Tactical Medicine: A Joint Forces Field Algorithm

INTRODUCTION Tactical emergency medical support (TEMS) is a specialized area of emergency medical services (EMS). Its primary goal is to provide medical care under tactical environments to help save lives and accomplish the team’s mission. It may reduce the likelihood of death, injury, permanent disability, and illness among tactical operators, civilians, and suspects; reduce lost work time; decrease liability for the law enforcement agency; and enhance team morale. In addition, TEMS providers can train officers to treat themselves and others, a valuable capability if medical personnel are not immediately available. Much of the medical care administered by TEMS providers is based on local or regional EMS protocols and on a number of tactical medical curricula, including Tactical Combat Casualty Care (TCCC), the STORM (Specialized Tactics for Operational Rescue and Medicine) family of courses, and CONTOMS (Counter Narcotics and Terrorism Operational Medical Support). The primary objectives of these curricula are to treat the casualty, prevent further casualties, and complete the mission. The TCCC curriculum addresses rapid hemorrhage control, including early tourniquet application; airway management; fluid resuscitation; field analgesia, antibiotic administration; and hypothermia prevention. Efforts are ongoing to expand the role of, and standardize the care administered by, TEMS providers. How to incorporate a military-based TEMS component into civilian Special Weapons and Tactics (SWAT) teams and how tactical commanders can use this potentially valuable asset receive less attention. Medical personnel can be an important addition to a SWAT team, but they can also be a liability. Tactical leaders tasked with integrating a medical component in their team must learn to utilize providers in a safe and effective fashion. They should have an appreciation for the potential benefits and limitations of on-scene medical care, how to manage victim evacuation and the timing for that evacuation, and how to balance the needs of the patient with the success of the mission. Although law enforcement and medical providers focus on different aspects of a mission, either addressing the threat or caring for the injured, the joint mission in scenarios such as an active shooter is to save lives. The medical and tactical efforts should be complementary and by this synergistic to the mission. Based on our experience in the Israeli Special Forces and in civilian EMS, TEMS, and SWAT teams in the United States, we propose a joint forces field algorithm that addresses the medical and tactical considerations of patient care in a hostile environment. It can be followed by medical providers and tactical operators to better coordinate their efforts. It may assist civilian SWAT leaders working with TEMS personnel to incorporate medical providers into their teams and medical considerations into their tactics. The aim is to narrow the gap that may exist between law enforcement and medical priorities in the field and provide higher-quality patient care so SWAT teams can better accomplish their mission.