Page 127 - Journal of Special Operations Medicine - Summer 2015

An Ongoing Series

A Descriptive Analysis of US Prehospital Care
Response to Law Enforcement Tactical Incidents

Sara J. Aberle, MD; Christine M. Lohse, MS; Matthew D. Sztajnkrycer, MD, PhD

ABSTRACT

Background: Law enforcement tactical incidents in- of cases. Better understanding of the nature and loca-
volve high-risk operations that exceed the capabili- tion of EMS responses to tactical incidents is required
ties of regular, uniformed police. Despite the existence to develop consistent EMS policies in support of law
of tactical teams for 50 years, little is known about enforcement tactical operations.
the frequency or nature of emergency medical services
(EMS) response to tactical events in the United States. Keywords: TEMS; emergency medical services; tactical;
The purpose of this study was to perform a descriptive SWAT
analysis of tactical events reported to a national EMS
database. Methods: Descriptive analysis of the 2012 Na-
tional Emergency Medical Services Information System Introduction
(NEMSIS) Public Release research data set, containing
EMS emergency response data from 41 states. Results: Law enforcement tactical incidents involve high-risk
A total of 17,479,328 EMS events were reported, of operations that exceed the capabilities of regular uni-
which 3,953 events were coded as “Activation-Tactical formed police. The explicit purpose of specialized
1,2
or SWAT Specialty Service/Response Team.” The most tactical units is to resolve critical incidents through a
common level of prehospital care present on scene was systematic approach emphasizing the priorities of life.
2
basic life support (55.2%). The majority (72.3%) of Despite this, the high-risk nature of police tactical oper-
tactical incident activations involved a single patient; ations results in significant potential for injuries among
mass casualty incidents occurred in 0.5% of events. law enforcement personnel, suspects, and bystanders.
3
The most common EMS response locations were homes An analysis of 120 events in Helsinki, Finland, revealed
(48.4%), streets or highways (37.0%), and public build- patient care was required in 28 events, with individuals
ings (6.3%). The mean age of treated patients was 44.1 declared dead on scene in an additional four cases. 4
years ± 22.0 years; 3.5% of tactical incident activation
patients were aged 8 years or less. Injuries were coded Although modern law enforcement tactical units have
as firearm assault in 14.8% and as chemical exposure existed for more than 50 years, little is known about
in 8.9% of events. Cardiac arrest occurred in 5.1% of the frequency or nature of emergency medical services
patients, with the majority (92.2%) occurring prior to (EMS) response to US law enforcement tactical events.
EMS arrival. The primary symptoms reported by EMS The few publications on this topic have primarily in-
personnel were pain (37.4%), change in responsiveness volved reviews, provider surveys, and case reports. 5–10
(13.1%), and bleeding (8.1%). Advanced airway proce- This lack of information results in a knowledge gap
dures occurred in 30 patients. No patients were docu- when planning and training for appropriate prehospital
mented as receiving tourniquets or needle thoracostomy. responses to law enforcement tactical events.
Conclusion: Approximately 11 EMS responses in sup-
port of law enforcement tactical operations occur daily Recent efforts by EMS agencies have focused upon com-
in the United States. The majority occur in homes and puterized data collection and standardization of data
involve a single patient. Advanced airway procedures elements within these reports. The National EMS In-
are required in a minority of patients. Cardiac arrest is formation System (NEMSIS) has been at the forefront
rare and occurs prior to EMS response in the majority of national collection of standardized EMS data. The
11

117