1. Concepts in Tactical EMS Prepared by B. Carr The Big Picture: SOP and TEMS Operations Overview Module 1/5

2. Overview Introduction Purpose TEMS History Operations Treatment Modalities TEMS TRAINING Next Steps Additional Resources

3. Introduction: Practicing Indirect-Threat Care Balances threats, civilian scope of practice, medical equipment limits, and variable resources for response to atypical emergencies Correlates risk/benefit ratio for civilian operational medical response Provides guidance on medical management of preventable deaths at or near the point of wounding Minimizes provider risk while maximizing patient benefit

4. Mass violence incidents continue to occur and disregard population size, community structure, and geographic area. As an all-hazards response agency, Jackson Hole Fire/EMS must train to provide unparalleled pre- hospital care under demanding conditions. Why This and Why Now? data from FBI Active Shooter Study, completed in 2014

5. TEMS PURPOSE Shortens barrier between time of injury (TOI) and application of care (AOC) Implements medical actions across all scene types with minimal delay Utilizes joint operations theory to stabilize incidents from different response angles and objectives Maximizes care of response team to ensure mission success The “Golden Hour” is one method of addressing preventable deaths from traumatic injuries

6. TEMS HISTORY Follows care and principles of battlefield medicine Combat medicine refined to address modern warfare techniques in World War I Organized by US Army Medical Department (AMEDD) to train soldiers in Tactical Combat Casualty Care (T-CCC) Adapted to civilian needs as Tactical Emergency Casualty Care (TECC) US Army Medical Corps Insignia, ca. 1908 US Army 62nd Medical Brigade Insignia

7. JH Fire/EMS TEMS Operations Jackson Hole Fire/EMS providers will currently operate in warm zone environments.  Casualty collection points with force protection (i.e. dedicated CCP law enforcement)  Rescue Task Force Casualty Collection Points  Designated location where responder personnel gather, triage, provide indirect threat care, and package patients for transport to medical treatment facilities Rescue Task Force  Fire/EMS personnel, paired with law enforcement, bomb team or HazMat team personnel, that operate within Cold and Warm Zones Cadre Jackson Hole Fire/EMS personnel will not deploy to hot-zone environments.  Any future hot-zone operations will require EMT-T certification and additional training (e.g. CONTOMS course)

8. Identified TEMS Scenarios Mass violence incidents Hostage-barricade situations Emergency ordinance disposal Protection details Civil demonstration or protest Dynamic training operations Search and rescue missions Acts of terrorism CBRN/HazMat scenes

9. Treatment Modalities C-TECC PHASESASSOCIATED PRIORITIES Direct Threat Care (DTC) -Hot zone -Area of evolving or unmitigated risk; hostile environment -Law enforcement, bomb team, HazMat team or first responder buddy care -Extraction -mitigate the threat -move wounded to cover or area of relative safety (e.g. casualty collection point) -manage massive hemorrhage Indirect Threat Care (ITC) -Warm zone/Cold Zone boundary (Casualty Collection Point) -Cleared but unsecured environment -Fire/EMS personnel with attached law enforcement, bomb team or HazMat team (Rescue Task Force) -initiated once the casualty is in an area of relative safety -focus on preventable causes of death -Hemorrhage, ABCs -Disability, Environment -Effective Triage Evacuation Care (EVAC) -Cold zone -Secured transport corridor -Fire/EMS personnel with attached law enforcement, bomb team or HazMat team -movement of casualty to definitive treatment facility -interventions similar to normal EMS transport operations -continued emphasis on reassessment of interventions and hypothermia management Treatment methods differ according to demands, resources, and prearranged mission objectives. Flexibility is essential.

10. TEMS TRAINING Adapts medic to provide care in austere and hazardous environments. Demands physical fitness excellence. Focuses on extracting and treating casualties, preventing additional casualties, and supports completion of mission. With additional training, allows medics to work with law enforcement units and/or SRTs as necessary. Jackson Hole Fire/EMS currently supports warm zone operations. Emphasis is on casualty collection point functionality Follows standard rescue task force models No additional certification required Differs from Tactical Medic (EMT-T) attachment to SRT, SWAT, or in-bound single law enforcement units engaged in hot-zone operations Please review and discuss the SOP provided with/prior to this training presentation.

11. Next Steps Module 1 presented an overview of the modified tactical EMS operations Jackson Hole Fire/EMS has adapted. Module 2 will build on this information. It will provide guidelines and templates for effective MCI operations and establishment of casualty collection points. Again, please review the SOP with your crews.

12. Additional Resources  Committee for Tactical Emergency Casualty Care Committee for Tactical Emergency Casualty Care  FBI Active Shooter Study, 2014FBI Active Shooter Study, 2014  International Association of Firefighters Position Statement International Association of Firefighters Position Statement  Tactical Combat Casualty Care Portal, NAEMT Tactical Combat Casualty Care Portal, NAEMT  AMEDD’s Contact Casualty Care (extensive information) AMEDD’s Contact Casualty Care