Page 111 - Journal of Special Operations Medicine - Fall 2014

mission preplanning, health surveillance of law enforce- Waco, Texas, the ATF tactical medical program today
ment personnel, urgent and emergency care, and serving is composed of approximately 70 providers nationally.
as the functional interface between law enforcement and ATF tactical medics are strategically distributed among
conventional emergency medical services (EMS). Tacti- 25 field divisions and the five SRTs around the coun-
cal medicine has become an essential intrinsic support try. Medics are typically trained to the level of Emer-
element for high-risk law enforcement operations and gency Medical Technician (EMT) with a small number
has evolved into a recognized specialty practice within of EMT-Intermediates (or AEMT) and Paramedics
prehospital emergency medicine. within the ranks. ATF providers maintain active compli-
ance with the National Registry of Emergency Medical
Technicians.
Background
The ATF under the US Department of Justice is the pri- In addition to core certifications, ATF medics receive
mary agency responsible for administering and enforc- intensive training in core concepts of tactical medicine,
ing the criminal and regulatory provisions of federal urgent care, sports medicine, and wilderness medicine.
laws pertaining to the illegal use and trafficking of fire- Authorized expanded field clinical interventions include
arms, destructive devices (bombs), explosives, and arson supraglottic airways, intravenous and intraosseous ac-
and the illegal diversion of alcohol and tobacco prod- cess, hemorrhage control adjuncts such as tourniquet
ucts. By virtue of its mission, the ATF is charged with and topical hemostatic agents, needle thoracostomy, and
9
the investigation and apprehension of some of the na- field expedient wound closure. A focused pharmaco-
tion’s most violent criminals. To help mitigate the inher- logic formulary is part of the programmatic capability.
ent risks of this operational setting, the ATF maintains Centralized medical oversight is provided by the Center
a tactical SRT program with five teams geographically for Law Enforcement Medicine at the Johns Hopkins
positioned across the United States. Established in 1996, University School of Medicine. Medical control is deliv-
the SRT program responds to high-risk operations that ered through formalized medical protocols, provider ed-
involve the service of arrest and search warrants, rob- ucation and training, continuous quality improvement
bery and home invasion investigations, undercover op- initiatives, and 24/7 online medical direction.
er ations, rural operations and personnel tracking, canine
operators, high-risk surveillance, precision marksmen
and weapon systems, response to natural disasters, and Methods
high-threat protection details. 10 A retrospective review and descriptive analysis were
performed of the clinical encounters of the ATF Tac-
In addition to the SRT, ATF has several other specialty tical Medical Program. Deidentified PCRs from 2009
resources to support its central missions. The NRT is through 2012 were provided by ATF to study investi-
a rapidly deployable cadre of experts, equipment, and gators. Redaction of identifiable patient information
support assets designed to help federal, state, and local within PCRs occurred prior to being received by the re-
investigators meet the challenges posed by significant search team. Reports with missing or incomplete data
arson and explosives incidents. Developed in 1978, the were excluded from analysis. This study was approved
NRT is composed of fire origin-and-cause and postblast by the Johns Hopkins University School of Medicine In-
forensic experts, forensic chemists, explosives enforce- stitutional Review Board (IRB) and ATF Headquarters.
ment officers, fire protection engineers, accelerant and
explosive detection canines, and support officers. As Clinical and operational data from patient care reports
11
part of the NRT, the ATF maintains an International were extracted and manually entered into a Microsoft
Response Team (IRT) under an agreement with the Excel (Redmond, Washington) spreadsheet. Chief com-
US Department of State, Diplomatic Security Service plaints were coded into preestablished categories for
(DSS). The IRT may provide technical/forensic assis- subsequent analysis. This coding was performed by
tance and oversight in large-scale arson and explosives two separate investigators and discrepancies in coding
investigations overseas under formal request by foreign were arbitrated by the principal investigator. Summative
governments. 12 analyses were performed to assess patient type, law en-
forcement incident type, chief complaint, interventions
performed, and medications administered.
ATF Tactical Medic Program
The ATF deploys specially trained Special Agent tactical
medics in support of its high risk and multifaceted law Results
enforcement operations. Conceived in the early 1990s A total of 267 PCRs were received from ATF for the
and bolstered by its first operational deployment in the 4-year study period from January 1, 2009, through
spring of 1992 at the Branch Davidian compound in December 31, 2012. Thirteen reports with missing or

Clinical Encounters of the ATF Tactical Medical Program 103