Abstract
Providing care at the scene of a tactical incident is a complicated process influenced by numerous dynamic variables. There are significant differences between Tactical Emergency Medical Support (TEMS) and traditional civilian Emergency Medical Services (EMS) that impact the decision making process of the provider. This article seeks to provide an overview of the problems encountered in the tactical care environment as well as insight into the unique role played by the TEMS provider.
MEDICAL DECISION MAKING and patient care at the scene of a tactical incident is the result of numerous fluid and unpredictable variables. These include mission type, operational flow, medical intelligence, opportunity for prior planning, necessary operational tactics, resources available, environmental circumstances, suspect behavior, and accessibility of casualties. Additionally, there are significant differences between tactical emergency medical support (TEMS) and traditional civilian emergency medical services (EMS). Unlike traditional EMS, the overall mission may take priority over the medical mission. Another significant difference between TEMS and traditional EMS is that the tactical medic may have to take significant risks in order to reach or evacuate a casualty. How tactical medics are integrated into the tactical team can have a considerable impact on how significantly circumstantial variables impact patient treatment. This article discusses each of the variables in order to clarify how and why decisions are made, and how patient care is delivered in a tactical setting.
First, TEMS does not lend itself well to the process of evidence-based medicine. Treatment priorities and opportunities may be completely dependent on circumstances beyond the control of the TEMS team. The conclusions set forth below are based on lessons learned not only from the military, but also from field experience of TEMS providers nationwide.
In order to provide medical personnel with a basic familiarity with the clinical practice of tactical medicine and care under fire, as well as with an understanding of the unique medical decision making required of the TEMS provider, it is necessary to define the missions or circumstances that require TEMS.