title: Into the fray: integration of emergency medical services and special weapons and tactics (SWAT) teams.
abstract: BACKGROUND
  The purpose of this study was to determine current experience and training of emergency medical support personnel for special weapons and tactics (SWAT) teams in North America.
  
  
  METHODS
  This cross-sectional, epidemiologic survey was sent to SWAT unit commanders from the 200 largest metropolitan areas. Questions included basic demographics, specialized training of emergency medical services (EMS) personnel, and where such personnel are deployed during tactical operations. Unit commanders also were asked to estimate the number and type of injuries sustained during tactical operations and to list any recommendations to improve the EMS response.
  
  
  RESULTS
  A total of 150 surveys was completed, for a response rate of 75%. The most common medical support (69%) was a civilian ambulance on standby at a predesignated location. Ninety-four percent of these prehospital care providers had no specialized training, and could not enter an area that was not secured tactically. Police officers with first aid or EMT training comprised the next largest group of medical support. Overall, 31% of SWAT commanders depended on remote EMS dispatch by radio to the scene when injuries occurred. Thirty-eight percent of respondents reported a significant injury had occurred during their tactical operations within the past 24 months. Common injuries included gunshot wounds, chemical exposure, and fractures. However, 78% (117/150) of respondents did not have a medical director, and 23% (35/150) of teams did not have an EMS preplan or protocol.
  
  
  CONCLUSIONS
  The results suggest a need for established EMS protocols, medical direction, and specialized tactical medical training, especially in large metropolitan areas.
authors.affiliation: Emergency Medicine Residency Program, Butterworth Hospital, Michigan State University College of Human Medicine, Grand Rapids, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Jones
authors.forename: K
authors.initials: K
authors.lastname: Reese
authors.forename: G
authors.initials: G
authors.lastname: Kenepp
authors.forename: J
authors.initials: J
authors.lastname: Krohmer
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians / Q000193:education* / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007373:Interinstitutional Relations; D009656:North America; D016495:Police / Q000193:education* / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014504:Urban Health