When a police officer taking his fitness test during SWAT school at the Ohio Peace Officer Training Academy in London, Ohio, dropped to the ground suffering from cardiac arrest, Brian L. Springer, M.D., jumped into action and resuscitated the officer.
“We had an automated external defibrillator on him within minutes and got his pulse back after a shock,” Springer said. “He was helicoptered in critical condition.
Twenty-four hours later, he called me on my cell and thanked me for saving his life.”
As director of the Division of Tactical Emergency Medicine in the Department of Emergency Medicine at the Wright State University Boonshoft School of Medicine, Springer and Jason R. Pickett, M.D., assistant professor of emergency medicine, work with regional law enforcement special operations teams in aviation, bomb disposal and SWAT teams that work in dangerous environments where injury is a constant threat.
The division, a component of the department’s Center for Prehospital and Operational Medicine, supports medical care of law enforcement agencies’ special operations through qualified faculty serving as tactical medical providers. Springer and Pickett are medical advisors and liaisons, providing lifesaving measures in the tactical environment and initiating medical care as necessary. They teach the officers about self-care and buddy-care and tactical emergency medical support.
“We know that the sooner that treatment is initiated, the better the odds of survival,” said Springer, who also is an attending emergency physician at Kettering Medical Center.
That training is making a difference. SWAT officers, medically trained by Springer and his colleagues, can immediately treat their colleagues who are injured. Springer said that a division-trained officer treated his colleague who suffered a gunshot wound to his leg from an unintentional discharge while holstering his sidearm. Another division-trained officer provided immediate medical attention to a colleague who suffered a severe laceration to his forearm when a breaching shotgun was used to blow off a door handle. The handle struck the officer, causing significant bleeding.
“In both instances, rapid control of bleeding with tourniquets quickly controlled hemorrhage, preventing shock,” Springer said.
Another division-trained officer found an intoxicated individual, whose foot was amputated by a train after he had passed out on the train tracks. The officer quickly applied a tourniquet before the ambulance arrived, saving the individual from bleeding out.
The division’s attending physicians and residents have provided care to officers, bystanders, and suspects. They have treated blunt injury, sprains, strains, lacerations, contusions, gunshot wounds, intoxication, chemical exposures, traumatic amputation, blast trauma, cardiac and respiratory complaints, and cardiac arrests. They have treated, released, and transported patients to hospitals via law enforcement vehicles, ambulances, and helicopters.
Springer and his colleagues have examined suspects and their families after raids and exposure to tear gas. They have provided rapid assessment and medical clearance on scene. “Most individuals, even suspects, are grateful to be medically evaluated,” Springer said. “They are scared and may be injured. They are not expecting to receive medical care so soon after contact with law enforcement.”
Springer identifies himself as the law enforcement team’s medical provider. He asks the individual whether he or she is injured. “Overall, injuries tend to be minor,” he said. “We have rarely had to send anyone to the emergency department for more detailed evaluation and treatment.”
Even if the suspect has committed a crime, Springer explained that his job is to provide compassionate care to that individual. “The ability to provide compassionate care to all in need is something that we teach in emergency medicine from the first day of residency training,” he said. “Your job is to evaluate and treat the patient, not pass judgment on them. This is no different whether you are in the emergency department or out on the streets working with law enforcement or EMS.”
Although most operations regionally are related to narcotics trafficking or barricaded suspects usually in the context of drugs or domestic violence, the division has supported operations where the focus is on international or domestic terrorism. It has trained hundreds of law enforcement officers in Ohio on self-aid buddy-aid (SABA), which is a military concept that has been adapted to civilian law enforcement. Officers are taught basic life support and limb-saving techniques that are key to surviving a life-threatening injury.
“In a terror attack or other violent threat to law enforcement and the public, law enforcement cannot rely on immediate response from emergency medical services. They must be able to bridge the gap between time of wounding and EMS response through aggressive hemorrhage control and airway management,” said Springer, who also serves as the tactical medicine director for the Ohio Tactical Officers Association. “It would be ideal if tactical medical providers could be embedded with law enforcement officers on the scene all of the time. But that’s not realistic.”
Tactical emergency medicine has gained tremendous insight from U.S. military operations. “What we learned about tourniquets, hemostatic dressings, and management of hemorrhages during the military conflicts in the Middle East has helped shape and improve tactical medicine,” said Springer, who served six years in the Marine Corps Reserve and was deployed during the first Gulf War before becoming a physician. “Most importantly, there is the relatively newfound realization that tactical emergency medicine is not just for SWAT teams. All civilian law enforcement officers are potentially in harm’s way and need to know these skills.”
Springer and his colleagues also train emergency medicine medical residents in tactical emergency medical support. Interested medical residents attend the tactical emergency medical support resident interest group during their first year of residency. Meetings include lectures, tactical first aid, hands-on activities, discussions of law enforcement tactics, equipment lessons, and field exercises.
“We prefer to wait until residents are mostly done with their intern year before we allow them to be active with a tactical emergency medical support team,” said Springer, who also serves as the medical director for the Kettering Fire Department and a police officer for the Grandview Medical Center Police Department. “It gives us a chance to vet and train them, and it gives them a chance to get through the internship and decide whether they want to be a part of this.”
For those who want to pursue tactical emergency medical support, the next step is to attend a tactical EMS class. Then, equipment is issued to the medical resident, and that person is assigned to a team. The medical resident is connected with attending-level mentors on the team to help them transition into an active role. “We want our emergency medicine residents out there in the field using their skills,” Springer said. “We want them to take the lessons learned in the field and bring them back to the emergency department.”
He explained that a physician who has experienced prehospital care, whether in tactical emergency medicine with public safety organizations or in a traditional emergency medical services setting, will be a better provider in the emergency department of a hospital. In addition, that physician will be a more effective medical director who can work with both emergency medical services personnel and tactical emergency medical services.
“Working with law enforcement officers and emergency medical services personnel in the field has given me tremendous respect for the day-to-day challenges they face,” Springer said. “It also has guided me in seeking solutions for the medical concerns faced by public safety.” VS