82 A Descriptive Analysis of United States Out-of-Hospital Care Response to Law Enforcement Tactical Incidents

Abstract

Study Objectives: Law enforcement tactical incidents involve high-risk operations that exceed the capabilities of regular, uniformed police. Despite the existence of tactical teams for 50 years, little is known about the frequency or nature of emergency medical services (EMS) response to tactical events in the US. The few publications on this topic have primarily involved provider surveys and case reports. The purpose of the current study was to perform a descriptive analysis of events reported to a national EMS database. Methods: Descriptive analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) research data set, containing EMS emergency response data from 41 states. Results: A total of 19,831,189 EMS events were reported, of which 3,953 (0.02%) events were coded as "Activation-Tactical or SWAT Specialty Service/Response Team". Of these tactical activations, mass casualty incidents occurred in 21 (0.53%) events. The most common level of out-of-hospital care present on scene was basic life support (55.2%). Two events involved helicopter EMS assets. The most common EMS response locations were homes (48.4%), streets or highways (37.0%), and public buildings (6.3%). The median age of treated patients was 44.0 years; 3.5% of patients were aged 8 years or less. Cause of injury was coded in 18% of NEMSIS reports identified as involving tactical events. Of these, 14.8% were coded as firearm assault and 8.9% as chemical exposure. Cardiac arrest occurred in 5.1% of patients, with the majority (92.2%) taking place prior to EMS arrival. Sixty-six percent of the cardiac arrest patients were declared dead on scene. The primary symptoms reported by EMS personnel were pain (37.4%), change in responsiveness (13.1%), and bleeding (8.1%); 11% had no symptoms. Twenty-nine patients had oral airways placed, 17 had nasopharyngeal airways placed, and 30 underwent endotracheal intubation. Peripheral IVs were established in 911 patients, 4 received external jugular IV access and 22 adults received intraosseous lines. Spinal immobilization was performed in 240 patients (6.1%). No data was recorded regarding the use of tourniquets or needle decompression. The most common medications provided were oxygen (19.9%), naloxone hydrochloride (9.0%), and normal saline (7.1%). Conclusion: Although uncommon, approximately 11 EMS responses in support of law enforcement tactical operations occur daily in the United States. The majority of incidents occur in homes and involve two or fewer patients. Advanced airway procedures are required in a minority of patients. Cardiac arrest is rare, and occurs prior to EMS response in the majority of cases. Better understanding of the nature and location of EMS responses to tactical incidents is required in order to develop consistent EMS policies in support of law enforcement special operations.