Page 156 - Journal of Special Operations Medicine - Spring 2016

Progress of Tactical Emergency Medical Support in Japan

Akira Fuse, MD, PhD; Richard B. Schwartz, MD; Daizoh Saitoh, MD, PhD;
Sato Ogawa, MD, PhD; Mitsuo Ohnishi, MD, PhD; Tetsu Okumura, MD, PhD

Introduction left the vehicle, and stabbed 12 people with a knife (kill-
ing four and wounding eight). The Tokyo Disaster Medi-
In the United States, Special Weapons and Tactics teams cal Assistance Team, which was deployed to the scene,
were developed in the 1960s. Around that time, the first provided medical support without any information from
Tactical Emergency Medical Support (TEMS) teams the police agency, such as an arrest of suspect or other
were also informally established to support these new information about the scene security. While working in
teams. The initial TEMS model was generally based this potentially dangerous environment, we recognized
upon the military Special Forces model of using med- the necessity of cooperation and improved communica-
ics who were also tactically qualified. In 1989, the tion between law enforcement and medical facilities. 2
National Tactical Officers Association, along with the
Los Angeles County, California, Sheriff’s Department, In 2011, the topic of tactical medicine in Japan was first
cosponsored the first tactical medicine conference. This presented orally at the annual meeting of Japanese Soci-
conference was pivotal and a huge success, and it led ety for Emergency Medicine (JSEM); in 2013, the subse-
to what we now know more formally as TEMS, which quent paper was accepted in the official JSEM journal.
3
has gained widespread adoption and acceptance in the Additionally, the Metropolitan Police Department
United States. In Japan in 1996, Special Assault Teams (MPD) and Nippon Medical School (NMS) hospital had
1
(SATs) were established in seven prefectures. However, been in discussion continuously about medical support
like the majority of the initial teams in the United States, at crime scenes, based on lessons learned from the Aki-
the SATs lack internal medical support or TEMS teams. habara massacre. From these discussions, an agreement
The injured, including SAT officers, were simply trans- was established, which was the first practical step for
ferred to the fire department service, which has lim- Japan to establish a TEMS program.
ited medical capability for transportation to hospitals.
TEMS in Japan has been developing over recent years Moving forward from the initial steps in this process, a
because of necessity. One key element in this is coopera- team from Japan took the Special Tactics for Operational
tion with partners in the United States. In this article, we Rescue and Medicine course in Los Angeles, California, in
report the current status of tactical medicine in Japan.
2012 for standardization, and translated and published,
in 2015, the text Tactical Medicine Essentials by the
The Development of TEMS in Japan American College of Emergency Physicians. Since 2014,
4
The SAT allegedly existed for some time before being the newly established tactical medical team has joined the
officially recognized by the National Police Agency in SAT training for bimonthly training and is continuing to
Japan in 1995, when All Nippon Airways flight 857 was prepare for response to future critical incidents, such as
hijacked with 364 passengers held hostage. This hijack- hijackings, active shootings, or similar incidents.
ing was successfully resolved without loss of life when
the SAT forcefully subdued the hijacker. In 1996, SATs The MPD has organized a presentation about tactical
were established in seven main prefectures. These SATs medicine. This presentation is given to the police com-
provided tactical elements but did not include a tactical manders on scene twice per year to educate the com-
medical provider (TMP) in the SAT. Following the es- manders in the field. The Japan Coast Guard (JCG) has
tablishment of the SATs, several incidents occurred that also established the Permanent Committee on Tactical
have demonstrated the need for tactical medical support Medicine in the agency. They have also started the dis-
of these teams. In 2007, a man barricaded himself in cussion with physicians to support this program. The
his ex-wife’s house. He had a firearm and, during the JCG already has advanced emergency medicine techni-
SAT raid, one officer was killed in the performance of cians (EMTs) in Special Rescue Team and Mobile Rescue
his duties. Additionally, at the Akihabara massacre (8 Teams, and plans to cooperate as tactical medical pro-
June 2008), which occurred in the central Tokyo, a man viders. The evacuation and care of casualties on a ship
drove a truck into a crowd, killing four people. He then at sea is another difficult issue that is being evaluated.

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