Page 96 - JSOM Spring 2021

TABLE 2 Immediate Response Results This was likely due to knowledge of the police and dispatcher
TEMS TECC of immediate availability of the team, but also potentially the
Number of Hawthorne effect. The second finding was the significantly
dispatches 54 11 reduced response time to scene from 53 minutes to 17 min-
Cause of dispatch utes. The reduced response time from dispatch to arrival at the
Arrest of a 42 0 scene is likely to better conform to the tactical needs of law
dangerous person enforcement personnel and makes the case for an increased
Siege 2 0 number of TEMS dispatches. This is particularly pertinent in
Terror/explosives the era of increasing terrorist attacks without warning, as oc-
threat 2 0 curred in Turku, Finland, in 2017.
Pursuit 5 0
Crowd/riot control 3 0 Finally, the overall TEMS mission duration was reduced by 2
hours after implementation of the immediate response unit.
Shooting 0 1 The reduced mission duration affects not only the burden of
Stabbing 0 10 the EMS positively but also that of the police. This is especially
Median time intervals (IQR) true when there is no need to wait extensively for TEMS ar-
Dispatch to rival before engaging a potentially hostile threat. It also allows
departure 3 (1–5) min 1:30 (0–2:30) min:ss for increased readiness in the system while abbreviating the
Dispatch to scene 17 (11–26) min 9 (5–10) min mission duration.
Dispatch to end 1 h 12 min 51 (25–55) min
of mission (34 min–1 h 18 min) Although the concept of an integrated and immediate EMS
Scene location response to hostile scenarios has been described over ten years
Urban 43 11 ago with further development and adoption, there is still a
Rural 9 0 dearth of published data regarding this approach. 7,8–10 From
Forest/uninhabited 2 0 Finland, Vainionpaa and colleagues have previously described
Treated conditions an integrated model for providing tactical emergency medical
Gunshot wound 1 1 support. 11
Stab wound 1 10 However, in that criticized model, EMS personnel had not
Canine bite 1 0 undergone dedicated training in tactical medicine and the
Psychiatric 2 0 teams were composed on an ad hoc basis. This is in contrast
Other nontrauma 3 0 to our described model of dedicated personnel with TEMS and
Treatment TECC training. 12
Hemorrhage control 3 5
Medication 1 2 Limitations
Escorted to hospital
by TEMS 4 5 This study was not designed to report individual patient data
Assisted breathing 1 1 but rather to present the introduction of dedicated TECC/
Fluid therapy 1 4 TEMS into the EMS system and its initial effect on that sys-
TEMS = Tactical Emergency Medical Support; TECC = Tactical Emer- tem. Detailed data on patient care and outcomes were not col-
gency Casualty Care; IQR = interquartile range. lected, limiting the conclusions regarding the actual clinical
benefit of the immediate response model to patients.

and from dispatch to scene 9 minutes (IQR 5–10). The median However, based on the available data, it is obvious that with
overall mission duration was 51 minutes (IQR 25–55). The delayed TEMS activation the overall mission rate and subse-
unit was diverted to a TEMS/TECC mission ten times while quently the number of patients treated by dedicated TEMS
already undertaking a nontactical mission. In these cases, the personnel is low. This is intuitive as the patient would already
median response time from dispatch to departure was 8 min- be transported to the hospital by the time of TEMS arrival in
utes, as the patient was either transported or care was first the prior model. With immediate response and the additional
handed over to another EMS unit. role of the tactical paramedic unit to perform as TECC sup-
port in non-TEMS dispatches, the number of treated patients
During TEMS and TECC missions, treatment was provided increased from 1 to 19 annually, with most presenting with a
for 19 patients, most of whom (n = 10) had sustained stab penetrating injury.
wounds. Additionally, two patients with stabbing inju-
ries were declared dead on scene. The most common treat- The paramedics involved in the immediate response were
ment modality was hemorrhage control, including wound aware of the prospective evaluation of the efficacy of immedi-
packaging, hemostatic dressing, and tourniquet use in eight ate response, which may have caused a Hawthorne effect on
cases. the system.

Discussion Conclusion
In this article, the initial results of the implementation of a tac- In summary, implementing immediate tactical paramedic re-
tical paramedic unit to a civilian EMS are described. The main sponse to an EMS system significantly decreases the response
finding was a large increase of emergency TEMS activations. time of dedicated personnel to high-threat police incidents,

92 | JSOM Volume 21, Edition 1 / Spring 2021