Tang - Institute of Medicine
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Transcript Tang - Institute of Medicine
Nelson Tang, M.D., FACEP
Director and Chief Medical Officer
Center for Law Enforcement Medicine
The Johns Hopkins University
Collaborative initiative between JHU and partnered
Agencies
• United States Secret Service
• Immigration and Customs Enforcement
• Bureau of Alcohol, Tobacco, Firearms & Explosives
• United States Marshals Service
• State and Local agencies
Academic Center of Excellence
Institutional tripartite missions of research, patient care,
and medical education
National Tactical Officers Association (NTOA)
• “the provision of TEMS has emerged as an important element of
tactical law enforcement operation” -1993
National Association of EMS Physicians (NAEMSP)
• Medical Support of Law Enforcement Special Operations -2001
American College of Emergency Physicians (ACEP)
• TEMS is an essential component of law enforcement teams and
“helps maintain a healthy and safer environment for both law
enforcement and the public” -2004
Highly skilled and trained medical providers
Functions under the premise of scene-safety FIRST
Transport-oriented approach to patient care
Reliance upon maximal visibility
Generally untrained for the high-risk tactical
environment
Staged remote from law enforcement inner
perimeter
Tactical medical support is the provision of
field medical care during high-risk,
extended-duration and mission-driven law
enforcement operations, often rendered
under functionally austere conditions.
The goals of law enforcement medicine
are to facilitate the success and the safety
of law enforcement missions during all
phases of a field operations through the
delivery of preventative, urgent, and
emergency medical care.
Mission Preplanning (Medical Threat
Assessments)
Coordination with EMS and local resources
Remote Assessment and Triage
Tactical Casualty Care
Preventative Medicine and Team Health
Urgent Care and “Sick Call”
Weapons Safety
Forensic Evidence Preservation
Tourniquets
Hemostatic
Field
agents
expedient airways
Needle
Splints
decompression
and slings
Evacuation
litters
Hydration
Nutrition
Sleep/Rest
monitoring
Environmental
exposures
Vaccinations
Referrals
Personnel
advocacy
Medical support of law enforcement
operations is a force protection mandate
Personnel
health and safety
Preservation of manpower
Sustain critical law enforcement functions
Liaison with EMS and established
medical infrastructure
Coordination of initial and follow-up care
Resource to command infrastructure
Inter-agency collaboration
Formal
relationships between law
enforcement agencies and JHU
Establishes the responsibilities and
authority of the Medical Director
Medical Direction is a position not an
individual
Multiple core functions and supplemental
support services
Initial
medical and “requalification”
training
Didactic, laboratory and clinical
education
Practice standards with basis in regularly
updated written guidelines
24/7 availability of Medical Control
Standardized patient care records
Quality assurance reviews
Physician operational medical support
Clinical
approaches based upon current
standards and practices
Breadth of experience and expertise
Diversity of faculty background
• EMS and prehospital care
• Disaster and emergency preparedness
• International and travel medicine
• Military medicine
• Mass gathering event support
Depth
of physician manpower
Clinical
sites for provider skills maintenance
Dedicated communications center
Hospital based critical care transport services
Referral and hospitalization mechanisms
Specialty and sub-specialty expertise
Safety
Quality
Wellness
Prevention
Infection
control
Peer assessment
Documentation
Agency
commitment and support of
leadership
Clear chain of command for medical
decision-making
Medical direction separate from agency
infrastructure
Consistency of training, policies,
protocols and medical command (interoperability)
Inter-agency
communication is variable
and historically unreliable
Academic partnerships foster
collaboration
Open exchange is routine in our Center
• Training methodologies
• Curriculum
• Educational venues
• Operational procedures
• Mutual aid support
Dynamic
nature of agency leadership
Fluctuation of intra-agency funding
National scale of programs
Evolving rosters of providers
Data collection and reporting
Metrics for evaluating programs