Tang - Institute of Medicine

Nelson Tang, M.D., FACEP
Director and Chief Medical Officer
Center for Law Enforcement Medicine
The Johns Hopkins University
Collaborative initiative between JHU and partnered
• United States Secret Service
• Immigration and Customs Enforcement
• Bureau of Alcohol, Tobacco, Firearms & Explosives
• United States Marshals Service
• State and Local agencies
Academic Center of Excellence
Institutional tripartite missions of research, patient care,
and medical education
National Tactical Officers Association (NTOA)
• “the provision of TEMS has emerged as an important element of
tactical law enforcement operation” -1993
National Association of EMS Physicians (NAEMSP)
• Medical Support of Law Enforcement Special Operations -2001
American College of Emergency Physicians (ACEP)
• TEMS is an essential component of law enforcement teams and
“helps maintain a healthy and safer environment for both law
enforcement and the public” -2004
Highly skilled and trained medical providers
Functions under the premise of scene-safety FIRST
Transport-oriented approach to patient care
Reliance upon maximal visibility
Generally untrained for the high-risk tactical
Staged remote from law enforcement inner
Tactical medical support is the provision of
field medical care during high-risk,
extended-duration and mission-driven law
enforcement operations, often rendered
under functionally austere conditions.
The goals of law enforcement medicine
are to facilitate the success and the safety
of law enforcement missions during all
phases of a field operations through the
delivery of preventative, urgent, and
emergency medical care.
Mission Preplanning (Medical Threat
Coordination with EMS and local resources
Remote Assessment and Triage
Tactical Casualty Care
Preventative Medicine and Team Health
Urgent Care and “Sick Call”
Weapons Safety
Forensic Evidence Preservation
 Tourniquets
 Hemostatic
 Field
expedient airways
 Needle
 Splints
and slings
 Evacuation
 Hydration
 Nutrition
 Sleep/Rest
 Environmental
 Vaccinations
 Referrals
 Personnel
Medical support of law enforcement
operations is a force protection mandate
 Personnel
health and safety
 Preservation of manpower
 Sustain critical law enforcement functions
 Liaison with EMS and established
medical infrastructure
 Coordination of initial and follow-up care
 Resource to command infrastructure
 Inter-agency collaboration
 Formal
relationships between law
enforcement agencies and JHU
 Establishes the responsibilities and
authority of the Medical Director
 Medical Direction is a position not an
 Multiple core functions and supplemental
support services
 Initial
medical and “requalification”
 Didactic, laboratory and clinical
 Practice standards with basis in regularly
updated written guidelines
 24/7 availability of Medical Control
 Standardized patient care records
 Quality assurance reviews
 Physician operational medical support
 Clinical
approaches based upon current
standards and practices
 Breadth of experience and expertise
 Diversity of faculty background
• EMS and prehospital care
• Disaster and emergency preparedness
• International and travel medicine
• Military medicine
• Mass gathering event support
 Depth
of physician manpower
 Clinical
sites for provider skills maintenance
 Dedicated communications center
 Hospital based critical care transport services
 Referral and hospitalization mechanisms
 Specialty and sub-specialty expertise
 Safety
 Quality
 Wellness
 Prevention
 Infection
 Peer assessment
 Documentation
 Agency
commitment and support of
 Clear chain of command for medical
 Medical direction separate from agency
 Consistency of training, policies,
protocols and medical command (interoperability)
 Inter-agency
communication is variable
and historically unreliable
 Academic partnerships foster
 Open exchange is routine in our Center
• Training methodologies
• Curriculum
• Educational venues
• Operational procedures
• Mutual aid support
 Dynamic
nature of agency leadership
 Fluctuation of intra-agency funding
 National scale of programs
 Evolving rosters of providers
 Data collection and reporting
 Metrics for evaluating programs