Page 147 - Journal of Special Operations Medicine - Fall 2014

CAT application or result in loosening (e.g., other Vel- Assembly. As always, the first day is open to the pub-
cro), and the universal requirement to move the casu- lic. Please contact the Committee through the website
alty. Further, if you train single routing, there exists a at www.c-tecc.org with any concerns, questions, or sug-
higher risk that, under stress, the rescuer will apply only gested topics for the upcoming meeting.
through the outer loop. This means a very thin piece of
plastic is the only thing bearing all of the pressure of the
constriction band. Again, slippage or fracture will result References
in catastrophic failure and loss of hemorrhage control. 1. Kotora JG Jr, Henao J, Littlejohn LF, Kircher S. Vented chest
Single-loop application on the lower extremity may seals for prevention of tension pneumothorax in a commu-
have some role in extremely time-constrained scenarios. nicating pneumothorax. J Emerg Med. 2013;45:686–694.
However, this situation should be rare and the C-TECC 2. Kheirabadi BS, Terrazas IB, Koller A, et al. Vented versus
continues to recommend utilization of both loops in the unvented chest seals for treatment of pneumothorax and
prevention of tension pneumothorax in a swine model. J
friction bar (i.e., double looping) on lower extremity ap- Trauma Acute Care Surg. 2013;75:150–156.
plication of the CAT. Proper training is critical, and the 3. Clumpner BR, Polston RW, Kragh JF Jr, et al. Single ver-
C-TECC believes it can mitigate the slightly increased sus double routing of the band in the Combat Application
time of application for double looping. Tourniquet. J Spec Oper Med. 2013;13:34–41.

Conclusion
C-TECC will hold its winter meeting on 8 December 2014
at the Special Operations Medical Association Scientific

The Ongoing Evolution (Revolution) of TEMS

Philip A. Carmona, NREMT-P, TP-C, RN

lobally, military tactical medical practices and asso- relevant tactical medical practices. Notions of military
Gciated kits have been moving into the nonmilitary tactical medical practice, both real and perceived, are both
Tactical Emergency Medical Support (TEMS) commu- synergizing and impeding the transfer of relevant medical
nities at a relatively quicker pace than in previous con- practice to the TEMS community in the United States.
flicts. The previous long-term conflicts (Vietnam, the
Cold War) saw a relatively slower transfer of medically Particularly problematic in the nonmilitary tactical
relevant areas to nonmilitary medical practice. medi cal community is the degree to which organization,
training, protocols, scope of practice issues, statues,
One possible factor is the use of digital media as a means and regulations differ between municipalities, counties,
to transfer areas of medical relevance to the nonmilitary states, and agencies. These differences greatly impede the
medical community. Unlike the conflicts since Vietnam, interoperability common to most military organizations.
the current conflict has also seen the use of Reserve and
National Guard medical personnel alongside their ac- Throughout the United States, the drive to be prepared
tive counterparts; this factor has also made for a more for active shooter and other crisis-related situations has
efficacious transfer of tactical medical practices to the significantly increased the demand for TEMS training
nonmilitary tactical medical community. Many Reserve (and associated funding). However, the lack of training
and Guard medical personnel step back into similar standardization, bureaucratic issues, varying local prac-
practices when they return home postdeployment. tices at the differing levels of governance, and funding
issues have further impeded the more efficient transfer
However, differences in organization, training, protocols, and acceptance of relevant and needed tactical medical
scope of practice issues, statues, and regulations between practices. The following chart gives a brief overview of
military practitioners and their nonmilitary counter- general characteristics of military and nonmilitary tacti-
parts act as brakes to a more efficient transfer and use of cal medical governance and practices.

TacMed Updates 139