San Antonio Police Department Launches Tactical Medic Program

At 2:20 on a Friday morning, San Antonio police were alerted to a motorist traveling at high speed in the wrong direction on a highway. As officers closed in on the vehicle, it collided with a motorcycle. Officer Jose Garay, a member of the San Antonio police tactical medic program and the first officer on scene, immediately began to triage two catastrophically injured patients, both from the motorcycle. The male victim, the bike’s operator, was dead; his female passenger was conscious but had an altered mental state. The SAPD medic ensured the patient had a clear airway and performed a rapid trauma assessment that revealed an open femur fracture with heavy bleeding and numerous lacerations with exposed muscle tissue.

Overview

In an effort to stay ahead of the curve with traumatic injuries and fatalities to police officers, the San Antonio Police Department has created its own tactical medic program. Using some of the latest military medicine strategies learned on the battlefield (e.g., permissive hypotension and clotting agents) and armed with some of the latest medical field gear (chest seals and a commercial tracheostomy kit) and interventions (EZ-IOs and King LTs), this group has been able to save a number of lives from very serious injuries—lives that would not have been saved a few years earlier.

The program is modeled after and taught by the U.S. Customs and Border Protection’s BORSTAR (Border Patrol Search, Trauma and Rescue) unit. The training lets SAPD officers and agents in the field treat and stabilize patients until they turn care over to EMS. This means treatment need not be delayed because EMS is a long way off or the patient is in a remote location. Often police officers are on scene quicker than already-stretched paramedics, especially during peak periods of activity. There are also times when scenes are not safe for EMS to enter. That is where police officer tactical medics fill the gap.

San Antonio is the seventh-largest city in the United States. SAPD has 4,000 uniformed officers who respond to more than 1.1 million call a year. More than 7,000 of these are considered violent crimes.

The San Antonio Police Department’s tactical medic program consists of 40 uniformed and plainclothes officers trained and equipped to respond and provide specialized emergency prehospital medical care. Members are trained as EMT-Basics, with additional training in tactical medicine and treatment under fire and in hazardous situations. Their primary mission is to treat police officers during tactical operations and civilians found to have life-threatening situations prior to arrival of EMS and before scenes are safe for EMS to operate in. Once EMS is on scene, the tactical officers continue to assist with patient care and may even accompany EMS to the hospital in the back of the ambulance.

Beyond stabilizing people who have been critically injured, tactical medics are also called on to provide medical standbys for officers serving arrest and search warrants. They also assist during any critical incident or unusual occurrence the department’s Special Operations Unit handles. These include hostage, barricade and suicide situations. Additional duties include medical standbys at the San Antonio Police Training Academy during high-risk training such as firearms, boxing, mixed martial arts and other physical training. There are police tactical medics concentrated in certain police units as well. These include the SWAT and hostage-negotiation teams, as well as executive protection detail.

Operational Capabilities and Equipment

Tactical medics perform all assessment and medical interventions within the scope of practice of an EMT-Basic. They write their own patient care reports and are trained to perform several advanced life support skills, such as IV and IO access, needle thoracostomy and insertion of a laryngeal tube airway.

All tactical medics are issued personal medical jump bags containing:

• Oral, nasal and King LT airways;
• Portable suction;
• Oxygen;
• BVM;
• IV equipment;
• EZ-IO;
• 0.9% sodium chloride solution;
• Bandaging and splinting supplies;
• Celox combat gauze;
• SOF tactical tourniquet;
• HyFin occlusive chest seals;
• ARS 14-gauge x 3.25” decompression needle;
• Nitroglycerin;
• Aspirin;
• Oral glucose.

Working With Others                                                                

SAPD tactical medics enjoy a great partnership with the San Antonio Fire Department. Medics ride on SAFD ALS ambulances at least six times a year. These rides help the tactical medics stay proficient in their assessment and medical skills. Also, when on scene tactical medics routinely assist EMS during patient care. This is powerful component of interagency operations that builds familiarity and collegiality. Fortunately, the incidence of serious injury to officers does not provide the appropriate exposure to critical events to maintain the intervention skills that riding with EMS provides.

The University of Texas Health Science Center at San Antonio oversees all medical training and assists with daily quality assurance. Doctors Craig Manifold and Emily Kidd have been involved from the start and are the program’s medical directors, providing both on- and off-line medical direction.

Since 2010, tactical medics have performed more than 300 traumatic patient contacts with great success. Most injuries are associated with penetrating trauma from gunshot wounds and high-speed motor vehicle accidents. The success of this pilot project, seeing nearly 100 patients each year, suggests potential benefit for other major law enforcement agencies.

Self-Aid Buddy Care/Tourniquet Program

In 2010, the San Antonio Police Department adopted a Self-Aid Buddy Care program modeled after the Tactical Combat Casualty Care course and tailored to meet departmental needs. Tactical medics were tasked with training all police officers and cadets in basic tactical first aid, occlusive bandages and the use of combat tourniquets. At the completion of training, each officer was issued a personal tourniquet.

In January 2011 officer Michael Thornton was seriously injured when he was struck on the highway by a drunk driver. The accident severed his leg, but due to responding officers applying an issued tourniquet, Thornton’s life was saved. Thornton recovered from his injuries, was fitted with a prosthetic leg and is back to full duty assigned to Traffic Division DWI detail.

Back to the Scenario

Realizing the gravity of the injuries, the SAPD tactical medic immediately placed a tourniquet above the open femur fracture to stop the bleeding and applied a rigid cervical collar to protect the woman’s c-spine. The patient then received supplemental O₂ and a large-bore IV of normal saline. The officer continued to assist maintenance of an open airway until the arrival of EMS and a San Antonio AirLIFE helicopter. They flew the patient to University Hospital (one of two area Level 1 trauma centers), where surgeons successfully managed her life-threatening orthopedic injuries. Trauma surgeons attributed the successful outcome to the quick actions by SAPD officers to suppress hemorrhage and maintain the patient’s airway.

Richard Smith bio

Craig Manifold, DO, is medical director for the San Antonio Fire Department and San Antonio AirLIFE, as well as commander of the 149th Medical Group, Texas Air National Guard.

David Wampler, PhD, LP, is an assistant professor of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, TX. He is also a member of EMS World’s editorial advisory board.