Concepts in
Tactical EMS
The Big Picture: SOP and TEMS Operations Overview
Module 1/5
Prepared by B. Carr
Overview
 Introduction
 Purpose
 TEMS History
 Operations
 Treatment Modalities
 TEMS TRAINING
 Next Steps
 Additional Resources
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
Why This and Why Now?
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 prehospital care under
demanding conditions.
data from FBI Active Shooter Study, completed in 2014
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
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
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)
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
Treatment Modalities
Treatment methods differ according to demands, resources, and
prearranged mission objectives. Flexibility is essential.
C-TECC PHASES
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
ASSOCIATED PRIORITIES
-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
Jackson Hole Fire/EMS currently supports warm zone operations.
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.
• 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.
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.
Additional Resources
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Committee for Tactical Emergency Casualty Care
FBI Active Shooter Study, 2014
International Association of Firefighters Position Statement
Tactical Combat Casualty Care Portal, NAEMT
AMEDD’s Contact Casualty Care (extensive information)