Tactical emergency medical support
Section snippets
Military development and use
The development and growth of TEMS has its roots in both military and civilian law enforcement operations. The military in particular has long included medical support within its organizational structure. During the French-Prussian War, Napoleon's surgeon-in-chief, Larrey, developed the first battlefield medical triage and evacuation [3]. He noticed that delayed resuscitation of battlefield casualties contributed to increased mortality. Larrey devised wheeled carriages to accompany ground
Need for TEMS
Law enforcement is a high-risk profession. In 1999, 42 law enforcement officers were killed and 55,026 were injured by assaults in the line of duty [10]. Modern-day law enforcement officers and special operations teams face unique and challenging management problems, including organized opposing forces, perpetrators armed with military-type weapons, hostage situations, barricaded subjects, and toxic hazards associated with clandestine drug labs. Law enforcement activities such as serving
Unique attributes and skills
Emergency medical care during law enforcement special operations requires special knowledge, skills, and the modification of civilian field medical priorities. In addition, the tactically proficient medic may perform many equally important but unique functions, including the following: acting as the health maintenance and preventive medicine officer; performing preemptive medical reconnaissance, on-scene medical intelligence, tactical medical care, and integration with civilian medical
Goals of TEMS
The successful accomplishment of the tactical mission is the primary concern for all tactical team members. The shared goal among the law enforcement component and medical component of the tactical team includes the preservation of life and the safety for those involved in the mission including tactical team members, innocent bystanders, hostages, and perpetrators [1], [13]. From a wider perspective, TEMS may allow civilian law enforcement tactical teams ready access to additional medical
TEMS team structure
The structure of the tactical team varies considerably between law enforcement agencies, as does the TEMS component within any team. Aspects of TEMS structure that need to be addressed include the total number of team members and their respective duties, level of EMS training, level of law enforcement experience (if any), full-time dedicated medical personnel versus on-call medical capabilities, methods of recruiting, and whether to provide firearms for TEMS members.
Zones of care
During mission operations, the tactical team establishes various areas or zones of operation surrounding the objective or target. Lines established during an operation called the outer perimeter and the inner perimeter divide the theater of operations into three tactical zones: from a tactical perspective, these are known as the safe zone, warm zone, and kill zone. These tactical zones describe the area outside the outer perimeter (safe zone) and the two areas circumscribed by the outer and
Standard EMS versus TEMS
Standard EMS doctrine considers that scene and rescuer safety is the first priority, with patient care a secondary concern. Because the nature of tactical operations requires that officers and TEMS personnel operate in unsecured environments and situations with high potential for violence and injury, TEMS runs counter to traditional EMS response. Whereas tactical scenes are not safe from the civilian standpoint, TEMS personnel must be trained to conduct concise and limited medical interventions
Medical threat assessment
TEMS personnel perform an important function during the preplanning and execution of the tactical mission—that is, the development of the medical threat assessment (MTA) [2]. The MTA is the medical predeployment plan that coordinates the interaction of all medical assets to include both those internal to the team and those accessible within the surrounding medical community. In addition, the MTA must take into account any potential injury or medical care scenario that may affect the health or
Summary
As increases in criminal activity collide with more aggressive law enforcement postures, there is more contact between police officers and violent felons. Civilian law enforcement special operations teams routinely engage suspects in these violent, dynamic, and complex interdiction activities. Along with these activities comes the substantial and foreseeable risk of death or grievous harm to law officers, bystanders, hostages, or perpetrators. Further, law enforcement agencies who attempt to
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Cited by (35)
Physician roles in tactical emergency medical support: The first 20 years
2014, Journal of Emergency MedicineCitation Excerpt :Law enforcement officers and special operations teams (SWAT) are placed in dangerous situations on a routine basis. Such unsafe scenarios increase the morbidity and mortality of law enforcement officers, perpetrators, and innocent bystanders (1). These environments are especially unsafe for untrained emergency medical providers to deliver tactical medical care.
Resident Involvement in Tactical Medicine
2008, Journal of Emergency MedicineNursing practice within the French national gendarmerie intervention group
2016, Revue de l'InfirmiereEthical considerations in embedding a surgeon in a military or civilian tactical team
2012, Prehospital and Disaster MedicinePrototype of a Simulator for Hemorrhage Control During Tactical Medical Care for Combat Wounded
2023, Lecture Notes in Networks and Systems