History of Tactical Emergency Medicine
What is Tactical Emergency Medicine?
Tactical emergency medicine (TEM), as it pertains to civilian emergency physicians, is a field in emergency medicine (EM) that supports law enforcement operations relating to or constituting actions requiring an immediate, upgraded level of law enforcement response. Local, state, and federal law enforcement tactical teams are experiencing an unprecedented increase in scope of response situations including: hostage situations, mass shootings, anti-terrorism activity, clandestine operations, mass gathering event security, national security activities, and disaster response activity. According to the National Tactical Officers Association, physicians trained in Tactical Emergency Medical Support (TEMS) “conduct medical threat assessments, render immediate medical care in austere environments, and provide logistical support to further the health and safety of law enforcement personnel and reduce the incidences of injury, illness, disability, and death associated with training and tactical operations.” Tactical emergency physicians are also responsible for the development of medical policies, and for the training of medical support teams, as well as the tactical teams themselves.
The History of TEM
On August 1, 1966, a shooting conducted by a student occurred at the University of Texas at Austin resulted in the deaths of 14 individuals and wounding of another 31 people. This event, now referred to as the “Texas Tower Shooting,” resulted in a large, unorganized response from civilian and law enforcement individuals. The incident demonstrated to law enforcement agencies the need for the formation of specialized “tactical” response teams that could respond to situations that required expertise above those of a normal police officer. The result of the Texas Tower Incident was the construction of specialized teams now referred to as Special Weapons and Tactics (SWAT) teams. Today, SWAT teams respond to a host of law enforcement operations and tactical missions such as hostage situations, security missions, explosive ordnance disposal, mass gathering security, anti-terrorism activities, and high-risk warrant service. The development of tactical emergency medical services quickly followed, and in 1993, the National Tactical Officers Association (NTOA) issued a policy statement in support of tactical medical support as, “an important element of tactical law enforcement operations.” These position statements have been revised twice; in 2007 and 2013. In 2018, the NTOA created a section devoted solely to TEMS guidelines, which established the importance of the medical operations in the field of tactical operations.
In conjunction with the NTOA's position policy, the National Association of EMS Physicians (NAEMSP) in 2001 provided a position paper further describing the role of physicians and emergency medical services in law enforcement activities. Further, the American College of Emergency Physicians (ACEP) issued a position statement affirming the position of NAEMSP in 2004 stating TEMS, "helps maintain a healthy and safer environment for both law enforcement and the public."
Although there has been incredible strides in adoption of tactical medicine components to law enforcement, EMS agencies, and emergency departments, TEMS are not standardized or implemented throughout the United States. The ACEP TEM Section continues to advocate for formal recognition of TEM as a subspecialty. Most recently, for an EMS Fellowship to maintain ACGME subspecialty certification, the fellowship must offer certain requirements in tactical training or education. There is currently one two-year fellowship offered in TEM, but board certification is currently unavailable.