Abstract

There is a growing need to ensure that there are minimal losses of lives within the Law Enforcement without compromising efficiency and efficacy of teams in question. As such, necessary measures have to be taken to keep combatants safe and in good health during their mission. The aim of this research is to examine relevance and significance of tactical emergency medics on US Law Enforcement SWAT teams in counterterrorism, high threat, and hostage rescue operations.

It is widely expected in this research that tactical emergency medics are often highly trained to operate even in the most dangerous and difficult contexts. This discourse is important because it will prove or disapprove efficacy of tactical emergence medics in rescuing operatives in life-threatening situations.

Introduction

It is expected that there would be casualties in any situation where there are combatants engaged in counterterrorism, high threat, and hostage rescue operations, especially with the possibility of gunfire and the use of explosives among other forms of violence used in the confrontation. Various units during national security and defense operations always report high numbers of injuries and fatalities that indicate volatility of the operations and the nature of danger that combatants face. It is thus normal that one would expect teams on the ground to have medics that can cater to their wounds and at least attempt to save lives of those who have been badly injured.

While it can be noted that each combat unit has a medical team on their base, combatants often go out alone without any emergency medics to back them up when they need extra attention. A scenario such as this confirms that the SWAT personnel is sometimes forced to return to their base if they are in dire need of medical help. Most of them never make it back due to the extent of their injuries. Americas Public Broadcasting Service estimates that over the last two centuries the US has lost over 1.5 million lives in battle with another 3 million being wounded (Crigger & Santhanam, 2015).

As such, wars that America has to wedge are almost always likely to claim lives and inflict injuries on many of deployed combatants. Some of the most recent figures from the Operation Inherent Resolve show that there have been 11 deaths and about 25 casualties so far (Wood & Hall, 2016). While most people would argue that one is more likely to die from other things rather than in combat, it must be appreciated that lives are actually lost in these wars. This means that there is cause for worry when it comes to emergency situations faced while fighting under counterterrorism, high threat, and hostage rescue operations.

This research will be looking at how to reduce these deaths by having tactical emergency medics in the field with combatants. A medic is trained to ensure that life of a casualty is saved by employing the best available means to preserve the individual until they can get further medical care. Therefore, even with limited resources that can be availed while being in combat medics would be able to prevent a gunshot wound from becoming fatal or even metal pieces from an explosion from causing further damage to the casualtys body (Hershkovich, Gilad, Zimlichman, & Kreiss, 2016).

All these situations are however left to chance as combatants are deployed on their own without the medics expertise. This means that even casualties who may have had a chance to make it out of a life-threatening situation have a smaller possibility of surviving since they have no trained help in their delicate contexts.

The research will attempt to prove that having tactical emergency medics on the US Law Enforcement SWAT teams will make working conditions relatively safer for these law enforcement personnel. It can be appreciated that while the conditions are unavoidably dangerous, having tactical emergency medics means that any life that could be saved will be actually saved. This may not completely eliminate the loss of lives in the battlefield, but it will certainly reduce the rate at which casualties in these operations succumb to their injuries.

Most people who lose their lives while on an operation could be saved if blood loss is stopped on time or if they get first aid as soon as they are hurt in order to relieve their pain. Medics will ensure fast and effective treatment of the said casualties so that they do not get worse or give up before getting access to a comprehensive medical care once out of the warzone.

The findings of this study are meant to inform policy when it comes to the deployment of SWAT teams. A streamlined team may be considered as more effective in terms of the cost and other operational logistics, but having emergency medics will ensure that more operatives get out alive even if they are badly wounded. In such a situation, it must be considered that saving lives of law enforcement operatives is as pivotal as being able to effectively manage costs of operations.

Literature Review

Aberle, Lohse, and Sztajnkrycer (2015) in the article A Descriptive Analysis of US Prehospital Care Response to Law Enforcement Tactical Incidents assess effectiveness of emergency medical service (EMS) within high risk operations. Aberle et al. (2015) have delved into the national EMS database to analyze statistics that provide a clear picture of what EMS does in terms of saving lives. In the findings, it becomes clear that emergency medical services are critical in a variety of contexts, including saving lives and preventing cardiac arrests.

Among other things, one can argue from the findings of this article that emergency medical services are effective not just in conventional situations such as medical emergencies involving a heart attack. Medics are highly trained to save lives even in the most complex situations provided they are alerted in good time. Their training generally enables them to react effectively to the situation at hand, thus preventing complications and deaths that could be averted. As such, it can be expected that tactical medics would be the most effective solution against the loss of lives on the US Law enforcement missions involving volatile contexts and SWAT teams.

Tactical emergency medics are better than conventional EMS teams because they are further trained for volatile contexts that would need more complex medical responses with the ability to survive a warzone environment. The fact that emergency medical responders are able to save many lives in their day-to-day operations should indicate a projected success for tactical emergency medics as well.

According to the chapter titled Terrorism and Urban Traumain Trauma Team Dynamics by Allen, Glenn, Mulhern, and Kaplan (2016), terror attacks often result in trauma for victims and the first responders in some cases. While it is understandable that the US law enforcement may fall short despite having done everything that they can do to prevent terror attacks, it must be considered that attacks still happen from time to time and an effective response protocol must be devised. In this case, it is important to understand the value of medics in trauma situations that come after attacks.

Allen et al. (2016) have established that the US is committed to remaining proactive when it comes to counterterrorism, but this does not imply that the country should not work on effective responses. Once the government is unable to prevent a terror attack, it is their responsibility to ensure that the situation is managed as effectively as possible. One way to do so is to limit the number of deaths by availing tactical emergency medical care on site.

A victim of an explosion may not be in the position to be moved to a health facility without further deterioration of their status, especially considering the possibility of bleeding out. With medics in place at the site, it gets easier to contain the bleeding so that the casualty can be transported safely. It is situations like these that make one appreciate value of a medic at the site of the incident in question. Immediate medical response limits the risk of death on site since there is a prompt recourse for saving lives.

Furthermore, Andersen, Papazoglou, and Collins (2016) argue that SWAT teams need medics within their teams owing to the strenuous nature of their work in field. In Reducing Robust Health-relevant Cardiovascular Stress Responses among Active-duty Special Forces Police, the authors present the idea that SWAT teams are likely to benefit more from having tactical emergency medics not just due to direct combat risks, but also due to pressure that they consistently face while on duty. A SWAT team member is usually in good physical health based on intensity of their training, but they also deal with a lot of stress in high risk environments within which they work.

Having a trained tactical emergency medic on the team ensures that team members are treated as soon as possible when it comes to cardiovascular complications related to their stress levels in the field. An emergency medic would identify signs of an impending heart attack early enough to ensure that a SWAT team member does not collapse in the face of enemy fire. Besides, the medic will be able to preserve the team members life until they are out of the warzone and able to get conventional medical attention in a health care facility.

Without the medic, it could be too late for the operative and this sudden loss in the field could also compromise efficacy of the team in that specific operation. Basically, the article presents the role of the tactical emergency medic in maintaining health of the SWAT team operatives, citing that the medic is not only important to casualties, but also to the otherwise healthy operatives who could develop unforeseen problems, especially with their hearts.

Besides, Blaivas, Sargsyan, and Karakitsos (2016) have elucidated the importance of tactical medics in austere contexts with a keen focus on the context of a hostage rescue mission. According to the findings of Blaivas et al. (2016), many things happen in a hostage rescue mission, from a gun fight with perpetrators to having hostages who are injured in one way or another. This means that when going on a hostage rescue mission, it is prudent for SWAT teams to anticipate casualties and other health-related challenges such as mental trauma amongst hostages.

Generally, the role of a tactical emergency medic in a hostage rescue mission involves helping out anyone who needs to be helped. They could be casualties with physical ailments or even individuals psychologically affected by the context of the hostage situation. A conventional SWAT team is only trained to eliminate the threat and save hostages, but they would not be able to preserve lives of those injured physically or psychologically in the process. This is where tactical emergency medics come in. It is very important to have the medical personnel on site because sometimes hostages may get hurt as the ones holding them hostage get desperate in their struggle against the SWAT teams.

Desperate hostage takers are known to hurt their hostages out of exasperation and this means that hostages are at risk physically or emotionally. Tactical emergency medics would work to ensure that any physical or emotional damages of hostages are not fatal and this is something that a SWAT operative may not be able to accomplish.

However, according to Bozeman, Morel, Black, and Winslow (2012), tactical emergency medics are as important to SWAT teams as emergency response teams are to the civilian population. Bozeman et al. (2012) found that there are over 56 law enforcement agencies that have already been using tactical emergency medics on their teams as a way of ensuring that their operations are effective, especially when it comes to life-saving missions. Eppright (1998) corroborates this scenario by stating that when undertaking a mission that involves confrontation with weapons, it is prudent to expect casualties. It is also important to understand that regardless of the side of the fight that the casualty is on, life must be preserved to the best of ones ability.

This means that having medics on site makes the mission more effective even if lives that will be saved are those of criminals. Justice requires a due process and in most cases medics ensure that even when law enforcement operatives end up shooting or hurting an offender, justice is served in the end. Tactical emergency medics in this case ensure that no lives are lost unnecessarily on a law enforcement mission. With their high level skills on saving lives, TEMS are able to ensure that SWAT teams do not end up labeled as kill-squads by reducing the number of perpetrators who die in the hands of the law enforcement. Extra judicial killings remain illegal in the US and having medics on a mission could help ensure that offenders are safely arrested and convicted.

Similarly, Johnson, Carlson, Murphy, Flory, Lankford, and Wyllie (2016) have examined the role of a tactical emergency medic in an active shooting case in their analysis. They have established that so far there have several incidences of active shooter situations in the recent past with SWAT teams being the most effective way to save the situation. In these situations, it can be noted that there is often a lot of panic and most civilians are injured by a shooter or in a stampede as they attempt to scamper to safety. Injuries in this case could also be either psychological or physical. SWAT teams may be able to stop an active shooter, but they cannot attend to those with gun wounds, broken limbs, and damaged minds.

Conventional emergency responders could come in after the shooter has been deactivated in order to transport the injured and the dead to the health care facilities and morgues as needed. However, this is often considerably late as active shooters take hours on site. A more effective approach is thus the use of tactical emergency medics who are able to navigate the scene of an active shooting and rescue casualties even as the shooter continues to be a threat.

The TEMS in this case are highly effective in saving lives in an ongoing high risk situation, thus having the capacity to save more lives. They are able to extract victims before they bleed out or die of terror. In more ways than one, this ability of going the extra mile is what makes the TEMS highly effective in volatile situations.

In turn, Kaplan, Glenn, Maung, and Mulhern (2014) investigate the significance of a surgeon in a tactical team. In each mission that involves the possibility of casualties, there is often a follow-up rescue operation by conventional ambulances and emergency responders. The government thus ends up incurring extra expenses in providing medical care and mostly first aid to the casualties on the ground. If the law enforcement team has its own medical personnel, however, the authors argue that there would be no need for extra expenses incurred when ambulances are called in.

Having a trained surgeon in the tactical team in this case is seen to ensure that the casualties are effectively attended to on site and, thus, they only have to be transported to a health care facility. Without the trained surgeon, emergency paramedics would have to be called in and they are an extra expense that could be avoided easily. In this case, one gets to appreciate that having the right personnel on a SWAT team is not a burden, but rather a cost-cutting measure that does not compromise efficacy of the team.

The TEMs in the SWAT team would thus make the team more cost-effective than expensive. Professional medics may also come at a high cost in terms of getting them on the team, but in the long term they save the government more money than they cost them. A self-sufficient team is herein argued to be more reasonable not just in terms of the cost, but also in terms of operational efficacy. The first responders may not be able to work on casualties until the threat is eliminated, while the surgeon is inside the warzone and can thus attend to the casualties immediately.

Levy and Tang (2014) have studied the role of medical support in law enforcement-extended operation incidents. The article mainly reviews the clinical support of Maryland State Police with a focus on operation incidents that are reported to have lasted for 8 hours and more. The findings indicate that in such operations people involved often suffer from a myriad of challenges and ailments, including dehydration, musculoskeletal injury, wounds, headaches, or other cold-related injuries. This means that in order for such a mission to succeed, there must be a stand-by medical team that is ready and willing to attend to those in need.

The rescue team comprises of human beings with weaknesses and limitations that inhibit their efficacy in extended operations. In a hostage situation, for example, operatives may not have the luxury of changing shifts or taking a lunch break. This means that they would be active for as long as the operation takes. Medics should be available to ensure that they provide all the medical support needed by rescue operatives and any hostages that they can access during the rescue mission.

In such a situation, it can be argued that a larger and riskier task lies with the medics whose main role is to keep rescue team members alive and fully functional to the end of the operation. Medics will then be able to attend to hostages as soon as they are rescued. Without these medics on site, it is highly likely that SWAT teams would be overpowered after such a long wait and drastic conditions that not only weaken their bodies, but also their minds and spirits.

Pennardt, Kamin, Llewellyn, Shapiro, Carmona, and Schwartz (2016) discuss the history of TEMs and how they have benefited SWAT teams over the years. The authors find that over the years TEMs have served as a critical part of many domestic high risk operations that involved hostages and other mass casualty situations across the nation. TEMs in this case are considered as the most effective out-of-hospital medical care service that the government could provide. Ideally, first response teams should be able to transport casualties to health care facilities in record time, thus limiting the loss of lives in such high risk contexts.

However, if one is to appreciate the reality, it will be noted that some casualties have no chance of survival if they are moved without comprehensive measures to stop bleeding or further injuries in transit. This means that having a medical service on site is a better and only effective option when seeking to save such a casualty. The TEMs have been used several times in such situations with impressive results as indicated by the authors. Prehospital care in this case takes the credit for a majority of lives that have been saved in the field in active hostile situations. The ability of medics to treat casualties and alleviate any life-threatening situations before they can be transported to a health care facility ensures that more lives are saved and not lost.

This article mainly enables one to appreciate that prehospital care cannot be left to emergency responders whose main role is to ensure that the casualty gets to a health care facility. Saving lives in a volatile context is best left to the TEMs and, looking at history, it is clear that they continue to deliver.

Arnatt and Beyerlein (2014) provide an insight into the work environment of the SWAT team. According to their findings, SWAT teams are dependent on a number of factors if they are to be effective in their mandate. These factors include effective team management, resource allocation, and immediate response. Other than these, the article also mentions emergency medical response as one of the greatest influencers on the teams performance. Without effective medical response when needed, the team is unable to conduct its operations as needed.

SWAT team members are often checked and trained for fitness, but they need medical services while in the field. Ensuring that they are in top performance at all times often involves having a tactical emergency medic with the team at all times. The article generally appreciates the importance of a tactical emergency medic on the SWAT team with relevance to the basic performance of the team without considering a hostage context. This means that even though medics may not be as well trained in combat as SWAT team members, they also play a critical role in the success of any SWAT mission.

In their investigation, Vainionpaa et al. (2012) have analyzed the role of tactical emergency medicine support by analyzing up to one hundred and twenty tactical situations. The findings indicate that the TEMs not as inconveniencing as they may be presumed to be within a complex operation. The authors in this article argue that the TEMs are not only feasible but also the most efficient and rapid alternative in different tactical situations.

The TEMs are able to classify and attend to casualties as needed not only efficiently, but also promptly and effectively without necessarily incurring unnecessary costs. The TEMs in this case are highly trained and thus effective in difficult situations that would be challenging to conventional paramedics. High quality and intensity of their training enables them to navigate difficult situations effectively while accomplishing their mission of saving lives.

Young, Sena, and Galante (2014) have also looked into the role of physicians in tactical emergency medical support with a focus on the first 20 years. In the article, the TEMs are stated to provide prompt medical care while also effectively preventing injury on location. The TEMs are particularly appreciated in hostage operations due to their ability to save lives of any casualties, which is something that SWAT operatives are originally not trained to do. Physicians in a tactical team ensure that any lives that can be saved are saved mainly because they have a wider scope of knowledge on how to treat and heal the human body.

Physicians in this case are seen to compliment the work of SWAT team members, especially in situations where casualties are a solid likelihood. Hostage rescue missions rarely miss casualties whether these are hostages, rescue operatives, or even perpetrators. In such a situation, SWAT team members are likely to focus on eliminating the threat by killing or securing hostage takers depending on the situation and freeing hostages. The question of how hostages actually make it out of the situation rests with medics on the ground and this is where a physician becomes more important in the rescue mission.

Hypothesis

The working hypothesis for the study is that having tactical emergency medics on US Law Enforcement SWAT teams will reduce the loss of lives in the field for operatives in counterterrorism, high threat, and hostage rescue missions. Research questions that will guide the study include:

  1. How effective are emergency medical services in a high risk context as related to US law enforcement SWAT teams?
  2. What are the costs of tactical emergency medics on a SWAT team?
  3. What are the benefits of tactical emergency medics on a SWAT team?

Definitions

The main terms used in the research will include law enforcement operatives, tactical emergency medics, and a SWAT team. A law enforcement operative in this case will be used to refer to a government operative who could be in any homeland or national security unit deployed on a counterterrorism, high threat, or hostage rescue mission. This includes members of various military units in the US, but excludes private contractors who are responsible for their own operations even when they are conducted on behalf of the government and citizens of the United States.

Tactical emergency medics (TEMs) as implied in this research will be used refer to fully trained and qualified medical personnel with the knowledge and expertise to work effectively within a high risk context. A tactical emergency medic in this case is not the same as the first responders who work with the fire department or emergency report units in conventional situations. They must be highly trained personnel who fully understand the premise of their operations and risks that they face while in the field.

A SWAT team as used in the research will simply refer to teams that are sent on high risk missions during which they risk losing their lives to enemy fire. These teams are usually highly trained and effective in their missions although they also face significantly higher levels of risk based on volatility of situations within which they operate.

Research Design

This study is focused on proposing a working solution for an existing problem. A number of lives lost in combat under counterterrorism, high threat, and hostage rescue missions is too high and something can be done to remedy the situation. The researcher will be working to justify the use of tactical emergency medics on a SWAT team with the consideration of both pros and cons of such an endeavor, as well as how well these tactical emergency medics can adapt to high risk contexts of the missions in question. The research is thus more about understanding contexts and capabilities in order to support a working hypothesis (Creswell, 2013).

The researcher will employ a qualitative approach towards all the three research questions. The approach will rely mainly on content analysis as a method of data collection, implying a heavy reliance on secondary data, especially from the ProQuest database. Content analysis is in this case a digital method of collecting data, which relies on online access to databases that have peer-reviewed articles and journals. The researcher simply has to define their objectives and identify right keywords with which to conduct numerous and extensive searches (Matthews & Kostelis, 2011).

The obtained hits are then checked for relevance to the research with the relevant ones being used to obtain information. The information is then coded and analyzed to obtain the desired answers. Considering the scope of a digital search, there may be a need for stricter search parameters to ensure that one only gets hits that are relevant and informative enough for their research questions (Matthews & Kostelis, 2011). The researcher will also need to conduct an interview in order to understand what a medic would cost a SWAT team and how a SWAT team could benefit from having a medic.

The first step is to understand how effective emergency medical services can be in a high risk context as related to US law enforcement SWAT teams. The researcher will in this case conduct a content analysis aimed at establishing contexts of SWAT teams as related to their work in the field. The idea is to vividly explain the warzone within which SWAT teams operate so as to have a clear picture of what medics would be dealing with. The researcher then has to look into medical services that can be offered within the established contexts and how these services would benefit operatives and their mission. Ideally, medical services that can be offered should be relevant to needs of SWAT operatives while in combat.

The second step in the study is to look at what a tactical emergency medic may cost a SWAT team. One of the stronger arguments against having non-SWAT team members on the mission is the cost to the team in terms of risks and operational efficiency. SWAT teams are highly trained in terms of how they operate and it is likely that having an outsider on a mission could compromise their efficacy.

This part of the research will look into the details of how SWAT teams work and how a medic could compromise this. This will require input of a SWAT team member, whether serving or retired. The main consideration to be made here includes the fact that these teams are highly secretive and for the most part members would be unwilling and unauthorized to reveal details of their operational tactics. The researcher will thus only ask generic questions that seek out no classified details on SWAT operations.

In order to understand benefits of tactical emergency medics on a SWAT team, the researcher will also have to interview a tactical emergency medic. The interview in this case will mainly focus on what the medic can do in a high risk situation. The idea of this interview is to dispel fears of the SWAT team in relation to the cost of having a tactical emergency medic on a mission, while stating how the team will benefit from having their own medical unit in the field. The interview will also examine some volatile situations that can be resolved and the danger averted simply because the tactical emergency medic is present in the team.

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