Page 133 - Journal of Special Operations Medicine - Summer 2014

these guidelines, and the TCCC guidelines may not al- Table 1 Expert Panel and Reviewers
ways be applicable to the civilian setting. The goals of Almeida, Jose Ashworth, Jason Ballard, Jed
5
this project were to develop a minimum set of medical
competencies and learning objectives for both tactical Beeghly, Drew Bollard, Glenn Bowling, F
medical providers and operators and to serve as the next Brinsfield, Kathryn Bronson, Brent Burnett, Thomas
step in the development of national TEMS standards. Butler, Frank Callaway, David Carmona, Phil

Carmona, Richard Casillas, Ray Chapman, Greg
Initiation of the TEMS National Consensus Project Cohen, Rafael Colantoni, Tony Coyne, Scott
In 2009, a group of experts in tactical operations and Croushorn, John Davidson, Robert DuBose, Joseph
emergency medical care developed a list of competency Doucette, Stephen Eastman, Alex Fabbri, William
domains for all levels of providers associated with tacti- Fitzgerald, Denis Fraiser, Barry Gandy, John
cal operations. This included operators, medical pro-
3
viders, team commanders, and medical directors. The Gerold, Kevin Giebner, Stephen Gilpin, Brad
group developed a draft which listed the broad com- Godbe, Dan Halcome, Chuck Hernandez, Ricky
petency domains that should be taught to each level Holtzman, Liam Johnson, Kevin Heath, Chris
of provider. The competencies were then reviewed and Kamin, Richard Kane, Shawn Lee, Bradford
modified by member of the American College of Emer-
gency Physicians Tactical Emergency Medicine Section Lerner, Brooke Lewis, Ryan Llewellyn, Craig
using a modified Delphi process. The resulting product Mazzorana, Vicki McKay, Sean McManus, John
included 18 competency domains that could be used McNair, Michael Meoli, Michael Mulry, Rob
as the basic educational standard for designing TEMS Nieman, Gary Nicely, Barbara Pennardt, Andre
training for each of the four target audiences. This ef-
fort was intended to be part of an ongoing process for Piazza, Gina Rathbun, David Ruiz, Ramon
updating the list based on the growing TEMS literature Ryan, Stephen Schwartz, Richard Seifarth, William
and the involvement of more stakeholders. The group Sonstrom,
also acknowledged that explicit terminal and enabling Shapiro, Geoffrey Benjamin Soto, Rob
learning objectives needed to be developed. Studley, Chuck Walsh, Jessica Wedmore, Ian

Wightman, John Wilson, Stephen Wipfler, John
Methods Yeskey, Kevin Young, Scott
For the current project, the 2009 panel of experts ex-
panded to ensure broader representation. Panel members Once the competency domains were finalized, the panel
from the Departments of Defense, Homeland Security, separated into smaller groups to develop draft com-
Justice, and Health and Human Services, as well as petencies for each domain and terminal and enabling
federal, state, and local law enforcement officers, were learning objectives for each competency. The draft com-
recruited through requests to stakeholder agencies and petencies and learning objectives were each reviewed
individuals involved in TEMS or TEMS oversight. The and, if needed, modified by the entire expert panel. An
members of the consensus panel are listed in Table 1. audience response system was again used so that the
panel could vote on each of them. The same process for
The development process used the previously published establishing consensus was used; to be considered final,
TEMS competencies as a starting point for discussion. more than 80% of participants had to support a compe-
3
The available literature addressing the competencies tency or learning objective.
was reviewed and used to reevaluate the domains. Dur-
ing two face-to-face meetings, an independent modera- This process required the group to make several over-
tor guided the group through a modified Delphi process arching assumptions. First, the focus of the project was
wherein the group could suggest additions, deletions, or to identify only the essential skill sets for both tactical
edits to the 2009 competency domains. An audience re- operators and medical providers supporting tactical
sponse system was used to anonymously vote on each teams, such as Special Weapons and Tactics (SWAT) or
competency domain. To remain, competency domains Special Response Teams (SRT). Second, the panel as-
needed to receive support from more than 80% of the sumed that all medical providers had at least Emergency
panel members. Domains that received less than 50% Medical Service-Basic (EMT-B) level knowledge and
were rejected. Support ranging from 50% to 80% re- skills as defined by the National EMS Education Stan-
sulted in further discussion and modification, and then dards published by the National Highway Traffic Safety
the vote was repeated. Administration (NHTSA).

National Consensus for TEMS Training Programs 123