Page 93 - JSOM Summer 2024

An Ongoing Series

Audit and Inventory of
Federal Law Enforcement Agency Tactical Medic Bags

Joshua G. Knapp *; Nelson Tang, MD 2
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ABSTRACT
Separate evidence-based, best practice guidelines and recom- regulatory and criminal provisions of federal laws pertaining
mendations exist for the prehospital management of traumatic to the illegal use and trafficking of firearms, destructive de-
injuries sustained in combat settings and those encountered vices, and explosives; commercial arson; and the illegal diver-
during high-threat civilian operational incidents. The Bureau sion of alcohol and tobacco products. By virtue of its mission,
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of Alcohol, Tobacco, Firearms and Explosives (ATF) Tactical the ATF is charged with investigating and apprehending some
Medic Program is a mature operational medicine asset sup- of the nation’s most violent criminals. In large part to miti-
porting high-threat federal law enforcement operations. The gate the inherent risks of life-threatening injuries in this civil-
ATF conducted an audit of its agency-issued tactical medic ian operational setting, the ATF maintains the Tactical Medic
bags with regards to completeness, as defined by authorized Program. 4
medical protocols, which are aligned with current Tactical
Combat Casualty Care and Tactical Emergency Casualty Care This program consists of specially trained Special Agent tac-
guidelines. tical medics who support its high-threat, multifaceted law
enforcement operations. Conceived following the events that
Keywords: TCCC; TECC; tactical medic bags; ATF took place at the Branch Davidian Compound in Waco, Texas,
in 1993, the Tactical Medic Program today is composed of ap-
proximately 70 providers nationally. ATF tactical medics are
strategically distributed among 25 field divisions and five Spe-
Introduction
cial Response Teams around the country. Medics are typically
Separate evidence-based, best practice guidelines and recom- trained to the level of emergency medical technician (EMT)
mendations exist for the prehospital management of traumatic with a small number of advanced EMTs and paramedics
injuries sustained in combat settings and those encountered within the ranks. ATF providers maintain active compliance
during high-threat civilian operational incidents. The Tac- with National Registry of Emergency Medical Technicians
tical Combat Casualty Care (TCCC) guidelines offered by (NREMT) certifications. 5
the United States military prioritize life-saving interventions
along with specific supply and equipment recommendations In addition to core educational content, ATF tactical medics
for those responses. By contrast, the Tactical Emergency Ca- receive intensive specialized training and preparation in key
1
sualty Care (TECC) guidelines do not endorse specific prod- disciplines of operational medicine, resuscitation, sick call
ucts, rather recommend agency-specific decisions based on medicine, sports medicine, and wilderness medicine. Physi-
available unbiased scientific data as well as program and pro- cian-authorized expanded clinical interventions include supra-
vider preferences. The Bureau of Alcohol, Tobacco, Firearms glottic airways; intravenous and intraosseous vascular access;
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and Explosives (ATF) Operational Medical Support Program hemorrhage control adjuncts, such as tourniquet and topical
(Tactical Medic Program) is a mature operational medicine hemostatic agents; needle thoracostomy; canine medicine;
asset supporting high-threat federal law enforcement opera- and field-expedient wound management. Recent additions
tions. The ATF conducted an audit of its agency-issued tactical to programmatic capability include use of end tidal carbon
medic bags with regards to completeness as defined by autho- dioxide monitoring and limited 12-lead electrocardiograph
rized medical protocols, which are aligned with current TCCC interpretation. A focused pharmacologic formulary is an es-
and TECC guidelines. sential component of the ATF’s tactical medical capability.
Centralized medical oversight is provided by the Center for
The ATF Tactical Medic Program Law Enforcement Medicine at the Johns Hopkins University
Under the U.S. Department of Justice, the ATF is the pri- School of Medicine. Medical control is delivered through for-
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mary agency responsible for administering and enforcing the malized medical protocols, provider education and training,
*Correspondence to joshua.knapp@atf.gov
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1 Special Agent Joshua Knapp is the National Medic Program Manager and Dr. Nelson Tang is the Medical Director with the Bureau of Alcohol,
Tobacco, Firearms and Explosives at the U.S. Department of Justice, Washington, DC.
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