How Dr. Alexander Eastman Helped Redefine Tactical Trauma Care in Dallas

Emergency response in the U.S. had a predictable pattern for decades. Police secured the area of an incident. Emergency Medical Services (EMS) would stage their vehicles near the scene. Hospitals would then wait for EMS to bring the injured patients to them. This approach worked perfectly in theory; however, it did not work well in practice with respect to gunshots, chaotic situations, and/or active shooters.

The Dallas Police Department (DPD) developed the Tactical Medic Program to address the gap between theory and reality. Dr. Alexander Eastman had treated numerous patients who were technically alive upon arrival at Parkland Memorial Hospital/UT Southwestern Medical Center; however, their survival outcome was decided prior to entry into the operating room. Dr. Eastman believed that the issue was not lack of medical expertise/surgical skills, but rather delayed treatment. Patients suffered from uncontrolled bleeding, limited access, etc., and received medical care too late.

Instead of accepting these patient outcomes as inevitable, the DPD asked a different question: what if advanced medical treatment could be provided at the location of an injury instead of waiting for the patient to be transported to a hospital?

The Tactical Medic Program incorporates clinically competent medical personnel into law enforcement tactical units. As such, these medical professionals do not wait for the scene to be secured, nor for ideal environmental conditions to exist. These medical professionals are trained to provide critical life-saving interventions in conjunction with officers in unstable and potentially hazardous environments while threats may still exist.

There are three major distinctions between the DPD's Tactical Medic Program and conventional emergency medical response:

Firstly, the DPD program views scene safety as fluid and therefore addresses risk management instead of risk elimination.

Secondly, the DPD program prioritizes early hemorrhage control and providing early medical intervention versus just transporting patients.

Thirdly, the DPD program understands that time spent before arriving at a hospital is more important than anything that can occur after.

Unlike traditional tactical medical support, which typically involves paramedics staging at the perimeter of the scene, the DPD program provides advanced medical capabilities as part of the tactical unit itself. The medical personnel not only receive training in the provision of trauma care but also receive training in movement, communication, and operational command structures utilized during law enforcement operations. The ultimate goal of the program is to facilitate coordination among all stakeholders involved in law enforcement operations, rather than create separate entities.

The DPD program has been implemented in actual operations, including officer-involved shootings and mass casualty events. These events have illustrated that systems designed to wait for certainty will likely fail under the duress of an emergency situation, whereas systems that account for uncertainty will generally perform better.

Therefore, the implications of the DPD Tactical Medic Program extend beyond the City of Dallas. The concepts of this program have impacted the manner in which many agencies throughout the nation view tactical emergency casualty care, active shooter response, and public safety medical planning. The DPD program demonstrated that early control of bleeding, rapid decision-making, and an integrated response to emergencies can result in the preservation of life regardless of whether or not the circumstances surrounding it are controlled.

Crucially, the DPD program does not suggest that violent activity no longer carries any risk or potential loss of life. By definition, violence generates uncertainty. Rather, the DPD program challenges the notion that medical care must be isolated from harm to be both effective and ethical. Rather, the DPD program presents a framework for preparedness as a design choice. The location at which care can be initiated reflects what organizations value most: either tradition or outcomes.

The DPD program also introduces challenging questions. For example, what level of risk is acceptable for medical personnel? How should authority be shared between clinicians and law enforcement? What responsibilities should rest with systems versus individuals? There are no simple answers to these questions, and the DPD program does not purport to provide them. The DPD program's contribution is not in terms of providing certainties, but rather in clarifying existing trade-offs.

Ultimately, the DPD Tactical Medic Program embodies a paradigmatic shift in thought. Trauma care does not commence at the entrance to a hospital. Rather, trauma care begins the moment an injury occurs. Acknowledging this fact and designing systems accordingly will ultimately contribute to reducing avoidable losses.

The DPD program's lasting influence is not based upon innovation for the sake of innovation, but rather upon its emphasis on pragmatism. When seconds count, so does proximity. When environments are dynamic and unpredictable, systems must be designed to function in similar environments. Waiting for optimal conditions to initiate an emergency response is itself a decision, and frequently the most expensive one possible.