SWAT candidates practice dynamic movement into and through a training house. A DTEM faculty member (in the black uniform) participating as a student and acting in an operator role provides right-flank cover on exterior windows before making entry with a SWAT team.

Division of Tactical Emergency Medicine

The mission of the Division of Tactical Emergency Medicine (DTEM) is to provide the highest quality preventive and interventional care to law enforcement agencies (LEAs) in both clinical and tactical settings; create educational opportunities for law enforcement officers, current and future tactical medical providers and other medical personnel; and lead the nation in determining and disseminating best evidence and practices for tactical medical education and clinical care.

Background

Public safety organizations often work in dangerous environments with the possibility of injury a constant threat to their members — those who are protecting people in the communities they serve. One method of decreasing member risk and potential liability for interactions with others is to provide medical resources capable of operating in those same environments. Tactical emergency medical support (TEMS) is the ability to safely provide medical care in high-threat situations where conventional emergency medical services (EMS) personnel are not equipped or qualified to respond. This is particularly true for law enforcement special operations: aviation, bomb disposal and special weapons and tactics (SWAT) teams.

Tactical emergency medical support is based on three pillars:

• achieving and maintaining team health through preventive medicine, human performance and sports medicine;
• education and training programs for all team members (including commanders, operators and medics) on tactical casualty care; and
• provision of medical expertise in the forms of advice for decision-making and direct care during all training activities and operational missions.

Over the last century, a systematic approach to the management and evacuation of battlefield casualties has been developed. Rapid, efficient and effective trauma management by medical personnel embedded in operational units has uniformly been accepted as the standard of care in the military tactical environment. Advances in military medicine have been applied in the civilian realm when medical personnel returned from conflicts and applied their skills back home. The fundamental concepts of medical support for LEA special operations evolved from these military roots. Although there are important distinctions between the two environments, military medicine and law enforcement TEMS each embody special knowledge, skills and abilities that define them as intertwined medical disciplines.

Team Health

The Division of Tactical Emergency Medicine supports medical care of law enforcement agency special operations through qualified faculty serving as tactical medical providers. They are responsible for care of tactical team members during fitness, training and operational activities. In this capacity, they act as medical advisor and liaison to the team commander, provide lifesaving measures in the tactical environment and initiate other medical care as necessary. Supervised resident participation is strictly voluntary.

This TRIG member had the opportunity to take a Basic SWAT Course as part of his senior rotation in EMS administration.

The division supports preventive medicine and enhanced performance through a partnership with the Dayton Sports Medicine Institute’s Athletic Workshop-Tactical Division. Activities include departmental physical examinations, pre-participation screening, fitness training, nutritional counseling, tactical performance enhancement training and injury clinics. Providers include athletic trainers, who are also trained tactical medical providers, acting under the supervision of the division director. When deployed, these services are under the control of the individual team’s medical director.

Education & Training

Education and training is provided to law enforcement officers, tactical medical providers, conventional out-of-hospital providers and other interested healthcare personnel. Example topics include self-care and buddy care, concepts and practice of tactical emergency medical support and medical support of the tactical athlete.

Educational opportunities are provided for the emergency medicine resident physicians and other graduate level physicians. These consist of classroom lectures, small-group discussions, skill labs and field exercises. Content is drawn from the current peer-reviewed TEMS literature. Delivery is overseen by division faculty. Interested residents may teach as well, and will be mentored by a qualified attending physician.

The DTEM directly supports the Tactical Resident Interest Group (TRIG).

Operational Support

Division members provide medical standby care and participate in SWAT training sessions and real-world missions. Care is provided to all operators, bystanders and suspects under the principles of humanity and impartiality.

The photos above show breaching and clearing during a local SWAT team's training devoted to operations at industrial sites. TEMS was provided by a DTEM faculty member (not shown).

Faculty

Brian L. Springer, EMT-T, M.D., FACEP, is division director. As division director, he has overall responsibility for coordination with tactical medical directors and providers in the community, coordination with participating LEAs and civilian EMS organizations, developing the roles and responsibilities of residents in the DTEM, developing and implementing a tactical emergency medical support educational curriculum for residents and other tactical medical providers, quality improvement of care provided, supervision of the budgetary items, coordination of division activities with the WSU National Center for Medical Readiness and supervision of the DTEM’s assistant directors. Dr. Springer has EMS experience in urban and suburban settings and TEMS experience with Dayton Police Department, Federal Bureau of Investigation, Kettering Police Department and Xenia Police Division.

Jason R. Pickett, EMT-T/P, M.D., is assistant director for operations. His areas of responsibility include direct out-of-hospital medical support, education of non-physicians and publications in the professional law enforcement literature. Dr. Pickett has EMS experience in urban, suburban and rural settings and TEMS experience with the Kettering Police Department and Warren County (Ohio) Sheriff’s Department. He completed SWAT School at the Ohio Peace Officer Training Academy.

John M. Wightman, EMT-T/P, M.D., M.A., FACEP, FACFE, is assistant director for academics. His areas of responsibility include assembling the evidence base for best practices, physician education and publications in the medical literature. Dr. Wightman has EMS experience in urban and semi-rural settings and TEMS experience with the U.S. Park Police; Bureau of Alcohol, Tobacco, Firearms, and Explosives; Federal Bureau of Investigation; U.S. Marshals Service; U.S. Secret Service; Montgomery County (Maryland) Police Department; Greene County (Ohio) Sheriff’s Office; and Xenia Police Division. He completed SWAT School at the North American SWAT Training Association. Dr. Wightman also serves as an instructor in the Counter Narcotics & Tactical Operations Medical Support (CONTOMS) course co-sponsored by the U.S. Department of Health and Human Services, the U.S. Department of Homeland Security and the U.S. Park Police.

Publications

1. Springer BL, Kleiner DM, Wightman JM: Medical support of the tactical athlete. In Schwartz RB, McManus JG, Swienton RE [eds]: Tactical Emergency Medicine (Lippincott, Williams & Wilkins: Philadelphia, PA; 2008), pp 32-43.
2. Wightman JM, Gibbons ME, Gebhart ME, Brown JB: Critical casualty evacuation from tactical settings. In Schwartz RB, McManus JG, Swienton RE [eds]: Tactical Emergency Medicine (Lippincott, Williams & Wilkins: Philadelphia, PA; 2008), pp 109-122.
3. Blankenship SB, Gebhart ME, Pickett JR: Emerging technologies for the tactical medical provider. In Schwartz RB, McManus JG, Swienton RE [eds]: Tactical Emergency Medicine (Lippincott, Williams & Wilkins: Philadelphia, PA; 2008), pp 240-252.