Concepts in Tactical EMS

Prepared by B. Carr

The Big Picture: SOP and TEMS Operations Overview

Module 1/5

Overview

IntroductionPurposeTEMS HistoryOperationsTreatment ModalitiesTEMS TRAINING Next StepsAdditional Resources

Introduction: Practicing Indirect-Threat Care

Balances threats, civilian scope of practice, medical equipment limits, and variable resources for response to atypical emergencies

Correlates risk/benefit ratio for civilian operational medical response

Provides guidance on medical management of preventable deaths at or near the point of wounding

Minimizes provider risk while maximizing patient benefit

Mass violence incidents continue to occur and disregard population size, community structure, and geographic area.

As an all-hazards response agency, Jackson Hole Fire/EMS must train to provide unparalleled pre-hospital care under demanding conditions.

Why This and Why Now?

data from FBI Active Shooter Study, completed in 2014

TEMS PURPOSE

Shortens barrier between time of injury (TOI) and application of care (AOC)

Implements medical actions across all scene types with minimal delay

Utilizes joint operations theory to stabilize incidents from different response angles and objectives

Maximizes care of response team to ensure mission success

The “Golden Hour” is one method of addressing preventable deaths from

traumatic injuries

TEMS HISTORY

Follows care and principles of battlefield medicine

Combat medicine refined to address modern warfare techniques in World War I

Organized by US Army Medical Department (AMEDD) to train soldiers in Tactical Combat Casualty Care (T-CCC)

Adapted to civilian needs as Tactical Emergency Casualty Care (TECC)

US Army Medical Corps Insignia, ca. 1908 US Army

62nd Medical Brigade Insignia

JH Fire/EMS TEMS Operations

Jackson Hole Fire/EMS providers will currently operate in warm zone environments. Casualty collection points with force protection (i.e. dedicated CCP law

enforcement) Rescue Task Force

Casualty Collection Points Designated location where responder personnel gather, triage, provide

indirect threat care, and package patients for transport to medical treatment facilities

Rescue Task Force Fire/EMS personnel, paired with law enforcement, bomb team or HazMat

team personnel, that operate within Cold and Warm Zones

Cadre Jackson Hole Fire/EMS personnel will not deploy to hot-zone environments. Any future hot-zone operations will require EMT-T certification and additional training (e.g.

CONTOMS course)

Identified TEMS Scenarios

Mass violence incidents Hostage-barricade situations Emergency ordinance disposal Protection details Civil demonstration or protest Dynamic training operations Search and rescue missions Acts of terrorism CBRN/HazMat scenes

Treatment Modalities

C-TECC PHASES ASSOCIATED PRIORITIESDirect Threat Care (DTC) -Hot zone -Area of evolving or unmitigated risk; hostile environment -Law enforcement, bomb team, HazMat team or first

responder buddy care -Extraction

-mitigate the threat -move wounded to cover or area of relative safety (e.g. casualty collection point) -manage massive hemorrhage

Indirect Threat Care (ITC) -Warm zone/Cold Zone boundary (Casualty Collection

Point) -Cleared but unsecured environment -Fire/EMS personnel with attached law enforcement, bomb

team or HazMat team (Rescue Task Force)

-initiated once the casualty is in an area of relative safety -focus on preventable causes of death

-Hemorrhage, ABCs-Disability, Environment-Effective Triage

Evacuation Care (EVAC) -Cold zone -Secured transport corridor -Fire/EMS personnel with attached law enforcement, bomb

team or HazMat team

-movement of casualty to definitive treatment facility -interventions similar to normal EMS transport operations -continued emphasis on reassessment of interventions and

hypothermia management

Treatment methods differ according to demands, resources, and prearranged mission objectives. Flexibility is essential.

TEMS TRAINING

Adapts medic to provide care in austere and hazardous environments.

Demands physical fitness excellence.

Focuses on extracting and treating casualties, preventing additional casualties, and supports completion of mission.

With additional training, allows medics to work with law enforcement units and/or SRTs as necessary.

Jackson Hole Fire/EMS currently supports warm zone operations.

• Emphasis is on casualty collection point functionality

• Follows standard rescue task force models

• No additional certification required• Differs from Tactical Medic (EMT-T) attachment to

SRT, SWAT, or in-bound single law enforcement units engaged in hot-zone operations

Please review and discuss the SOP provided with/prior to this training presentation.

Next Steps

Module 1 presented an overview of the modified tactical EMS operations Jackson Hole Fire/EMS has adapted.

Module 2 will build on this information. It will provide guidelines and templates for effective MCI operations and establishment of casualty collection points.

Again, please review the SOP with your crews.

Additional Resources

Committee for Tactical Emergency Casualty Care FBI Active Shooter Study, 2014 International Association of Firefighters Position State

ment Tactical Combat Casualty Care Portal, NAEMT AMEDD’s Contact Casualty Care (extensive information)