slightly expanded patient population. 5 Patients
treated with TCCC in combat settings were
typically young and healthy.
When a civilian tactical event occurs, the
demographics are much more diverse. Potential patients also include children and elderly,
patients with multiple medications—which
could be blood thinners—as well as other
issues such as federal/civilian legal constraints.
The goal of JHFEMS was to provide
TECC care into a formalized rescue task force
(RTF) program. The RTF concept applies the
TECC protocols in an integrated overall operational group during a larger event.
In this model, after initial law enforcement
efforts have isolated the threat to a hot zone,
a combined EMS and law enforcement team
could enter the warm zone (i.e., an area of
indirect threat requiring protection of caregivers) and begin patient care.
Escorted warm zone care, a key component
of the RTF concept, is based on the idea that
care provided near the point of injury could
rapidly treat the similar type of reversible life
threats identified during wartime. 6
The complex decision-making in each of
these settings can be applied to not only mass
violence events, but can also be used in other
high-risk situations such as hostage barri-
cade situations, emergency ordinance disposals,
Along with operating in the warm zone
to provide “indirect threat care,” the RTF
program also emphasized creating a casu-
alty collection point (CCP), a location used
for assembly, triage, medical stabilization and
subsequent evacuation of casualties.
After Chief Coe outlined the program, the
reception from all the different representatives in the room that afternoon was appreciation and awe.
Law enforcement was particularly grateful, realizing that JHFEMS was now offering
them additional support during active shooter
incidents, serving high-risk warrants and officer rescue scenarios.
“For those willing to put on the hat of tac-
tical EMS, we share a special bond, cut from
the same cloth,” says Teton County Sheriff’s
Sgt. Lloyd Funk, “They have training and
skills that make them an EMT, but they have
something more [internally] that allows them
to venture into harm’s way to use those skills to
help others. I think the perfect phrase would
be ‘angel on my shoulder.’ To know EMS is
closer than ever is very reassuring.”
Now that JHFEMS had all the community
stakeholders on board, Coe was able to move
forward with the next step: TEMS training.
COMMAND & CONTROL
After interest had been gathered from
JHFEMS staff, the first step was to send
two firefighters—Captain Carr and Para-
medic John Tobey—to the U.S. Park Police
and Department of Health and Human
Service’s Counter Narcotics and Terrorism
Operational Medical Support (CONTOMS)
class, a 1-week, 56-hour course that “presents
a nationally standardized curriculum, certi-
fication process, and quality improvement
procedure to meet the needs of those EMTs,
paramedics, and physicians who operate as
part of a law enforcement team.”
Although the CONTOMS course is spe-
cifically designed for tactical EMTs and para-
medics operating in the hot zone and attached
to SWAT teams, it also presented a lot of great
information on working with law enforce-
ment, reading a room, moving through a room,
“clearing” a weapon of bullets, victim carries
and officer rescue scenarios that could benefit
any RTF team providing indirect threat care
in the warm zone. The plan was for Captain
Carr and Paramedic Tobey to bring the les-
sons learned from the CONTOMS course
and then lead training back in Jackson Hole.
Chief Coe, Captain Carr and Dr. Smith also
knew it was time to supplement the training on
paper. They spent countless hours drafting protocols. The components identified for a sustainable TEMS program began with strong medical
oversight, protocols that outlined phases of care,
specialized equipment and organized implementation with TEMS instructors.
The best practices of TCCC and TECC,
as well as other established TEMS programs,
were reviewed and adapted to emphasize
bleeding control with the acronym: XABC
(i.e., exsanguination, airway, breathing and
circulation). Other components of the RTF
and escorted warm zone care were also introduced, such as the creation and implementation of CCPs.
When the training and protocols were
firmly in place, it was time to select the right
equipment to get the job done in a safe, effective manner. The big debate was about what
level of ballistic gear the department wanted.
The department explored various equipment
options and ultimately, decided upon Level 3A,
which is capable of withstanding multiple hits
and is designed to protect against pistol caliber
threats up to . 44 magnum at 1,430 feet per
second or lower, including all lesser pistol calibers. In addition, the Level 3A ballistics gear
Armed police officers provide protection for tactical EMS providers as part of a rescue task force.
Photo David Bowers