By Michael Carr, IPSA TEMS Committee Member

Paperwork, is a necessity to our existence. We have protocols, standard operating procedures, treatment reports, narcotic logs and training logs. Not only do policies help streamline our operations and keep our agencies organized, but they also help protect us from a legal perspective. This article highlights some standard protocols and SOPS, and it also asks key questions that your agency must start addressing.

Protocols: Do you only use the local hospital protocols? What about specific SWAT equipment such as hemostatic agents, dental emergencies, light suturing or even being able to numb prior to suturing? Some local protocols don’t cover tourniquet placement. What about giving a team member a nonsteroidal anti-inflammatory drug for a sore back or some acetaminophen for a headache? Don’t ever assume your Medical Director will authorize this, make sure any skill done is written in your protocol. 

SOPs: If you are fire department-based or ambulanced-based, contact your chief and discuss any special rules, legislation and needs of the team. Items to discuss include such as call in while on duty, weapons on station and staffing while at training. Again, any need or want outside of the department’s standard operating procedures needs to be documented. 

Treatment Reports: Are you going to do any paperwork for the treatment of a team member? This is a policy discussion to have between you and your EMS Chief, Fire Chief, Medical Director and Team Commander. 

I use an individual treatment form in which I describe the injury or illness, treatment and how the patient reacted. Once completed, the form is presented to another TEMS provider who audits the report, signs it and places it in a secured file. This system can be audited for both my reports security and content of the reports by the Medical Director or my EMS Chief from the Fire Department. Any treatment to a person outside of the Team must be documented according to my Fire Department SOG’s like a regular 911 EMS call.  

Narcotic logs: Narcotic logs should be self-explanatory. However, if you don’t carry any Narcotics – ask yourself why or why not.

Here’s a scenario to consider. There’s a call out to a drug house and a 34-year old male stripped naked, was acting weird and was combative, diaphoretic. Once the subject was placed prone and in handcuffs he goes into cardiac arrest - maybe it’s from excited delirium. Or maybe the subject has needles on him and an officer is stuck with a needle. Ketamine, a narcotic, in these circumstances could possibly save a life or two. Why? Do your research.   

Whether your team has the option to use narcotics or not isn’t the point. The point is for you to always do research to see if there are different treatments, equipment and tactics that can better your system. 

Training logs: Now, training logs can be used in a few different ways. They can provide proof of training that was accomplished and documentation of trainings that were taught.

If your TEMS unit is not teaching officers self-aid or buddy-aid at every training, then you are truly doing an injustice to your team. These training logs also will show the officers have been trained and tested for retention and competency in the skills being taught.

Another way to think of training logs is to consider them as production logs. A TEMS leader should consider writing a letter to the Team Commander outlining the year’s productivity to show the value of the TEMS program. At a minimum, the following should be captured in the training log:

1. Number of hours of training taught,
   
2. Number of people treated
   
3. Number of Team members treated
   
4. Public details
   
5. Goals for next year
   
6. Education or training performed to the rest of the police department.
   

In order to show value and sustain your TEMS Program, you must continually demonstrate success – and then brag about it. Through documentation, you can easily show the value of the TEMS Program, and even identify areas for improvement (e.g. more cross-disciplinary training).

Simply put, documenting productivity makes it easier to demonstrate value, the need for a TEMS program, outside education, upgraded equipment and additional personnel/resources.

Real-world, reality check

Let me step off my soap box and venture into reality. If your TEMS Team resists change, then start making subtle changes, be methodical and strategic about what issue needs to change first and go through the proper chain of command to explain why and how you want to instill change. 

Write out a syllabus for the year’s training schedule, make a plan, do your due diligence and be prepared for questions and some resistance. 

Explain to leadership that the mission of the TEMS program is make sure everybody makes it home alive.  Be systematic and document the testing process, test everyone’s skills, document the results and save them in a secure file.

I test our TEMS Team on tourniquet, chest seal, hemostatic agents and CPR every year. The biggest pet peeve of mine is when I’m asked, “do I need to tighten the tourniquet down?” Of course, you need to tighten it down. Two words, muscle memory saves lives – especially during crisis, high stress and unpredictable environments.   

Once the testing is complete I review everyone’s personal medical history, medications, allergies recent surgeries and then I obtain vitals. I’ve been asked about why I capture vitals. Simply put, if an officer becomes injured or ill how would I know what is out of the ordinary for that officer?

Ultimately, my goal is to be able to offer a First Responder Tactical course to police departments. Having a State or even National Certification would mandate a continued medical education program for police officers in order to maintain that certification. 

About the Author

Michael Carr is a member of the IPSA’s TEMS Committee and a 20-year Firefighter/Paramedic with the City of Noblesville, Indiana. He started Noblesville’s first TEMS program eight years ago having to write protocols and SOG’s without any training or experience. He is currently working in an administrative role on the TEMS Team. This past spring, he hired his replacement for entry on the team. It’s been bitter sweet, but a great relief knowing this individual is a good Medic and he’s passionate about the work. I continually strive to be better, make the TEMS program better and make sure my whole team goes home at the end of the call out.     

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