Tactical Medicine while not an EP?

[gunnerdoc]

I know there exists two Tactical Medicine Fellowships out there and other EPs train with police departments to work with SWAT teams or as an officer as part of giving aid as a first responder or a medic. I've even heard of a trauma surgeon doing it. I wanted to know if you've heard of any other specialties working in that similar capacity - AKA an OBGYN, psych, FM, doing that sort of thing? I understand being an EP might give you additional training via residency, but would taking/doing a paramedic course basically teach you what you needed to know? Thanks for any help on this!

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[goodoldalky]

I'll say a couple things, first, to answer your question, no, other specialities don't do this. Second, it would be a very exceptional circumstance where a physician would actually work in this capacity. It's mainly theoretical. To do so would mean insane liability, exceedingly high disability insurance costs (I'm guessing 1-2K a month depending on how often you actually did this), and decreased pay. I know it sounds cool but it is something that is as likely to happen as you being a doctor-astronaut, post NASA.
Being a paramedic or something along those lines, in my opinion, is just as useful in this capacity and more practical, if working with law enforcement is what you really want to do.
-Person with zero personal experience with any of this.

 

[Mad Jack]

I know there exists two Tactical Medicine Fellowships out there and other EPs train with police departments to work with SWAT teams or as an officer as part of giving aid as a first responder or a medic. I've even heard of a trauma surgeon doing it. I wanted to know if you've heard of any other specialties working in that similar capacity - AKA an OBGYN, psych, FM, doing that sort of thing? I understand being an EP might give you additional training via residency, but would taking/doing a paramedic course basically teach you what you needed to know? Thanks for any help on this!

I worked with a guy that was a trauma surgeon that did this sort of stuff, but other than him, never met anyone in the field. He'd mostly do training exercises with them and teach SWAT medics different procedures that could save a life in the field. He was trained to go into an insane situation were it to arise, but never got taken up on that offer because it would require something truly exceptional like terrorism or the like happening.

 

[racerwad]

I do know of an OB that that does what you're describing, but as others have mentioned in this thread and the other threads on this topic, the utility of a physician on a tactical team is most often pre-incident as a "force-multiplier" to teach the folks going into harm's way how to provide care to their team and those injured at the scene. I am personally aware of physicians who are deputized and can be part of the entry element, if needed, but usually those duties are handled by the tactical medic.

Simply being a civilian paramedic is not adequate, but is certainly helpful. Honestly, apart from traumatic amputations, I can't think of a single thing that a physician in the field could do better than a paramedic. Being an EP doesn't make you inherently more suitable for this role, but I do think that those who self-select into EM are better suited to become useful in this role, if that makes sense. Same for those who come from surgical backgrounds, but there is certainly no reason a psychiatrist or family practitioner (to use your examples) couldn't do it. It is just that most folks who choose those paths do not desire the opportunities available in a tactical environment.

Check out the faculty list from the one of the better known training programs: http://www.tacticalmedicine.com/faculty-profiles/

 

[EM/CC_23]

http://www.cnn.com/2015/12/03/health/san-bernardino-swat-doctor-profile/

http://arrowheademergency.wix.com/armcemresidency#!form__map/c24vq

I remember reading the above article and thinking it was interesting--about a Dr. Neeki, an ED attending at Arrowhead Regional Medical Center (their research director according to the ARMC residency website) who is also reportedly a voluntary member of the local SWAT team. According to the article, he was one of the first rescuers to arrive on scene at the recent shooting in San Bernadino, and entered the building with his own police-issued weapon and body armor in order to provide aid to victims before the building was cleared of combatants. (PS...I have no idea how accurate or common this is--I just read it and thought it was interesting.)

Per the article, he grew up in Iran and was required to serve in its military during a conflict with Iraq as an 18 year old prior to becoming a physician in the US (and he obviously had weapons training/combat experience during this period.)

 

[SeekerOfTheTree]

http://www.cnn.com/2015/12/03/health/san-bernardino-swat-doctor-profile/

http://arrowheademergency.wix.com/armcemresidency#!form__map/c24vq

I remember reading the above article and thinking it was interesting--about a Dr. Neeki, an ED attending at Arrowhead Regional Medical Center (their research director according to the ARMC residency website) who is also reportedly a voluntary member of the local SWAT team. According to the article, he was one of the first rescuers to arrive on scene at the recent shooting in San Bernadino, and entered the building with his own police-issued weapon and body armor in order to provide aid to victims before the building was cleared of combatants. (PS...I have no idea how accurate or common this is--I just read it and thought it was interesting.)

Per the article, he grew up in Iran and was required to serve in its military during a conflict with Iraq as an 18 year old prior to becoming a physician in the US (and he obviously had weapons training/combat experience during this period.)

I'm a brown guy. I could just imagine in this situation putting on my own body armor and having a weapon to go into a situation to help...and I will get shot.

 

[Mad Jack]

I'm a brown guy. I could just imagine in this situation putting on my own body armor and having a weapon to go into a situation to help...and I will get shot.

Tactical armor is very clearly labeled for a reason. It's not like the guy was just wearing some off-hand-held Kevlar vest and going in alone, he was wearing labeled police gear and going in as a part of a team.

http://www.cnn.com/2015/12/03/health/san-bernardino-swat-doctor-profile/

http://arrowheademergency.wix.com/armcemresidency#!form__map/c24vq

I remember reading the above article and thinking it was interesting--about a Dr. Neeki, an ED attending at Arrowhead Regional Medical Center (their research director according to the ARMC residency website) who is also reportedly a voluntary member of the local SWAT team. According to the article, he was one of the first rescuers to arrive on scene at the recent shooting in San Bernadino, and entered the building with his own police-issued weapon and body armor in order to provide aid to victims before the building was cleared of combatants. (PS...I have no idea how accurate or common this is--I just read it and thought it was interesting.)

Per the article, he grew up in Iran and was required to serve in its military during a conflict with Iraq as an 18 year old prior to becoming a physician in the US (and he obviously had weapons training/combat experience during this period.)

This is a good example of the rare sort of instance when a doctor might be called in if available, as minutes can matter in such mass casualty incidents and there might be a procedure or two you could do in the field that a paramedic wouldn't be qualified or comfortable with.

 

[Apollyon]

A guy a year ahead of me did a tactical fellowship, and is now the police surgeon for one of the 10 largest cities in the country. He goes with SWAT for various call outs. He and a colleague (surgeon who did the same fellowship) did a field trach on a lieutenant that got shot through the neck. They later got on "Extreme Makeover: Home Edition" (the whole team) when the LT got home from rehab. So, it's possible.

 

[Tenk]

Possible yes, practical no.

For many reasons, here are some:

1) You really don't offer many field skills that are not already mastered by SWAT medics. These guys aren't your typical medic. I know some and let me tell you, these guys are badass. They have a lot of training under their belt and know what to do in almost any situation.

2) You are a high value target. You will jeopardize your team due to your status whether you know it, they know it, or not.

3) Your higher stature/training may actually make you a detriment to the team. As a physician you are used to calling the shots and making decisions. Most SWAT medics function at a location that is a warm zone and from this locale they support the hot zone. You are actually not involved in any fire fights and typically are out of harms way relatively speaking. You are there to support, not lead. You will also be expected to follow any commands and not question your superiors. I think this goes without saying that for 99% of docs, we are the type that tend to question everything and have others follow us.

If it's something you truly are interested in, it can be done and it has been done. Just don't expect to grab an AR-15 and kick down doors yelling here's doctor death. SWAT medics play a support role and they are incredibly good at this. But that's all you are. Support.

 

[deleted480308]

having a doc near the team is a great idea, having the doc breach is a poor utilization of resources

 

[gunnerdoc]

I wouldn't be talking about going into the situation as part of the breach team, more like standby as a medic for any acute injuries. I'm really not sure on any of the hard specifics of this kind of work, which is why I was asking, but I figured you would need paramedic training at the very least, I'm just wondering, does it matter what kind of doctor you are if you wnated to do this sort of thing. And yes, I realize I wouldn't be able to play with people who have been training for years, nor would I want to play with them anymore than I'd want them in the OR or in my office - but support is entirely fine by me.

 

[polygonal]

Could an EP work at a pediatric psych hospital doing psych consults? A fertility clinic? A lipids clinic?

 

[Fox800]

It's disheartening how the bastardization of EM is viewed as perfectly acceptable by other specialties (FM, IM, etc.) due to the financial aspects of working in the ED and the negatives of their own specialty.

"Hey I didn't match into EM, I'm a family medicine resident. Can I do an EM fellowship and work full-time in the ER?"

"Hey, I've been an IM attending for 20 years. Obviously I'm just as good board-certified EP!" No, you're not.

 

[Fox800]

I wanted to know if you've heard of any other specialties working in that similar capacity - AKA an OBGYN, psych, FM, doing that sort of thing?

No, although I believe the Dallas SWAT physician is a trauma surgeon.

I understand being an EP might give you additional training via residency, but would taking/doing a paramedic course basically teach you what you needed to know?

No. (I've been a paramedic for almost ten years).

 

[Zebra Hunter]

No, although I believe the Dallas SWAT physician is a general surgeon.

He's a trauma surgeon/reserve police officer, and he's an interesting individual, to say the least.

 

[Apollyon]

He's a trauma surgeon/reserve police officer, and he's an interesting individual, to say the least.

There's two of them - one is the trauma surgeon, and the other is an EP.

 

[Zebra Hunter]

There's two of them - one is the trauma surgeon, and the other is an EP.

I'm aware, I know both of them. Was just making a small correction regarding the surgeon.

 

[Apollyon]

I'm aware, I know both of them. Was just making a small correction regarding the surgeon.

Roger that.

 

[RustedFox]

It's disheartening how the bastardization of EM is viewed as perfectly acceptable by other specialties (FM, IM, etc.) due to the financial aspects of working in the ED and the negatives of their own specialty.

"Hey I didn't match into EM, I'm a family medicine resident. Can I do an EM fellowship and work full-time in the ER?"

"Hey, I've been an IM attending for 20 years. Obviously I'm just as good board-certified EP!" No, you're not.

You're starting to notice that, eh ?

What's equally as frustrating to me is when patients or their families (and its a common myth/misconception) think that working in the ER is just something that you do between practices or whatever else it is that you do. It's clearly a job that any doc can do.

 

[txterp98]

Yes, it's rare for physicians outside of Emergency Medicine and Trauma Surgery to hold these positions, but it does occasionally happen.

I have a friend who is an Interventional Cardiologist who provides tactical medical support for the Travis County SWAT team. In addition to being a licensed peace officer for this role, he was recently named a US Special Marshal.

Feel free to get in touch with him. He's a great guy.

https://www.linkedin.com/in/jonathan-sheinberg-md-facc-2599a483

 

[DeadCactus]

Think one of the local SWAT medical directors here is a urologist.

These are volunteer positions. For all the medical students and residents dreaming of wilderness medicine, tactical medicine, international medicine, and McGuyver ninja careers there is a dearth of people who actually want to volunteer that kind of time when they're in their 30's with a family and the ability to earn over a $1000/shift at work. Suddenly going to the gun range or taking a ski vacation sounds a lot more appealing than working for free. You can find a team happy to take what they can get.

And while I agree that an EM trained physician is ideal, the pre-hospital toolkit is so limited I don't think the added value is so great as to be mandatory. EM dominates these positions because it is attractive to the people who go into EM.