First let me address a simple point I urge the reader to carry with them through this article: Being a paramedic requires a unique skill set where one can function through stress, operating fine motor skills with the application of various pre-hospital devices and tools, administration of medications that require precise mathematics, where the efficacy of their work requires often 2 years of schooling and hundreds of hours of field time experience prior to national testing. As a paramedic and a shooter, I can tell you that shooting requires far less skill and knowledge than being a paramedic. I would argue that most paramedics with proper training would be exemplary at handling a firearm, whereas most shooters would never be able to qualify as a proficient licensed paramedic. In other words – shooting and handling a firearm is not that hard, especially given proper training.

Why would rescue task force medics be issued ballistic helmets and bullet proof vests? Because of the risk of being shot. If you can receive gun fire, and you have hands, then by God you better be able to return gunfire. The more guns on your side in a fight the greater the chance of winning that fight. That is just the way it works. I’m sorry does that make you uncomfortable? I attended a great lecture once where the speaker, Lt Col. Dave Grossman stated, “There is no such thing as unarmed security, they are just the first guys to get shot and die”.

Pretend you are on a rescue task force, you respond to a large active shooter scenario where the landscape is urban and there are multiple shooters in unknown locations. Think Paris, a shopping mall, NYC. You enter, unarmed. A team of operators is moving with you and pursues the threats. You begin to provide care with possible one or two operators remaining in the rear to cover you (that just weakened the main SWAT force by having to leave them with you exposing the team to more harm), now pretend as you are working in the “tactical field care” phase, that as is with tactical combat casualty care, you are immediately, without warning thrust back into “care under fire”. A suspect/perpetrator took a flank position or came from an unknown location and begins to engage YOU, the already wounded victim and the officers covering YOU. What do you do? Take cover? Where? Move? Play dead? Now pretend the officer protecting you is struck in the neck – deceased. This is a likely scenario whether you can handle it or not.

How do you effectively engage the threat now? Pick up the officers weapon? You have no weapon or weapon training, just a brain bucked and a bullet sponge vest that likely cannot even stop a rifle round. You are then shot and killed by the aggression and momentum of the enemy and the entire situation is worsened by mounting casualties. Remember, the best medicine is always fire superiority, no matter what some admin, or bureaucrat politician or medical director “feels is right”. Your job as a medic in this environment is three-fold: treat casualties, prevent more casualties (including you) and complete the mission, stop the threats.

The timeline of these incidents is unique and there are no guarantees. It moves in one direction, forward, however the success and momentum of the good guys changes, like a football game, back and forth at times. One minute you may be in control, with good cover, concealed, protected, the next second you can be thrust in the middle of air cracking rounds penetrating around you as what was a safe zone immediately becomes compromised by the movement or momentum of the bad guys.

CUF-TFC that is care under fire and tactical field care are tenets of TCCC training. The mindset and skills executed in these two phases as well as priorities vary greatly. Doing the RIGHT thing, at the RIGHT time is critical. While under fire, there is truly only one right thing to do – return fire, move to cover/concealment, communicate with team/responders/victims, instruct victim to gain cover, neutralize the threat, gain fire superiority.

Tactical field care is that moment of pause when threats are temporarily stalled by either being neutralized, or you have moved to a safer location and you are no longer taking fire. Here you can provide more focused care to casualties, yourself or the team. You must remain diligent, observant and alert however. TFC can immediately without notice turn back into care under fire as your position becomes over run, compromised or the threat gains momentum or fire superiority over whatever elements you find yourself in. At that time disengaging from treating a patient and returning fire is the priority.

Look at the raid on Entebbe. Please look it up and study it. Lets fast forward to the raid itself. Israeli Mossad advance to the terminal where hostages are being held. The team had already be briefed that there would be no time to stop and care for wounded until the threats were eliminated, otherwise the terrorists would begin to kill anything in sight. As the team advanced, the commander Netanyahu was struck (soon to be lethal) and collapsed. The team advanced with momentum and purpose, killing the terrorist hostage takers with speed and skill. No hostages were killed. Had the team or part of the teak halted to protect or care for Netanyahu, the outcome may have been much worse. The momentum may have shifted to the terrorists who had cover in the building. Hostages may have been rapidly executed due to a delay in entry and less of a force assaulting the hostage takers.

Tactical environments are dynamic, chaotic and violent. Any increase in casualties complicates an already nightmarish scenario for this in charge of finding a solution and minimizing casualties. Introducing more unarmed, potential victims and more meat, more bodies that have no ability to defend themselves or the team, puts the mission, the team, the responders themselves and those they are trying to rescue further into harms way.

Abandon the fear of weapons. Weapons are always the solution to these problems whether you want to believe it or not. If you are not comfortable discussing these tactics, the skills of a gunfight, or response to such incidents, you have no business entering the discussion of rescue task forces. The only way to stop a bad guy with a gun, is a good guy with a gun. As Petzl says, “If you are heading to a gunfight, take a long gun, and take all your friends with long guns”, as well as, “You need to make the decision now, to be lethal enough fast enough”.

There are many adages and quips I could quote, as well as training doctrines that back my position, there is nothing that supports sending unarmed street medics wearing a brain bucket into a hostile environment or an environment that has the potential to erupt again with gunfire.

Place qualified medics into courses, train them on weapons with qualification standards. Arm these medics and teach them team movements, CQB as well as the strategies and tactics behind tactical combat, casualty care. Only then will you ensure a more positive outcome and reduce the body count.

I attended fire academy in 1999 – getting my FFI, FFII and EMT-B. I graduated with a degree as a Paramedic in 2002 and was hired as a professional firefighter paramedic. I have trained exhaustively in many skill sets for 18 years related to a myriad of hazards and emergencies. I qualified for SWAT in 2006, attended multiple TCCC and LETTC courses taught by US Special Forces (PJs, Delta, USAF Trauma Surgeon) as well as attending two other courses related to terrorist bombing incidents. I have been decorated with the police Exceptional Service Medal, and participated in thousands of hours in tactical training, CQB, as well as instructed bleeding control courses and hemostatic agents. I am responsible for a large portion of the agencies in my region learning and adopting tourniquets dating back to 2006 even though it was at the time frowned upon by the dinosaurs of EMS.

This post was previously published here: https://steemit.com/swat/@dennyducet/psychology-of-arming-paramedics

You can read Denny’s blog here: https://steemit.com/@dennyducet