Abstract
The development of a tactical emergency support (TEMS) program is an involved process. Multiple TEMS models effectively function and there is no "best model" for every agency. This article summarizes common components that must be considered in the development of a TEMS program. Components discussed include: goals of TEMS program, structure of the TEMS element, training for TEMS providers, law enforcement status, TEMS provider skill level, arming of TEMS providers, operating location, liability issues, insurance issues, and equipment for TEMS units. The proper development of a TEMS program will meet the primary goal of enhancing the tactical unit's mission accomplishment.
DEVELOPING a tactical emergency medical support (TEMS) program for a law enforcement special operations team is not an easy task. While tactical commanders are increasingly aware of the benefits of an organic medical element (ie, an element that is part of the special operations unit), many still require convincing that this is a cost-effective and mission-enhancing investment. In addition, the tactical commander rarely gets to make this decision on his own. Rather, collaboration and approval by many different entities, such as the police chief, fire-rescue or emergency medical services (EMS) authority, general counsel or the legal department, and risk management, is usually required to initiate a TEMS unit.
The development of a TEMS program must be based on individual agency need, applicable law, custom and practice, and the resources that can be brought to bear on the situation. There is no single "best" model that will work for every application and the people most suited to design a TEMS program are those with intimate knowledge of the affected agencies and systems. However, experience has demonstrated that there are basic questions that remain constant to all of these efforts.1 This article discusses those common issues and explores a variety of proven solutions that have worked around the globe. Each solution must be judged on the basis of its applicability to individual circumstances.
Today, law enforcement agencies increasingly acknowledge the benefits of far forward emergency medical care at a broad spectrum of law enforcement missions.2 Although tactical medicine was originally conceived as a support function for military and later, for police tactical teams, its value in other types of operations has become apparent over time. This type of medical support is now often utilized in counter drug and counterterrorism missions, surveillance cases, weapons of mass destruction crisis management, protection details, forensic investigations, national security incidents, and major public events. The basic principles of tactical medicine have wide applicability to those situations in which people must work under hostile, austere, and prolonged transport conditions.
A rich military history and modern experience have suggested that a purely traditional approach to EMS in the tactical environment is not feasible and will expose out-of-hospital providers to unnecessary danger.3 Such an approach may also be detrimental to the law enforcement mission. These factors mandate a different set of field assessment and treatment priorities, intelligence gathering and analytical skills, injury control practices, and strategies for managing performance decrement. Specialized medical support that is fully integrated with the team, executed by medical practitioners who are trained, skilled, and well equipped to operate in these unique environments, is part of the tool kit that allows special operations teams to push to the edge of the envelope with reasonable safety.