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scientific data through a nationally accepted and vali- work should serve as a platform for ensuring minimum
dated standard. knowledge among providers, enhancing team interoper-
ability, and improving the health and safety of tactical
One of the limitations of the development of this docu- teams and the public.
ment is the relative lack of peer-reviewed scientific liter-
ature to support the outcome competencies. If scientific
literature lacking consensus was used, an attempt was References
made to include the majority of national leaders in tacti- 1. Heck JJ, Pierluisi G. Law enforcement special operations
cal medicine as part of this process; however, it is pos- medical support. Prehosp Emerg Care. 2001;5:403–406.
sible that key opinion leaders were not included. 2. Tang N, Kelen GD. Role of tactical EMS in support of
public safety and the public health response to a hostile
The project’s panel members are working to develop mass casualty incident. Disaster Med Public Health Prep.
2007;1(Suppl):S55–S56.
a national organization whose mission will be to (1) 3. Schwartz RB, McManus JG Jr, Croushorn J, et al. Tacti-
develop and maintain the competencies, (2) maintain cal medicine: competency-based guidelines. Prehosp Emerg
and expand the involvement of all TEMS leaders and Care. 2011;15:67–82.
stakeholder representatives, and (3) serve to encourage 4. Committee of Tactical Combat Casualty Care. Tacti-
the expansion of the TEMS literature base. As the base cal Combat Casualty Care Guidelines: 28 October 2013.
grows, the curriculum recommendations will evolve and http://www.usaisr.amedd.army.mil/assets/pdfs/TCCC_
improve including the need for developing a research Guidelines_131028.pdf
agenda to identify tactical medicine knowledge gaps and 5. Committee on Tactical Emergency Casualty Care. Tacti-
support research endeavors. cal Emergency Casualty Care Guidelines. http://c-tecc.org/
tactical-emergency-casualty-care-guidelines.
In conclusion, this project has developed a minimum 6. Butler FK Jr, Hagmann J, Butler EG. Tactical Combat
Casualty Care in Special Operations. Mil Med. 1996;161
set of medical competencies and learning objectives (Suppl):3–16.
for both tactical medical providers and operators. This 7. Butler FK, Jr., Holcomb JB, Giebner SD, et al. Tactical
Combat Casualty Care 2007: evolving concepts and battle-
field experience. Mil Med. 2007;172(Suppl):1–19.
MEDEX Northwest 8. Callaway DW, Smith ER, Cain J, et al. Tactical Emergency
Casualty Care (TECC): guidelines for the provision of pre-
Physician Assistant Program hospital trauma care in high threat environments. J Spec
Oper Med. 2011;11:104–122.
9. Bozeman WP, Morel BM, Black TD, Winslow JE. Tacti-
cal emergency medical support programs: a comprehensive
statewide survey. Prehosp Emerg Care. 2012;16:361–365.

Educating Correspondence to: Richard B. Schwartz, MD, FACEP;
e-mail: RSCHWARTZ@gru.edu.
Physician
Assistants
since 1969

For over 40 years, MEDEX Northwest has been educating PAs to
expand access to healthcare in primary care, rural settings and medi-
cally underserved practice.The program structures its two-year, compe-
tency-based curriculum to prepare students with prior clinical experience
to meet the needs of our northwest service region.
MEDEX accepts and educates the
highest percentage of military
veterans among civilian PA
programs. With years of experience
MEDEX Northwest programs. With years of experience
4311 11th Avenue NE, Ste 200 integrating veterans into the class-
Seattle, WA 98105 room, and having faculty who are
206.616.4001 also veterans, MEDEX is uniquely
email: medex@uw.edu positioned to help veterans be
web: depts.washington.edu/medex
2 Facebook pages: MEDEX Northwest successful in the transition into
MEDEX Northwest Veterans
MEDEX Northwest Veterans civilian life.

138 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014