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Make your ED part of a law enforcement team
An ED doctor on a SWAT team? It’s not as crazy as it sounds. If you visited Augusta, GA, you’d see it all the time.
For the past several years, the department of emergency medicine at the Medical College of Georgia has had a thriving Tactical Emergency Medicine Support (TEMS) program that includes a formal working relationship with three local SWAT teams. The TEMS program, say team leaders, not only provides a valuable community service, but yields big dividends to the department in terms of positive public relations.
Phillip L. Coule, MD, FACEP, associate director of the Center of Operational Medicine at the Medical College of Georgia in Augusta, says, "Although certainly not directly profitable, the perception and reputation of the health care facility can be greatly impacted by providing TEMS services," he says.
Just what is tactical emergency medicine? "Most commonly, it consists of medical support for law enforcement operations, and in most local communities, you’re talking about special response or SWAT teams," says Richard B. Schwartz, MD, FACEP, interim chair of the department of emergency medicine and director of the Center of Operational Medicine, and author of a chapter on tactical medicine for the next edition of Rosen’s Emergency Medicine (New York City: McGraw-Hill Professional; 2004).
"However, it can be broader, involving, for example, the medical support of federal agencies as well as military operations," he says.
Tactical emergency medicine has been growing steadily since the Columbine High School tragedy, "where the lack of TEMS led to major problems," Schwartz explains.
"Since traditional EMS would not enter the scene until it was safe,’ and the law enforcement providers could not completely secure’ the scene for several hours, medical attention was not provided to several of those who were wounded and eventually died," Coule points out.
A TEMS program is really a subset of EMS, adds Schwartz. Most operations are going to be with a law enforcement unit when you may have someone injured, he notes.
"There’s an area where there is an unsafe perimeter, and where the traditional EMS is not trained to enter," Schwartz says. "On the other hand, law enforcement is not necessarily trained to take care of a patient."
TEMS also involves a great deal of preventative medicine, Schwartz continues. You develop a threat assessment before the team goes in, he says. "You plan what the potential risks to the team are and how to mitigate them before they occur. Also, you go on all training call-outs with the team and do a fair amount of medical care there to minimize time away from the job," he adds.
"For example, an officer who twists his ankle during training, but is uncertain if the ankle may be broken, may have to leave training to go to the emergency room to determine if X-rays are necessary," Coule explains. "The tactical emergency physician may be able to examine the officer on the scene and determine that X-rays are not necessary and provide a splint or other treatment that may allow the officer to continue the training session."
All participants in Augusta’s TEMS, including law enforcement, receive training by Medical College of Georgia faculty.
"The physicians have oversight of the EMS training," says Schwartz. "Also, they have a considerable role in training law enforcement."
For example, there is a training program for tactical federal providers in basic trauma care, called "Law Enforcement Life Saver." Participants are taught skills such as how to assist a medic in securing an airway for ventilation, and proper lifts and carries. "They are also taught self-aid," adds Schwartz.
Nurses, physicians, medics, and EMTs all receive training. How intense the training is for the doctors "depends on what level of knowledge the provider has. A number of physicians are EMS trained," Schwartz notes. Medical training is not a major component for many; rather, most of their time involves on-the-job training working with tactical teams to learn how to function within a tactical environment.
The course for law enforcement is a two-day course; the tactical medicine course lasts five days, Schwartz says. There also are courses for residents at the medical college who are interested in TEMS. "They spend almost their entire first year getting to the point where they could respond with a team,"he adds.
They are trained in the use of force, continuum of force, firearms training, and SWAT school. "Our intent is to train them so thoroughly that when the residents graduate, they will be able to go out into other communities to start a TEMS there," Schwartz notes.
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