The delivery of Emergency Medical Services (EMS) is far from ordinary and the demands for service can be quite unique. As our society evolves, so must EMS in order to keep pace with the growing threats against our community. Natural and man-made disasters, threats of violence or terrorism, and the ever growing number of dangerous chemicals transported and stored throughout our community every day are just some of the examples of our new and increasing challenges.

Med-Act has met this challenge by establishing the Special Operations Division. This division is comprised of paramedics with interests in specific areas of emergency services. The team members must have met each groups specific requirements, have completed their performance trial period, and be on good educational and performance standing during normal paramedic operations.

The organizational structure of the Special Operations Division is comprised of Team Coordinators for each of the teams. The teams are free to establish their own internal subcommittees or ad hoc task forces as needed to manage projects. The Division Chief of Special Operations directly oversees the Team Coordinators and the division members.

Med-Act's Tactical Medical Team (TMT) provides immediate medical support for the law enforcement tactical teams of Johnson County, Kansas. These teams include those from the cities of Lenexa, Merriam, Olathe, Overland Park, Prairie Village, Shawnee Police Departments, and the Johnson County Sheriff's Department. The TMT supports the Explosive Ordinance Disposal Teams of Overland Park Police and Olathe Fire Departments. The TMT also enjoys a close training relationship with the Kansas City Metro Tactical Officer's Association, by doing medical standbys during courses and providing instructors when necessary.

In 1993, Johnson County Med-Act created the Hazardous Materials Medical Support Team (HMMST) to respond to incidents involving chemicals that require specialized medical evaluation and support. The team consists of paramedics who have acquired training specifically to support fire department haz-mat response teams.

The HMMST members are trained to a high level of hazardous materials certification in comparison to the rest of the Med-Act department. This includes, but is not limited to:

• Haz-Mat First Responder Operations
• Hazardous Materials Chemistry
• Hazardous Materials Technician
• NFPA 473: Advanced Life Support Haz-Mat
• National Fire Academy Haz-Mat Advanced Life Support
• Contaminated patient decontamination and treatment
• Toxicology
• Hazards of Clandestine Labs (Methamphetamine Labs)
• Effects of Biological and Chemical Warfare Agents

The Disaster Response Team (DRT) is comprised of Med-Act employees, at all levels within the organization, who are dedicated to the preparedness for and management of multi-patient and special operations incidents. Team members have a strong working knowledge of the Incident Management System (IMS) and roles within that system, multi-patient scene management, disaster scene management, and operations of the department's Special Operations vehicles and equipment. The members of the DRT will be able to work at any level within the Medical Branch as needed to support the incident.

Many DRT members have been involved in Med-Act disaster preparedness for many years as members of the former Disaster Task Force. Their role was to help teach yearly department mass casualty incident (MCI) training, participate in the planning of disaster exercises, and to develop and maintain the Special Operations vehicles. In March of 2001, the Disaster Response Team was developed with an additional focus of becoming a true "response team" that would have specific roles at the scene of a major incident. With the new responsibilities came a new emphasis and commitment to learning about MCI management. The training and preparedness efforts of the DRT address the four phases of emergency management; preparedness, response, mitigation, and recovery.

During severe weather, mass casualty incidents, and/or special system needs, the EOT activates the department's operations center, known to the organization as the Emergency Medical Services Operations Center (EMSOC). The EMSOC provides a command and control center for all EMS activities and operations. Located at headquarters, EMSOC ensures system stability by adequately staffing of ambulance and rapid response units, strategically placing units, monitoring impending weather conditions and other system stressing causative factors, and facilitates additional resource requests.

Large crowds at public events can present unique challenges in gaining quick access to those in need. Many EMS providers across the country are now using bicycle teams to address this issue.

Med-Act’s Bicycle Medic Team (BMT) began in the summer of 2003, and has proven to be an effective way to deliver care when reaching patients becomes difficult.

Every year there are several large events held in Johnson County where the team has proven very useful. These include The Johnson County Fair (in Gardner), Old Shawnee Days (in Shawnee), and Old Settler’s Days (in Olathe), to name just a few.

The BMT also participates in bike rodeos, safety fairs, and other events that are held with the intent of promoting safety in general, and safe cycling in particular.

Each bicycle is set up to operate independently, although most often the BMT paramedics work in teams of two. In its panniers, each bike carries an AED, Oxygen and airway equipment, IV supplies, and medications to effectively provide initial treatment until a transporting ambulance arrives.

In order to more effectively manage the unique challenges of inter-hospital critical care patient transfers, Med-Act and the City of Overland Park Fire Department established a cooperative Critical Care Transfer Team (CCTT) in 2005.

Two ambulances in the Johnson County Emergency Medical Services System are designated as the Critical Care Transfer Ambulances and are staffed by a team of approximately fifteen paramedics who have undergone additional critical care-level training. The CCTT ambulances are primarily charged with responding to calls for emergency medical assistance in the community, while their special second priority is to handle requests for inter-hospital critical care transfers originating from the seven Johnson County hospitals. In affiliation with the HCA Midwest Neonatal Transfer Team (based at Overland Park Regional Medical Center), the CCTT also conducts interfacility transfers of high-risk neonates. With a volume of approximately 300 transfers per year, the CCTT is the most utilized and the most cost effective Johnson County EMS specialty team.