Medical planning for SWAT team and tactical operations

When getting information regarding a particular suspect or person of interest, there are risk assessment details for the medic to collect

Medical planning for tactical operations can differ significantly from normal EMS situations. Within many SWAT and tactical teams, medical personnel are organic to the team. These medics may be operating in either a basic or paramedic role.

SWAT medics are also trained in specialized tactics and weapons, including the wide arsenal used by these teams. This series of articles will focus on the medical planning considerations for SWAT operations, specifically when there is time to plan for an operation. This series will not cover situations where SWAT teams are deployed to incidents that are in progress, such as with an active shooter.

There are two trains of thought when it comes to medical providers and tactical operations. One concept is to rely on EMTs and paramedics in the traditional role, operating from an ambulance in the cold zone. The other concept is to embed medical personal within the tactical or SWAT team, and train them in tactical operations so they can function as part of the team as SWAT medics.

AP Photo/Scott Sady

AP Photo/Scott Sady

This allows them to provide care in the hot and warm zones. Often, these medics are armed for their protection. These SWAT medics provide immediate life-saving care in tactical environments, which often may be stopping hemorrhage and moving the patient to the cold zone to transfer to the staffed ambulance.

Similar to military special operations, where the medic is a member of the team, the SWAT medic also provides preventive and emergency care to the team as well as civilian casualties. This component of preventive care to the team is unique to most EMS providers.

Also unique is that these medics need to be very physically fit and be able to pass all the physical fitness requirements as the rest of the team. This is important as the medics will be carrying all their medical equipment in addition to their other tactical equipment such as body armor, load carrying vests, helmet, weapon, and hydration.

Team deployment
SWAT teams can be called into action in two basic methods. First is in response to an immediate incident, such as an active shooter or hostage situation. These situations offer limited preparation time. Teams often arrive at, or near, the incident where the team may quickly deploy in response to the situation at hand.

The second method for deploying a team is to initiate a plan, such as a high risk warrant, or search warrant. These situations offer the opportunity to plan and deploy to the best advantage of the team. In these situations, planning is critical to the success of an operation. This preplanning is also vital for the medical portion of the operation. This type of deployment is the primary focus of this series of articles.

In the planning phase of an operation, the medics will need to determine what other agencies may need to be notified. Careful consideration needs to be taken when notifying other agencies in order to maintain operational security (OPSEC).

There have been instances where operations were compromised due to other agencies' lack of understanding of OPSEC and releasing information. If there is a concern for OPSEC, providing limited information may be appropriate in order to ensure success of the mission and team safety.

Local ambulance services should be advised of the impending operation, as well as the importance of OPSEC. This notification is important as the most critical type of injuries will require transportation to a trauma center without the delay of having to wait for an ambulance to respond to a cold area staging area.

The information provided to them should be the location of ambulance staging, when they need to be in position and how long to expect the operation to last, who to notify of problems, and anything that the medic feels may be appropriate. This appropriate information may be part of the risk factors mentioned later.

The staging area should be close to the area of operation, while at the same time not giving any obvious indication that there is an impending operation in the area. Staging at a local fire station may be appropriate and will not "advertise" that something may be up within the neighborhood.

Depending on the size of the community, it may be a consideration to notify the local hospital emergency department that an operation will be occurring within their coverage area. However, with large trauma centers, they usually have adequate staff to handle any incoming emergency without major issues. If this notification is made, a follow-up notification should be made when the mission is complete.

Another consideration with communications to a local hospital is that it may be appropriate to put a medical helicopter on notice of an impending operation. Helicopters may not be an operational concern in urban settings, but in certain situations their use could be a valuable asset. These include when an operation is in a rural area. Such areas can have long transportation times for ground transport, something that can be greatly reduced with helicopters.

When working with helicopters, it will be important to ensure a large enough landing zone (LZ) to allow the helicopter the ability to land and also be close enough to move an injured patient. These LZs should be identified ahead of time, and be preplotted so that the leadership is aware of their locations.

There will also need to be trained personnel to set up a landing zone. Generally in rural areas, both law enforcement and firefighters are often quite proficient at setting up an LZ. There will be a need to establish a communication plan with radio frequencies and any call signs.

Risk assessment
When getting information regarding a particular suspect or person of interest, there are certain extremely important details for the medic to collect. Getting this information at an operational briefing will be vital to the SWAT medical operatives as they determine possible situations that they may encounter. This list, although lengthy, can be adjusted to the situation.

Suspect's criminal history
Knowing the suspect's criminal background can provide a better indication of potential safety concerns. Every person needs to be handled with a great degree of suspicion and security. However, knowing a suspect has a history of violence against law enforcement, murder, and escapes will offer the SWAT medics better insight to increase their level of vigilance as well as ensure other providers are protected.

If the operation will involve a suspect with a history of meth labs, there may be a concern for chemical decontamination before the suspect can be transported from the scene, and the potential for burns due to flash fires.

Suspect's medical history
The suspect's medical history can offer insights into issues that can impact operations and patient care. Care should be taken regarding patient confidentiality, but knowing the history can increase the awareness and level of care provided to meet any preexisting conditions. The medic will need to consider planning of care of a subject who may present with a chronic illness.

Review of a suspect's medical conditions may be useful but should generally not influence SWAT operations. The safety of the SWAT team and potential victims will always take precedence over the suspect. Some brief examples of concerns can include:

  • Respiratory illnesses can be exasperated with the use of chemical agents
  • Diabetes and a long-duration incident can lead to decreased glucose levels and impaired judgment
  • Mental illness and suicide attempts can lead to impaired thoughts and judgment
  • History of illegal drug use
  • Bloodborne pathogens. Although personal protective equipment is worn and universal precautions are used, in a tactical environment gloves and glasses can be torn off , exposing team members to blood and body fluids

In the event the suspect is turned over to EMS and transported to the local hospital, the patient's condition may prevent them from giving their medical condition to other medical providers. The SWAT medic can provide this information and treatment provided in the hot and warm zones. Depending on the situation, it may be appropriate to travel with the ambulance crews along with a security detail of law enforcement.

This article covers the basic information that a SWAT medic should gather and consider as part of their medical operation planning. Part two will provide other considerations and look at preplanning for team safety with environmental and extended operations.

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