Very rapid assessments and treatments to reduce or stop blood loss are of paramount concern. Time spent assessing airway in a shouting, otherwise healthy Operator is blood on the ground.
Medical evacuation is identified as the second Tactical Medical Response Initiative©. This may be accomplished by the safest most expeditious method possible. During the planning phase the Incident Commander with input from the tactical Medic should have a plan in place for medical evacuation. The modality (vehicle) is less important than the time required getting the patient to the hospital. For example, do not wait on a helicopter that may be 20 minutes en route when a ground ambulance would take 10 minutes! Cardiopulmonary resuscitation, which is virtually eliminated in the combat environment, may be started by civilian tactical medics because of resources, personnel, and rapid transport to a trauma facility for surgical intervention. (NOTE that the survival rate for traumatic arrest, [dead at the scene] is < 1%) Helicopter ambulance will also enhance civilian tactical medical profile with highly skilled nurses and paramedics who are brought to the scene along with additional medical equipment and specialty gear, but delay in transport waiting on a helicopter is counter productive. There are multiple resources for dealing with complex medical (vs. traumatic) injuries. Good medical control and a person familiar with community resources are essential.
Critical incident stress management program is the third Tactical Medical Response Initiative©. The Critical Incident Stress Debriefing (CISD) of civilian first responders is a highly successful program that returns the operators of law enforcement, fire and emergency medical personnel to duty. The long term detrimental effects of mental performance are almost nonexistent because it places responders in a group to discuss the traumatic events and identify those operators in need of consultation immediately following the incident.
The most important feature here is that operators are able to continue their respective careers to retirement and function normally in civilian life. The CISD program also involves volunteers and civilians that were injured in the incident, as well as bystanders. The Red Cross is a valuable resource to help relocate displaced civilians to temporary housing and provide consultation. The mission profile for civilian tactical medicine spans a broad range of environments with the end goal of stopping the incident with as little loss of life and environmental impact as possible, with accurate data to be relayed to the media.
The combat/SWAT environment is very unique. Often traumatic and hard to stabilize, this environment demands unconventional thought processes that are likely not acceptable in the civilian tactical environment. The military strategy and tactics also involve a Hearts and Minds campaign to win over the foreign civilians to western influence. In the civilian tactical environment, hearts and minds are always at the forefront because it is Americans helping Americans. The media is always present and uncensored. The dictates of all civilian tactical operations are governed by public response and is subject to immediate investigation and accountability of actions for poor planning, loss of life, and criminal charges, if applicable.
The Global War On Terrorism is moving into its seventh year with new methodology and ideology. Weapons of Mass Destruction (WMD) and clever ways to deliver it to the public are at the forefront of incident mitigation. Hazardous material incidents are now being handled by law enforcement in case the incident is deemed a crime scene and evidence must be preserved. Whatever the methodology, more and more agencies are being crossed trained in various disciplines to serve, protect and secure the American way of life. It takes all of us to combat the threats now prevalent on American soil and abroad. Soldiers secure our national interest abroad and protect us from harm. Civilian tactical initiatives strive to protect lives, property and provide safety and security to our society.
We owe the next generation of warfighters, fire rescue, emergency medical responders the knowledge we gained and the lessons learned from our success and failure. Then and only then, can we be the best medical personnel in the worst places.