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  • Writer's pictureTJ

Medics in the Hot Zone: Liabilities, Independents and Assets (LIA)

You’re sitting down for lunch with your shift when the EAS siren activates for an explosion and ongoing shooting incident at the shopping mall just 2-miles from your station. On route you receive updates from LEOs on scene, reporting multiple shooters inside with “wounded people everywhere”. On final approach, as you identify a safe place to stage, you don your department issued body armor and grab a loose-fitting helmet and an ‘active shooter bag’ full of tourniquets and gauze. Two additional police vehicles arrive next to you and officers grab plate carriers and rifles from the cruiser. The Officers take one look at you and your partner and say, “Can you folks come with us?”

I first heard about the LIA principles while training with a buddy Dom RASO, a few years ago. Having observed such a wide variety of ‘tactical EMS’ structures around the country, I feel it’s a worthwhile exercise to understand the differences and reflect on how you as a private or professional responder may rank, in your contribution to such major incidents.

In short, Liabilities are those that place additional burden on the available resources for their own security. This could be family members or the public that need to be controlled, corralled, or evacuated under imminent threat – Liabilities take attention away from Problem #1 (Stopping the Killing). In the context of professional EMS, the Rescue Task Force (RTF) concept is an example of managing EMS providers who are a liability in a Hot Zone. RTF requires armed police/LEO support to provide security escort to EMS personnel in the Hot Zone; enabling EMS to more rapidly access, stabilize and evacuate the most critically injured casualties.

By comparison to Liabilities, Independents are those personnel that can provide their own security and operate independently in the Hot Zone. While these Independent personnel may not be completely familiar with the tactics of responding security forces, they can be used to free up limited police and security resources to focus on their primary task. Put another way, while police and security forces are capable of taking new ground and advancing to a threat, Independents, can hold ground, protect ‘pockets’ of safety (Warm Zones) within a larger uncontained Hot Zone and divert or deny access to attackers, thereby contributing to the containment of the attackers. In jurisdictions suffering manpower shortages or in dealing with major critical incidents, this additional redundancy can be invaluable. In the context of professional EMS responders, this model sees EMS providers authorized to carry firearms exclusively for their own defense, and defense of their patient’s and others; should the priorities of police/security forces need to change on the fly. This may be through recognition of their existing municipal or state concealed carry legislation, or through special powers that the provider only has, while under the direction of law enforcement (e.g. Illinois Auxiliary police).

The last category of the LIA principle is Assets. Assets are those personnel that further enhance the capacity of police or security forces. Assets are familiar with the tactics of responding police/security force and can integrate into the team fully. In the most extreme circumstances, this may include paramedics that are fully trained and sworn law enforcement personnel; a titled referred to in some departments as a ‘Triple Canopy’ – Police, Fire, Paramedic (a term adopted from the US military). A Rescue Task Force comprising of such cross trained EMS Assets can deploy as a true self sustained task force, focusing on Priority #2 (stopping the dying), so limited police/security resources focus on their primary role – to stop the killing.

Slightly more center of the Asset spectrum, are EMS providers that are empowered to protect themselves, akin to Independents; while receiving additional training that enables them to perform many of the support tasks associated with such a tactical response. EMS providers that can assist with tasks like mechanical breaching, assistant grenadiers, AV driving, fire suppression or police rescue (ie. RIT) serve as force multipliers to the police units on scene and provide important rest & recouperation for Officers on prolonged callouts and more conventional special operations police responses.

There is no debating that sending EMS personnel into the Hot Zone exposes them to significant additional risk and is clearly not for everyone. Furthermore, this additional risk is not (or was not) in the EMS job description when many of our current EMS colleagues signed up. Moving forward though, as discussions continue about professionalizing EMS, increasing pay, and improving training standards to address the challenges of the next decade, recruitment must reflect the competencies and capabilities that EMS are increasingly being called upon to provide.

While special operations teams comprise of a range of specializations, it is imperative that every member of the team possesses core critical skills. Just because a team has designated Breachers, Snipers, Drone operators etc, doesn’t mean that all members of the team shouldn’t possess basic skills in these areas. Likewise, Medics, as team Assets must be prepared to fill the gaps if they are ever to be considered as equals; and risk is part of the job. Afterall Firefighter/Medics have been risking life and limb to for decades. Redundancy is key to success in many fields, least of which our own. Liabilities, Independents and Assets, all have a place – Which one are you?

Bio: The author TJ is a tactical paramedic and security specialist currently assigned to a rapid response capacity with an international organization, operating in the Middle East and North Africa. Affiliated with the Special Operations Medical, and National Tactical Officers Associations, TJ is an independent contractor for the US Dept of State - Special Program for Embassy Augmentation Response (SPEAR), TeamONE Network, Tactical Energetic Entry Systems (TEES) and Operational Skills Solutions (OSS). TJ has been with Penn Tactical since 2020 where he delivers a range of courses and works with industrial and commercial partners to establish capable onsite security/rescue capacities. To contact TJ for more information email us at

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