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deemed unprepared to handle the major causes of death on the especially with regards to interventions likely to be required
battlefield, based on the state of their aid bags. 9 for severe traumatic injuries. Potential explanations for this
include the frequent nature of ATF tactical medic support of
Overall, we found most ATF tactical medic bags to contain enforcement activities, training approaches that foster medic
the essential supplies and equipment required to address familiarity with bag contents, and tiered mentorship of medics
those prioritized traumatic injuries and medical emergencies that help bridge gaps in knowledge and experience.
as identified by program and medical leadership. Consistent
with the TECC approach to operational medical supplies and Author Contributions
equipment, our audit did not assess adherence to specific “pre- JGK conceived of project design, participated in data collec-
ferred” products. The Tactical Medical Program considers the tion and analysis, and contributed to manuscript writing. NT
selection of medical equipment and supplies a matter of active, performed data analysis, literature review, and contributed to
ongoing due diligence, weighing a multitude of factors, includ- manuscript writing.
ing clinical science, logistical considerations, cost and supply
chain limitations, provider scopes of practice, and anticipated Disclosures
civilian patient population cohorts. The authors have nothing to disclose.
Explanation for the apparent high degree of mission readiness Funding
demonstrated by this audit of ATF tactical medic bags is likely No funding was received for this work.
multifactorial. Operational tempo of federal law enforcement
activities may be higher than that of military units not de- References
ployed to actual combat zones. Across the board, all ATF tac- 1. Deaton TG, Drew B, Montgomery HR, Butler FK Jr. Tactical
tical medics support a large number of enforcement operations Combat Casualty Care (TCCC) Guidelines: 25 January 2024.
and high-risk training missions on a routine basis. Further, the J Spec Oper Med. Published online March 13, 2024. doi:10.55460/
QT3B-XK5B
routine and frequent training for ATF medic personnel typi- 2. Committee for Tactical Emergency Casualty Care. Tactical emer-
cally involves scenario-driven learning that involves working gency casualty care (TECC) guidelines: preamble. Published June
out of issued medic bags. This requires medics to demonstrate 22, 2023. Accessed September 30, 2023. www.c-tecc.org/images/
familiarity with their bag contents as well as present opportu- TECC_Preamble_FINAL.pdf
nities for inspection and correction of potential deficiencies. 3. Bureau of Alcohol, Tobacco, Firearms and Explosives. About ATF.
Finally, while this identity-unlinked bag audit did not analyze Accessed September 22, 2023. https://www.atf.gov/about
the relative experience of their corresponding medics, the ATF 4. Bureau of Alcohol, Tobacco, Firearms and Explosives. Medics.
Updated October 1, 2020. Accessed September 17, 2023. https://
Tactical Medic Program maintains a tiered senior medic pro- www.atf.gov/about-atf/medics
gram that actively and intensively mentors newer program 5. National Registry of Emergency Medical Technicians. Certification
personnel with the specific intent to mitigate potential defi- policies. Accessed September 30, 2023. https://nremt.org/Policies/
ciencies in clinical and operational knowledge and experience. Certification-Policies
6. Johns Hopkins Medicine. Division of Special Operations. Accessed
September 29, 2023. https://www.hopkinsmedicine.org/specialops
Conclusion 7. Committee for Tactical Emergency Casualty Care. FAQs. Accessed
September 18, 2023. https://www.c-tecc.org/about-us/faqs
The ATF maintains a long-standing federal law enforcement 8. Tang N, Kubit J, Berrett OM, Levy MJ. A multiyear analysis of
operational medicine program that supports enforcement op- the clinical encounters of the ATF tactical medical program. J Spec
erations and high-risk training missions nationwide on a rou- Oper Med. 2014;14(3):102–106.
tine basis. ATF tactical medics operate under unified protocols 9. Schauer SG, Naylor JF, Uhaa N, April MD, De Lorenzo RA. An in-
and centralized medical direction using supplies, equipment, ventory of the combat medics’ aid bag. J Spec Oper Med. 2020;20
and medications from agency-issued medic bags. A recent au- (1):60–64.
dit of medic bag contents demonstrated a high degree of com- PMID: 38788223; DOI: 10.55460/0NS2-Z6OS
pleteness, suggesting overall programmatic mission readiness,

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