Page 113 - Journal of Special Operations Medicine - Fall 2014

topical antibiotic (12; 10.8%), and acetaminophen (12; as EMS ride-alongs, MEDEVAC flight time, and emer-
10.8%). gency department rotations.

High-frequency/low-acuity patient encounters are not
Discussion
medically emergent or even urgent in many instances.
Few reports exist that describe the long-term clinical However, with the preponderance patients in this se-
experiences of tactical medical programs in the United ries being law enforcement officers, the impact on an
States. The explanation for this is likely multifactorial. operational team can be real, as measured in terms of di-
Despite an ever-increasing number of programs nation- minished performance, capacity, or time lost from work.
wide, many are relatively new and without significant The challenge for tactical medics is that the assessment
clinical experience to report. Further, compared with and management of these low-acuity medical complaints
conventional EMS systems, the overall volume of pa- are almost universally out of the conventional scope of
tient encounters in tactical medicine remains relatively training for EMS providers. Tactical medical programs
low. Consequently, tactical medical protocols and train- therefore must devote significant educational resources
ing paradigms have often been developed with a paucity toward developing these capabilities and crafting appro-
of data and sometimes based on anecdotal evidence. priate protocols to allow supportive management. Un-
This analysis of the ATF experience represents the first conventional training venues must be sought to include
of a federal law enforcement agency tactical medical primary care clinics and urgent care centers. Medic atti-
program over a multiyear period. tudes toward training in these lower-acuity settings may
be a barrier and must be monitored closely for compli-
The historical impetus for the development of many ance and reaching educational objectives.
tactical medicine programs was the awareness of the
threat of traumatic injuries in law enforcement special
operations. In the absence of data-driven best practices Limitations
in the civilian arena, military trauma care—specifically, Our study design involved retrospective review of dei-
Tactical Combat Casualty Care (TCCC)—has served dentified field patient care reports and follow-up infor-
as an effective surrogate model. As tactical medicine mation regarding patient outcomes was not available.
5,8
programs have matured, opportunities to provide more Descriptive information was limited to the narrative
comprehensive medical support beyond the narrow documentation supplied by tactical medics in the PCRs
scope of trauma care have emerged. Evidence to justify reviewed. It is possible that some encounters were of
broadened medical training, protocols, and expanded such perceived low acuity (such as simple vital signs as-
clinical skills sets for tactical medics in these additional sessment, request for over-the-counter medications, and
directions has not previously been demonstrated. application of simple bandages) that a PCR may not
have been created. As a result, this data set may under-
This study examined 254 patient encounters by a fed- represent the total number of encounters and overrepre-
eral law enforcement agency tactical medical program sent the overall acuity of complaints. Finally, this study
over a 4-year period. Two distinct subgroups of encoun- does not establish the percentage of overall tactical in-
ters were identified: low-frequency/high-acuity (for ex- cidents or responses that were associated with medical
ample, gunshot wound, cardiac arrest, and overdose) encounters. The total number of ATF tactical operations
and high-frequency/low-acuity (such as musculoskeletal during the study period was not known to investigators.
injuries, wounds, and lacerations). Recognition of this Additionally, it cannot be discerned whether a medical
dichotomy is important as each presents a fundamen- encounter was realized due to the incidental presence of
tally different set of challenges to program development a medic or planned medical coverage for an operation.
and sustainment.

Management of low-frequency/high-acuity patient en- Conclusion
counters requires provider proficiencies in lifesaving Tactical medical programs are an important support ad-
interventions. The rapidly perishable nature of these junct for law enforcement special operations. Two subsets
skills is well-established challenge in low-volume EMS of clinical encounter types are experienced by programs
systems. Tactical medics are typically cross-trained in over time. Low-frequency/high-acuity encounters require
13
this capacity and serve in their role as medics as a col- significant resources and diverse training venues to main-
lateral responsibility to their primary law enforcement tain proficiencies in lifesaving skills. High-frequency/
duties. As such, resources including time, funding, and low-acuity encounters require expanded training and
opportunities to maintain skills proficiencies are often pro tocols beyond those in conventional EMS. Tactical
limited. Further, as the incidence of these encounters is medics most frequently encounter law enforcement offi-
by definition low, tactical medics must typically seek cers as patients, validating these programs as force pro-
extrinsic venues for comparable clinical exposure such tection initiatives.

Clinical Encounters of the ATF Tactical Medical Program 105