Tactical Emergency Medical Services
The concept of Tactical Emergency Medical Services (TEMS) was born at a series of national conferences in 1989 and 1990 with representatives from EMS, law enforcement, and emergency medicine. The National Tactical Officers Association endorsed that TEMS should be on every tactical team in 1994 and again in 2007. Since the introduction of having TEMS on tactical teams, casualty survival increased by 44%.
TEMS provides many unique attributes that include care under fire, weapons safety, hazardous material expertise, forensics, unconventional patient situations, preventative medicine, primary care, special equipment and training, medical threat assessment (MTA), remote assessment methodology, sensory deprived physical assessment, sensory overload physical assessment, medicine across a barricade, and hasty decontamination.
The Tactical Emergency Casualty Care (TECC) Guidelines are the predominant source for protocols in TEMS. TECC is written and controlled by the Council for Tactical Emergency Casualty Care (C-TECC). TECC covers such a broad level of topics that not all content applies to all TEMS units. TECC allows for TEMS units to customize the content of its education per the needs of each individual unit.
The Tactical Primary Survey
A tactical primary survey is a medical survey that considers the dynamic and austere circumstances that occur on tactical teams. It can be remembered by two different mnemonics: SMARCH or XABCDE:
SMARCH = Security/Safety, Massive hemorrhage, Airway, Respirations, Circulation, Head trauma/Hypothermia
XABCDE = eXsanguinating hemorrhage control/eXtrication, Airway, Breathing, Circulation, Disability, Evacuation. Regardless of the mnemonic used, security is the first priority.
The zones of care include the hot zone, warm zone, and cold zone.
A hot zone is where a direct threat exists. Casualty extrication is paramount, but the X portion of the tactical primary survey can be addressed in the hot zone. This includes eXtrication of the casualty and controlling eXsanguinating hemorrhage. When it comes to extrication, the casualty should attempt self-extrication if possible. If the casualty cannot self-extricate, the team must extricate the casualty. Control of exsanguinating hemorrhage should be addressed with limb or junctional tourniquets.
A warm zone is where an indirect threat exists. Care is delivered based on risk/benefit ratio. Airway, breathing, and circulation are addressed in the warm zone, unless otherwise deferred due to risk.
A cold zone is where no threat exists. Care is delivered based on the tactical primary survey and secondary survey.
It is important that TEMS providers know how to handle all weapons on the tactical team, including LLWs, chemical irritants (oleoresin capsicum [OC] and ortho-chlorobenzylidene [CS]), kinetic impact weapons, conducted energy weapons (CEWs), and noise-flash diversionary weapons (NFDDs).
