Page 132 - Journal of Special Operations Medicine - Summer 2014

Development of a National Consensus for
Tactical Emergency Medical Support (TEMS)
Training Programs—Operators and Medical Providers

Richard Schwartz, Brooke Lerner, Craig Llewellyn, Andre Pennardt,
Ian Wedmore, David Callaway, John Wightman, Raymond Casillas,
Alex Eastman, Kevin Gerold, Stephen Giebner, Robert Davidson, Richard Kamin,
Gina Piazza, Glenn Bollard, Phillip Carmona, Ben Sonstrom,
William Seifarth, Barbara Nicely, John Croushorn, Richard Carmona

ABSTRACT
Introduction: Tactical teams are at high risk of sustain- Introduction
ing injuries. Caring for these casualties in the field in- Events requiring military or law enforcement based, tac-
volves unique requirements beyond what is provided by tical team response have been occurring with increasing
traditional civilian emergency medical services (EMS) frequency. Tactical teams perform in high-risk, adverse,
systems. Despite this need, the training objectives and and nonpermissive environments all over the world.
competencies are not uniformly agreed to or taught. The likelihood of sustaining casualties during these op-
Methods: An expert panel was convened that included erations is high, despite innovations in safety equipment
members from the Departments of Defense, Homeland and tactics. Caring for these casualties in the field in-
Security, Justice, and Health and Human Services, as volves unique requirements beyond those provided by
well as federal, state, and local law-enforcement offi- traditional civilian EMS systems.
cers who were recruited through requests to stakeholder
agencies and open invitations to individuals involved Following the lead of military special operations units,
in Tactical Emergency Medical Services (TEMS) or its many communities and organizations with tactical teams
oversight. Two face-to-face meetings took place. Using a (e.g., Special Weapons and Tactics [SWAT], hostage res-
modified Delphi technique, previously published TEMS cue) have begun to incorporate tactical medical provid-
competencies were reviewed and updated. Results: The ers into their response teams. Providing medical support
original 17 competency domains were modified and the for tactical operations requires unique knowledge and
most significant changes were the addition of Tactical skills not provided in conventional EMS education and
Emergency Casualty Care (TECC), Tactical Familiariza- training programs. This includes the ability to keep the
tion, Legal Aspects of TEMS, and Mass Casualty Tri- team operationally ready and to provide support during
age to the competency domains. Additionally, enabling all operational phases without jeopardizing the team’s
and terminal learning objectives were developed for mission or putting the team or the general public at
each competency domain. Conclusion: This project has risk. There is a need for specialized training for these
1,2
developed a minimum set of medical competencies and providers; however, currently, there is no national stan-
learning objectives for both tactical medical providers dardization among programs.
and operators. This work should serve as a platform for
ensuring minimum knowledge among providers, which In 2011, an expert panel of leaders in TEMS published a
will serve enhance team interoperability and improve list of competency domains for TEMS, but this list was
the health and safety of tactical teams and the public. not operationalized to the level of training competen-
cies and learning objectives. Currently, many courses
3
Keywords: Tactical Emergency Casualty Care, TEMS train- follow the U.S. Military Tactical Combat Casualty Care
ing programs, emergency medical services (TCCC) guidelines, although a comprehensive TEMS
4
program is broader in scope than what is provided by

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