Medical planning considerations for tactical operations
In addition to ensuring officers receive proper tactical medical training, a well-written medical plan is vital for appropriate response to potential casualties
Tactical operations carry inherent risks, posing potential dangers to both officers and civilians. Therefore, a well-coordinated medical response is crucial. Quick and efficient medical intervention can mean the difference between life and death, or minimal injury and long-term disability, making it a vital component of any successful tactical operation.
While we cannot anticipate every scenario, most tactical operations should have an operational plan (OPLAN) in place. A critical component of that plan is the inclusion of a medical section. Once an injury occurs, the window for formulating a plan or considering our response is closed. The clock starts ticking, with lives hanging in the balance, calculated in mere minutes. Pre-emptive planning can significantly reduce the necessary response time.
All plans, including medical ones, must be documented in writing. This ensures clarity, provides a reference point for all team members and prevents confusion. If an operation derails and results in injuries to officers or civilians, the operations plan is the primary document scrutinized during the subsequent investigation. Absence of a medical plan or a poorly constructed generic plan could potentially heighten the liability for both the agency and the operations commander.
Here are some points to consider when drafting a medical section for inclusion in an OPLAN:
Individual medical equipment
The layout of the OPLAN can dictate whether this information is included in a medical section or another relevant section. Regardless of its location within the document, it’s essential to outline what gear each officer should carry as part of their operational kit. The requirements may differ according to each officer’s specific mission and role. For instance, an undercover or plain-clothes officer’s gear will be significantly less comprehensive than that of a fully equipped tactical officer. However, at the very least, each officer should carry a tourniquet, and all officers must be aware of its position on their uniform.
Actions on a wounded officer
Planning for a potential officer-down scenario must be done prior to any operation. However, a one-size-fits-all plan is not feasible for every mission. The nature of individual missions will determine the appropriate response should an officer get wounded. Each OPLAN must undergo a thorough review to establish the overall priorities.
During a hostage rescue or active shooter response where innocent lives are at risk, the highest priority is the execution of the mission. If a casualty occurs during such an operation, the remaining officers must press on, prioritizing the mission over casualty care. This necessitates officers being skilled in administering self-aid.
Contrast this with scenarios like executing an arrest warrant or search warrant where an officer is injured. Here, the priority shifts to recovery and aid for the downed officer. We can establish and hold a perimeter, as there is no immediate threat to innocent lives. The nature of the mission should dictate whether the focus is on aiding the downed officer or completing the mission.
Identify operations medic
Designating a team member to serve as the medic for the operation is essential. Many teams are fortunate to have actual paramedics or other licensed medical professionals who can fulfill this role. However, even if your team lacks a licensed medical practitioner, it’s crucial to assign someone as the operations medic. This reduces confusion in the event of an injury, as that officer is charged with primary care responsibilities, while others assist. Moreover, the designated medic is tasked with overseeing the medical planning for the operation. This ensures that planning is tailored to each mission and not neglected.
The responsibilities of the operations medic encompass the following tasks.
Pre-coordinate with EMS: During the planning phase, reach out to local fire/EMS to ascertain what level of support they can provide, if any. This step can considerably expedite the transfer of a casualty to a higher level of care. The following considerations should be addressed:
- Staged: If feasible, request EMS to assign an ambulance to your operation, positioning it at your staging point or directly on the scene during the operation. Having an ambulance already on-site is the optimal arrangement.
- Standby: If EMS staffing constraints or policies preclude an ambulance from being stationed on the scene, an alternative is to request standby ambulance support for your operation. Since the ambulance is likely stationed at a fire department rather than on the scene, its arrival at the actual location may be delayed. This scenario is referred to as a hybrid transport, where an initial casualty might be loaded into a police vehicle and then transferred to an ambulance at a predetermined location.
CASEVAC: If EMS indicates they cannot provide support or lack the necessary staffing during the required timeframe, then the primary transport option will be to use a police vehicle to transport any casualties. Some agencies may have policies prohibiting this due to perceived liability. However, studies have shown that patient outcomes are statistically similar whether transport is provided by police or EMS. The crucial factor is the speed at which the casualty reaches the required level of care, not the mode of transport. That said, it doesn’t mean we should default to moving every injured officer in a squad car. Various factors need to be considered. They include the following:
The extent of injuries and treatments provided: The timing of initiating transport is crucial. If we hastily carry an officer who has been shot and place them into the back of a squad car, it’s likely they could succumb to their injuries during transport. Life-threatening injuries that could prove fatal during transport must be addressed. Administering medical interventions in the back of a police vehicle is nearly impossible, so any necessary treatment should be provided before initiation of transport. Specifically, it’s essential to control any arterial bleeding from the extremities, either through a tourniquet or wound packing, seal any sucking chest wounds to prevent tension pneumothorax and ensure the casualty has an open airway.
Proximity of EMS: If EMS is nearing the scene or would reach our location considerably before we could arrive at a hospital, it is preferable to wait for EMS. They can begin care on the scene in ways we cannot and continue to provide care en route to the hospital.
Time to necessary level of care: We need to evaluate the level of care the casualty requires and who can best provide it. For instance, a paramedic can promptly address airway injuries through methods like intubation or decompression. If a paramedic can reach us faster than we can get to a hospital, even though it might take them longer overall to transport the casualty to the ER, they have the skills to extend the patient’s life during that period, which we lack.
Stress/emotional level of the driver: An often overlooked factor is the emotional state of a police officer tasked with transporting wounded colleagues compared to that of EMS personnel. We have a personal connection to the patient, and our adrenaline levels are likely significantly higher. We might have been involved in a shooting or witnessed a fellow officer get wounded. This emotional investment significantly increases the risk of reckless driving and potential accidents. Our aim is to swiftly transfer the patient to a higher level of care without causing additional harm. If officers are required to conduct the transport, it’s recommended that officers present at the scene avoid doing so, if possible. Instead, it’s preferable to entrust this task to the first backup officer to arrive.
- Time to hospital vs. time of EMS: The most significant factor in deciding whether it’s appropriate to transport a wounded officer ourselves is the overall transport time. If EMS is significantly delayed or if we can complete the transport before EMS even arrives on the scene, conducting a police transport becomes a sensible choice. During the planning phase, the operation medic can help estimate the EMS transport window, aiding our decision-making process during the crisis.
Determine the closest care facility: During the operations planning phase, the medic is responsible for locating and identifying the closest medical facility. If this has not yet been determined, the medic should contact the facility to ascertain its level of care. It’s important to note that while some facilities may be listed as emergency rooms, they might not have trauma capabilities.
Determine the closest trauma center: As mentioned earlier, many hospitals have limited trauma capabilities. If the nearest care facility is not a trauma center, the medic must identify the location of the closest trauma center. It’s unproductive to transport a casualty to a facility that cannot adequately handle the injuries. However, if the trauma center is significantly far from the operation area, we might need to transport the patient to a lower-level facility for immediate care and then arrange for a safe transfer to the trauma center.
Identify a casualty evacuation (CASEVAC) vehicle: Whether police transport is our primary method or not, every mission should designate a CASEVAC vehicle. Circumstances might necessitate officer transport such as multiple casualties, or an ambulance not arriving as planned. The chosen vehicle should be prepared for transport, meaning any extra equipment should be removed and a patient area cleared. Medical supplies should be readily accessible. An external GPS should already be configured with the designated care facility and set for the trip. The CASEVAC driver should be identified as part of the operations plan. It is recommended to assign a member of the perimeter team to drive rather than a member from the entry team.
Airlift option: The medic should evaluate the feasibility and availability of an airlift. This assessment will likely involve several phone calls during the planning phase. Questions to consider include: Does the operational area have air medical capability, and if so, is it reserved for scheduled transports during mission times? What are the capabilities of the helicopter and its crew? What is their estimated flight time? What size of landing zone does the helicopter require? Are there any pre-determined landing zones in the area to which police could transport for a hybrid solution? These are all essential considerations when planning an operation.
The medical section of the OPLAN should be succinct, allowing the officers’ training to guide appropriate care interventions. It need only cover actions specific to a downed officer for that particular mission, the designated medic, chosen transport method and the selected transport location. Our Standard Operating Procedures (SOPs) or policies should already encompass our actions in scenarios involving wounded civilians or suspects. It is of paramount importance that we avoid including any statements in the written OPLAN that prioritize an officer’s care over a suspect’s or any other civilian’s. Besides ensuring that all officers involved in tactical operations have undergone the necessary tactical medical training, the written medical plan is a crucial factor in determining whether we will respond appropriately should casualties arise. Thorough planning and preparation can mitigate poor performance and potentially save lives.