Page 129 - Journal of Special Operations Medicine - Summer 2015

total NEMSIS EMS activation group (Figure 2). The Five percent of tactical incident activations involved car-
mean age for patients admitted to the ED after tactical diac arrest; 7.8% of these occurred after EMS arrival.
incident EMS response was 44.1 ± 22.0 years, as com- Cardiopulmonary resuscitation was initiated in 78.8%
pared with 56.2 ± 24.1 years for total EMS activations of cardiac arrest patients. Patients were declared dead
(p < .001); 3.5% of tactical incident activation patients on scene in 133 of tactical incident activations. Figure
were aged 8 years or less. 3 shows ED dispositions in patients with documented
outcomes.
Figure 2 Age distribution in years for patients assessed
during tactical incident activations and total EMS activations. Figure 3 Reported outcomes for patients transported from
All numbers are percentages. scene to hospital as a result of tactical incident activations.
All numbers are percentages.

The primary patient symptoms observed by EMS per-
sonnel were pain (37.4%), change in responsiveness Discussion
(13.1%), and bleeding (8.1%). The most common inter-
ventions were blood glucose analysis (30.7%), pulse ox- Tactical or SWAT (Special Weapons and Tactics) teams
imetry (29.8%), extremity intravenous access (23.0%), are defined as “a designated law enforcement team,
and cardiac monitoring (21.8%). On-scene airway man- whose members are recruited, selected, trained, equipped
agement included oral airway placement (29 patients), and assigned to resolve critical incidents involving a
nasopharyngeal airway placement (17 patients), and threat to public safety which would otherwise exceed
endotracheal intubation (30 patients). In contrast with the capabilities of traditional law enforcement first re-
total activations, no tactical incident activation patient sponders and/or investigative units.” Although figures
2
was documented as receiving extremity tourniquets, are difficult to determine, both the number of tactical
hemostatic dressing, needle decompression, or TASER teams and the number of incidents resulting in team de-
barb removal. The most commonly reported medica- ployment have increased. 13,14 Despite this, little is known
tions administered during tactical events were oxygen about the nature of prehospital response to law enforce-
(20.5%), naloxone (9.0%), ondansetron (7.8%), and ment tactical incidents.
normal saline (7.3%).
In the current study, 3,953 EMS activations reported to
Mean call times for tactical incident activations and all the NEMSIS data set were coded as Activation-Tactical
EMS activations were 50.1 ± 39.5 minutes and 65.8 ± or SWAT Specialty Service/Response Team. Due to the
81.4 minutes, respectively. A total of 55.7% tactical in- limitations of the NEMSIS Public Research Database,
cident activations resulted in patient transportation by a national incidence rate could not be determined. 12,15
EMS, compared with 75.5% of total EMS activations (p However, this represents more than 10 activations per
= .004). On-scene responding units transported 97.2% day in the 41 states participating in NEMSIS.
of tactical incident activation patients to hospitals, as
compared with 95.4% of total EMS activations (p = .72). The primary objective of tactical team deployment
Transfer of care to another EMS unit occurred in 2.8% is to mitigate risk of harm to civilians, law enforce-
of tactical incident activations, as did 4.6% of total EMS ment personnel, and suspects by the use of specially
activations (p = .72). Two patients were transported by trained personnel, in accordance with the priorities of
helicopter. Sixty-seven patients were transported by law life. However, by definition, tactical incidents involve
enforcement, while 275 were treated and released. Re- a higher threat level than routine law enforcement
fusal of care occurred in 14.0% of patient encounters. operations. In a study of civilian–law enforcement
1,2

US Prehospital Care Response to Law Enforcement Tactical Incidents 119