Page 95 - JSOM Spring 2021

aspects on police tactics in different scenarios, and general occurred in cases of shooting and stabbing even when the dis-
principles of patient care in these settings. Each county has patch or situation itself did not require activation in the TEMS
their own individual TEMS group that trains and operates to- role. These primary missions that were not dispatched by the
gether with local police on a variable basis. police were categorized to be of TECC support type in nature
as the role differed from that of TEMS. The purpose was to
Nationally, the procedure of TEMS activation following dis- benefit from the additional expertise of the tactical paramedics
patch by police has been based on a volunteer model and no for- in terms of patient care, but also to provide on-site real-time
mal roster of availability—personnel respond from their other direction and training to other paramedics.
duties or from home. In the Pirkanmaa area, it was observed
that this model results in prolonged response times and subop- For the current study, the tactical EMS mission reports from 1
timal performance in terms of the tactical needs of the police. January 2014 to 13 April 2017 were retrospectively analyzed.
Data were extracted to calculate mission rates, dispatch tim-
To counteract these shortcomings, selected additional para- ings, scene time, and treatment provided. The first year (14
medic personnel were trained according to the national TEMS April 2017 to 14 April 2018) of immediate tactical paramedic
standard. The aim was to implement teams of two paramedics response was also analyzed. This relied on prospective data
with TEMS training in one of the ALS units operating in the collection using a dedicated form to record the same vari-
county on a 24/7 immediate response basis. This basic training ables as above. Data were not collected on an individual pa-
was complemented with a distinct TECC course. Ongoing tac- tient level, but rather on the system and procedures. Because
tical training was commenced, including operating in, for ex- detailed patient data were not collected, the need for ethical
ample, active shooter, armed siege, and other hostile scenarios. board review was waived and the study was approved by the
Research Approval Committee of the City of Tampere.
Alongside additional training of specific personnel, one am-
bulance was modified to have the capacity to carry tactical Data are presented as rates, medians, and IQRs unless other-
equipment (e.g., ballistic vests and helmets, lightweight treat- wise indicated. The Kruskal-Wallis test was used to compare
ment packs) in addition to regular EMS equipment. dispatch delays between groups. Statistical significance was
set at p < .05. IBM SPSS version 20 for Windows (SPSS ,
®
®
The decision to dispatch the tactical EMS team was made by https://www.ibm.com/products/spss-statistics) was used for
the police coordinating the operation in cooperation with the data analysis.
EMS field commander. Standard EMS dispatches were cate-
gorized into four categories from A to D, with A- and B-level Results
dispatches reflecting potentially life-threatening emergencies,
and C- and D-level dispatches corresponding to less urgent Preceding Immediate Response
situations. As the tactical paramedic unit was not segregated In the total of 17 emergency TEMS dispatches, the median
from standard EMS dispatches, a corresponding risk strati- response time from dispatch to arrival at scene was 54 minutes
fication tool for tactical missions was drafted to enable pri- (IQR 39–65). The overall duration of these missions from dis-
oritization between EMS and tactical dispatches. Nonurgent patch to departure from scene was 3 h 13 min (IQR 2 h 29 min
and planned police operations requiring TEMS presence were to 4 h 40 min). The delays from dispatch to departure were
managed separately from the immediate response. not recorded during this period. During the four operations,
treatment for mild injuries was provided (Table 1).
During operations, the unarmed tactical paramedics were
integrated to the police team that also provided protection. Immediate Response Results
TEMS operated primarily in the warm or cold zones under The number of emergency TEMS dispatches increased to 54.
police command. If required, the tactical EMS response could In TEMS missions, the median response time from dispatch to
be complemented with further tactical paramedics and physi- departure was 3 minutes (IQR 1–5), the delay from dispatch
cians, but generally this response was not immediate. to scene decreased to 17 minutes (IQR 11–26) (p < .0001), and
the overall mission duration decreased to 1 h 12 min (IQR 34
As the paramedics underwent additional and ongoing tactical min to 1 h 18 min) (p < .0001) (Table 2).
medical training mainly in the treatment of severe penetrating
injuries according to the TECC context, the unit was also used In the 11 TECC missions, the median response times from dis-
as an additional ALS unit in regular EMS dispatches. This patch to departure were 1 min 30 sec (IQR 0–2 min 30 sec)

TABLE 1 Tactical Emergency Medical Support Dispatches Prior to Immediate Response
2017 Prior to
2014 2015 2016 Immediate Response
TEMS dispatches total 10 9 8 3
Emergency 7 3 5 2
Planned 3 6 3 1
Median (IQR) delay from
dispatch to scene (emergencies) 52 (29–65) min 54 (39–90) min 55 (47–71) min 45 (33–57) min
Median (IQR) mission 2 h 45 min 4 h 39 min 4 h 11 min 4 h 30 min
duration (emergencies) (1 h 43 min–3 h 3 min) (2 h 29 min–6 h 20 min) (3 h 17 min–4 h 40 min) (3 h 13 min–5 h 47 min)
Treated conditions 1 canine bite 1 canine bite 1 evaluation of assault injuries 1 canine bite
TEMS = Tactical Emergency Medical Support: IQR = interquartile range.

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