By Linda Childers
Nurses working on SWAT teams
A 35-year-old man had sustained a gunshot wound to his arm and was being treated by Julie Settles, RN, ACNP, CEN, WEMT-T.
This was far from a typical day for Settles. Her patient was a highly decorated SWAT officer, and she was tending to his injury in a “hot zone” area, with SWAT team members poised nearby negotiating with an armed gunman. And rather than wearing her traditional hospital scrubs, Settles was clad in a bullet-resistant Kevlar helmet and vest.
Settles, an emergency room nurse at Methodist Hospital in Indianapolis, is one of a select cadre of nurses who volunteer their medical expertise as tactical emergency medics on police SWAT teams. Law enforcement agencies and the American College of Emergency Physicians have started to recognize the need to have emergency medical care available at the scene of any incident involving police tactical operations. Settles and other tactical emergency medics work as actual members of the SWAT team, providing care and stabilizing patients until it’s safe for an ambulance to arrive on the scene.
Settles first learned about the role of tactical emergency medics when several SWAT officers signed up for a wilderness medicine course she was teaching. An avid adventurer, Settles was intrigued by the idea of offering her medical experience to the team, but quickly learned that no women had ever served on their SWAT team.
“One night we had an incident where one of our patients [in the ED] was wielding a gun and I intervened and was able to talk the patient into giving up his weapon,” Settles says. “I think that experience proved to the SWAT team that I was capable of working in tense and dangerous situations and had the skills needed to work as part of their team.”
Settles is now on call one week each month with the Indiana FBI SWAT team, when she’s not assigned to the emergency room. She responds to an average of six incidents a year, and although she has been caught in crossfire, she has never considered leaving the volunteer role.
“We joke around that SWAT means ‘sit, wait, and talk,’” Settles says with a laugh. “A lot of our calls involve hours of sitting around in the cold followed by two minutes of intense chaos.”
To train as a tactical medic, Settles participated in an intense 10-day course that included firearms training. She is also required to perform training exercises with the team on a monthly basis.
In addition to providing emergency care, Settles and the other medics instruct the team in preventative care and have put together a list of medication guidelines.
“We used a guide similar to that used by airline pilots,” Settles says. “There are certain meds such as Benadryl that we don’t want our officers using when they are called to duty. If they have to shoot a suspect, we don’t want to have their cognitive abilities put into question.”
After four years on the SWAT team, Settles hasn’t tired of the adrenaline rush that she gets whenever she responds to a call.
“I think being a tactical medic has made me a better nurse,” she says. “It forces me to think outside of the box, and there’s nothing that can happen in the ER that will faze me anymore.”
From nurse to police officer
Bill Keller, RN, BSN, CEN, has worked in special operations in the military, served as a paramedic, and spent time as a flight nurse. He worked as an emergency room nurse at Tuality Community Hospital in Hillsboro, Ore. until this past January, when he left to become a full-time K-9 officer and tactical emergency medic.
“My wife jokes that I can’t decide what I want to be when I grow up,” Keller says with a laugh.
These days Keller works full-time as a K-9 patrol officer for the Washington County (Ore.) Sheriff’s Department. He also responds to calls with the Sheriff’s SWAT team, serving as both a sniper and tactical emergency medic.
In addition, Keller instructs other nurses and other medical personnel in tactical emergency medical support (TEMS). His courses, offered through the Insights training program in Washington, teach medical protocols, tactics, and safety when operating in potentially hostile environments.
“Nurses who have emergency or trauma experience or a background in the military, as a flight nurse or as a paramedic, have the skills and experience needed to serve as a medic on a SWAT team,” Keller says.
As a tactical emergency medic, Keller provides immediate lifesaving treatment to his fellow team members as well as to hostages and the perpetrators. On one call, Keller was sent to care for an elderly blind diabetic who lived within the “hot zone” and couldn’t be evacuated. Due to the fact that her caregiver wasn’t allowed in the area, Keller stayed with her until the situation was resolved.
Keller enjoys the camaraderie of working as part of the SWAT team.
“It’s like having 30 brothers,” he says. “We work closely and are there for each other outside of work whenever someone needs a favor.”
Keller says his current job allows him to tap into his past work experience. In addition to providing immediate medical care on the SWAT team, he ensures that his team members are kept up-to-date on immunizations, and he stresses preventative care.
“Working as a tactical emergency medic is a different kind of nursing,” Keller says. “You’re not working in a sterile organized environment, and you need to be prepared for whatever comes your way.”
Creating the perfect job
When Navin Sharma, RN, BSN, CEN, couldn’t find the perfect job, he created it.
In 1997, Sharma discovered a way to merge his experience in nursing with a career in law enforcement. He works as a full-time police officer with the Vancouver (Wash.) Police Department and also serves as a tactical emergency medic with the department’s SWAT team and Civil Disturbance Unit (Riot Squad). Sharma, who began working as a nurse in the early 1990s, continues to work on call as an emergency room nurse at Providence Portland Medical Center in Portland, Ore.
Sharma is credited as the driving force behind creating the TEMS unit for his police department. He remembers approaching the SWAT team’s commander about the idea of having tactical emergency medics assigned to the team.
“I gave him a scenario where the airway of one of his SWAT officers was compromised,” Sharma says. “If the fire truck, which was several blocks away, responded to the call, it would have taken approximately six minutes, and the officer would have died.”
Sharma then illustrated how a tactical emergency medic on the SWAT team could quickly intubate the officer or begin performing advanced life support within a matter of seconds.
“Ambulances and fire department paramedics aren’t usually versed in the tactics of a SWAT team or the riot squad and aren’t equipped for a situation where they could come under fire,” Sharma says. “Having a trained medic working as part of the SWAT or riot units can mean the difference between life and death.”
The TEMS team now boasts four medics including two EMTs and one paramedic, and was the first police-based team in Washington to offer advanced life support services including medications, IVs, and some advanced trauma life support (ATLS) surgical procedures.
While on duty, Sharma wears a pager that could send him to a critical incident at any time. His patrol vehicle is equipped with all necessary advanced life support equipment including cardiac monitors, defibrillators, an emergency pharmacy with narcotics, and an advanced airway kit.
Sharma says his background as an emergency nurse brings a fresh perspective to his police work. He served as a volunteer firefighter, an emergency medical technician, and later a paramedic before going through nursing school.
Earlier this year, Sharma was one of a select group of officers chosen to work crowd control at the inauguration of President Bush.
“Because the terror alert was so high, they handpicked 3,300 officers from 72 agencies across the country,” he says. “We had a lot of incidents that didn’t make the news. There was a threat of hydrofluoric acid being tossed into officers’ faces.”
Sharma finds his work addicting and hopes his own nontraditional career path will inspire other nurses to consider second careers as tactical emergency medics.
“I come home each day feeling a true sense of accomplishment. If I have made a positive difference in someone’s life, then it has all been worthwhile.”
Linda Childers is a freelance writer for NurseWeek.