Tactical Emergency Medicine - An Introduction -

1. Tactical Emergency Medicine- An Introduction - Dan Olesnicky, MD Associate Director Department of Emergency Medicine Christ Hospital Jersey City, NJ

2. TEMS - Why bother? • Docs with Glocks? • Is there really a need? • Waco Texas • Community Service • Team health • Disruption of the Law enforcement mission • Understanding the mission and the gear • Special training is required

3. Docs with Glocks? • Not a bunch of weekend warriors armed and dangerous • Tactical Medics • Sworn or not • Armed or not • Physicians and medics need to keep a low profile in the community and especially from the media • Cowboy Label

4. SWAT and SpecOps • S.W.A.T.: Special Weapons and Tactics • SpecOps: Special Operations • Purpose: SWAT teams are composed of highly trained personnel, each of whom can assume varied responsibilities with a high degree of proficiency and expertise. The Unit is prepared to assume full control of specific high-risk tactical situations, which by nature would be considered excessively dangerous or complex for conventional police officers. Practically speaking the team is organized as both a crisis intervention team and a rescue team with negotaition and assault capabilities.

5. Mission Goal • The goal of the team is to accomplish its mission without injury or death resulting from the team’s intervention. • Foremost is the minds of the team members is the preservation of life and safety of bystanders, hostages, team members and victims.

6. TEMS Providers are trained • TEMS providers are trained to work in a tactical environment. • Evidence perservation • Weapons trained • Render a weapon safe • Understand the equipment • Less likely to become victims than Non-TEMS • Provide care that Officers CANNOT

7. Evidence Preservation • One of the major priorities in a police or military operation. • Most civilians overlook evidence and are unaware of how they are destroying it. • It makes prosecution and conviction difficult when a crime scene is destroyed by EMS personnel.

8. Canary in a Coal Mine • TEMS providers are less likely to be victims themselves • Drug Labs • Chemical Hazards • Getting yourself shot

9. Unique working environment • Special equipment and applicatons are used • Most or all of your equipment is carried on your person • Worst Case Scenarios must be planned for before the operation • You can’t go to the supply room in the ED • Difficult to work in the Hot Zone

10. Equipment

11. Ambu Bag • Airway Kit • IV’s • Trauma Supplies • Chest tubes • Surgical Kits • Light source • Suture Material • Burn Supplies • Personal protective equipment • Drugs • All your SWAT Gear and Body Armor

12. More Stuff • Body Armor • Side Arm • Long Gun • Spare magazines and ammunition • Flash Bangs • Helmet • Goggles • Gloves • Knee and elbow pads • Tactical Load Bearing vest or pack • Protective Sheild • Mirror or Breaching Equipment

13. Common Injuries • Most common injuries are sprains and simple lacerations • Suspects usually sustain fall injuries rather than team members or hostages • Equipment dealing with such injuries should be on hand • Heat and Cold Exposure

14. Trauma • Get to at least the Warm Zone before any lengthy medical interventions are done • Hot Zone is for IDL’s ONLY! • Scoop and run • ABC’s • Bleeding • Safe and quick exit to warm zone • Rarely a need to rush into a situation • Can help get to victim?

15. TEMS Trauma FactsSame Care, yet not the same • 90% of victims in war die on the battlefield • 2,500 died from a simple extremity hemorrhage in Vietnam • Golden Hour – most die in 30 minutes of injuries that require simple interventions • Penetrating injury requires different care from blunt trauma • Boarded and collared? • Forget collar under fire • Board and Collar in the Warm Zone • Scoop and run?

16. So what does TEMS really do?

17. Planning Operator Location of TEMS Physician Medical Intelligence Prediction of medical problems of suspects and hostages Improves public opinion Reduces Liability Provisions for transport Evidence Preservation Barricade medicine Remote physical assessment Extrication and evacuation Canine first aid TEMS Role

18. TEMS Provider Must Understand • Chemical Munitions and deployment techniques • Distraction devices and effects • Booby Traps and unconventional weapons • Weapons Systems and management • Active countermeasures • Dynamic Clearing and movement • Stealth Movement • Medical advisor to the mission commander

19. Team Concepts • Training • 360 degree protection • Invisible Deployment • Noise Discipline • Cover and Concealment • Communications • Negotiation Training • Chemical Agents

20. Operation Planning • Warning Order • Building Intelligence • Suspect and hostage Intelligence • Recon Mission • Operations Order • Debrief

21. Operation • Situation • Location • Suspects • Number of suspects • Physical description • Dogs • Mission • Warrants • Barricaides

22. Execution • Recon Report • Danger Areas • Movement Plan • Entry Plan • Alternate Entry Plan • Specific Duties • Team Leaders • Recon Team • Apprehension Team • Perimeter Team • Marksman • Observer • Rescue Team

23. TEMS in Action • Pre-Determine Hard Cover • Prepare for the Unexpected • Recognize the Medical Problem • Maintain Emotional Composure • Triage Accurately and rapidly • Treat what you need to

24. Tactical Mangement • Airway Management • No airway obstruction • Chin Lift or Jaw thrust • Nasal Airway • ETT or Esophageal airway • LMA • Breathing • O2 • Ventilate • Needle Thoracostomy • Chest Tube Insertion • Circulation • IV Access • Control Hemorrhage • Hespan

25. Tactical Management • Monitoring Vitals • Inspect and dress all wounds • Analgesia • Splint fractures and establish neurovascular integrity • Antibiotics • Open Fractures • Penetrating abdominal Trauma • CPR • Evacuation and Transport

26. Injury Priority • Breathing • Bleeding Wounds • Broken bones • Burns

27. Get Involved • Heckler and Koch • Tactical EM Basic • Tactical EM Advanced • CO.N.T.O.M.S. • Get involved with and train with a SWAT Team • SBHCS SOD Team • Stay Safe!

28. Questions?