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Old 21 March 2018, 19:48
firemed1394 firemed1394 is offline
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Question SWAT Medic Needing input

FF/Paramedic here, 13 years total last 4 carrying Texas Peace Officer license as a reserve officer with a small town. My employer is a bigger more “active” city. Super stoked to have finally accepted a SWAT medic position with my full time employer. I took on a challenge day one meeting with commander. I want all of our officers to carry on person a med card. Back story-I attended TCCC course three years ago and met a man who introduced himself as a SPECOPS medic getting some refresher. He Passed on a great idea Ive been trying to put together since. He meets with each of his members pre-deployment (small units 8-10) and builds a card for each perspective operator. I don’t recall all of the info he obtained but it was minimal and trauma specific I.e height weight, allergies,thinners yes/no, airway size, blood type, and pre calculated drug doses for pain and airway management narcs. Any other relevant ideas that would be great for a 4x6 laminated card?
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Old 21 March 2018, 19:56
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Originally Posted by firemed1394 View Post
FF/Paramedic here, 13 years total last 4 carrying Texas Peace Officer license as a reserve officer with a small town. My employer is a bigger more “active” city. Super stoked to have finally accepted a SWAT medic position with my full time employer. I took on a challenge day one meeting with commander. I want all of our officers to carry on person a med card. Back story-I attended TCCC course three years ago and met a man who introduced himself as a SPECOPS medic getting some refresher. He Passed on a great idea Ive been trying to put together since. He meets with each of his members pre-deployment (small units 8-10) and builds a card for each perspective operator. I don’t recall all of the info he obtained but it was minimal and trauma specific I.e height weight, allergies,thinners yes/no, airway size, blood type, and pre calculated drug doses for pain and airway management narcs. Any other relevant ideas that would be great for a 4x6 laminated card?
Don't bother on the blood type unless the person has had their blood type confirmed by a reputable source.

I don't like the idea of pre-calc'd drug dosage on a card for a variety of reasons. Same with the airway size. Better to figure that out the old fashioned way in the event of injury.

Current meds, allergies, pre-existing conditions.
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Old 21 March 2018, 20:03
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So you're a paramedic and you're now on a Swat team for a bigger agency in the city that employed you as a paramedic? Just making sure I understand. How big is your team?

While I think it's a good idea to have that kind of info, I'd ask you this: is everyone carrying stuff to do self aid/buddy aid? TQ, gauze etc? If not, that would be my primary focus first.

I'm lucky in that I have 3 no shit paramedics on my team with a no shit trauma surgeon running my agencies tacmed program for both patrol/ swat sections. He also is the chief of trauma medicine for a large hospital and at 50 plus years old, passed our Swat qual and school.

Edit to add: my medical knowledge isn't much more than the standard TCCC
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Old 21 March 2018, 20:05
firemed1394 firemed1394 is offline
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Not be argumentative but could you elaborate a bit for understanding. I’m looking for “I don’t have to think about it’s”, accurate ones. Doses would be initial or loading doses not max doses. Aside from weight, not much of the rest is going to change, with airway size whether they gain 50-100lbs , the cords and trachea won’t change size. Agreed 100% on the blood type. We’ve got access to packed reds where I am.
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Old 21 March 2018, 20:13
firemed1394 firemed1394 is offline
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All conclusions correct.

Team is 8-14 depending on availability and staffing. We are also attached to a combined/regional team for numbers on extended or large scale events. Not planning to gather info on 80 dudes. Department has all officers covered with TQ’s, Israelis and majority have SABA Training whether official or in house. First time since inception the team itself has had a compliment of 4 medics, in the past they called for a medic unit to stage. Most of the team members carry halo chest seals and their own selected accessories as well as city provided TQ’s. As far as the medics we carry more than I could list both on attached and bagged equipment for bleeding and airway management. On person equipment is quantities for for two-three officers with wounds and or airway issues.
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Old 21 March 2018, 20:16
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Originally Posted by firemed1394 View Post
Not be argumentative but could you elaborate a bit for understanding. I’m looking for “I don’t have to think about it’s”, accurate ones. Doses would be initial or loading doses not max doses. Aside from weight, not much of the rest is going to change, with airway size whether they gain 50-100lbs , the cords and trachea won’t change size. Agreed 100% on the blood type. We’ve got access to packed reds where I am.
You can always trust the troops to mess shit up, put on their buddy's body armor, etc. My concern is the possibility of the wrong card being with the patient and no one noticing. How often do you plan to check the cards? How often do you plan to verify that each guy has the right card? If this going to be a check you do for every op?
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Old 21 March 2018, 20:21
8654maine 8654maine is offline
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Meds, allergies, previous surgery/medical conditions, blood type.

Have them clarify the reaction to meds. I find more than a few "allergies" to be side effects.

For adults, airway size varies little.

For most adult males of the SWAT variety, Endotracheal tube sizes will usually be 7-0 or 8-0. You'll have to have a smaller size, like 6-0 for nasal intubation or emergent field cric.

Also, whatever your kit is, make sure it is standardized in terms of location for each person. Also, each person needs to know about each other and it needs to be refreshed regularly.
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Old 21 March 2018, 20:25
firemed1394 firemed1394 is offline
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That is a valid point I have yet to realize or address. We train every other Tuesday. I’ve been on two weeks and I’m still getting a good feel. We have outlined some regs for medics this far regarding checks. Checking expiration’s monthly, drug counts weekly as they are secured in the swat barn, pre-incident checks for self aid buddy aid equipment etc. certainly we could find a time and place for that. Our PD/FD relationship is phenomenal, so we’re using our current FD ems protocols and adding a few specialities not currently practiced but wanted to have an edge on rapid point of injury care.
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Old 21 March 2018, 20:26
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So the reason I asked size of team: 8-14 dudes isn't a whole lot. Gavin is head and shoulders above me on the application side of this. If he said you're getting into the weeds a bit, well, you are. Based on the size of your team, how hard would it be to get to know these guys and any relevant medical history associated(meds, allergies, etc)? This isn't a hypotical question, I'm genuinely asking. With a team that small, I assume you will be tasked with doing other shit as well, so what I'm asking may be difficult when combined with additional duties.

I honestly think you answered you're own question when you referenced "not planning to gather info on 80 dudes".
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Old 21 March 2018, 20:32
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Originally Posted by gavin View Post
You can always trust the troops to mess shit up, put on their buddy's body armor, etc.
This times a million.
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Old 21 March 2018, 20:36
firemed1394 firemed1394 is offline
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So the reason I asked size of team: 8-14 dudes isn't a whole lot. Gavin is head and shoulders above me on the application side of this. If he said you're getting into the weeds a bit, well, you are. Based on the size of your team, how hard would it be to get to know these guys and any relevant medical history associated(meds, allergies, etc)? This isn't a hypotical question, I'm genuinely asking. With a team that small, I assume you will be tasked with doing other shit as well, so what I'm asking may be difficult when combined with additional duties.

I honestly think you answered you're own question when you referenced "not planning to gather info on 80 dudes".
True true. Just wanted to see if I’m headed the right direction or as you said getting into the weeds. I appreciate anything I am given and information is at the top of the list. It’s not stone and not completed so I’ve plenty of room to change the game plan. No concerns getting to know my teammates, but the four medics assigned are on call, respond two at a time, and we’re all full time employees of the FD. The more I explain the more disadvantaged I feel. We are not full time swat only medics so our active time quiet frankly is limited to training and active incidents. Again we’re working on firsts for everything and as such, admins on both sides FD and PD have fingers in all of it specifically who’s footing the bill. With that being said, call outs, hands down on the clock do work, Training on the other hand, limited to one medic per session. So each of us will attend 1-2 times a month. Huge disadvantage in the get to know em and remember pertinent medicals.
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Old 21 March 2018, 20:47
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Quote:
Originally Posted by 8654maine View Post
Meds, allergies, previous surgery/medical conditions, blood type.

Have them clarify the reaction to meds. I find more than a few "allergies" to be side effects.

For adults, airway size varies little.

For most adult males of the SWAT variety, Endotracheal tube sizes will usually be 7-0 or 8-0. You'll have to have a smaller size, like 6-0 for nasal intubation or emergent field cric.

Also, whatever your kit is, make sure it is standardized in terms of location for each person. Also, each person needs to know about each other and it needs to be refreshed regularly.
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I enjoy your commentary.
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Old 21 March 2018, 21:25
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Originally Posted by firemed1394 View Post
True true. Just wanted to see if I’m headed the right direction or as you said getting into the weeds. I appreciate anything I am given and information is at the top of the list. It’s not stone and not completed so I’ve plenty of room to change the game plan. No concerns getting to know my teammates, but the four medics assigned are on call, respond two at a time, and we’re all full time employees of the FD. The more I explain the more disadvantaged I feel. We are not full time swat only medics so our active time quiet frankly is limited to training and active incidents. Again we’re working on firsts for everything and as such, admins on both sides FD and PD have fingers in all of it specifically who’s footing the bill. With that being said, call outs, hands down on the clock do work, Training on the other hand, limited to one medic per session. So each of us will attend 1-2 times a month. Huge disadvantage in the get to know em and remember pertinent medicals.
I think you have your head in the right place.
Congrats on making Swat and forget to get a SWAT brick
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Old 21 March 2018, 23:17
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How far are you from your trauma center? Is focus on PRBCs and blood typing relevant to your transport time? Is your employer and your medical director willing to accept liability for improper administration of a blood product prior to typing/cross-matching in hospital? These are some questions you need to consider, in my opinion.

You're two weeks/one training day in. Take some time to observe and learn the flow of things before you disrupt it. A card isn't a bad idea for history purposes, but blood type labeling tends to be a misunderstood and inaccurate practice outside of very specific and controlled circumstances.

Were I to give you unsolicited advice, it would be to chill and listen, and don't try to change anything for a couple of months. Brush up on the non-sexy stuff (sports med/overtraining/overuse injuries, environmental injuries, wellness stuff). This is going to be your daily bread and butter until someone gets hurt by a bad guy. You may go an entire TEMS career without taking care of a team member with a GSW, but I guarantee you'll be dealing with sprains/strains, fractures, heat exhaustion, and stress management on a regular basis.
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Old 22 March 2018, 06:33
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Were I to give you unsolicited advice, it would be to chill and listen, and don't try to change anything for a couple of months.
Great advice.
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Old 22 March 2018, 16:03
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You're two weeks/one training day in. Take some time to observe and learn the flow of things before you disrupt it. A card isn't a bad idea for history purposes, but blood type labeling tends to be a misunderstood and inaccurate practice outside of very specific and controlled circumstances.

Were I to give you unsolicited advice, it would be to chill and listen, and don't try to change anything for a couple of months. Brush up on the non-sexy stuff (sports med/overtraining/overuse injuries, environmental injuries, wellness stuff). This is going to be your daily bread and butter until someone gets hurt by a bad guy. You may go an entire TEMS career without taking care of a team member with a GSW, but I guarantee you'll be dealing with sprains/strains, fractures, heat exhaustion, and stress management on a regular basis.
Coming off a career as a Tac Medic for a national team who has written papers on this subject and helped set up numerous programs, I can say that the guy I quoted above knows EXACTLY what he is talking about. You are going to make your bones with band aids and not tourniquets. Every new medic wants to come flying in and "help" the team. I appreciate that but you need to remember that they have umpteen higher priorities not the least of which is mandated Social Justice touchy feely classes. Your impulse to "help" will be viewed by many as a pain in the ass right now. SLOW DOWN AND TAKE A KNEE.

FWIW, I tried to push the Med Card idea for my 40 man element and it didn't fly. You will quickly learn that many guys are very protective of their health care info. Lots of them may be on BP meds, Viagra, PED's, HGH or who knows what and they certainly aren't going to tell some new medic that. Plus the fact that you may well run into issues with management, their Union, etc. Then getting an unaffiliated health care facility to believer anything on a card is a whole separate issue. This isn't the military where you will be going to your own care facility that knows your SOP's.

Best single piece of advice I ever got at the start of my career. "Be an Enabler and not a Hindrance." Don't tell them what they are doing wrong or add to their task list. Conduct your duties in the background and be as invisible as possible while doing your job. Don't be the medic standing up at every training and every op briefing carrying on about proper hydration and threatening the guys with an IV catheter. NO ONE likes that medic. Don't be in the TL's grill every five minutes. My TL was one of my closest friends and I rarely if ever spoke to him during an op unless there was a casualty. He has other shit to be doing.

The guys have to TRUST you implicitly. That takes time. Get with the other medics and ask the training officer to give y'all a training date to do medical. Then put together some FUN and informative training that the guys will enjoy and that showcases your knowledge and abilities. Let them SEE that you know your craft without you telling them that. And keep your gear, especially your medical gear, spotless. Everyone else can look the slob with dirty gear but no one wants the medic that can't wash his uniform on the regular and crap falls out of his bag when he opens it.

Lastly and I don't mean this as a joke, make sure they see you washing your hands every time you take a piss. You ever see the Seinfeld episode where Jerry is in the bathroom with the chef that doesn't wash his hands? This goes back to the trust thing. I worked years to gain my guys trust and I wasn't going to sacrifice that by someone thinking I wasn't the cleanest most meticulous guy on the team.
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Old 22 March 2018, 21:17
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Hi JBG, I would like to read some of your papers you have written. It's always cool to be published.
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Old 22 March 2018, 22:34
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Loads of great advice here. JBGleason is dead on. I also came from the traditional EMS side and ended up in LE as a "tactical medic". The guys have to trust you to know your shit and be the stone cold expert at your specialty/craft. There's no short cut to it, and it takes time. The biggest thing you can do is just be rock solid at the medicine. You don't have to be Mr. Tactical-there's 8-14 other dudes there to do that. But, there's only 1-2 docs, so be the expert in that. Our role is to be support, not the main show. Work in the background and make sure everyone is good to go.

And yeah, the other guys are right. I've got a ton of sexy trauma gear at my disposal, but my most commonly used items are ibuprofen, band-aids and Immodium. I probably do more sports-medicine and sick call stuff than anything else, by far. It's not sexy, but it keeps the guys up and running and makes the team more effective.

If the guys can trust you to handle the little stuff like headaches and cuts, and be a master at the basics of med care, then you're on the right path. Try to get a training slot for a med day and crush it-demonstrate that you know your stuff. Good luck!!
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Old 23 March 2018, 21:20
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And yeah, the other guys are right. I've got a ton of sexy trauma gear at my disposal, but my most commonly used items are ibuprofen, band-aids and Immodium. I probably do more sports-medicine and sick call stuff than anything else, by far. It's not sexy, but it keeps the guys up and running and makes the team more effective.
Running IV bags on guys who are dehydrated (whatever the reason) is a sure way to make points.
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Old 23 March 2018, 22:22
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Running IV bags on guys who are dehydrated (whatever the reason) is a sure way to make points.
Yeah...well, that too!

Like I said, I go through a LOT of motrin...
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