Though most TEMS units are fire-medic based, some teams, like the Southwest Washington Regional (SWWR) TEMS team, start with a primary background of law enforcement officers who acquire medic training.
"A lot of teams were cross-training firemen and giving them some type of minimal law enforcement training so they could carry a gun, be in the stick, and at least protect themselves," recalls Sheriff's Commander of Special Operations Mike Nolan with the Clark County Sheriff's Office in Vancouver, Wash. "We were fortunate enough to have a number of police officers who had [paramedic] training."
The Vancouver SWWR TEMS was developed in 1998 by a full-time law enforcement officer and part-time trauma nurse and paramedic. "This guy was kind of an over-achiever," recalls Cpl. Doug Rickard, team leader of the SWWR SWAT-TEMS. His team responds on all SWAT missions, training and supports the civil disturbance and riot teams.
Working units that combine EMS, SWAT and law enforcement require collaboration on many parts. Riley says his team is fortunate to have a good working relationship with its EMS personnel, though sometimes it takes a little effort to get the ball rolling. Wood was proud to "knock some of those doors down" at the fire and police departments and develop a camaraderie between the bomb squad and TEMS medics, adding: "It's something that's never been done here before."
As more and more "special teams" are carved out in civil service, traditional roles are redefined. "The focus, I believe nationally, is all-hazards," says Nolan, "and all disciplines: fire, police, EMS … [and] you have to include SWAT, HNT, EOD and civil disturbance in this group, [as well]."
Collaborative SWAT teams are a vivid example of how agencies are improvising to better use resources and manpower. Adds Nolan, "We combine the teams because there's no reason for duplication."
Tactical medic units provide clear lines of responsibility and help build relationships across departments that often resonate beyond TEMS itself. In high-trauma scenes, cooperation is crucial and even the best-equipped men and women are not immune to danger.
Rickard recalls one officer who was shot while mitigating a hostage situation. Tactical medics swiftly entered the house while shots were still being fired. They took the injured officer around to an adjacent house where he was stripped of his body armor, medically stabilized on the scene and "ready for transport in 14 minutes from the time of the call." The officer could have sustained fatal injury. Fortunately he survived.
Shelter in the storm
This level of care and expertise certainly does save lives. But TEMS is not all-trauma, all the time. Some of the biggest benefits Riley has seen inside his unit involve preventative measures. For example, medics can effectively monitor officers' welfare on-scene, bearing in mind things like the temperature, food and water supplies, heavy equipment, etc.
During a suicide call-out one day, Cabarrus County TEMS medics continually provided feedback to the command post. "He's up on the frontline checking all kinds of vitals," says Riley. "It got to a point where we had [other agencies' SWAT teams] on standby. In a tactical situation you can't afford to call time-out."
But TEMS medics do not only serve their own. When sending civilian emergency medical service is not an option, TEMS is fast on the scene. During one of the Vancouver team's first missions, a man had barricaded himself in a house on a cul-de-sac loop and threatened to kill anyone who came near. At the same time, a couple in their 80s were next door, both of whom had critical medical issues.
"Both were on home dialysis, both were on oxygen and both were diabetics, and this standoff lasted 8 hours," remembers Rickard. "So one of our missions was to make sure those folks were OK." As the standoff progressed, tactical medics repeatedly went into the hot zone to check on the couples' oxygen and blood sugar. They also moved them to another side of the house and sealed it off from hazardous gasses.