Lessons Learned from LE Medicine with the Dallas Police Department

- [Springer] Just that I'm actually really thrilled to have these two guys here, 'cause they definitely have been in the forefront as far as for tactical EMS for a long time. And I mean, kinda starting from back in the days where this was looked at as this sort of little niche thing and as it's grown in importance and these guys were on the cutting edge right from the get go and continue to be very actively involved. And I'm just, I'm thrilled to have them here and looking forward to having them talk. So I'll turn it over to our speakers.

- [Metzger] Awesome. Thank you guys. Definitely happy to be here. Certainly nothing makes me feel older than to say I've been in this field and particularly with the Dallas Police Department for a little over 17 years now, which has been a long time, a lot of pretty amazing experiences. Just a quick little bio. So I've been here in Dallas with the police department since 2005. First actually started a little bit with the Durham set team, the selective enforcement team, kind of their version of a SWAT team since about 2003, came here to Dallas in 2005, have been with UT Southwestern and Parkland Hospital since then. And then Alex, you wanna kind of introduce yourself?

- [Eastman] Yeah. You bet. Good to see everyone. There's there's literally folks. I checked the participant list. There's people I've known since before I was in high school and people from this part of and mentors and friends, so good to see everyone. Yeah, so I am with Jeff, have been at this about 18 years. I started the year before Jeff and the fellowship and laid a little bit of groundwork. And then we have been partners in this for the last 17 years. And I couldn't ask for a better friend and brother and guy go through this with, so as you know, I feel a little bit like the hen in the rooster house or the rooster in the hen house. I am not an emergency physician. I'm a trauma surgeon and was the chief of trauma at Parkland for about a decade just before I was headhunted away to join the United States government and currently serve as the senior medical officer for operations at the US Department of Homeland Security, for another about five days in the countering weapons of mass destruction office, but effective Monday in the brand new office of health security that it was being founded Monday of next week. So I'll talk a little bit more about the DHS experience at the end, just in a bit of a shameless plug, but yeah, just an absolute pleasure to be here. And so with that, let me, we got some slides. I give this 50 50 shot we're working on limited bandwidth where I am, but let me give this a stab and see if I can get these to pull up, and I'm gonna turn it back over to Jeff, can y'all see that I hope?

- [Metzger] Yeah, it looks like it's showing up.

- [Woman] Yep.

- [Eastman] Yeah. I'll just say before we roll, I'll just say look, neither of us, we're not dumb. We're not smart enough to have anything financial to disclose. I think what I would say is that from a mindset standpoint, I think it's really important like many people on, in the participant list both of us come to this job every day as legitimate law enforcement officers who put people in jail and, and you know, certainly in my day job now I spend a lot of time dealing with people who'd like to do harm against the United States. So I think that mindset is critical. And then the last thing is I used to say, when I gave these talks that none of what we say is the official policy of the police department, the Department of Homeland Security or the Marshall Service, all of which were affiliated with in one way shape or form or another. But since I make those policies now that is not exactly accurate, but we'll let that ride from a disclosure standpoint. And let me go ahead and turn it over to Jeff and I'll pick it back up here in a minute.

- [Metzger] Awesome. So a little bit about our objectives for tonight. So we're gonna talk a little bit about kind of how we got to where we are within the Dallas Police Department. We'll talk a little bit about kind of the roles that our tactical medical support team plays within the police department. It certainly has extended well beyond the operational aspect, which is why I originally came here. And then we'll talk about several of our key incidents over the last decade and a half, and then some. So when we talk about the history, a lot of this really kind of started from what was called the GEMSS Fellowship, the Government Emergency Medical Security Services Fellowship, which was really kind of developed from, or was kind of the brainchild of Paul Peppy who wanted to create a fellowship that extended beyond what was offered in most other locations. And it was really sort of designed as a EMS pre-hospital fellowship, along with some disaster medicine and some tactical medical component. And Alex really, I think you may be better suited talk about kind of those early years and those early discussions, as far as the relationship between the Dallas Police Department and UT Southwestern.

- [Eastman] Yeah. So I think it's fascinating the way things begin, but in 2004, I convinced my chair to let me take two years out from surgical residency training to try to get surgeons back involved in the provision of prehospital care and particular prehospital trauma care that led to the idea of the GEMSS Fellowship, which was at the time they had had a single fellow go through. And it was really more of Paul's wishlist at the time, rather than so very established connections. And the one thing I will say about Paul is set Jeff and I up with the sort of ability and freedom to spread our wings and make those connections happen. And so the GEMSS Fellowship really gave us the time and the ability and a bit of a of an excuse to explore this. And one of my very first meetings was with the Dallas Police SWAT Team commander. They had had a couple of false starts in establishing, what became the TEMPS program didn't really call it then, we went and had lunch and the rest is history, became one of my closest dearest friends to this day. And ironically, Vietnam era Marine tunnel rat longtime SWAT team commander did 20 something years as the commander of the Dallas team now retired. But eight years ago, couple of days, July 5th, eight years ago, when my son was born, premature was the first person I saw when I came out of the delivery room. And so Bob Owens, a dear friend, and really, the guy that put the Dallas, not just the tactical medical support team, but put the Dallas Police SWAT Team on the map in its glory years.

- [Metzger] And there's no doubt that kind of, that level of early support and acceptance is what allowed this program to kind of become what it has since then.

- [Eastman] Yeah. I mean, I would say to add to that there's no excuse for hard work and blood, sweat, and tears as you're embarking on establishing a program like this. And so I think Jeff would agree that when at the beginning in particular you've gotta do all of the things the team does, whether it's savory or unsavory, whether that's stand in the rain or pick up brass, or some glorious assignment you gotta do them all. And the idea of the fellowship really gave you the time to be able to do that. And solidify some relationships that are really critical in this business.

- [Metzger] Since then the team has grown, we've had several fellows kind of come and go throughout the program. We've had several people who have kind of come to the program, not through the GEMSS Fellowship. I think really the introduction of, or the EMS track becoming a board certified pathway, I think has really sort of changed the field of TEMS and kind of the candidacy of TEMS. And so we've had a lot of people who have kind of come to the program sort of through that different route. And that has led to a pretty significant expansion of a team. One of them who is, I think, still on here, going through the, yeah, so obviously Fruit Mekery, who has come through our EMS fellowship program, was a Dallas police officer throughout medical school and went away for residency and has come back and become kind of one of the certainly very helpful members of the team. And so since kind of the creation, we've had a pretty significant expansion of the team, which has been helpful, given our operational tempo, we have developed a separate tactical medical fellowship. Again, I think the kind of utility of it within our particular program has been maybe a little bit questionable. Most of the people who we have now have kind of gone through the traditional EMS route. And then like we'll give some tactical medical opportunities for those who are interested and then kind of pull them onto the tactical side after their EMS fellowship without doing this separate tactical medical fellowship. And that really sort of describes our current state where we have, five operators, five tactical medical physicians supporting the team, Talking about a couple incidents Oak Park Drive is really kind of, for me personally, one of the first incidents where we've had kind of significant operators wounded, certainly as I'm sure any of you who have spent any time with the tactical team know, their operations where you get cuts, or you get injuries, kind of more minor injuries. And the number of incidents where you have kind of the serious injuries are pretty few and far between. So this was really kind of my first significant gun battle. My first significant operation, where we had several officers injured. So with Oak Park Drive, essentially what happened was a early morning federal warrant. And we had a team on the front side of the house. We had a team on the back side of the house, and as the front side team was going to make entry, one of the breachers was setting a pool again bar. And as they were doing that, the suspect fired a gunshot from inside the house. It went through the door, went through his front arm and kind of struck him in the chest, in the vest. He was evacuated off to essentially the right side of the house. There was some gunfire exchanged. There were several other officers injured, which what I'll probably do is kind of give sort of my side of the story. And then let Alex kind of give his side of the story. 'Cause this was one of the operations that fortunately we were both on. So I was stationed on the backside of the house, heard all the gunfire, heard all the gunfire, heard all the radio chatter, went over to the side of the house where the officer who was shot in the arm was one of our other operators was actually already starting to kind of bandage the arm. It wasn't a arterial bleed. So we basically just put a bandage on and were working on evacuating him kind of to the outer perimeter. So we pulled one of our armored vehicles up to that front corner of the house, used it for cover as we sort of evacuated out still within the inner perimeter, but further away from the house. And as we were behind some cars and I was kind of assessing him, he was coughing up a little bit of blood, which obviously kind of made me think he maybe had a little bit of pulmonary contusion or some other injury we haven't identified yet. And then we essentially evacuated him to the outer perimeter put in an ambulance and went to the hospital. And interestingly it wasn't until we got to the hospital where we saw that he had a pulmonary infiltrate on the opposite side of his gunshot wound, it turned out he had been coughing, coughing up a little bit of blood even before the operation. And he basically was doing the operation with the pneumonia, which had nothing to do with the gunshot wound. And so his wound ended up being a through and through didn't even hit bone, no fractures. And he made a full recovery. Alex, you wanna kinda give?

- [Eastman] Yeah, so I was on the front and we approached the structure and there was an exchange of gunfire through the door when we made first contact with the mechanical breach on the door. So I was standing back in the street when the shots rang out and I saw a guy, a long time member of the team, tall skinny guy named Dale Hackbarth fall to the ground. And it was sort of like that scene in "The Untouchables", you could see the blood coming from his leg onto the ground. So I was like, okay, shot pretty badly. There was a brief exchange of gunfire, but you know, we knew we had to go up and get Dale. So another officer and I went up and grabbed him and dragged him back. Interestingly, we dragged him down, away from the sidewalk, but up to the front fence of the house that was still intact. There was a tall tree, like a bush looking thing, right at the end, just inside the fence. And right about this time long time sergeant on the team, Bob Newton, who had been the equipment sergeant and was the tenured member of the team at the time decided that was when he was gonna crash through the fence with the armored vehicle. It was interesting because obviously I'm not a tall skinny guy and Dale is, and the fence sort of lean toed onto this tree. And I thought after surviving this gunfight, I was gonna get crushed by this piece of fence. And of course I would've died, but Dale would've survived 'cause I would've created dead space for him with my body. He would've fit in perfectly, but we ended up, put a tourniquet on Dale, evacuated him to the street, interestingly, the ambulance wouldn't approach 'cause they heard mistook the continued 40 millimeter rounds that were being fired for ongoing gun battle. And so we took our own van pile, Dale, and as I was working on Dale in the door of the van, before we were getting ready to depart, two other officers pulled us over. One said he'd been shot in the head, but he was still talking and one was grabbing his hand. So all of a sudden we went from having one casualty that I had Jeff had the other on the other side of the house to having four total. Luckily the worst of the injured was the guy with the leg wound that had the pretty severe femoral vein injury that was obviously easily controlled, and a decent nerve injury. The guy that was shot in the head thankfully was a graze. And the guy that was shot in the hand was likely self-inflicted in the gunfight. Interestingly you remember of variety of things from these events. And I was in the back of the van were in route to Parkland. We'd already called and activated the trauma and emergency medicine teams four separate and distinct attending traumatologists with four ORs, ready to go to receive these injured officers. And just a blessing to have a place like the lands where you can do that. But it was interesting as we're riding down the street, I hear I'm working on the, looking at assessing the head wound and trying to get it bandaged and make sure he really was neurologically intact. And I could hear crying and someone telling someone they loved him and I turned around and Dale had a cell phone out and was talking to his wife, telling her if he didn't make it, that he was gonna, he loved her and all that, loved the kids. And so I grabbed his phone and obviously these are guys who I spent a lot of time with, his wife, Martha, both dear friends, he's retired now, but I've grabbed his phone. I'm like, listen, I'm not giving Dale permission to die today. So we'll see at the hospital everything's gonna be okay. And hung the phone up and then scolded him for making that phone call. Good lesson learned to take your people's cell phones from them for a variety of reasons when you're on the way to the hospital. But I think in terms of lessons learned from Oak Park Drive, that's really the first time this unit proved its value because four guys shot on approach to a house. All four officers were treated immediately, cared for, taken to the trauma center, got evaluated and all were able to give a press conference later in the day or early the next day and back to work, relatively quickly thereafter. And so the idea, certainly for us, the idea that an embedded tactical medical component, that solidified our place on the team and it was never to be challenged again.

- [Metzger] I think one of the other kind of big things that this really pointed out was the benefit of having the two of us there with where Dafo, the officer that I took care of kind of when it was sort of an opposite direction from where Hack went. So having the two of us there, it was certainly kind of beneficial understanding that a lot of times resources don't always allow for that. It's now very rare that we have two of us on an operation.

- [Eastman] Yeah, and that's a great point. I think when you have a critical casualty no matter how much training you do for the guys and train them how to support you, like having another guy there that knows what he's doing, as you're about to see with this next case makes a huge difference. And it saves you from like I took care of, we're not gonna talk about this in great detail, but I took care of a suspect who shot himself in the head. And I basically had to do an RSI on him to get him intubated, 'cause he had trismus. And you know, I asked one of my SWAT supervisors to gimme a hand and by the time I had drawn up the drugs, put him in the ambulance, done the intubation, transported him to the hospital and come back to the scene that SWAT supervisor was still trying to get his latex gloves on. So I was like, hey, you can probably stop that man. We're good from here. So I just think having another, Jeff's point, about having another pair of trained hands, if you can get it is a luxury that most people don't have and we don't have much anymore, but it makes a big difference.

- [Metzger] Yeah. Alright. Talking about another big operation, another big event, certainly kind of one that obviously stands out within the Dallas Police Department experience was the Hollywood Avenue shooting. In this incident, we had actually our police lieutenant who wanted to be very hands on, wanted to kind of insert himself into the operations. And so he actually played a role up front in this particular incident where he threw a flash bang in the back, on approach. And then as they were breaching the bedroom window, heard some of the other officers that were contacting the suspect and his girlfriend. And so when he went to kind of open the blankets and stuff that they had covering the windows, the suspect fired a gunshot through the window, striking him just underneath the mandible. The bullet kind of went through his posterior pharynx, bounced off his lateral mass of I think C3, C4 and then kind of came out his upper shoulder. So this was kind of an interesting one. I didn't hear the gunshot. I don't know. It sounds like maybe she might have fired from underneath a pillow or something. It was very muffled. It was in the back of the house. And really kind of, all I heard was officer down. I figured it was an officer that, someone like stepped in a hole kind of hurt their leg or whatever. And so in this particular one, Alex and I were both on the front side of the house. We didn't have kind of a good access to the back of the house. The total approach was from the front. And so as we were kind of coming around the corner of the house to reach the injured officer, they were kind of dragging the lieutenant up and pretty distinctly remember him kind of looking up, looking like he was gonna try to say something and then a pretty significant amount of blood coming up from his mouth. He went-

- [Siri] I didn't get that. Could you try again?

- [Metzger] Sorry, Siri's trying to record this also. So he went unconscious pretty quickly. And so we were sort of assessing him. I think Alex found the gunshot wound to his neck under the mandible. So we were applying pressure and kind of assessing him, figuring out sort of what all his injuries were. It was obviously he was having an airway issue, given the amount of blood that was coming from his mouth. So as we were initially kind of setting up for a oral intubation, it became pretty apparent that that wasn't gonna be possible in that situation. So we didn't have any kind of suction at that time. And he had pretty significant, I mean his basically his cheeks were kind of ballooning with blood and you kind of squeeze that out, but there was no way we were gonna be able to get all that blood out of his mouth in a really good way. So we decided pretty quickly to go with a surgical cric, and Alex, I don't know if you wanna.

- [Eastman] Yeah.

- [Metzger] Talk about that?

- [Eastman] Yeah, I would say a couple of things, I always make fun of Jeff, good natured kidding about, letting me take care of all the bleeding and him do all the hard real medicine, but I'll tell you this was a lot of blood and I included this. Jeff gave us this diagram. You can see the incident occurred. I guess you can see my pointer here on what we would call the D side of the house, he was shot at this window and dragged to here. The interesting thing about this, if we would've dragged him another 20 feet or so, which would've basically taken no time, we would've had been behind armor, which would've been appropriate and a big ass tree, which was right here. And so I think we would've done this differently today than we did then, but that's the care went down here and I'll put the next picture on the screen, 'cause you'll see, that's the corner of the house where, and that's Carlton's vest that is flipped open like, the groin protector's obviously where his head was and the feet would've been down towards the rest of the driveway. But you know, the cric itself was really uneventful and easy, always a little nervewracking when you're doing a cric and the person doesn't respond to a knife to their neck. And the other thing I would say is that we don't carry necessarily carry transport capability with us. So obviously we can throw someone in a car that's far from optimal when you have a real casualty. And in this case, bleeding was controlled. We'd established an airway, he had a strong pulse, a strong radial pulse. So we were able to wait for the ambulance. And I sort of remember, I mean, not sort of, I remember, the cric took seconds and Jeff and I were just kind of sitting there looking at each like, holy shit, did that just happen? As the team was working the rest of the problem inside. And one of the other things that I remember very clearly, thankfully I've been around many, many, many law enforcement shootings, never had to pull the trigger myself, but you know, when you hear people talk about tunnel vision under stressful situations, this is exactly what happened to me on this deal. Like basically all of the external stimuli. And there was a ton of it going on at the time. I don't remember anything other than Carlton's neck until I was sure we had an airway. And then when the aperture opened back up, as things calmed down I think we both realized that we had done this cric, under rifle mounted light, and there were a bunch of guys pointing guns at the back of our heads to try to be helpful. And so I think from my standpoint, I would do many things differently. Tactically, I would do a few things different. Medically, I would've treated some of his injuries different. And you know, some of his residual disability that he has to this day are the result of a vertebral artery injury and stroke treated at a different trauma center in Dallas. Something to be said for going to your home institution where you control the way things are done. Interestingly, Lieutenant Marshall, obviously he returned to work, is and was wheelchair bound, but returned to work for a few years, did some detective work from a wheelchair and then ultimately retired had his house redone on that old show, "Extreme Makeover Home Edition", which was again, one of the truly, most emotional weeks of my career watching a house get built from the ground up and getting to participate in that. But, but yeah, so Jeff, I don't know what else you wanna say about Hollywood?

- [Metzger] Yeah, I don't have much else. I mean, it was like Alex said it was you certainly kind of tunnel vision. It's very easy to sort of focus on the patient that you have in front of you. And then sort of, as things progressed he actually started kind of waking up a little bit, obviously once he started getting oxygen back to his brain, and it was, I mean it was certainly a very kind of surreal experience as you sort of played back what just happened and realizing kind of how all that went down. And like Alex said, definitely some things I would've done differently, but I think this was overall a good outcome. And one of the few times where I can definitely say that, if it wasn't for the TEMS team, he wouldn't have had a chance.

- [Eastman] Yeah. I think that's spot on. And look, I mean, Carlton has residual disability and retired, but he's watching his children grow up and still being able to be their dad. So I think giving somebody that back a pretty profound experience. Yeah, so I'll talk about the next one for a few slides. And that's obviously we just had the sixth anniversary of the July 7th ambush. You know, this is a great incident to talk about for so many reasons. Obviously it's also a gut wrenching incident, five, four DPD, one Dallas area rapid transit officer lost their lives this day. But I think it is a good sort of case study for TEMS. It's a good case study for active shooter and opens up a whole host of topics to discuss, it was a really peaceful night. It was interesting. In fact, both Jeff and I took this night off, even though we had SWAT officers in the field, this was if you remember the summer of 2016, it was kind of a rough time to be the police in America, not just in Dallas, but this was a very peaceful protest. You can see two guys down in the bottom left picture, that's Lonzo Anderson. Who's our executive assistant chief on the left, a protestor in the middle, and recently retired from Dallas, and now the deputy chief of police in Tacoma, Washington, Paul Younger, but I mean, people were taking pictures and hanging out and I wanna play this video 'cause I think it's really important. A lot of people talk about active shooter. Few people have been in the middle of one. So I think it's important to get a sense of just what this was like. So I'm gonna play a little video for you. You'll have to excuse the language. My language is worse most of the time, but there's some colorful language in the video. This was taken by bystanders the night of July 7th.

- Holy shit. Holy shit.

- [Eastman] Just to narrate what you're looking at. So this is a view, you're looking west. The gunman is to the north. So to the right of the screen. Most of the approaching officers are coming from the left. And what you see in the picture is a Dallas police officer who's been mortally wounded, but being treated by two of his colleagues, we were very early adapters of a TCCC based self aid buddy aid program. We put that in place as early as, the beginnings of it in as early in place as 2006, way before most municipal departments. And those officers are there's a lot of grace in that picture. They're behind the cover of the engine block. They're receiving effective fire on the other side of the vehicle from the suspect. Other officers are trying to deal with the problem. And they're trying to take care of Patricio Zamarripa, who's down behind the car and ultimately perished, but proud of those guys for, I mean, that is the definition of care under fire that they are providing in the middle of this incident. And I'm gonna play a little bit more of the video I think.

- [Man] Holy shit. Holy shit.

- [Eastman] I think people look at active shooter video and they, or hear about active shooters and they think that it only lasts a few seconds and it's over, this gun fight went on for, in my opinion, way too long, but went on for quite a bit of time. And so one of the things that's interesting and I'll talk a little bit more about this, but I was on my way home from having dinner with my college roommates this night, when I got a phone call and the guy was actually a guy that I worked very closely with at DHS now, he was like, holy shit, are you okay? He had watched the whole thing occur on CNN. It was being livecast interestingly, the first, so I immediately got it, the phone rang again, and it was our communications section saying multiple officers down at Market and Lamar with an active shooter. And I was already headed south. I was in civilian clothes, but in my squad car, in my Tahoe at the time and activated my emergency equipment headed into downtown, the only problem is, and this is so common at the beginning of these, that Market and Lamar Street don't intersect in Dallas in any place where you would have an active shooter. And so understanding the geography of the area, but realizing that at the beginning of these, the information's gonna be terrible. And as evidence by I'll play a little bit of the radio transmissions from that evening. But you know, I'm sure many of you heard that this was an elevated sniper in a parking garage at the community college, all of which was false. He did get elevated, but he never made it to the parking garage. And he wasn't a sniper per se. He was just an active shooter. Anyway, let me play some of the radio traffic so you can just hear the chaos.

- [Officer] Market and Lamar, Market and Lamar, Officer shots fired. Code three, cut the radio, officer down. Shots fired, officer down, it's an assist officer.

- [Eastman] So one of the things that I'll say again, in a full version of this talk on July 7th, I talk a lot about lessons learned. One of them is radio procedures and discipline, our policy doesn't for an officer assist with officers down or whatever, what we call an officer assist. It doesn't require anyone to check on the radio to respond to that. You just go and we deal with all the figure out who was there and who's responding later. And so you hear people checking on the radio, which just gets in the way, right? You need critical transmission to guide your responding elements, to where the problem is. You don't need to hear like who's going, who's en route. Stupid, just know your policy and work to your policy.

- [Officer] 885, I don't see anybody down over there on Lamar.

- [Officer 2] Can we get the location?

- [Officer 3] All squad officers channel two, code three, Market and Lamar, code three, Market and Lamar, shots fired.

- [Eastman] So the dispatchers did a tremendous job that night of getting the sort of situation back under control. I pulled up into an intersection with four guys and what you saw and I'll show you some pictures of this, but I can't really describe to you the amount of chaos. There were people running every which way, there were abandoned squad cars, motorcycle, police motorcycles on their side, people trying to come up and hand you civilian rifles and weapons, 'cause they wanted no part of being there in the middle of this mess. And when I jumped out of the Tahoe at the time this has been a change now in our new vehicles, but at the time all of our rifles were stored in trays in the back. So you had to take your eye off the problem, theoretically, run around behind your car to open your tray and get your rifle. That's been fixed now. But the other thing is I was in plain clothes. So at the time had my stuff set up poorly for active shooter response. And so I wanted to put on some police looking clothes before I ran up into. So we took just a minute, put some clothes on. And the four of us used a bounding over watch tactic to get up into the fight. And I'll tell you that, so I'll play this video. This is probably the hardest video to watch. This is where, this is the suspect in the foreground. My group arrived probably 25 seconds after this occurred, 30 seconds after it occurred, maybe. And you see the suspect there in the video, I'll play it in a second. You're gonna see one of our rapid transit officers, Brent Thompson approach from the right side, which is north headed south to the left of the screen. And I think, look like you gotta train hard. And the tactics of these are challenging. You'll see him make a tactical error. He tries to use that pole as cover. And you know, those of you've been in a gunfight before you know that it's very uncomfortable and the natural instinct is to really suck into that cover and get close to it rather than use it from farther away and get the benefit of both visibility and the cover. So he gets up into that pole and the suspect doubles back around him and executes him. It's hard to watch, but really it was this piece of the incident where Brent Thompson really draws the suspect's attention long enough and you will see rounds striking the pole. It really is what pushes the gunman inside the building and gives us the chance to get up into the scene and really get this thing back under control and put it back in the bottle. But let's watch video, hard one to watch. You're gonna see Brent Thompson lose his life in the ultimate sort of act of heroism, but he did what he was supposed to do, which was take the fight to the guy. And again, this is probably what allows us to get into the mix. You can see, this is not your average adversary. This guy shoots on the move. He's well versed with his rifle. He's wearing body armor.

- [Man] Open the door.

- [Man] Get down. Four oh.

- I'm pretty, I'm reasonably certain that's the only rounds that struck the suspect from gunfire. So we ended up chasing him around the side of the community college building. He did get elevated and fired down off the back side of the building. Ironically, when we got to that intersection we realized like, hey, we're gonna have to cross. There's no cover. There's no concealment. Like it'd be open territory with an elevated adversary. And for me again, it's ironic the things you remember, but as we cross the street, I remember very clearly thinking, like, what are you doing out here? Like, you're a doctor, you have no business out here, but you gotta do your job. So we formed a group together and crossed the street together, ironically, as we moved, they were like, hey, slow down, Alex. And you know, I'm clearly the least athletic of any of these operators. So I was like, nah, y'all need to keep up. We got across the street, and found the door where he had made entry into the building and pursued him into the building. Ironically, there was a community college officer there who had been, he was sort of guiding us into the building and showing us the stairwell he used to get upstairs, which is this one here. But I noticed the community college officer had some blood on his gun belt. And when I looked at him, he had been shot in the abdomen, thankfully a graze but he wanted to continue and stay in the fight. I was like, now player, you're gonna have to go sit this one out. You've been shot. And so we passed him back and continued up the stairs, engage a suspect in the stairwell again. And again, so at this point we had bounded each other for four and a half blocks in a gun fight. And I remember I was doing every bit of like tactical warrior, whatever you call it, breathing to try to get my heart rate back below 200. And I was like, shit I think I'm gonna have a heart attack in the stairwell. And everybody's gonna put tourniquets on me and not think to defibrillate me instead, but got it. Sort of those techniques work, got it together and got upstairs and got him cornered. So in the first 17 minutes of this six law enforcement officers and one civilian were wounded, again, I'll talk a little bit more about just what a sort of shitty intelligence situation this is, but you're not gonna have accurate information. And this really helped shape how I feel about active shooter response. And some of the other things that have been done. That civilian who was wounded, she ran like seven blocks to the convention center. So we diverted a squad of SWAT officers there because the initial reports where we were under attack in two locations, that turned out to be false. And it took some time to sort that out. So you're diverting some of your best manpower based on that information, which I think is a real problem. For the next 20 or so minutes, another six cops were wounded during this and by about 1:30 in the morning, the active phase of the incident concludes. This is what you see here are patients treated at Parkland this night. And you'll see that that those in red are part of the incident. Those in black are just lucky enough to be trauma patients at Parkland. But I think the thing that's worth noting for all the people on the call is at at 19:00. So this occurred 9:00 PM at 19:00, there were 226 people seeking care in the Parkland ED with a number of admin holds holding, look, hospitals are designed in 2022 to function at a hundred percent occupancy. So if your mass casualty plan, the first step in that is not making room to take care of people, you're gonna fail. And you have to have the ability to make space to care for folks because no one has extra space sitting around, hospitals are full, ERs are full. So I'll spare you the details of how this, much of the talk about how this ends, other than to tell you that what you see on the screen is the control box for a remote tech robot. Interestingly, the robot was widely hailed as the Dallas police department's employee of the month after it's sacrificed itself in the cause. However, it was actually the ATF's robot. They let us borrow that night. It didn't come home. And the way this ended is well publicized. We drove a bomb essentially up to the suspect and detonated it ending the incident you can see on the screen that the suspect is prone out behind his gun. I believe he thought an assault was coming behind the robot, but you, you literally could watch the, and I was there, interestingly, the team was like, okay, we're gonna get everybody out. We don't really know how this is gonna go. So everybody go ahead and back, your perimeter positions up. We're just gonna keep essential personnel. So I was like, okay, I'm out. I went to leave. And they were like, no, no, you stay in case something bad happens, which I knew something bad was gonna happen. 'Cause we had never trained for this, never done this. And it basically was a device built by a committee of the interested. They had had me go back and assess whether I thought the device was gonna be lethal or not. And I had advocated initially for placing some frag into the device, essentially making a homemade claymore. But when you then realize you're gonna be standing on the other side of the wall, from where this is detonated, you change your mind quickly, but there's no commercially available off the shelf solution for this problem. And initially a lot of people have said, why use the explosion rather than a sniper shot or whatever, the suspect had sort of secreted himself in the perfect location, where there was literally no way to get to him other than to do this. And no one really wanted to put additional lives at risk. He had proven his ability to kill police and willingness to kill many of us. And during the negotiation, nearly three hour negotiation, the only thing he was remorseful about was that he wasn't able to kill more law enforcement officers at the time. This is the aftermath. You can see that's the robot that was destroyed by the device. Ironically, walking up to him to try to declare him dead. That was his weapon. He was using an AK 74. It's basically a 308 chambered AK platform, but there were computer parts everywhere on the ground, like destroyed unbeknownst to any of us, right behind where the suspect was. And what took a lot of damage from the device was the community college's server room. So there was a lot of mess there, but he had been talking a lot about having other devices, explosives, having explosive devices with him. So we made a very hasty determination that he was deceased and then hooked a strap up to him to flip him over from far away to just determine. He had nothing under him and then everything else was left in place for evidentiary purposes. And we evacuated the building. Couple of things, I think that are worth talking about. Look, I've never been in the military and I appreciate everyone who served and been forward deployed, but the fog of war is real, when I got outta my truck and there was a gun fight going on in front of me with the sounds of gunfire, ricocheting off buildings and people and chaos everywhere. I had no idea whether we were under attack by one person or a team of 20, but in the first six minutes of this incident, every officer that was wounded received appropriate tactical combat casualty care based treatment on the spot by their law enforcement colleagues, no other medical providers were around. And it really shaped the way that I think we as America have to respond to these because it's not going to be traditional responders. And if we think of it as such, you will fall into the trap that many people have fall into of this idea of warm zone clearing and a rescue task force. And I think the best example of this is in Vegas and the music festival shooting, Vegas had perhaps the most advanced well trained rescue task force in America at the time. And they will tell you, they treated nary a single live casualty because no one is going to sit around and wait to be treated anymore. Everybody evacuates the scene. And then the other thing is that the idea of warm zone clearing is predicated on you having situational awareness of where the warm zone is and where the hot zone is and all that. And that is just in my opinion, and in my experience, complete bullshit, like those are after action concepts. You won't know until it's too late to stop anyone from bleeding to death. So the non-traditional provider training your cops who are gonna be there anyway is really the way to go in my opinion. And this is a great example because this is those two officers treating Patricio behind the vehicle I showed you in the video earlier, we ran by this officer who is a great guy, a motorcycle officer taking cover. Unfortunately he's five blocks away from the nearest hostility. And when I knelt beside him and said, Hey, where are you hit? What's going on? He couldn't even speak to me. He just said, vapor locked and couldn't move. So I was like, hey, dude, just stay here. You're gonna be all right. We'll take it from here.

- [Metzger] I wanna add-

- [Eastman] Sorry, Jeff, jump in here please.

- [Metzger] So I kind of got thrown the okie doke when I first showed up on scene, because I showed up on what was the east side of the park, which was essentially a block and a half probably from where this all went down and pulled up. Not really knowing obviously where kind of the shooter was, but saw a bunch of officers hunkered down behind a vehicle, pulled up behind them, got out, kind of got my equipment and tried to figure out sort of what they knew kind of where the threat was. And it became very apparent very quickly that they had no idea that the parking garage that this suspect was apparently shooting from was probably 600 yards away and kind of where I was at was pretty useless. And so there's, that's definitely kind of plays into the idea of the communication, the kind of location identify where the threat exactly kind of what the threat is, how many shooters, all of that stuff is, in the very beginning parts of these kind of scenarios. That information is very suspect and just typically not very useful.

- [Eastman] So we spent some time talking about just for a minute about the aftermath of this, this was a press conference that was convened by the hospital. The day after this everybody was still a mess, no one had slept. I will never do this again like this, these things have to be much more tightly controlled than this was, this was way too spontaneous. And it was at this press conference where my partner and friend and overall great guy, Brian Williams, former partner now at the University of Chicago was the trauma surgeon on the night before obviously lost several officers, should not have been speaking to the media, but utilized this time to convey to everyone that he, as an African American man was scared of the police and it didn't come out very well. I got a lot of angry texts that were like, hey, did your boy take care of our friends appropriately? Which he did, but again, one of the issues with this, the hospital PIO never let any of us know that we're participating in the press conference, that it was being live broadcast on CNN. Recovering from these is not just a challenge for the people that are involved. And this took me a good probably 30 days to feel like myself again, but the community, this is thousands of people in front of Dallas City Hall, having a candlelight vigil for the fallen officers in the days afterwards. And the community hurts. We still, the police department today see behavioral problems and discipline issues with officers that our psychology team tie back to survivor guilt and many other parts of problems from July 7th. It's difficult. And I think part of the issue is that we don't spend a lot of time talking about this ourselves. And so we really need to get better about that. This is from a different topic, but it really is appropriate. The medical or tactical footprint in any of these events is actually dwarfed by the ongoing psychological footprint. And I think we as leaders in the field have to pay attention to that because if you don't you have folks, I still see departments that use critical incidents stress debriefing despite the fact that the International Association Chiefs of Police, police psychologist section has come out very clearly to say that that program probably is not optimal for the prevention of PTSD and that all the agencies that I support and that Jeff supports use psychological first aid, which I'm not gonna spend a lot of time talking about it, but if you haven't switched your folks over, you should most definitely do it because you don't wanna run the risk of leaving your people behind. And this is a challenge. This is the memorial outside of police headquarters in the days after the shooting, where thousands of people left mementos and flowers, and there's a couple of squad cars underneath of there with black bunny, but you can't see 'cause the pile of stuff is so big. And Brian really struggled for quite some time after this and really never returned to operating at Parkland. Took a administrative job for a bit of time and then moved on and now is back at the University of Chicago in full swing. So we wanna leave some time for discussion. I just want to, but let me turn to Jeff first to see if he's got anything else to add for the seventh. And I just wanna spend a few minutes talking about my role now for the folks on the call. Once we get done with the seventh, Jeff.

- [Metzger] I don't have a whole lot to add. I mean, it's definitely the healing process is long. It's, something that I think people don't talk about enough and definitely something that I think, I mean, I do think we're getting better at, but definitely like wanna stress the importance of taking care of yourself and talking to kind of your fellow officers who could still be going through a lot of stuff even for years after an event like this.

- [Eastman] So I just wanted to take a few minutes and give you guys, maybe worth coming back and talking down the road, but I get the pleasure in addition to my Dallas duties of serving at DHS now, pretty diverse operational medicine program with nearly this number's a little bit dated, we're up to about 4,000 providers across the system in all every components. It's the second largest federal EMS system after the Department of Defense and has providers at the three conventional levels and what we call our austere paramedics, which are function essentially like 18 deltas and are deployed to provide care literally in all 50 states and about 60 countries around the world. The mission occurs in every EMS setting. You can imagine from rural to tactical and austere covering traditional law enforcement operations, and up to an including big NSSE and SEAR related events across the United States. It's it occurs on the ground. It occurs in the air with guys and the opportunity to care for and work with guys who really get the chance to get out and do what we do. There's also the opportunity to in terms of a shameless plug to shape the future of this program and how we evacuate people on how we do things. Really, it is a pleasure to work with these guys every day and to do some things that to keep the country safe, that that many folks don't get to do. So I'm gonna leave this up for a minute. This is my contact information. I meant to put Jeff's phone number up here too, and I was adding pictures to this, like right before I logged in, so typical presentation, but don't hesitate to reach out to us at any time and can hit either one of those emails or that cell phone. That's my government cell phone, by the way. So don't send anything too stupid to that. I'll give you my personal for all the other things, but again, it is an absolute pleasure for both of us to be here. And I think it's worth, I'm gonna turn the slides off. I think it's worth spending some time discussing whatever topics are on y'all's mind and I'll stop there. Hopefully the slides are off and everybody can see each other again.

- [Bradley] Yeah. Thanks, Alex. I know some people have some questions for both you and Dr. Medsker, a great presentation. First of all, from both of y'all. I know everyone, when they hear Dallas police, they think of the shooting event downtown. I got the, I guess, privilege at my academy class to go through that as well with Larry. So he had some good stuff, including that video on it, but I had two questions. I was hoping y'all could kind of touch on, one y'all hit on a little bit was how much I was curious how much the Dallas police department and y'all's section in particular works with RTF as far as Dallas fire or anything. Is there any involvement with that? And then the other question is, can you kind of touch on how the system for DPD and is built with you guys, any of the medics, paramedics that work with you guys? Do they work under your license? Do they work still under their department's license? Just kind of to give out people an idea of how to structure y'all set up works.

- [Eastman] Let me take, go ahead, Jeff, go ahead.

- [Metzger] No, I was gonna say, I'll take the second part if you wanna take that.

- [Eastman] Good, 'cause that's exactly what I was gonna say. Go ahead.

- [Metzger] So within the Dallas police department, we don't have really don't have operational paramedics. We do have several police officers who are also paramedics, who kind of serve in several different roles, but not as kind of the operational medical component. It's all physicians. A lot of this has to do with sort of how we were built 18 years ago. I think there's obviously there's pros and cons to all the different models of tactical medical support. I certainly don't think this is kind of the answer for every situation. I think the relationship between the police department and the university of Texas really kind of has a lot to do with sort of the system that we have in place certainly if you look at all of the medicine that has been provided in the field it's pretty much all stuff that can be done by well trained paramedics. This is kind of the system that we have.

- [Eastman] Yeah. I'll take your question on the RTF. There has been some, so RTF is something that's a great program to sell to your city council. It makes everybody feel good. People talk about working together and joint training and integrated training. And then you get to the brass tacks of RTF and you realize that it's not really powered to save anyone's life. And I could give you countless examples of that. I talked about Vegas in the presentation, like if the best, most well trained RTF in the biggest active shooter incident in the nation's history by volume, couldn't find a single live person to treat. And they now have changed their model to basically send the RTF to the driveway of the trauma centers to help facilitate the transition from civilian transport to inside the medical centers, like the RTF concept needs to go. And the problem with it in my opinion is that, you're not gonna ever see firemen making entry, and you shouldn't see firemen making entry into a scene that still has active hostilities because they're going to take the time to link up with people and people that can protect them that doesn't come as a unit. So by the time you get them to the scene, unless you have body armor at every riding position, which we now do in DFR, they would've to find their armor in the initial versions of this, find their protection. And by that time look, quite frankly, everybody that's gonna bleed to death has already bled to death. And everybody that isn't, isn't going to anyway. The other thing is, if you remember from the Vegas video footage, like nobody, people were getting carjacked, not like Dallas style carjacking, but like nicely, people were getting carjacked to give up their trucks. So civilians could transport truck beds full of civilians to Sunrise, which was right around the corner. And so, again, like, I think the RTF concept is a byproduct of not including the fire rescue community in the initial active shooter response planning that was done around the Hartford consensus and stop the bleed and all that. And I think that was a tactical error on the part of those that were involved, which I say, including myself, 'cause I was involved. So we've done some RTF training. The firemen are engaged, but it's not the con I don't think. And I'm happy to have this argument with someone who wants to advocate for it, but it brings other benefits to the public safety system in terms of being able to work together. And if you have an incident in a shopping mall or an airport that you have to clear, it's good to take those guys so you can drop them as you go through the mall to deal with whatever medical issues you encounter. But it's not the active shooter response paradigm that I think the nation needs. And we have a lot of work to do to find that paradigm. And I'll say this, if somebody can give me a tangible example of an RTF saving someone's life, like I'm all ears, 'cause I can't find one yet. And so I think that that's a concept still looking for an indication to use it.

- [Springer] Yeah. I got a question for you guys. So in general, what role does the tactical medical director play or need to play or at least be aware of in homeland security issues?

- {Eastman] Yeah. Great question, man. So look, I think the tactical medical director sits at this unique nexus of the interaction regarding this unique nexus of law enforcement, public health and good trauma medicine. And that's discounting all of the other things that come into play with regards to force protection and health of your unit and team. But I think that the tactical medical director who speaks both languages is a really critical person to have in the overall Homeland security apparatus for your community. Obviously that occurs at the big national level with my group. But I think in every community where you guys are involved, you've got to be at the table and that tactical medical director is gotta be married up pretty closely with fire department counterpart, but also with police and fire department leadership, because you have to be at the table for these sorts of things. And again, not just for incidents that occur, but for planning that goes on. I'm sure Jeff knows this and Farouk knows this, but the current Dallas police chief was my roommate for about four months, lived with, he's a dear friend from before he came to Dallas, but lived in my house when he came to town for a few months. And it's one of my close, close dear friends to this day, but the relationship's gotta be close. 'Cause you guys are going to do some things together that are really challenging.

- [Man] I have a question.

- [Eastman] Fire away, but I can barely hear you.

- [Christianson] You've done a great job. And thanks for presenting your experiences here. I just have a question about the Hollywood . Would it have been easier if you had moved back, a few tens of yards to better light, would it have gone more smoothly?

- [Eastman] Yeah, go ahead, Jeff.

- [Metzger] Well, so I don't think the light situation was any better, further away from the house. I think certainly kind of the security we could have been behind better cover, so this was a 6:00 AM warrant, so it was very early in the morning. And I think as far as the light side, I don't know if that would've made any difference, but definitely.

- [Eastman] I used to tell the residents that you, first of all, the number of people you cric is inversely proportional to your ability to use the laryngoscope. So I pride myself on never having to do this very often, and in fact, Jeff used to, when I was the trauma director and Jeff was the ER director, it used to give me great pleasure to come up there and intubate someone when one of Jeff's people couldn't, it was one of my favorite pastimes in the trauma hall, but look cricing someone is not a procedure that needs a lot of light. It's done by feel and knowledge of anatomy and you should be able to do it in the dark or the light or whatever. You're not gonna see anyway, their bloody, you've got blood and sputum and all kinds of stuff coming out, so it's not a light issue. It was simply a fact of, if you would've tried to orotracheally intubate this casualty, like you would've never been able to see literally the bullet traversed his posterior oral pharynx and that tissue was bleeding like it was its job. And you just wouldn't have been able, even if you were in the operating room with all the suction and all the tools that your disposal, I don't think you would've been able to get it done, too much trauma in the posterior oropharynx.

- [Springer] There's a question here under chat regarding force protection and readiness. What kind of discussions are you having with personnel regarding vaccination, specifically COVID, some folks remain resistant to getting them.

- [Metzger] I mean, it's probably the same thing you all experience, there's a lot of banging your head against the wall, trying to convince people to get vaccinated and kind of do things they're supposed to do.

- [Eastman] Yeah. I mean, look, trying to, we have about 3,500 sworn at DPD right now, and it was exquisitely painful to get the vaccine program up and running and get people to take them and then to follow trying to do that to for 250,000 employees at DHS was like the pain of my existence for months. And I basically stopped having arguments with people. Like once, you know, my favorite of these stories to tell is someone said, look, I'm not taking the vaccine. It's got dead babies in it, wrong. And I was like, and that same person was like, okay, well, look, I'm Catholic. Like I'm not gonna take this vaccine. I was like, here's a letter from the Pope saying, get your ass vaccinated. And then we argued about whether the Pope was crooked or not. And at that point, I'm like, look, do what you want, don't take the vaccine. Like I can only give you the best information that's out there. But in terms of overall like a force protection and health comment, I think the closer you are to your guys and the more they trust you, the better off you're gonna be in terms of whatever unsavory health advice you have to give them. And I say it as I sit here abusing my body and drinking a monster at eight o'clock at night to try to get through this webinar, like we're terrible patients. And the closer you are to being the police, you sort of have their ailments as well. And so I try to get it, I try to be understanding, but the closer you are with the team you support and the people you support, the better your advice is gonna be received.

- [Metzger] And this obviously goes outside of the pandemic, outside of COVID. I mean, just there's a lot of discussion about supplements and testosterone and kind of general operational readiness. And it all like, I think you can definitely play a big role if they have that trust.

- [Wipfler] That's great comments. Thank you very much. So great to join you, gentlemen, Jeff, Alex, thank you very much. My apologies for joining late. Actually I was looking good for getting outta the ER on time until about 20 minutes before then a proverbial patient, the stable GI person started throwing up this black and red stuff all before the blood pressure crashed. After we intubated sent off GI lab, then we able to get here only about 20 minutes late anyway, but thank you so much. I caught most of your presentation there. So just a lot of tough times going through losing officers like that. I'm sure some of these officers you guys knew personally, and thank you for your comment on that. So appreciate it. But tying a little bit off of Brian's question two, one of the questions I'd after you guys maybe could share is we were working with a big police department. Whether it's a big place department, medium or small size police department. What can the physician do? Not only in direct operational stuff, but also on the sideline of quieter moments, as far as advice to the chief, advice to the lieutenants and captains, what are some things you guys have done that's worked? What do you think the things you've done did not work, also, is there something called a medical director or a physician advisor that we really need to push nationally? Is that something that in your opinion, police departments would benefit from?

- [Metzger] So, yeah, so I think definitely there's a lot that goes into kind of this whole big category of law enforcement medicine outside of just operational medical support. A lot of, from kind of basic training I would say probably within the department more lives had been saved from patrol officers putting tourniquets on people then Alex and I have saved within the department kind of in our capacities. So sort of that self aid, buddy aid kind of advocating, making sure that your officers have the equipment that they need to potentially prevent someone from dying in the field is huge. Certainly there's been a lot of topics that have come up over the years. Things like community acquired MRSA outbreaks in the gyms. we had a case of Ebola in Dallas. And so some discussions about kind of how we as the police department should respond, would respond kind of from the medical side, sort of what kind of things do we need to think about in that kind of situation?

- [Eastman] Yeah, I would say this, if you look at, I certainly think about my real job right now, John, and if you look at all the things just over the last 18 months that the country has faced, it's been a pandemic, a migration surge, couple of terrorist attacks, homegrown violent extremism, and a host of other issues. I was joking about this actually just before this, we started this when I got a call from the big boss, and the secretary sometimes marvels at how frequently we have to talk because of the things that are going on. And I would just say that there's a, whether it's a big city or a small city, the nexus to not just health and health security of communities that you serve in, but to your personnel, if you tie it all the way down to the force protection and health level, you're involved in everything and you should be involved in everything. And every aspect of the department's operation affects your personnel, affects the public you interact with, your personnel or the health security of the community. And so I think the sky's the limit to what that role can be. By how much time you have to give to it, how much support you're afforded and the relationships you build within those departments. But I think the role is critical. And obviously having been doing this now for the better part of 18 years, I think come, the reward comes back to not just to you personally for putting the time in, but to the community you serve by being there.

- [Wipfler] Excellent, thank you all for your response.

- [Wong] Is there any talk on the federal level of having on a local or state level, more of a physician involvement on that front, As far as the Homeland Security enterprise?

- [Eastman] I got a job right now, if you want it, call me.

- [Wong] I do. .

- [Eastman] So I am hiring some regional part-time folks, which is basically how I started at DHS. So longer conversation to have about what the role is and what things are out there, but there is. And look, I mean, there are, the federal level is interesting. There is still a matter of debate. I wouldn't put anyone I care about into those jobs just yet. I need a few months to see how this new office shakes out and how what happens, but there are, and will be opportunities. And look, I mean, the federal system is complicated, is particularly at DHS the way it was formed and the way it's come together with authorities in other places, I just was at some joint training for the United Nations meeting coming up, talking to Ricky Thomas and the guys from HHS who have a very small, but mighty tactical team tactical medical support team. That's sometimes looking for a mission and we're gonna use them at UNGA this year to do some stuff, but there are, and there will be opportunities. We should talk after this. Where are you located?

- [Wong] I'm in Southern Ohio, West Virginia area.

- [Eastman] Okay.

- [Wong] I had another question for you too. So when you're talking, I had heard also that, and it seems like the rescue task force is this clumsy stilted model, but are you thinking that the obviously training the officers who are gonna be there, all patrol officers in first aid or whatever you wanna call it, TECC, is the way to go go then rather than having some sort of formal joint structure between fire, EMS and law enforcement?

- [Eastman] I don't think it's an or proposition. I think, first of all, I always find it pretty cool to see officers with tourniquets on their belts knowing that we at least played some role in that. I have served for a long time as the medical advisor for the Major City Chiefs Association, which is the chiefs of police in the 75 largest cities in the United States and a few international partners. And watching us become the first and then watching all the major city chiefs organizations come online. Now you're talking about 175, 200 million people in the United States that are covered by law enforcement hemorrhage control programs now. And so I don't think it's, or, but I think it's and, I think the once you train the law enforcement officers to be hemorrhage control experts, What the RTF does gets even more complicated, because if it's transport people, then like, let's just train officers how to drag folks to some place where it's safe. If you've got an active shooter event that, is like Uvalde, where they couldn't get people out for a number of reasons, like that's not an RTF problem, that's a law enforcement problem. So that's not the right space for it. I don't know. I mean, I think we've gotta continue to learn and look at every one of these. The one thing I think that will come in the coming days is that the after action, not the alert center after action, I don't think that was done very well. I think that still has some room to grow, but the formal after actions, you'll see, we're making a hard push at the federal level to include looking at the medical and tactical medical responses to those. Gina Piazza, who's a longtime member and leader in this section. I don't know if she's here, but she really had the idea of a go team that has not gotten, we wanted to form an NTSB-like team to go out and look at some of these incidents. It's not ready for prime time yet. Nobody's really jumped at funding it and appropriating money to do it. But I think you'll see, as we're deeper involved in some of these organizations that are doing these after actions, you'll see more of that. And that will just only demonstrate our ability to learn from these and figure out what the right model is.

- [Ackerman] Any chance any of these jobs you're looking for part-time would be offered as grant or contract roles for those of us in academics, who would like to be able to do more of this as part of our paid job?

- [Eastman] Yeah, so we don't, we're not allowed to utilize volunteer labor, Jeremy. So these jobs will be paid positions. Some of them will be part-time. Some of them will be full-time. We don't have the part-time ones exactly nailed down yet, but there's money in the budget for them this year. And we can certainly talk, we have the ability and the legal authority to execute some of these agreements as IPA. So as intergovernmental personnel agreements, basically we contract with your employer for your time essentially. It's not the best. It has some limitations, but we'll talk. So short answer to your question is yes.

- [Ackerman] Well, I'm happy to help out in the Southeast.

- [Wipfler] To tie into that perhaps we can do, Alex's at some point in time near future, if you have a document or two that you'd like to get all the facts of these positions, feel free. We're happy to share with all the members, we have 576 physcian members of the section right now, the ACEP tactical emergency medicine. So we can distribute that whenever you say the word, just let us know.

- [Eastman] Yeah, hiring done by the US government on USA jobs. So I'll certainly as these things get, we're in the midst of this office reorganization. So new office opens Monday, which is like, you can't even imagine moving from one place to not physically moving from one place to another, but moving from one place in this massive organization to another is a real challenge. So we'll need some time to get our feet under us. But I think in the early to mid fall, we should be ready to have some serious discussions about next steps to fill out what we call our regional medical operations group.

- [Wipfler] Sounds great. Is Farouk still on there. I knew he was on earlier. Is he still the cell phone not there or not. Do you know, anybody know, Farouk, are you still there? Jeff did you, I've been sorry.I missed the first time.

- [Eastman] Probably probably past his bedtime. We try to put him to bed early 'cause-

- [Metzger] Exactly. Yeah.

- [Eastman] We try to give him his bottle and put him to bed early, so I'm not sure.

- [Wipfler] He does so many things. He probably is very tired by this time that's for sure. So anyway, so Jeff, do you wanna tell a little bit about Farouk?

- [Eastman] We did.

- [Metzger] Yeah, we talked a little bit about how he kind of went through the police academy as a medical student here in Dallas and then went away for residency and now is a active part of the team.

- [Wipfler] Great. Okay. So if anybody wants to reach out and contact him, I've contact information as well as I'm sure, Jeff and Alex and qualified physician members, that is so anyway. So what other questions, who else-

- [Metzger] Of our recent former members, Brandon Machete who's on as well.

- [Morshedi] Hey, sorry I'm late. Just got home from work. I'll have to watch the whole recording tomorrow. Miss you guys.

- [Metzger] You too.

- [Wipfler] Well, Brandon, do you wanna comment a little bit, tell us a little bit about yourself, any particular things you'd like to share with the group?

- [Morshedi] Well, I don't know what's been said already. Don't wanna repeat. So I was one of a couple of non-sworn non-law enforcement trained, but went through the TTPOA SWAT training courses. After the fact I did it as part of my EMS fellowship year. I did fellowship at UT Southwestern and Parkland. So I've known Jeff and Alex since I was a baby intern and made my intentions known to them pretty early on that I was interested in EMS. I was a paramedic for 12 years before becoming a physician. So sometimes I still feel like a paramedic who just accidentally went to medical school. So I enjoy being out in the streets and being able to practice our skill set out there. Dallas is a pretty unique team, being a full-time spot team. And I dunno, Jeff and Alex, you guys may know more, there can't be more than a handful of police departments that utilize physicians only for their tactical medical support team. It was probably one of the most enjoyable experiences of all the years I spent in Dallas. I was being a part of that team being out there and watching them perform their craft. It's not like on TV where you're just plugging bullet holes all day long. I felt like a unique primary care physician. I'd be answering questions one day about is HDH really gonna shrink my you know what, all the way to can CBD oil help with my ADHD? You answer a lot of questions for the team that you usually have to go back and search out on Google for proper answers for them. And then of course, a lot of actual support during operations with them. But, we'd go with them to the ERs. And if they got injuries, we'd see them through the healthcare system, kind of white glove type treatment with them at the hospitals that we worked at. So it was kind of a 360 degree level of care that we provided to them.

- [Wipfler] That's great. Well, thank you very much, Brad, appreciate all you do. Thank you. I'm gonna hand it over to Keegan. Keegan, wrap up things and real quick, I think it's Jeff and Alex, thank you so much again, it's been an honor to be with you here and thank you for sharing it. Keegan, it's all yours.

- [Bradley] Well, I appreciate y'all coming on. That was a great talk as always, Jeff, I know we've run into each other a few times at ACEP, Alex, we've run into each other actually out in Arizona of all places. That was interesting, but you know, we really appreciate y'all coming on and taking the time to talk about this stuff. It's I'm sure people could ask questions all night too. So we'll try and respect y'all's time. We'll get y'all's contact. So if anyone has any further questions, they can talk to y'all, but it was a really great experience and we appreciate it.

- [Metzger] Awesome. Well thank you for having us.

- [Bradley] All right, everyone. Yep, they're putting in the context in the chat, if y'all need it. Other than that, we appreciate the talk and we'll go ahead and conclude at this point.