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high threat environments. The concept of TEMS teams mob. As the police response increased, the non–riot-
of tactically trained paramedics under the operational trained officers found themselves trying to protect and
control of the SWAT team commander is an innova- evacuate the bus driver, timekeeper, initial responding
tive operational concept that answers the question of paramedics, and themselves from an advancing mob.
how to deliver prehospital care in a tactical, hostile, or Vehicles were torched and the police had to move from
direct-threat environment. It allows lifesaving medical the initial incident area to a safer perimeter (Figures 3
interventions to be initiated at the point of wounding to 6). Maintaining the perimeter to contain the riot was
by medical providers, rather than delaying medical care essential while additional law enforcement support ar-
interventions until victims are evacuated to a triage area rived. During the riot, as officer injuries were sustained,
that is considered to be outside the perimeter in a “cold additional officers were removed from riot control to
zone” of tactical operations. evacuate the injured to a cold zone where EMS waited.

In the case of the Little India Riot, the riot situation At this point, the concepts of tactical medicine for pre-
was fluid. A number of different circumstances all oc- hospital providers have not yet reached maturity in
curred during this riot that increased the severity of the Singapore. Therefore, prehospital medical care for this
riot. The initial paramedic response arrived nearly si- incident was limited by the standard scene safety re-
multaneously with the street level patrol officers from quirement limiting paramedic involvement to the cold
the SPF. As the paramedics tried to deal with the injury, zone. In this incident, establishing the initial casualty
the crowd, many of whom had been drinking, increased collection point (CCP) outside the perimeter in the cold
in number on this hot and humid night. With the death zone could have resulted in a possible delay of treat-
of the casualty, the crowd became agitated, rapidly over- ment initiation. In retrospect, prior training in tactical
whelming the ability of the non–riot-trained patrol of- medicine would have enabled the paramedics to manage
ficers to deal with the increasingly angry and riotous the casualties in the warm zone, thus freeing up officers

Figures 3–6 The Little India Riot.

Source: asiapacific.anu.edu.au/newmandala/2013/12/09/stop-and- Source: therealsingapore.com/content/i-could-have-stopped-riot.
think-lessons-from-little-india/. Eddy Blaxell.

Source: helenang.wordpress.com/2013/12/09/breaking-news-deaths-
Source: gmstore.wordpress.com/2013/12/09/riot-in-singapore-2013/. reported-in-singapore-riots/.

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