Armed Rescue Task Force Medics

[Lon]

Read the article. This guys concept of RTF is no where similar to what we have around here. We have 3 FD’s in my county who are RTF trained. They won’t go into a hot zone. Period. Nor would we ask them to. Warm zone, yes.

Here’s how it would work around here. Imagine a school shooting where the shooter is down or contained in one part of the school (say a classroom). Our RTF Medics would go into the other areas of the school which haven’t been officially made “safe” (which won’t happen for hours) and triage or grab and go (depends on # of injured). They’d have at least 2 LEOs with them, if not more. If they’re grabbing people to extricate them, they’re taking them to another medic unit outside and turning them over to them for transport. The RTF medics have mass casualty kits, triage stuff and body armor (hard/soft armor and helmets).

I think it’s a good concept. And a lot of area FDs have bought into it. Most of the FDs around here also do EMS and are .gov, not private.

Most of the bigger agencies in my county also have their officers trained and supplied with GSW kits so they can help as well.

[03RN]

This is an interesting topic with no simple solution imo.

I think the best way to proceed is to pick​ a couple different ways, implement them, then compare and contrast.

I think that most cops should have a fair level of trauma training, carry bandages and tqs. That covers a lot but I don't think that's enough for an actual medic on entry teams.

When kicking in doors in Fallujah we'd have Corpsman handy but not in the stack. That wasn't their job. When people are getting shot all available guns should be neutralizing the threat. That is the best way to prevent more casualties but we try not to expose our Corpsman to unnecessary fire (my nephew is named after my Corpsman, he was killed dragging another wounded Marine out of fire. Loosing a friend notwithstanding we lost our Corpsman which hurt our ability to stay in fighting shape as a company)

When treating PT's in stressful scenarios I need to focus on my PT. As a current nurse and a former Infantryman I'm not really sure I'd want to be taking care of PT's under fire without a means to return fire but that's going to leave my pt unattended. I think I might prefer to have a handgun, because I always do, but not a long gun, armor, and a team I trust to neutralize the threat while I focus on my job.

Giving cops more training would be great but they still need a medic. Giving a paramedic/ems a handgun for self defense I think is a better solution. You just need to find the medics who don't necessarily want to be cops but want the means to defend themselves and their patients. I think teaching someone to be effective and safe shooter is easier than making a medic.

[peterb]

Both of the articles referenced in the OP seem reasonable. Hot zone? Nobody goes in unarmed. Warm zone? Unarmed EMS with armed cover may be the best of your bad choices.

It does take significant time and training to make a good medic or a good tactical shooter. I would argue that it's easier to get someone to the "does more good than harm" level on the EMS side. The basics of TCCC should be in everyone's toolbox.

Unarmed EMS folks responding to the warm zone should have enough firearm training to safely operate their cover officer's weapons if needed.

Sure, in a perfect world everyone responding to an active shooter is a SWAT paramedic.....but that's not realistic. Having worked small-town volunteer fire/EMS, my experience is that you have to work with whoever shows up, and make it work the best you can.

[TGS]

It is most certainly NOT sending "unarmed future victims" into the heart of the fray with the initial assault team.

Read the article. This guys concept of RTF is no where similar to what we have around here. We have 3 FD’s in my county who are RTF trained. They won’t go into a hot zone. Period. Nor would we ask them to. Warm zone, yes.

The author clarified in the comments that his point was that a warm zone can easily turn hot.....not that they were purposing unarmed EMS to go into a hot zone vs a warm zone (as is commonly defined). Seems to me that he did a poor job of conveying such in the original article. See below:

There is no such thing as a "warm zone". A "warm" zone is a place that's just not "hot" yet. I do not believe in arming all medics, all responders, all firefighters whatsoever my friend, just as I do not support introducing all responders into an environment that may require being armed to safely do ones job. If the individuals are on a "RTF" and wearing armor they need to also be armed. That simple.

How about legal liability? Imagine an armed Paramedic opens fire on an armed suspect who is, say, fleeing the scene. From my understanding of the use of lethal force in LE, this would be potentially acceptable assuming they could operate under this authority -but what if they don't?

Not to mention legal liability if an armed paramedic opens fire and strikes a bystander, or strikes a suspect who is surrendering/no longer armed, etc. That is sort of what I was envisioning to be the biggest potential issue if we tried to arm EMS who are not also sworn LE.

Per my earlier posts, I think the only way for this to work effectively would be with deputization as some sort of reserve officer, similar to how Polk County Sheriff's Office in Florida has Sheriff's Sentinels.....reserve deputies with very narrow enforcement authority for the purpose of having armed LE responders embedded in faculty/staff at a school in case of an active shooter.

As for shooting someone who is fleeing, that has nothing to do with having LE authorities and everything to do with articulating your actions to shoot them as necessary under the UOF standards set in Graham v Connor, because you believed that the shooter was fleeing and would still pose an imminent grievous danger to the public (he's likely retreating to find a soft target, retreating to a vantage point to reengage you, etc). Doesn't matter if you're LE or civilian.

I think that most cops should have a fair level of trauma training, carry bandages and tqs. That covers a lot but I don't think that's enough for an actual medic on entry teams.

The topic is not tactical medics on entry teams.

Giving cops more training would be great but they still need a medic.

Well, not really. Again, we're talking about the medical-component of a rescue task force and not tactical teams. With the exception of impinged casualties or casualties you are otherwise unable to move, almost all of the interventions you render prior to moving them to the CCP are going to be BLS level interventions. In many places the RTF medical-component aren't going to be full-blown medics, anyway, but rather a good bit of EMT-Bs......the use of the word "medic" is sort of loose here, referring to anyone in EMS responsible for providing patient care.

[TGS]

By the way, I think it's cool that so many of your guys' locales have adopted RTF models.

They're pretty rare here in NJ, likely because of the archaic political system where every municipality is its own fiefdom and none of the chiefs work together out of fear for someone else putting their hands in their precious rice bowl. The EMS system is largely fractured and highly inefficient for the purpose of an RTF, as well.

The county that my office is in has a RTF, that's the only one I know of, personally. Maybe there's more.

[Nephrology]

As for shooting someone who is fleeing, that has nothing to do with having LE authorities and everything to do with articulating your actions to shoot them as necessary under the UOF standards set in Graham v Connor, because you believed that the shooter was fleeing and would still pose an imminent grievous danger to the public (he's likely retreating to find a soft target, retreating to a vantage point to reengage you, etc). Doesn't matter if you're LE or civilian.

Interesting. I was under the impression that Graham v. Connor did not apply if you were not sworn LE. My impression (at least per what I've learned through CCW courses and my limited understanding of my legal rights and responsibilities as an armed citizen) was that if you aren't sworn LE, shooting at a fleeing suspect is a big no-no, even if they are armed. Don't want to derail the thread too far here but that was sort of where I was hung up.

By the way, I think it's cool that so many of your guys' locales have adopted RTF models.

They're pretty rare here in NJ, likely because of the archaic political system where every municipality is its own fiefdom and none of the chiefs work together out of fear for someone else putting their hands in their precious rice bowl. The EMS system is largely fractured and highly inefficient for the purpose of an RTF, as well.

The county that my office is in has a RTF, that's the only one I know of, personally. Maybe there's more.

I'm not as familiar with Denver Paramedics' RTF role but I know in my ridealongs they all have lvl 2 vests on under uniform shirts and plate carriers w/ level III plates hanging in the back of the ambulance specifically for what was described to me as a role that sounds like RTF (I don't recall if they used that term or not). I do know it was controversial on adoption, and there was an incident soon after that prompted Denver Paramedics to scale back their commitment to this concept.

This is all 2nd hand info, so take it with a big grain of salt.

[ST911]

My lane. Good stuff above from others. Short version:

RTF is a concept, not an SOP. You build it with what you have and what makes sense for your AO.

"Tactical medic" is a pretty generic term. It's a troop with training to use medical skills where they must be balanced and prioritized with tactics, esp confrontational environments. When talking about tactical team medics, we need to use words like swat medic, team medic, unit medic, etc reflecting that assignment. I don't know what the best one is. And in solid well developed programs the roles of those folks encompass additional skills, such as med threat assessments, injury prevention and team health, special skills/expanded scope of practice, etc.

Similarly, "hot" and "warm" descriptors are a start but need more conversation. People will define them differently, they change in real time, and specific hazards inform the plan. That being said, most RTF is for the warm stuff.

Lots less involved in teaching cops to do hot/warm zone BLS, TCCC/TECC basics than EMS/FF side armed skills.

Integration of EMS/FF with security cover is viable...taught well. It's the only answer for some folks and communities.

Troop is gonna troop. Mass self-dispatching, ad hoc groups of professional and lay rescuers, disorganized good sams doing their own thing, will be the norm. Make peace with that. In some places, all you're going to have for a lengthy period is 1-3 cops, 2-5 fire/EMS, and a bunch of a good sams that need something to do.

The regulatory stuff isn't unimportant, but it will take up much more of the conversation than it deserves and it's the refuge of the handwringers.

[peterb]

Mass self-dispatching, ad hoc groups of professional and lay rescuers, disorganized good sams doing their own thing, will be the norm. Make peace with that. In some places, all you're going to have for a lengthy period is 1-3 cops, 2-5 fire/EMS, and a bunch of a good sams that need something to do.

Sounds like my neck of the woods. We have exactly one professional ambulance service within a 30-minute radius. Everything else is volunteer. Scene command has to be good at improvising.......

[AMC]

My lane. Good stuff above from others. Short version:

RTF is a concept, not an SOP. You build it with what you have and what makes sense for your AO.

"Tactical medic" is a pretty generic term. It's a troop with training to use medical skills where they must be balanced and prioritized with tactics, esp confrontational environments. When talking about tactical team medics, we need to use words like swat medic, team medic, unit medic, etc reflecting that assignment. I don't know what the best one is. And in solid well developed programs the roles of those folks encompass additional skills, such as med threat assessments, injury prevention and team health, special skills/expanded scope of practice, etc.

Similarly, "hot" and "warm" descriptors are a start but need more conversation. People will define them differently, they change in real time, and specific hazards inform the plan. That being said, most RTF is for the warm stuff.

Lots less involved in teaching cops to do hot/warm zone BLS, TCCC/TECC basics than EMS/FF side armed skills.

Integration of EMS/FF with security cover is viable...taught well. It's the only answer for some folks and communities.

Troop is gonna troop. Mass self-dispatching, ad hoc groups of professional and lay rescuers, disorganized good sams doing their own thing, will be the norm. Make peace with that. In some places, all you're going to have for a lengthy period is 1-3 cops, 2-5 fire/EMS, and a bunch of a good sams that need something to do.

The regulatory stuff isn't unimportant, but it will take up much more of the conversation than it deserves and it's the refuge of the handwringers.

All of the above. We have tried several models here over the last 25 years or so. Started after an active shooter incident in which two officers and a responding paramedic were shot. Solution was to have several selected medics go through SWAT training, but not be armed. Had very few volunteers (like 5), so the project withered. Around 2000 during our departments initial round of Active Shooter/First Responder training, we planned to include the FD guys into the final big scenario, doing EVAC and triage on site. They would not be exposed at all to SIMS gunfire, but were gonna wear Simunitions Protective gear while in the building. When the FD medics learned that, they flat out refused to participate, and that program died as well.

I tend to agree that for the need we're describing, it's easier to provide TCCC training to cops than to teach medics tactics and shooting. Many folks with contrary opinions are basing that on the military model, which is not an exact analogy. In the field, you are quite far away from definitive care, and a properly trained medic is irreplaceable. In most big cities, definitive care is minutes away, and we need to control bleeding more than anything. Of course, this equation changes in very rural or remote areas.

Lastly, in my experience, very few agencies/cities give this training the resources and time it deserves. It's almost always lip service/check the box nonsense so the political leaders can say "We did something!" when it all goes to shit.

[Rex G]

One things that pops into my mind, regarding this subject, is that so very much of LE training, at the cadet level, and in-service training of sworn officers, involves things that have zero application in an emergency/disaster situation. An ARTFM would not need this LE- and investigation-oriented training, and would need considerably less legal training, because their mission would not include investigation, interrogation, search-and-seizure, obtaining warrants, detention, running persons and property through local, state and NCIC databases, entering official original police reports, etc.

Its seems quite logical that a significant number of emergency medics be trained, and legally allowed to be armed, in order to, at the very least, protect themselves and their patients.

With the terr’s playbook having long recommended the targeting of first responders, and because fire/EMS personnel, in my region, generally arrive well before police, it seems logical to train and equip them to deal with this probability with more than just their scissors. Explosions have been followed by gun-totin’ terrs OCONUS, so it follows that we will see it happen locally, sooner or later.

I will leave the debate overwhether EMS personnel should be entering “hot” scenes/zones, to others, smarter than I am.

I did notice that the Texas Penal Code was recently changed to increase the number of places that EMS personnel, with handgun carry licenses, can be armed with handguns. I had figured this was mostly to allow volunteer EMS personnel to respond to an emergency, and handle the transport of patients, without having to disarm themselves, or leave weapons inside unattended vehicles, but now wonder if this legislative change may have been at least partially prompted by a move toward armed on-duty EMS personnel.