Division of Tactical Emergency Medicine

About

The mission of the Division of Tactical Emergency Medicine (DTEM) is to provide the highest quality preventive and interventional care to law enforcement (LE) agencies in both clinical and tactical settings; create educational opportunities for law enforcement officers, current and future tactical medical providers and other medical personnel; and lead the nation in determining and disseminating best evidence and practices for tactical medical education and clinical care.

Background

Public safety organizations often work in dangerous environments with the possibility of injury a constant threat to their members - those who are protecting people in the communities they serve. One method of decreasing member risk and potential liability for interactions with others is to provide medical resources capable of operating in those same environments. Tactical emergency medical support (TEMS) is the ability to safely provide medical care in high-threat situations where conventional emergency medical services (EMS) personnel are not equipped or qualified to respond. This is particularly true for law enforcement special operations: aviation, bomb disposal and special weapons and tactics (SWAT) teams.

Tactical emergency medical support is based on three pillars:

• Achieving and maintaining team health through preventive medicine, human performance and sports medicine;
• Education and training programs for all team members (including commanders, operators and medics) on tactical casualty care; and
• Provision of medical expertise in the forms of advice for decision-making and direct care during all training activities and operational missions.

Over the last century, a systematic approach to the management and evacuation of battlefield casualties has been developed. Rapid, efficient and effective trauma management by medical personnel embedded in operational units has uniformly been accepted as the standard of care in the military tactical environment. Advances in military medicine have been applied in the civilian realm when medical personnel returned from conflicts and applied their skills back home. The fundamental concepts of medical support for LE special operations evolved from these military roots. Although there are important distinctions between the two environments, military medicine and TEMS each embody special knowledge, skills and abilities that define them as intertwined medical disciplines.

Team Health

The Division of Tactical Emergency Medicine supports medical care of LE special operations through qualified faculty and resident physicians serving as tactical medical providers. They are responsible for care of tactical team members during fitness, training and operational activities. In this capacity, they act as medical advisor and liaison to the team commander, provide lifesaving measures in the tactical environment and initiate other medical care as necessary. Supervised resident participation is strictly voluntary.

The Division supports preventive medicine and enhanced performance through cooperation with community medical providers. Activities include departmental physical examinations, pre-participation screening, fitness training, nutritional counseling, tactical performance enhancement training and injury clinics.

Education and Training

Education and training is provided to law enforcement officers, tactical medical providers, conventional EMS providers and other interested healthcare personnel. Example topics include self-care and buddy-care, concepts and practice of tactical emergency medical support and medical support of the tactical athlete.

In association with the Ohio Attorney General’s Office and the Ohio Peace Officers Training Academy, the DTEM has created and conducted courses on Self-Aid/Buddy Aid for the Law Enforcement Officer, in which patrol officers and tactical operators learn the basics of tactical emergency casualty care, training them to recognize immediately life threatening injuries and intervene quickly and effectively before the arrival of conventional EMS personnel. This training served as the model for the Critical Injury First Aid module that is now part of Ohio’s Basic Peace Officer curriculum.

Educational opportunities are provided for the emergency medicine resident physicians and other graduate level physicians. These consist of classroom lectures, small-group discussions, skill labs and field exercises. Content is drawn from the current peer-reviewed TEMS literature. Delivery is overseen by Division faculty. Interested residents may teach as well, and will be mentored by a qualified attending physician.

Operational Support

Division members provide medical standby care and participate in SWAT training sessions and real-world missions. Care is provided to all law enforcement personnel, bystanders and suspects under the principles of humanity and impartiality.

Faculty

Forms

• Data Collection System Casualty Report Form (PDF)
• Data Collection System Incident Report Form (DOCX)
• Emergency Medical Information Form (PDF)
• Hospital Site Survey (PDF)
• Medical Threat Assessment Form (PDF)
• TCCC Casualty Care Card (PDF)

Tactical Resident Interest Group

The purpose of the Tactical Resident Interest Group (TRIG) is to gather faculty, residents, medical students and other participants for conceptual discussions, educational sessions and operational participation regarding tactical emergency medical support (TEMS) of law-enforcement and military operations. Although many of the physicians and medics provide real-world tactical emergency medical support for regional organizations, operational activities are not a requirement for TRIG membership.

Tactical emergency medical support is based on three pillars:

• achieving and maintaining team health through preventive medicine, human performance and sports medicine;
• education and training programs for all team members (including commanders, operators, and medics) on tactical casualty care; and
• provision of medical expertise in the forms of advice for decision-making and direct care during all training activities and operational missions.

Some faculty and law enforcement partners have more than 15 years of experience in tactical emergency medical support of federal, state, regional and local agencies and organizations. All faculty from the Division of Tactical Emergency Medicine (DTEM) have written authoritative chapters in relevant civilian and military manuals and textbooks. Others bring backgrounds in Air Force and Army conventional and special operations. Because of the civil-military integration of the residency program, many residents also bring important past experiences to TRIG meetings. Drawing on this cumulative expertise is critical for understanding and innovation.

Conceptual Discussions

TRIG members must understand the unique nature of the tactical environment before they can begin to grasp the specific concepts of TEMS delivery in training and real-world settings. The tactical environment bears little resemblance to conventional out-of-hospital care practiced by civilian emergency medical services systems.

Recent TRIG meetings have included introductions to tactical emergency medical support, tactical athlete nutrition and performance, casualty extraction and organization of personnel and equipment assets.

Educational Sessions

Education and training takes two forms: 1) experienced medics teaching operators and other medics; and 2) experienced operators teaching medics and other operators. Some TRIG members have had the opportunity to take a basic SWAT course.

Three DTEM faculty and a senior TRIG member recently conducted a one-day course teaching tactical casualty care to a local SWAT team. Basic concepts of hemorrhage control, airway and breathing issues and casualty extraction were presented in the morning, with each being followed by hands-on practice sessions. Multiple scenarios in the afternoon reinforced concepts by integrating tactical operations and operator injury and rescue scenarios.

Operational Participation

TRIG members have several opportunities to provide medical standby care and participate in SWAT training sessions and real-world missions. Care is provided to all operators, bystanders, and suspects under the principles of humanity and impartiality.

One of our alumni, John Trentini, M.D., hosted a tactical medical training exercise for our residents at his farm. Watch a video from the training exercise. (off-site) This particular exercise focused on medical care in the field vs. medical care in the hospital.