Protective Medical Services

Medical Considerations for the Protective Service Detail

As protectors, the Executive Protection (EP) community is comprised of “Alpha-type” personalities who are well skilled and tend to focus on the “direct action” skillsets of the EP mission, the so-called “hard skills”.  But EP is more.  It is full-time customer service also.  EP agents serve their clients and their family members in a variety of ways, many of which were probably not envisioned while on the shooting range. Driving course or dojo.  While shooting, driving and combatives often define the qualifications of an EP agent, it may be other skills that define his or her effectiveness in protection when it matters most.  Frankly, pre-hospital emergency medical care is also a hard skill that any EP agent will likely use before a tactical reload.  The close protector will likely be the first responder when the Protectee grimaces and declares, “my chest hurts and I am having a hard time breathing!”.

It doesn’t matter if the Protectee is a high-ranking government official, a music superstar on tour or an ultra-high net worth entrepreneur on vacation, the mission of the Protective Service Detail (PSD) is the same: protect the Protectee and mitigate those risks that can be controlled.  Medical-based situations can often be effectively managed with training and immediate access to appropriate equipment.  (For the purpose of this article, “Protectee” includes immediate family members.)

Protective Medical Services (ProMed) Versus Medical Care…there is a difference!
“Protective Medical Services”, or ProMed, should be viewed as a much broader level of EP service provided than just direct medical care provided after the “bang”.  In addition to direct medical care of the Protectee before and after an incident, ProMed can encompass such things as pre-travel medical planning, destination medical intelligence, equipment and treatment readiness, medical training of the PSD, etc.  An “incident” can be anything where medical intervention is required ranging from a serious medical event (heart attack) to minor medical event (scrape to a knee or hand) to major trauma (gunshot wounds or auto accident).

Major Consideration Points
The PSD’s medical capability should be as serious and thoughtful consideration as the selection of the communications gear or type vehicles used to move the Protectee.  There is a plethora of factors to consider so let us look at two main overarching variables for determining the need for and skill level of an integrated ProMed capability into the PSD: (1) the Protectee’s “Travel Mode”, and (2) Protectee’s proximity and access to “definitive medical care”.  There is some overlap between these two variables and they are a constantly changing week to week and trip to trip.  Other factors like budget, Protectee’s wishes (if different from those of the hiring client), desire for confidentiality, and size of the PSD, among others, will also influence the decision.

Protectee’s Travel Mode
For ProMed considerations, Travel Mode refers to whether or not the Protectee is “static” or “mobile”.  In ProMed static mode, the Protectee is living at his or her main residence and going to and from his or her business or primary occupation location whether it is an office building, studio, athletic training ground or government facility on a regular basis.  Routine medical care such as physical examinations and appointments may be performed by the Protectee’s physician and the PSD may only encounter “non-routine” situations where immediate medical care is needed.

In mobile mode, the Protectee may be travelling away from his or her primary residence for days, weeks or longer.  They may be on tour, at a vacation location, at an international conference, or business meetings where hotels are the temporary residence and the language, culture and currency may be unfamiliar, and where local medical care and quality of facilities may not be up to Western standards.

If the Protectee is in static mode then the need for a high level of medical skill or certification integrated into the PSD may not be necessary since quality healthcare facilities, reliable transportation or 911 (or 999/112) Advanced Life Support (ALS) pre-hospital emergency medical services are likely close by.  If, on the other hand, the Protectee is in the midst of extended travel with multiple stops and venues or travelling internationally or remotely, an ALS provider integrated into the PSD may be the preferred option to ensure an immediate and known level of care within the “Golden Hour”—usually the first sixty minutes after onset of a serious medical or traumatic event in which definitive medical care and life-saving interventions can positively influence the outcome and survival of the patient.

Protectee’s Proximity and Access to Definitive Medical Care
Simply put, definitive medical care means the medical people, facilities, equipment and medications that can save a life or correct a serious medical illness or injury of the patient.  In most developed parts of the world, the quality of medical care is acceptable for most situations.  But even then, there still may be instances when definitive medical care is geographically close by but access to it is not feasible.  For instance, your Protectee is on a fishing trip offshore but the port and subsequent trip to the hospital is four-hours away.  In situations like this the PSD may require a higher level of medical skill integrated into the close protection PSD if access to definitive care could be delayed.  Further, an emergency is no time to struggle with language barriers, lack of medications, inferior facilities, cultural issues, etc.  An integrated medical provider into the PSD can go a long way to mitigate the unknown and uncontrollable alligators that may pop up with thorough pre-deployment/travel planning.

Appropriate Certification Level Required for the ProMed
Without question, any PSD should have some integrated emergency medical capability regardless of location or what the latest threat assessment is reporting.  The question is “what is the right skill level?”  While it may seem logical to think “highest is best”, such as a licensed paramedic or even a MD, the truth is the answer may be something else.  A licensed (sometimes referred as certified) paramedic is skilled in pre-hospital Advanced Life Support (ALS) and experienced in rapid triage, patient assessment and early care in a dynamic environment.  A licensed (certified) Emergency Medical Technician (EMT) is skilled in Basic Life Support (BLS) care and while doesn’t have the same level and quantity of advanced tools in his medical toolbox in comparison, he or she is also skilled in patient assessment and basic care in a dynamic pre-hospital setting.  In an emergency medical system, both paramedics and EMTs operate under the license, authority and supervision of a medical doctor and follow protocols established for that jurisdiction.  Some ALS skills a paramedic is trained to do, e.g., cricothyrotomy, are rarely used.  Many of the medications an EMS paramedic is allowed to administer are Class II or III controlled substances, e.g., Fentanyl and Ketamine, and tightly regulated.  In an EP setting, particularly if the Protectee is close to quality medical care, the advanced skills may not be needed or authorized for use.  A street-experienced EMT with solid patient assessment and trauma experience may be appropriate for the detail.  The EP Team Leader will need to determine the appropriateness (and availability) of deploying a paramedic or an EMT for the detail.  In situations when the decision is made to not have an integrated medical capability on the detail then it becomes even more imperative for the team leader to select members who have some medical skills or at least a level of ability to communicate effectively with the family physician or a responding EMS paramedic unit.

Minimum Medical Skills for the EP Agent

Medical skills are a hard skill and competence and proficiency will perish with time like shooting and combatives.  Every EP agent who will have ongoing close proximity to the Protectee should be expected to have a minimum baseline of medical skills and a solid stroke recognition ability.  As a minimum, EP agents should be capable of the following:

• Perform adult Cardio-Pulmonary Resuscitation (CPR) to include CPR for children and newborns if the Protectee has children in those age groups
• Use of an Automated External Defibrillator which should be part of the EDC med gear
• Extremity hemorrhage and wound management with a tourniquet and/or direct pressure,
• Stroke (Cerebral Vascular Accident) recognition and management (e.g., knowing the “Last Known Well” time) if Protectee is aged 40 or older.  While an EP agent can’t reverse a stroke, early detection and medical intervention are essential to minimize permanent cerebral damage to the Protectee.

Tactical Considerations

• Hospital selection:  know where the closest and most appropriate hospitals are located.  They may not be the same.  Know where the closest Level I or II trauma center, burn, stroke and pediatric centers are located.
• Air medevac capabilities: Know what is available and needed (helo or fixed wing back to higher level of care) and how to contact them.
• Availability of meds:  Ensure PSD has enough quantities of prescription meds used by the Protectee, e.g., insulin for diabetics, and ensure meds are taken as prescribed
• Foreign Travel:
• Medical intelligence: know the local situation on the ground for disease issues/health environment
• PSD’s, especially the advance agents, should know what the local 911/999/112 or emergency number and how to overcome a language barrier.
• Preplanning should exploit “friendly” resources such as home country embassy and expat community networks which will know what hospitals are safe and up to Western standards.
• Know local payment methods and consider having local currencies.

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Protective Medical Services
By Rick Charles, PCI, NREMT, TR-C

Rick Charles has served his country and community for over 32 years.  He is a former military officer, aviator and intelligence officer.  He currently serves as a senior national security investigator and threat analyst at the headquarters of a major U.S. federal agency and serves on a task force with the leading federal law enforcement agency.  Since 1995, he has served his community as a firefighter and 9-1-1 nationally registered emergency medical technician in three different states.  Rick is also the owner and founder of Polaris Intelligence, a fledgling Virginia-based protective intelligence firm.  He has earned certifications as an ASIS International Professional Certified Investigator (PCI) and Certified Tactical Responder (TR-C).