Abstract
Tactical Emergency Medical Support (TEMS) operates in a dynamic environment. The needs of tactical commanders and the agencies that TEMS providers support vary widely and the role of the medical operator is at times as fluid as the environment they operate in. This article defines 10 topics in which differences of opinion exist in the TEMS and tactical law enforcement communities.
ALTHOUGH tactical emergency medical support (TEMS) has been practiced on some individual teams in diverse forms for over 30 years, its formal beginning was not until 1989, with the first TEMS course sponsored by the Los Angeles County Sheriff's Department and the National Tactical Officers Association (NTOA).1 During the ensuing 14 years, we have witnessed the dynamic growth of TEMS into an international program and an evolving standard in the United States.2-4
As with the implementation of most new medical and tactical programs, there will undoubtedly be honest differences of opinion between knowledgeable individuals of the professions. TEMS has been no different.5 The differences have been more challenging since there is very little evidence base available to us to clearly develop policy, procedures, and guidelines. Much like emergency medicine itself as it developed, TEMS practice is founded on anecdote and/or extrapolation of related scientific information.
During the 1990s, many individuals and several organizations worked together to develop curricula and a general approach to TEMS. These would include but not be limited to early leaders such as the NTOA, the Department of Defense, and its Uniformed Services University of the Health Sciences via its Counter Narcotics Tactical Operations Medical Support Course (CONTOMS), and later several universities, private organizations, and groups.
Early on, a general supportive philosophy emerged nationally although the individual courses, curricula, and standards varied considerably. Many felt their offerings were "best" because of the seasoned military and/or police instructors that were teaching. However, there were no best practices supported by an evidence base. To this day, the search continues as to how to achieve the most cost-effective and efficient TEMS programs commensurate with available resources, department commitment, threat level, and mission profile while balancing potential risk and liability.2
In fact, based on the wide variation of tactical teams' ability, and types of missions and resources, it is clear that there is no single TEMS configuration that is "right" for all teams. Instead, applying a basic set of mutually agreed upon principles with several options to meet the needs of each individual team will have the best chance for success. Because of the complexity as well as depth and breadth of TEMS, it is not surprising to find that there are areas in TEMS that have been and remain controversial.5 The following items are some of the most debated issues in TEMS.