William "Dave" Sanders is another name that will slip into history. He was a father, a coach and a beloved teacher, but you most likely don't know of him unless you responded to — or were directly affected — by the shootings at Columbine High School in April 1999. Having survived the initial assault, the severely wounded Sanders retreated to an area inside the school, barricaded himself with his students inside a classroom and waited for help. He later died. The after-action report noted that tactical medics could have made a difference.

An event a decade later, March 21, 2009, in Oakland, Calif. — in which four police officers were killed and a fifth injured — is the latest in countless battles between criminals and outgunned law-enforcement personnel. Again, could tactical EMS have given these officers a better chance of survival?

The number of officer injuries and multiple-civilian deaths at such events is rising. Indeed, statistics from 2007, on police-officer deaths related to shootings indicates a 44% increase in this category of line-of duty-deaths. And the trend likely will continue.

America is armed today better than at any time in history thanks to the fear created by expected bans on certain assault weapons. Drug and gang violence is exacerbating the situation, in some measure spilling over from organized crime in other countries. Add to this the effects of an economy in deep recession — job loss, financial ruin and perceptions of an unfair system — and people will do desperate things.

Consequently, there is more justification for law-enforcement deployments with special weapons and tactics. The limited and valuable resources that make up a SWAT team should have the utmost protection. One statistical report indicates an injury rate of 33 injuries per 1,000 officer missions. It is time for the fire service to step up and support our brothers in law enforcement.

The National Fire Academy's EMS Special Operations class has a day devoted to tactical EMS. The course content indicates that 1 in 52 high-risk police operations will result in an officer-related injury. This includes high-risk search warrants, barricaded suspects and narcotics raids.

When you consider that bullets fired from small-caliber weapons that penetrate the chest or neck will injure the spine 70% to 80% of the time, the careful removal of an officer using spinal protection is an important skill. Gunshot wounds to the head and neck require superior skills to establish an airway. Moreover, the toxicology issues surrounding weapons of mass destruction, blast effects from improvised explosive devices and the complexities of supportive care for long-term operations that may go hours or days requires an experienced, proficient and well-trained paramedic.

After Columbine, the International Association of Fire Fighters changed its position on tactical EMS and created a packet that, in part, outlines how to deploy and cooperate with law enforcement. One issue concerns whether to arm firefighters involved in tactical EMS operations. A less-than-lethal weapon is an option. A Taser, a rubber-bullet gun or a bean-bag shot gun all are quite capable of providing some protection. This represents a common-ground solution that would meet the needs of both sides — the police chief usually wants firefighters armed, while the fire chief usually is against it.

If tactical medics are going to be armed, a fire department should consider sending tactical EMS personnel through a law-enforcement academy for liability purposes. The possibility of shooting and seriously wounding or killing a suspect is very real, and the scrutiny of a shooting-review board or a defense attorney will put the operation at risk in the absence of proper training and credentialing.

Another benefit from certified police-officer training for tactical medics is that it provides an applicant pool for the position of arson investigator. As most arson teams need police powers for arrest and often find themselves up against bad people with superior fire power, such training benefits both the future arson investigator as well as the tactical medic.

There are several training programs available to bring EMS providers online with tactical training. One is the Counter Narcotics and Terrorism Operational Medical Support Program, which has trained thousands of providers and its course material has migrated into other for-profit organizations.

In addition, the National Tactical Officer's Association developed a tactical EMS curriculum that currently is offered by Texas A&M, and the firearm manufacturer Heckler & Koch has developed a tactical emergency medical course that provides a strong tactical EMS background with the added benefit of firearms training during the course.

In these financially tough times, the equipment costs associated with tactical EMS can seem like a barrier. Tactical medics need the same protective outfits that the SWAT team has, including a bulletproof vest and military-style Kevlar helmets. Law enforcement usually can pay for this equipment with seized money and the proceeds of confiscated property auctions from drug arrests. Also, a tremendous amount of law-enforcement grants are available as compared with fire and EMS grants.

The deployment of a tactical EMS unit often eliminates the need to hold an engine on scene for hours, and this cost can be measured. The costs to deploy an engine or an EMS vehicle as a standby for law enforcement can be calculated by dividing your total fire and EMS budget by your annual run volume. This produces a cost per response that can be compared to the cost of deploying a tactical EMS unit.

A debate often centers on the use of law-enforcement personnel for tactical EMS versus firefighters/paramedics. Most cities do not have the call volume to maintain the proficiency of a tactical medic assigned to a law-enforcement unit. Moreover, the skill proficiency needed for IVs and advanced airway control makes it more feasible for experienced firefighters/paramedics to fill this role.

Despite the fact that cardiac arrest represents less than 0.5% of total EMS call volume, an enormous investment has been made in preparing for that type of response. Yet, after all that expense, the effort has achieved only limited success. In comparison, the cost of a tactical medic program has far more potential for a return on the investment. The cost of training one police officer ranges between $50,000 and $120,000 — and the cost associated with the loss of an officer's life is incalculable. Police officers are in short supply and it should be the fire service's responsibility to make their mission to protect the public as successful — and safe — as possible.

Bruce Evans is the EMS chief for the North Las Vegas (Nev.) Fire Department. He also is the fire science program coordinator at the Community College of Southern Nevada and an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. He has an associate's degree in fire management and a master's degree in public administration.

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