What are the similarities and differences between these critical functions?
The simple answer is that tactical medics are “attached” to a tactical law enforcement team and are considered part of the team. Whereas a Rescue Task Force is a trained, but hastily formed group of EMS medical providers (private and/or fire based) that partner with law enforcement on scene and enter a newly secured area such as an active shooter incident, to provide triage, emergent care and extrication to the casualties.
Both Tactical Medics and Rescue Task Force personnel provide emergent care in less than ideal situations, often under significant stress and in chaotic, sometimes hostile environments. Both work very closely with law enforcement during planning, training and actual events. Most Rescue Task Force members are outfitted with ballistic vests and helmets, and likewise, almost without exception, Tactical Medics are protected with body armor and helmets. Both Rescue Task Force and Tactical Medics are specifically trained and equipped to deal with ballistic, blast and other violence-induced trauma. Rescue Task Force members wear their usual daily uniform (Fire/ EMS/ law enforcement) and are typically dispatched during their normal shift. Tactical Medics wear the uniform of the tactical team they are attached to and are physically located with the team, or just outside of the “hot zone”.
Tactical Medics are somewhat analogous to the hockey team trainer who travels with the team and is there primary to provide medical aid to the team, whether the injury or ailment is serious or not. The most common items requested of the Tactical Medic are Band-Aids and ibuprofen. However, the Tactical Medic must also be prepared to provide life-saving interventions to team members and other on scene law enforcement. The Tactical Medic will provide initial medical care as needed to victims, bystanders, and perpetrators once the scene is secured. They will transfer patient care to a standard EMS unit if further care and transportation to the hospital is needed.
Tactical EMS models
Some law enforcement agencies (LEA) send officers/agents/deputies to EMT school, or comprehensive tactical medical classes and those officers may become the default Tactical Medic for the team. That may be a workable solution; however, it is unlikely those individuals have the medical experience and patient assessment skills needed to be the best medical practitioner in high-risk, high-stress situations.
There are countless workable models for the incorporation of a medical contingency plan for law enforcement operations. Some of the more common models are listed below:
- Officer/Agent/Trooper/medic- These are sworn law enforcement officers (LEO) having dual roles as an "operator" and medic; they have law enforcement powers and can certainly protect themselves from potential threats.
- Agency contract- In this case the LEA has a contract or MOU with a local EMS provider (Fire or private EMS service, or hospital medical group) to provide up-close medical care. Some agencies put the medics through a Reserve Officer school, so that they can be armed as LEOs.
- Individual contract- An individual or a team of individuals are under contract or MOU with the LEA for providing medical coverage for SWAT missions and training.
- ALS Stand by- In this outdated model, there are no Tactical Medics, but LE will stage a standard ambulance some distance away and they would respond to the scene after being secured by law enforcement.
There have been two major shifts in doctrine related to law enforcement operations over the last 10 years. One change focuses on aggressively going after active shooters with whatever assets happen to be on hand, instead of waiting for a SWAT team.
The second major change is recognizing the need for emergency medical contingency planning. This includes training all tactical personnel and line officers in the basics of self-care and buddy care with the focus on bleeding control and the addition of a dedicated Tactical Medic.
An aspect of this doctrine shift (in addition to the Tactical Medic) is - at minimum notifying –but ideally involving local EMS and hospitals about planned or developing law enforcement operations that have a high risk for injuries. SWAT teams are increasingly including a dedicated tactical medical component, and medical threat assessment as part of their organizational structure.
Learning about Tactical EMS
Many in the EMS/medical field have demonstrated and voiced interest in exploring what is required to get into the field of tactical medicine. In addition to the pre-existing medical training one already has (i.e. physician, nurse, paramedic, EMT, etc.), it is highly recommended to procure specific tactical medical education.
Programs such as NAEMT Tactical Combat Casualty Care (TCCC), Tactical Life Saver and others like it are one or two days in length and have been well received by the EMS and LE community. The International School of Tactical Medicine (ISTM) offers a 2 week intensive program aimed at medical practitioners who need basic training on law enforcement operations, and how to work within a law enforcement team as the medic.
Scenario of a tactical mission
On a typical planned SWAT operation there are several phases and steps that take place well before the “hit”. Most often, the mission is a planned high risk search or arrest warrant. After getting a "warning order", the SWAT team operators and all of the support elements (medical, communications, negotiators, etc.) typically convene at a Forward Staging Area (FSA).
A briefing will occur, where mission goals, subjects, and target location layouts are reviewed. Depending on the nature of the mission and Operations Security (OP-SEC) issues, the tactical medic may coordinate with the local EMS transport provider to have an ALS ambulance stage close to the location.
The Tactical Medic is the logical liaison to the on-scene EMS assets that support law enforcement operations. Typically the Tactical Medic will have a face-to-face meeting with EMS supporting units if they are available.
Rescue Task Force
Prompt integration of EMS medical rescue teams with Law Enforcement escort (Rescue Task Force) into an active shooter and other violent threat incidents is a recently adopted concept in the civilian first responder world. The introduction of the Rescue Tack Force (RTF) to the wounded casualties should be just after the threat has been eliminated, when the scene has been deemed relatively secure. Historically, Fire and EMS crews staged a distance away until LE methodically secured the scene before permitting EMS to access victims. This practice is being phased out and is being replaced with a more patient centric and life-saving approach.
There are two priorities in these types of events.
In terms of providing life-saving interventions, there are four ways to render medical aid in these types of situations.
The RTF focus should be on quick initial medical assessments and to provide life-saving interventions on scene at the point of wounding (POW) if needed. This should be done in concert with efforts to extricate victims to a Casualty Collection Point (CCP) where a secondary triage, treatment and transport can be provided. The RTF group should use a pre-entry LE/EMS checklist to insure important issues are addressed. The law enforcement aspect of the RTF is focused on escorting and protecting the medical member of the RTF. Urban Shield has been conducting several tactical and EMS/medical integrated scenarios each year since 2008. These scenarios are created to be realistic, tactically and medically challenging and create an obvious nexus between the tactical resolution and providing life-saving care to the casualties in a timely manner. The Urban Shield EMS Branch has a well-deserved reputation for creating some of the highest rated scenarios in Urban Shield. We aim to continue that trend.
The Rescue Task Force concept is becoming more widespread and adopted nationwide. Fire Departments, local EMS providers and law enforcement need to collaboratively train, drill and develop procedures and protocols for this concept to be effective. You do not want to be exchanging business cards the day of the horrific event.