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Tactical medicine concepts have been around since the dawn of medicine….and warfare. Even in early battles the “King’s Doctor” was to be close at hand to deal with injuries, but only to the royal few. Outcomes were not very good as the initial insult might have killed the victim; if that didn’t, then infection usually did. Historical accounts and personal diaries of military medics through the centuries are fascinating and show a steady progression of tools and techniques and an ever improving understanding of injury management. The Vietnam War showed that rapid transport to a higher echelon of care had a significant impact on survival.
Tactical medicine has become a discipline and specialty within law enforcement circles. High profile events such as the Columbine, Virginia Tech, Aurora Movie Theater and countless other “active shooter” incidents have shifted the way law enforcement operates. There have been two major shifts in doctrine related to SWAT and law enforcement operations over the last 10 years. One change was focused on aggressively going after active shooters with whatever assets happen to be on hand, instead of waiting for a SWAT team. The second has been to recognize the need for emergency medical contingency planning. This includes training officers/agents in the basics of “self-care” and “buddy care” with the focus on bleeding control. Another aspect of this doctrine shift is the inclusion of organic assets (the tactical medic), and involving, or at least notifying local EMS, hospitals about law enforcement operations that have a high risk for injuries. SWAT teams have increasingly a dedicated tactical medical component as part of their setup. Some law enforcement agencies (LEA) have decided to send officers to EMT school, or specific tactical medical classes. That may be a workable solution; however, it is unlikely those individuals have the experience and patient assessment skill needed to be the best medical practitioner they can be.
Tactical emergency medicine services (TEMS) has emerged as a specialized niche within the field of emergency medicine. With increasing demand for physician participation in civilian tactical teams, there will be efforts by residents to become involved at earlier points in their clinical training. Interest in prehospital care research continues to grow within emergency medicine (EM), and the operational boundaries of its providers are continually being pushed further outward. Indeed, for many of us in the field, potential involvement in this earliest phase of care—with television images of lifesaving in-field cardiac defibrillations, racing ambulances, and medical helicopter evacuations in our minds—was one of the most alluring calls to join the ranks of emergency physicians, with the goal that we too would practice the best medicine "anywhere, anytime." Tactical Emergency Medical Services (TEMS) is out-of-hospital care given in hostile situations by specially trained practitioners. It is distinct from the care given by medics in war zones, as TEMS generally refers to care rendered by civilians. Tactical Medics are Emergency medical technicians (EMT), paramedics, nurses, and physicians who are trained to provide life-saving care and, sometimes, transport in situations such as tactical police operations, active shooters, bombings, and natural disasters (though rarely the latter). As the number of training programs in emergency medicine has grown, so too has the number of subspecialty areas within the field. One such niche is tactical emergency medicine services (TEMS), herein defined as the provision of emergency medical support to civilian law Special Weapons and Tactics (SWAT) and military special operations units. Importantly, this care encompasses not only that provided while under active fire, but also includes the preventive and primary care that takes place before combat ever begins.
Traditionally, the involvement of physicians in this area of medicine, and especially in the training for such participation, has come at the fellow or attending level. Currently, some emergency medical services (EMS) and occupational medicine fellowships include involvement with a TEMS team as an option for those interested.
But, as former tactical medic and Surgeon General Richard Carmona pointed out, tactical medicine is a field that is likely to grow over the next few decades, and as that expansion occurs, it is likely that residents will try to become increasingly involved at earlier points in their postgraduate training. It is neither a clinical study nor a structured literature review, but rather an opinion piece intended to help emergency medicine residents and emergency physicians better understand the difference between conventional prehospital and inpatient emergency medicine and that of tactical emergency medicine. Tactical emergency medicine is a specialty that utilizes the full array of the emergency physician's skill set. It is also a field that is ripe for continued expansion, but the resident looking to become involved with a team should be aware of the requirements necessary to do so and the obstacles likely to be encountered along the way.
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1) 3rd International Conference and Exhibition on Physical Medicine & Rehabilitation, May 18-20, 2015 San Antonio, USA
2) International Conference and Exhibition on Pain Medicine, June 08-10, 2015 Chicago, USA
3) Global Summit on Emergence Medicine & Medicare Expo, October 05-07, 2015 Dubai,UAE
4) 2015 NYTOA TACTICAL TRAINING CONFERENCE, New York, April 27, 2015
5) 2015 Tactical Conference, February 20-22, 2015, Memphis, Tennessee
6) Bio-IT World Conference & Expo, April 21- 23, 2015 in Boston
7) 2015 Southeastern Student Wilderness Medicine Conference, Johnson City, TN
8) 4th International Conference on Translational Medicine, October 26-28, 2015 Baltimore, USA
1) National Tactical Officers Association
2) National Association of Tactical Medics
3) Special Operations Medical Association
4) Tactical Medics International (TMI)
5) International School of Tactical Medicine
6) OUTHERN NEVADA WILDERNESS MEDICAL SOCIETY
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This page was last updated on February 18, 2020