Page 148 - Journal of Special Operations Medicine - Fall 2014

General Characteristics of Military and Nonmilitary C-TECC: Committee for Tactical Emergency Casualty
(TEMS) Tactical Medicine Care, first convened in 2011, continues to progress in
redefining TCCC methodologies for nonmilitary entities
Military TEMS
as well as seeking to add to areas of nonmilitary clinical
Centralized protocols and procedures relatively equal TEMS practice.
between units—Decentralized execution
Centralized training through service schools with NTEMSC: National TEMS Counsel (formerly National
known instructor qualifications TEMS Initiative and Council) was convened in 2011
to bring national TEMS leaders together to standard-
Multidecade history of joint training and operations ize the field of tactical medicine. An article published
Mission-driven clinical practices among varying levels last month in the JSOM describes some of the ongo-
1
of licensure ing work of the NTEMSC. Seventeen domains and ac-
Nonmilitary (TEMS) Tactical Medicine companying competencies were derived to describe the
minimum training standards in those areas. Future en-
Frequently varying protocols and procedures between deavors include standardizing the areas of TEMS com-
states, counties, and municipalities, and agencies petency for first responders (law, fire, EMS) and first
Market-driven training with varying standards care providers (civilians).
and outcomes
Historically operated as separate agencies Per the aforementioned JSOM article, “The [NTEMSC]
(law, fire, EMS) project’s panel members are working to develop a na-
Statutory- and regulatory-driven clinical constraints tional organization whose mission will be to (1) develop
and maintain the competencies, (2) maintain and expand
varying with licensure and locale the involvement of all TEMS leaders and stakeholder
Allocated federal and state (National Guard) representatives, and (3) serve to encourage the expan-
funding sources sion of the TEMS literature base. As the base grows, the
Significant variations in the ability to fund TEMS curriculum recommendations will evolve and improve
training and operations; frequently federal including the need for developing a research agenda to
identify tactical medicine knowledge gaps and support
research endeavors” (italics added).
The command and control structure of the military af-
fords the opportunity for greater standardization. Even Future endeavors of the NTEMSC committee are inte-
across national boundaries there is standardization gration of research, data collection and analysis, and
to ensure the best outcomes. In combined operations, implementation in education and training. Critical re-
STANAGS (Standard NATO Agreements) allow for search areas identified by the Research Committee and
the exchange of information and operational methods conducted by appropriate academic centers agencies can
amongst the NATO allies. The “nine line for casualty then be further translated into identifiable education
evacuation” is one such example. I have used it in more and training standards by the Education and Training
than one crisis situation. Committee and can be disseminated in a nonproprietary
manner.
The foundational principles of our republic and its
methods of governance can present challenges to getting TEMS research is an area needing great focus but may
everyone practicing in like manner. It is the aforemen- require federal funding in the future. Such funding may
tioned issues that increase the chances of problems with answer questions currently surfacing in the nonmilitary
interoperability. arena. The NTEMSC, when fully organized, will be poised
to facilitate such research and data collection and transla-
However, a number of organizations have arisen to assist tion into education and training programs and updates.
in bringing order and structure to TEMS practices and to
ensure greater interoperability nationally. Predating those Although basic and applied research are the fundamen-
organizations is the Committee for Tactical Combat Ca- tal areas where new discoveries and devices are born,
sualty Care (CoTCCC), which is under the auspices of translational research amassed from event and agency
the Institute for Surgical Research. This groundbreaking data will be paramount in determining evidence-based
organization continues to translate worldwide battlefield best TEMS practices and judging the validity of current
experience into evidence-based tactical medical practices TEMS practices.
for the global military and nonmilitary medical commu-
nities. CoTCCC provides foundational input into the A multicenter approach aided by an academic center
following two other TEMS organizations: with a strong informatics program will be paramount

140 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014