Tactical medicine: Is this potentially dangerous subspecialty right for you?

By Anastasia Climan, RDN, CD-N | Fact-checked by Barbara Bekiesz
Published February 14, 2024

Key Takeaways

  • Tactical medicine integrates doctors into SWAT teams and police forces.

  • Balancing the ethical standards of medicine and the interests of law enforcement may be challenging.

  • Doctors bring tremendous value to high-risk situations, but only when proper training and protocols are in place.

A controversial but innovative trend has emerged in law enforcement—putting doctors on the tactical squad. Mass shootings and terrorist attacks have led to rapid deployment strategies, which aim to neutralize threats as quickly as possible. This shift towards a more proactive response includes early medical care, often directly at the crime scene. 

While military settings have involved doctors for decades, integrating them into civilian police teams is a relatively recent move that raises ethical dilemmas. Here are some crucial considerations for the responsible practice of tactical medicine.

What is tactical medicine?

Tactical Medical Providers (TMPs) work with SWAT teams, federal law enforcement, and military special operations. They augment emergency care in situations where normal EMS teams cannot respond.

According to the American College of Emergency Physicians (ACEP), TMPs play essential roles before, during, and after deployment to a mission.[]

Examples of their responsibilities may include:

  • Assessing medical threats

  • Providing casualty-care training

  • Delivering emergency care on-site

  • Accompanying injured or ill personnel to the hospital

  • Reviewing operations, identifying mistakes, and providing recommendations

Tactical medicine fellowships are available nationwide and range from 1 to 2 years.[] To apply, you must be board-certified (or board-eligible) in emergency medicine, able to pass a background check, and willing to participate in potentially dangerous missions.

Navigating blurred lines of duty

Traditionally, the roles of police officers and medical professionals have been distinctly separate, each with its own set of ethical guidelines and obligations. Integrating doctors into police tactical teams blurs these boundaries, potentially leading to conflicts of interest or compromised professional ethics.

An article in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine outlines some of the ethical issues in this line of work for physicians to consider.[]

In some cases, law enforcement's duties may conflict with a physician's role to prioritize patient care above all else. Conflicting priorities are only heightened in stressful and risky scenarios with such high stakes.

Physicians in tactical roles are tasked with balancing their responsibilities toward patients and the team's objectives. A physician who is also a sworn police officer may feel pulled in different directions when making care decisions. For example, these doctors may be obligated to use force, harming an individual while eliminating a greater threat to protect public safety.

Defining and understanding the physician's role within the police team regarding medical vs tactical decisions is crucial to avoid dangerous delays in action.

Ensuring specialized training for doctors

Physicians face nuanced risks in tactical settings, and decisions regarding their placement shouldn’t be taken lightly. While doctors have extensive medical expertise, they may lack the specialized training required to navigate high-stakes volatile situations characteristic of police work. 

The ACEP explains that TMPs may be at risk for various hazards, such as gunshot and stab wounds, explosions, biological or chemical weapons, burns, PTSD, head injuries, infectious diseases, animal bites, and illicit drug exposure. As a result, they must have training in weapons safety, waterborne operations, HazMat, wilderness deployment, defensive tactics, and more.

Without adequate training in tactical procedures, safety protocols, and law enforcement, their inclusion could pose risks to everyone involved. Police forces have an ethical responsibility to ensure physicians' proper training and preparedness, including ongoing training and evaluation.

Protecting patient confidentiality

As the authors writing in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine point out, balancing confidentiality with the need to disclose crucial information, especially if the patient is a suspect posing an immediate threat, can emerge as a significant challenge to healthcare providers who have a deeply ingrained sense of obligation to protect patient privacy. Doctors operate under strict confidentiality codes, safeguarding patient information to maintain trust and uphold individual rights. 

In a scenario where a doctor is part of a police tactical team, law enforcement may demand immediate access to medical information that could compromise patient privacy. The need for real-time information in crises vs the fundamental rights of patients presents a complex ethical dilemma that should be clarified before placing doctors in volatile situations.

Should doctors be part of the team?

Certainly, there are many questions and concerns to address before doctors join police operations. Establishing clear guidelines, protocols, and oversight mechanisms is essential to ensure the safety and success of tactical medicine programs. Robust training programs must equip medical professionals with critical tactical skills while reinforcing their ethical obligations. Moreover, TMPs need frameworks that safeguard patient confidentiality while allowing necessary information sharing in a crisis.

Introducing doctors into police tactical teams demands meticulous attention to prevent unintended consequences and maintain the integrity of both professions.

What this means for you

While physicians in tactical teams present a new opportunity to save lives, they can also represent an obstacle to police work if not properly prepared and integrated into the team. Clarity in roles, proper training for high-stress environments, and alignment with medical ethics are vital for physicians to contribute effectively while upholding professional standards. If you’re up for the challenge, a career in tactical medicine may be right for you.

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