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Embedding a surgeon in a civilian tactical team reduces resource utilization and is cost effective

Lewis J. Kaplan, MD, FACS, FCCM, FCCP, Kevin J. Glenn, BA, Adrian Maung, MD, FACS, Jonathan Mulhern, MBA

Abstract


Objective: This study evaluates whether embedding a surgeon in a civilian tactical team (Special Weapons and Tactics [SWAT]) reduces resource utilization during training or deployment and is cost effective.

Design: Prospective, noninterventional.

Participants: All tactical police surgeon (TPS) activities (2011-2013) were prospectively captured via databases (Bento and Excel) including days of activity, training and deployment care (team members, suspects, and bystanders), academic activity, costs incurred for equipment and training, as well as costs avoided by onscene care and evaluation. Umbrella activities related to non-SWAT care and system referral were recorded.

Interventions: None.

Main outcome measures: Resource utilization, costs, and outcomes derived from embedding a surgeon in a civilian tactical team.

Results: There were 24 days of training and two deployments; 3 days of staff coverage were required. Team members required 18 distinct care episodes; no suspects required care. Bystander care was required twice; both were treated on-scene avoiding transport and hospital care. Non-SWAT care occurred 36 times. No complications occurred except for one urinary track infection. Comorbid medical condition evaluation and management advice in non-SWAT officers, spouses, or significant others occurred 24 times. New health system referral occurred 26 times. Total TPS equipment charges ($6,000) were offset by reduced scene transport ($3,000) and hospital care ($4,000), as well as reduced team member hospital care ($9,000) leading to a net Police Department (PD) charge surplus of (+)$9,000. New referral initial evaluation ($10,400) and operative charges ($30,800) were balanced against lost work ($6,500/d × 3d = $21,500) for a net health system charge surplus of (+)$19,700. One international presentation, three local presentations, and four peer-reviewed and five lay press publications accrued from these activities.

Conclusions: A TPS reduces scene and Emergency Department resource utilization and increases new patient health system entry. Establishing a TPS is cost effective for a PD and an academic health system and supports academic productivity but may not be supportable without nonclinical days.


Keywords


law enforcement, SWAT, resource utilization, Tactical Emergency Medical Services, trauma surgeon

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References


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DOI: http://dx.doi.org/10.5055/ajdm.2014.0148

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