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Tactical emergency medical support, or TEMS, was patterned after the successful military model of specially trained medics embedded within remotely deployed fighting units. While the military took full advantage of specialized medical support years ago, it was not until the late 1980s that civilian law enforcement began to embrace the concept of integrated medical care.1


  1. Briefly describe the origins of tactical emergency medical support (TEMS).

  2. Describe various models of the provision of TEMS along with advantages and disadvantages of each.

  3. Explain basic concepts of tactical operations.

  4. List ways in which the medical element in tactical operations enhances mission success.

  5. List specific medical threats that must be managed during tactical operations.

  6. List unique considerations specific to a TEMS program.


Most EMS providers are taught to stage away from a scene where their personal safety may be in jeopardy. Police action, by definition, is inherently unsafe, making civilian EMS providers unable to deliver expeditious care in areas of high threat. Several high-profile incidents, however, have reinforced the need for EMS providers trained to function “inside the perimeter” where a scene may not be totally secure. In February 1997, two heavily armed robbers entered the Bank of America in North Hollywood and engaged law enforcement officers in a long and bloody firefight. Ultimately, one of the robbers committed suicide while the other was shot by police as he tried to flee and later died at the scene. Surviving family members soon afterward brought suit against the Los Angeles Police Department alleging that his death was due, in part, to lack of timely medical care.2 One of the more vivid illustrations of the value of embedded tactical medical support came in October 2007 when a SWAT officer was shot in the neck during a high-risk warrant service. Two physicians with the Dallas Police Department were immediately at the injured officer's side where it was determined he was without a patent airway. The tactical physicians achieved hemostasis and performed a surgical airway saving his life.3

Being a tactical medical provider, however, is more than simply taking an on-duty medical crew and donning them with ballistic helmets and vest. Highly specialized medical training should precede any provider's deployment for real-world missions with a law enforcement team.4 Dozens of civilian and government-sponsored training programs in tactical medicine exist, but students seeking such training should carefully examine the curriculum choosing schools that focus on medicine in the tactical environment as opposed to schools that seem to center on weapon manipulation and tactical techniques. While important, these fundamentals of tactical movement should be learned and practiced with the student's own team.

The configuration of tactical medical support varies greatly across the country. Some agencies still depend on EMS standby far away from the incident scene in the cold zone. ...

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