Preparing For Rescue Operations
By Scott Sheldon EMTP/T
President - SERT Group International

Rescue operations present a unique challenge to those executing the mission. For the medical operator it may mean having to deal with injuries caused by the environment, terrain, and hostile action. All in the same operation!  This months article is a reminder to all operators, military and civilian alike, that undertaking a rescue mission, may be the most dangerous of tasks we perform.

Most, if not all, organizations train for “man down” scenarios. Military SPECOPS teams have techniques, tactics, and procedures (TTPs) for quick reaction ops and casualty rescue. Techniques may differ, according to the tactical scenario, but all are geared toward the rapid removal of casualties, and friendly forces from harms way by whatever means are appropriate. But, what if there are obstacles impeding the rescue attempt? Some of these may include: hostiles still at large and able to employ effective fire on the rescuers, or the rescue team becoming weathered in. What if the situation was deliberately set up as an ambush? What if an operator is injured enroute to the rescue site?

Preparation for the rescue and medical care of an injured operator begins with effective training. The keyword here is: effective. The considerations, obviously, go beyond medical care issues. First there is the rescue itself, and the risk it will pose to the team executing it. Obviously, no one gets left behind, but is this going to be a rescue or body recovery? This requires a solid risk assessment. There may be no option, as in military operations such as Takur Ghar, where the battle of Roberts Ridge took place, or Operation Redwing, when 11 SEALS and eight Army SPECOPS aviators were killed as they prepared to help out a SPECOPS team engaged in a running firefight against a large enemy force. Both of these battles resulted in the necessity for quick reaction forces to be deployed resulting in the rescuers being ambushed. Both of these operations resulted in many fatalities.

In other instances, there may be time to assess and evaluate the situation before a decision is finalized. Hostage situations are often a good example of this, as are casualties down in an area that can be kept under observation.

In law enforcement tactical operations, teams may have to rescue downed officers, civilians, or hostages. Tactical medical operators need to be prepared for the possibility that one or more of their teammates may become injured during the rescue, adding to their casualty care load. Although law enforcement doesn’t usually face the same risks that are frequently encountered in SPECOPS missions and combat search and rescue (CSAR), the risks these officers do face can be equally significant and deadly. Think of Columbine High School, the North Hollywood bank shootout, or the Oxnard DMV shooting spree. These are just a few incidents that come to mind. Attacks against law enforcement are rising. Multiple victim shooting rampages are also increasing. Any one of these incidents can precipitate a situation that requires the rescue of personnel or
innocents.

The medical operator has to be prepared to provide input into the decision process, if asked. Hostage negotiators may need the medic to evaluate a suspects’ medical condition, or assess a wounded or ill hostage. To prepare for these types of operations, it is important for the medic to learn and practice other skills. Some of these include: remote assessment using binoculars, direct sight, or a weapon scope; barricade medicine, or the ability to communicate and assess a casualty using a third party via phone, radio, or other means, including direct communication. Training at night using NVGs, and / or infrared Cyalume light sticks is also an extremely beneficial skill. It takes time to get used to this gear and on a mission is not the time to figure that out.

A common complaint I hear from tactical medics, when they attend our courses, is the lack of creativity on the part of their training staff. Usually, it is just a basic “man down” drill with a predictable outcome. I personally believe that planning for the unexpected, using various and different scenarios, regardless of how improbable it may seem at the moment, can save lives. Create scenarios that require care under fire, tactical field care, and CASEVAC operations. Train with tourniquets, and hemostatic agents, and make sure all members of your team are familiar with them. Another issue is casualty recovery. Tactical teams spend a lot of time practicing movement to, through, and away from a problem. Does your team practice recovering downed personnel under fire? In darkness, or on rough terrain? Is there coordination during training with CASEVAC personnel, and transport platforms? These are important issues to consider.

What about utilizing equipment in training. Does your team practice movement to a casualty behind a ballistic shield or a car? Have access to rescue vehicles? Use these options in rescue scenarios, and find what techniques work best for any given situation. Practice will certainly make that task easier if it becomes a necessary option in a real world op. This is really what it comes down to: having options. Create rescue situations in various locations, and incorporate multiple victims, including hostiles, into the problems. Utilize urban, open field, and vehicle problems to gain confidence in executing a rescue in those environments; Place OPFOR players in apartments or in multiple locations. Remember, in urban operations multi story structures are the “high ground”. This type of training will ensure that every member of the team is keeping a 360 degree vertical and horizontal situational awareness.

Tactical triage is another issue. If there are numerous casualties to deal with, it will be the medics’ responsibility to coordinate triage and care. Set up training situations that require you to quickly triage and assign tasks to other members of the team , if needed, while under fire, or with other threats present such as, the possibility of a secondary explosive device. Occasionally, the medic should be the casualty. Practice self care, and talking other teammates through your own care. Put yourself out of the fight while other casualties occur and monitor how your team handles the first responder tasks. Stress in training is a good thing.

Consider the reality: during a rescue attempt on Takur Ghar Afghanistan, an Army Ranger Quick Reaction Force supported by SPECOPS aviators, an Air Force Pararescueman (PJ), and an Air Force combat Controller, suffered four KIA in the first fifteen seconds of a seventeen hour firefight against overwhelming odds. There were11 wounded for the 2 medics to deal with, eventually including one of them, a Ranger medic, who sustained three gunshot wounds. Does this type of situation apply to law enforcement? Remember the Cobb County, Georgia incident where several SWAT officers were shot just moments after entering a residence?

The last issue to consider is the prolonged operation. Hostage negotiations, inclement weather, terrain, and accurate incoming hostile fire can all cause an operation to become extended. Depending on the type of operation it is, the medic needs to prepare to treat casualties of the environment as well. Thinking ahead quickly (anticipatory thinking), while gathering gear for an operation can go a long way to helping save lives. Try to stay informed about any anticipated weather changes in your area of operations when preparing for a mission. A little preparation will go a long way.

Tactical operators don’t want to think about teammates or themselves becoming casualties during an operation. In the world of the tactical medical operator, it will be you that will have to deal with the immediate care, and management of an injured team member, civilian, or possibly, prisoner. Questions every medical operator needs to ask are: Am I prepared enough? Have I trained hard enough?, Is there anything I may be missing in knowledge or gear? Your team will be looking to you for answers, and will expect nothing less than your very best efforts. After all, that’s what you are there for.  

“It wasn’t raining when Noah built the Ark”

Stay safe, alert, and keep a prayer for all those at the sharp end.

This article is dedicated to the memories of the11SEALS and the USAF SPECOPS aviators killed during Operation Redwing, Afghanistan June 2005, while executing a QRF operation in the Hindu Kush, Afghanistan; as well as to those men killed on Takur Ghar, Afghanistan trying to rescue Petty Officer (SEAL) Neal Roberts during Operation Anaconda.