Page 128 - Journal of Special Operations Medicine - Summer 2015

purpose of the current study was to provide a descriptive The most common level of prehospital EMS care pres-
analysis of US EMS activations coded through NEMSIS ent on scene at tactical incident EMS activations was
as “Activation-Tactical or SWAT Specialty Service/Re- basic life support (BLS) (55.2%); 3.3% received more
sponse Team” events, and to describe the prehospital advanced life support (ALS) response, defined as ALS
care delivered during such responses. Level 2, paramedic intercept, specialty care transport,
or rotary wing transport (Figure 1). Tactical incident
activations were characterized by a smaller percentage
Methods of ALS level responses (41.5%) when compared with
the total NEMSIS data set (47.5%; p < .001).
Study Design
A descriptive analysis of the 2012 National EMS Infor- The majority (72.3%) of tactical incident activations
mation System Public Release Research Data Set version involved a single patient. In 7.0% of cases, no patient
2.2.1 (NEMSIS Technical Assistance Center, University was present, while in 20.7%, more than one patient was
of Utah School of Medicine; www.nemsis.org) con- coded as being present. Twenty-one (0.5%) tactical inci-
taining EMS emergency response data submitted by dent activations were coded as mass casualty incidents,
41 states was performed. The study was reviewed by compared with 0.2% of total EMS responses (p = .45).
12
the Mayo Foundation Institutional Review Board and Tactical events most frequently occurred in residences
deemed exempt. (48.4%), streets or highways (37.0%), and public build-
ings, including schools and government offices (6.3.%).
Study Setting
Individual EMS agencies collect patient-care-specific Cause of injury was coded in 18% of tactical incidents.
data using standardized data element definitions with Firearms assault accounted for 14.8% of injuries, while
computer software programs conforming to NEMSIS falls accounted for 19.4%. Chemical exposures were re-
data element standards. These data are aggregated at the ported in 8.9%. Patients in tactical incident EMS acti-
state level by the respective lead EMS regulatory body; vations tended toward a younger age than those in the
statewide aggregate data are subsequently exported to
the NEMSIS national data repository. 11,12 These data Figure 1 Reported provider level of prehospital emergency
are subsequently de-identified to remove patient- and medical services (EMS) response for tactical incident
agency-specific information prior to release as a public activations and total EMS activations. All numbers are
research database. percentages.

Selection of Study Participants
The non-mandatory code 101.206, “Activation-Tactical
or SWAT Specialty Service/Response Team,” was used
to identify specific EMS run records for subsequent
analysis. The unique data element “EventID” was used
to match elements across tables associated with the
same EMS event.

Invalid Data Codes
Observations with invalid codes were set to “missing”
to more easily report frequency counts and percentages.
Definitions:
Primary Data Analysis BLS: Basic life support is transportation by ground ambulance vehicle
Descriptive analyses were generated from the NEMSIS and the provision of medically necessary supplies and services, includ-
Research Data Set using SAS version 9.3 (SAS Institute; ing BLS ambulance services as defined by the State.
www.sas.com). Two-sided Fisher exact tests and two- ALS 1: Advanced life support, level 1, is the transportation by ground
sample t tests were used to compare groups, with an α ambulance vehicle and the provision of medically necessary supplies
level of 0.05 considered statistically significant. and services including the provision of an ALS assessment or at least
one ALS intervention.
Advanced ALS: Includes ALS 2, Paramedic Intercept, Specialty Care
Results Transport, and Rotary Wing Transport. ALS 2 is the transportation
by ground ambulance vehicle and the provision of medically necessary
A total of 17,479,328 EMS activations were reported supplies and services including (1) at least three separate administra-
tions of one or more medications by intravenous push/bolus or by
during the study period, of which 3,953 were coded as continuous infusion (excluding crystalloid fluids) or (2) ground am-
Activation-Tactical or SWAT Specialty Service/Response bulance transport, medically necessary supplies and services, and the
Team. provision of at least one ALS2 procedures.

118 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015