Page 75 - Journal of Special Operations Medicine - Summer 2014

The rioters in Little India used concrete slabs, beer bot- the case of the Mumbai attacks, or serious rioting can
tles, and stones to pelt the police and overturned and spread very quickly. Movement of the shooters or rioters
torched vehicles, which resulted in explosions of oxygen could render the initial staging areas unsafe. Equipping
tanks in the burning ambulance, creating blast-type inju- the paramedics with body armor and ballistic helmets is
ries. Hence, medical equipment brought to the scene of a a critical next step in ensuring the safety of those para-
mass casualty incident should include large numbers of medics integrating with tactical medical units.
chest seals, eye shields, airway devices (nasopharyngeal
airways, King, laryngeal mask airway, etc.) compression The challenges facing the creation of a tactical medical
dressings, splints, hemostatic gauze, tourniquets, and service are considerable and must be planned carefully
burn dressings. Blast injuries should be expected. Force to allow for the integration of the different departments
protection is important for the tactical medics including and services while developing a plan that affords maxi-
protective gear such as ballistic helmets with face shield, mum protection to the citizens of Singapore and the law
hard body armor, respirators and flame resistant cloth- enforcement officers dedicated to preserving the Sin-
ing and gloves. gaporean way of life. While some of the concepts dis-
cussed in the paper vary from the integrated operating
Dedicated or improvised forms of transport for mass ca- principles of TCCC or TECC utilizing tactically trained
sualties must be preplanned so that they can be used for medics in the hot zone (Direct Threat), plans must re-
evacuations to the hospitals during a riot. Dispersing the flect individual jurisdictions, operating authorities, and
casualties so that no hospital is overwhelmed is also crit- scope of practice, as reflected in this report.
ical. The evacuation platforms should be reinforced to
enable deployment in nonpermissive environments since
ambulances are unsuitable in such circumstances. Es- References
sential items such as rescue/extrication and extra medi- 1. TCCC Updates. J Spec Oper Med. Winter, 2013 (4);13:128–
cal equipment with fire safety measures must be part of 130.
transport system to manage burning wounds caused by 2. Inclusion of Tactical Emergency Medical Support (TEMS)
incendiaries. in Tactical Law Enforcement Operations, Dr. Kevin Ger-
old, NTOA TEMS Section Chair, Tactical Edge, Fall, 2013,
pp. 86–88.
Conclusion 3. Tactical Medical Emergency Training for Law Enforcement
Personnel, International Association of Chiefs of Police,
Future threats to law enforcement operations can take 2013.
the forms of terrorism, active shooters, and serious 4. Position Statement: Tactical Emergency Medical Services,
crimes. Hence paramedics from the ambulance services International Association of Fire Fighters, June 2013.
in support of such operations should be prepared and 5. Committee on Tactical Emergency Casualty Care. www.c
trained to operate seamlessly with tactical medics. -tecc.org.
6. Jacobs L, Wade D, McSwain N, et al: The Hartford Con-
To introduce the concept of tactical medicine to the am- sensus: THREAT, a medical disaster preparedness concept.
bulance service in the current scope of practice, decision J Am Coll Surg. 2013;17:947–953.
makers should be able to identify the requirements to 7. Jacobs L, McSwain N, Rotonda M, et al: Improving sur-
vival from active shooter events: the Hartford Consensus. J
support tactical medicine in the management of casual- Trauma Acute Care Surg. 2013;74:1399–1400.
ties after they have been evacuated by the tactical teams,
especially when there is a mass casualty incident. This
has to occur concurrently with force protection of para-
medics. Resources need to dedicated for this capability Dr. Chew currently works as a flight physician and serves as
development a reserve physician in the Singapore Special Operations Task
Force. Trained in tactical medicine, he instructs various secu-
For the paramedics to respond effectively to such tacti- rity forces in tactical medicine. He is also managing director of
cal challenges, training should include: Aris Integrated Medical, a medical consultancy company that
specializes in operational medicine and evacuation operations.
1. Understanding the tactical environment.
2. Operating in the tactical environment Dr. Hammesfahr is the medical director of the Tactical
Emergency Medical Support unit of the Marietta Police De-
3. Integration with law enforcement or security units.
partment, a member of the CONTOMS faculty, and teaches
tactical medicine for law enforcement officers. He serves on
Even though the paramedics and the ambulances are the Board of Advisors of the Committee for Tactical Emer-
staged in the cold zone or in a relatively safe area, gency Casualty Care and is a tactical medical instructor for the
constant monitoring of the tactical situation is critical Center for Operational Medicine of Georgia Health Sciences
since area of operations for active shooter scenarios, in University.

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