FEATURED AUTHOR
IAN McDEVITT

I learned about the importance of "the medic" right out of college while at Infantry Officers Basic Course at Fort Benning, Georgia, in 1988. The end of '88 saw me as a brand new emergency medical technician (EMT) jumping into prehospital emergency medicine with both feet. When I accepted a job with a commercial service that responded to half a city and the surrounding towns, I had no idea what I was in for. To say emergency medical services (EMS) or prehospital emergency medicine is an extreme occupation is an understatement. The next 13 years of my life would see me on the night shift in some of the most extreme situations I could ever have imagined; dealing with gunfire, knife-wielding drunks, and domestic disturbances was definitely not taught in EMT class. At one point, I worked as many as 80 and 90 hours a week for a period of several years doing "street EMS." This time was normally divided into 24- and 36-hour shifts in and around the city of Hartford, Connecticut.

The first thing I learned about was scene safety. Working in the fluid environment of the city taught me to keep my eyes open and to be constantly aware of my surroundings. I came to realize that often, although it doesn't seem so, help is far away.

Calls involving combative patients and multiple injuries were the norm. I quickly learned to set priorities: before treatment begins, you must ascertain how many patients you have and not allow yourself to get tunnel vision.

My education in EMS progressed to EMT-Intermediate and through paramedic school, which I attended at a level-one trauma center in the heart of Hartford while working full time. After receiving my license, I decided to take a little vacation and ended up in Dhahran, Saudi Arabia, working for a private company as an advisor to the Ministry of Defense and Aviation. While there, I taught classes to Saudi military medics during the day and worked in an ER as a paramedic at night. I was often tasked with long-distance transports, which consisted of bringing patients from city to city along the borders with Iraq and Kuwait.

After five months I returned to the States and resumed my first love, street EMS. My Tactical Emergency Medical Support (TEMS) education began several years ago at the side of Fabrice Czarnecki, MD, MPH, and current medical director of the American Society of Law Enforcement Trainers (ASLET). I had attended several classes with Dr. Czarnecki, and because he knew of my background as a paramedic and officer in the USAR Infantry, Airborne (U.S. Army reserves/National Guard), he advised me to try TEMS. I attended basic CONTOMS (Counter Narcotics Tactical Operations Medical Support), H&K Tactical Medical School, Blackwater Lodge Tactical Handgun I and II, Kni-Com, Knife Combat with Bob Kasper, Chem-Bio Weapons through the CONTOMS program, and High Angle Rescue class from the wilderness organization S.O.L.O (Stonehearth Open Learning Opportunities) in New Hampshire. Today, Dr. Czarnecki and I are co-instructors at the World Survival Institute in Tok, Alaska, teaching Wilderness and Survival Medicine for three weeks in the summers.

I currently operate as a paramedic from a small emergency room in northeast Connecticut, where we run a hospital-based intercept unit. This means that a single paramedic responds to calls from several towns in the area. In my case it's 17 towns and 115,000 people. I am the sole advanced life-support provider when I am on shift. As you can guess, we are very busy. The paramedics quickly learn map reading, diplomacy (dealing with the various volunteer units), and setting and sticking to priorities. In addition to approximately 60 hours a week doing street EMS and teaching classes to local fire departments, I operate as advisor to several area Emergency Response Team (ERT) officers, medics, and police officers and accompany them on training exercises. On my down time, as diversions from finishing classes for my Registered Nurse (RN) certification, I work out and spend time chasing my yellow lab, Tigger, along northeastern Connecticut’s wooded trails.

Q & A

Paladin: What led you to write Tactical Medicine?
McDevitt: I wrote Tactical Medicine to fill a definite need. I really believe that there is not a single book published that lays out the information as clearly and completely. I wrote the book from the street medic's point of view, and I believe EMTs of all levels of experience will find it full of useful information that they can adapt and apply.

Paladin: What is the most important thing you teach in Tactical Medicine?
McDevitt: The single most important thing for the tactical medic to learn is patient assessment. There is nothing without timely and accurate patient assessment. The medic has to refine his or her skills and keep them sharp. Assessment is the key to success. Tactical Medicine outlines the immediate assessment methodology needed to succeed in rough situations.

Paladin: How has street EMS changed in the years you've been doing it?
McDevitt: When I first started in EMS, it was like the Wild West. We drove like maniacs, kicked in doors, climbed through windows, subdued violent patients – and as a group we were inseparable. Things were a lot more lax back then. I also think that back then we didn't have half the technology or half the capability we have now to treat the patient effectively.

Paladin: What are the common misconceptions about your line of work?
McDevitt: There are several common misconceptions. The salaries, the hours, the danger – all are underated. We don't make any money, we work outrageous hours, and it's extremely easy to get sick.

Paladin: What was your most dangerous rescue?
McDevitt: My most dangerous rescue? After 13 or 14 years they all kinda blur together. I work alone and have been for the last six years. Each time I go out I push it. Everything we do can take a terrifying turn very quickly. I push it so hard some times that I even wonder myself. In the last six months I've had a 15-year-old shot in the back several times and a young correctional officer shot in the abdomen with a .357 Mag. I just recently responded to a car-vs.-pole involving four drunk college kids, driver and front seat passenger trapped. There was very little help on scene, and it was pouring rain, no helicopter available. The closest hospital was a level three, which means they do not handle multi-system trauma. The extrication went from bad to worse when the cable to the Hurst tool got pinched and snapped, spraying hydraulic fluid under my glasses, into my eyes. I still had to manage the airway on these kids and gain some IV access. All went well, and I went home that night with both eyes bandaged. I think I had a little help from up above. I know that because I'm not that good. Somebody decided to smile down on me and give me a hand that day.

Paladin: In your opinion, what's the best tactical medicine course out there today? Why?
McDevitt: There are several TEMS courses being offered now throughout the United States. I know that INSIGHTS, based in Washington state, offers a course that is supposed to be excellent. The best course I have attended had to have been H&K Tactical Medical School. The instruction is great, mainly because the staff is extremely knowledgeable and approachable. Dr. Lawrence Heiskell runs the program. Most of the staff are physicians and actively involved with emergency response teams or law enforcement-related medicine.

Paladin: What advice would you give to newcomers interested in entering the field of emergency medical care?
McDevitt: I'd tell them that it's not what you think. There are many sleepless nights, hours away from your family, and extremely dangerous situations. People involved in emergency medical services have a particular personality type. They are a mix of hero, loner, and realist. I'd tell them to check around and make sure this is really what they want to do. I'd tell 'em to get involved with a volunteer department in their area and run a few calls – see how they enjoy that before they commit to something. Then I'd more than likely tell them that no one ever got rich in this field; they'd better be getting into this field for something other than money. There has to be something else that draws you to emergency medical services.

TACTICAL MEDICINE
An Introduction to Law Enforcement Emergency Care