Tactical Emergency Medicine

What is this newer medical specialty? Tactical Medicine (TM) is a discipline that specializes in the emergency medical support and services required to support the mental and physical health and the overall safety of law enforcement and military special operations (i.e., SWAT) personnel during critical incidents and training. Tactical Medical Providers (TMP) not only provide training for high-threat deployments, but they are also often cross-trained in military/law enforcement activities and function as integral members of their teams. Training often includes weapons training, arrest techniques, criminal law, pyrotechnics and many other non-medical skills required for specific missions. Other areas of training might encompass waterborne operations, wilderness skills, HazMat skill knowledge and skill, helicopter extraction and defensive tactics.

The primary goal of all of this training is to save officer/soldier lives. The secondary goal is provision of care for others at the scene and facilitate extraction and enable and enhance EMS services when they become available.

The overall goal of tactical/military specialty teams is the accomplishment of a mission with as few injuries and deaths as possible. The TMP's primary goal is the safely help secure the team's mission. The medical goals of the TMP's include effective performance of medical duties as safely as practical. TMP members conduct post-event debriefing and well as participation in the overall team debriefing analyzing their response as medical providers as well as their response as team members. The goal is always to improve tactics, procedures and protocols leading to higher-quality medical care as team member improvement.

NTOA's Definition of Tactical Law Enforcement Operations

The National Tactical Officers Association (NTOA) in their public website stated the following SWAT standards description.

SWAT Tier 1 teams must be mission capable in all of these areas:

• Hostage rescue
• Barricaded gunman
• Sniper operations
• High-risk warrant service and apprehension
• High-risk security missions
• Special assignments
• Terrorism response
• Other incidents that exceed the capability and/or capacity of the agency's first responders

The greatest challenge is clearly the planned deliberate hostage rescue operation. (mass shooting situations, etc.) Such large-scale needs create requirements for a larger number of, and more specifically trained TMP's. Having a well-trained tactical medical component of the team allows for trained medical providers to assist commanders with the development of pre-deployment risk assessment, implementation of risk reduction strategies, provision of logistic support and a liaison to coordinate medical operations with local emergency medical services. (EMS)

Members of the tactical medical team

• EMT's, paramedics
• PAs
• APRN's
• Physicians

Advantages of tactical medicine

• Speed life-saving immediate interventions
• Provide early high levels of skill
• Provide protection for patients and other team members
• Creates a positive psychological benefit for the team and public

Is CPR, ACLS and PALS part of the Tactical Medical curricula?

CPR, ACLS and PALS are indeed CORE required knowledge for each and every tactical medical practitioner. Most program require certification in addition to trauma focused resuscitation programs such as BTLS, TEMS, etc.

Because of the imposing physical, psychological and training requirements, only a few medical practitioners will be attracted to this area of specialty. There are now several ACEP accredited post graduate medical training programs (residencies) scattered around the U.S. Currently, the typical physician member brings specialty training in emergency medicine, family medicine, surgery and anesthesiology. Many of these TMP's have received training and certification as sworn law enforcement officers as well. (Reserve deputy is the most common) It is likely there number of TMP's will increase in the future.