Inclusion of Tactical Emergency Medical Support (TEMS) in Tactical Law Enforcement Operations

The NTOA endorses and supports the incorporation of a well-trained and equipped Tactical Emergency Medical Support (TEMS) element into all tactical teams. Tactical Emergency Medical Support is the provision of preventative, urgent and emergent medical care during high-risk, extended duration, and mission-driven law enforcement special operations. The ability of TEMS providers to develop medical threat assessments, render immediate medical care in austere environments and provide logistical support will further the health and safety of law enforcement personnel and reduce the incidence of injury, illness, disability and death associated with training and tactical operations. Therefore, the NTOA recommends the following:

1. TEMS should be provided by specially-trained pre-hospital emergency care providers operating within state and local EMS guidelines. Law enforcement agencies should request that EMS jurisdictions develop advanced scope of practice guidelines for use by TEMS providers.

2. The TEMS element should function at the advanced life support (ALS) level of care. If ALS services are unavailable, then TEMS should be provided at the highest level of care feasible.

3. A designated physician Medical Director with tactical knowledge and training should oversee a TEMS program. This Medical Director should oversee training, operational medical procedures and the quality assurance program.

4. TEMS providers should undergo a formal training program in supporting law enforcement operations and trained providers should be required to undergo periodic retraining and skills reviews. This training should include, but not be limited to, tactical methods, techniques, equipment, tactical casualty care and casualty extraction.

5. Once TEMS providers are fully trained and tactically operational, the ultimate goal should be that TEMS providers are deployed within the operational perimeter in proximity to tactical operations. Doing so permits rapid access to casualties, the opportunity to provide medical countermeasures, and enables TEMS providers to make recommendations to team leaders.

6. TEMS personnel should operate under written policies and procedures that address the selection and training of TEMS personnel, the chain of tactical medical command and operational guidelines.

7. The effectiveness of a TEMS program requires its providers to be highly proficient in their medical and decision-making skills. To maintain levels of proficiency required of TEMS providers, they must have ongoing experience as field EMS providers.

8. Law enforcement agencies should provide TEMS providers with protections against civil liability, as well as compensation for work-related injury.

9. TEMS providers should serve as the consultants to commanders on matters of team health and safety and serve as the liaison between law enforcement operations and local health care providers. Further, the duties of the TEMS provider may also include nutrition, safety issues and maintenance of team health records, including immunizations.

In the Spring 1994 issue of The Tactical Edge, NTOA published, "Position Statement on the Inclusion of Physicians in Tactical Law Enforcement Operations in the USA." This Position Statement is the final version of that original document.