Prospective planning requires that emergency medical personnel, both EMS and hospital based, be familiar with the basic principles of personal and operational security utilized by police organizations and develop and exercise interoperative procedures for providing emergency care in the context of a law enforcement contingency.

The direct involvement of physicians in tactical law enforcement operations is a relatively new phenomenon. As recently as 1996, a survey of large metropolitan SWAT teams in North America demonstrated that 23% did not utilize a protocol for support by EMS, and 78% did not utilize a physician for medical planning (1).

The need for specialized medical support of law enforcement has recently been recognized by officers responsible
for tactical (SWAT) operations (2). Some law enforcement agencies combine tactical with search and rescue or technical rescue capabilities, and therefore have tactical officers trained and equipped for EMS operations within their special operations teams. Many other communities and jurisdictions provide technical rescue capability as part of a broader fire/rescue service, with variable degrees of interaction between EMS and law enforcement (3). Additional law enforcement specialty teams, such as negotiation units, may also benefit from medical support intrinsic to law enforcement (4). Evidence teams must develop protocols and procedures for evidence collection in the context of a suspected or actual release of biohazardous materials.

Some aspects of the law enforcement counterterrorism mission have required direct interaction with the medical community, both to ensure the safety of officers working to contain and control hazards during actual terrorist attacks and to assist law enforcement investigators tasked to collect evidence and other information necessary to protect the public from future attack. Existing procedures used by medical and other non-law enforcement public safety agencies are applicable to WMD counterterrorist contingency response and investigation (5).

Current public safety doctrine dictates that any counterterrorism contingency response assumes the potential for involvement of WMD. Police tactical teams must be capable of containing and potentially engaging terrorists in a setting of suspected or actual biohazard contamination. More frequently, investigators must conduct evidence collection in the context of potential or confirmed contamination. These incidents may involve preplanned evidence collection, as in the investigation of violations of laws governing hazardous waste disposal or in response to a terrorist act, as demonstrated in the criminal deployment of anthrax bacillus in Florida, New York, and Washington, D.C., in 2001. Associated requirements for PPE and plans for the management of potential exposure of officers due to breach of PPE require those law enforcement agencies without EMS or field medical capability to develop appropriate medical support plans.

The Federal Bureau of Investigation (FBI) has adapted the training, equipment, and procedures proven in fire service and industrial hazmat operations to the problem of evidence collection in a potential or actual contaminated crime scene. Requirements for medical monitoring (6), work-restcycles, and emergency response within the contaminated zone are addressed by law enforcement in a manner consistent with existing hazmat regulations (7) and procedures applied in the fire service and civilian industry. Integration into and collaboration with the existing local public safety infrastructure is an important part of these operations, which have served as a model for similar activities at various levels of government, both domestically and internationally.