Stephen Crabtree, DO, FACEP
Center for Operational Medicine
Tactical Medical Section
Department of Emergency Medicine
Medical College of Georgia
The rewards of providing care to a SWAT team are innumerable. The risk, however, is incalculable. There is probably no other area in medicine that affords this level of risk, and as such, it has become difficult if not impossible to find the necessary disability and liability coverage needed to perform the tasks of a tactical medical provider with an adequate safety net. Liability and disability can be addressed in several ways, sometimes requiring clever and innovative means by which to obtain them. There are several models that can provide limited coverage, but a multifaceted approach will ultimately be required to provide comprehensive coverage.
One way to address the need for both liability and disability coverage is to consider becoming attached to a university based system that provides medical support to a tactical team. As faculty of the medical support program, a memorandum of understanding (MOU) can be generated between the university and the agency to provide medical care. As a university faculty, this mechanism affords coverage through the university as you are operating within your "scope of practice" as defined by the MOU.
Although disability can be addressed through a specific insurance carrier, we have not found one willing to cover our team for the specified duties as a tactical medical provider. Unfortunately, this has meant that some of our cohorts in the private sector have been excluded from participation due to the inability to secure coverage during missions. A nuance to this exists in that insurance carriers may be willing to provide disability coverage if specific risk criteria are addressed and adequate premiums are paid.
Outside of any MOU, liability can and should be addressed through state legislative action. In Georgia, we have had the opportunity to amend the state constitution to allow for physician coverage during a "Tactical" event. This provision allows for liability coverage of medical actions performed during any police related action, not just SWAT related events. This can be reviewed through Georgia State Bill 408. We also have a state code 16-3-21 that covers anyone assisting an officer in the dispatch of their duty.
Whether or not you carry a weapon during training and call outs will potentially create an opportunity for exclusion from both disability and liability coverage. This can be addressed through appropriate training, certification by the department heads and frequent re-qualification. Becoming certified as a reserve officer may be another approach. By doing so, your actions are covered under the departmental umbrella and addresses the law enforcement but not medical liability concerns. Unfortunately departments typically do not have underwritten policies with the dollar amounts required for physicians but it may be possible to create this avenue.
Remember that the issue of disability and liability coverage will require a multifaceted approach. Recruitment of key political figures is the paramount to achieving success. The example from Georgia was achieved after securing the assistance of the head of the sheriffs' association and aligning with state representatives. With the precedent set in states like Georgia our hope is that it will become easier for other states to follow the lead and amend legislation to protect those physicians who are willing to provide care in austere environments.
