Tactical Medical Unit

The Maryland Tactical Medical Unit consults with Maryland State Police during high-risk and prolonged operations. Program director Dr. Kevin Gerold was online Tuesday, April 24 at 2 p.m. ET to discuss how they aim to minimize the dangers during standoffs, exposure to hazardous materials and other scenarios.

A transcript follows.

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Dr. Kevin Gerold: Good afternoon. Pleased to be here with you this afternoon.

The rise in violent crime in the United States is requiring law enforcement to modify its tactics. Increasingly, police departments are realizing that incorporating a medical element into their specialized operations can reduce the incidence of injuries, disabilities, and human losses associate with high-risk operations.

The Johns Hopkins Department of Emergency Medicine has joined forces to provide emergency medicine residents the opportunity to learn about supporting law enforcement operations through first-hand experiences gained during training and assisting with active operations.

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Arlington, Va.: Hi Dr. Gerold, thanks for coming on today. Would having a medical unit like yours have made a difference at Va. Tech? What would you have done at a scene like that?

Dr. Kevin Gerold: I haven't spoken with anyone involved with the Virginia Tech operation, but I've heard indirectly that medical elements were part of the police response.

Our medical unit in the Maryland State Police uses state trooper/paramedics who are trained in tactical operations. These paramedics would enter the building with medical equipment along with the SWAT team and begin rendering essential care as required. At least one of our tactical physicians would also respond to this type of event. The physician would work with the law enforcement commanders to coordinate the care and act as the liaison between the police and local EMS services.

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Baltimore: I've heard talk about the "golden hour" when there is a good chance of saving somebody's life. How critical are those early moments? And what difference could a swat paramedic make, if he doesn't have much equipment and is possibly having to check things out lying on his side beside a victim?

Dr. Kevin Gerold: The golden hour is a concept developed by Dr. R Adams Cowley at the University of Maryland's Shock Trauma Center. Dr. Cowley believe that if you could begin to resuscitate a wounded individual within and hour and treat his/her injury, then he could save their life.

Experience in combat tells us that roughly 80 percent of deaths from otherwise survivable wounds occur from uncontrolled bleeding. Initial life-saving care in a shooting situation does not require much in the way of equipment. Initially, the objectives are to identify and correct major bleeding, if possible, to prevent shock. If the casualty is unconscious, it is important to make certain that the airway is open so that they can breathe.

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Silver Spring, Md.: How do law enforcement officers view the medical unit? What's your day-to-day working relationship with them like?

Dr. Kevin Gerold: When we first started the tactical medical unit more than 10 years ago, the SWAT officers viewed us with polite skepticism. Today, they view us as an essential part of their operation.

One characteristic of a tactical medical unit is the close working relationship that the physicians have with the trooper/paramedics and the SWAT officers. We train and work together so that we know each other personally.

During training, the tactical paramedics learn to think like the docs, and the docs learn to think like state troopers.

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D.C.: What kind of developments in battlefield medicine have come out of the Iraq war? It's been said the rates of wounded coming home (rather than dead) are much higher than in past wars because the treatment is much better.

Dr. Kevin Gerold: I believe the survival rates from battlefield casualties are the result of minimizing the time to definitive care. Combat units provide initial battlefield care, helicopters fly casualties to combat field hospitals where they undergo "damage control surgery" before transfer to higher echelons of care. This is similar to what occurs in Maryland with its statewide EMS system, State Police Medivac program, and network of trauma centers.

The experiences in Iraq have caused us here in the U.S. to re-evaluate the value of using tourniquets to control life threatening extremity trauma and specialized dressings that contain clot forming substances.

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Maryland: In the 10 years it's been around, about how many times a year is the unit called to a scene?

Dr. Kevin Gerold: The tactical medical unit in the Maryland State Police is part of the Special Operations Command. The unit responds to all high-risk, large-scale, and extended law enforcement operations. I believe we were involved in over 300 operations last year. The doctors go out for all of these.

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La Plata, Md.: Dr. Gerold: How does one apply for a position on your team? Is it made up of MSP officers who are also or then trained in emergency health services? Could an EMT-B or EMT-P qualify? What is the Web site for employment opportunities with your organization? Thank you.

Dr. Kevin Gerold: The medics on the tactical medical unit are all Maryland State Troopers. Some of the State Trooper/Flight paramedics in the Aviation Division wish to join the tactical medical unit. We have a selection process to select qualified candidate from the Aviation Division.

We currently have two full-time tactical paramedics within the Special Operations Command and five flight paramedics have undergone specialized training and back-up our unit on a part-time basis.

The Maryland State Police is always looking for qualified paramedics to become state troopers and work in the MedEvac program (advertisement).

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Washington, D.C.: Are you, or your fellow physicians, trained to deal with psychiatric issues, too? It seems to me that there must be a lot of questions of this kind in an event like a mass shooting or a hostage standoff.

Dr. Kevin Gerold: The Virginia Tech shooting was tragic. Part of the tragedy was that our system of care failed a a mentally ill individual.

As physicians, we are trained to provide initial care to persons with psychiatric conditions; as are paramedics

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Washington, D.C.: How did you get involved with the Medical Tactical Unit? Was there something in your background that made you a good fit? What kind of training did you go through to help start the program?

Dr. Kevin Gerold: Fell into it by accident. Started my medical career as an EMT, then paramedic, became a physician. Spent most of my career at shock trauma, so I was well prepared medically. I had worked with police officers in my past.

I identified an emerging need for a tactical medical element within law enforcement, crossed paths with Lt. Mark Gibbons (then Corporal Gibbons) who had a similar interest. We identified our common interests, sold the concept to the MSP leadership and the rest is history.

In addition to my medical background and being a lawyer, I trained with team. At the time we did not have a formal training program for docs, so I would train with the SWAT team.

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Dr. Kevin Gerold: Any more questions?

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