Page 125 - Journal of Special Operations Medicine - Spring 2017

An Ongoing Series

Graduate Medical Education in Tactical Medicine and the
Impact of ACGME Accreditation of EMS Fellowships

Nelson Tang, MD; Matthew Levy, DO; Asa Margolis, DO; Nathan Woltman, MD

hysician interest in tactical medicine as an area of durations are usually brief and often emphasize the
Pprofessional practice has grown significantly over the hands-on aspects of tactical medicine.
past decade. The prevalence of physician involvement
in terms of medical oversight and operational support Formal physician subspecialty training at the graduate
of civilian tactical medicine has experienced tremendous medical education level is an endeavor of enormous pro-
growth during this timeframe. Factors contributing to portion and delivered through fellowship programs at
this trend are multifactorial and include enhanced law hospitals and medical schools affiliated with accredited
enforcement agency understanding of the role of the tac- institutions of higher education. Physicians who un-
tical physician, support for the engagement of qualified dergo advanced training at this level have finished medi-
medical oversight, increasing numbers of physicians for- cal school, completed a residency program in a given
mally trained in tactical medicine, and the ongoing esca- specialty and demonstrate the additional commitment
lation of intentional mass-casualty incidents worldwide. to subspecialty fellowship training of one or more years
Continued vigilance for the sustenance of adequate and in duration. The highest caliber of subspecialty medical
appropriate graduate medical education resources for education in this country occurs at this level under the
physicians seeking training in the comprehensive aspects auspices of formal academic fellowships.
of tactical medicine is essential to ensure continued ad-
vancement of the quality of casualty care in the civilian The desire to attain graduate medical education level
high-threat environment. training in tactical medicine by physicians strictly seeking
personal involvement in this practice arena remains an in-
Keywords: tactical medicine; emergency medicine; law dividualized decision. It is possible to accumulate the basic
enforcement clinical content and technical skills required to perform as
a tactical physician, typically with a single law enforce-
ment team, through a compendium of ad hoc training
endeavors and brief courses. However, tactical medicine
Background
at the highest level is a constantly evolving and highly
The emergence of the tactically trained law enforcement dynamic mission with many dimensions all experiencing
medical provider domestically is a relatively recent phe- tremendous growth and expansion. Beyond active opera-
nomenon. As tactical medical providers become an tional practice, the scope of tactical medicine in the context
1–5
increasingly familiar concept across the United States, of the magnitude of ongoing global threats will continue
adherence to sound principals of prehospital and out- to require qualified physician medical oversight capable
of-hospital emergency care in this country mandates of shaping public policy, defining sound provider scopes
the meaningful involvement of qualified physician level of practice and guiding law enforcement and homeland
medical oversight. 6–11 Despite this, physician education security agency approaches to high-threat casualty care.
in tactical medicine has been a heterogeneous experi-
ence in the United States, subject to great variability and Subspecialty Certification in EMS and
insufficient standardization. Basic technical training Accreditation of Fellowships
for medical providers in the operational considerations
of the law enforcement tactical environment has been Historically, subspecialty board certification in emer-
successfully delivered through multiple standalone plat- gency medicine has been relegated largely to clinically
forms. 12–14 Commercial opportunities of this nature con- based disciplines to include pediatric emergency medi-
tinue to emerge with some regularity, though training cine, critical care, toxicology, and hospice/palliative care.

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