Transcript Tactical Emergency Medicine - An Introduction - NH-TEMS

Tactical Emergency
Medicine
- An Introduction -
Dan Olesnicky, MD
Associate Director
Department of Emergency Medicine
Christ Hospital
Jersey City, NJ
TEMS - Why bother?
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Docs with Glocks?
 Is there really a need?
 Waco Texas
 Community Service
 Team health
 Disruption of the Law enforcement
mission
 Understanding the mission and the
gear
 Special training is required
Docs with Glocks?
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Not a bunch of weekend
warriors armed and
dangerous
Tactical Medics
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Sworn or not
Armed or not
Physicians and medics
need to keep a low profile
in the community and
especially from the media
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Cowboy Label
SWAT and SpecOps
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S.W.A.T.: Special Weapons and Tactics
SpecOps: Special Operations
Purpose: SWAT teams are composed of highly
trained personnel, each of whom can assume
varied responsibilities with a high degree of
proficiency and expertise. The Unit is prepared
to assume full control of specific high-risk tactical
situations, which by nature would be considered
excessively dangerous or complex for
conventional police officers. Practically speaking
the team is organized as both a crisis
intervention team and a rescue team with
negotaition and assault capabilities.
Mission Goal
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The goal of the team is to
accomplish its mission
without injury or death
resulting from the team’s
intervention.
Foremost is the minds of
the team members is the
preservation of life and
safety of bystanders,
hostages, team members
and victims.
TEMS Providers are trained
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TEMS providers are
trained to work in a
tactical environment.
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Evidence perservation
Weapons trained
Render a weapon safe
Understand the equipment
Less likely to become
victims than Non-TEMS
Provide care that Officers
CANNOT
Evidence Preservation
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One of the major priorities
in a police or military
operation.
Most civilians overlook
evidence and are
unaware of how they are
destroying it.
It makes prosecution and
conviction difficult when
a crime scene is
destroyed by EMS
personnel.
Canary in a Coal Mine
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TEMS providers are
less likely to be
victims themselves
 Drug Labs
 Chemical Hazards
 Getting yourself shot
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Special equipment
and applicatons are
used
 Most or all of your
equipment is carried
on your person
 Worst Case
Scenarios must be
planned for before the
operation
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You can’t go to the
supply room in the ED
Difficult to work in the
Hot Zone
Unique working
environment
Equipment
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Ambu Bag
 Airway Kit
 IV’s
 Trauma Supplies
 Chest tubes
 Surgical Kits
 Light source
 Suture Material
 Burn Supplies
 Personal protective
equipment
 Drugs
 All your SWAT Gear and
Body Armor
More Stuff
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Body Armor
Side Arm
Long Gun
Spare magazines and
ammunition
Flash Bangs
Helmet
Goggles
Gloves
Knee and elbow pads
Tactical Load Bearing vest or
pack
Protective Sheild
Mirror or Breaching Equipment
Common Injuries
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Most common injuries are
sprains and simple
lacerations
Suspects usually sustain
fall injuries rather than
team members or
hostages
Equipment dealing with
such injuries should be
on hand
Heat and Cold Exposure
Trauma
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Get to at least the Warm
Zone before any lengthy
medical interventions are
done
Hot Zone is for IDL’s
ONLY!
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Scoop and run
ABC’s
Bleeding
Safe and quick exit to
warm zone
Rarely a need to rush into
a situation
Can help get to victim?
TEMS Trauma Facts
Same Care, yet not the same
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90% of victims in war die on the battlefield
 2,500 died from a simple extremity hemorrhage
in Vietnam
 Golden Hour – most die in 30 minutes of injuries
that require simple interventions
 Penetrating injury requires different care from
blunt trauma
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Boarded and collared?
• Forget collar under fire
• Board and Collar in the Warm Zone
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Scoop and run?
So what does TEMS really do?
TEMS Role
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Planning
 Operator
 Location of TEMS
Physician
 Medical Intelligence
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Prediction of medical
problems of suspects
and hostages
Improves public
opinion
Reduces Liability
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Provisions for
transport
Evidence
Preservation
Barricade medicine
Remote physical
assessment
Extrication and
evacuation
Canine first aid
TEMS Provider Must Understand
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Chemical Munitions and
deployment techniques
Distraction devices and effects
Booby Traps and
unconventional weapons
Weapons Systems and
management
Active countermeasures
Dynamic Clearing and
movement
Stealth Movement
Medical advisor to the mission
commander
Team Concepts
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Training
360 degree protection
Invisible Deployment
Noise Discipline
Cover and
Concealment
Communications
Negotiation Training
Chemical Agents
Operation Planning
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Warning Order
Building Intelligence
Suspect and hostage
Intelligence
Recon Mission
Operations Order
Debrief
Operation
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Situation
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Location
Suspects
Number of suspects
Physical description
Dogs
Mission
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Warrants
Barricaides
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Execution
Recon Report
 Danger Areas
 Movement Plan
 Entry Plan
 Alternate Entry Plan
 Specific Duties
 Team Leaders
 Recon Team
 Apprehension Team
 Perimeter Team
 Marksman
 Observer
 Rescue Team
TEMS in Action
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Pre-Determine Hard
Cover
Prepare for the
Unexpected
Recognize the Medical
Problem
Maintain Emotional
Composure
Triage Accurately and
rapidly
Treat what you need to
Tactical Mangement
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Airway Management
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Breathing
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No airway obstruction
Chin Lift or Jaw thrust
Nasal Airway
ETT or Esophageal airway
LMA
O2
Ventilate
Needle Thoracostomy
Chest Tube Insertion
Circulation
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IV Access
Control Hemorrhage
Hespan
Tactical Management
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Monitoring Vitals
Inspect and dress all
wounds
Analgesia
Splint fractures and
establish neurovascular
integrity
Antibiotics
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Open Fractures
Penetrating abdominal
Trauma
CPR
Evacuation and Transport
Injury Priority
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Breathing
 Bleeding Wounds
 Broken bones
 Burns
Get Involved
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Heckler and Koch
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Tactical EM Basic
Tactical EM Advanced
CO.N.T.O.M.S.
 Get involved with and
train with a SWAT
Team
 SBHCS SOD Team
 Stay Safe!
Questions?