In the summer of 2009, a blast erupted from rigged explosives inside a doorway of a local school in Lawrence County, Ohio, a mostly rural county of approximately 62,000 people—the 40th most populated county in the state. Members of the Sheriff’s department carried fellow deputies—both seriously injured and killed—from the site.
Fortunately, this incident was only part of an active shooter training scenario, orchestrated at the request of Sheriff Jeff Lawless by the Collins Career Center Law Enforcement Academy, designed to enhance awareness of possible school shootings and provide training for law enforcement, fire and EMS.
During the exercise, Lawless became concerned the wounded weren’t receiving immediate medical attention. The county’s EMS agency, at that time provided by Southeast Ohio EMS, was staged a safe distance away from the school because agency policy didn’t allow EMS personnel to enter hot zones.
Like most American communities, Lawrence County has become conscious of the domestic terrorism that’s spread in recent years, including events such as the mass shooting at Columbine High School in Littleton, Colo., the movie theater shooting attack in Aurora, Colo., the school shooting in Newtown, Conn., and the Boston Marathon bombing. Communities have taken extra measures to protect its schools and citizens, and when Southeast Ohio EMS closed its doors in late 2010 resulting in each county establishing individual EMS entities, Sheriff Lawless approached newly appointed Lawrence County EMS Executive Director Earl Fry to formulate a plan to train some of the county’s EMS personnel as tactical medics able to treat patients in hot zones and serve alongside the Sheriff’s office’ newly formed SWAT team.
In late 2011, I delivered—at Fry’s request—a presentation on tactical medicine to Fry, EMS Medical Director Kimberly Triplett, DO, and supervisor Robert Yates, NREMT-P. I was selected because of my military experience, correctional emergency response team experience and criminal justice education from Marshall University. This presentation eventually led to the establishment of the Lawrence County Tactical EMS (TEMS) team on Jan. 6, 2012, and I was appointed its captain.
To recruit tactical medics, we hosted informational meetings within Lawrence County EMS. Prospective team members were informed of the hazards of the job and the commitment needed to make the team successful, and each of the 32 staff expressing an interest in joining the team were required to complete a general application and undergo a psychological examination.
A timed agility test for all candidates was conducted by Collins Career Center Law Enforcement Academy instructor and Deputy Sheriff Charlie Hammonds. In bitter cold and windy conditions, applicants had to do sprints across rough terrain, push-ups, sit-ups, low crawls and a five-foot wall climb into a window of a house. Once in the house, candidates had to go to the second floor and drag a 200-pound dummy down the steps and outside.
After reviewing all the applicants, 12 of the 32 were selected to join the TEMS unit.
Ready & Prepared
Team members completed 40 hours of initial training from instructors Hammonds and Ashley Tordiff of the Collins Career Center Law Enforcement Academy, including courses in self-defense, legal aspects of tactical EMS, firearms recognition, advanced firearms, self-aid/buddy aid and an Ohio concealed carry permit class.
To date, the Lawrence County Tactical EMS unit is the only one of its kind in Ohio operated by a paid EMS service.
The second round of training was a 60-hour advanced tactical EMS course through Mountain State Tactical Officers Association (MSTOA) that included instruction in room clearing, evidence preservation and firearms safety. The cost for this advanced training was underwritten by Steve Wilson, MD, a trauma surgeon at Cabell Huntington Hospital in Huntington, W.V., and an instructor for MSTOA, who had become an advocate for the TEMS team. Wilson also offered to provide his services to any TEMS/SWAT team member injured during a call.
Upon completion, team members earned Tactical Combat Causalty Care (TCCC) certification through nationally accredited Marshall University. The goal of TCCC is to decrease preventable combat death at the point of wounding and certification is built around three definitive phases of casualty care:
1) Care under fire: Care rendered at the scene of the injury while both the medic and the casualty are under hostile fire.
2) Tactical field care: rendered once the casualty is no longer under hostile fire.
3) Tactical evacuation care: rendered while the casualty is evacuated to a higher echelon of care.
Training for the TEMS unit continues following certification and is ongoing. Every week the team participates in realistic simulations with the Lawrence County SWAT team. Past scenarios have included school shootings, barricaded shooters, school and tour bus hijackings, urban maneuvers, hostage situations and high-risk warrant deliveries.
Monthly TEMS-only training sessions are also held, and have included refreshers in TCCC, patient drags, care under fire and patient evacuations. The sessions have also been used to practice “hot loads”—where a patient is loaded while the helicopter’s rotors remain running—with local air ambulance service Air Evac as a time-saving measure that decreases overall scene times for a severely injured patient.
As part of their ongoing skill development, TEMS team members also help the community prepare for possible MCIs by providing education to local agencies and schools. One example is MCI first-aid training delivered to teachers, where they learn to act as first responders during a school shooting by applying pressure to a gunshot wound or using a tourniquet for an arterial bleed.
Armed for the Hot Zone
As part of their training TEMS medics learned how to secure a downed officer’s firearm—AR-15s and tactical shotguns—and use it to protect themselves, the officer and the patient. But arming the medics was a hotly debated community issue—should TEMS medics be allowed to carry their own guns?
Opinions ranged from, “Officers shouldn’t have to babysit medics with guns,” to “Are they trying to be police?” to “If they’re going to be in hot zones with SWAT, they should be armed to protect themselves and wounded victims.”
Lawrence County’s Tactical EMS team acts as SWAT’s medical support.
The Sheriff’s office decided the team could carry side arms, but protocols were required to be written to cover their use, and each tactical medic has to be firearms qualified semiannually to Ohio Peace Officer Training Academy standards.
Unit members are authorized to have firearms aboard ambulances during regular shifts, secured in a locked box. This allows tactical medics to respond in a hot zone while on duty as a field medic, although this is done only at the request of law enforcement and with law enforcement’s presence. In the absence of a law enforcement officer, TEMS members use all standard scene safety precautions.
TEMS is part of the SWAT element, acting as its medical support by being in the stack, moving into a hot zone with SWAT or following behind the stack to provide a quick response to an injured officer or victim and provide rear security. This extra protection also provides assurance for SWAT officers.
For self-protection, TEMS members are protected with body armor purchased with a Federal Department of Homeland Security Grant. Each member has level 3A and level 4 ballistic vests and helmets, and a ballistic shield is shared by the team. HealthNet Aeromedical Services of Huntington, W. Va., donated Blackhawk knee pads and QuickClot to each team member.
TEMS team members also have resources to expedite treatment/transport in the means of a dedicated Lawrence County EMS ambulance stocked with trauma equipment and have access to air ambulances.
Working with Law Enforcement
The Lawrence County TEMS team is accepted by the local law enforcement community and surrounding agencies, which give us full support of our mission and participation in calls, allowing us to be part of a team that dedicates itself to the safety and wellbeing of others.
A brotherhood has formed between the tactical medics and law officers. Our unit is expected to respond with SWAT without questions. This brotherhood has helped to improve relationships between even non-TEMS truck medics and non-SWAT police officers. Everyone knows each other’s names and has a high level of trust for each other.
Established protocols included treatments within the TCCC guidelines that weren’t practiced by Lawrence County EMS.
To date, the Lawrence County TEMS team has participated in over 13 callouts with the Lawrence County Sheriff’s SWAT team. Calls have varied from serving high-risk warrants to suicide-by-cop threats and shootings. As of yet, however, no response has required any treatment of victims.
It takes a special person to run into places most would run from and stay focused on treating and preserving life. A few of our tactical medics found it hard to transition from the conventional EMS standards of treatment to the “life before limb” mode, but they found their way quickly when frequent training with SWAT began.
The Lawrence County TEMS unit is the only one of its kind in Ohio from a paid EMS service. Thanks and recognition goes to the Lawrence County commissioners, the Sheriff’s office, prosecutor’s office, Lawrence County EMS, 9-1-1, Lawrence County Emergency Management Agency, and all the men and women who’ve come together to make this team a success.