The concept of a tactical medic is not a new one. In the civilian setting it has grown exponentially in the past 10 years. The concept originated from the military. Since the early days of war there have always been “aidmen” official or unofficial. These individuals were tasked with the care and evacuation of the wounded from the battlefield. Using minimal resources and until now, minimal training to save lives of teammates. Fast-forward to the 1960s, 1964 to be exact. The Philadelphia Police Department created the first “SWAT” team in America. The team in its infancy was a quick reaction team to the significant increase in bank robberies within the city. The rest of the nation soon followed suit. One of the most notable teams to form next was the LAPD SWAT team. These teams have since evolved from the 60s, to the mission they fulfill today. SWAT teams are routinely utilized for high-risk warrants, hostage situations, stand-offs and other high threat situations. These teams’ tactics are deeply rooted in military tactics. One significant difference, that appeared minimal in the grand scheme of things, was the addition of the medic to the military team. Unfortunately due to the nature of military and SWAT operations, one day someone will get injured whether it is on an operation or training. The military medic program has grown for years, more so in the past 15 than the 100 before that combined. The massive amount of data and knowledge gathered from recent military operations have shown the benefit of embedded medical personnel, better training and equipment for all. This information has returned to the civilian SWAT teams. Teams have now begun adding medical assets to teams, and it has proved to be a wonderful thing. The initial role of the medic within the team was to provide point of injury trauma care to team members and victims. The role has since grown to include mission medical planning, limited primary care of team members, as well as remote assessment and treatment of the injured. The small role has grown to an integral part in the tactical team.
Making the Cut
Tactical medics have a very unique mission and skill set, few happen upon it by chance. It is a fairly involved and long road from the start. Medics are commonly EMS employees attached to the tactical team for training and call outs. This means from the start there has to be a relationship built between the team and the medics. Personalities can ultimately make or break a good relationship between agencies. Finding the “right guy” is the name of the game. There are many clinically intelligent medics, however, if the personality doesn’t fit it may not be right for the team. I can speak from our tryouts, and I’m going to go ahead and assume others do it similarly; we involve the law enforcement guys on our tryouts. It only makes sense to involve the members of the team we will support. Better to find out before you send someone to school, that they may not get along with the culture of the team. So who are they looking for? That is a loaded question, but here is the best answer I am able to give. The tactical medic has to be clinically competent, a critical thinker able to operate autonomously, personable, physically fit, and have a good bit of common sense. This is not the place for a cookbook paramedic. A candidate that has some common sense, and can work well under pressure, but may need some help with skills, will always make the cut before the know it all. Skills can be taught, but personality cannot be easily altered. Someone has to come into it with a willingness to learn. Once a candidate is chosen, it’s time for school.
While there is currently no standardized program for tactical medics, the community has adapted some general concepts. There has been some recent discussion of standardizing the training and skill set. The International Board of Specialty Certification (IBSC) has created a certification in hopes of it picking up steam as a standard. IBSC is the same organization that certifies flight and critical cares paramedics.
Most programs require that medics attend some kind of specialty course — the range in duration from two days to six months. This is one of the factors that allow so much variability in provider levels. Some teams only require medics to manage traumatic injuries, while other teams utilize the medic to their full potential as a team healthcare provider. All tactical medics are trained in either Tactical Combat Casualty Care (TCCC) or Tactical Emergency Casualty Care (TECC). Conceptually both have the same goal, provide lifesaving care as close to the point of injury as possible. The major difference is in the name. TCCC is designed for just that, combat. The U.S. military has adapted it for all members entering a theatre of combat. TCCC concepts have lead to the lowest percentage of death from potentially survivable injuries in combat. It only made sense to bring the concepts back home and apply them on the streets and in the tactical setting. However, this direct implementation of military medicine to the civilian world needed a few changes. In comes TECC, this adaptation of TCCC made the changes needed for a smooth transition to the civilian side. This was a great change for the tactical medic because it incorporates some of the chief considerations that exist on the civilian side. TECC has become the closest thing to a standard in existence in the civilian tactical medicine world.
TEMS (tactical emergency medical support) takes the training a step further. TECC gives the tools needed for a medic to function in a tactical environment. It is the groundwork for tactical trauma care. It is only a percentage of what is required of the tactical medic. TEMS incorporates team health, sports medicine, basic defensive tactics and tactical operations. These programs supplement the clinical and operational knowledge medics already have. It is an additional skill set or rather a different thought process; it is a totally different environment than most medics are used to. This is the reason why TEMS school is so demanding, it prepares the medics for the type of situations they may encounter once on a team. The levels of stress are significantly increased from day-to-day street medicine.
On the Team
Once a medic makes it on to the team, the journey has just begun. The team is where everything really starts; learning how to interact with the teammates as well as the basic tactical “flow” of the team varies. There is no one answer to how a team functions, learning the workings of the team is an important step for a continued relationship with the team you support. In my experience there have been very few situations where we’ve had to conduct significant trauma care. A majority of the treatment that we perform on the team is related to sports medicine, orthopedic injuries, as well as minor allergies, headaches and general sick call. I think this is one of the biggest differences or misconceptions, as seen from the outside. The tactical medic functions as a team health provider, that looks after the team’s wellbeing whether it be on a mission, during training or on a day to day basis. The medic is responsible for maintaining the force. This is also one of the largest responsibilities of the medic, and requires a great deal of confidence in the medic from the team. The teammates are often apt to trust “doc” over a physician or some other health care provider. The medic needs to have a great deal of judgment as to whether something can be taken care of on scene or does someone need to be referred to a higher level of care. The tactical medic is a wonderful job. It definitely takes a great deal of time and training. It is certainly one of the most rewarding experiences, and a chance to make friends for life. If you have ever considered or thought about trying out for a TAC team, do it!
Andrew Rowley began his career as a firefighter/EMT at a volunteer fire department. He joined the Army as a medic and is now teaching combat medicine and sustainment at the unit level. He worked in Charlotte, North Carolina for Mecklenburg EMS Agency, as a paramedic. Rowley’s current position is flight paramedic with Wake Forest Baptist Health in Winston-Salem, North Carolina. He is the president of Special Operations Aid and Rescue, LLC.