Today’s criminals and terrorists are more determined, violent and heavily armed than ever before. Law enforcement tactics and tactical medical techniques need to constantly evolve to treat and evacuate the wounded, sick and injured, as well as address and eliminate the threats.

Crisis situations that the police and their special weapons and tactics teams commonly encounter include active shooters, barricaded subjects and hostage-takers. These occur with alarming frequency. In the cases of the Bank of America in North Hollywood, Calif., and Columbine High School in Littleton, Colo., conventional law enforcement responders were hard-pressed to effectively resolve these high-risk situations. Since then, and in preparation for future situations, many law enforcement agencies have integrated specialized emergency medical technicians, paramedics and even physicians into their swat teams. These medical providers can maintain the wellness of swat team members and provide immediate medical care to anyone in need.

The three goals of tactical combat casualty care are to treat casualties, prevent additional casualties and complete the mission. The role of the tactical medic is to support the law enforcement mission. Usually when a SWAT team takes a hit from the bad guys, more than one team member is wounded. Tactical medics care for the downed team members, the police, citizen victim and the bad guys, too. In applying combat medicine triaging — the sorting of victims according to a system of priorities — the police are treated first because they are not a threat. Officers also have a higher survival rate because they wear body armor.

On the Gulf Coast of Florida, area fire departments provide tactical medics who work in partnership with law enforcement tactical teams. There were few tactical emergency medical teams prior to the 1990s. Following American military practice, both fire/ems workers and paramedics are called “medics” when members are part of a tactical teams. Nationwide, the levels of tactical training and participation of fire department medics with law enforcement tactical response vary from team to team.

In some police–fire partnerships, the medics stand by with their ambulance and play a lesser role in swat training and on call-outs. Although agencies still practice standby rescues, these standby medics may be considered obsolete by some. Failure to provide appropriate and expedient care leaves such agencies open for harsh adjudication in the courts and by the media. During the Columbine shootings, for example, a good guy bled out; the result has been law enforcement’s active shooter training and a rethinking of medical response methods.

In Pinellas County, Fla., the ante has been upped to provide “appropriate and expedient care.” Because of this, once a fire department medic volunteers to become a tactical-rescue medic and he or she meets the departmental requirements, that medic must enter the severe, perfectionist world of SWAT. Being a tactical medic doesn’t just mean wearing a tactical uniform, staffing an ambulance and hobnobbing with SWAT; it also requires training alongside full-fledged, pedal-to-the-metal SWAT officers.