Page 109 - Journal of Special Operations Medicine - Summer 2014

emergency medical and trauma care, and promoting the curriculum, all tactical paramedics undergo training in
safety and health of law enforcement personnel. 6–8 tactical emergency casualty care, scene management,
medical support during extended operations, as well as
Despite an ever-widening acceptance of the role of an orientation to primary care, sports medicine, and oc-
TEMS in the support of public safety, advancements in cupational health. They also train with state and allied
its practice and implementation have occurred largely at federal law enforcement teams, where they are required
the local or regional level, often through innovative col- to master SWAT tactics, movements, weapon systems,
laborations and unconventional strategies. Similarly, and immediate action drills. Developed in collaboration
4,9
few reports have emerged in the history of tactical medi- with an academic medical center with expertise in law
cine that provide quantitative insight into the longitudi- enforcement medical support, a database is maintained
nal experiences of such initiatives and, more specifically, by the MSP TMU to track all operational deployments.
the nature of clinical encounters as related to law en- Included in this database is mission-specific information
forcement mission type. This study describes the 5-year pertaining to each deployment, as well as summative
longitudinal experience with tactical medicine in Mary- data about patient encounters during each mission. Pa-
land rendered under the auspices of the MSP TMU. tient care is documented in a separate electronic medical
record.

Background Maryland TEMS Standards and Protocols
All aspects of EMS care in the state of Maryland are es-
The MSP TMU tablished by law and administered, regulated and coordi-
The Maryland Department of State Police formally nated by the Maryland Institute for Emergency Medical
established its TMU in July 2000. A critical impetus Services Systems (MIEMSS).The MSP and its TMU led a
for implementing this program was a 4-day hostage statewide initiative starting in 2004 to develop standard-
barricade incident that drew national attention in the ized tactical EMS protocols. Formal tactical EMS pro-
Baltimore suburb of Dundalk in March 2000. During tocols were approved by MIEMSS in 2010. Included
12
this incident, state trooper flight paramedics under the in these protocols are specific provider qualifications,
MSP Aviation Command demonstrated the impact of training and equipment standards, and physician medi-
providing ongoing medical support services during an cal director requirements. Currently in force as an op-
extended, large-scale, and high-risk law enforcement tional protocol set, the Maryland tactical EMS protocols
operation. The TMU today consists of state trooper provide a robust yet flexible framework of skills and in-
10
tactical paramedics assigned to the MSP Special Op- terventions for law enforcement agency tactical medical
erations Division (SOD). These specially trained tacti- providers at basic and advanced levels.
cal paramedics deploy with the MSP’s full-time Special
Tactical Assault Team Element (STATE) tactical team
on all high-risk operations, as well as MSP dive op- Methods
erations and select executive protection missions. In In this retrospective review of existing de-identified op-
addition to MSP operations, as a statewide resource, erational data, all entries in the MSP TMU operational
MSP tactical paramedics support SWAT operations response database were analyzed for the 5-year period
conducted by local, regional, and federal Special Op- from January 2007 through December 2013. Personal
erations teams. 11 identifiers were removed from this data set before access
by the research team. Incomplete or missing entries were
The primary functions of MSP tactical paramedics dur- excluded from analysis. This project was determined to
ing law enforcement missions are providing medical sur- be exempt from review by the Johns Hopkins School of
veillance for ongoing risks, preventing injury and illness, Medicine Institutional Review Board and approved by
allocating and designating emergency medical resources, the MSP.
and rendering immediate trauma care within the inner-
most perimeter of operations. All medical functions are Descriptive and summative analyses were performed
coordinated under the law enforcement incident com- to determine the nature of missions on which the MSP
mand system. 11 The MSP selects internal candidates TMU was deployed, as well as the types of patients en-
for this specialized activity based on qualifications that countered during deployments and the chief complaints
include exceptional clinical skills as flight paramedics, of patients encountered. Mission types were based on a
exemplary work history and communication skills and list of existing mission categories used by MSP. A sub-
demonstrated leadership qualifications based on prior group analysis was performed to further characterize
experiences. Once selected, these trooper paramedics patient encounters based on the type of mission. Sta-
are required to successfully complete additional special- tistical analysis was performed using Microsoft Excel
ized training in tactical medicine. Under a standardized (Microsoft Corporation, Redmond, WA).

Maryland State Police Mission-Specific Analysis 99