WHEN SWAT CALLS 911…

1. WHEN SWAT CALLS 911…

2. Intro to TEMSCare Under Fire

3. Tactical Emergency Medical Services S. Haynes, EMTP/T M. Gautreau, MD R.Witkos, EMTP/T K. Horst, MD T. MacDonald, EMTP/T A. Garrett. MD C. Montiverdi, EMTP/T

4. TEMSHistory • 1803 - Napoleon trained select soldiers to act as nurses on the front lines • 1961 - JFK assigned specially trained combat medics to US. Special Forces teams • 1969 - EMT's assigned to LAPD SWAT teams • 1991 - Uniformed Services University of the Health Sciences creates EMT-T to standardize TEMS training (CONTOMS) • 2000 – U Mass paramedics join CEMLEC

5. EMT-Tactical • CONTOMS, Counter Narcotics & Terrorism Operational Medical Support • Casualty Care Research Center • Military-Civilian hybrid EMS • Medicina bona, locis malisGood medicine in bad places

6. Gary Paul Johnston SHPD SWAT Shaker Heights, OH 1987

7. The Need For TEMS • Preventable Combat deaths: • -Hemorrhage from extremity wounds (60%) • -Tension pneumothorax (33%) • -Airway compromise (6%)

8. Casualty Rates: Per 1000 Man Missions

9. SWAT Litigation • March 1994-Boston MA, Rev. Accelyne Williams, 75, suffers cardiac arrest after SWAT raids wrong apartment, $1 million • 1997 Bethlehem PA, John Hirko,21, killed after being shot and distraction device started fire, emergency crews denied access due to scene volatility $8 million • April 1999-Columbine CO, teacher Dave Sanders dies of wounds sustained hours earlier EMS denied access, $1.5 million • Aug. 1999-Compton CA, Mario Paz shot by SWAT as he reached for gun, alleged police waited 30 minutes to call EMS, $5 million • Sept. 2000-Modesto CA, 11 y/o Alberto Sepulveda shot in back on floor after AD, $2.55 million

10. Medic Up

11. Goals of Tactical Medical Support

12. EMT-T Specialized TrainingCONTOMS • Medical threat assessment and medical intelligence • Care under fire • Hostage survival • Evidence collection & clinical forensics • Weapons and their effects • Toxic hazards risk and management • Medical effects of extended operations • Special equipment and medical kits • Medicine across the barricade • Chem/Bio WMD

13. In-service Training(184 Hours/year) • Tactical Entry/Simunitions • Defensive Tactics/Weapon Retention • PT Testing • Less Lethal • Firearms Qualification-Handgun, Rifle, & SMG

14. Reserve Officer Academy • Mass. Municipal Police Training Committee, Boylston Academy • 120 hours • Baton/OC certification • Annual in-service training 24 hours

15. Unarmed MedicsPro • No issues surrounding weapons and need for police basic training • No threat to fire control • No special permit or training required • No liability associated with use of deadly force

16. Unarmed MedicsCon • Medic can become a liability to the team, requiring protection by scarce assets • More difficult for medic to operate safely within inner perimeter • Unable to defend self and patient • Possible limited proficiency when attempting to render a weapon safe

17. Armed MedicsPro • Can provide basic level of protection for self and patient inside inner perimeter • May reduce need to divert primary team members for protection of medics • Increased proficiency when rendering weapons safe

18. Armed MedicsCon • Threat to fire control if not well integrated into team • Possible limited proficiency with weapons • Political “Red Flag” • Special permit and training may be required • Liability from use of deadly force taken on by certifying agency

19. Specialized Equipment • Helmet & eye protection • Body armor • Subdued uniforms • Hoods and pads • Boots and gloves • Protective mask • M5 medical bag • Tactical vest • Weapon Systems

20. Protective Mask

21. M5 Medical Bag

22. M5 Medical Bag

23. M5 Medical Bag

24. Tactical Vest

25. Glock 22

26. H&K UMP

27. H&K Mp5

28. Colt AR 15

29. PERIMETERS

30. Team Elements • Command • Negotiators • Sniper/Observers • Assault/Entry • Medical • Canine

31. Team Assignments • Point/Shield • Point Cover • Team Leader • Right Flank • Left Flank • Medic • Rear Cover

32. Area Entry • Dynamic • Small areas • Fast movement, surprise of overwhelming force • Lights used to intimidate suspects • Loud voice commands used to intimidate

33. Area Entry • Stealth • Larger areas • Slow careful movements to maintain surprise • Strict light discipline to conceal position • Communicate via hand signals or earpiece equipped radio

34. Hand Signals Silence

35. Hand Signals Weak Heart

36. Hand Signals Can’t see without my glasses

37. Hand Signals Crybaby

38. Hand Signals No way I’m going in there

39. Hand Signals I’ve been hit (indicating size of hole)

40. Hand Signals Gear is too heavy, Request back rub

41. Less Lethal • Specialized weapons used to subdue a suspect without fatal consequence • OC Spray • OC Grenade • CS Grenade • Distraction Devices • LL munitions and grenades, may still cause significant blunt trauma (Bean bags, rubber projectiles) • Pyrotechnics have high fire risk

42. OC Spray

43. Chemical Grenades

44. Distraction Device

45. Distraction Device

46. 37 mm Less Lethal

47. 37mm Rounds

48. Smoke Grenades

49. Differences In Care • Remote Assessment • Tactical Exam • Sensory Deprived/Overload Assessment • Inner perimeter largely BLS • Rare CSI • No CPR • ABCDE-airway, breathing, circulation, "den evacuate"

50. Remote Assessment • Determine if area is secured • Determine if patient is perpetrator/threat • Determine level of injury/stability of victim • Assess risk/benefit of exposing providers in an unsecured area • Assess risk/benefit of stabilizing vs. evacuating patient