Tactical Emergency Medical Support

Purpose: The scene of a law enforcement special operation presents numerous barriers to traditional Emergency Medical Services access; thus, there is a need for medical support of law enforcement special operations to be performed by well-trained and properly equipped tactical medics who can operate effectively within the perimeter. Though military and law enforcement special operations are unique, similarities exist in the realm of tactical medical. Therefore, the purpose of this translational research project was to adopt the US military’s Tactical Combat Casualty Care guidelines, which are currently considered to be the standard of care for military prehospital medicine, to civilian tactical law enforcement. Methods: In 2005, the TCCC guidelines were adopted by US Army Special Operations for use in the Global War on Terrorism and training began at the Center for Predeployment Medicine, Fort Sam Houston, TX. When later considering adaptation of the guidelines to civilian special operation use, the Committee on Tactical Emergency Casualty Care was formed to determine the extent to which the three phases of tactical care—Care under fire (Direct threat care), Tactical field care (Indirect threat care), and Tactical Evacuation Care (Evacuation care)—needed to be modified. Results: Some specific content areas and provider competencies were amended; otherwise, each phase was determined applicable and modified in name change only. In addition, the overall structure and decision-making of the TCCC model was applicable to civilian special operation use. The austerity and danger of the operational environment require that the tactical medic be trained with a unique set of decision-making skills to be able to constantly balance the benefit of a particular intervention against the special risks inherent in performing the intervention in the environment. Modification of techniques, establishing priorities, and ongoing assessment of risk permit the tactical medic to provide the greatest good for the most people without exposing himself to unnecessary risk. Conclusion: The principles of medical care in the military tactical care environment are similar to those in the civilian tactical care environment. Although some TCCC content needed to be adapted for the civilian law enforcement, the phases of tactical care and the principles and flexibility of the system were efficiently and effectively incorporated.