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?