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TEMS: Can You Afford Not to Have Them?

Written by Kelly Sharp

When they first came into existence, SWAT teams were fairly simple and straightforward.

A group of officers, provided with specialized training and tools, worked together on high-risk incidents. Then specialization began for even the specialized. Bomb squads were added, followed by hostage rescue teams, negotiators and even marine units. Now the tactical medic (TEMS) is up for consideration as an addition for many departments. Some administrators are wondering, “Can we afford them?” A better question is, “Can we afford not to have them?”

TEMS is a specialized unit within the SWAT team that exists to provide emergency medical care first to officers, then to suspects and citizens injured during high-risk events. The ideology of the TEMS program is to provide a dedicated person to handle pre-planning of possible medical issues during an incident and be available to provide care during the event.

So why is TEMS important? If the ambulance parked just down the street can provide medical care, why spend the funding for someone to be on site? The answer is in the nature of the injury, according to Dave Stephenson, a lieutenant for the Public Safety and Police Services at Washington State University, Vancouver, and a member of the Southwest Washington Regional TEMS Team.

Normally, emergency care refers to the basics of maintaining breathing and heartbeat, which allows a patient three to six minutes of time for treatment to begin. However, the injuries in a SWAT environment may be tremendously different. “Bleeding will kill you first in tactical medicine,” Stephenson said. Unlike injuries that can cause unconsciousness or breathing difficulties, a victim of an explosive injury can bleed out in 90 seconds, so Stephenson believes having someone immediately on site is crucial.

Once bleeding is controlled and an airway established, the TEMS unit needs to evacuate the patient to the ambulance through the hot zone, possibly while shots are still being fired. According to Corporal Doug Rickard of the Southwest Washington Regional TEMS Team (SWWRT), without separate medics on the SWAT crew, the team is diminished by the number of people needed to treat the injured. “If it takes one officer to treat the victim, two to carry him to safety and a third to cover your retreat, soon you have no one left for the SWAT incident,” he said.

However, even if the assumption is made that TEMS is a necessity, how can a department justify the cost of adding it? Where should tactical medics come from? Should they be drawn from the pool of law enforcement or EMS? And most importantly, how much is it going to cost?

Surprisingly, the road to creating a TEMS team begins far from the law enforcement world. Regardless of how a department decides to staff TEMS, the final licensing and responsibility for the program will fall under the auspices of the local medical program director (MPD). The MPD is the medical administrator or doctor who defines the parameters that all emergency services personnel will follow when dealing with patient care. No TEMS program can exist without the MPD’s approval, so it is imperative that he is included in planning and creating a tactical medic program.

Once the MPD has signed off on the creation of a TEMS position, the next step is to determine where the medics will come from. In most agencies, TEMS units are made up of either paramedics who are given basic law enforcement training, or law enforcement officers who have received medical training. While both routes are excellent options, each has pros and cons.

For agencies that choose to pursue the “law enforcement first, paramedic second” program, decisions will begin with how the program will be funded. Stephenson estimates costs for the Southwest Washington Regional TEMS at approximately 8 percent of the SWAT budget. These costs cover training and equipment for a fully functioning and trained team.

However, if an agency wants to start from scratch, costs can be expected to be much higher. A basic EMT certification usually requires at least three months of training at a community college, while a paramedic license may take more than 1,000 hours of classroom and on-the-job training. Once the license is achieved, additional training and re-certifications are also required throughout the year to keep current, as well as costs for providing officers with the appropriate gear.

When budgeting for startup costs for this type of program, administrators will need to determine if they will fund the price of the classes, how they will fund the overtime for officers to attend school, and if they will need to budget for overtime to cover their shifts while they are gone.

If an agency is funding the entire process, Rickard estimates budgeting for a minimum of 120 hours of salary for each officer to attend school, plus approximately $4,000 for a variety of medical equipment and appropriate uniforms to outfit the officer. Additional training hour requirements will be set by the MPD but can often be done with local fire and ambulance agencies, so the only budget consideration will be in overtime hours.

While creating a paramedic from an officer may sound expensive, there are ways to make this option less damaging to the budget. There is a variety of grants available from Homeland Security, and collaboration with local fire and ambulance agencies can cut the costs of re-certification training.

Another option for agencies is to follow the lead of the Southwest Washington Regional TEMS Team, which only allows officers who already hold an EMT or paramedic certification to apply. Because the officers on the SWWRT have prior military or medical experience, Stephenson said, their only requirement is to keep current on their certifications, which helps keep costs down.

Though it can be time-consuming and expensive, the “law enforcement first, medic second” program is popular with many agencies because it provides dual certification for those on the team, as well as full appreciation of law enforcement duties and responsibilities during high-risk incidents. “We prefer this route because the medics are armed and have a greater understanding of the police role in a high risk incident,” Rickard said.

For those agencies with tighter budgets or less access to officers with medical experience, a second option is to create a TEMS unit by drawing on local fire and EMS resources. This is how John Filer, chief of emergency medical services and the tactical response team for Charles County, Md., created his TEMS team. In this type of collaborative system, fire agencies are included in the TEMS, Hazmat and marine branches of the SWAT team.

According to Filer, this structure benefits all agencies involved through the sharing of training and resources. The trick to making this format work, Filer said, is to create alliances between fire and police. “Cooperation is imperative,” he said, “It will not work without cooperation between the agencies.”

In this format, fire department personnel who apply to be TEMS medics are given a background check and physical and are then sent to a SWAT school to learn law enforcement basics. They then train regularly with SWAT to build the trust that Filer believes is paramount to the success of the team. TEMS medics in Charles County do not have a commission to carry weapons, but they are required to show proficiency with a handgun as part of their training, which builds an understanding of the aspects of law enforcement’s job during a high-risk event.

Funding this type of collaborative plan requires each agency to pay for its own people on SWAT callouts, with paramedics funded under the fire budget and police under the police budget. This reduces questions of who was working for whom as far as overtime and liability issues. As with the Southwest Washington Regional TEMS team, Filer estimates the total cost of the TEMS unit at approximately 8 percent of the SWAT budget. Filer budgets approximately $40,000 for wages and relies on a variety of grants from Homeland Security for the approximately $20,000 for the cost of training and equipment for both fire and police.

While 8 percent may seem like a small part of the overall budget, justifying the cost of the program may still be a challenge from a fiscal viewpoint. In these tough economic times, the last thing any agency wants to be accused of is having expensive programs in place, just in case. This may be one instance, however, where the court of public opinion works for a program.

While many in both the civilian and law enforcement communities may have a perception that the medic is simply standing by in case an officer is injured, both Filer and Rickard disagree. “Our TEMS medics treat more general citizens and suspects than they do officers,” Filer said.

Few people realize that part of a TEMS medic’s job is pre-planning to determine medical issues that both suspects and those nearby may have. Rickard tells a story of a TEMS medic who simply sat in the home of a next-door neighbor during a warrant service. The elderly couple, he with medical issues and she with mobility issues, could not be evacuated easily, and the medics decided they were safer sheltering in place. The TEMS medic on scene stayed with them to provide any needed care during the high stress incident.

Another example of pre-planning is determining any health issues the suspect may have. For example, TEMS may determine that tear gas could compromise the health of the suspect with a known breathing problem and advise operators to choose another method during entry. These are the kinds of stories the community needs to hear for the team to gain support and, through that support, necessary funding.

Media coverage of recent incidents shows that popular police programs such as K9 or school services can be saved when the public understands what the program does, and TEMS should be no different. While the main emphasis is to save officers, agencies that promote their TEMS teams as community friendly can only benefit the entire SWAT program.

While Rickard estimates that only 50 percent of SWAT teams have designated medics, he expects that to rapidly increase. “The coming trend is that all teams will be required to have this,” Rickard said, “and those who don’t may be found negligent.” For agencies that do not currently have a TEMS team in place, or for those that are struggling with justifying the costs, this may be something to think about.


Published in Tactical Response, Jul/Aug 2011

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