Tactical Paramedics

[Donut]

Blackhorse, Bart, et al,

BC no longer has a tac medic program.  In the past, BCAS had a number of crews the GVRD who had a secondary tasking as ERT support, but that program ceased some time ago. 

The VPD CCU had it's own medics, I'm pretty sure they still do, but they're currently nothing more then a PC with an OFA 3 ticket.  In the past they've had various levels of skills, from P1/ EMA 2 who had gone LEO, out of province EMT's who moved here, etc.

That's the sit in BC afaik.

DF

 

[Thompson_JM]

What does Rozko's weapon have to do with anything?  What do you mean by trouble going up against it?  Are you talking about armor effectiveness or tactics and how does it relate to having medical support integral with the ERT team that responded?  My point is that response to a call like that, or any high risk warrant that ERT conducts should have integral medical support, or at least the members should be trained in TCCC.  To say that they can rely on local paramedics is a bit naive. 

So are you asking the ERT response time, or a TEMS response time?

JANES, what im saying is using the mayerthorpe tragedy is a weak argument... it was a small rural town with little to no TRU capability.
TEMS wouldn't have made a difference there. by the time they were able to get to the site and actually go in, it was too late. 

lets not use that one as an example please.. it really doesn't strike me as being a good one.. especially right around the one year anniversary of that horrible event.

 

[JANES]

Then make up any scenario you want.  I'm try and explain.  Every firefighter is trained to First Responder and sometimes even higher, PCP, and every fire call gets a dedicated ambulance support.  Given any potential call for an ERT team, a HRW, drug bust, hostage, anything, any potential ERT mission.  What is the potential for a casualty occuring?  Any less then at a house fire?  They are both pretty dangerous situations.  So why are the firemen so prepared with training, and support, yet the ERT teams are lacking if the situations both warrant similiar potentials for danger?  Why are the ERT team members not trained in TCCC, as firefighters are trained as First Responders?  Appropriate style medicine for your working environment.  And why does an ERT team not get a dedicated medical asset?  Cost!  Training!  Lots of reasons.  So what is the solution?  Do it like the firefighters.  Both have a security perimter.  EMS isn't allowed into a burning building or inside a Tactical security perimter.  The firefighters will bring a casualty out of a buring building, do initial interventions then hand over to EMS, so the ERT team should be trained to provide Care Under Fire, and extract the casualty, when tactically appropriate to the local EMS waiting outside the security perimeter.  The only problem with the scenario, is that sometimes the tactical situation will not allow that, and then you are looking at a delay in care.  This is why so many tac teams are adopting a TEMS capability.  The question is how far do you want to go?  How much can you afford?  But something is better than what they have now. 
Without reffering to any specific incident.  There is alot to be said about TCCC, not just teaching medical skills, but teaching how and when to use them in a tactical context, how a casualty affects the mission, how to plan for a mission with a med plan, when to fight and when to treat.  And what kills people from penetrating trauma, and how to prevent it, and self aid and buddy aid, and buddy rescue.  It's good stuff, that every police officer, tactical and patrol should be taught.  Just like the firefigher is a First Responder.  This is the new reality.  We must evolve.

 

[Bart Nikodem]

How do I put this delicately? A Firefighter typically has more "free time" then a Police officer. As such they are able to train medically, and use their medical skills on both fire and non fire calls. Don't get me wrong, I would love Police officers to have First responder training, since, as the name implies, it is for people who respond first. As a paramedic I would like nothing more than to arrive at a call that I had been staged a block away for, because of security concerns that the police were taking care of, to find an airway in and oxygen put on.
Unfortunately I think that the skill set required of a police officer is burdensome enough without adding another element.
Due to the fact there are less fire calls than police calls and that usually a fire truck doesn't roll with less then 4 Fire fighters, it makes it more feasible for them to do First Responder medical calls, an there by having the skills ready in a fire call. Hope that made sense.
All the best,
Bart

 

[JANES]

For starters O2 has no place or requirement in a tactical enviroenment.  The only time the O2 is required is for shunting - read asthma etc.  and CO poisoning.  Beleive it or not, O2 doesnt do much for trauma.  If you want to references just ask.  Thats the problem with civi pre-hospital medicine, it's old and hasn't changed in years (especially in BC) and everybody all the way up to the civi doctors are quite stuck in their ways.  They do not realize the difference in working enviroenments between the back of an ambulance/ER dept of a hospital, and a tactical casualty environment.  The other issue is only 1% of all combat type deaths and 6% of preventable combat deaths are caused by airway compromise.  Recovery position is the best manager, or an NPA.  From there you go straight to a cric.  Not much training in a recovery position or NPA placement.  TCCC training focusses on what the preventable casues of death and tactics of dealing with casualties.  I'm not going to go on about TCCC, there are many other threads that explain it, and other resources out there.  The bottom line is that effective officer down rescue and TCCC instead of first aid should be mandatory to improve officer survival.  It's ignorance and reluctance to change that prevents improvements and evolution.

 

[Thompson_JM]

You know JANES, I dont think anyone is arguing that this is a good idea. i think that pretty much anyone in the front line emergency services would be supportive of the idea. but as Bart has said, police already have enough on their plate at that point. and in case youre not aware, at least in ontario (and im pretty sure all of canada) all police must have 1st aid trg. so although they may not have the 1st responder quals they got something.... I personally think it would be easier to teach a paramedic how to be a Tac Medic, then it would to teach a mbr of the ETF how to be a Paramedic.

Also, its a tired and true phrase repeated many times... but JANES, Fill out your profile. It would be nice to know just who we're all talking to here. also, it does help us to digest the information when we know what the source is... ie: Bart who is a paramedic and deals with this stuff on a regular basis, vs. someone who is taking information off a website or out of a book somewhere.... (not that im saying You are specifically..) but on this board there is a big difference between those who do, and those who regurgitate info from another source.

in other words as far as the Tac Medic Issue goes, youre preaching to the choir here....

and as this is becoming an issue well outside of MY Arcs, im gonna swich back to recieve for a bit...

 

[JANES]

police already have enough on their plate at that point. and in case youre not aware, at least in ontario (and im pretty sure all of canada) all police must have 1st aid trg. so although they may not have the 1st responder quals they got something.... I personally think it would be easier to teach a paramedic how to be a Tac Medic, then it would to teach a mbr of the ETF how to be a Paramedic.

As I have stated before, first aid has no place in a tactical environment, nor does "First Responder" training.  Tactical Officers should be trained in TCCC.  About training a paramedic to be a TEMS medic rather than teaching a police officer to be a paramedic; thats fine, but there aren't to many EMS services willing to support a TEMS capability.  So far there is only four in the country, and they are not considered law enforcement officer, so they are not armed. 

Who are these guys?  http://tacmedtraining.com/  They are advertising to be training the RCMP in some sort of tactical medicine, though it looks like first aid with a different name to me!

 

[Thompson_JM]

As I have stated before, first aid has no place in a tactical environment, nor does "First Responder" training.  Tactical Officers should be trained in TCCC. 

Okay, I will agree with that. but the question is to what level should they be trained? remember, Tac Officers already have a lot on their plate, just like EMS does. if you start training someone on too many things some of those skills will start to suffer... ie: cutting into firearms trg, to cover TCCC? not such a good idea, so where do they make the cut? (Note: I'm not against the idea, but I'm wondering how it could be implemented)

About training a paramedic to be a TEMS medic rather than teaching a police officer to be a paramedic; thats fine, but there aren't to many EMS services willing to support a TEMS capability.

Why not? what can be done to change that? how can you/we start to process to get people on board with this idea?

So far there is only four in the country, and they are not considered law enforcement officer, so they are not armed.

Nor should they be. Paramedics are not and never will be Law enforcement officers... there is no need to arm them, when, if they are going into a high risk med-evac they would be escorted by ETF mbrs.... they have one job, save a life. giving them a gun on the civy streets makes no sense. now they have to start training on use of force, firearms training, etc... taking away from the time they should be spending on their primary job of saving lives... just like police should not be trained as EMS..  Also if we classify them as LEO's then they will start doing the job of LEO's as well... traffic stops, domestics, etc.... See where I'm going with this? its not worth the hassle to give them a gun. they can do the job without one.


So essentially we are in agreement here.

Yes, there should be more TEMS around the country

so what is the next step then, how do you get municipalities to recognize that TEMS is a Valuable asset to have in a high risk Tactical environment.

 

[JANES]

Okay, I will agree with that. but the question is to what level should they be trained? remember, Tac Officers already have a lot on their plate, just like EMS does. if you start training someone on too many things some of those skills will start to suffer... ie: cutting into firearms trg, to cover TCCC? not such a good idea, so where do they make the cut? (Note: I'm not against the idea, but I'm wondering how it could be implemented)
Why not? what can be done to change that? how can you/we start to process to get people on board with this idea?
Nor should they be. Paramedics are not and never will be Law enforcement officers... there is no need to arm them, when, if they are going into a high risk med-evac they would be escorted by ETF mbrs.... they have one job, save a life. giving them a gun on the civy streets makes no sense. now they have to start training on use of force, firearms training, etc... taking away from the time they should be spending on their primary job of saving lives... just like police should not be trained as EMS..  Also if we classify them as LEO's then they will start doing the job of LEO's as well... traffic stops, domestics, etc.... See where I'm going with this? its not worth the hassle to give them a gun. they can do the job without one.

so what is the next step then, how do you get municipalities to recognize that TEMS is a Valuable asset to have in a high risk Tactical environment.

You could say the same thing about teaching soldiers TCCC.  Where do you draw the line?  Is training an Infanteer in TCCC taking away from his (her) infantry training?  Not really!  I'm drawing parallels here, but I think that TCCC is an integral part of ERT training and operations, just as it is an integral part of an infateers training.  Bot work in an environment that has a high probablility for casualties.  I think it is a duty to prepare for that possibility of occurance because if you don't you are not fully trained to work in that environment. 

About Paramedics being LEO's, my point was, if you make a LEO a paramedic to support the team, then he will be armed, if you make a Paramedic a TEMS medic to support the team, he won't be armed.  I'm not saying arm them or dont arm them.  If they are not though, you are asking someone to go into a high threat environment without the ability to protect themslef.  They are relying totally on their escort for protection and security of them and the casulties.  I guess I just prefer to be in control of my own life.  That would fell very strange to me.  Also, there are many EMS services in the US who are wearing side arms to protect themselves and their patients.  (I'm not saying that this is what we should do.  We're not there yet, thank goodness)   

The next step is education.  It is making as many people aware as possible of the existence of LEO oriented TCCC and TEMS.  The reason for the resistence in adoption of TEMS on a greater scale is not just ignorance but money vs. requirement.  Can the service justify the cost of training and maintaining a TEMS team?  In the big cities, yes.  Anywhere else, even the smaller cities?  Not any time soon.  That it why it is even more important for the Police, at least the tactical officers, to be trainined in TCCC, so they know how to apply appropriate "first aid" and to get the casualty out to regular EMS waiting in the safe area.

 

[Thompson_JM]

All that sounds pretty good to me...

I think that giving a TEMS Member a sidearm for all the time use would not be a good idea. though the idea of issuing one to them during the call itself, and returning it afterwards, doesnt seem like it would be too bad of an idea, and to me, the relatively untrained observer, it sounds like a good compromise between the best interests of public safety and Protection of the casualty...

the only thing i can think of, is as a combat medic you would be operating under very different conditions then a TEMS. since IIRC in a high risk arrest or something where the ETF are called in, there are usually alot more cops then crooks in the area. and the police tend to know where in the general area they are. ie: they know the baddies are in 213 somewhere Ave. they just dont know what room. they then cordon off the area, and form a perimeter right? so when the ETF go into a bldg its a little more controled then a Cbt Medic doing TCCC and Evac from the site of an IED Attack or say a village full of hostiles...

Im going to have to leave the discussion now though... not because i want to, but because this is getting way too far out of my lanes.
perhaps someone with a BTDT T-shirt could step in and take over for me

thanks 

 

[rregtc-etf]

I hope I can shed some light on Tactical EMS in Toronto.  I am a former ETF officer and have attended gun calls with Tactical EMS.  In cases of tactical calls the ETF and Ambulance are requested to attend by the regular police.  If a Tactical EMS trained unit is available they will attend, if not just a regular paramedic unit or if they are also unavailable a regular ambulance will attend. 

In addition to being paramedics the tactical EMS are trained and equipped to work in an area contaminated by teargas.  In some tactical police situations tear gas may be used, so the tactical EMS guys and girls have and knows how to strap on a gas mask.  As for the ETF / SWAT / ERT / SRT being able to provide medical first aid, they do not have the training or equipment to deal with seriously injured persons and still maintain a tactical stance.  They can do little, beyond evacuating an injured person from a room into the hands of the EMS. 

As for the fire fighters....God made police officers so firefighters could have heroes too.

 

[Scott]

As for the fire fighters....God made police officers so firefighters could have heroes too.

Oh snap! Didn't I last see you dancing with the Village People?  ;D

 

[Armymedic]

"tactical paramedics" can be a misnomer, like military intelligence. Often, they are not trained in "tactics"(gunfighting, CQB) and are usually selected paramedics who have a bit of additional training, but rarely get to go inside the fight.

BTW, RCMP teams out of Ottawa have a medical component to them (people I know taught them a course or two). I am not sure what their relationship is, but they are all trained RCMP officers.

And paramedics exist so that both police and firefighters have heroes too. (thats why so many firefighters dream to do medical stuff)

 

[Scott]

And paramedics exist so that both police and firefighters have heroes too. (thats why so many firefighters dream to do medical stuff)

I says Pardon? The band aids are slamming us now?

Source considered.... :

;D