Tactical Emergency Tactical Emergency MedicineMedicine
- An Introduction -- An Introduction -
Dan Olesnicky, MDDan Olesnicky, MDAssociate Director Associate Director
Department of Emergency MedicineDepartment of Emergency MedicineChrist HospitalChrist HospitalJersey City, NJJersey City, NJ
TEMSTEMS - Why bother?- Why bother?
Docs with Glocks?Docs with Glocks? Is there really a need?Is there really a need? Waco TexasWaco Texas Community ServiceCommunity Service Team healthTeam health Disruption of the Law enforcement Disruption of the Law enforcement
missionmission Understanding the mission and the Understanding the mission and the
geargear Special training is requiredSpecial training is required
Docs with Glocks?Docs with Glocks?
Not a bunch of weekend Not a bunch of weekend warriors armed and warriors armed and dangerousdangerous
Tactical MedicsTactical Medics Sworn or notSworn or not Armed or notArmed or not
Physicians and medics Physicians and medics need to keep a low profile need to keep a low profile in the community and in the community and especially from the mediaespecially from the media
Cowboy LabelCowboy Label
SWAT and SpecOpsSWAT and SpecOps S.W.A.T.: Special Weapons and TacticsS.W.A.T.: Special Weapons and Tactics SpecOps: Special OperationsSpecOps: Special Operations Purpose: SWAT teams are composed of highly Purpose: SWAT teams are composed of highly
trained personnel, each of whom can assume trained personnel, each of whom can assume varied responsibilities with a high degree of varied responsibilities with a high degree of proficiency and expertise. The Unit is prepared proficiency and expertise. The Unit is prepared to assume full control of specific high-risk tactical to assume full control of specific high-risk tactical situations, which by nature would be considered situations, which by nature would be considered excessively dangerous or complex for excessively dangerous or complex for conventional police officers. Practically speaking conventional police officers. Practically speaking the team is organized as both a crisis the team is organized as both a crisis intervention team and a rescue team with intervention team and a rescue team with negotaition and assault capabilities.negotaition and assault capabilities.
Mission GoalMission Goal
The goal of the team is to The goal of the team is to accomplish its mission accomplish its mission without injury or death without injury or death resulting from the team’s resulting from the team’s intervention. intervention.
Foremost is the minds of Foremost is the minds of the team members is the the team members is the preservation of life and preservation of life and safety of bystanders, safety of bystanders, hostages, team members hostages, team members and victims.and victims.
TEMS Providers are trainedTEMS Providers are trained
TEMS providers are TEMS providers are trained to work in a trained to work in a tactical environment. tactical environment.
Evidence perservationEvidence perservation Weapons trainedWeapons trained Render a weapon safeRender a weapon safe Understand the equipmentUnderstand the equipment Less likely to become Less likely to become
victims than Non-TEMSvictims than Non-TEMS Provide care that Officers Provide care that Officers
CANNOTCANNOT
Evidence PreservationEvidence Preservation
One of the major priorities One of the major priorities in a police or military in a police or military operation. operation.
Most civilians overlook Most civilians overlook evidence and are evidence and are unaware of how they are unaware of how they are destroying it. destroying it.
It makes prosecution and It makes prosecution and conviction difficult when conviction difficult when a crime scene is a crime scene is destroyed by EMS destroyed by EMS personnel. personnel.
Canary in a Coal MineCanary in a Coal Mine
TEMS providers are TEMS providers are less likely to be less likely to be victims themselvesvictims themselves
Drug LabsDrug Labs Chemical HazardsChemical Hazards Getting yourself shotGetting yourself shot
Unique working Unique working environmentenvironment
Special equipment Special equipment and applicatons are and applicatons are usedused
Most or all of your Most or all of your equipment is carried equipment is carried on your personon your person
Worst Case Worst Case Scenarios must be Scenarios must be planned for before the planned for before the operationoperation You can’t go to the You can’t go to the
supply room in the EDsupply room in the ED
Difficult to work in the Difficult to work in the Hot ZoneHot Zone
EquipmentEquipment
Ambu BagAmbu Bag Airway KitAirway Kit IV’sIV’s Trauma SuppliesTrauma Supplies Chest tubesChest tubes Surgical KitsSurgical Kits Light sourceLight source Suture MaterialSuture Material Burn SuppliesBurn Supplies Personal protective Personal protective
equipmentequipment DrugsDrugs All your SWAT Gear and All your SWAT Gear and
Body ArmorBody Armor
More StuffMore Stuff Body ArmorBody Armor Side ArmSide Arm Long GunLong Gun Spare magazines and Spare magazines and
ammunitionammunition Flash BangsFlash Bangs HelmetHelmet GogglesGoggles Gloves Gloves Knee and elbow padsKnee and elbow pads Tactical Load Bearing vest or Tactical Load Bearing vest or
packpack Protective SheildProtective Sheild Mirror or Breaching EquipmentMirror or Breaching Equipment
Common InjuriesCommon Injuries
Most common injuries are Most common injuries are sprains and simple sprains and simple lacerationslacerations
Suspects usually sustain Suspects usually sustain fall injuries rather than fall injuries rather than team members or team members or hostageshostages
Equipment dealing with Equipment dealing with such injuries should be such injuries should be on handon hand
Heat and Cold ExposureHeat and Cold Exposure
TraumaTrauma Get to at least the Warm Get to at least the Warm
Zone before any lengthy Zone before any lengthy medical interventions are medical interventions are donedone
Hot Zone is for IDL’s Hot Zone is for IDL’s ONLY!ONLY!
Scoop and runScoop and run ABC’sABC’s BleedingBleeding Safe and quick exit to Safe and quick exit to
warm zonewarm zone Rarely a need to rush into Rarely a need to rush into
a situationa situation Can help get to victim?Can help get to victim?
TEMS Trauma FactsTEMS Trauma FactsSame Care, yet not the sameSame Care, yet not the same
90% of victims in war die on the battlefield90% of victims in war die on the battlefield 2,500 died from a simple extremity hemorrhage 2,500 died from a simple extremity hemorrhage
in Vietnamin Vietnam Golden Hour – most die in 30 minutes of injuries Golden Hour – most die in 30 minutes of injuries
that require simple interventionsthat require simple interventions Penetrating injury requires different care from Penetrating injury requires different care from
blunt traumablunt trauma Boarded and collared?Boarded and collared?
• Forget collar under fireForget collar under fire• Board and Collar in the Warm ZoneBoard and Collar in the Warm Zone
Scoop and run?Scoop and run?
So what does TEMS really do?So what does TEMS really do?
TEMS RoleTEMS Role
PlanningPlanning OperatorOperator Location of TEMS Location of TEMS
PhysicianPhysician Medical IntelligenceMedical Intelligence
Prediction of medical Prediction of medical problems of suspects problems of suspects and hostagesand hostages
Improves public Improves public opinionopinion
Reduces LiabilityReduces Liability
Provisions for Provisions for transporttransport
Evidence Evidence PreservationPreservation
Barricade medicineBarricade medicine Remote physical Remote physical
assessmentassessment Extrication and Extrication and
evacuationevacuation Canine first aidCanine first aid
TEMS Provider Must UnderstandTEMS Provider Must Understand
Chemical Munitions and Chemical Munitions and deployment techniquesdeployment techniques
Distraction devices and effectsDistraction devices and effects Booby Traps and Booby Traps and
unconventional weaponsunconventional weapons Weapons Systems and Weapons Systems and
managementmanagement Active countermeasuresActive countermeasures Dynamic Clearing and Dynamic Clearing and
movementmovement Stealth MovementStealth Movement Medical advisor to the mission Medical advisor to the mission
commandercommander
Team ConceptsTeam Concepts
TrainingTraining 360 degree protection360 degree protection Invisible DeploymentInvisible Deployment Noise DisciplineNoise Discipline Cover and Cover and
ConcealmentConcealment CommunicationsCommunications Negotiation TrainingNegotiation Training Chemical AgentsChemical Agents
Operation PlanningOperation Planning
Warning OrderWarning Order Building IntelligenceBuilding Intelligence Suspect and hostage Suspect and hostage
IntelligenceIntelligence Recon MissionRecon Mission Operations OrderOperations Order DebriefDebrief
OperationOperation
SituationSituation LocationLocation SuspectsSuspects Number of suspectsNumber of suspects Physical descriptionPhysical description DogsDogs
MissionMission WarrantsWarrants BarricaidesBarricaides
ExecutionExecution Recon ReportRecon Report Danger AreasDanger Areas Movement PlanMovement Plan Entry PlanEntry Plan Alternate Entry PlanAlternate Entry Plan Specific DutiesSpecific Duties Team LeadersTeam Leaders Recon TeamRecon Team Apprehension TeamApprehension Team Perimeter TeamPerimeter Team MarksmanMarksman ObserverObserver Rescue TeamRescue Team
TEMS in ActionTEMS in Action
Pre-Determine Hard Pre-Determine Hard CoverCover
Prepare for the Prepare for the UnexpectedUnexpected
Recognize the Medical Recognize the Medical ProblemProblem
Maintain Emotional Maintain Emotional ComposureComposure
Triage Accurately and Triage Accurately and rapidlyrapidly
Treat what you need toTreat what you need to
Tactical MangementTactical Mangement Airway ManagementAirway Management
No airway obstructionNo airway obstruction Chin Lift or Jaw thrustChin Lift or Jaw thrust Nasal AirwayNasal Airway ETT or Esophageal airwayETT or Esophageal airway LMALMA
BreathingBreathing OO22 VentilateVentilate Needle ThoracostomyNeedle Thoracostomy Chest Tube InsertionChest Tube Insertion
CirculationCirculation IV AccessIV Access Control HemorrhageControl Hemorrhage HespanHespan
Tactical ManagementTactical Management
Monitoring VitalsMonitoring Vitals Inspect and dress all Inspect and dress all
woundswounds AnalgesiaAnalgesia Splint fractures and Splint fractures and
establish neurovascular establish neurovascular integrityintegrity
AntibioticsAntibiotics Open FracturesOpen Fractures Penetrating abdominal Penetrating abdominal
TraumaTrauma CPRCPR Evacuation and TransportEvacuation and Transport
Injury PriorityInjury Priority
BreathingBreathing Bleeding WoundsBleeding Wounds Broken bonesBroken bones BurnsBurns
Get InvolvedGet Involved
Heckler and KochHeckler and Koch Tactical EM BasicTactical EM Basic Tactical EM AdvancedTactical EM Advanced
CO.N.T.O.M.S.CO.N.T.O.M.S. Get involved with and Get involved with and
train with a SWAT train with a SWAT TeamTeam
SBHCS SOD TeamSBHCS SOD Team Stay Safe!Stay Safe!
Questions?Questions?
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