Over the years, the role of EMS in high-risk operations has expanded and evolved in ways that reflect the changing threat dynamics that public safety responders face. Mass-casualty incidents, tactical law enforcement operations, hazmat responses, civil unrest and other large-scale disasters have forced EMS professionals—regardless of whether we’re talking about ambulance-based, fire-based or tactical EMS—to operate in environments that are far more complex and dangerous than the traditional scope of prehospital care.
The ‘routine’ call
Historically, EMS providers’ primary focus was on rapid response, stabilization and transport of patients from relatively secure environments. Gone are the days when almost every call was “routine.” Incidents now regularly occur in dynamic, hostile and uncertain conditions. Active shooters, terrorist attacks and high-threat law enforcement operations highlight the need for EMS providers to integrate into response frameworks that recently were considered outside of routine. The implementation of Tactical Emergency Casualty Care (TECC) guidelines is one clear example of this evolution. TECC emphasizes lifesaving interventions that can be performed in high-threat environments where traditional medical care protocols aren’t immediately possible.
Another step forward for public safety is the shift toward joint operations between fire departments, EMS agencies and law enforcement. Interagency collaboration no longer is just about coordination on scene. It involves joint training programs, unified command structures, and joint operating procedures and guidelines. Increasingly, EMS providers are training alongside law enforcement SWAT teams or within Rescue Task Force (RTF) teams, moving into increased threat zones to treat and evacuate victims. This integration reduces delays in medical care and reflects a broader cultural change. Medical care no longer is seen as a supportive role that waits for a totally secure scene. It’s seen as an active participant in increasing the survivability of victims in high-threat incidents.
Training & equipment
In support of these new roles, EMS agencies are investing heavily in specialized training and equipment. Simulation-based training that utilizes moulage, wearable bleed props and task-based trainers enables emergency responders to hone their decision-making and care under realistic stress conditions. Integrating this training into a joint exercise with police, fire and other responding agencies helps all participants to build muscle memory for coordinated actions.
The type of equipment that’s carried by EMS providers also is advancing. Ballistic protective equipment, tourniquets, hemostatic agents and other wound-packing materials, hemorrhage control kits and advanced communication systems all support the new level of readiness that’s required.
Extreme stress, increased risk
With these expanding roles, EMS providers are asked not only to master technical skills and advanced medical tasks but also to maintain resilience in the face of extreme stress and increased risk. The need for agencies to recognize the importance of health resources, peer support programs and wellness initiatives is critical to sustain their most important asset: their people. The importance of physical and mental fitness must be emphasized now more than ever. EMS providers must remain effective and efficient while maintaining tactical and situational awareness in unpredictable environments. We never know when we might be saving the life of a civilian or another responder or even our own life.
Integrated public safety
The evolution of EMS readiness for high-risk public safety operations is ongoing. Future incidents likely will necessitate even greater integration throughout public safety. Expanded cross-training between public safety disciplines will become increasingly critical. What will remain constant, however, is the mission: the preservation of life in the moments when it hangs in the balance.
We will continue to adapt, proving ourselves not just as EMS providers but as vital members of an integrated public safety team.
