Page 75 - 2020 JSOM Winter

Riot Medicine

Civil Disturbance Applications of the
National Tactical Emergency Medical Support Competency Domains

1
2
Andre Pennardt, MD ; Morgan West, TP-C *

ABSTRACT
The Portland, Oregon, Bureau of Fire & Rescue (PF&R) TABLE 1 The Tactical Emergency Medical Support (TEMS)
established a tactical emergency medical support team embed- Competencies
ded within the Police Bureau’s Rapid Response Team (RRT). 1. TECC methodology and TECC threat-based trauma
The authors describe the team’s training and their recent work. interventions
a. Hemostasis
Keywords: rapid response team; TEMS; teams; emergency b. Respiration/breathing
medical support c. Circulation
d. Medication administration
e. Casualty immobilization and packaging
Introduction 2. Medical planning
3. Remote medical assessment and surrogate treatment
Hours into a raucous protest, things have become
tense. It is dark. Rocks and bottles are beginning 4. Force health protection
to fly, and the crowd is loud. Then, it happens. Two 5. Legal aspects of TEMS
quick shots from deep in the crowd. It is impossible 6. Hazardous materials management
to pinpoint where they are coming from. The crowd 7. Environmental factors
instantly changes to a panicked stampede. More 8. Mass casualty triage
shots, and more screams. As the protesters flood 9. Tactical familiarization
away from the scene, two officers lie motionless 10. Operational rescue and casualty extraction
and dozens of civilian casualties are spread across
at least an entire city block.
revisited as an appropriate paradigm for other novel, high-
In early 2017, the Portland, Oregon, Bureau of Fire & Res- threat medical applications.
cue (PF&R) established a tactical emergency medical sup-
port team embedded within the Police Bureau’s Rapid
Response Team (RRT). RRT is an all-hazards unit and has Tactical Emergency Casualty Care (TECC)
primary responsibility for the management of civil distur- The competencies were originally proposed in 2009, and a
bances, of which Portland has many. RRT has an exacting 2014 revision incorporated the TECC guidelines. TECC is
operational tempo, but the work of the teams’ medics has closely related to TCCC but differs most markedly in that
been made easier by relying on professional, credible, and TECC guidelines allow for a more subjective evaluation of
operational medical practices. Most notably, the team built the threat. TECC is therefore relevant to situations in which
its training and operational guidelines around the 10 tacti- a medical responder and patient are not under fire per se but
cal emergency medical support competencies described by are still at risk of serious injury or death due to some external
Pennardt et al. and derived from Schwartz et al. (Table 1). factor. This broadly subjective interpretation of direct threat
1–3
These competencies were intended explicitly for “medical pro- is germane to civil disturbances. With a few horrific excep-
viders supporting tactical teams, such as Special Weapons And tions, protests—and even riots—do not usually involve hostile
Tactics (SWAT) or Special Response Teams (SRTs).” RRT rep- fire. They do, however, involve rapidly moving hostile crowds,
resents a different capability, most notably because civil dis- incendiary devices, hazardous materials, thrown objects, and
turbance operations are conducted in a chaotic, uncontrolled any manner of dangerous situations which would invoke the
environment, rather than the restricted, single-building envi- application of the TECC direct threat care guideline, but not
ronment in which many SWAT operations occur. Nevertheless, a strict interpretation of the care under fire guideline. The key
RRT found the tactical emergency medical support (TEMS) here is that medical responders must be well trained to recog-
competencies aptly suited for the civil disturbance environ- nize when a civil disturbance is becoming dangerous and must
ment. The authors hope that other tactical medical profession- remain in close communication with tactical leaders in order
als can glean valuable lessons from Portland’s experience with to constantly evaluate what phase of care would be most ap-
the competencies and, more broadly, that the competencies are propriate at a given moment.
*Correspondence to Charles.M.West24.mil@mail.mil
2
1 COL (Ret) Pennardt is a board-certified emergency medicine/EMS physician, deputy sheriff, and TEMS medical director, FL. Mr West is a flight
paramedic in the Oregon Army National Guard, Salem, OR.
73