With society facing ever-increasing violence and the subsequent increase in incidents involving critically wounded persons, law enforcement is being trained to advanced levels of casualty care and prepared to render closer to, if not at, the point of injury in a vast array of environments. Even with the strongest interoperability relations with fire rescue and emergency medical services, until scenes are secured, most will not respond into a direct or indirect threat environment. The Lake County Sheriff's Office (FL) has addressed this with the establishment of Operational Medicine Detachment, supporting emergency and non-emergency incidents. With 30 tactical medical responders, with scope-of-practice ranging from Tier 2 (T2) emergency medical responder, with enhanced skills-sets, to paramedic (T4), all are sworn law enforcement officers, including agency physician responsible for medical direction and oversight.