Page 94 - JSOM Spring 2021

Immediate Paramedic Tactical Response Unit
in a Civilian Emergency Medical Service

The First Year Experience

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Antti Kämäräinen *; Janne Virtanen ; Jukka-Pekka Lintunen ;

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Jari Kolkkinen ; Ismo Nykopp ; Matti Isotalo ; Janne Välimaa ; Tapio Uotila 8
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ABSTRACT
Purpose: An immediate paramedic tactical response unit was As TEMS may not be immediately available in certain circum-
implemented into a civilian emergency medical services (EMS) stances, initial treatment may need to be provided by the first
system. This was compared with the preexisting traditional responding EMS personnel or the police. To guide immediate
tactical EMS support (TEMS). The primary aim of the study management in these situations, the concept of TECC has been
was to evaluate the effect on tasking frequencies. The second- introduced. 6
ary aims of the study were to assess mission timings and the
effect on patient encounters. Methods: Paramedics with tacti- In Finland, the current national provision of TEMS is mainly
cal emergency medical training provided immediate response based on dispatching dedicated TEMS personnel from home or
on a 24/7 basis. They responded to support police in high- other duties with prolonged response times. Furthermore, the
risk TEMS scenarios and incidents in a Tactical Emergency provision of TECC has not been implemented in a structured
Casualty Care (TECC) role. Tasking frequencies, timings, and form in many Finnish EMS systems. The aim of this study is
clinical input were compared between the first year of imme- to describe the introduction of an immediate response tactical
diate response and 3 preceding years of TEMS. Results: The paramedic unit into a civilian EMS system and to compare the
number of TEMS dispatches increased from an average of 5 to performance of this model to the traditional model of TEMS
54 annually. The median time from dispatch to scene arrival performance in Pirkanmaa County, Finland.
decreased from a median of 54 minutes (interquartile range
[IQR] 39–65) to 17 minutes (IQR 11–26) (p < .0001). The Materials and Methods
overall mission duration decreased from a median of 3 hr 13
min (IQR 2 h 29 min to 4 h 40 min) to 1 h 12 min (IQR The county of Pirkanmaa is located in Southern Finland
34 min–1 h 18 min) (p < .0001). The number of treated pa- with a population of 500,000. The county is served by a
tients increased from one minor injury annually to 13 severe three-tiered EMS system of firefighter and trained volunteer
and six minor injuries annually. Conclusions: Implementing first responding units (FRU), advanced life support (ALS)-
immediate tactical paramedic response significantly decreases level nurse-paramedic units, and an anesthesiologist-critical
response time and mission duration and increases the number care paramedic-staffed helicopter emergency medical service
of activations and resultant number of treated patients. (HEMS). The EMS is coordinated by a senior paramedic-
staffed field commander unit, also operating at an advanced
Keywords: paramedics; tactical response unit; emergency ALS level.
medical services; Tactical Emergency Casualty Care (TECC);
Finland In police operations requiring EMS response, the standard
practice has been to dispatch the nearest ALS unit to stage
near the scene clearly away from any obvious threat (cold
zone). TEMS is then dispatched at police command discretion
Introduction if there is any suspicion of a high-threat scenario such as on-
Providing appropriate patient care in high-threat civilian emer- going or expected violence, or a prolonged clear threat such as
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gency scenarios such as active violent incidents is challenging. an armed siege.
Based on the tactical situation and level of risk, the provision
of life-saving procedures may be limited as EMS personnel are Official TEMS personnel in Finland are selected experienced
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not able to approach the scene due to safety issues. To assist paramedics and prehospital physicians with a 3-day initial
law enforcement and to provide patient care, TEMS services training and further 3-day advanced training in tactical emer-
have been developed with variable models. 3–5 gency medicine. Training consists of theoretical and practical
*Correspondence to antti.kamarainen@fimnet.fi
1 A. Kämäräinen is affiliated with Emergency Medical Services, Tampere Region Rescue Department, Tampere, Finland; Emergency Medical
Services, Tampere University Hospital, Tampere, Finland; and Department of Emergency Medicine, Hyvinkää Hospital, Hyvinkää, Finland.
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2 J. Virtanen is affiliated with Laurea University of Applied Sciences, Vantaa, Finland. J.-P. Lintunenis affiliated with Emergency Medical Services,
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Tampere Region Rescue Department. J. Kolkkinen is affiliated with Emergency Medical Services, Tampere University Hospital. I. Nykopp is
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affiliated with Central Finland Police Department, Tampere, Finland. M. Isotalo, J. Välimaa, and T. Uotila are affiliated withEmergency Med-
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ical Services, Tampere Region Rescue Department.
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