Police work can be war — unpredictable and downright dangerous. Sometimes police lines more resemble enemy territory, with flying bullets, impenetrable standoffs and erratic players. When the stakes are high, the threat of serious injury to responders can be great. So why must law enforcement officers in high-risk situations depend so often on civilian medical care?

   Agencies who have designed their own Tactical Emergency Medical Service (TEMS) units within the last decade or so can't imagine not having these highly skilled, highly versatile men and woman onboard. SWAT paramedics not only protect officers in the hot zone, but they offer immediate aid to suspects, victims and hostages. Like military medics, TEMS units accompany teams on virtually all high-risk missions and training. When a situation heats up and SWAT is stacked, they're standing in line.

Officer in trouble

   Standard medical protocol does not allow medics near a scene until it is secured. So what becomes of those inside? Lt. David Wood, commander of the Columbus (Ohio) SWAT team, was forced to consider this one day as his team was called to perform a dynamic entry. While inside, an officer was shot in the flashlight mount of his machine gun. Not knowing the extent of injury, fellow officers promptly called for assistance.

   "Of course, when you give an officer in trouble call, all the cruisers come with their red lights and sirens on and try to help," recalls Wood. "What happened that particular day was they blocked all the streets so the medics couldn't get in. After that, we said we've got to have them closer."

   The system was re-worked and medics were now trained to come to the command post rather than stand by at the firehouse. Still, Wood decided this wasn't good enough.

   "I wanted them even closer. A lot of teams in the country were having their police officers actually trained as medics, SWAT officers, and going right in with the teams."

   The cross-training of Columbus' SWAT and paramedic units started around 1988, when medics from the fire department would standby to assist SWAT during dynamic entries, or "crack house raids." Now Columbus' tactical medics are trained above the level; they possess firearms and tactics training as well as the medical training and qualifications of the standard civilian EMS system. Of the 100 people who applied for the Columbus tactical emergency medical team, 27 are currently employed — and all are current fire department medics.