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As TEMS has matured, the specialty now has an obli- 10. Smith E, Shapiro G, Sarani B. The profile of wounding in
gation to move from a cloistered set of individual ex- civilian public mass shooting fatalities. J Trauma Acute
perts, to a national standard of care. Recognizing that Care Surg [serial online]. 8 March 2016. Available from:
MEDLINE Complete, Ipswich, MA. Accessed 16 May 2016.
the unique mission profiles related to TEMS preclude 11. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability
rigid protocols, the JRC believes the 10 NTIC Core /ucm358271.htm. Accessed 10 May 2016.
Competency Domains reflect a commonsense, practi- 12. Carmona R, Rasumoff D. Evolving roles of the TEMS pro-
cal framework for the future. Building on the previous vider. Tactical Edge. 1997;15:57–59.
work of the NTIC and the creation of acknowledged 13. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the bat-
tlefield (2001-2011): implications for the future of combat
competency domains for TEMS and the acknowledged casualty care. J Trauma Acute Care Surg. 2012;73(Suppl 5):
civilian translation of TCCC by the C-TECC, the JRC S431–S437.
has created an opportunity to bring forward the work 14. Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminat-
in a form that could be operationally useful in an all- ing preventable death on the battlefield. Arch Surg. 2011;146:
1350–1358.
hazards and whole-of-community format. The oppor- 15. Fisher AD, Callaway DW, Robertson JN, et al. The Ranger
tunity to build on preexisting work and lessons learned First Responder Program and tactical emergency casualty
in a collaborative and engaging manor should not be care implementation: a whole-community approach to reduc-
missed. If not capitalized on now we could be looking ing mortality from active violent incidents. J Spec Oper Med.
back at this point in time with the understanding that 2015;15:46–53.
we had the components of a plan at our disposal but did
not execute an effective amalgamation.

Dr Pennardt is professor in the Department of Emergency
Disclosures Medicine and Hospitalist Services, Medical College of Georgia
The authors have nothing to disclose. at Augusta University. E-mail: apennardt@augusta.edu.
Dr Callaway is director of Operational and Disaster Medicine
References and associate professor in the Department of Emergency Med-

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66 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016