The Game Is Changing: Building a Medical Plan for the Protective Detail

The security game is changing in the provision of medical care, and it's not just in EMS.

Pre-hospital care, EMS, and hospital services are all under strain. Staffing shortages mean many parts of the country now wait longer for an ambulance to reach the scene, and longer again once patients get to the emergency room. Clients know this, and they want a protection team that can deliver advanced medical care. That is why it is crucial that we offer advanced medical training to security personnel. When EMS is delayed, the team on the ground must be able to provide adequate medical care until paramedics arrive and take over.

It can occasionally be challenging to integrate the operational plan's security and medical care plans. Most people are very picky about who knows about their medical issues. Even as a doctor, the majority of patients will not always be completely honest, sometimes leaving out details like smoking, a history of drinking, or substance use that they may feel they could be judged for. Most high-end clients only trust their doctor with this information. Therefore, conducting a medical assessment is a very delicate subject and issue in the EP sector. Clients can be comforted that HIPAA (the Health Insurance Portability and Accountability Act of 1996), a federal law requiring the protection of sensitive patient health information from being disclosed without consent, applies to medical providers.

How should your medical plan be set up to work with your operational plan? As I see it, your medical plan has three parts:

The assessment should be carried out by the most qualified medical personnel on the team. This should be a person who at the very least has paramedic training with real-world experience, or a physician assistant, nurse practitioner, or physician. The assessment should ideally be carried out by the team's medical director, and there should be one paramedic on the team who is capable of carrying out some of the more complex medical examinations, procedures, and treatments. Along with the medical director, the paramedics can assist in ensuring that other team members are prepared to evaluate and handle medical emergencies.

Client Medical Assessments should be standardized and can be done in conjunction with the client's primary physician.

Does the patient have any of the following?

Appendix, gallbladder, CABG, extremity surgery, etc.

Heart attack, stroke.

This is helpful in informing providers that these deficits are chronic and not new.

Baseline Vitals: Is your client's heart rate in the 40s because they are an endurance athlete, or do they typically have blood pressure in the low 100s with a dip into the 90s?

DNR/DNI Status: Carry paperwork on your travels to prevent medical professionals from performing procedures that patients have requested not be done.

Power of Attorney: Who makes decisions when the client is not able to?

Pre-Travel Health Check: Is the client dealing with any ailment, pain, or not feeling 100% prior to a prolonged trip away from their daily medical care or medical providers? Should you recommend they get checked out by their primary medical team before traveling abroad, so as to get updated medications or equipment they may need if they start to feel worse?

The second phase of the medical plan is conducting a Medical Threat Assessment. Based on the location of movement, what medical condition or injury to the client is most likely to occur? Is it merely another day spent traveling the city? Are you traveling to a state or country where you won't have access to advanced medical care? Are you getting ready to travel for a long time to a place that might be more geopolitically unstable? Having said all of that, are you ready for even the most common emergencies? Do you have the skills necessary to handle the most common illnesses that might arise, according to the client's medical assessment? Have you reviewed the signs and symptoms, physical exam findings, and treatment of common emergencies that may occur given your client's medical history?

For instance, if the client has diabetes and you notice that their speech is slurred, confused, and unclear, do you know the differences between the symptoms of a stroke and hypoglycemia? Are you prepared to check their blood sugar with your glucometer? And do you have IV glucose or glucagon available in case the patient is lethargic and unable to take oral glucose when you get a blood sugar reading of 35? If the patient is now acting normally after receiving glucose and a subsequent blood sugar reading of 120, is it likely that the client had a stroke? (The answer is probably not: this is most likely hypoglycemia with no stroke component.) After the acute emergency is stabilized, call your medical director and inquire as to the cause of the client's problem.

Other things to consider: Have you received training in providing long-term field care, should the need arise? Have you brought enough medication to last the duration of the trip? What happens if your medications disappear or are somehow ruined? Where will you obtain medications while traveling abroad? Can you arrange express overnight delivery of prescription drugs abroad? Is it illegal to mail prescription drugs to another country if they contain controlled substances? When traveling abroad, you ought to have thought through and planned answers to all of these issues.

The final phase of medical planning is conducting the medical advance. Each situation that arises when traveling to a different city, state, country, or maritime area in international waters presents its own set of difficulties.

Know your people. Knowing your client, their family, and their friends is crucial for determining the kind of medical care they require in the event of a medical or traumatic emergency.

If you can't easily access an emergency room, such as if you're on a yacht in open water or flying in a private jet over the ocean, do you have advanced medical and trauma equipment with you? Are you able to keep an airway open while being transported to a hospital?

Based on where you're going, is there a disease that is endemic there? Chagas disease, dengue fever, malaria, and a number of other diseases. The CDC's Travelers' Health website is a fantastic resource.

These trips take place in areas that are farther from advanced medical care centers, in areas where there may be a higher incidence of crime or endemic disease. These are some of the fundamental considerations when working with a client who demands more sophisticated medical capabilities from their security team. A variety of planning and preparation will be needed for various details or journeys. We must be prepared for all emergencies that might occur, but we must also be over-prepared for those emergencies that are most likely to occur based on the Client Medical Assessment, Medical Threat Assessment, and Medical Advance we have conducted prior to any operation.