Page 110 - Journal of Special Operations Medicine - Fall 2014

An Ongoing Series

A Multiyear Analysis of the

Clinical Encounters of the ATF Tactical Medical Program

Nelson Tang, MD; Josh Kubit, MD;
Oliver M. Berrett, MD; Matthew J. Levy, DO, MSc, NRP

ABSTRACT
Background: The Bureau of Alcohol, Tobacco, Fire- Introduction
arms and Explosives (ATF) Tactical Medical Program Law enforcement agencies throughout the United States
provides tactical medical support for ATF’s tactical Spe- have standing access to highly trained and specially
cial Response Teams (SRTs) and investigative National equipped elements capable of responding to those high-
Response Teams (NRTs) through the deployment of est risk and most operationally complex situations.
specially trained ATF Agent-Medics. All patient care ac- Conceptually developed over 40 years ago in response
tivities are centrally coordinated through ATF Headquar- to the rapidly increasing prevalence of violent crimi-
ters. Methods: A retrospective analysis of de-identified nal activity, tactical support has become a seemingly
patient care reports (PCRs) from the ATF Tactical Medi- ubiquitous component of modern law enforcement
cal Program from 2009 to 2012 was performed. Clinical operations. Often retaining the historic acronym of
2–4
and operational data were extracted from PCRs and were S.W.A.T. (Special Weapons and Tactics) or other such
entered into a database by the research team. Descriptive dynamic nomenclature, tactical teams deploy in support
and summative analyses were performed to assess patient of an ever-widening scope of responses to include both
type, law enforcement incident type, chief complaint, preplanned and no-notice law enforcement missions
and interventions performed. Results: Analysis was per- such as high-risk warrant service, violent felon appre-
formed on the 254 charts. Nearly half (114; 44.9%) of hension, dignitary and executive protection, hostage/
patients encountered during the study period were law barricade situations, active shooter incidents, and acts
enforcement officers. High-risk warrant service was as- of terrorism and disasters. 5,6
sociated with one third (85; 33.5%) of the ATF medics’
clinical encounters. The most common chief complaints The proliferation of law enforcement special operations
of patients encountered were musculoskeletal pain/in- teams has functionally engendered the evolution of ded-
jury (57; 22.4%) and wounds/lacerations (57; 22.4%), icated Tactical Emergency Medical Support (TEMS).
followed by heat illness (17; 6.7%). The most common Developed to address the well-recognized potential for
intervention was wound care (61; 26.9%), followed by high lethality injuries intrinsic to tactical operations,
control of bleeding with direct pressure (43; 18.9%). the initial focus of TEMS was training and preparing
The most common medications administered were ibu- its providers to render lifesaving trauma care. Tactical
profen (28; 25.2%), topical antibiotic (12; 10.8%), and medicine is today much broader in scope and often po-
acetaminophen (12;10.8%). Conclusion: This multiyear sitioned to provide comprehensive medical support for
analysis represents an important contribution to the law enforcement special operations, drawing from fun-
growing body of scientific literature surrounding tactical damental tenets of preventative, sports, occupational,
medicine. The results of this analysis demonstrate a con- and emergency medicine. The broad objectives of
5–7
tinued need for expanded scope of practice training, as such programs are to support the overall success of the
well as enhanced treatment protocols for tactical medics.
tactical mission by optimizing the health and prepared-
ness of the operational team as well as being capable
Keywords: tactical emergency medical support, tactical of providing immediate emergency medical and trauma
medicine
care. Core tactical medicine responsibilities include
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