Page 108 - Journal of Special Operations Medicine - Summer 2014

An Ongoing Series

Clinical Encounters in Tactical Medicine:

A Mission-Specific Analysis of the Maryland
State Police Experience

Matthew J. Levy, DO, MSc, NRP; Rebecca Smith, MD, EMT-B;
Kevin B. Gerold, DO, JD; Donald W. Alves, MD, MS; Nelson Tang, MD

ABSTRACT
Introduction: The Maryland State Police (MSP) Tactical and reinforce the need for expanded scope of practice
Medical Unit (TMU) provides tactical emergency medi- training and enhanced treatment protocols for tactical
cal support (TEMS) through the deployment of specially medics.
trained state trooper tactical paramedics. The MSP TMU
maintains an operational database of all mission related Keywords: tactical emergency medical support, tactical
medical activity. This information constitutes a robust medicine
dataset derived from real world operational medicine
experiences. Methods: A retrospective analysis of de-
identified entries from the MSP TMU operational re-
sponse database was performed for the 5-year period of Introduction
2007–2013. A summative analysis of missions, as well Throughout the United States, police departments have
as a subgroup analysis of types of patients encountered, developed and deployed specialized tactical elements.
was performed to further characterize patient encounters Commonly referred to as SWAT (Special Weapons and
based on the type of law enforcement tactical mission. Tactics) teams, the conceptual development for these re-
Results: Analysis was performed on 1,042 tactical mis- sources generated from the rapid escalation in patterns
sions, of which there were 367 total patient encounters of crime and violence, requiring the need to provide an
during the study period. The majority (67%; 246/367) effective law enforcement response. Disturbingly, the ac-
of patients encountered were law enforcement tactical tivation and deployment of such specialized resources
team personnel. The most frequently occurring mis- have become a routine occurrence. 1–5 Modern law en-
sion, by type, was high-risk warrant service, account- forcement tactical units are typically deployed to support
ing for 45% (470/1,042) of all missions in this series. high-risk warrant service, hostage or barricade incidents,
Law enforcement training support missions comprised civil disturbances, dignitary and executive protection,
25% (259/1,042), and 15% (157/1,042) of all missions maritime and dive operations, explosive ordnance dis-
in the database were medical standbys for law enforce- posal (EOD), and Homeland Security missions. 3,5
ment operations. The highest number of patient contacts
were associated with training activities, resulting in 29% The prevalence of dedicated emergency medical services
(108/367) of clinical encounters. The next most common (EMS) support of tactical law enforcement operations
mission associated with patient encounters was high-risk has grown tremendously since its initial description more
1,3
warrant service (24%; 88/367). Conclusion: The 5-year than 20 years ago. The goals of TEMS are broad and
analysis conducted in this study represents the largest include facilitating overall success of the law enforcement
known retrospective assessment of a state police tacti- mission during all phases of a tactical operation through
cal medical program. Training activities resulted in the the delivery of preventative, urgent, and emergent medi-
highest number of patient encounters by this program, cal care. 1,2,4,5 Uniquely trained and prepared tactical
with law enforcement/tactical team personnel compris- medical assets often support high-risk law enforcement
ing the majority of patient encounters. The majority of operations by providing scene commanders with medical
chief complaints encountered were non–life threatening threat assessments and advisories, delivering immediate

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