Page 76 - Journal of Special Operations Medicine - Summer 2016

Integration of Tactical Emergency Casualty Care
Into the National Tactical Emergency Medical Support
Competency Domains

Andre M. Pennardt, MD, FACEP; David W. Callaway, MD, MPA, FACEP;
Richard Kamin, MD, FACEP; Craig H. Llewellyn, MD, MPH, FACPM, FRSM;
Geoffrey L. Shapiro, BSHS, EMTP; Richard H. Carmona, MD, MPH, FACS;
Richard Schwartz, MD, FACEP

ABSTRACT
Tactical emergency medical support (TEMS) is a critical As TEMS becomes increasingly professionalized, na-
component of the out-of-hospital response to domestic tional efforts continue to standardize core competencies
high-threat incidents such as hostage scenarios, warrant and create common language to improve interoper-
service, active shooter or violent incidents, terrorist at- ability. TEMS standardization facilitates response ca-
tacks, and other intentional mass casualty–producing pabilities by increasing agency concurrence, enhancing
acts. From its grass-roots inception in the form of medi- adherence to evidence and consensus based clinical
cal support of select law enforcement special weapons practice standards, and ensuring communities of vali-
and tactics (SWAT) units in the 1980s, the TEMS subspe- dated responder competence. Despite the understanding
cialty of prehospital care has rapidly grown and evolved that the most effective response framework is a whole
over the past 40 years. The National TEMS Initiative community, all-hazards approach and major efforts by
and Council (NTIC) competencies and training objec- multiple government agencies and professional organi-
tives are the only published recommendations of their zations, as of 2016 there are still no nationally agreed-on
kind and offer the opportunity for national standardiza- standards for responder training, competency, certifica-
tion of TEMS training programs and a future accredita- tion, and practice. This is true even within the hyperspe-
tion process. Building on the previous work of the NTIC cialized TEMS sphere.
and the creation of acknowledged competency domains
for TEMS and the acknowledged civilian translation of In order to address this gap, the NTIC and the C-TECC
TCCC by the Committee for Tactical Emergency Casu- have collaborated to ensure development of common
alty Care (C-TECC), the Joint Review Committee (JRC) language recommendations and guidelines that are
has created an opportunity to bring forward the work foundational for both TEMS and broader all-hazards
in a form that could be operationally useful in an all- response programs. This article briefly outlines the evo-
hazards and whole of community format. lution of the TEMS Core Competencies and proposes
a new consolidated national standard founded on the
Keywords: National TEMS Initiative and Council; tactical principles of tactical emergency casualty (TECC).
emergency medical support; Committee for Tactical Emer-
gency Casualty Care; incidents, domestic high-threat Background
In 2009, the National Tactical Officers Association
(NTOA) and the Center for Operational Medicine
(COM) of the Medical College of Georgia spearheaded
Introduction
an effort to identify the core competencies required
TEMS is a critical component of the out-of-hospital re- to successfully support civilian law enforcement op-
sponse to domestic high-threat incidents such as hos- erations through tactical medical programs. Additional
tage scenarios, warrant service, active shooter or violent participants in this collaborative effort included the
incidents, terrorist attacks, and other intentional mass TEMS section of the American College of Emergency
casualty–producing acts. From its grass-roots inception Physicians (ACEP) and the departments of emergency
in the form of medical support of select law enforce- medicine at Brooke Army Medical Center in Fort Sam
ment SWAT units in the 1980s, the TEMS subspecialty Houston, Saint Vincent’s Mercy Medical Center in To-
of prehospital care has rapidly grown and evolved over ledo, and the Medical College of Wisconsin. A study
the past 40 years. 1 group of tactical medical providers, tactical operators,

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