Page 124 - Journal of Special Operations Medicine - Spring 2014

TEMS v. 2014

Philip A. Carmona, NREMT-P, RN, 18Z, 18B, 18D
U.S. Army Special Forces (Ret)
Center of Operational Medicine, Georgia Regents University

he Tactical Emergency Medical Support (TEMS) arena in the United States (and worldwide) continues to un-
Tdergo a dynamic state of change as agencies, jurisdictions, and departments scramble to deal with the everyday
needs and concerns of the populations they serve. Those aforementioned entities compete for ever-diminishing re-
sources and wrestle daily with the perceptions and expectations, real or otherwise, of local, state, and federal leaders
to whom they answer.

This struggle is further exacerbated by real-world events ranging from local active shooter tragedies to Mumbai-
style operations planned, executed, and coordinated with precision.

In the midst of these events is the struggle to determine best science and evidence-based TEMS practices that will
deliver training, and operational solutions to best deal with the TEMS component of any crisis.

I have been an active member of the Special Operations community for more than 40 years and observed the dy-
namic changes from the Vietnam conflict to the current conflicts. And while progress is being made to translate
conflict-related TEMS experience into stateside practices, there are some impediments to that translation. In my
view, it is imperative that egos, publishing credit, legacy generation, profits, and other related self-serving afterbirths
of this grand global crisis be set aside for a more cogent team approach. Analogous to that is the great command
given as a tactical team attempts to break through the surf in their inflatable vessel, “Give way together.” It is time
for leaders to lead to get this TEMS “boat” moving together. One example in my view is for the National TEMS
Council (NTEMSC; formerly NTIC) and the Committee for Tactical Emergency Casualty Care (C-TECC) to work
together to bring solutions to TEMS-related issues and problems.

I do a considerable amount of traveling in support of these endeavors. I recently received this report from a colleague
who leads the California TEMS Initiative and Council (CAL-TIC), a separate 501c3 offshoot of the NTEMSC. He is
also a member of the C-TECC and the NTEMSC, frequently existing in the gap between the two important agencies.
Ray Casillas is a senior Firefighter Paramedic and a tactical medic/leader of almost two decades. He writes:

The California Fire Chief’s Training section convened a symposium on February 4, 2014, Burbank, Cali-
fornia, to orient many from the fire and police professions to crisis response to active shooter events. This
was a follow-on to the well-received conference hosted by the same in November of 2013. In a somewhat
historical moment, it was amazing to witness 120-plus firefighters and police officers with varying ranks
sitting in the same room, receiving the same information, vastly agreeing to work together.

The 2014 symposium was led by certain members of the NTEMSC and the grass-roots consortium,
CALTIC. The day started out with presentations on the NTEMSC, CALTIC, and the National Education
Security Initiative (NESI). Unbeknown to many in the audience, schools K–12, public and private, have
access to many great Critical Infrastructure Protection training opportunities under the NESI umbrella.
Frank Quiambao, EdD, an executive loaned officer to the United States Secret Service, presented a succinct,
but powerful presentation on the many NESI products, as well as the connectivity and continuity of care
as it relates to crisis response to school shootings and allied first responder methodologies. Captain Jack
Ewell and Deputy Paramedic Dave Carver from the Los Angeles County Sheriff’s Department, Special En-
forcement Bureau briefed the audience on best practices as it relates to Hot Zone Operations. Interestingly

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