48-Day Manhunt Places Unprecedented Demand on Tactical EMS Operators

On Sept. 12, 31-year-old Eric Frein–a military reenactment buff and self-taught survivalist, who some say had morphed into thinking he was one of the Serbian rebels he was infatuated with–ambushed two Pennsylvania State Police (PSP) troopers at the Blooming Grove PSP Barracks in the Pocono Mountains.

Frein, armed with an AK-47 and a .308 caliber sniper rifle, shot and killed Cpl. Bryon Dickson as he was exiting the front entrance of the barracks. Trooper Alex Douglass rushed to Dickson’s aid and was severely wounded by Frein in the process.

Frein became one of the FBI’s Ten Most Wanted Fugitives and was captured 48 days later. More than one thousand members of various law enforcement agencies from at least five states spent 24 hours a day searching for him.

This isn’t the story of the search–which was conducted by courageous law enforcement officers–but rather, one of the tactical EMS (TEMS) teams that accompanied the officers and cared for them for those 48 long, stressful days.

TEMS Team Activation

The initial call from the special emergency response team (SERT) commander was brief–one PSP corporal was deceased at the scene and a second trooper was in critical condition and evacuated by medical helicopter to a trauma center. This basic information was all that was needed to activate the PSP SERT and the Pennsylvania Region 2 TEMS team to search for the shooter, who was believed to be in a wooded area near the barracks.

The activation set into motion an event that tested the resources and stamina of not only law enforcement personnel, but also the TEMS units assigned to provide care to the more than 1,000 officers involved in one of the longest sustained manhunts in United States history.

The Region 2 TEMS team is comprised of 17 members from multiple EMS agencies within the eastern Pennsylvania EMS region including paramedics, prehospital registered nurses, one physician assistant and two co-medical directors. Positions within the team include a commander, two team leaders, two assistant team leaders and operators. All team members are capable of performing all duties of any other member of the team.

The TEMS team began in 1998 with one EMS service but expanded to a regional team in 2004 in an effort to maximize limited resources and provide service to multiple area law enforcement agencies. The team currently covers five organized law enforcement tactical teams and one bomb squad.

A TEMS medic administers IV fluids to a law enforcement officer during deployment.


Communication & Deployment

The initial assigned staging area was at a local church. One team leader noted that when he walked into the church that first night, it was quiet enough to hear a pin drop despite being full of troopers and officers ready to be briefed and deployed.

The TEMS team utilizes its regional advanced medical communications center, MEDCOM, for team notification and accountability. An adjunct system, Active911, is linked to the primary dispatch center and provides team member status and mapping capabilities. Immediately upon notification of the event, the team commander sent an all page and TEMS operators were advised of the staging location.

Due to the type of event, all available TEMS units were deployed immediately and the Region 2 TEMS team members began the 1.5-hour drive to the Blooming Grove Barracks. Their area of operation was in the heavily wooded area surrounding the incident location.

For the next 24 hours, Region 2 TEMS supported the initial response in a manner it was accustomed to. After completion of the initial assignment, the members were released from their area of operation and returned to regular duties.

Within 48 hours, additional information surfaced about the suspect and his apparent intent on killing additional law enforcement personnel and a reactivation of Region 2 TEMS occurred. What would then ensue was a protracted event like nothing the team had previously experienced.

The next 45 days were spent providing care and support, adapting usual practices to varied daily missions, and sharing ideas, updates and equipment with other medical support components.

Sniper’s Advantage

Early in the manhunt, law enforcement personnel scouring the dense woods found a weapon, multiple ammunition clips, improvised explosive devices (shrapnel-packed pipe bombs booby-trapped with trip wires) and a journal the sniper left behind at one of his campsites. His journal detailed how he had scouted the Blooming Grove PSP Barracks and made it clear he was out to kill law enforcement personnel.1

The journal contents and the improvised explosive devices the suspect was known to have with him immediately intensified the stress on the searching officers and the TEMS personnel accompanying them, because they were now aware the heavy foliage and rural, wooded terrain gave Frein the advantage in seeing and shooting those searching for him.

The 24-hour/day search activities that lasted more than 1,000 consecutive hours also placed additional enormous physical and emotional stress on the personnel involved in this manhunt.

Preparing for the Long Term

After the discovery of the weapons, extended operations at the command center were established and preparation for around-the-clock health, safety and welfare issues associated with prolonged operations began.

Shelter, food, bathrooms, showers, hot and cold beverages, and easily carried meals/snacks with nutritional value were made available. Logs for team member shifts, unanticipated needs and expenses were initiated to assist with both accountability for the current event and post-incident review and planning for future incident needs.

One unanticipated need that was realized early was ensuring availability of sufficient over-the-counter medications for team needs, such as nonsteroidal anti-inflammatory drugs, acetaminophen, antidiarrheals and medications for seasonal allergies.

On a regular basis, communication and information from the command center, as well as information from operators in the field, was used to produce medical threat assessments (MTA) and needs requests. An MTA is an overall assessment of resources available, emergency plans, extrication routes and environmental concerns and threats.

Region 2’s MTA includes an injury probability scale, which accounts for overall team health, work-rest cycles, environmental conditions and terrain that may affect the overall mission. The information provides an opportunity to preplan and anticipate team needs during an event.

Two needs requests that were unique to this event were the need to establish a military-style sick call on site with daily participation from two area hospitals and the need for on-site veterinarian care for the large number of K-9 animals involved in the operation.

Communications, a key focal point at all mass casualty and major incidents, was one of the challenges faced during this protracted operation. TEMS’ radio system wasn’t compatible with that of the multitude of law enforcement teams (local, state and federal) working together on this incident.

Medic movements and requests were directed through the tactical command post and relayed to the tactical medics through TEMS command. TEMS teams had access to team physicians at all times. Medical command was obtained when necessary and physicians were updated regularly to maintain situational awareness.

The Region 2 TEMS team was assigned to provide primary medical support to the PSP SERT east team as well as extended support to the many additional assigned troopers, officers and federal agents. Throughout this ordeal, the team perspective and mission mantra was simple and clear: We were there for Trooper Alex Douglass and Cpl. Bryon Dickson.

During the first two weeks of this protracted deployment, personnel operated at full speed and the need for proper work-rest cycles became evident. Every day seemed to blend into the next. It always started with a briefing, a search area and deployment.

The schedule eventually went to a three-day on, four-day off one week and the opposite the following week with the PSP SERT west team and their TEMS medics, with whom we shared information and updates when available. When the west team was staffed as Region 2’s relief during the incident, the east team was tasked with additional coverage duties for the region and vice versa.

Tactical providers needed to account for, transition to and adapt to rapidly evolving changes such as working in an openly hostile environment with a subject who knew the terrain, was believed to be carrying a weapon(s) capable of defeating ballistic wear, and was within an expanded area of operation.

TEMS team members were challenged with simultaneously maintaining the ability to provide emergent care as well as the need to plan for and provide extended care, taking on more of a military medic posture with expanded responsibilities for unit health, safety and welfare.

TEMS providers were also tasked with mentally reevaluating treatment and extrication plans due to changing conditions, time of day, geography and environmental factors that were uncontrollable. This was all coupled with regular work and family responsibilities.

A TEMS medic provides care to a K-9 during the manhunt.


Additional TEMS Challenges

Additional challenges arose that were unique to this prolonged incident. We had environmental extremes–the operation began in relative warmth of September (with highs between 60—80 degrees F and lows between 40—50 degrees F) and ended in late fall (with highs between 40—60 degrees F and lows between 30—40 degrees F). The team planned for environmental risks ranging from heat exhaustion to wind chill and cold exposure.

Another significant challenge was the need for team members to transition from the prolonged tactical and wilderness environment to a normal routine during the shift rotations and after this assignment. During the operation, TEMS members’ sleep patterns were limited to just catnaps for days on end, there were days with minimal or no hot food, there was a lack of running water. Then a few days later at home, there was a soft bed, flushable toilets and a hot pizza delivered to the door with a phone call.

While the need for flexibility was great, the realization that we were participating in one of the largest searches in recent memory in our commonwealth was both humbling and at times overwhelming.

Our medical/rehab area became a regular place of respite. Coffee pots and hot beverages were set up for everyone to share. Even if they only had five or 10 minutes of downtime, it was a relatively safe location for officers, highly stressed from days of searching for an elusive killer, to get some rest. As described by a teammate: “The coffee was like gold and hot food was like Christmas.”

The Search

Medics were part of the searches and moved with the law enforcement teams, many times running the line from one end to the other assessing the involved officers for injuries and delivering hydration supplies and minor medical equipment to team members.

We marched shoulder to shoulder with some of the most highly trained law enforcement operators in the nation. Some days we were in open fields and other days we were in vegetation so thick you couldn’t see two feet in front of you. The terrain covered throughout the search was some of the most challenging terrain we’ve ever encountered.

Wildlife encounters made the job even harder as we encountered multiple rattlesnakes, deer, porcupines, turkeys and black bears getting ready for hibernation. One particularly close encounter occurred while a TEMS medic was walking the line, carrying a backpack full of burgers. He caught the attention of a bear, which started to follow him. One of the SERT operators quietly got his attention and when the medic turned, the officer mimed what he was observing and pointed over the medic’s shoulder. The bear was frightened away with the help of the team, but was evidence of what can occur in this environment.

Our gear and equipment required modification for this unique mission as well. In addition to the normal hemostatic agents and tourniquets, multiple 1,000 cc bags of fluid were carried to complete IV fluid replacements in the field for operators suffering from dehydration. Medications to treat anaphylactic reactions were also carried throughout each mission and our usual gear was lightened to allow for easier mobility in the rugged terrain. The team’s goal was to make sure everyone went home in one piece at the end of the day.

Medical Director Perspective

Medical direction required flexibility and trust. Team selection, education and training of the appropriate candidates all led to the development of trust in the providers’ skills and abilities. While direct medical command wasn’t a daily requirement, access to the team’s physicians was always available through the region’s MEDCOM system and cellular communication.

Daily updates were provided by the on-duty providers. The team commander and team physicians had additional regular discussions relating to operational issues and as a way to monitor needs of the team. This regular communication with the medical directors allowed them to continually judge the team’s overall well-being and assist with situational planning and preparedness.

Incidents and encounters occurring during daily missions resulted in treatment update discussions for team members. For example, all members were updated on snake envenomation as well as facility availability of CroFab (antivenin) and extrication plans.

Discussions of fluid management, electrolytes, asthma treatment and bee stings also occurred. Regular communication between the medical directors and the team commander led to the early recognition and planning for debrief through a formal critical incident stress management process upon completion of the incident.

Onsite presence of medical directors occurred on several occasions. These visits allowed a face-to-face evaluation of both law enforcement and TEMS team members. Splinters were removed, injuries were assessed and supplies were replenished.

Team missions requiring hours of hiking with heavy gear lead to multiple musculoskeletal complaints. Fortunately, one of the team’s medical directors is an osteopathic physician and was able to administer manipulative therapy to the officers and medics in the team’s medical treatment area.

Time on site allowed for a working knowledge of logistics and operations that assisted with medical decision-making. It also gave the medical directors the opportunity to be present with the team and provide their support, sometimes in unorthodox ways.

During one mission, two officers were injured when their tree stand collapsed and resulted in a 30-foot fall. The responding aeromedical service, alerted to the need to transport two patients, arrived but was only able to transport one of the injured officers. Time estimates to the availability of a second aeromedical unit were protracted.

An on-scene Blackhawk helicopter was available. Immediate contact was made with the medical director, which allowed for a joint assessment of the injury probabilities and the risks of delayed transport. The decision to do what was best for the patient was made and the Blackhawk helicopter was used to transfer the second officer.

The team commander was contacted between these communications and he immediately responded to the receiving hospital to meet the team and provide any advance information needed. Our policy is to have a TEMS provider accompany injured officers throughout their treatment and remain at the receiving facility until their family arrives. This allows a minimal response to the facilities involved and provides for a flow of information to the hospital and, in return, to the team leadership. A medical director for the team then responded to the receiving hospital as well. This afforded them the opportunity to debrief the TEMS team immediately, which proved to be of great value. It allowed all providers to address any concerns with a medical director present and then immediately return to duty.

Overall, this event showed tactical medicine at its finest: flexibility, rapid assessment and decision-making, teamwork and, ultimately, team support and brotherhood.

Final Comments

During this deployment, a saying evolved within the group of law enforcement officers and TEMS members that helped us remain focused and keep our morale high: “Today is the day.”

“The day” finally came on Oct. 30–the 48th day–when the suspect was apprehended when spotted by a U.S. Marshall’s team. As team members received word that the suspect had been taken into custody, many were overcome with emotions. We were happy it ended. We were happy everyone was going home alive. We were happy the families of the officers were finally going to get closure.

Frein was captured crossing an open field outside an abandoned airplane hangar he’d been using for shelter. He had a sniper rifle and knives in the hangar, but no shots were fired during his capture. He was shackled with the handcuffs of Cpl. Dickson and driven to the PSP Barracks in the late officer’s police vehicle.2

Our commander and medical directors decided that, because of the unprecedented length of the manhunt, a debriefing should occur following the culmination of the incident. This allowed team members to reflect on their experiences and address any concerns so they could smoothly transition back to a more traditional TEMS role. Team members participated in a group setting with members of the Eastern Pennsylvania EMS Council’s critical incident stress management team.

The Region 2 TEMS team is a highly trained, motivated and resourceful collection of providers. Each member brings a skill set that works to complement and enhance the functionality of the team.

It was the ability to adapt to any situation presented and still be prepared to render the highest level of care that was the team’s mission standard. The situations that presented challenges requiring adaptation and modification of usual practices will provide the basis for improvement of the team’s operations.  


1. Connor T. (Oct. 8, 2014.) Cop-killer Frein left behind diary of ambush. NBC News. Retrieved March 18, 2015, from www.nbcnews.com/news/us-news/cop-killer-suspect-eric-frein-left-behind-diary-ambush-n221436.

2. Katersky A, Date J, Thomas P. (Oct. 30, 2014.) FBI most-wanted fugitive Eric Frein captured alive. ABC News. Retrieved March 18, 2015, from http://abcnews.go.com/US/fbi-wanted-fugitive-eric-frein-captured-alive/story?id=26587018.


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