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Looking for anyone with experience in this field. 

 

I have been given a unique opportunity to work as a tactical medic with SWAT team for my local PD.  It is volunteer and I am only expected to be at raids/call outs when I am available.  I train with the team and pass all fit tests just like they do.  I carry a weapon, and while trained on being "in the stack", it is RARE that I would be expected to do this, if ever.  In all liklihood, I would drive a vehicle to the raid and remain at a casualty collection point until needed.

 

I would recieve a special commission through the department and carry a badge as well signifying me as a medic.  I work with 3 other docs and at least 2 paramedics and 1 officer trained as a medic.  I recieve training in TCCC (Tactical Combat Casualty Care) and PHTLS and combat pistol training (this is what I would carry in the field). The tactical medic roll is not new to this department and has been around for at least 4-5 years.

 

Anyone else do this or have any insight?  Any tips or tricks you know of?  I am really excited about doing it and working with the team is interesting to see how they operate.

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badtriangle,  I worked for nearly five years as a tactical medic. I had the privilege of being selected to the first TEMS team to the local SWAT team. Not sure if I have anything constructive to add, but here's some of my thoughts.

 

First: All our medics had ACLS, PALS, BLS, PHTLS as conditions of our employment at the ambulance service. after being selected, and passing the admittance tests you were sent to TCCC training.

 

Being in the first team selected to the TEMS unit of our local SWAT team they had no clue what our roll was. Over the first 3-6 months we spent many hours educating them and advocating the advantage of having medics on THEIR team .

 

We never carried side arms. 

 

ideally we had 3 medics for stand offs/hostage situations. Minimum  2 for high risk warrants.  One medic was assigned to the entry team as the last man in "the stack". 

The entry medic carried equipment (on a leg bag) for trauma and airway management. The "back up" medics carried the same equipment plus some.  

 

In longer situations, our responsibilities for the team included the health and well being of the team, and bystanders.

 

One thing I would recon=mend it to have EVERY team member carry a trauma dressing AND a 

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sorry, I hit the wrong button

 

 As I was saying....... EVERY  member of the team should carry a trauma dressing and a tourniquet on their person. AND they should all carry them in the SAME place on their body. That way, if you need it you know where it is and don't have to look for it under pressure.  The only other thing I have to ad is.... education..... education, education, hammer home the basics of stopping an arterial bleed...ect. they will scoff..... but it will save one of them.... trust me.

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As a regular ole Emt I cant imagine going into a building with the baddies still walking around free. I'm the guy in the rear with the gear staging a hundred yards away. "Is my scene safe? No? Go get'em PD!"

 

Jokes aside my brother is a cop so ive got a lot of respect for you joining the team to look out for them.

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Thanks for all the input. Some answers:

 

We have had this program with our EST for about 4-5 years and it has been ever evolving.  We serve all high risk warrants and respond to situations as dictated by the situation. We shoot/train along side the teams, but we rarely do any entry and if needed, the medic would be last in the stack or in the take down team.

 

Our role is to be there for any hostages, victims, etc. and then for the team.  We are trained to be able to pick up any weapons system they utilize and know how to run it, clear, clean it, etc.  Mostly for when on meth lab raids.  All weapons get cleared and wiped down as they come back out of the house. 

 

I am in the process of trying to digest as much info as possible (drinking from the fire hydrant), with regard to not only tactical medicine, but also tactical movements with the teams. 

 

Good point on making the team carry their personal medpacks in the same spot on their rigs.  Each team member has one, but they do carry it in different positions on their kits.  Each personal kit has a TQ, chest seal, quickclot, battle dressing and maybe some gauze.  Each medic has a full pack and smaller "tear away" packs on their rigs for "bleeding" and "airway". We also carry a bag with 10-12 throw bags stocked similar to the personal kits.   Everyone carries TQs just about everywhere on their kits some strapped to their weapon.  When I go on a call out/raid, I have about 5 CATs on me at all times.

 

One question I do have:  Do you chart on any treatment dispensed and if so, how?  Example:  Had a suspect taken into custody that said his shoulder was injured in the process of the takedown.  He was evaluated appropriately and declined a trip to the hospital in a medic truck.  Do you chart that and if so, what do you use?  We basically just use an "after action" report and essentially write a progress note.  Similar to what the officers do, but focused only on the medicine.

 

Thanks for the input.  It sounds like you have done/seen quite a bit with tactical medicine.

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...  Everyone carries TQs just about everywhere on their kits some strapped to their weapon.  When I go on a call out/raid, I have about 5 CATs on me at all times.

 

Sounds interesting for sure and I wish you much success with this opportunity. During deployment, I came across and interesting article regarding CATs which were strapped on body armor/weapons which had a higher failure rate. From the article, it was felt exposure to elements caused a higher failure rate so ensure these do have protection by either being in kit with other equipment or in a cargo pocket or TQ holster. Interestingly, a follow on study showed less failure with SOFT-W when exposed to the elements.

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One question I do have:  Do you chart on any treatment dispensed and if so, how?  Example:  Had a suspect taken into custody that said his shoulder was injured in the process of the takedown.  He was evaluated appropriately and declined a trip to the hospital in a medic truck.  Do you chart that and if so, what do you use?  We basically just use an "after action" report and essentially write a progress note.  Similar to what the officers do, but focused only on the medicine.

 

 

 

I had a partner for a couple of years who was a tactical medic for the local PD, so I went along a lot of the time. Every time they had a mission, we'd generate a run number through communications and chart a "stand-by" call in EMS Charts. If treatment was rendered, we'd generate another chart in the same program and document treatment and disposition just as with any other call. Are you doing this in conjunction with an EMS agency? If so, I'd guess that you could do the same thing. If they're using an online charting program (like EMS Charts), you'd just need to get them to add you to their roster and show you how to use the system. 

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Badtriangle,

 

I would recommend that all medics also carry the same personal kit the law enforcement members carry and in the same place on their person. this is b/c if a medic goes down the other members of the team will most likely not know where to find said equipment in your bag. When they render aid their first instinct should be to look for the needed chest seal, trauma dressing. etc in the same place on the medic. 

 

Documentation can be tricky, as I'm sure you are finding out. Here's how we documented.

 

the entry medic would (if no medic aid rendered) document the entry what was seen, what they did. ie, entered bldg. as the last in the stack, moved into xxx room did/did not enter bldg further then first room. xxx suspect removed form bldg. by SWAT team members. etc.

If aid was rendered we would document that.

 

The back up medic would document what they did as well.

 

In hostage/standoff situations we had a tactical ambulance as well. In these cases the additional medic was responsible for the other members of the team. IE snipers, command. etc. and they would document as such. If aid was rendered at any time each medic would document what they did and that they transferred care to xxx medic. For example, suspect #1 gets shot in the first room, team still clearing the house. entry medic renders aid and removes suspect/patient from house, turns care over to back up medic, back up medic and the additional medic render aid until transport ambulance arrives they turn care over to transport medic. each medic would document their part. that way the reader should have a complete record of pt care until pt arrived at the ED.

 

We used modified ambulance run sheets. This was before EHR thou. IDK what they use now.

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With regard to your example of the suspect claiming shoulder injury. It was very common to have a suspect claim injury. Our policy was to get as complete Hx as possible, including from the officer(s) involved and preform a PE. If the suspect refuses transport to the ED be sure to document GCS status and that you recommended he/she be treated at the ED (if you did) I always recommended they go to the ED as a CYA. then document. document. document.

 

The other thing I did was to be sure to NEVER call the suspect a suspect in my reports. I always referred to them as patient. Suspect is a law enforcement term. Patient is a medical term. If you get the privilege of testifying any lawyer worth their salt will pick up on this. So Mr. evolute I see that you referred to my client as a suspect and not a patient, there fore you obviously regarded him/her as such and there fore did not act quickly, aggressively, appropriately (insert any descriptor here) as you would had he/she accidently shot him/herself. there for you (and everyone else) are liable for my clients bad medical out come.

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