Medic On Board
In the post-9/11 era, the spheres of public safety overlap more than ever. Against varied and complex threats, EMS, fire and law enforcement have to work closely together in a tightly knit tapestry of fast, safe and efficient response.
That’s why it makes a certain sense for even the Federal Air Marshal Service—tasked with the safety and security of the nation’s civil aviation—to have an EMS wing.
“We’re a group of individuals with unique and dynamic backgrounds who answered the call after 9/11 to come and do this,” says John Matthews, special agent in charge of the program. “A lot of us had law enforcement backgrounds, some had military backgrounds, and a lot had medical backgrounds. With the requirements of the air marshal service, it has to be a group of people who are highly trained, highly motivated and able to deal with just about anything that comes their way.”
EMS is a collateral duty for FAMS; its primary mission is law enforcement, and safety/security concerns always take priority. But its prehospital cadre is available for deployment as needed by major events and, individually, to provide medical assistance if emergencies happen in flight.
That depends on circumstance and is at each marshal’s discretion. It’s generally only for serious events. If they do respond to a passenger, they need not identify themselves as marshals. They’re traveling EMTs or paramedics willing to assist—true enough.
“The safety and security of the aircraft is always the primary responsibility, but if our people choose to engage, they can,” says Matthews. “They’ve done so on a number of occasions—not for minor things like airsickness, but assisting childbirths, cardiogenic shock, anaphylactic shock, sepsis. We see our share of very serious medical emergencies.”
The larger component of the FAMS EMS mission is force protection at large or protracted incidents. In fact, it was this kind of post-hurricane support that drove the feds to colligate and streamline the program over the last few years.
EMS had been a part of the FAMS mission since the beginning, but without much defined form. Leaders in the service’s various field offices developed programs that worked for them. All had capabilities, but they weren’t standardized or well-linked horizontally.
“People were doing the right things for the right reasons, but it was disjointed,” Matthews says. “Houston didn’t know what Dallas was doing, which didn’t know Miami’s capabilities, who didn’t know what the New York office brought to the table, but we’d all end up on the same scene. So with the hurricane deployments, we realized, Here’s a learning takeaway. We can bring this in house, clean it up, codify it, and establish some benchmark training and equipment.”
With the support of higher-ups, Matthews, a medic in South Florida since the mid ’80s, orchestrated the necessary purchasing and training. The result today is an ALS-capable force of around 200 providers FAMS can deploy alongside other responding assets to bolster a federal response. The EMS arm also provides training support for FAMS’ local field offices.
Because of the austere environments in which its agents can work, FAMS’ EMS protocols are a bit more wide-ranging than local providers may be used to. They include components of wilderness medicine, advanced burn treatment, digital nerve blocks, even emergency dental extractions. Deployment to a disaster or on a flight can take providers anywhere in the world, and on planes and after major events, providers may only have a fraction of the equipment and meds they might need, so FAMS providers have to be adaptive and self-sufficient. In fact, because they get relatively fewer opportunities to exercise their skills on real patients, they have to be particularly good.
“Their margin for error is very small,” says Matthews. “We make it up with training, and try to augment it with a scheduling matrix that gives the marshals a certain number of days each month where they’re down to do administrative stuff. In most cases, the EMS providers can use that day in our field offices to go out and ride with their local services. That helps them keep their touch in the field and keep everything fresh, because they’re very perishable skills.”
Performing 100% QA/QI on patient care reports helps the service identify and prioritize training needs. An emergency doc, Daniel Weeks, DO, an attending physician with the Philadelphia-area Kennedy Health System, serves as FAMS’ top medical officer.
In the complicated mosaic of major incident response, it’s not an easy thing to put together a top-notch team and integrate it effectively with the panoply of state, local and other providers who’ll be answering too. Templates like NIMS help define roles and duties, but politics and turf battles can still hamper operations.
FAMS has been able to avoid that on the EMS side, Matthews says, due to its law enforcement orientation and the street-level backgrounds of its people.
“We’re the worker medics. We’ve all been down in the weeds,” he says. “We’ve all done our time riding trucks and running calls at 3 in the morning, and now that we’re in management positions, I think that helps us avoid the kind of political teeth-gnashing that can happen when organizations with disparate functions and backgrounds try to conduct an operation. We work extremely well everybody.” That includes contacts and colleagues across the emergency world from marshals’ diverse pre-FAMS backgrounds.