Tactical Emergency Medicine - An Introduction -

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Tactical Emergency Medicine- An Introduction -

• Dan Olesnicky, MD
• Associate Director
• Department of Emergency Medicine
• Christ Hospital
• Jersey City, NJ

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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

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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

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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.

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Mission Goal

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

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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

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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.

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Canary in a Coal Mine

• TEMS providers are less likely to be victims
  themselves
• Drug Labs
• Chemical Hazards
• Getting yourself shot

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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 cant go to the supply room in the ED
• Difficult to work in the Hot Zone

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Equipment
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• Ambu Bag
• Airway Kit
• IVs
• Trauma Supplies
• Chest tubes
• Surgical Kits
• Light source
• Suture Material
• Burn Supplies
• Personal protective equipment
• Drugs
• All your SWAT Gear and Body Armor

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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

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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

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Trauma

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

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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?

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So what does TEMS really do?
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TEMS Role

• 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

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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

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Team Concepts

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

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Operation Planning

• Warning Order
• Building Intelligence
• Suspect and hostage Intelligence
• Recon Mission
• Operations Order
• Debrief

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Operation

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

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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

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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

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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

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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

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Injury Priority

• Breathing
• Bleeding Wounds
• Broken bones
• Burns

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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!

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Questions?