A topic I’m very interested in is Tactical medicine, and here’s a trauma surgeon putting it to work: Former Firefighter/Paramedic Turns SWAT Team Doctor in Dallas
Dallas SWAT officers are now more likely to survive an injury thanks to emergency medical support from a full time, tactically trained trauma surgeon.
Some other SWAT teams around the country are served by doctors on a volunteer or part time basis, but Dallas officials know of no other major city that has a doctor dedicated to the team full time.
"I’m the first physician who’s every day job is to be on a major metropolitan SWAT team," said Dr. Alex Eastman. He’s on call 24 hours a day and deploys alongside SWAT officers in order to provide immediate, comprehensive medical care at the scene of an emergency. He said he has the same training as the rest of the team.
"It’s just that my job is not to go out there and be a police officer. My job is to go out there and take care of these guys," he said.
I did a senior resident project on this topic and think it would have yielded major dividends in some of the ‘active shooter’ mass casualties, like Columbine.
I have other thoughts on this, and I’ll get ot them soon.
There are a lot of changes coming up in tactical medicine. Both from the military side and from the civilian side. This could be a very interesting ride for the next two decades or so.
As a volunteer medical asset for our local SWAT team, I ask, what the heck does this guy do to make this a full time job. Even with 50 team members, if this guy was the primary care doc for all the team members and their families, in addition to training and operations, that leaves a great deal of time.
Nice to meet some other tactical physicians. I also wonder how he makes this a full-time job.
I did the tactical ER physician gig for about 7 years as a volunteer, and it was great. Went to the police academy, CONTOMS, Tactical Medic school, SWAT school, sniper school, multiple conferences (all on my own dollar), and got to meet some really great people.
The problem came when we changed police chiefs.
The new chief wasn’t comfortable with my role on the team, thought I was a liability (!), and wanted to restrict me to the command post. I wasn’t comfortable with a move that compromised officer safety, so I attempted to educate him, to no avail. Bottom line: I left my team, and never went back. Last I heard, they got what they wanted: a doc with no tactical skills that sits at the command post drinking coffee.
Being a SWAT doc is a great service that you can render to the community… but beware of the politics.
What good can the doctor bring to a tactical situation that is not offered by a tactical paramedic? The key in such situations is to safely evac the victim, and then transport to the hospital for proper intervention. The fireground is not the place to be putting in chest tubes, etc.
Sounds like overkill to me (pardon the pun.)
— J
A tactical physician from the appropriate specialty can offer interventions that a paramedic cannot (for instance, I used to carry an 8.5F introducer sheath in my backpack). The physician can also act as his own medical control.
If he works the ER, or is a surgeon, that physician also knows the area hospitals intimately. In fact, he probably personally knows the specialists that his wounded officer/civilian/perp is likely to require, and can grease the skids to expedite care… he could even care for that individual himself, provided he had the appropriate hospital privileges.
Ideally, evac to the nearest cover and transport to a medical facility would be done, but that assumes evac is feasible or even possible. If you’re still under fire or cannot withdraw, and you need to bring medical care inside the hot zone, you’re better off bringing the highest level of medical skill possible.
That said, some doctors are absolutely worthless in the field. Paramedics live pre-hospital, so their adeptness in a more-austere environment must be taken into account. They’re also cheaper, have easier-to-maintain skills than a physician, and are more readily available.
For most teams, tactical paramedics are more than adequate. Last time I heard the statistics, less than 1% of teams nationwide have a physician attached. For most teams a tactical physician is a luxury.
Let’s not forget the other benefits to having a trained physician attached to the tactical team: 1. Preventative medicine for the team members (everybody up-to-date on immunizations, knowledge of the operator’s medical history, etc.) 2. Serving as the medical advisor to the tactical commander (can we fill the house with oc if the hostage has a history of emphysema, does our distance from a trauma center modify our tactical strategy, etc.). Granted, having a (squared-away) physician on the team is a luxury, but having done it for 10+ years, it’s a real benefit to the operation.
All good points, temsdoc.
It’s also worth pointing out that you have to pay your dues in TEMS. Cops are clannish, and paramedics/docs are often pushed aside during training, as “just medics,” and the appropriate team integration is never practiced. It helps to go through the academy, SWAT school, and have face time with the team. Even so, you sometimes have to be assertive about your role in the tactical environment. Sometimes even that doesn’t work (as in my particular case), and you have to find a new home.
Before I resigned, I’d worked with my team for years, with zero problems. But then again, the previous chief/dept. had been burned badly by a wrongful death suit they were forced to defend, including very expensive expert witness testimony, after a hostage was killed by a perpetrator during an entry. Needless to say, he was a huge TEMS fan. The new chief, unfortunately, had no such experience.
It’s axiomatic that medics aren’t truly appreciated until somebody gets hurt.
A Dr offers no new set of skills of relivance in the real world (as far as tactical medicine goes). Taking care of patients in a tactical scenario involves ABC’s and not really much more. Maintaining an airway, and getting a handle on bleeding is about all you need to do. The minimal ACLS that is approriate in that scenario a paramedic is VERY qualified to provide (AMI being an example, an example of inapproriate: if a guy codes after getting shot center of mass he needs a surgeon in a surgical suite NOT being held on to in the field.). The kind of trauma that you are concerned about in SWAT scenario is mainly scoop and run.
A Dr. has tons more knowledge than a paramedic, however the amount and kind of tools avail greatly limit his ability to provide care. Having a physician avail does not equate to having patients live and even hinting that to senior SWAT types is unethical.
A paramedic is able to provide ACLS, basic trauma care, triage, and basic interventions (such as tx a sucking chest wound). What more could be needed in that scenario?
In addition how is a surgeon going to keep his skills up if he is working full time as a SWAT doc (I don’t think that any dr will argue that skills degrade fast)? Is he still going to keep working in the OR (what happens when a SWAT call goes out in the middle of a case)? Are the SWAT teams going to have multiple Dr’s to allow them to roatate OR time (that is alot of $$$)?
My personal opinion is that having a Dr out with SWAT is an inapproriate use of resources. They bring no practical knowledge or skills to SWAT that a paramedic doesn’t allready possses.
Just my opinion, it could be wrong.
PenguinMan,
A physician, if available, is almost NEVER a liability to a team. A physician choosing to use his resources (all the SWAT docs I know are unpaid) to help out their local police department isn’t inappropriate in ANY way. Availability is sometimes an issue, so some teams have a backup plan, like keeping few team members certified as EMTs.
I personally wonder about a team keeping a doc full-time. There would have to be some mechanism for him to do ongoing civilian clinical care. This, however, is the same problem with keeping tactical paramedics current on their skills… it’s only a difference in degree.
A surgeon or EM physician brings a much more comprehensive knowledge of trauma care (both prehospital and definitive) to the field. Most of the injuries suffered in the field are not GSWs, they’re orthopedic, lacerations, eye injuries, etc. A paramedic may be able to splint a limb, but he might be in trouble doing a reduction. A paramedic may apply pressure to a wound, but he’d be in trouble suturing it. The physician simply knows more, and is legally licensed to do more. Additionally, he can operate completely independent of any medical control, something many paramedics cannot do.
Scoop and run is fine… if you’re able to do so (see my previous post). If you have to bring care inside the hot zone, you’re probably better off bringing someone with the full spectrum of abilities. If evec is going to be delayed, a physician can improvise and do a lot more than a paramedic who’s restricted by his local EMS protocols, or the comfort of his medical control.
Paramedics are fine for most teams… but there are things they cannot do. Consider medicine-across-the-barricade… a physician has a far deeper knowledge of medications, illness, etc, and is in a much better position to advise the tactical commander.
Physicians ARE a luxury item, but are in no way inappropriate.