On Tuesday 4/29/03 the NYC Police Department's Emergency Service Unit was approved by the Regional EMS Council of NYC to provide an Advanced Life Support (ALS) First Responder Service.  ALS care will be provided for injured, ill or wounded civilians, police officers or others trapped in a tactical environment where the risk of injury exists and the scene is unsafe for a prehospital care provider not trained or equipped for inner-perimeter tactical situations.  If the NYPD wishes to expand beyond this limited area it must return to the Regional Council for approval.  The next step is for the NYS Department of Health to issue an ALS Operating Certificate.  Medication and controlled substances clearances, policies and procedures have to be secured or put in place and the Regional Medical Advisory Committee (REMAC) must also review the service's planned equipment and protocols.

POLICE DEPARTMENT, CITY OF NEW YORK
EMERGENCY SERVICE UNIT TACTICAL MEDICAL TEAM

OPERATIONAL PLAN
(As Submitted to REMSCO in 3/03)


The Tactical Medical Team is designed to respond to calls for service at the scene of tactical situations where the risk of injury exists and the scene is unsafe for a pre-hospital provider not trained and equipped for inner perimeter conditions.

The Team will be available for response twenty-four (24) hours a day, seven (7) days a week.  All Team members will be New York State paramedic and New York City REMAC certified providers.  The Team will have a coordinator and quality assurance officer to provide administration and record keeping.

The ALS unit will operate out of Floyd Bennett Field, Building 90, Brooklyn, NY and will respond as requested or needed to tactical scenes to fully equip the members of the Tactical Medical Team anywhere in the City of New York or locations outside of NYC with whom a mutual aid agreements exists.  [At the hearing on 4/10/03 it was indicated that NYPD ESU intends to equip possibly only one ESU vehicle as an ALS First Response Vehicle and have it respond when needed to join up with Team members at a scene.]

Response will be in various New York City Police Department vehicles.

Each Team member will be issued a tactical medic bag.  This will be a Blackhawk Industries S.T.O.M.P. II Medical Coverage Bag.  All ALS equipment will be safeguarded by the individual provider in Police department facilities and vehicles and they will insure protection from the environment, temperature and damage.

All providers will operate under New York City REMAC ALS and BLS protocols as approved by the Team medical Director and will follow direction of the established on-line medical control facility.

It is anticipated that the Team would have a maximum of twenty-five medics who are assigned to the various commands and squads that are located throughout the five Boroughs.

In the event that a Tactical Team member is not on duty and is requested, members will respond from home.  The Tactical Medical Team when not performing their regular duties will be either on patrol or in a patrol support function.  When requested by the Emergency Service Unit Incident Commander, they will respond to the location requested.  They will be partnered with either a second Tactical Medic or an Emergency Service Unit EMT if a second Tactical Medic is unavailable.  If requested, upon arrival of the Advanced Life Support First Response Vehicle all part 800.23 ALS and BLS equipment will be available.

If no Team members are available, the current practice of Emergency Service Unit personnel providing Basic Life Support and removal to awaiting EMS units will be adhered to.  New York State Paramedics and New York City REMAC certified providers assigned to the New York City Police Department Emergency Service Unit are the only Police Department personnel eligible to participate in this program.

All Team members must maintain a NYS drivers license.

On-line Medical Control will be provided by the Fire Department City of New York as per their agreement with the New York City Police Department Emergency Service Unit Tactical Medical Team.

When a Team member encounters a patient while in performance of their routine patrol duties they will be authorized to act as a paramedic on a BLS unit and perform the following skills (in addition to all BLS procedures) if indicated:
" Endotracheal Intubation
" Needle Decompression
" Needle Cricothyroidotomy

Team members will only perform treatment as authorized by the Medical Director and Medical Control Physician.

All Team members must allow all medical equipment, records, procedures and facilities to be inspected by authorized representatives of the NYS Department of Health Bureau of Emergency Medical Services.

The Team coordinator will maintain complete personnel files for all Team members including qualifications and levels of training.  Health records for Team members will be maintained by the New York City Police Department Health Services Division in accordance with current Police Department guidelines.  These records are reviewed semi-annually by the Medical Director.

The coordinator will maintain the records of all calls for service by the team.  All Team members will complete a NYS Pre-hospital Care Report (PCR) for all patient contact and forward to the team coordinator.

All equipment will be stored in Police Department facilities when not in use.  Daily inspections by Team members will assure that all medical equipment is clean, secure and any soiled or contaminated equipment will be disposed of with compliance to body substance isolation procedures.

Patient transport will be provided by New York City 911 responding ambulance in compliance with current New York City Fire Department and New York City Police Department procedures.
[Note: At the REMSCO Certificate of Need Public Hearing on 4/10/03, Detective John Busching, NYPD ESU Program Coordinator clarified this to mean any ambulance dispatched to the scene.]

The team will respond to calls for service within the five (5) Boroughs of New York City or as requested under current mutual aid plan maintained by the Operations Unit of the New York City Police Department.

Team members will notify the proper agency in the event of suspected: crimes, child abuse, patient abuse and/or domestic violence, including any directed toward the elderly.

Team members will reasonably search the area for any reports of a patient and contact the dispatcher for further information or call back.

Team members who need to gain entry to a patient may do so as they are trained and equipped to do so.

If a patient refuses assistance or transport and it is deemed to be against medical advice or protocol, the Team member will contact medical control and/or an FDNY EMS Supervisor.

Transport will be provided to any appropriate medical receiving facility.

If a receiving hospital requests that transport be made to anther facility, it will be honored if it is in the best interest of the patient.

Patients that are minors will be treated with life saving treatment until a parent or guardian is located.

Patients with a reported psychiatric problem will be presumed to have an altered mental state status until proven otherwise.

In the event of unattended death, if there are signs of obvious death or mortal injury, resuscitative efforts will not be begun and FDNY communications will be notified for the pronouncement, as is current practice.

The NYPD health Services Unit will do infection control, management and tracking of exposure.

Team members will act as medical support for NYPD ESU personnel at the scene of hazardous materials incidents if requested by an ESU supervisor.  All team members are trained as Hazardous Materials Technicians.

Team members will not routinely respond to MCIs unless specifically requested by the NYPD ESU or FDNY EMS Incident Commander.  They would then act a medical support for the NYPD ESU rescue team or as directed by the FDNY EMS Incident Commander.

Required Reporting
" Upon discovery by or report to the governing authority of the ambulance service, report to the Department's Area Office by telephone no later than the following business day and in writing within 5 working days every instance in which:
" A patient dies, is injured or otherwise harmed due to actions of commission or omission by a member of the ambulance service;
" An authorized EMS response vehicle operated by the service is involved in a motor vehicle crash in which a patient, member of the crew or other person is killed or injured to the extent requiring hospitalization or care by a physician;
" Team personnel are killed or injured to the extent requiring hospitalization or care by a physician while on duty:
" Patient care equipment fails while in use, causing patient harm;
" It is alleged that any member of the service has responded to an incident or treated a patient while under the influence of alcohol or drugs;
" On or in a form approved by the Department, maintain a record of all unexpected authorized EMS response vehicle and patient care equipment failures that could have resulted in harm to a patient and the corrective actions taken. A copy of this record shall be submitted to the Department with the EMS service's biennial recertification application.

ALS First Response Vehicle Requirements
Every ALS First Response Vehicle shall be equipped and supplied, meeting all requirements of 800.23.

Team members would be dispatched over NYPD radio SOD frequency 470.837.  each Team member would also be issued a Nextel two-way radio/cell phone.  This would be a secondary means of contacting on-line medical control.

[Team members would be provided] one or more of the following categories of advanced life support equipment as defined by medical control for the level of ALS care authorized:
" Fluid administration equipment and supplies
" Airway management equipment and supplies
" A defibrillator and supplies
" Medication administration equipment and supplies
" Other equipment and supplies to provide ALS care as authorized by medical control, the Commissioner and the State EMS Council

Team members will wear a tactical medic patch on their issued backpack and heavy vest which will be deployed in the tactical environment.  Team members will not wear any tactical medic identifying insignia on their patrol uniform.