Crossing Local Lanes for Adaptive Service

How loosening some roles between police and emergency medical services can lead to surprises

If you have worked in any form of government, especially public safety, you have most certainly heard the phrase “that’s not in our lane.” This and its more sinister version, mission creep, are viewed as cardinal sins. For many, mission creep is you, Department A, intruding on the operating environment or the core function of Department B. When done intentionally it is viewed as an attempt to undermine the value of a specific department — to take away the exclusivity of their mission in order to phase them out, or to demonstrate that your organization can do it better. When done accidentally, it is usually chalked up to bureaucratic inexperience and someone gets a stern talking to.

Where do these lanes come from? For most public safety departments, specifically Police and Fire/EMS, their unique roles have evolved over long periods of time. For both disciplines now firmly rooted in the modern area, their performance is now measurable (e.g. number of arrests and number of extinguished fires) and can be used in budget requests. To creep into someone’s mission space is to covet that data and diminish their performance — and potentially their funding. This should elicit that same emotional response as collaring someone else’s long-investigated suspect. But what if these lanes don’t mean that much anymore when adversaries can hop between them?

As departments have grown over time, it is often overlooked that the threats and hazards they must address have also kept pace. Overseas and combating Al-Qaeda, General Stanley McChrystal realized that to defeat an adaptable and asymmetric enemy, he would have to break down barriers between tactical teams, intelligence officers, and commanders so that information could move freely and collaboration could happen in real-time. From his efforts emerged the concept of a Team of Teams. Despite enhancing collaboration and speed, the secret to McChrystal’s Team of Teams was the flexibility afforded to those in parallel organizations to contribute directly to parts of the mission at hand. This was not mission creep — this was mission enhancement.

2000–2013 Active Shooter Incidents Report:

At home, the rise of the active shooter threat introduced new complexity into the public safety environment. From lessons learned, the defined lanes and linear progression of law enforcement neutralizing the shooter, securing the scene, and then EMS following behind to triage the casualties created a delay in medics reaching victims. The outcomes were not always ideal. As attack after attack unfolded, there was a realization that this process could be innovated upon: More would have to happen at the same time and national thinking led to the emergence of tactical medic teams and the necessity for cross-training. This was not mission creep — this was mission enhancement. Once this is embraced, an interesting phenomenon can unfold:

Not long after the Boston Marathon bombing in 2013, Chief Inspector Joe Sullivan of the Philadelphia Police Department (PPD) — the commander for homeland security and counter-terrorism — had the opportunity to attend a meeting on active shooter situations. In the meeting, a trauma surgeon spoke about how first responders can increase the survival of shooting victims by controlling the bleeding, ensuring their airway is open, and getting them to a hospital, where — if the first two conditions were met — a trauma surgeon would be highly likely to ensure their survival. One of the ways the surgeon said police officers could accomplish this would be through the use of tourniquets. 

In 2014, the Philadelphia Police Department issued 5,000 tourniquets to patrol officers. Two days after issuing the equipment, Officer Tighe Wingrove came upon a shooting scene in the middle of a street and used his tourniquet to save a man’s life who had been wounded in the leg.

A typical tourniquet —

For countering active shooter consequences in Philadelphia, this thinking also took the shape of Rapid Assessment Medical Support (RAMS) Teams. Paramedics with ballistic armor would follow law enforcement teams into areas that were cleared, but not yet fully secured. This was a significant improvement from waiting for a scene to be secured, which sometimes requires a detailed search of a facility. Treatment of victims was now done in the warm zone. Training for paramedics on how to operate in these environments was provided by the Police Department and RAMS Teams have now been institutionalized.

Images by Crawford C. Mechem, MD PFD-EMS Medical Director

When blurring the lines between public safety disciplines, there emerges an ongoing dialogue of opportunities for mission enhancement. Cross training is a two-way street for the development of new capability:

[In 2015,] Two runners were saved by FBI agents, police officers and medics after going into cardiac arrest on the Broad Street course this past Sunday, the Daily News reports. One runner, a 35-year-old man, collapsed about two miles into the race and FBI Special Agents Erik Negron, Tom Powell and Brian Hoffman, who were working security for the run, along with Police Officer Matthew Fleming, were quick to jump to action. Luckily, two of them were trained EMTs, and, with the help of an emergency defibrillator they had on-hand, they were able to kick start the man’s heart. Medics arrived soon after.

Of course there are serious considerations to crossing local lanes and an inevitable and natural resistance to change. It is hardwired into us. Further, tactical medicine provided by EMS in an active shooter scenario is not without its critics. The thing to keep in mind is that adversaries do not align themselves neatly within swim lanes. Adaptability and flexibility between public safety disciplines are quickly becoming a necessary new normal.