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Rescue Task Force RTF? / FUERZAS de TAREA de RESCATE. TEMS vs EMS #ChamanTacticoMD

EMS Solutions International |

¿EXISTE LA POSIBILIDAD DE QUE SEA EL UNICO, O DE LOS POCOS QUE SE HAN LEIDO Y Han ENTENDIDO ESTO DE LOS UNIFORMES EN SITUACIONES DE RIESGO "TACTICAS"?
NO SOLO ES PARECER, TAMBIEN DEBEMOS SER...
DONT SHOOT THE EMS "PARAMEDIC"
#DONTSHOOTEMS #DONTSOOTPARAMEDIC #Tacticool #ChamanTacticoMD


Pueden analizar esta foto con los fines de ver un sinergismo de potencializacion de recursos y competencias, casa incendiada, amenaza real en su interior para bomberos y rescatistas, pues un escudo de seguridad y proteccion armada para evitar mayor dao por el incendio, al mismo tiempo evitar poner en peligro real a los bomberos y demas respondedores. #DrRamonReyesMD Excelente ejemplo de una situacion Tactica tipo TECC Tactical Emergency Casulty Care. Un tirador activo en la ciudad de Boston, EUA. Incendia su casa el riesgo de que se afectaran mas viviendas por el incendio y por ende mayor riesgo de victimas, Se inicia sofocacion del fuego por los Bomberos de la Ciudad con proteccion con escudos balisticos y custodiados por el Equipo SWAT de la ciudad... Gracias Christian Goring, NREMT-P Boston EUA. por el aporte de la foto. https://emssolutionsint.blogspot.com/2018/03/tactical-medics-vs-rescue-task-force.html #StopTheBleed #BleedingControl #Tourniquet #Torniquete #PHTLS #ACLS #TACMED #MEDIVAC #TACEVAC #CASEVAC #CoTECC #CoTCCC #TECC #TCCC #MilitaryMedicine #Spain #HartfordConsensus #ATLS #Trauma #EMS #RemoteMedicine #TECCSpain #Intraosseous


Cuando busques un curso, piensa en el precio, avales, recursos de simulación en el curso, recursos didácticos, perfil de los instructores, credibilidad de los instructores, certificaciones de los instructores, en esto no es válido quien tenga mejor diseñador gráfico, nombre más TACTICOOL, fotos más chuliguay... Cuantos trapos se tira encima el instructor, sellitos, parches, equipos de airsoft, entre otras parafernalias. Si es por fotos... ufff Investiga, ¿Quien es ese RAMBO? ¿Es reconocido por instituciones reconocidas? ¿Se vale de sellos como Stop The Bleed, El Rojo de TECC, ASOCIACIONES MEGA MUNDIALES, que solo existen en un logo muy chuliguay? Pues esos son datos que te llevan a la duda. La gran mayoría de esos, no les he visto en reunión de facultados de TCCC en la NAEMT, no les he visto en la reunión del Comité C-TECC, no son reconocidos como instructores por instituciones como la NAEMT, la AHA, etc. Entonces. ¿Que son? Para mi falsos profetas. by Dr. Ramon Reyes, MD




Updated



Rescue Task Forces vs. Tactical Medics: What's The Difference

Posted by Graham Medical on Oct 8, 2019 10:00:00 AM

Everyday Emergency Medical Services (EMS) responders provide an important service in treating and transporting patients with minor injuries up to serious, life-threatening conditions. While highly trained and skilled, neither the Emergency Medical Technician (EMT), nor the Paramedic was ever meant to be an expert in mass casualty incidents such as an active shooter event. Just as police units have regular patrol and also SWAT, medical responders also need specialized response teams.

Specialized Teams Provide Faster Patient Care

Enter the tactical medic and rescue task force concepts. Both tactical medics and rescue task force personnel provide emergency care at the scenes of heavy casualty incidents where scenes are not always secure. Tactical medics and task force personnel work very closely with law enforcement in emergency situations. Yet, there are distinct differences in the type of care and response protocol provided as described in this EMS1.com article.

Rescue task forces are primarily created by a quick assembling of responding EMS personnel, paramedics, and fire personnel. Tactical medics are often specifically attached to a response team like SWAT.
Rescue Task Forces
In past active shooter incidents, there have been communication lags and delays in care when responding. During these delays, precious life-saving minutes tick away for the injured victims.
A rescue task force is, in short, a coordinated response that allows access to victims faster.
Rescue task forces prioritize stabilization, extrication and transport for further care for patients. This is the opposite of care models that prioritize triage first.
Without a designated rescue task force, the different participating organizations must figure who should take the lead and when it is safe to provide care. Rescue task forces designate a lead for these situations, and divide responses based on hot, warm, and cold zones of the incident. By responding from a centralized staging zone, EMS can quickly deploy to cleared areas and provide point of wound care.

Rescue task forces generally consist of specially trained EMS responders that are on their regularly scheduled shift.

Tactical Medics

Usually called in for emergency responses, medics show up in full uniform of the unit to which they are attached, such as a SWAT team. The tactical medic will provide initial medical care as needed to victims, bystanders and perpetrators once the scene is secured, but they may be there, primarily, to provide medical aid to the team members.
The tactical medic will generally transfer patient care to a standard EMS unit if further care and transportation to the hospital are needed.
Another way that you can distinguish these two teams is that rescue task force members wear a standard daily uniform (i.e. fire or police) and are typically dispatched during their normal shift. Their uniforms may be supplemented with tactical vests as needed for safety. Tactical medics wear the uniform of the tactical team they are attached to, often including body armor. Tactical medics are physically located within the team, or may stay just outside of the hot zone.

Graham Medical is proud to be able to provide EMS products to help first responders do their job more effectively and efficiently.

Graham Medical works to make patient transport faster, easier and safer to promote better outcomes in an emergency. For more information on EMS products, contact us here or visit Grahammedical.com.  







#TactiCool Ficcion vs Realidad by #ChamaTacticoMD


#TactiCool by #ChamanTacticoMD

Active Shooter Incidents: The Rescue Task Force Concept
by ROBERT MUECK Wed, September 20, 2017

The concept of the Rescue Task Force (RTF) came from the Arlington County (Virginia) Fire Department. Looking at active shooter events around the country, these fire department leaders created a model that enables emergency medical services (EMS) to provide emergency medical intervention faster and within the Incident Command System (ICS) construct.

Robert Mueck headshotKnown as “warm zone integration,” the RTF concept uses the phrase “Task Force,” which is an ICS term for a unit consisting of mixed resources assembled to meet a specific tactical need. Regardless of the name, the RTF should be able to integrate easily into public safety agencies anywhere. The RTF consists of EMS and law enforcement personnel who work together to provide immediate basic medical care to victims. This differs from Tactical EMS, which usually focuses on medical care for the responders.

The Current EMS System
Civilian EMS personnel are not combat medics, so they do not go into the line of fire like their counterparts may in the military. In a traditional response to an incident involving gun violence, EMS personnel set up in a staging area and await word from law enforcement that the building is declared clear and secure. However, when people are bleeding out and dying in mass casualty incidents, the urgency of medical care is being pushed to new limits.

As part of the RTF concept, three zones must be understood:

The Hot Zone – The area where there is a known hazard or threat to life that is potentially direct and immediate. This includes any uncontrolled area where the active shooter could directly engage people.
The Warm Zone – The areas where law enforcement has either cleared or isolated the threat, and the risk is minimal or has been mitigated. This area may be considered clear but not secure.
The Cold Zone – The area where there is little or no threat. It may include the outside of the building or an area law enforcement has secured. It is safe to operate in this zone.
In its initial stages, an active shooter incident in a building makes the entire building the hot zone. Law enforcement personnel immediately move toward the shooter to stop the attack and prevent more injuries or deaths. As law enforcement personnel move inside and begin to secure parts of the building, these areas become warm zones because there is some certainty that the shooter is not in the immediate vicinity. This is where EMS personnel could have an opportunity to join law enforcement and make entry to locate and treat victims, even as other officers search for and neutralize the suspect. Keep in mind that incidents with multiple shooters make this more difficult for first responders.

What the RTF Concept Offers
The RTF concept focuses on the needs and care of victims, not responders. EMS members of the RTF work with patrol officers to deliver immediate medical intervention for readily treatable injuries, like severe bleeding and airway compromise. The team then stabilizes victims for evacuation to definitive care.

The RTF provides “point of wound” care to victims where there is an ongoing threat. These teams (there may be more than one) treat, stabilize, and remove the injured in a speedy fashion under the protection of armed law enforcement. Although the RTFs operate in the warm zone, they do not engage in triage. Injured persons encountered by RTF teams are treated as they are reached. People who can walk without assistance are directed to self-evacuate down a cleared corridor under law enforcement direction (within the warm zones).

This process requires coordination between law enforcement and EMS personnel. Incident command needs to direct the RTF to locations where they are needed. That means the RTF would probably be under law enforcement command, but the RTF is essentially a unified command asset.

Initially, those first on the scene – both bystanders and victims – may provide aide to one another before responders arrive. First responders may direct them to provide aide to each other until the RTF reaches them. Injured victims may eventually be placed in a casualty collection point (CCP) before being moved to a cold zone, where they can be transported to definitive care. Where survivors are placed is determined by initial responders and should be communicated to the RTF teams through unified command.

Challenges for Implementation of This Model
The RTF model presents some challenges. Members should be equipped with the proper tools – including Kevlar helmets and body armor – to operate in dangerous environments. This may prove to be an issue for EMS, as EMS organizations often include volunteers. Issues of purchasing the equipment, sizing protective gear to fit EMS staff, and storing additional tools and equipment in ambulances can prove difficult.

As local jurisdictions adopt the RTF concept, it is important everyone involved understand how teams will operate. There is no “one way” to develop an RTF. The important issue is that law enforcement and EMS know how to integrate and understand their own written policies to work as an RTF. Policies and training dictate how they interface during a response. Although there may be some differences from one area to the next, the basics remain the same: identify those wounded, determine the need for emergency medical care, and extract those injured to a CCP. Patients eventually are evacuated to an external CCP well outside the building to a secure location where traditional EMS care is initiated.

As with any emergency incident, it is important to achieve mutual communications to coordinate the RTF during an incident. This requires training together and conducting drills so the coordination of the RTF becomes second nature. Failing to train together can reveal challenges that were not considered in the planning phase. For example, RTF officers provide security for EMS personnel as they move into the building and down corridors secured by initial contact teams. These escort officers cannot wander off once they get EMS on site. They need to understand their role and remain in place to provide security for the medics while they treat victims.

When public safety staff members are unarmed, it is known upfront that these members would not be part of the initial entry. However, if members are trained to assist in rendering emergency first aid, they can be proactive and perform a critical task. EMS resources may be limited, so having personnel assist could go a long way in saving lives. However, the RTF concept only works if personnel have what they need to participate.

Providing Additional Medical Assistance
If staff cannot participate in an RTF, they could still render assistance to responders. They may assist in establishing an internal CCP near a secure entry point, where casualties can be grouped to allow for faster and more efficient evacuation by non-RTF EMS personnel. Having body movers available for staff may allow them to assist in moving victims from a warm zone to a cold zone. Having them trained and equipped in the use of tourniquets and hemostatic gauze, for example, may make staff invaluable for saving lives.

Beyond traditional first responders, it is important to remember the first “first responders,” which are the people on the scene when the incident happens. For example, stocking up on bleeding control kits and training staff in using tourniquets as part of the “Stop the Bleed” campaign may save lives. For all facilities or institutions, though, understanding the RTF is critical to understanding what to do to save lives. Being an armed or unarmed agency does not prevent personnel from rendering aid. The training and background of these agencies may make their staff good candidates for the RTF.

Robert Mueck is an adjunct associate professor of public safety administration and homeland security at University of Maryland, University College; and director of public safety at St. John’s College in Annapolis, Maryland. He currently serves as: an active member of the Governors Workgroup on Active Assailant Response in Maryland; an adjunct faculty member for the Texas A&M Engineering Extension Service (TEEX); and a sector chair for the Maryland Chapter of Infragard. He formerly was the training coordinator at the George Washington University in Washington, D.C., for the University Police and the Consortium of Universities of the Washington Metropolitan Area. He retired after a 29-year career at the University of Maryland Police Department (UMPD), having served in a variety of capacities in operations, administration, and command positions.  https://www.domesticpreparedness.com/healthcare/active-shooter-incidents-the-rescue-task-force-concept/ 
TCC-LEFR
TECC
TCCC Tactical Combat Casualty Care Handbook
TACMED España
BCon  Saber un poco mas sobre control de sangrados 
Hartford
Tactical Medics vs Rescue Task Force

GUIA DE SOPORTE VITAL PARA SEGURIDAD PRIVADA COMO PRIMER INTERVINIENTE EN INCIDENTES ARMADOS. by Juan Jose Pajuelo Castro y David Grevillen Carretero. SEMES 2018 

http://emssolutionsint.blogspot.com.es/2018/02/guia-de-soporte-vital-para-seguridad.html

 Mochilas a prueba de balas nueva tendencia en inicio escuela en los EUA emssolutionsint.blogspot.com/2018/09/mochilas-prueba-de-balas-nueva.html



PROTOCOLO PARA INTERVENCIONES DE SOPORTE VITAL EN INCIDENTES DE MÚLTIPLES VÍCTIMAS POR ATENTADOS TERRORISTAS ABRIL 2016 (Actualizado Marzo 2018) by Juan Jose Pajuelo

http://emssolutionsint.blogspot.com.es/2018/03/protocolo-para-intervenciones-de.html

8 trampas a evitar en el controlhemorragias 

Guia de Soporte en Incidentes con Amenaza para Primer Interviniente Policial by Juan Jose Pajuelo Castro  
emssolutionsint.blogspot.com/2018/07/guia-de-soporte-en-incidentes-con.html

TACTICAL COMBAT CASUALTY CARE Handbook version 5 May 2017 
emssolutionsint.blogspot.com/2017/07/tactical-combat-casualty-care-handbook.html

Updated TCCC Guidelines (31 JAN 2017) "Actualizacion 2017 de las Guias" Tactical Combat Casualty Care 
emssolutionsint.blogspot.com/2012/07/presentacion-del-programa-phtls-tccc.html

TCCC TACTICAL COMBAT CASUALTY CARE Quick Reference Guide First Edition 2017 FREE PDF  
emssolutionsint.blogspot.com/2018/07/tccc-tactical-combat-casualty-care.html

Updated TCCC Guidelines (31 JAN 2017) "Actualizacion 2017 de las Guias" Tactical Combat Casualty Care emssolutionsint.blogspot.com.es/2012/07/presentacion-del-programa-phtls-tccc.html

MANUAL DE SOPORTE VITAL AVANZADO EN COMBATE Ministerio de Defensa España 2014   

ttp://emssolutionsint.blogspot.com.es/2016/02/manual-de-soporte-vital-avanzado-en.html


COMTOMS TACTICAL MEDIC HANDBOOK 2013 Edition

Guías para el Manejo de Heridos en Incidentes Intencionados con Múltiples Víctimas y Tiradores Activo "MACTAC" 
emssolutionsint.blogspot.com/2016/12/guias-para-el-manejo-de-heridos-en.html


Manejo de Heridos en Incidentes Intencionados Múltiples Víctimas y Tiradores Activos 09/07/2017 
emssolutionsint.blogspot.com/2018/07/manejo-de-heridos-en-incidentes.html 

TERRORISMO Y SALUD PÚBLICA - "GESTIÓN SANITARIA DE ATENTADOS TERRORISTAS POR BOMBA"  

emssolutionsint.blogspot.com/2013/08/terrorismo-y-salud-publica-gestion.html

TRAUMA DE TORAX: DOCENA DE LA MUERTE en trauma toracico

https://emssolutionsint.blogspot.com.es/2013/01/penetrating-chest-trauma-photo-trauma.html

75th Ranger Regiment Trauma Management Team (Tactical) Ranger Medic Handbook FREE pdf  

emssolutionsint.blogspot.com.es/2018/02/75th-ranger-regiment-trauma-management.html


SPECIAL OPERATIONS FORCES Medical Handbook Free PDF  
emssolutionsint.blogspot.com/2018/02/special-operations-forces-medical.html

Balística de las heridas: introducción para los profesionales de la salud, del derecho, de las ciencias forenses, de las fuerzas armadas y de las fuerzas encargadas de hacer cumplir la ley
http://emssolutionsint.blogspot.com/2017/04/balistica-de-las-heridas-introduccion.html

Guía para el manejo médico-quirúrgico de heridos en situación de conflicto armado by CICR 
http://emssolutionsint.blogspot.com/2017/09/guia-para-el-manejo-medico-quirurgico.html

CIRUGÍA DE GUERRA TRABAJAR CON RECURSOS LIMITADOS EN CONFLICTOS ARMADOS Y OTRAS SITUACIONES DE VIOLENCIA VOLUMEN 1 C. Giannou M. Baldan CICR 
http://emssolutionsint.blogspot.com.es/2013/01/cirugia-de-guerra-trabajar-con-recursos.html

Manual Suturas, Ligaduras, Nudos y Drenajes. Hospital Donostia, Pais Vasco. España http://emssolutionsint.blogspot.com/2017/09/manual-suturas-ligaduras-nudos-y.html

Técnicas de Suturas para Enfermería ASEPEYO y 7 tipos de suturas que tienen que conocer estudiantes de medicina 
http://emssolutionsint.blogspot.com/2015/01/tecnicas-de-suturas-para-enfermeria.html

Manual Práctico de Cirugía Menor. Grupo de Cirugia Menor y Dermatologia. Societat Valenciana de Medicina Familiar i Comunitaria 
http://emssolutionsint.blogspot.com/2013/09/manual-practico-de-cirugia-menor.html



Protocolo de Atencion para Cirugia. Ministerio de Salud Publica Rep. Dominicana. Marzo 2016
 http://emssolutionsint.blogspot.com/2016/09/protocolo-de-atencion-para-cirugia.html

Manual de esterilización para centros de salud. Organización Panamericana de la Salud 
http://emssolutionsint.blogspot.com/2016/07/manual-de-esterilizacion-para-centros.html

Asistencia de salud en peligro: la importancia de proteger al personal de salud en zonas de guerra PDF Gratis 
http://emssolutionsint.blogspot.com/2018/06/asistencia-de-salud-en-peligro-la.html

SERVICIOS PREHOSPITALARIOS Y DE AMBULANCIAS EN SITUACIONES DE RIESGO. PDF GRATIS 

http://emssolutionsint.blogspot.com/2018/06/servicios-prehospitalarios-y-de.html

PDF Update on Prehospital Trauma Courses, NAEMT, Alex Eastman, Lieutenant and Deputy Medical Director, City of Dallas 

http://emssolutionsint.blogspot.com.es/2016/12/phtls-prehospital-trauma-life-support.html



Tactical Emergency Casualty Care (TECC) Guidelines for First Responders with a Duty to Act Guías para Primeros Respondedores con Deber de Actuar “En Acto de Servicio” (Fuerzas de Seguridad, Bomberos no SEM)    emssolutionsint.blogspot.com/2018/07/tactical-emergency-casualty-care-tecc.html


PAGINA FCEBOOK 

TACMED Spain Medicina Tactica España  GRUPO  
https://www.facebook.com/groups/311284402300505/

MEDICINA TACTICA 
Medicina
Del lat. medicīna.

Táctico, ca
Del lat. mod. tacticus, y este del gr. τακτικός taktikós, der. de τάσσειν tássein 'poner en orden'; la forma f., del lat. mod. tactica, y este del gr. τακτική taktikḗ.
1. adj. Perteneciente o relativo a la táctica.
2. adj. Experto en táctica. U. t. c. s.
3. f. Arte que enseña a poner en orden las cosas.
4. f. Método o sistema para ejecutar o conseguir algo.
5. f. Habilidad o tacto para aplicar una táctica.
6. f. Mil. Arte de disponer, mover y emplear la fuerza bélica para el combate.
Fuente http://www.rae.es   #ChamanTacticoMD 






"Estoy a favor 100% de la creacion y puesta en operacion de las RTF Rescue Task Force o FUERZAS DE TAREA DE RESCATE en toda IBEROAMERICA, por una razon simple SALVAN VIDAS, hablo castellano-español perfecto, estoy solo encontra del uso uniformidad LEO (Fuerzas del Orden), la tendencia entiendo es erronea de utilizar a Sanitarios (Personal Medico) Desarmado con uniformidad de agentes que su principal TARGET (Objetivo) es suprimir la amenaza, salvo el sanitario sea TESM (Tactial EMS) que no es mas que un agente de autoridad armado y entrenado como sanitario. Todavia insisten en tratar de descalificar, pero insisto no soy propietario de la verdad, la verdad siempre estara ahi y sera obvia, asi que os dejo una vez mas mis argumentos en la compilacion de articulos y documentos, aunados a mi opinion profesional y personal al respecto. No creo que descalificar sea el mejor metodo para defender una posicion. Mientras os invito a visitar el link (enlace)". by Dr. Ramon Reyes, MD​



Conjunto de Habilidades del C-TECC Segun el Nivel del Asistente 
Version 1

Version 2

Tactical Emergency Casualty Care (TECC) Guidelines for First Responders with a Duty to Act
Guías para Primeros Respondedores con Deber de Actuar “En Acto de Servicio”

(Fuerzas de Seguridad, Bomberos no SEM)


Enlace para descargar PDF Gratis
http://emssolutionsint.blogspot.com/2017/09/curso-tecc-espana-28-septiembre-2017.html
¿Es correcto que el SEM en situaciones Tacticas utilice uniformidad similar a la policial? Respuestas en video mañaña sabado 19 de mayo 2018. by Dr. Ramon Reyes, MD, EMT-Tactical, DMO en nuestra pagina en facebook @drramonreyesmd https://www.facebook.com/DrRamonReyesMD/


Rescue Task Force RTF? / FUERZAS de TAREA de RESCATE

Guatemala military/medic special ops team. Art by Dansun Photos @DansunPhotos
Todos Nuestros VIDEOS en YouTube https://www.youtube.com/c/RamonReyes2015 

Grupo en TELEGRAM Sociedad Iberoamericana de Emergencias
https://t.me/joinchat/FpTSAEHYjNLkNbq9204IzA




NO SOLO ES PARECER, TAMBIEN DEBEMOS SER...

El Dr. James Vretis, D.O es un MEDICO TACTICO, no parece, lo es... y lleva lo mismo que cualquier miembro de las Fuerzas del Orden...Porque el es Fuerza del Orden... ¿Es correcto que el SEM en situaciones Tacticas utilice uniformidad similar a la policial? Respuestas by Dr. Ramon Reyes, MD​, EMT-Tactical, DMO en nuestra pagina en facebook @drramonreyesmd http://emssolutionsint.blogspot.com.es/2018/03/tactical-medics-vs-rescue-task-force.html

Dr. Ramon Reyes, MD https://www.facebook.com/DrRamonReyesMD/

Publicado en TWITTER
Que los ORCAS de Cataluña, son los unicos sanitarios a entrar a zona CALIENTE (Vamos que entrarn en CUF Zona de Fuego, Zona ROJA)... ¿Quien ha sido el experto de la NASA que se ha inventado esta cosa, que pondria en peligro inminente a Sanitarios DESARMADOS? Comentario by Dr. Ramon Reyes, MD

Cito Documento Original de TWITTER:
Els equips UIS (ORCAS) de @semgencat son els únics en accedir a zona “calenta” una vegada autoritzats per FFSS #simulacreTiradorActiu #emergenciesCOIB @COIBarcelona
http://emssolutionsint.blogspot.com.es/2018/03/tactical-medics-vs-rescue-task-force.html


Dejo compilacion de razones logicas y procedimientos Internacionales al respecto... Ni el TCCC, Ni TCC-LEFR, Ni CONTOMS, Ni CTECC, Ni nadie con algo de sentido comun diria o haria tal locura... Menos en España, pais de competencias muy claras y definidas, pais de islas profesionales... veremos el final de la peli.... como queda.





CONFUNDIR TACTICAL MEDICS VS. RESCUE TASK FORCE MEDICS, Pues tengo la ligera impresion es lo que han hecho en España, uniformar al personal sanitario, violando principios basicos de seguridad, al dejar bajo confusion total a quienes intervienen en la escena (Escena desde el principio especial y atipica), diferencia entre los RTF y EMS-T,

DEPAS-MADRID: El Dispositivo Especial Preventivo Actos Antisociales es un equipo constituido por 113 voluntarios que actúan en caso de manifestaciones, desalojos, altercados públicos o partidos de fútbol catalogados de alto riesgo.


¿Es correcto que el SEM en situaciones Tacticas utilice uniformidad similar a la policial? Respuestas en video mañaña sabado 19 de mayo 2018. by Dr. Ramon Reyes, MD, EMT-Tactical, DMO en nuestra pagina en facebook Dr. Ramon Reyes, MD


Personal SAMUR PC Madrid en RTF, noten el miembro de SAMUR de negro... ¿Es esta una practica segura? vestir parecido a un poli representa peligro, saque usted sus conclusiones...

RESPUESTA:




Rescue Task Force RTF? / FUERZAS de TAREA de RESCATE

En el dia de mañana trataremos este tema a fondo, para dejar claro, que ha sucedido en esta confusion, que podria realmente poner en peligro al personal sanitario.

Dr. Ramon Reyes, MD, EMT-T, DMO
Tactical Medical Specialist
TCCC-TECC Faculty
TCC-LEFR Medical Director
VP-Militar Comite Iberoamericano de Medicina Tactica y Operacional


Graduado de Tactical Protective Medical Support y Grupo de Entrenamiento Contra-Terrorismo del Gobierno de Estados Unidos

"NO SOLO ES PARECER, TAMBIEN DEBES DE SER" by Dr. Ramon REYES, MD

Guatemala military/medic special ops team.Guatemala military/medic special ops team.Guatemala military/medic special ops team. Art by Dansun Photos @DansunPhotos


Guatemala military/medic special ops team. Guatemala military/medic special ops team. Art by Dansun Photos @DansunPhotos
TACMED, Tactical Medicine, Active Shooting, Terrorism Attack.


Rescue Task Force is a new concept to SFD that is designed to get lifesaving medical treatment to victims in mass shootings quicker. The current standard fire/EMS response to the active shooter is to stage in a secure location until police mitigate the threat and secure the area to create a scene safe for fire/EMS operations. Unfortunately, while waiting for a secure scene, those injured inside the building aren't receiving care and are dying from their injuries. The RTF concept involves placing Paramedics in a forward position during an active shooter. The Paramedics are protected with cover and Police Officers, but are able to begin life-saving care much sooner than traditional

FUERZAS de TAREA de RESCATE "Rescue Task Force" RTF. es un nuevo concepto de los Servicios de Emergencias, ha sido diseñado para brindar tratamiento médico para evitar muertes prevenibles en víctimas durante tiroteos masivos y de manera más rápida y efectiva. La respuesta estándar actual ante fuego / SEM ante tiradores activos consiste en ubicarse en lugar seguro hasta que la policía suprima la amenaza y asegure el área para crear una escena segura para las operaciones de Bomberos / SEM. Desafortunadamente, mientras se espera una escena segura, los heridos dentro del edificio no estarán recibiendo atención y estarán muriendo por sus lesiones. El concepto de RTF implica colocar a los paramédicos en una posición en el frente durante un tirotesos activos. Los paramédicos estarán protegidos por cobertura (Escudos) y resguardos en la escena, ademas oficiales de policía,asi podran comenzar a salvar vidas mucho más rápido que con los métodos tradicionales de despliegue.

deployment methods.


TACTICAL MEDICS VS. RESCUE TASK FORCE MEDICS
What are the similarities and differences between these critical functions?



Written by

Jim Morrissey- ALCO EMS

Terrorism Preparedness Director

Senior SF FBI Tactical Medic

The simple answer is that tactical medics are “attached” to a tactical law enforcement team and are considered part of the team. Whereas a Rescue Task Force is a trained, but hastily formed group of EMS medical providers (private and/or fire based) that partner with law enforcement on scene and enter a newly secured area such as an active shooter incident, to provide triage, emergent care and extrication to the casualties.


 EMS uniforms: Does color matter? A majority of readers are most concerned about the color of their uniforms in regard to setting them apart from police officersFeb 16, 2017
By EMS1 Staff

Gone are the days of all EMS providers wearing white pants, white shirt or a dark navy outfit.

And because of this variety, EMS1 columnist Catherine Counts looked at the impact and role uniform color plays. Specifically, she looked at research regarding police-public interactions and if EMS could benefit and change anything with the findings.

Uniforms are part of the first impression the community will have on the responding crew. (Photo/Hennepin EMS)
Uniforms are part of the first impression the community will have on the responding crew. (Photo/Hennepin EMS)
We asked our Facebook fans what color they thought paramedics should wear. A majority of commenters were most concerned about the color of their uniforms in regard to setting them apart from police officers. Others talked about the need for more high-visible clothing in EMS and their color preference based off weather resistance and job-related messes.

Do you think color matters? Let us know in the comments below.

1. "No badge. I'm a big fan of high visible uniforms, because this way at 3 a.m. we don't look like cops. I worked at one place where they had jumpsuits. As long as we don't look like cops. When we do, it tends to cause problems." — Brian Conner

2. "We have white tops and navy pants with BLS in all navy. I like how my uniform looks brand new. However, a white shirt is not practical for EMS providers day-to-day. Everything from fluids, to sweat stains, dirty footprints on your chest and even food. Without fail, I always spill my coffee the morning I wear a brand new shirt." — Denise Chagnon Beady

3. "I'm from Germany, and here it is a law that EMS providers have to wear high-visible clothes. So we have orange trousers, orange jackets and white shirts." — Moritz Werthschulte

4. "I agree to not having badges. I used to work for a private service and our class A's were 100 percent red. To me, that just screams 'medical' and I have yet to come across any LE that wears red. That's how it should be." — Luke Ailiff

5. "I've been mistaken for a police officer all of the time. I prefer the blues. I think they look professional. I have worn white shirt and blue pants and by the first 10 minutes they're already dirty. I prefer a blue polo shirt with EMS and professional licensure on back." — Brian Schilling

6. "Red shirts, black pants. Red and black are great at hiding stains, helps you to stay looking professional. Red doesn't retain much heat when working an MVC in the blistering Texas sun. Red is more flashy and EMS-related than blues, blacks and other dark colors and sets us apart from police officers, helps reduce danger as well. When I see gray, I think correctional officer. When I see beige, I think security guard." — Ari Andalman

7. "I would love a universal color coding. I also think we need to ditch the dark blue. I'm patriotic, but Europe is right to put their first responders that are not police into high visibility yellows and greens. I say fire should move toward a high visible yellow and red, and EMS should be high VI's yellow and royal blue." — Lawson C Stuart

8. "Ours are white. Not real practical, but the argument is that they want us to not look anything like our local LEOs who have blue and tan." — Adrian Hoesli

9. "Red. Easily recognizable and no confusion with law enforcement." — Jake Walker

10. "I like the idea of scrubs. Not just any type, though. Something specially designed for EMS in whatever colors a specific company is." — Britni Martinez https://www.ems1.com/ems-products/uniforms/articles/194890048-EMS-uniforms-Does-color-matter/




How's it? I'm looking for some feedback on what different departments' policies are on wearing class B shirts versus uniform t shirts on calls. I worked for a different fire department for 6 years which had a policy that made sense to me, where we could wear uniform t shirts while responding to all calls, specifically medical calls, but would wear our class B shirts when interacting with the public at schools, for PR events, or while in class room training sessions. 
My current department has a hard-line policy that button-up class B shirts are to be worn in all cases, with the exception of removing them when putting on full turnouts for fires or MVAs. My biggest issue is that we look like police officers in our button up shirts, and I feel it can negatively impact our safety on scene as well as be detrimental to some of our patient/care provider relationships. I've tried to make a case from the safety standpoint that we make ourselves targets when we look like officers (with personal experiences of patients and other people on scene mistaking me for an officer even when we've been in the back of the ambulance providing care or carrying EMS equipment).
The current response is for us to add a part of our PPE, whether it's a turnout coat or fire helmet, to help identify ourselves as Fire/EMS. I really don't like that for a couple of reasons. First, as a medic, the turnout coat hinders my ability to start lines or intubate. The helmet can do the same, and I end up removing both ASAP when initiating patient care. Second, in the summer, it can be over 110 degrees, and I don't like having to add an unnecessary layer or piece of equipment when removing my class B shirt will identify me just as easily (our t shirt has a big reflective "FIRE" printed on the back, and our department logo on the front.) 
Additional benefits of t shirts over class Bs, in my opinion are that they are easier to launder and cheaper to throw away if I get contaminants on them (there's only so much blood or vomit I'm willing to try to remove before the whole shirt is gonna get scrapped). Most of my department sleeps in their T shirts currently, but we have to waste time at night to put on our class B shirts when responding to calls after we've hit the rack. There's always an emphasis on response times and it seems like a no-brainer to not require shirts at night when they make us even more mistakable as cops as well as slow down our response times. 
Any one else have these issues or successfully get policy changed? It seems like the brass has placed form firmly over function in this instance & it's frustrating. I'm generally all for supporting the upper chain of command, and feel like I have made a good personal effort to support and improve my new department (3 years on the job here), but would love to see a more functional policy put in place. I agree  that we should look professional, but feel like that concept should fit the situation. Sharp looking uniform t shirts can look professional to the public when we are on emergency calls, and don't hinder our first priority of personal and crew safety.  http://my.firefighternation.com/forum/topics/class-b-uniforms-make-us-look-like-cops



Mistaken Identity

Article Aug 31, 2008



This issue's close call was sent in by a reader who had a brush with violence and was almost drawn into the fray because of the badge on his uniform.



"My partner and I were at our usual convenience store/gas station at about 10:30 p.m. It's in a somewhat seedy neighborhood and was crowded. While we were in line, someone came running in and yelled, "They're fighting with guns outside!" As everyone else in the store ran toward the front windows to watch (why, I have no idea), we quietly sauntered to the back of the store. We got as far away as we could and called it in. We were stuck.



"Someone from outside came into the store again, looked at us and pleaded for us to help. 'Look at those police officers,' she added, gesturing toward us for the benefit of others in the store. 'They don't even care!' I calmly replied that we were paramedics, not police officers, and that the police would arrive soon. It didn't seem to register, and soon several people in the store were asking us why we weren't helping. The police arrived quickly, and two bad guys were arrested. My supervisor showed up, and as we were talking to him, someone approached us. 'Did you get the guy who did it?' he asked."



Over the years, EMS has grown serious roots in the arena of public safety. This identity has spawned similarities in the authority-based uniforms we often wear, which can resemble those worn by our public safety brethren. In this case, it almost put two EMSers in the middle of a dangerous situation.



Tactically, I applaud the medics for not getting involved in the fight. It may seem like a no-brainer when people are fighting with guns, but it took maturity and solid decision-making to stay back when urged to get involved by citizens.



This situation also provides a backdrop for bringing up some other safety and survival points:



Don't leave your ambulance running outside a store, even just for a minute. The ambulance here could have become a getaway vehicle for one of the shooters.

Remember the concepts of cover and concealment. If you ever find yourself in a situation such as this, look for something that will hide your body and protect you from bullets—this is cover. Examples include trees, brick walls and the engine block of your ambulance. Concealment is good in a pinch because it hides you, but it doesn't offer protection.

Retreat is always a strategy. Get away from the danger. Put as much space between you and any threats as possible. Go as far as you need to be safe—and then go a little further—until police secure the scene. Integrate cover and concealment while you are retreating.

Work through different situations in your head during down time. If you go to a store in a tough part of town (sometimes these are the only choices we have), come up with some safety strategies in the event things go bad (e.g., what if someone tried to jack your rig or steal your narcs?).

Carry a portable radio at all times. In this case, the medics had a link directly to the dispatcher. Most of us carry cell phones as well.

Communicate with your partner. The safety and survival strategies of a team may be greater than the sum of its individual efforts. Two heads are better than one.

Finally, don't forget the value of observation as a tactic. It's always better to observe a dangerous situation and avoid it than to have to use tactics to get out of it. Look for suspicious activity, drug or alcohol use and crowds gathering. Sometimes you can watch an area become "charged" or energized with activity prior to a violent outburst.



Other times an unusual silence is as valuable a sign of danger as suspicious activity.



Here is what the medics in this close call were wearing:



"Our uniforms have light-blue button-down shirts with a badge over the left chest and a nameplate on the right. There are patches on either shoulder also shaped like badges, along with patches to symbolize rank and years of service on the sleeves. Our uniforms are almost identical to those of several area police agencies, and nothing on them clearly identifies us as EMS workers."



What does your uniform look like, and why? While many like the authoritative-looking public safety uniform, others have moved to different styles (e.g., embroidered or screened polos) for a variety of reasons that include lower cost, comfort, practicality and (of course) safety.

Don't forget, a professional in a polo outperforms and looks better than a guy with a badge any day. It's the way you walk the walk.

Be careful out there.

To submit a case for review, e-mail Nancy.Perry@cygnusb2b.com.

Daniel D. Limmer, AS, EMT-P, is a paramedic with Kennebunk Fire-Rescue in Kennebunk, ME. He is the author of several EMS textbooks and a nationally recognized lecturer.

EMS EXPO™
Dan Limmer is a featured speaker at EMS EXPO, October 15–17, in Las Vegas, NV. For more information, visit www.emsexpo2008.com. https://www.emsworld.com/article/10320853/mistaken-identity
















Both Tactical Medics and Rescue Task Force personnel provide emergent care in less than ideal situations, often under significant stress and in chaotic, sometimes hostile environments. Both work very closely with law enforcement during planning, training and actual events. Most Rescue Task Force members are outfitted with ballistic vests and helmets, and likewise, almost without exception, Tactical Medics are protected with body armor and helmets. Both Rescue Task Force and Tactical Medics are specifically trained and equipped to deal with ballistic, blast and other violence-induced trauma. Rescue Task Force members wear their usual daily uniform (Fire/ EMS/ law enforcement) and are typically dispatched during their normal shift. Tactical Medics wear the uniform of the tactical team they are attached to and are physically located with the team, or just outside of the “hot zone”.



Tactical Medics



Tactical Medics are somewhat analogous to the hockey team trainer who travels with the team and is there primary to provide medical aid to the team, whether the injury or ailment is serious or not. The most common items requested of the Tactical Medic are Band-Aids and ibuprofen. However, the Tactical Medic must also be prepared to provide life-saving interventions to team members and other on scene law enforcement. The Tactical Medic will provide initial medical care as needed to victims, bystanders, and perpetrators once the scene is secured. They will transfer patient care to a standard EMS unit if further care and transportation to the hospital is needed.



Tactical EMS models



Some law enforcement agencies (LEA) send officers/agents/deputies to EMT school, or comprehensive tactical medical classes and those officers may become the default Tactical Medic for the team. That may be a workable solution; however, it is unlikely those individuals have the medical experience and patient assessment skills needed to be the best medical practitioner in high-risk, high-stress situations.

There are countless workable models for the incorporation of a medical contingency plan for law enforcement operations. Some of the more common models are listed below:



- Officer/Agent/Trooper/medic- These are sworn law enforcement officers (LEO) having dual roles as an "operator" and medic; they have law enforcement powers and can certainly protect themselves from potential threats.



- Agency contract- In this case the LEA has a contract or MOU with a local EMS provider (Fire or private EMS service, or hospital medical group) to provide up-close medical care. Some agencies put the medics through a Reserve Officer school, so that they can be armed as LEOs.



- Individual contract- An individual or a team of individuals are under contract or MOU with the LEA for providing medical coverage for SWAT missions and training.



- ALS Stand by- In this outdated model, there are no Tactical Medics, but LE will stage a standard ambulance some distance away and they would respond to the scene after being secured by law enforcement.



There have been two major shifts in doctrine related to law enforcement operations over the last 10 years. One change focuses on aggressively going after active shooters with whatever assets happen to be on hand, instead of waiting for a SWAT team.



The second major change is recognizing the need for emergency medical contingency planning. This includes training all tactical personnel and line officers in the basics of self-care and buddy care with the focus on bleeding control and the addition of a dedicated Tactical Medic.



An aspect of this doctrine shift (in addition to the Tactical Medic) is - at minimum notifying –but ideally involving local EMS and hospitals about planned or developing law enforcement operations that have a high risk for injuries. SWAT teams are increasingly including a dedicated tactical medical component, and medical threat assessment as part of their organizational structure.



Learning about Tactical EMS

Many in the EMS/medical field have demonstrated and voiced interest in exploring what is required to get into the field of tactical medicine. In addition to the pre-existing medical training one already has (i.e. physician, nurse, paramedic, EMT, etc.), it is highly recommended to procure specific tactical medical education.



Programs such as NAEMT Tactical Combat Casualty Care (TCCC), Tactical Life Saver and others like it are one or two days in length and have been well received by the EMS and LE community. The International School of Tactical Medicine (ISTM) offers a 2 week intensive program aimed at medical practitioners who need basic training on law enforcement operations, and how to work within a law enforcement team as the medic.



Scenario of a tactical mission

On a typical planned SWAT operation there are several phases and steps that take place well before the “hit”. Most often, the mission is a planned high risk search or arrest warrant. After getting a "warning order", the SWAT team operators and all of the support elements (medical, communications, negotiators, etc.) typically convene at a Forward Staging Area (FSA).

A briefing will occur, where mission goals, subjects, and target location layouts are reviewed. Depending on the nature of the mission and Operations Security (OP-SEC) issues, the tactical medic may coordinate with the local EMS transport provider to have an ALS ambulance stage close to the location.

The Tactical Medic is the logical liaison to the on-scene EMS assets that support law enforcement operations. Typically the Tactical Medic will have a face-to-face meeting with EMS supporting units if they are available.


Rescue Task Force

Prompt integration of EMS medical rescue teams with Law Enforcement escort (Rescue Task Force) into an active shooter and other violent threat incidents is a recently adopted concept in the civilian first responder world. The introduction of the Rescue Tack Force (RTF) to the wounded casualties should be just after the threat has been eliminated, when the scene has been deemed relatively secure. Historically, Fire and EMS crews staged a distance away until LE methodically secured the scene before permitting EMS to access victims. This practice is being phased out and is being replaced with a more patient centric and life-saving approach.

There are two priorities in these types of events.

Eliminate the threat (LE responsibility)
Provide immediate life-saving interventions ASAP (everyone’s responsibility)

In terms of providing life-saving interventions, there are four ways to render medical aid in these types of situations.

Bystanders/ victims provide care to one another prior to any responder arrival.
LE rapidly extricates, escorts victims to a safe area where EMS is waiting and provides medical aid.
LE secures the area and THEY provide life-saving interventions at the point of wounding (POW).
LE secures the area and brings in the RTF under a force protection model.

The RTF focus should be on quick initial medical assessments and to provide life-saving interventions on scene at the point of wounding (POW) if needed. This should be done in concert with efforts to extricate victims to a Casualty Collection Point (CCP) where a secondary triage, treatment and transport can be provided. The RTF group should use a pre-entry LE/EMS checklist to insure important issues are addressed. The law enforcement aspect of the RTF is focused on escorting and protecting the medical member of the RTF. Urban Shield has been conducting several tactical and EMS/medical integrated scenarios each year since 2008. These scenarios are created to be realistic, tactically and medically challenging and create an obvious nexus between the tactical resolution and providing life-saving care to the casualties in a timely manner. The Urban Shield EMS Branch has a well-deserved reputation for creating some of the highest rated scenarios in Urban Shield. We aim to continue that trend.

The Rescue Task Force concept is becoming more widespread and adopted nationwide. Fire Departments, local EMS providers and law enforcement need to collaboratively train, drill and develop procedures and protocols for this concept to be effective. You do not want to be exchanging business cards the day of the horrific event.


PDF https://www.summahealth.org/~/media/files/summahealth/ems/ems-protocols/tactical-ems/tems%20protocol%20final.pdf





Tactical EMS: An overview
Learn about the basics of this rapidly evolving EMS subspecialty
Jul 31, 2013

What is a "SWAT medic" and what does it take to become one? Tactical medicine is a specialized and highly discriminating endeavor that requires intensive training, discipline and a unique relationship with law enforcement. Tactical medics have the primary responsibility of providing medical care to the SWAT team, but their duties extend far beyond that task.

This article examines the evolution, and current tactical medical principles and procedures employed by military and law enforcement agencies (LEA), specifically SWAT teams.

History
Tactical medicine concepts have been around since the dawn of medicine….and warfare. Even in early battles the “King’s Doctor” was to be close at hand to deal with injuries, but only to the royal few. Outcomes were not very good as the initial insult might have killed the victim; if that didn’t, then infection usually did.

Historical accounts and personal diaries of military medics through the centuries are fascinating and show a steady progression of tools and techniques and an ever improving understanding of injury management. The Vietnam War showed that rapid transport to a higher echelon of care had a significant impact on survival.

The last 10 years of conflict overseas has shown that controlling extremity hemorrhage and aggressive airway management accounted for a significant reduction in the casualty fatality rate (CFR). The CFR is the percentage of those who are wounded in battle die.1

Casualty Fatality Rate:

WWII 19.1 %
Vietnam War 15.8
Iraq/ Afghanistan conflicts 9.4
Prior to 2004, there were a significant proportion of deaths in American soldiers during the Global War of Terror (GWOT) associated with each of the following injuries:

Hemorrhage from extremity wounds
Junctional hemorrhage (where an arm or leg joins the torso, such as in the groin area after a high traumatic amputation)
Non-compressible hemorrhage (such as a gunshot wound to the abdomen)
Tension pneumothorax
Airway problems
It was noted that extremity hemorrhage was the most frequent cause of preventable battlefield deaths. The U.S. military re-introduced and emphasized tourniquet use and hemostatic agents with measurable success.

Tourniquets were proven to save lives on the battlefield including 31 lives saved in 6 months by tourniquets after the retraining. Kragh et al. estimated that 2000 lives were saved with tourniquets during the Iraq conflict. As importantly, there were no arms or legs lost because of tourniquet use.2

Causes of preventable battlefield death are not that different from the potential injuries of law enforcement/ SWAT operators during high-risk law enforcement operations.

Today's tactical EMS
Tactical medicine has become a discipline and specialty within law enforcement circles. High profile events such as the Columbine, Virginia Tech, Aurora Movie Theater and countless other “active shooter” incidents have shifted the way law enforcement operates.

There have been two major shifts in doctrine related to SWAT and law enforcement operations over the last 10 years. One change was focused on aggressively going after active shooters with whatever assets happen to be on hand, instead of waiting for a SWAT team.

The second has been to recognize the need for emergency medical contingency planning. This includes training officers/agents in the basics of “self-care” and “buddy care” with the focus on bleeding control.

Another aspect of this doctrine shift is the inclusion of organic assets (the tactical medic), and involving, or at least notifying local EMS, hospitals about law enforcement operations that have a high risk for injuries. SWAT teams have increasingly a dedicated tactical medical component as part of their setup.

Some law enforcement agencies (LEA) have decided to send officers to EMT school, or specific tactical medical classes. That may be a workable solution; however, it is unlikely those individuals have the experience and patient assessment skill needed to be the best medical practitioner they can be.

It may make more sense to train an experienced medic to work in a warm zone environment and keep the scope of that person's job as the medic.

Tactical EMS models
There are countless workable models for the incorporation of a medical contingency plan for law enforcement operations. Some of the more common models are listed below:

Officer-Agent/medic- sworn LEO having either dual roles as an "operator" and medic, or strictly as a medic; but has law enforcement powers and can certainly protect themselves from potential threats.

Agency contract: LEA has a contract or memorandum of understanding (MOU) with a local EMS provider to provide "up-close" medical care. Some agencies put the medics through a Reserve Officer school, so that they can be armed as LEOs.
Individual contract: An individual or a team made up of individuals who have either a contract or MOU between them and the LEA providing coverage for SWAT missions and training.
ALS Standby: No Tactical Medics, but ALS unit will stage close by and respond if scene is secured by law enforcement.
Learning about Tactical EMS
There are many in the EMS field that would like to explore the option of getting into the field of tactical medicine. In addition to the medical training one already has such as a physician, nurse, paramedic or EMT, it is highly recommended to procure specific tactical medical education.

Programs such as NAEMT Tactical Combat Casualty Care (TCCC) and other like it are one to two days in length and have been well received by the EMS community. The International School of Tactical Medicine (ISTM) offers a 2 week intensive program aimed at medical practitioners who need basic training on law enforcement operations, and how to work within a law enforcement team as the medic.

The emphasis in this program is to insure that the tactical situation is resolved and EMS providers are not put in harm’s way. There are many skills sessions and tactical/ medical scenarios to test the knowledge learned under stressful conditions.

The tactical medic
The Tactical Medic is the logical liaison to the on-scene EMS assets that support law enforcement operations. Typically the Tactical Medic will have a face-to-face meeting with EMS supporting units if they are available.

It is imperative that EMS providers are not put in harm’s way and are not allowed to enter a scene where there is a shooter, or other threats are still possible. In an active shooter type situation, once the threat is eliminated, the scene is no longer a hot zone. A quick sweep from a SWAT team can confirm this assumption.

If there are significant casualties, the next priority should be to escort the EMS providers into the scene quickly and safely into the newly created “warm zone." They would work closely with the Tactical Medic throughout the event.

Scenario of a tactical mission
On a typical hypothetical SWAT operation there are several phases and steps that take place well before the “hit”. Most often, the mission is a planned high risk search or arrest warrant. After getting a "warning order", the SWAT team operators and all of the support elements (medical, communications, negotiators, etc.) typically convene at a Forward Staging Area (FSA).

A briefing will occur, where mission goals, subjects, and target location layouts are reviewed. The tactical medic then calls the local EMS transport provider to have an ALS ambulance stage close to the location.

Most times if EMS is notified beforehand, they are welcome into the briefing. The local EMS crews are given instructions and a communications plan. In most cases they follow the vehicle convoy in and are in close proximity to the target location.

Local hospitals and trauma centers are notified that the mission is taking place and to be on alert in the event of casualties.

Personally, I’ve been on close to 200 SWAT missions and thankfully there have been no gun-fights with injuries.

On most of SWAT missions, we have a day or two to plan. Most large city police departments have a higher percentage of spontaneous SWAT missions such as a bank robbery “gone bad” or a barricaded subject.

Summary
Tactical medicine is an exciting and evolving field of emergency medicine. Consider taking a tactical medicine class and see if you are up to the task.


References

NAEMT Tactical Combat Casualty Care (TCCC) Curriculum, http://www.naemt.org/education/TCCC/tccc.aspx
Kragh J et al. Practical use of Emergency Tourniquets to stop Bleeding in Major Limb Trauma Journal of Trauma, 2008:64; 30-50 http://www.smcaf.org/InPressKragh.pdf
About the author
Jim Morrissey is a Tactical Paramedic for the San Francisco FBI SWAT team and the founder of the Tactical Medical Association of California (TMAC). Jim is also the Terrorism Preparedness Coordinator for the Alameda County EMS Agency. Jim has a master’s degree in Homeland Security from the Naval Postgraduate School in Monterey, CA. He can be reached at jim.morrissey@acgov.org.

https://www.ems1.com/ems-education/articles/1482674-Tactical-EMS-An-overview/



Active Shooter/Mass Casualty Incidents (AS/MCIs) in the U.S. have increased at an alarming rate in recent years. According to date collected by researchers at Texas State University, 47 active shootings events transpired between 2000 and 2008 — an average of 5.22 per year. Why should we be concerned? These figures have more than tripled in the past five years to an average of 16.8 annually, with a total of 89 active shooting incidents taking place between 2009 and 2013. There have also been disturbing trends in the scope and lethality of AS/MCIs. In the 2012 shootings in Aurora, Colorado, 70 people were wounded-12 fatally-when a gunman stormed the Century Theatre movie complex. Later that same year, 26 people, including 20 children, were murdered inside an elementary school in Newtown, Connecticut. And in April 2013, 264 people were injured in the Boston Marathon bombings, with 3 of the victims dying.



AS/MCIs present several dilemmas for public safety officials — the first of which is expediency of police response. There is a direct correlation between police response time and AS/MCI duration: the average AS/MCI lasts 12 minutes, with 37% ending in 5 minutes or less. Once police arrive on scene, the perpetrators typically turn their attention on police or commit suicide. Regardless, additional loss of life is usually mitigated upon police arrival and deployment on scene, as police prevent the assailants from accessing further victims.
Another notable problem manifested at AS/MCIs is the timeliness of emergency medical personnel response. In most instances, firefighter/paramedics are required to stay outside the secure perimeter while police clear the scene of the threat. This is a process that can take hours, as was the case with the Columbine and Washington Navy Yard shootings. While police search and neutralize active shooting scenes, those wounded desperately lay in wait for medical attention; a human being can die of blood loss in as little as 2-3 minutes, airway obstruction in 4-5 minutes, and a collapsed lung in 10 to 15 minutes. Therefore, paramedics need to be able to access and treat victims on scene, and cannot always wait for the police to conduct an exhaustive search for the perpetrators of active shootings.
In stark comparison to the rapid interdiction model implemented by police organizations across the U.S., most fire/EMS departments do not have established protocols for treating the wounded at active shooting events. The typical response is for fire personnel and paramedics to remain on standby until the scene has been rendered safe by police. Officials at some jurisdictions, such as the Arlington County Fire Department (ACFD), have s adopted a more proactive approach. In 2007, ACFD established the nation’s first Rescue Task Force (RTF). The RTF is based on the military’s Tactical Combat Casualty Care (TCCC) protocols. RTF consists of specially equipped firefighter paramedics partnered with police officers to respond to active shooter or other atypical, high threat medical emergencies. Other fire departments, such as those in Orange County and Los Angeles, California have also recently created Rescue Task Forces after active shooting events. Although the initiation of these RTFs is a positive development, the majority of municipalities in the U.S. do not have the standard operating procedures, equipment, or trained personnel to effectively deal with medical emergencies during active shooter and mass casualty incidents. It often takes a tragic event, such as the Los Angeles International Airport Shooting in November 2013, to demonstrate why Tactical Emergency Casualty Care (TECC) programs such as Rescue Task Forces are necessary.
Several prominent public safety organizations in the U.S. have recommended the establishment of formalized tactical emergency programs. The International Association of Firefighters (IAFF), a fire service advocacy group with over 300,000 members, has issued Position Statements recommending the establishment of TECC and Rescue Task Force programs. The Hartford Consensus, an ad-hoc group medical emergency professionals which includes representatives from the American College of Surgeons, fire service officials and Federal Bureau of Investigation (FBI) also recommends the adoption of Tactical Combat Casualty Care (TCCC) programs* by state and local public safety agencies. According to the Hartford Consensus, TCCC programs are quintessential in improving survivability of victims in active shooting events because they make provisions for “a more integrated response by law enforcement fire/rescue.”
In September 2013, the U.S. Fire Administration issued formal recommendation that public safety agencies across the U.S. look to TECC programs to provide optimal response to active shooter and mass casualty events: “Training, equipment and protocols around use of TECC for medical first responders should be explored, considered and implemented when feasible.”
The Committee-Tactical Emergency Casualty Care (C-TECCC), which is comprised of emergency medical experts from over 55 agencies, is working to expedite the transition of TCCC to the civilian domain. C-TECC recommends, and works with agencies all over the U.S. to advocate and assist with implementation of TECC programs.
Despite the declared need for tactical emergency medical programs by emergency medical professionals and public safety officials across the U.S., there exists no national standard or policy for the implementation of such programs. In fact, most jurisdictions in the U.S. currently have no standardized tactical emergency programs; if TECC programs are implemented, they are frequently established only after calamities involving loss of life occur. On a multi-jurisdictional level, there appears to be disconnect between identification of the problem, and realization of the solution to this problem.
Chances are, you live in an area that does not have a Rescue Task Force, or any other type of formalized TECC program. I would recommend that you engage your elected officials and public safety officials to see what the comprehensive plans are for response to a mass casualty event in your city or town. It is not a matter of if, but when your community will have to endure a mass casualty event.

*TCCC (Tactical Combat Casualty Care) is the original tactical emergency medical program created by the U.S. military, and TECC is the civilian off-shoot version of TCCC. Rescue Task Force (RTF) is a TECC-based program.
 NIJ 06 Level IIIA Soft Armor Ballistic Protection
Front and back hard armor plate pockets able to receive multiple size plates
Mil-Spec industrial reinforced webbing
Front and back MOLLE modular attachment system (PALS compatible)
Durable 1,000-denier Cordura nylon external carrier construction
Adjustable hook and loop side straps – expandable up to 60”
The Rescue Task Force Vest Kit combines state-of-the-art ballistic personal protection along with life-saving, battlefield proven medical equipment from North American Rescue. This ideal solution was designed for EMS, Fire-Rescue and Law Enforcement personnel performing medical operations in response to Active Shooter and Mass Casualty Incidents (AS/MCI).
Developed for rescue personnel working in the Direct and Indirect Threat areas of AS/MCI’s, the Rescue Task Force Vest Kit provides rescuers with a personal protective ballistic vest combined with the essential medical equipment to provide immediate point-of-wounding care to injured casualties in accordance to Tactical Emergency Casualty Care (TECC) guidelines.
The ballistic protective vest provides rescuers with one of the largest NIJ 0101.06 Level IIIA front/back panel soft armor protection systems available in the industry. The vest comes with built-in front and back hard armor plate pouches to allow the option to upgrade up to various sizes of Level IV hard plate protection. The ballistic soft armor is comprised of a unique, multi-hit capable, patent-pending assembly of ballistic materials that capture projectiles and disperse the energy over the entire surface of the panel. The kit is also available with the optional cummerbund-style side Level IIIA soft armor that also has an additional plate pouch to add hard plates for increased lateral protection. This full configuration offers Level IIIA soft armor front, back and side ballistic protection that has the capability to be upgraded with Level IV hard plates.
This “one-size-fits-most” soft armor ballistic vest easily adjusts at the shoulder and waist to fit different size rescuers. The front and back panels, shoulder straps and optional cummerbund side armor have MOLLE capability that allows for the attachment of additional medical or extraction equipment. Designed to address the top leading causes of potentially preventable death in a tactical environment, the medical equipment can also be modified to meet your agency’s needs as required by your protocols. Armor and medical products can also be purchased separately.
Special Features:
NIJ 06 Level IIIA Soft Armor Ballistic Protection
Front and back hard armor plate pockets able to receive multiple size plates
Optional cummerbund-style Side Armor Protection available with additional plate pouch
Mil-Spec industrial reinforced webbing
Front and back MOLLE modular attachment system (PALS compatible)
Durable 1,000-denier Cordura nylon external carrier construction
Adjustable hook and loop side straps – expandable up to 60”
Rescue Handle – 1,200 lbs. tensile strength reinforced strap
One of the largest soft armor coverage areas in the industry
Adjustable hook and loop padded shoulder straps with MOLLE plus two fixed “D” rings
5-year manufacturer’s warranty
Blast mitigation configuration
Comes complete with NAR-4 Chest Pouch with modified equipment list (see kit contents list) and additional CAT Tourniquets and CAT Holders
Made in the USA
Kit Contents:
1 x Armor, Tactical Responder Vest MKII
1 x Armor, Rescue Responder Side Set
4 x Combat Application Tourniquet – BLK
2 x Emergency Trauma Dressing – 6”
2 x S-Rolled Gauze
2 x NPA w/Lube – 28F
1 x HyFin® Vent Chest Seal Twin Pack
3 x Bear Claw Glove Kit (Pair) – Size Lg
1 x NAR Trauma Shears – 7-1/4”
1 x NAR Scissor Leash
4 x Combat Casualty Card
2 x Black Permanent Marker
2 x CAT Holder
1 x Bag, NAR-4 Chest Pouch
1 x MED Illuminous Patch
2 x Rescue Task Force Patch
Technical Specifications:
Complies with and exceeds NIJ Ballistic Resistance Standard 0101.06 for ballistic performance of Level IIIA body armor
Front, back and side hard armor plate pouches for increased protection (plates not included)
Front/back panel protection area: 187 sq. inches (11”W x 17”H)
Proprietary assembly of ballistic materials
Available Side Armor protection
Ballistic Vest Weight: Less than 13 lbs.
Tactical EMS
with Jim Morrissey

Active shooter: Rescue Task Force medics get to victims fasterRescue task forces and tactical medics offer different, yet more aggressive approaches to active-shooter incidents than standing by until all is clearJul 24, 2015
There have been two major shifts in doctrine related to law enforcement operations in the last 10 years. The first shift is the aggressive pursuit of an active shooter with whatever assets happen to be on hand instead of waiting for a SWAT team.

The second major change is recognizing the need for emergency medical contingency planning. This includes training all tactical personnel and line officers in the basics of self-care and buddy care with the focus on bleeding control and the addition of a dedicated tactical medic.

An aspect of this doctrine shift is SWAT teams are increasingly including a dedicated tactical medical component and medical threat assessment as part of their organizational structure. The result is a tactical medic being assigned to the law enforcement team using one of several models.

In addition, law enforcement is at minimum notifying — or ideally involving — local EMS and hospitals about planned or developing law enforcement operations that have a high risk for injuries, like an active shooter incident. This change has given rise to the rescue task force.

TACTICAL MEDIC VS. RESCUE TASK FORCE
Tactical medics are attached to and considered part of a tactical law enforcement team. Whereas a rescue task force is a trained, but hastily formed group of EMS medical providers (private and/or fire based) that partner with law enforcement on scene. They will enter a newly secured area, such as an active shooter incident, to provide triage, emergent care and casualty extrication.

Both tactical medics and rescue task force (RTF) personnel provide emergent care in less than ideal situations, often under significant stress and in chaotic, sometimes hostile environments. Both work very closely with law enforcement during planning, training and actual events.

Most RTF members are outfitted with ballistic vests and helmets, and likewise, almost without exception, tactical medics are protected with body armor and helmets. Both are specifically trained and equipped to deal with ballistic, blast and other violence-induced trauma.

RTF members wear their usual daily uniform (Fire/ EMS/ law enforcement) and are typically dispatched during their normal shift. Tactical medics wear the uniform of the tactical team they are attached to and are physically located with the team, or just outside of the hot zone.

RESCUE TASK FORCE MEDICS
Historically, EMS providers staged a safe distance away until police methodically secured the scene before permitting EMS to access victims. This practice is being phased out and replaced by the rescue task force, a more patient-centric and life-saving approach.

The RTF should have access to the wounded casualties when the threat has been eliminated, when the shooter is confined to another area, or when the scene has been deemed relatively secure. In the RTF model, providing life-saving interventions is done as soon as possible and is everyone's responsibility. There are four ways to render medical aid in these types of situations.

Bystanders and victims provide care to one another prior to any responder arrival.
Police rapidly extricate and escort victims to a safe area where awaiting EMS provides medical aid.
Police secure the area and provide life-saving interventions at the point of wounding.
Police secure or clear the area and bring in RTF medics under a force protection model.
The RTF focus should be on quick initial medical assessments and to provide life-saving interventions on scene, at the point of wounding or injury. Finding and treating patients should

be done in concert with efforts to extricate victims to a casualty collection point where a secondary triage, treatment and transport can be provided.

The RTF should use a pre-entry checklist to ensure important issues are addressed. The law enforcement job with the RTF is focused on escorting and protecting the medical members.

The RTF concept is becoming more widespread and adopted nationwide. However, fire departments, local EMS providers and law enforcement need to collaboratively train, drill and develop procedures and protocols for this concept to be effective.

TACTICAL MEDICS