By: Tripp Winslow, MD MPH
In the medical literature, there is a paucity of peer-reviewed articles regarding Tactical Emergency Medical Services (TEMS). The majority of TEMS based articles are reviews of extrapolated EMS, Trauma, or Emergency Medicine literature. While these review articles are informative and promote awareness of TEMS as a specialty, it is evident that a greater effort must be made to advance the science and evidence based literature available for use in the field. In this journal scan identifying existing TEMS literature, I have summarized a few review articles and presented several original research papers as well. This review was carried out on PubMed. The bibliographies of all articles were reviewed for additional relevant articles.
Heck, J. J. and G. Pierluisi (2001). "Law enforcement special operations medical support." Prehosp Emerg Care 5(4): 403-6.
This position paper by NAEMSP is an important document. It defines TEMS and lists its goals. This paper describes the position of NAEMSP. It also describes the different aspects of TEMS care which include prevention, urgent care, and emergency care. This is a helpful document when a team is deciding what its goals should be and how it should be constructed.
Heiskell, L. E. and R. H. Carmona (1994). "Tactical emergency medical services: an emerging subspecialty of emergency medicine." Ann Emerg Med 23(4): 778-85.
This article by Heiskell and Carmona is a very good and concise review of TEMS and tactical law enforcement. The article starts with a review of their history and organization. The article continues by describing the structure of a typical "SWAT" team. The authors also give the objectives of a tactical EMS section. The roles of a TEMS unit are also described and the importance of resources, planning, training, and the provision of care. Other important topics touched on include the CONTOMS training program and the team physician concept.
Jones, J. S., K. Reese, et al. (1996). "Into the fray: integration of emergency medical services and special weapons and tactics (SWAT) teams." Prehospital Disaster Med 11(3): 202-6.
The above study by Jones was done in 1995. It is a survey of "SWAT" unit commanders. One hundred surveys were sent out and 75% were returned. Surveys were sent to large metropolitan areas throughout the United States. The survey addresses what percentage of tactical law enforcement teams had medical support. It also describes the level of medical support available and the type of training the medical support underwent. One interesting bit of data was that 94% of personnel providing prehospital support had no tactical training. Other specific areas including the arming of medical support members were addressed. This study gives a good overview of the state of tactical medicine in 1995.
Bozeman, W. P. and E. R. Eastman (2002). "Tactical EMS: an emerging opportunity in graduate medical education." Prehosp Emerg Care 6(3): 322-4.
The paper by Bozeman studies the effectiveness of the CONTOMS physician's course. The study consists of testing physicians before and after taking the course. There were 39 participants in the study. The study seems to show that the CONTOMS course is an effective TEMS training curriculum.
Ordog, G. J., J. Wasserberger, et al. (1987). "Electronic gun (Taser) injuries." Ann Emerg Med 16(1): 73-8.
The study by Ordog prospectively looks at the use of Tazers in Los Angeles from 1980 to 1985. The study included 218 patients who were shot by police with Tazers. It compares this group to 22 patients who were shot by the police with .38 Special handguns. The study describes the different injuries suffered by patients who were exposed to the Tazer. It also describes the three patients who died after Tazer use. The study finds that the mortality from Tazers is about 1.4%. It found that the mortality from the .38 Special was 50%. The paper provides tactical medical personnel with a better understanding of the medical consequences of Tazer use. In addition, it gives a description of the psychiatric state of patients shot with Tazers or .38 Specials. The study also describes the incidence of drugs of abuse among the patients. It appears to be a well done study. It is rare to find a prospective study that addresses police use of force.
Schwartz, R. B. and B. M. Charity (2001). "Use of night vision goggles and low-level light source in obtaining intravenous access in tactical conditions of darkness." Mil Med 166(11): 982-3.
This study by Shwartz is an example of one type of study that benefits TEMS. It addresses the important question of how to obtain IV access under conditions that mandate light discipline. The study compares IV success rates when using either night vision goggles or a small green light called the "Fingerlite". It found that IV success rates were much better when using the "Fingerlite". The study design is simple yet effective. Although the study participants were military nurses and medics, the results of this study may also apply to civilian TEMS providers.
Thomsen, T. W., A. J. Sayah, et al. (2000). "Emergency medical services providers and weapons in the prehospital setting." Prehosp Emerg Care 4(3): 209-16.
Thomsen conducted a survey of the incidence of EMS exposure to weapons. This study does not relate directly to TEMS. It is of some interest because it demonstrates that some small amount of weapons familiarization and tactical training may be of benefit to rank and file EMS personnel. This study was conducted in Boston and Los Angeles. It showed that 62% of EMS personnel have discovered weapons. Of all EMS personnel interviewed, 20% reported receiving some type of weapons familiarization.
de Brito, D., K. R. Challoner, et al. (2001). "The injury pattern of a new law enforcement weapon: the police bean bag." Ann Emerg Med 38(4): 383-90.
The article by de Brito does not relate directly to tactical EMS but it is still a useful article. It is a retrospective review of police bean bag injuries in Los Angeles County. It reviewed the charts of all patients who presented to the jail ward at the University of Southern California Hospital. The paper is instructive because it reviews the types of injuries suffered by people struck with the less lethal weapon, the bean-bag. It also reviews the psychiatric state of those shot with the bean bags. Providers of tactical medical care are more likely to see people struck by these weapons. The paper describes the only known death from bean bag use. It also describes many other life threatening injuries.
Lavery, R., M. Addis, et al. (Jan 200). "Taking Care of the "Good Guys:" A Trauma Center-Based Model of Medical Support for Tactical Law Enforcement." The Journal of Trauma: Injury, Infection, and Critical Care 48: 125-129.
The paper by Lavery gives a description of the organization of the tactical EMS team that supports the Newark FBI SWAT. This is a descriptive paper, not a research study. It does give an in depth description of how one TEMS unit is organized. It describes the type of training involved, the type of personnel who make up the team, and how the TEMS unit is integrated into the entire tactical team. Some description of legal and other liability issues is given. Memorandums of understanding are also described. The paper also gives some of the policies and procedures that must be put into place. This paper is helpful because it gives a model of organization that may prove useful to some teams. The model described cannot be used by all teams, however, because the TEMS unit is based out of a trauma center and supports a Federal, not local unit.
Rinnert, K. J. and W. L. Hall, 2nd (2002). "Tactical emergency medical support." Emerg Med Clin North Am 20(4): 929-52.
This review article by Rinert is an extensive review of tactical medicine. It covers many different aspects of TEMS. It starts with the history of tactical medicine and the need for TEMS. It describes the basic principles of tactical emergency care such as zones of care, forensic medicine, and barricade situations. Rinert describes some of the unique skills needed in TEMS. The goals of TEMS are also described. This article gives a very extensive review of TEMS.
Heck, J. J. (2003). "Stun guns. The medical implications." Emerg Med Serv 32(7): 96-7.
The above paper by Heck gives a good description of "Stun Guns" also known as Tazers. It is useful because it gives a description of a "less lethal" use of force. A brief description is given of how the gun works and its effect on the body. It then describes how the gun is utilized by police. The article also goes into possible injuries that the gun can cause and how the Tazer darts should removed.
