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TACTICAL MEDICINE TACMED España

TACTICAL MEDICINE TACMED España
by EMS SOLUTIONS INTERNATIONAL

Facebook Dr. Ramon Reyes, MD

NIVEL DE ALERTA ANITERRORISTA, España

lunes, 21 de mayo de 2018

Guia Sanitaria a Bordo by Instituto Social del Mar. España

Guia Sanitaria a Bordo  by Instituto Social del Mar. España

Guia Sanitaria a Bordo 

Enlace para bajar guia en formato PDF Gratis   by Instituto Social del Mar. España




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Balística de las heridas: introducción para los profesionales de la salud, del derecho, de las ciencias forenses, de las fuerzas armadas y de las fuerzas encargadas de hacer cumplir la ley http://emssolutionsint.blogspot.com/2017/04/balistica-de-las-heridas-introduccion.html

Guía para el manejo médico-quirúrgico de heridos en situación de conflicto armado by CICR http://emssolutionsint.blogspot.com/2017/09/guia-para-el-manejo-medico-quirurgico.html

CIRUGÍA DE GUERRA TRABAJAR CON RECURSOS LIMITADOS EN CONFLICTOS ARMADOS Y OTRAS SITUACIONES DE VIOLENCIA VOLUMEN 1 C. Giannou M. Baldan CICR http://emssolutionsint.blogspot.com.es/2013/01/cirugia-de-guerra-trabajar-con-recursos.html

Manual Suturas, Ligaduras, Nudos y Drenajes. Hospital Donostia, Pais Vasco. España http://emssolutionsint.blogspot.com/2017/09/manual-suturas-ligaduras-nudos-y.html

Técnicas de Suturas para Enfermería ASEPEYO y 7 tipos de suturas que tienen que conocer estudiantes de medicina http://emssolutionsint.blogspot.com/2015/01/tecnicas-de-suturas-para-enfermeria.html

Manual Práctico de Cirugía Menor. Grupo de Cirugia Menor y Dermatologia. Societat Valenciana de Medicina Familiar i Comunitaria http://emssolutionsint.blogspot.com/2013/09/manual-practico-de-cirugia-menor.html


Protocolo de Atencion para Cirugia. Ministerio de Salud Publica Rep. Dominicana. Marzo 2016 http://emssolutionsint.blogspot.com/2016/09/protocolo-de-atencion-para-cirugia.html

Manual de esterilización para centros de salud. Organización Panamericana de la Salud http://emssolutionsint.blogspot.com/2016/07/manual-de-esterilizacion-para-centros.html

6 años de Garantia
Libre de Mantenimiento 
El mas ECONOMICO
Vendemos en España y Rep. Dominicana
Hacemos entrega del Sistema Completo

eeiispain@gmail.com

“UNA VIDA NO TIENE PRECIO”

TELEFUNKEN AED DISPONIBLE EN TODA AMERICA 6 AÑOS DE GARANTIA (ECONOMICO) http://goo.gl/JIYJwk

Follow me / INVITA A TUS AMIGOS A SEGUIRNOS

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¿Por qué el Desfibrilador TELEFUNKEN?

El DESFIBRILADOR de Telefunken es un DESFIBRILADOR AUTOMÁTICO sumamente avanzado y muy fácil de manejar.

Fruto de más de 10 años de desarrollo, y avalado por TELEFUNKEN, fabricante con más de 80 años de historia en la fabricación de dispositivos electrónicos.

El desfibrilador TELEFUNKEN cuenta con las más exigentes certificaciones.

Realiza automáticamente autodiagnósticos diarios y mensuales.

Incluye bolsa y accesorios.

Dispone de electrodos de "ADULTO" y "PEDIÁTRICOS".
Tiene 6 años de garantía.
Componentes kit de emergencias
Máscarilla de respiración con conexión de oxígeno.
Tijeras para cortar la ropa
Rasuradora.
Guantes desechables.

¿ Qué es una Parada Cardíaca?

Cada año solo en paises como España mueren más de 25.000 personas por muerte súbita.

La mayoría en entornos extrahospitalarios, y casi el 80-90 % ocasionadas por un trastorno eléctrico del corazón llamado"FIBRILACIÓN VENTRICULAR"

El único tratamiento efectivo en estos casos es la "Desfibrilación precoz".

"Por cada minuto de retraso en realizar la desfibrilación, las posibilidades de supervivencia disminuyen en más de un 10%".

¿ Qué es un desfibrilador ?

El desfibrilador semiautomático (DESA) es un pequeño aparato que se conecta a la víctima que supuestamente ha sufrido una parada cardíaca por medio de parches (electrodos adhesivos).

¿ Cómo funciona ?

SU FUNDAMENTO ES SENCILLO:

El DESA "Desfibrilador" analiza automáticamente el ritmo del corazón. Si identifica un ritmo de parada cardíaca tratable mediante la desfibrilación ( fibrilación ventricular), recomendará una descarga y deberá realizarse la misma pulsando un botón.

SU USO ES FÁCIL:

El desfibrilador va guiando al reanimador durante todo el proceso, por medio de mensajes de voz, realizando las órdenes paso a paso.

SU USO ES SEGURO:

Únicamente si detecta este ritmo de parada desfibrilable (FV) y (Taquicardia Ventricular sin Pulso) permite la aplicación de la descarga. (Si por ejemplo nos encontrásemos ante una víctima inconsciente que únicamente ha sufrido un desmayo, el desfibrilador no permitiría nunca aplicar una descarga).

¿Quién puede usar un desfibrilador TELEFUNKEN?

No es necesario que el reanimador sea médico, Enfermero o Tecnico en Emergencias Sanitarias para poder utilizar el desfibrilador.

Cualquier persona (no médico) que haya superado un curso de formación específico impartido por un centro homologado y acreditado estará capacitado y legalmente autorizado para utilizar el DESFIBRILADOR (En nuestro caso la certificacion es de validez mundial por seguir los protolos internacionales del ILCOR International Liaison Committee on Resuscitation. y Una institucion de prestigio internacional que avale que se han seguido los procedimientos tanto de formacion, ademas de los lineamientos del fabricante como es el caso de eeii.edu

TELEFUNKEN en Rep. Dominicana es parte de Emergency Educational Institute International de Florida. Estados Unidos, siendo Centro de Entrenamiento Autorizado por la American Heart Association y American Safety and Health Institute (Por lo que podemos certificar ILCOR) Acreditacion con validez en todo el mundo y al mismo tiempo certificar el lugar en donde son colocados nuestros Desfibriladores como Centros Cardioprotegidos que cumplen con todos los estanderes tanto Europeos CE como de Estados Unidos y Canada

DATOS TÉCNICOS

Dimensiones: 220 x 275 x 85mm

Peso: 2,6 Kg.

Clase de equipo: IIb

ESPECIFICACIONES

Temperatura: 0° C – + 50° C (sin electrodos)

Presión: 800 – 1060 hPa

Humedad: 0% – 95%

Máximo Grado de protección contra la humedad: IP 55

Máximo grado de protección contra golpes:IEC 601-1:1988+A1:1991+A2:1995

Tiempo en espera de las baterías: 3 años (Deben de ser cambiadas para garantizar un servicio optimo del aparato a los 3 años de uso)

Tiempo en espera de los electrodos: 3 años (Recomendamos sustitucion para mantener estandares internacionales de calidad)

Número de choques: >200

Capacidad de monitorización: > 20 horas (Significa que con una sola bateria tienes 20 horas de monitorizacion continua del paciente en caso de desastre, es optimo por el tiempo que podemos permanecer en monitorizacion del paciente posterior a la reanimacion)

Tiempo análisis ECG: < 10 segundos (En menos de 10 seg. TELEFUNKEN AED, ha hecho el diagnostico y estara listo para suministrar tratamiento de forma automatica)

Ciclo análisis + preparación del shock: < 15 segundos

Botón información: Informa sobre el tiempo de uso y el número de descargas administradas durante el evento con sólo pulsar un botón

Claras señales acústicas y visuales: guía por voz y mediante señales luminosas al reanimador durante todo el proceso de reanimación.

Metrónomo: que indica la frecuencia correcta para las compresiones torácicas. con las Guias 2015-2020, esto garantiza que al seguir el ritmo pautado de compresiones que nos indica el aparato de forma acustica y visual, podremos dar RCP de ALTA calidad con un aparato extremadamente moderno, pero economico.

Normas aplicadas: EN 60601-1:2006, EN 60601-1-4:1996, EN 60601-1:2007, EN 60601-2-4:2003

Sensibilidad y precisión:

Sensibilidad > 90%, tip. 98%,

Especificidad > 95%, tip. 96%,

Asistolia umbral < ±80μV

Protocolo de reanimación: ILCOR 2015-2020

Análisis ECG: Ritmos cardiacos tratables (VF, VT rápida), Ritmos cardiacos no tratables (asistolia, NSR, etc.)

Control de impedancia: Medición9 de la impedancia continua, detección de movimiento, detección de respiración

Control de los electrodos : Calidad del contacto

Identificación de ritmo normal de marcapasos

Lenguas: Holandés, inglés, alemán, francés, español, sueco, danés, noruega, italiano, ruso, chino

Comunicación-interfaz: USB 2.0 (El mas simple y economico del mercado)

Usuarios-interfaz: Operación de tres botones (botón de encendido/apagado , botón de choque/información.

Indicación LED: para el estado del proceso de reanimación. (Para ambientes ruidosos y en caso de personas con limitaciones acusticas)

Impulso-desfibrilación: Bifásico (Bajo Nivel de Energia, pero mayor calidad que causa menos daño al musculo cardiaco), tensión controlada

Energía de choque máxima: Energía Alta 300J (impedancia de paciente 75Ω), Energía Baja 200J

(impedancia de paciente 100Ω)

Rescue Task Force RTF? / FUERZAS de TAREA de RESCATE

¿Es correcto que el SEM en situaciones Tacticas utilice uniformidad similar a la policial? Respuestas en video mañaña sabado 19 de mayo 2018. by Dr. Ramon Reyes, MD, EMT-Tactical, DMO en nuestra pagina en facebook @drramonreyesmd https://www.facebook.com/DrRamonReyesMD/


Rescue Task Force RTF? / FUERZAS de TAREA de RESCATE

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Guatemala military/medic special ops team. Art by Dansun Photos @DansunPhotos
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NO SOLO ES PARECER, TAMBIEN DEBEMOS SER...
El Dr. James Vretis, D.O es un MEDICO TACTICO, no parece, lo es... y lleva lo mismo que cualquier miembro de las Fuerzas del Orden...Porque el es Fuerza del Orden... ¿Es correcto que el SEM en situaciones Tacticas utilice uniformidad similar a la policial? Respuestas by Dr. Ramon Reyes, MD​, EMT-Tactical, DMO en nuestra pagina en facebook @drramonreyesmd http://emssolutionsint.blogspot.com.es/2018/03/tactical-medics-vs-rescue-task-force.html

CONFUNDIR TACTICAL MEDICS VS. RESCUE TASK FORCE MEDICS, Pues tengo la ligera impresion es lo que han hecho en España, uniformar al personal sanitario, violando principios basicos de seguridad, al dejar bajo confusion total a quienes intervienen en la escena (Escena desde el principio especial y atipica), diferencia entre los RTF y EMS-T,

DEPAS-MADRID: El Dispositivo Especial Preventivo Actos Antisociales es un equipo constituido por 113 voluntarios que actúan en caso de manifestaciones, desalojos, altercados públicos o partidos de fútbol catalogados de alto riesgo.


¿Es correcto que el SEM en situaciones Tacticas utilice uniformidad similar a la policial? Respuestas en video mañaña sabado 19 de mayo 2018. by Dr. Ramon Reyes, MD, EMT-Tactical, DMO en nuestra pagina en facebook Dr. Ramon Reyes, MD

RESPUESTA:



Rescue Task Force RTF? / FUERZAS de TAREA de RESCATE

En el dia de mañana trataremos este tema a fondo, para dejar claro, que ha sucedido en esta confusion, que podria realmente poner en peligro al personal sanitario.

Dr. Ramon Reyes, MD, EMT-T, DMO
Tactical Medical Specialist
TCCC-TECC Faculty
TCC-LEFR Medical Director
VP-Militar Comite Iberoamericano de Medicina Tactica y Operacional


Graduado de Tactical Protective Medical Support y Grupo de Entrenamiento Contra-Terrorismo del Gobierno de Estados Unidos

"NO SOLO ES PARECER, TAMBIEN DEBES DE SER" by Dr. Ramon REYES, MD

Guatemala military/medic special ops team.Guatemala military/medic special ops team.Guatemala military/medic special ops team. Art by Dansun Photos @DansunPhotos


Guatemala military/medic special ops team. Guatemala military/medic special ops team. Art by Dansun Photos @DansunPhotos
TACMED, Tactical Medicine, Active Shooting, Terrorism Attack.


Rescue Task Force is a new concept to SFD that is designed to get lifesaving medical treatment to victims in mass shootings quicker. The current standard fire/EMS response to the active shooter is to stage in a secure location until police mitigate the threat and secure the area to create a scene safe for fire/EMS operations. Unfortunately, while waiting for a secure scene, those injured inside the building aren't receiving care and are dying from their injuries. The RTF concept involves placing Paramedics in a forward position during an active shooter. The Paramedics are protected with cover and Police Officers, but are able to begin life-saving care much sooner than traditional

FUERZAS de TAREA de RESCATE "Rescue Task Force" RTF. es un nuevo concepto de los Servicios de Emergencias, ha sido diseñado para brindar tratamiento médico para evitar muertes prevenibles en víctimas durante tiroteos masivos y de manera más rápida y efectiva. La respuesta estándar actual ante fuego / SEM ante tiradores activos consiste en ubicarse en lugar seguro hasta que la policía suprima la amenaza y asegure el área para crear una escena segura para las operaciones de Bomberos / SEM. Desafortunadamente, mientras se espera una escena segura, los heridos dentro del edificio no estarán recibiendo atención y estarán muriendo por sus lesiones. El concepto de RTF implica colocar a los paramédicos en una posición en el frente durante un tirotesos activos. Los paramédicos estarán protegidos por cobertura (Escudos) y resguardos en la escena, ademas oficiales de policía,asi podran comenzar a salvar vidas mucho más rápido que con los métodos tradicionales de despliegue.

deployment methods.




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TACTICAL MEDICS VS. RESCUE TASK FORCE MEDICS
What are the similarities and differences between these critical functions?



Written by

Jim Morrissey- ALCO EMS

Terrorism Preparedness Director

Senior SF FBI Tactical Medic

The simple answer is that tactical medics are “attached” to a tactical law enforcement team and are considered part of the team. Whereas a Rescue Task Force is a trained, but hastily formed group of EMS medical providers (private and/or fire based) that partner with law enforcement on scene and enter a newly secured area such as an active shooter incident, to provide triage, emergent care and extrication to the casualties.


 EMS uniforms: Does color matter? A majority of readers are most concerned about the color of their uniforms in regard to setting them apart from police officersFeb 16, 2017
By EMS1 Staff

Gone are the days of all EMS providers wearing white pants, white shirt or a dark navy outfit.

And because of this variety, EMS1 columnist Catherine Counts looked at the impact and role uniform color plays. Specifically, she looked at research regarding police-public interactions and if EMS could benefit and change anything with the findings.

Uniforms are part of the first impression the community will have on the responding crew. (Photo/Hennepin EMS)
Uniforms are part of the first impression the community will have on the responding crew. (Photo/Hennepin EMS)
We asked our Facebook fans what color they thought paramedics should wear. A majority of commenters were most concerned about the color of their uniforms in regard to setting them apart from police officers. Others talked about the need for more high-visible clothing in EMS and their color preference based off weather resistance and job-related messes.

Do you think color matters? Let us know in the comments below.

1. "No badge. I'm a big fan of high visible uniforms, because this way at 3 a.m. we don't look like cops. I worked at one place where they had jumpsuits. As long as we don't look like cops. When we do, it tends to cause problems." — Brian Conner

2. "We have white tops and navy pants with BLS in all navy. I like how my uniform looks brand new. However, a white shirt is not practical for EMS providers day-to-day. Everything from fluids, to sweat stains, dirty footprints on your chest and even food. Without fail, I always spill my coffee the morning I wear a brand new shirt." — Denise Chagnon Beady

3. "I'm from Germany, and here it is a law that EMS providers have to wear high-visible clothes. So we have orange trousers, orange jackets and white shirts." — Moritz Werthschulte

4. "I agree to not having badges. I used to work for a private service and our class A's were 100 percent red. To me, that just screams 'medical' and I have yet to come across any LE that wears red. That's how it should be." — Luke Ailiff

5. "I've been mistaken for a police officer all of the time. I prefer the blues. I think they look professional. I have worn white shirt and blue pants and by the first 10 minutes they're already dirty. I prefer a blue polo shirt with EMS and professional licensure on back." — Brian Schilling

6. "Red shirts, black pants. Red and black are great at hiding stains, helps you to stay looking professional. Red doesn't retain much heat when working an MVC in the blistering Texas sun. Red is more flashy and EMS-related than blues, blacks and other dark colors and sets us apart from police officers, helps reduce danger as well. When I see gray, I think correctional officer. When I see beige, I think security guard." — Ari Andalman

7. "I would love a universal color coding. I also think we need to ditch the dark blue. I'm patriotic, but Europe is right to put their first responders that are not police into high visibility yellows and greens. I say fire should move toward a high visible yellow and red, and EMS should be high VI's yellow and royal blue." — Lawson C Stuart

8. "Ours are white. Not real practical, but the argument is that they want us to not look anything like our local LEOs who have blue and tan." — Adrian Hoesli

9. "Red. Easily recognizable and no confusion with law enforcement." — Jake Walker

10. "I like the idea of scrubs. Not just any type, though. Something specially designed for EMS in whatever colors a specific company is." — Britni Martinez https://www.ems1.com/ems-products/uniforms/articles/194890048-EMS-uniforms-Does-color-matter/


How's it? I'm looking for some feedback on what different departments' policies are on wearing class B shirts versus uniform t shirts on calls. I worked for a different fire department for 6 years which had a policy that made sense to me, where we could wear uniform t shirts while responding to all calls, specifically medical calls, but would wear our class B shirts when interacting with the public at schools, for PR events, or while in class room training sessions. 
My current department has a hard-line policy that button-up class B shirts are to be worn in all cases, with the exception of removing them when putting on full turnouts for fires or MVAs. My biggest issue is that we look like police officers in our button up shirts, and I feel it can negatively impact our safety on scene as well as be detrimental to some of our patient/care provider relationships. I've tried to make a case from the safety standpoint that we make ourselves targets when we look like officers (with personal experiences of patients and other people on scene mistaking me for an officer even when we've been in the back of the ambulance providing care or carrying EMS equipment).
The current response is for us to add a part of our PPE, whether it's a turnout coat or fire helmet, to help identify ourselves as Fire/EMS. I really don't like that for a couple of reasons. First, as a medic, the turnout coat hinders my ability to start lines or intubate. The helmet can do the same, and I end up removing both ASAP when initiating patient care. Second, in the summer, it can be over 110 degrees, and I don't like having to add an unnecessary layer or piece of equipment when removing my class B shirt will identify me just as easily (our t shirt has a big reflective "FIRE" printed on the back, and our department logo on the front.) 
Additional benefits of t shirts over class Bs, in my opinion are that they are easier to launder and cheaper to throw away if I get contaminants on them (there's only so much blood or vomit I'm willing to try to remove before the whole shirt is gonna get scrapped). Most of my department sleeps in their T shirts currently, but we have to waste time at night to put on our class B shirts when responding to calls after we've hit the rack. There's always an emphasis on response times and it seems like a no-brainer to not require shirts at night when they make us even more mistakable as cops as well as slow down our response times. 
Any one else have these issues or successfully get policy changed? It seems like the brass has placed form firmly over function in this instance & it's frustrating. I'm generally all for supporting the upper chain of command, and feel like I have made a good personal effort to support and improve my new department (3 years on the job here), but would love to see a more functional policy put in place. I agree  that we should look professional, but feel like that concept should fit the situation. Sharp looking uniform t shirts can look professional to the public when we are on emergency calls, and don't hinder our first priority of personal and crew safety.  http://my.firefighternation.com/forum/topics/class-b-uniforms-make-us-look-like-cops


Mistaken Identity
Article Aug 31, 2008

This issue's close call was sent in by a reader who had a brush with violence and was almost drawn into the fray because of the badge on his uniform.

"My partner and I were at our usual convenience store/gas station at about 10:30 p.m. It's in a somewhat seedy neighborhood and was crowded. While we were in line, someone came running in and yelled, "They're fighting with guns outside!" As everyone else in the store ran toward the front windows to watch (why, I have no idea), we quietly sauntered to the back of the store. We got as far away as we could and called it in. We were stuck.

"Someone from outside came into the store again, looked at us and pleaded for us to help. 'Look at those police officers,' she added, gesturing toward us for the benefit of others in the store. 'They don't even care!' I calmly replied that we were paramedics, not police officers, and that the police would arrive soon. It didn't seem to register, and soon several people in the store were asking us why we weren't helping. The police arrived quickly, and two bad guys were arrested. My supervisor showed up, and as we were talking to him, someone approached us. 'Did you get the guy who did it?' he asked."

Over the years, EMS has grown serious roots in the arena of public safety. This identity has spawned similarities in the authority-based uniforms we often wear, which can resemble those worn by our public safety brethren. In this case, it almost put two EMSers in the middle of a dangerous situation.

Tactically, I applaud the medics for not getting involved in the fight. It may seem like a no-brainer when people are fighting with guns, but it took maturity and solid decision-making to stay back when urged to get involved by citizens.

This situation also provides a backdrop for bringing up some other safety and survival points:

Don't leave your ambulance running outside a store, even just for a minute. The ambulance here could have become a getaway vehicle for one of the shooters.
Remember the concepts of cover and concealment. If you ever find yourself in a situation such as this, look for something that will hide your body and protect you from bullets—this is cover. Examples include trees, brick walls and the engine block of your ambulance. Concealment is good in a pinch because it hides you, but it doesn't offer protection.
Retreat is always a strategy. Get away from the danger. Put as much space between you and any threats as possible. Go as far as you need to be safe—and then go a little further—until police secure the scene. Integrate cover and concealment while you are retreating.
Work through different situations in your head during down time. If you go to a store in a tough part of town (sometimes these are the only choices we have), come up with some safety strategies in the event things go bad (e.g., what if someone tried to jack your rig or steal your narcs?).
Carry a portable radio at all times. In this case, the medics had a link directly to the dispatcher. Most of us carry cell phones as well.
Communicate with your partner. The safety and survival strategies of a team may be greater than the sum of its individual efforts. Two heads are better than one.
Finally, don't forget the value of observation as a tactic. It's always better to observe a dangerous situation and avoid it than to have to use tactics to get out of it. Look for suspicious activity, drug or alcohol use and crowds gathering. Sometimes you can watch an area become "charged" or energized with activity prior to a violent outburst.

Other times an unusual silence is as valuable a sign of danger as suspicious activity.

Here is what the medics in this close call were wearing:

"Our uniforms have light-blue button-down shirts with a badge over the left chest and a nameplate on the right. There are patches on either shoulder also shaped like badges, along with patches to symbolize rank and years of service on the sleeves. Our uniforms are almost identical to those of several area police agencies, and nothing on them clearly identifies us as EMS workers."

What does your uniform look like, and why? While many like the authoritative-looking public safety uniform, others have moved to different styles (e.g., embroidered or screened polos) for a variety of reasons that include lower cost, comfort, practicality and (of course) safety.

Don't forget, a professional in a polo outperforms and looks better than a guy with a badge any day. It's the way you walk the walk.

Be careful out there.

To submit a case for review, e-mail Nancy.Perry@cygnusb2b.com.

Daniel D. Limmer, AS, EMT-P, is a paramedic with Kennebunk Fire-Rescue in Kennebunk, ME. He is the author of several EMS textbooks and a nationally recognized lecturer.

EMS EXPO™
Dan Limmer is a featured speaker at EMS EXPO, October 15–17, in Las Vegas, NV. For more information, visit www.emsexpo2008.com. https://www.emsworld.com/article/10320853/mistaken-identity











Both Tactical Medics and Rescue Task Force personnel provide emergent care in less than ideal situations, often under significant stress and in chaotic, sometimes hostile environments. Both work very closely with law enforcement during planning, training and actual events. Most Rescue Task Force members are outfitted with ballistic vests and helmets, and likewise, almost without exception, Tactical Medics are protected with body armor and helmets. Both Rescue Task Force and Tactical Medics are specifically trained and equipped to deal with ballistic, blast and other violence-induced trauma. Rescue Task Force members wear their usual daily uniform (Fire/ EMS/ law enforcement) and are typically dispatched during their normal shift. Tactical Medics wear the uniform of the tactical team they are attached to and are physically located with the team, or just outside of the “hot zone”.



Tactical Medics

Tactical Medics are somewhat analogous to the hockey team trainer who travels with the team and is there primary to provide medical aid to the team, whether the injury or ailment is serious or not. The most common items requested of the Tactical Medic are Band-Aids and ibuprofen. However, the Tactical Medic must also be prepared to provide life-saving interventions to team members and other on scene law enforcement. The Tactical Medic will provide initial medical care as needed to victims, bystanders, and perpetrators once the scene is secured. They will transfer patient care to a standard EMS unit if further care and transportation to the hospital is needed.

Tactical EMS models

Some law enforcement agencies (LEA) send officers/agents/deputies to EMT school, or comprehensive tactical medical classes and those officers may become the default Tactical Medic for the team. That may be a workable solution; however, it is unlikely those individuals have the medical experience and patient assessment skills needed to be the best medical practitioner in high-risk, high-stress situations.
There are countless workable models for the incorporation of a medical contingency plan for law enforcement operations. Some of the more common models are listed below:

- Officer/Agent/Trooper/medic- These are sworn law enforcement officers (LEO) having dual roles as an "operator" and medic; they have law enforcement powers and can certainly protect themselves from potential threats.

- Agency contract- In this case the LEA has a contract or MOU with a local EMS provider (Fire or private EMS service, or hospital medical group) to provide up-close medical care. Some agencies put the medics through a Reserve Officer school, so that they can be armed as LEOs.

- Individual contract- An individual or a team of individuals are under contract or MOU with the LEA for providing medical coverage for SWAT missions and training.

- ALS Stand by- In this outdated model, there are no Tactical Medics, but LE will stage a standard ambulance some distance away and they would respond to the scene after being secured by law enforcement.

There have been two major shifts in doctrine related to law enforcement operations over the last 10 years. One change focuses on aggressively going after active shooters with whatever assets happen to be on hand, instead of waiting for a SWAT team.

The second major change is recognizing the need for emergency medical contingency planning. This includes training all tactical personnel and line officers in the basics of self-care and buddy care with the focus on bleeding control and the addition of a dedicated Tactical Medic.

An aspect of this doctrine shift (in addition to the Tactical Medic) is - at minimum notifying –but ideally involving local EMS and hospitals about planned or developing law enforcement operations that have a high risk for injuries. SWAT teams are increasingly including a dedicated tactical medical component, and medical threat assessment as part of their organizational structure.

Learning about Tactical EMS
Many in the EMS/medical field have demonstrated and voiced interest in exploring what is required to get into the field of tactical medicine. In addition to the pre-existing medical training one already has (i.e. physician, nurse, paramedic, EMT, etc.), it is highly recommended to procure specific tactical medical education.

Programs such as NAEMT Tactical Combat Casualty Care (TCCC), Tactical Life Saver and others like it are one or two days in length and have been well received by the EMS and LE community. The International School of Tactical Medicine (ISTM) offers a 2 week intensive program aimed at medical practitioners who need basic training on law enforcement operations, and how to work within a law enforcement team as the medic.

Scenario of a tactical mission
On a typical planned SWAT operation there are several phases and steps that take place well before the “hit”. Most often, the mission is a planned high risk search or arrest warrant. After getting a "warning order", the SWAT team operators and all of the support elements (medical, communications, negotiators, etc.) typically convene at a Forward Staging Area (FSA).

A briefing will occur, where mission goals, subjects, and target location layouts are reviewed. Depending on the nature of the mission and Operations Security (OP-SEC) issues, the tactical medic may coordinate with the local EMS transport provider to have an ALS ambulance stage close to the location.

The Tactical Medic is the logical liaison to the on-scene EMS assets that support law enforcement operations. Typically the Tactical Medic will have a face-to-face meeting with EMS supporting units if they are available.


Rescue Task Force

Prompt integration of EMS medical rescue teams with Law Enforcement escort (Rescue Task Force) into an active shooter and other violent threat incidents is a recently adopted concept in the civilian first responder world. The introduction of the Rescue Tack Force (RTF) to the wounded casualties should be just after the threat has been eliminated, when the scene has been deemed relatively secure. Historically, Fire and EMS crews staged a distance away until LE methodically secured the scene before permitting EMS to access victims. This practice is being phased out and is being replaced with a more patient centric and life-saving approach.

There are two priorities in these types of events.

Eliminate the threat (LE responsibility)
Provide immediate life-saving interventions ASAP (everyone’s responsibility)

In terms of providing life-saving interventions, there are four ways to render medical aid in these types of situations.

Bystanders/ victims provide care to one another prior to any responder arrival.
LE rapidly extricates, escorts victims to a safe area where EMS is waiting and provides medical aid.
LE secures the area and THEY provide life-saving interventions at the point of wounding (POW).
LE secures the area and brings in the RTF under a force protection model.

The RTF focus should be on quick initial medical assessments and to provide life-saving interventions on scene at the point of wounding (POW) if needed. This should be done in concert with efforts to extricate victims to a Casualty Collection Point (CCP) where a secondary triage, treatment and transport can be provided. The RTF group should use a pre-entry LE/EMS checklist to insure important issues are addressed. The law enforcement aspect of the RTF is focused on escorting and protecting the medical member of the RTF. Urban Shield has been conducting several tactical and EMS/medical integrated scenarios each year since 2008. These scenarios are created to be realistic, tactically and medically challenging and create an obvious nexus between the tactical resolution and providing life-saving care to the casualties in a timely manner. The Urban Shield EMS Branch has a well-deserved reputation for creating some of the highest rated scenarios in Urban Shield. We aim to continue that trend.

The Rescue Task Force concept is becoming more widespread and adopted nationwide. Fire Departments, local EMS providers and law enforcement need to collaboratively train, drill and develop procedures and protocols for this concept to be effective. You do not want to be exchanging business cards the day of the horrific event.


PDF https://www.summahealth.org/~/media/files/summahealth/ems/ems-protocols/tactical-ems/tems%20protocol%20final.pdf





Tactical EMS: An overview
Learn about the basics of this rapidly evolving EMS subspecialty
Jul 31, 2013

What is a "SWAT medic" and what does it take to become one? Tactical medicine is a specialized and highly discriminating endeavor that requires intensive training, discipline and a unique relationship with law enforcement. Tactical medics have the primary responsibility of providing medical care to the SWAT team, but their duties extend far beyond that task.

This article examines the evolution, and current tactical medical principles and procedures employed by military and law enforcement agencies (LEA), specifically SWAT teams.

History
Tactical medicine concepts have been around since the dawn of medicine….and warfare. Even in early battles the “King’s Doctor” was to be close at hand to deal with injuries, but only to the royal few. Outcomes were not very good as the initial insult might have killed the victim; if that didn’t, then infection usually did.

Historical accounts and personal diaries of military medics through the centuries are fascinating and show a steady progression of tools and techniques and an ever improving understanding of injury management. The Vietnam War showed that rapid transport to a higher echelon of care had a significant impact on survival.

The last 10 years of conflict overseas has shown that controlling extremity hemorrhage and aggressive airway management accounted for a significant reduction in the casualty fatality rate (CFR). The CFR is the percentage of those who are wounded in battle die.1

Casualty Fatality Rate:

WWII 19.1 %
Vietnam War 15.8
Iraq/ Afghanistan conflicts 9.4
Prior to 2004, there were a significant proportion of deaths in American soldiers during the Global War of Terror (GWOT) associated with each of the following injuries:

Hemorrhage from extremity wounds
Junctional hemorrhage (where an arm or leg joins the torso, such as in the groin area after a high traumatic amputation)
Non-compressible hemorrhage (such as a gunshot wound to the abdomen)
Tension pneumothorax
Airway problems
It was noted that extremity hemorrhage was the most frequent cause of preventable battlefield deaths. The U.S. military re-introduced and emphasized tourniquet use and hemostatic agents with measurable success.

Tourniquets were proven to save lives on the battlefield including 31 lives saved in 6 months by tourniquets after the retraining. Kragh et al. estimated that 2000 lives were saved with tourniquets during the Iraq conflict. As importantly, there were no arms or legs lost because of tourniquet use.2

Causes of preventable battlefield death are not that different from the potential injuries of law enforcement/ SWAT operators during high-risk law enforcement operations.

Today's tactical EMS
Tactical medicine has become a discipline and specialty within law enforcement circles. High profile events such as the Columbine, Virginia Tech, Aurora Movie Theater and countless other “active shooter” incidents have shifted the way law enforcement operates.

There have been two major shifts in doctrine related to SWAT and law enforcement operations over the last 10 years. One change was focused on aggressively going after active shooters with whatever assets happen to be on hand, instead of waiting for a SWAT team.

The second has been to recognize the need for emergency medical contingency planning. This includes training officers/agents in the basics of “self-care” and “buddy care” with the focus on bleeding control.

Another aspect of this doctrine shift is the inclusion of organic assets (the tactical medic), and involving, or at least notifying local EMS, hospitals about law enforcement operations that have a high risk for injuries. SWAT teams have increasingly a dedicated tactical medical component as part of their setup.

Some law enforcement agencies (LEA) have decided to send officers to EMT school, or specific tactical medical classes. That may be a workable solution; however, it is unlikely those individuals have the experience and patient assessment skill needed to be the best medical practitioner they can be.

It may make more sense to train an experienced medic to work in a warm zone environment and keep the scope of that person's job as the medic.

Tactical EMS models
There are countless workable models for the incorporation of a medical contingency plan for law enforcement operations. Some of the more common models are listed below:

Officer-Agent/medic- sworn LEO having either dual roles as an "operator" and medic, or strictly as a medic; but has law enforcement powers and can certainly protect themselves from potential threats.

Agency contract: LEA has a contract or memorandum of understanding (MOU) with a local EMS provider to provide "up-close" medical care. Some agencies put the medics through a Reserve Officer school, so that they can be armed as LEOs.
Individual contract: An individual or a team made up of individuals who have either a contract or MOU between them and the LEA providing coverage for SWAT missions and training.
ALS Standby: No Tactical Medics, but ALS unit will stage close by and respond if scene is secured by law enforcement.
Learning about Tactical EMS
There are many in the EMS field that would like to explore the option of getting into the field of tactical medicine. In addition to the medical training one already has such as a physician, nurse, paramedic or EMT, it is highly recommended to procure specific tactical medical education.

Programs such as NAEMT Tactical Combat Casualty Care (TCCC) and other like it are one to two days in length and have been well received by the EMS community. The International School of Tactical Medicine (ISTM) offers a 2 week intensive program aimed at medical practitioners who need basic training on law enforcement operations, and how to work within a law enforcement team as the medic.

The emphasis in this program is to insure that the tactical situation is resolved and EMS providers are not put in harm’s way. There are many skills sessions and tactical/ medical scenarios to test the knowledge learned under stressful conditions.

The tactical medic
The Tactical Medic is the logical liaison to the on-scene EMS assets that support law enforcement operations. Typically the Tactical Medic will have a face-to-face meeting with EMS supporting units if they are available.

It is imperative that EMS providers are not put in harm’s way and are not allowed to enter a scene where there is a shooter, or other threats are still possible. In an active shooter type situation, once the threat is eliminated, the scene is no longer a hot zone. A quick sweep from a SWAT team can confirm this assumption.

If there are significant casualties, the next priority should be to escort the EMS providers into the scene quickly and safely into the newly created “warm zone." They would work closely with the Tactical Medic throughout the event.

Scenario of a tactical mission
On a typical hypothetical SWAT operation there are several phases and steps that take place well before the “hit”. Most often, the mission is a planned high risk search or arrest warrant. After getting a "warning order", the SWAT team operators and all of the support elements (medical, communications, negotiators, etc.) typically convene at a Forward Staging Area (FSA).

A briefing will occur, where mission goals, subjects, and target location layouts are reviewed. The tactical medic then calls the local EMS transport provider to have an ALS ambulance stage close to the location.

Most times if EMS is notified beforehand, they are welcome into the briefing. The local EMS crews are given instructions and a communications plan. In most cases they follow the vehicle convoy in and are in close proximity to the target location.

Local hospitals and trauma centers are notified that the mission is taking place and to be on alert in the event of casualties.

Personally, I’ve been on close to 200 SWAT missions and thankfully there have been no gun-fights with injuries.

On most of SWAT missions, we have a day or two to plan. Most large city police departments have a higher percentage of spontaneous SWAT missions such as a bank robbery “gone bad” or a barricaded subject.

Summary
Tactical medicine is an exciting and evolving field of emergency medicine. Consider taking a tactical medicine class and see if you are up to the task.


References

NAEMT Tactical Combat Casualty Care (TCCC) Curriculum, http://www.naemt.org/education/TCCC/tccc.aspx
Kragh J et al. Practical use of Emergency Tourniquets to stop Bleeding in Major Limb Trauma Journal of Trauma, 2008:64; 30-50 http://www.smcaf.org/InPressKragh.pdf
About the author
Jim Morrissey is a Tactical Paramedic for the San Francisco FBI SWAT team and the founder of the Tactical Medical Association of California (TMAC). Jim is also the Terrorism Preparedness Coordinator for the Alameda County EMS Agency. Jim has a master’s degree in Homeland Security from the Naval Postgraduate School in Monterey, CA. He can be reached at jim.morrissey@acgov.org.

https://www.ems1.com/ems-education/articles/1482674-Tactical-EMS-An-overview/












Active Shooter/Mass Casualty Incidents (AS/MCIs) in the U.S. have increased at an alarming rate in recent years. According to date collected by researchers at Texas State University, 47 active shootings events transpired between 2000 and 2008 — an average of 5.22 per year. Why should we be concerned? These figures have more than tripled in the past five years to an average of 16.8 annually, with a total of 89 active shooting incidents taking place between 2009 and 2013. There have also been disturbing trends in the scope and lethality of AS/MCIs. In the 2012 shootings in Aurora, Colorado, 70 people were wounded-12 fatally-when a gunman stormed the Century Theatre movie complex. Later that same year, 26 people, including 20 children, were murdered inside an elementary school in Newtown, Connecticut. And in April 2013, 264 people were injured in the Boston Marathon bombings, with 3 of the victims dying.
AS/MCIs present several dilemmas for public safety officials — the first of which is expediency of police response. There is a direct correlation between police response time and AS/MCI duration: the average AS/MCI lasts 12 minutes, with 37% ending in 5 minutes or less. Once police arrive on scene, the perpetrators typically turn their attention on police or commit suicide. Regardless, additional loss of life is usually mitigated upon police arrival and deployment on scene, as police prevent the assailants from accessing further victims.
Another notable problem manifested at AS/MCIs is the timeliness of emergency medical personnel response. In most instances, firefighter/paramedics are required to stay outside the secure perimeter while police clear the scene of the threat. This is a process that can take hours, as was the case with the Columbine and Washington Navy Yard shootings. While police search and neutralize active shooting scenes, those wounded desperately lay in wait for medical attention; a human being can die of blood loss in as little as 2-3 minutes, airway obstruction in 4-5 minutes, and a collapsed lung in 10 to 15 minutes. Therefore, paramedics need to be able to access and treat victims on scene, and cannot always wait for the police to conduct an exhaustive search for the perpetrators of active shootings.
In stark comparison to the rapid interdiction model implemented by police organizations across the U.S., most fire/EMS departments do not have established protocols for treating the wounded at active shooting events. The typical response is for fire personnel and paramedics to remain on standby until the scene has been rendered safe by police. Officials at some jurisdictions, such as the Arlington County Fire Department (ACFD), have s adopted a more proactive approach. In 2007, ACFD established the nation’s first Rescue Task Force (RTF). The RTF is based on the military’s Tactical Combat Casualty Care (TCCC) protocols. RTF consists of specially equipped firefighter paramedics partnered with police officers to respond to active shooter or other atypical, high threat medical emergencies. Other fire departments, such as those in Orange County and Los Angeles, California have also recently created Rescue Task Forces after active shooting events. Although the initiation of these RTFs is a positive development, the majority of municipalities in the U.S. do not have the standard operating procedures, equipment, or trained personnel to effectively deal with medical emergencies during active shooter and mass casualty incidents. It often takes a tragic event, such as the Los Angeles International Airport Shooting in November 2013, to demonstrate why Tactical Emergency Casualty Care (TECC) programs such as Rescue Task Forces are necessary.
Several prominent public safety organizations in the U.S. have recommended the establishment of formalized tactical emergency programs. The International Association of Firefighters (IAFF), a fire service advocacy group with over 300,000 members, has issued Position Statements recommending the establishment of TECC and Rescue Task Force programs. The Hartford Consensus, an ad-hoc group medical emergency professionals which includes representatives from the American College of Surgeons, fire service officials and Federal Bureau of Investigation (FBI) also recommends the adoption of Tactical Combat Casualty Care (TCCC) programs* by state and local public safety agencies. According to the Hartford Consensus, TCCC programs are quintessential in improving survivability of victims in active shooting events because they make provisions for “a more integrated response by law enforcement fire/rescue.”
In September 2013, the U.S. Fire Administration issued formal recommendation that public safety agencies across the U.S. look to TECC programs to provide optimal response to active shooter and mass casualty events: “Training, equipment and protocols around use of TECC for medical first responders should be explored, considered and implemented when feasible.”
The Committee-Tactical Emergency Casualty Care (C-TECCC), which is comprised of emergency medical experts from over 55 agencies, is working to expedite the transition of TCCC to the civilian domain. C-TECC recommends, and works with agencies all over the U.S. to advocate and assist with implementation of TECC programs.
Despite the declared need for tactical emergency medical programs by emergency medical professionals and public safety officials across the U.S., there exists no national standard or policy for the implementation of such programs. In fact, most jurisdictions in the U.S. currently have no standardized tactical emergency programs; if TECC programs are implemented, they are frequently established only after calamities involving loss of life occur. On a multi-jurisdictional level, there appears to be disconnect between identification of the problem, and realization of the solution to this problem.
Chances are, you live in an area that does not have a Rescue Task Force, or any other type of formalized TECC program. I would recommend that you engage your elected officials and public safety officials to see what the comprehensive plans are for response to a mass casualty event in your city or town. It is not a matter of if, but when your community will have to endure a mass casualty event.

*TCCC (Tactical Combat Casualty Care) is the original tactical emergency medical program created by the U.S. military, and TECC is the civilian off-shoot version of TCCC. Rescue Task Force (RTF) is a TECC-based program.
 NIJ 06 Level IIIA Soft Armor Ballistic Protection
Front and back hard armor plate pockets able to receive multiple size plates
Mil-Spec industrial reinforced webbing
Front and back MOLLE modular attachment system (PALS compatible)
Durable 1,000-denier Cordura nylon external carrier construction
Adjustable hook and loop side straps – expandable up to 60”
The Rescue Task Force Vest Kit combines state-of-the-art ballistic personal protection along with life-saving, battlefield proven medical equipment from North American Rescue. This ideal solution was designed for EMS, Fire-Rescue and Law Enforcement personnel performing medical operations in response to Active Shooter and Mass Casualty Incidents (AS/MCI).
Developed for rescue personnel working in the Direct and Indirect Threat areas of AS/MCI’s, the Rescue Task Force Vest Kit provides rescuers with a personal protective ballistic vest combined with the essential medical equipment to provide immediate point-of-wounding care to injured casualties in accordance to Tactical Emergency Casualty Care (TECC) guidelines.
The ballistic protective vest provides rescuers with one of the largest NIJ 0101.06 Level IIIA front/back panel soft armor protection systems available in the industry. The vest comes with built-in front and back hard armor plate pouches to allow the option to upgrade up to various sizes of Level IV hard plate protection. The ballistic soft armor is comprised of a unique, multi-hit capable, patent-pending assembly of ballistic materials that capture projectiles and disperse the energy over the entire surface of the panel. The kit is also available with the optional cummerbund-style side Level IIIA soft armor that also has an additional plate pouch to add hard plates for increased lateral protection. This full configuration offers Level IIIA soft armor front, back and side ballistic protection that has the capability to be upgraded with Level IV hard plates.
This “one-size-fits-most” soft armor ballistic vest easily adjusts at the shoulder and waist to fit different size rescuers. The front and back panels, shoulder straps and optional cummerbund side armor have MOLLE capability that allows for the attachment of additional medical or extraction equipment. Designed to address the top leading causes of potentially preventable death in a tactical environment, the medical equipment can also be modified to meet your agency’s needs as required by your protocols. Armor and medical products can also be purchased separately.
Special Features:
NIJ 06 Level IIIA Soft Armor Ballistic Protection
Front and back hard armor plate pockets able to receive multiple size plates
Optional cummerbund-style Side Armor Protection available with additional plate pouch
Mil-Spec industrial reinforced webbing
Front and back MOLLE modular attachment system (PALS compatible)
Durable 1,000-denier Cordura nylon external carrier construction
Adjustable hook and loop side straps – expandable up to 60”
Rescue Handle – 1,200 lbs. tensile strength reinforced strap
One of the largest soft armor coverage areas in the industry
Adjustable hook and loop padded shoulder straps with MOLLE plus two fixed “D” rings
5-year manufacturer’s warranty
Blast mitigation configuration
Comes complete with NAR-4 Chest Pouch with modified equipment list (see kit contents list) and additional CAT Tourniquets and CAT Holders
Made in the USA
Kit Contents:
1 x Armor, Tactical Responder Vest MKII
1 x Armor, Rescue Responder Side Set
4 x Combat Application Tourniquet – BLK
2 x Emergency Trauma Dressing – 6”
2 x S-Rolled Gauze
2 x NPA w/Lube – 28F
1 x HyFin® Vent Chest Seal Twin Pack
3 x Bear Claw Glove Kit (Pair) – Size Lg
1 x NAR Trauma Shears – 7-1/4”
1 x NAR Scissor Leash
4 x Combat Casualty Card
2 x Black Permanent Marker
2 x CAT Holder
1 x Bag, NAR-4 Chest Pouch
1 x MED Illuminous Patch
2 x Rescue Task Force Patch
Technical Specifications:
Complies with and exceeds NIJ Ballistic Resistance Standard 0101.06 for ballistic performance of Level IIIA body armor
Front, back and side hard armor plate pouches for increased protection (plates not included)
Front/back panel protection area: 187 sq. inches (11”W x 17”H)
Proprietary assembly of ballistic materials
Available Side Armor protection
Ballistic Vest Weight: Less than 13 lbs.
Tactical EMS
with Jim Morrissey

Active shooter: Rescue Task Force medics get to victims fasterRescue task forces and tactical medics offer different, yet more aggressive approaches to active-shooter incidents than standing by until all is clearJul 24, 2015
There have been two major shifts in doctrine related to law enforcement operations in the last 10 years. The first shift is the aggressive pursuit of an active shooter with whatever assets happen to be on hand instead of waiting for a SWAT team.

The second major change is recognizing the need for emergency medical contingency planning. This includes training all tactical personnel and line officers in the basics of self-care and buddy care with the focus on bleeding control and the addition of a dedicated tactical medic.

An aspect of this doctrine shift is SWAT teams are increasingly including a dedicated tactical medical component and medical threat assessment as part of their organizational structure. The result is a tactical medic being assigned to the law enforcement team using one of several models.

In addition, law enforcement is at minimum notifying — or ideally involving — local EMS and hospitals about planned or developing law enforcement operations that have a high risk for injuries, like an active shooter incident. This change has given rise to the rescue task force.

TACTICAL MEDIC VS. RESCUE TASK FORCE
Tactical medics are attached to and considered part of a tactical law enforcement team. Whereas a rescue task force is a trained, but hastily formed group of EMS medical providers (private and/or fire based) that partner with law enforcement on scene. They will enter a newly secured area, such as an active shooter incident, to provide triage, emergent care and casualty extrication.

Both tactical medics and rescue task force (RTF) personnel provide emergent care in less than ideal situations, often under significant stress and in chaotic, sometimes hostile environments. Both work very closely with law enforcement during planning, training and actual events.

Most RTF members are outfitted with ballistic vests and helmets, and likewise, almost without exception, tactical medics are protected with body armor and helmets. Both are specifically trained and equipped to deal with ballistic, blast and other violence-induced trauma.

RTF members wear their usual daily uniform (Fire/ EMS/ law enforcement) and are typically dispatched during their normal shift. Tactical medics wear the uniform of the tactical team they are attached to and are physically located with the team, or just outside of the hot zone.

RESCUE TASK FORCE MEDICS
Historically, EMS providers staged a safe distance away until police methodically secured the scene before permitting EMS to access victims. This practice is being phased out and replaced by the rescue task force, a more patient-centric and life-saving approach.

The RTF should have access to the wounded casualties when the threat has been eliminated, when the shooter is confined to another area, or when the scene has been deemed relatively secure. In the RTF model, providing life-saving interventions is done as soon as possible and is everyone's responsibility. There are four ways to render medical aid in these types of situations.

Bystanders and victims provide care to one another prior to any responder arrival.
Police rapidly extricate and escort victims to a safe area where awaiting EMS provides medical aid.
Police secure the area and provide life-saving interventions at the point of wounding.
Police secure or clear the area and bring in RTF medics under a force protection model.
The RTF focus should be on quick initial medical assessments and to provide life-saving interventions on scene, at the point of wounding or injury. Finding and treating patients should

be done in concert with efforts to extricate victims to a casualty collection point where a secondary triage, treatment and transport can be provided.

The RTF should use a pre-entry checklist to ensure important issues are addressed. The law enforcement job with the RTF is focused on escorting and protecting the medical members.

The RTF concept is becoming more widespread and adopted nationwide. However, fire departments, local EMS providers and law enforcement need to collaboratively train, drill and develop procedures and protocols for this concept to be effective.

TACTICAL MEDICS
A tactical medic is somewhat analogous to a professional sports team trainer who travels with the team and is there primarily to provide medical aid to the team, whether the injury or ailment is serious or not.

On a typical planned SWAT operation there are several phases and steps that take place well before the hit. Most often, the mission is a planned high-risk search or arrest warrant. After getting a warning order, the SWAT team operators and all of the support elements (medical, communications, negotiators, etc.) typically convene at a forward staging area.

A briefing will occur, where mission goals, subjects and target location layouts are reviewed. Depending on the nature of the mission and operations security issues, the tactical medic may coordinate with the local EMS transport provider to have an ALS ambulance stage close to the location.

The tactical medic is the logical liaison to the on-scene EMS assets that support law enforcement operations. Typically, the tactical medic will have a face-to-face meeting with EMS units.

The most common items dispensed by a tactical medic is bandages and over-the-counter pain relievers. However, the tactical medic must also be prepared to provide life-saving interventions to team members and other on-scene law enforcement officers.

The tactical medic will also provide initial medical care as needed to victims, bystanders, and perpetrators once the scene is secured. They will transfer patient care to a standard EMS unit if further care and transportation to the hospital is needed.

TACTICAL EMS MODELS
Some law enforcement agencies send personnel to EMT school or other comprehensive tactical medical classes. Those officers may become the default tactical medic for the team. That may be a workable solution; however, it is unlikely those individuals have the medical experience and patient-assessment skills needed to be the best medical practitioner in high-risk, high-stress situations.

There are countless workable models for the incorporation of a medical contingency plan for law enforcement operations. These are some of the more common models.

Officer, agent or trooper medic

A sworn law enforcement officer has dual roles as an operator and medic; they have law enforcement powers and can certainly protect themselves from potential threats.

Agency contract

The law enforcement agency has a contract or memorandum of understanding with a local EMS agency to provide up-close medical care. Some agencies put these contracted medics through a reserve officer school so that they can be armed as police.

Individual contract

An individual or a team are under contract or memorandum of understanding with the law enforcement agency for providing medical coverage for SWAT missions and training.

ALS stand by

In this outdated model, there are no tactical medics attached to the law enforcement team, but police will stage a standard ambulance some distance away to respond to the scene after the scene is secured by law enforcement.

LEARNING ABOUT TACTICAL EMS
Many in the EMS field have demonstrated an interest in getting into the field of tactical medicine. In addition to the pre-existing medical training, it is highly recommended to procure specific tactical medical education.

Programs such as NAEMT Tactical Combat Casualty Care (TCCC), Tactical Life Saver and others like have been well received by the EMS and LE community. The International School of Tactical Medicine offers a two-week intensive program aimed at medical practitioners who need basic training on law enforcement operations and how to work within a law enforcement team as the medic.

About the author
Jim Morrissey is a former Tactical Paramedic for the San Francisco FBI SWAT team and the founder of the Tactical Medical Association of California (TMAC). Jim is also the Terrorism Preparedness Coordinator for the Alameda County EMS Agency. Jim has a master’s degree in Homeland Security from the Naval Postgraduate School in Monterey, CA. He can be reached at jim.morrissey@acgov.org.







Tactical and Disaster Medicine
with Dr. David K. Tan

Rescue Task Force is best medical response to an active shooter incidentThe EMS providers on the RTF focus on care of the victims while tactical medics focus on needs of the SWAT teamOct 9, 2015
Nearly six years after Arlington County Fire Department introduced the modern concept of the Rescue Task Force (RTF) model for emergency medical response to active shooter incidents, many agencies have yet to even discuss the topic, let alone begin training their personnel to mitigate this ever-increasing threat in our communities. A common reason offered for this lack of planning is, "Well, we have SWAT medics with tactical EMS training in our area that will respond."

Tactical Emergency Medical Support, or TEMS or SWAT medics, is certainly one option for managing multiple casualties in a high-threat environment, but having it as the only option for your community is less than optimal for two important reasons.

1. TEMS is for the SWAT team

The focus of TEMS providers is on the overall health and well-being of the SWAT team itself. Their mission is to protect the protectors by being immediately available for downed officers and to provide medical intelligence that may be of tactical value to command staff.

2. TEMS providers are a SWAT asset

Tactical medics do not deploy independently. They are a SWAT asset under SWAT command with a typical SWAT response time that far exceeds the typical duration of active killing that occurs during such incidents.

Rescue Task Force

The RTF model focuses on the needs and care of the victims of a mass shooting. RTF providers work with the first-arriving patrol officers to deliver immediate medical intervention for readily treatable injuries, like severe bleeding and airway compromise, which stabilizes victims for evacuation to definitive care.

RTF providers do not wait for police to secure the scene while victims lay bleeding to death inside the perimeter. They respond with police into the warm zone to find victims, even as other officers search for and neutralize the suspect.

Both TEMS and RTF have their place in the continuum of medical care when it comes to acts of active violence, but we must begin focusing on wider acceptance of RTF integration into police response to make any meaningful impact on morbidity and mortality when active shooter incidents occur.

About the author
David K. Tan, M.D., EMT-T, FAEMS, is associate professor and chief of EMS in the division of emergency medicine at Washington University School of Medicine in St. Louis. He is double board-certified in Emergency Medicine and EMS Medicine by the American Board of Emergency Medicine. Dr. Tan remains very active in EMS at the local, state and national levels as an operational medical director for local police, fire, and EMS agencies, Vice-chairman of the Missouri State Advisory Council on EMS, and President-Elect of the National Association of EMS Physicians. Dr. Tan is a member of the EMS1 Editorial Advisory Board. He also provides medical direction to EMS1.com and the EMS1 Academy.












RESCUE TASK FORCE RTF
Procedimiento Antiguo:  , Bomberos (Paramedicos) responsables de hacer un Centro Medico de Triage a una distancia segura de los tiradores, mas conocida como ZONA FRIA, y espera hasta que la policia (Fuerzas de Seguridad" aseguren el area antes de tratar a las victimas (heridos)
Nuevas Tacticas: Paramedicos entraran a la "ZONA CALIENTE" con la policia, igualmente aun el tirador no ha sido contenido (Neutralizado) y aun la amenza persista. 

Active Shooter/Mass Casualty Incidents (AS/MCIs) in the U.S. have increased at an alarming rate in recent years. According to date collected by researchers at Texas State University, 47 active shootings events transpired between 2000 and 2008 — an average of 5.22 per year. Why should we be concerned? These figures have more than tripled in the past five years to an average of 16.8 annually, with a total of 89 active shooting incidents taking place between 2009 and 2013. There have also been disturbing trends in the scope and lethality of AS/MCIs. In the 2012 shootings in Aurora, Colorado, 70 people were wounded-12 fatally-when a gunman stormed the Century Theatre movie complex. Later that same year, 26 people, including 20 children, were murdered inside an elementary school in Newtown, Connecticut. And in April 2013, 264 people were injured in the Boston Marathon bombings, with 3 of the victims dying.
AS/MCIs present several dilemmas for public safety officials — the first of which is expediency of police response. There is a direct correlation between police response time and AS/MCI duration: the average AS/MCI lasts 12 minutes, with 37% ending in 5 minutes or less. Once police arrive on scene, the perpetrators typically turn their attention on police or commit suicide. Regardless, additional loss of life is usually mitigated upon police arrival and deployment on scene, as police prevent the assailants from accessing further victims.
Another notable problem manifested at AS/MCIs is the timeliness of emergency medical personnel response. In most instances, firefighter/paramedics are required to stay outside the secure perimeter while police clear the scene of the threat. This is a process that can take hours, as was the case with the Columbine and Washington Navy Yard shootings. While police search and neutralize active shooting scenes, those wounded desperately lay in wait for medical attention; a human being can die of blood loss in as little as 2-3 minutes, airway obstruction in 4-5 minutes, and a collapsed lung in 10 to 15 minutes. Therefore, paramedics need to be able to access and treat victims on scene, and cannot always wait for the police to conduct an exhaustive search for the perpetrators of active shootings.
In stark comparison to the rapid interdiction model implemented by police organizations across the U.S., most fire/EMS departments do not have established protocols for treating the wounded at active shooting events. The typical response is for fire personnel and paramedics to remain on standby until the scene has been rendered safe by police. Officials at some jurisdictions, such as the Arlington County Fire Department (ACFD), have s adopted a more proactive approach. In 2007, ACFD established the nation’s first Rescue Task Force (RTF). The RTF is based on the military’s Tactical Combat Casualty Care (TCCC) protocols. RTF consists of specially equipped firefighter paramedics partnered with police officers to respond to active shooter or other atypical, high threat medical emergencies. Other fire departments, such as those in Orange County and Los Angeles, California have also recently created Rescue Task Forces after active shooting events. Although the initiation of these RTFs is a positive development, the majority of municipalities in the U.S. do not have the standard operating procedures, equipment, or trained personnel to effectively deal with medical emergencies during active shooter and mass casualty incidents. It often takes a tragic event, such as the Los Angeles International Airport Shooting in November 2013, to demonstrate why Tactical Emergency Casualty Care (TECC) programs such as Rescue Task Forces are necessary.
Several prominent public safety organizations in the U.S. have recommended the establishment of formalized tactical emergency programs. The International Association of Firefighters (IAFF), a fire service advocacy group with over 300,000 members, has issued Position Statements recommending the establishment of TECC and Rescue Task Force programs. The Hartford Consensus, an ad-hoc group medical emergency professionals which includes representatives from the American College of Surgeons, fire service officials and Federal Bureau of Investigation (FBI) also recommends the adoption of Tactical Combat Casualty Care (TCCC) programs* by state and local public safety agencies. According to the Hartford Consensus, TCCC programs are quintessential in improving survivability of victims in active shooting events because they make provisions for “a more integrated response by law enforcement fire/rescue.”
In September 2013, the U.S. Fire Administration issued formal recommendation that public safety agencies across the U.S. look to TECC programs to provide optimal response to active shooter and mass casualty events: “Training, equipment and protocols around use of TECC for medical first responders should be explored, considered and implemented when feasible.”
The Committee-Tactical Emergency Casualty Care (C-TECCC), which is comprised of emergency medical experts from over 55 agencies, is working to expedite the transition of TCCC to the civilian domain. C-TECC recommends, and works with agencies all over the U.S. to advocate and assist with implementation of TECC programs.
Despite the declared need for tactical emergency medical programs by emergency medical professionals and public safety officials across the U.S., there exists no national standard or policy for the implementation of such programs. In fact, most jurisdictions in the U.S. currently have no standardized tactical emergency programs; if TECC programs are implemented, they are frequently established only after calamities involving loss of life occur. On a multi-jurisdictional level, there appears to be disconnect between identification of the problem, and realization of the solution to this problem.
Chances are, you live in an area that does not have a Rescue Task Force, or any other type of formalized TECC program. I would recommend that you engage your elected officials and public safety officials to see what the comprehensive plans are for response to a mass casualty event in your city or town. It is not a matter of if, but when your community will have to endure a mass casualty event.

*TCCC (Tactical Combat Casualty Care) is the original tactical emergency medical program created by the U.S. military, and TECC is the civilian off-shoot version of TCCC. Rescue Task Force (RTF) is a TECC-based program.


Credits https://medium.com/homeland-security/is-your-community-ready-for-an-active-shooter-event-66fb4000194d