Medical Integration into Executive/Close Protection

I'm sure if you've been in the executive/close protection (EP) field for any length of time you have likely witnessed first-hand the plethora of changes within the industry.  One of those changes has been the integration of medical support services directly into EP programs.  

This change has been a long time coming, and it fundamentally comes down to mitigating risk for our clients. In this field, oftentimes the most significant threats to our client are actually related to the client's own health!

While the idea of integrating medical support into an EP program can be daunting, it is becoming an unavoidable necessity for many of us who find ourselves supporting not just clients with existing health conditions, but also adventurous clients engaged in high-risk sports or travel as well. 

Clearly, this is a paradigm shift, as historically, an EP operator would not have been expected to provide medical support in addition to their normal security obligations.  Basic, first-responder activities, yes (CPR & First Aid), but not much beyond that.

The industry has rebuffed this integration for a variety of reasons, not the least of which is it's difficult and expensive to do it. Additionally, the two skill-sets (security and medical) do not always go hand in hand.  I know and have worked with many excellent EP/CP guys and gals in the last 20 years.  But I can count on one hand how many of them were ALSO proficient at both fields (Medical and EP).   This is understandable, as they are truly separate "fields", and trying to integrate them is like trying to integrate a Cop and a Fireman into one position.   Tough for most to wear both of those hats.

For most people, we end of being good at one thing and mediocre or lousy at best on the other thing.  So, we focus on what we like and are good at.    

So, in the past, security managers/directors focused on what THEY knew best and were comfortable at, choosing not to focus on what they don't particularly like or know.  And very few in our field are fluent in both security and medical.

Unfortunately for them, the statistics actually reveal the truth. 

The reality is, that our clients are more likely to be involved in a car accident, or boating accident or food poisoning while traveling, than they are to be shot, stabbed, kidnapped or assaulted. 

Yes, the probabilities vary slightly from location to location, but holds true for pretty much anywhere in the world.  When I say "they", I don't just mean our clients. I also mean the staff, and that includes EP personnel themselves.   Everyone! 

After dozens of trips to Africa, I still believe that if you've utilized good intel, and site planning to avoid the known 30 to 50 car-jackings per day, and high-risk areas, you are likely going to be ok.  However, my biggest fear on those trips is still the potential that my client, a member of my team, or that I myself would get injured on one of those trips and need ALS (Advanced Life Support) ANYWHERE in Africa. Yes, the prospect of having a life-threatening health condition or injury is much scarier than any of the more obvious threats you might consider when contemplating that sort of trip.   

How about closer to home? How many of you support a client with a pace maker? How many of your clients require insulin injections, or Epi pens?

While those may not be the typical threats you consider when you are doing your advances and planning, those are threats that follow you, and your client everywhere you go!

So yes, there is real need. And yes, the integration of medical with our security programs is of critical importance. The question then becomes....'What does that actually look like?' And what needs to be done to move in that direction?

I've seen some sticky challenges in the reality of integration, as most clients and security managers with their distinct perspective of risk mitigation factors, then try and stack the medical component over the top of protection. This is not an integration, but rather a layering. And I would argue that it creates a very inefficient and potentially dysfunctional scenario. Teams may bring on a paramedic or assign one or more team members to be the 'medical' support. Assignment of duties and perception of roles can be confusing, and the end result is typically a general 'chunkiness' in operations.

Typically, the first thing to be compromised is the client's experience of their support. By adding medical on top of an EP program (without truly integrating the functions), you end up with fragmented support and service.  And as we all know, our industry revolves around customer service, and the client's experience of that service.   So, what happens when actual EP/CP is back-scaled for medical services in a cover your a** fashion, rather than as a real part of the security program?   Schedules are late, clients sit in traffic, meeting are missed, and logistics become a nightmare.  Stress, Stress...  Clients/principals get really pissed and people get fired. 

How can we have the best of both worlds? 

Balanced Integration

The model I personally encourage my clients to consider, and that I've successfully deployed involves utilizing your existing EP/CP personnel, and then training them with the expertise of BLS (Basic Life Support). Once your whole team has some basic competency and training, you can then begin incorporating the needed Advanced Life Support ALS/ medical component, that your whole team can use.   

If resources allow, it's great to contract with a doctor or paramedic to provide training, and recurrent workshops to refresh your team's skills, and to assist you with ensuring adequate protocols, and equipment.

But, by incorporating medical support into your model beginning with all of your team members, you are establishing a culture that makes medical threats as relevant and addressable as more traditional security-based threats.

You may get lucky, and find those very FEW people that are Paramedics/PA's in addition to being top tier functioning EP/CP guys/gal. If so, you consider yourself very lucky!  You may truly have the best of both worlds.   The rest of us need to continue the balancing act and build that capacity within our existing EP teams.

What has worked well for most protection teams/personnel is to continue to train in BLS care i.e. stop the bleeding, stabilize and utilize 911 trained services (most of the US and mainland Europe) when and where available.   But remember, back to my earlier comment about our client's activities, if you are out rock climbing in Utah and your client falls, you won't have access to the same medical treatment available in Denver. 

Now, I'm not saying that your EP team all need to become over-night medics, and this integration model does have its limitations. For locations like Africa, just plan on paying for proven extraction medical service companies, and bringing in your own ALS (Paramedic, PA or Doctor) if you want to maintain a compatible balance.  Then, the decisions will only be when and where to fly them to for sufficient long term medical care. At least your team will have some fundamental skills they can employ, but don't bank on their limited experience when you know the availability of help is virtually non-existent.

If you are managing an EP/CP protection program and don't have any medical components in place, then hopefully the majority of your client's travel is with on the mainland of US, Europe and Australia, or in areas of population that have a proven quick response medical system outside your protection/medical team.  However, you might be living on borrowed time if you haven't yet begun to incorporate some aspect of medical support into your team model.

There are many ways to accomplish the integration of medical and protection and provide top tier service to your clients/principals.  It has to start with the specific needs of your client, having good communication with them and their support team to determine your areas of risk related to their immediate health. And then beyond any current/known conditions, ensuring that your team is competent in managing health-related emergencies, even at a basic level will dramatically improve your ability to ensure truly adequate risk mitigation for your client.

If you want to dig into this topic in more detail, please reach out to me. You can find me at [email protected] and I love to hear from you. The integration of medical and security supports is an area that really interests me, and I've had some good successes that I'm happy to share. Let me know what your experiences have been!