The tactical medic’s job is to maximize mission success by providing appropriate medical care before, during, and after missions. The most important aspect of this job is to prevent injury and illness from occurring, not just treating injury as it occurs. Tactical operations are inherently dangerous, and minimizing the risk to operators not only keeps them safe and injury free, but also ensures the success of the mission. Most special operations units have operators with unique attributes and capabilities. The loss of one of these members (e.g., sniper) to a preventable injury, such as a corneal abrasion from a tree branch, can significantly impact the success of a mission.

Injury prevention starts with adequate medical planning. Predicting medical threats associated with specific situations and developing medical assets and transport systems to accommodate potential injuries will help to minimize morbidity and mortality in the hazardous tactical environment.

Preparing operators before deployment with appropriate physical conditioning, health surveillance and immunizations will also help to ensure mission success. By addressing these issues prior to deployment, the provider will minimize medical equipment needs and will be able to inform the mission commander of any significant health-related issues that may impact operator performance.

Physician level medical oversight is essential in establishing good preventative medicine in the tactical community. This ensures the best guidance to the tactical medical provider, and protects the medical team in the event of an untoward outcome. The licensed practitioner is ultimately responsible to the tactical commander for all preventative medicine measures applied by members of the tactical medical team.

Preventative medicine in the operational environment has a broad scope, covering topics from food handling to immunizations to injury prevention during incidents. By addressing these issues before, during, and after deployment, the tactical medic will help to ensure operator well being and mission success.

The tactical medical provider should take as much time as possible leading up to deployment to assess the potential medical threats that members of the tactical team may face based on the intelligence given for a particular situation. The amount of time tactical medical personnel have to complete this planning may be minutes to weeks, depending on the type of incident. When developing a written survey of possibly medical hazards, the medic should work closely with the mission commander to ensure that he/she is informed of potential risks/complicating factors associated with a given situation and can possibly make alterations in mission planning where needed. This information should be documented in a concise, legible format so that it can be easily distributed to team members as needed.

The following is a list of data to be included in the development of medical risk survey. For each category, the survey should identify all conceivable risks and propose solutions to prevent operator illness or injury in a brief and easily referenced manner (Fig. 17.1).

1. Incident specific risks: Opposition weapon systems, known or possible chemical/biological warfare agents, preplanned evacuation routes, weapon systems utilized by the tactical team, entry methods, and other specific threats and hazards that members of the tactical team may face based on the situation.

2. Environmental health threats: Extreme heat or cold, hydration needs, nutritional needs based on the intensity of operator activity, sanitation considerations, risks associated with local wildlife/plant life, and specific risks associated with unique terrain (i.e. mountainous, desert, waterborne, etc).

3. Disease concerns: Should include diseases not covered by standard vaccinations, potential food borne illness, body fluid precaution risk, and region specific disease concerns as dictated by local departments of health or the Center for Disease Control.

4. Climate/weather forecast: Climate can be predicted based on location and time of year. An extended forecast should be obtained, in the event of prolonged or sustained operations. These can also be updated actively during deployments.

5. Regional medical assets: If air/ground evacuation support for casualties is not part of the deploying unit, the tactical medic should be aware of local/regional medical assets available from the civilian community, or possibly the military. If the potential exists for the utilization of medical evacuation assets outside of the tactical team, consideration should be made to informing these services in advance of the operation. This release of intelligence is clearly dependent on the secrecy of the situation.

6. Medical facilities: In addition to planning for casualty evacuation, the tactical medical team should know locations and distances to the closest medical facilities, the closest trauma center, and the closest burn center. Locations for hyperbaric chambers should also be noted if dive operations are planned. The ability to communicate with such facilities including radio frequencies and telephone numbers should be obtained. An assessment of the capabilities to include trauma center designation, ED physician staffing capabilities,
ancillary service availability (e.g., CT scan), presence of a helipad and its specifications, and which specialties are represented at the facility should be obtained in the planning phase.

7. Hazardous materials teams (HAZMAT): Contact information for local/regional/national HAZMAT services should be available regardless of whether or not this type of threat is anticipated.

Most of this information can be obtained via the internet and possibly a few phone calls. For the medical facilities and regional medical assets, face-to-face contact is the ideal option, as it helps them understand the mission and what to possibly expect in the event of casualties. This interaction is clearly limited by the level of operational security, which needs to be clearly established by the mission commander prior to any data collection. The ATF raid on the Branch Davidian compound in Waco, Texas, was compromised by an OPSEC breach for medical planning and extreme caution must be used when interacting with outside agencies and civilian EMS.

Because the time from the start of incident planning to actual deployment is extremely variable, it is important for the tactical unit to maintain records of previous risk surveys, which can be reused in the event of a return to the same location or environment. By developing a thorough risk assessment survey, the tactical medic can help prevent a great deal of unnecessary injuries as well as be better equipped to handle medical incidents as they occur.