Studies have shown that more than 60% of SWAT officers' injuries suffered during showdowns with criminals involve excessive bleeding, often from gunshot or knife wounds. In the past, downed officers would have to wait for an ambulance to arrive at the incident, then for police officers to deem the area safe for paramedics to enter and administer treatment — delay that increased the risk that injured officers would bleed to death.

"When I was a young firefighter, we'd have to stand by after a shootout where officers were injured and wait for the scene to be completely safe and clear before we could enter," said Alex Cohilas, fire chief of Clayton County (Ga.) Fire and Emergency Services Department, just south of Atlanta. "Those were precious moments lost."

But now, such incidents are where tactical medics come into play. In fact, many tactical medics are trained paramedics from area fire departments who are taken off their regular firefighting duties during a SWAT-team incident and sent to assist officers, Cohilas said.

Cohilas currently oversees the county's all-hazards department, which protects about 144 square miles and more than 273,000 residents and responds to about 29,000 calls per year — all of which is supported by a $25 million annual operating budget.

Every firefighter in Cohilas's department is cross-trained as an EMT-intermediate, a priority he set when he became chief in 2001 because he wanted to advance the department's ALS capabilities. He then began to lobby for a tactical-medic program to serve and protect Clayton County Police SWAT teams when they were deployed to high-risk incidents, such as hostage situations.

By 2008, Cohilas had put into place the building blocks for a tactical-medic program. Now, the department has 22 tactical medics spread across three shifts. These medics are on call to the SWAT teams for special response team operations overseen by the Clayton County police and sheriff's departments. The medics also assist the U.S. Marshal's Office and other Atlanta-area public-safety agencies.

"The program is geared to protecting law-enforcement officers with a motto of 'heal the warrior,'" Cohilas said. "If a SWAT team is making an advance or an entry, these medics are behind the officers. If an officer gets shot, they don't have to leave the officer behind or wait for medics to arrive on scene. Instead, the medics are embedded inside the unit and work alongside officers."

Since Clayton County started its tactical-medic program, there have been no gunshot or knife wounds to officers or suspects, Cohilas said. However, medics regularly evaluate and treat suspects and officers for injuries from physical confrontations, falls, twisted joints, chest pains and breathing difficulties.

Only the Seasoned

Tactical-medic candidates must have at least three years of experience as a certified paramedic in order to be considered for the program, Cohilas said. In addition, the minimum seniority of current tactical medics is seven years of service as firefighters. In fact, he said that almost all of the current medics are sergeants or lieutenants, and several are chief officers who have more than 25 years of service.

"The objective is to ensure that only seasoned and experienced paramedics are deployed to assist special response team operations," he said.

Tactical-medic candidates also must pass a battery of criminal background checks and driver-history investigations. In addition, they must pass medical exams and aptitude tests. All of the gathered data is reviewed by the fire department's tactical-medic coordinator, who approves the list of eligible candidates, Cohilas said.

With coordinator approval, candidates begin the process of gaining Georgia Peace Officers Standards and Training Council approval by attending and passing the six-month Basic Law Enforcement course.

During the peace officer training, candidates are certified on a .40 caliber Glock semi-automatic pistol and must pass sharpshooter tests. Cohilas said weapons are purchased out of the fire department's budget and training is done through a reciprocal agreement with Clayton County's regional training academy. Once certified as tactical medics, they then train on a regular basis with SWAT teams, practicing defensive tactics and sharpshooting.

In addition to firefighting gear, tactical medics have law-enforcement uniforms, body armor, Kevlar helmets and duty belts. Their pistols are secured in a locked gun vault and are accessed just before they are deployed to an incident, Cohilas said.

But all of this equipment and certification can get expensive, so much that Cohilas believes tactical medics may not be feasible in every jurisdiction. In fact, he said that the program is cost-prohibitive and works best in an urban department with a high population density and a high number of calls with a potential for violence.

No 'Normal' Days

To provide services on scene, it is important that tactical medics know their mission and the role of a SWAT team, said Dave Hall, president of Rescue Training. Hall said tactical-medic skill sets vary based on the specific needs of SWAT teams.

But all tactical-medic candidates must complete a trauma training course because of the unique environment in which they work. For example, Clayton County's tactical medics are certified peace officers. The benefits of this are enormous for operations, according to Jason Harmsen — paramedic lieutenant and training officer for Clayton County's program. He said that with armed medics, SWAT team members can continue their advance toward the gunfire without having to leave members behind to guard the EMS crew. And because they have authority to carry firearms, such medics also can make arrests and provide security, as well as medical care, to their patients.

However, there are many teams that don't require such training and medics are unarmed. In fact, Hall said about half the country uses unarmed medics and often places them in safe zones when called to an incident.

"In such cases, the SWAT team knows medics are unarmed and will stage them so they have immediate access to injured officers but are not put in the stack," he said. "So they won't be confronting bad guys, head on, by themselves."

Harmsen said his department's tactical-medic training closely mirrors military concepts. In fact, the team is trained in trauma combat-casualty care — commonly used during hostile, military operations by special operations corpsmen, medics and para-rescue teams.

"It is important to train medics on battlefield operations, so we mirror those combat-casualty care techniques closely," Harmsen said.

Harmsen said that it is important to train medics to prepare for a stressful, hostile environment that differs from normal EMS calls. Many medics are used to being in control of the environment, for example, arriving to a residential structure, taking a patient out on a stretcher and putting him in the back of an ambulance for hospital transport. But it's a different scenario when working with SWAT teams.

"In tactical-medic operations, we are going into an environment not built for us," he said. "It's hostile. We are training to operate in those stressful environments to get people used to that."

Clayton County trains at a regional center, but agencies without such resources can bring the training on site, Hall said. His company offers on-site EMT tactical certification for large groups for $795 per person. The 52-hour course is completed over a five-day period. Training only is offered to public-safety, police, fire EMS, military and homeland-security personnel.

Training includes SWAT operations, team health for extended operations, tactical patient assessment, extraction for officers and the type of medicine practiced while working in "a hot environment where people are shooting at you," Hall said.

For example, candidates are put into a sensory-overload lab — filled with smoke, flashing strobe lights, exploding firecrackers and people screaming at them — and asked to assess a downed officer's injuries.

"We really try to stress them as much as possible while they attempt to practice their medical skills in a high-stress environment," Hall said.

Other labs force participants to assess patients in a sensory-deprivation lab, where a blindfolded medic uses the sense of touch to find injuries and apply tourniquets for extremity wounds.

Highest Priorities

"The No. 1 cause of preventable death is bleeding to death and that can easily be fixed with a tourniquet. They also are timed on how long it takes to apply it and stop the bleeding," he said. "Tactical medics are invaluable in this role, as once trained, they can save the lives of their brothers and sisters in blue."

Clayton County tactical medics perform their regular firefighter/paramedic duties and handle fire suppression, EMS, hazmat calls and rescues during their regular 24-hour shift. However, a special operations call-out is their highest-priority alarm, and medics immediately don their gear and report to the SWAT briefing location or rally point, Cohilas said.

"If there is a deployment, such as a raid on a drug house, they go in as part of the special-response team. They will be out of service until the operation is complete," Cohilas said. "For such deployments, they are under the command of the senior law-enforcement officer."

Cohilas explained that when SWAT teams need assistance, the Clayton County Sheriff's Department contacts the 911 communications center and requests that a fire department supervisor return the call. A scheduling captain contacts the sheriff's department, determines the nearest fire station to the incident, and calls the on-duty tactical medic(s). Depending on the situation, medics may arrive in personal vehicles or in the EMS unit, engine or truck company to which they are assigned, Harmsen said.

Medics then report to command and control — which can be at police headquarters or at an on-site staging area — prior to entering the scene. Medics are briefed on green zones and safety measures, as well as any unusual circumstances, such as a strategic attack by the SWAT team on drug dealers protecting a methamphetamine lab, Harmsen said.

"We are firefighters also, so during several of these briefings we provide operational insight, such as how to attack a meth lab, since we are all trained hazmat techs who have put fires out in meth labs," he said. "It's been cool to find out the skills we wouldn't think were necessary have come into play."

While tactical medics are deployed primarily for officer safety, they also provide medical treatment to suspects, hostages and civilians, Harmsen said. Additionally, veterinary medical training is being developed to improve the tactical medic's ability to treat injured law-enforcement canines, he said.

Cohilas said that besides saving lives, the program has had an added benefit: better relationships with the brothers and sisters in blue. In his opinion, tactical medics have helped bridge the gap between law enforcement and the fire service.

"Ever since this program started, our departments have grown closer," Cohilas said. "Now there is a true spirit of cooperation, respect and improved efficiency, as well as shared ideas and experiences."

Basic Plan for Care Under Fire

  • 1. Return fire and take cover.
  • 2. Direct or expect casualty to remain engaged as a combatant, if appropriate.
  • 3. Direct casualty to move to cover and apply self-aid, if able.
  • 4. Try to keep the casualty from sustaining additional wounds.
  • 5. Airway management is generally best deferred until the Tactical Field Care phase.
  • 6. Stop life-threatening external hemorrhage if tactically feasible:
    • Direct casualty to control hemorrhage by self- aid, if able.
    • Apply a tourniquet for hemorrhage that is anatomically amenable.
    • Apply the tourniquet above the wound high on the extremity, over the uniform and tighten to stop arterial bleeding or until distal pulse is lost.
  • 7. Move the casualty to cover.

Source: National Tactical Officers Association

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