Page 76 - 2020 JSOM Winter

Medical Planning FIGURE 1 Portland Fire & Rescue RRT medic evaluates a patient
during a protest in August 2020.
The medical planning competency is familiar to anyone who
has been involved in a tactical operation. Identifying particular
hazards at a target, predesignating evacuation platforms, and
selecting appropriate destination hospitals are all fundamental
parts of a SWAT medical plan. In the civil disturbance environ-
ment, however, the focus of a medical plan must be broader.
In Portland, RRT medics established plans for potential mass
casualty incidents. While a traditional SWAT medical plan
might include selecting primary and secondary ambulance ex-
change points to hand off a wounded operator, civil distur-
bance TEMS units must evaluate dozens of such points along a
protest route. Similarly, traditional TEMS medical plans might
call for coordinating with a certain hospital in advance of a
planned operation to ensure appropriate resources are readily
available to care for a single critically wounded operator. CDU
TEMS medics must work with their tactical leadership and
medical directors to plan for dozens of wounded patients ar-
riving at multiple hospitals. Ultimately, the difference in med-
ical planning for SWAT and CDU TEMS is one of scale. Mass
gatherings, particularly civil disturbances, must be viewed as
potential mass casualty incidents. Appropriate medical plan-
ning for the myriad issues in mass casualty incidents (MCIs) is
squarely within CDU TEMS’ scope.

Remote Medical Assessment Photo by John Rudoff/Sipa USA).
The remote assessment of an ill or injured patient is another
competency that must be carefully honed by the CDU medic.
Remote assessment has obvious utility in SWAT operations
such as hostage rescue, and this skill has clear implications in
civil disturbances as well. Remotely assessing the relative grav- Source: Sipa USA/Alamy Live News
ity of a patient’s condition, and rapidly communicating the
most serious cases to tactical leaders, is a potentially life-saving that frontline police officers may be far older. Also concern-
intervention. Portland RRT medics regularly observed protes- ing is inconsistent (or possibly nonexistent) periodic health
tors suffer trip-and-fall injuries, panic attacks, and respiratory screening for law enforcement. All of these circumstances add
distress following exposure to riot control agents. More com- up to a vulnerability that the CDU medic must monitor vig-
plex injuries resulting from fights in crowds require a sharp fo- ilantly. Hydration status, pallor, level of responsiveness, and
cus on symptoms, such as posturing or excessive hemorrhage. mood can all be monitored with a quick look or question from
Given the challenge of patient access deep in a hostile crowd, the medic. If an officer is able to take a rest break during an
the decision to commit law enforcement officers to a rescue is operation, a more detailed screening, such as that described
laden with complexity. Therefore, remotely evaluating signs, in the National Fire Protection Association (NFPA) 1584
symptoms, and the kinetics of the trauma, all within the con- Standard on the Rehabilitation Process for Members During
text of a larger operational event, is an important competency Emergency Operations and Training Exercises, may be ap-
for CDU TEMS. Medics must also be aware of potential re- propriate. Such screenings, however, are time consuming and
sources to assist in remote evaluation. Law enforcement ob- therefore potentially unsuitable. Ultimately, prevention is the
servers, and even aircraft, can provide critical information to cure for CDU medics charged with monitoring the health of
a medic on the front line. Establishing communications proto- their team. Medics must incorporate weather considerations
cols for these assets, and calling on them when needed, can be into their planning, know the members of their team who are
of significant value when assessing a patient remotely. most at risk, be proficient at monitoring concerning signs and
symptoms, and communicate any concerns promptly to their
tactical leaders.
Force Health Protection and Environmental Factors
Civil disturbances are challenging for law enforcement for Legal Aspects of TEMS
many reasons, not least of which is that they often require sig-
nificant resources. In practical terms, this can mean that many Civil disturbances are fraught with legal issues, and medics
officers are putting in long hours to appropriately manage the must be aware of a broad range of issues, from constitutional
situation (Figures 1 and 2). The officers directly involved in law to issues surrounding patient abandonment. Freedom of
managing the event must wear heavy and hot personal pro- speech and assembly are directly implicated by a protesting
tective equipment (PPE) for extended periods. Fatigue is com- crowd, and a patient’s participation in such activities does not
pounded by high levels of activity, such as running or the use absolve the medic of their duty to act. The complex nature
of force, along with weather. Furthermore, police officers are of protests often compels law enforcement to adjust tactics to
demographically different from their military counterparts in avoid escalating a situation. Delaying an arrest of a person in a

74 | JSOM Volume 20, Edition 4 / Winter 2020