Page 135 - Journal of Special Operations Medicine - Summer 2014

1. Care Under Fire (CUF): medical care is rendered at concepts, such as use of force, search and seizure, and
the scene of the injury while the rescuer and the ca- preservation of evidence.
sualty are under hostile fire.
2. Tactical Field Care (TFC): medical care is rendered It is also important for tactical operators to understand
once the casualty is no longer under hostile fire but the medicolegal issues pertinent to patient care, such as
available medical equipment and expertise is limited. patient confidentiality. Law enforcement officers may
3. Tactical Evacuation (TACEVAC) care: medical care not frequently be involved in patient care during routine
is rendered while the casualty is being evacuated to a patrol duties, butr they may need to provide care or as-
higher level of care. sist with patient care during tactical operations. An un-
derstanding of state and federal laws, as they pertain to
TECC, similarly describes three phases of care but does patient confidentiality, is necessary to prevent violation
not limit the risk to hostile fire: of a patient’s legally supported right to privacy, includ-
ing knowing when violation of patient confidentiality is
1. Direct Threat Care (DTC): medical care in areas acceptable.
where there is a direct threat (e.g., hostile fire, un-
stable structure, or hazardous material). The provision of medical care falls under a variety of
2. Indirect Threat Care (ITC): medical care in an area laws at the state and local levels including issues of li-
where there is no direct threat but still requires pro- censing and scopes of practice of medical providers. Per-
tection or security and may have limited medical sonnel who can provide procedures considered prudent
resources. in the tactical setting may be limited in certain jurisdic-
3. Evacuation Care (EC): medical care provided en tions. Treatment protocols developed in concert with a
route to a higher level of care. medical director also set the standard of medical care
within a given organization. The operator and tactical
medical provider should know the limitations on scope
Inclusion of Tactical Familiarization of practice based on their level of medical certifications
in the Competency Domains
and the jurisdictions in which they operate.
The majority of medics supporting law enforcement
tactical teams are not sworn officers. Thus, personnel
9
who take part in tactical medicine training programs Inclusion of Mass Casualty Triage
may not have previous tactical experience. This added in the Competency Domains
domain ensures that medical providers have the base- Tactical teams face the high probability of having to
line knowledge and skills to operate in the tactical manage mass casualty incidents. All team members must
environment and understand the differences between have an understanding of mass casualty triage while
TEMS and conventional EMS. For example, providers’ working within an Incident Management System (IMS).
baseline knowledge should include an understanding of Integration of multiple agencies into ongoing tactical op-
the chain of command, command and control, and each erations is a key feature when incidents involve multiple
of the team members’ roles and responsibilities. An- jurisdictions. While multiple mass casualty triage sys-
other important component of tactical familiarization tems exist in the United States, the Federal Interagency
is operational security to avoid potential operational Committee on EMS has initiated an implementation
compromise. strategy for standardizing mass casualty triage which
will enhance and support this competency domain.
Inclusion of Legal Aspects of
TEMS in the Competency Domains Development of the Terminal
In law enforcement operations, federal, state, and local and Enabling Learning Objectives
laws vary in their recognition of support personnel who A second face-to-face meeting was held where terminal
are not sworn as officers. A paucity of case law exists and enabling learning objectives were developed for
to address the legal liability incurred by nonsworn per- each of the competency domains (Appendix 1). Each
sonnel during law enforcement tactical operations. Fur- objective was presented to the entire panel and received
ther, tactical medical providers must understand legal greater than 80% approval.

National Consensus for TEMS Training Programs 125