is also lightweight and flexible, so it wouldn’t
inhibit the ability of providers to move and
provide patient care within the warm zone.
The department also outfitted RTF providers with individual first aid kits (IFAKs)
stocked with supplies needed for the types of
reversible life threats that might be encountered during warm zone care: tourniquets,
bandages, decompression needles, occlusive
dressings and hemostatic agents.
These kits were standard issue for all
deploying soldiers in Iraq and Afghanistan,
and law enforcement agencies now also issue
IFAKs in many areas of the country.
Emergency Management officials in Pima
County, Ariz., credited several lives saved to
TCCC training and universal deployment of
IFAKs used during the Gabby Gifford shooting in 2011.8, 9
As these kits have been developed and
deployed, training and medical tactics have
also changed. Tourniquets are now recognized
as the first step to controlling severe bleeding.
Nasal pharyngeal airways (NPAs) are issued to
help treat air way compromise. Medical treatments for tension pneumothorax with needle
decompression and chest seals for open chest
wounds also benefit patient care, and are generally standard issue in most IFAKs.
Supplementing the ballistics gear and
IFAKs, the department also created two MCI
support units, along with CCP kits stocked
with enough first aid supplies to treat 50
The TEMS Program at JHFEMS was
moving forward but the two biggest challenges awaited: funding the program and introducing the program to its members, some of
whom were initially reluctant to accept this
paradigm shift, additional risk and adjusted
standard of care.
ADAPTING TO OVERCOME
Implementing a TEMS program proved to
be expensive. The upfront costs for CON-
TOMS training and equipment was pricey
and many of the equipment items, such as
the plates in the ballistic vests, expire after five
years, regardless of whether they’ve been used
or not. Department officials also realized that
they’d hadn’t budgeted for a TEMS program,
so there was an initial lack of funding. How-
ever, by placing the TEMS program under the
umbrella of its Regional Emergency Response
Team (RERT), Chief Coe and his team real-
ized they could apply for a State Homeland
Security Program (SHSP) Grant through
the U.S. Department of Homeland Security.
JHFEMS was awarded the grant, leaving one
last hurdle to implementing the TEMS pro-
gram: getting all the providers on board.
“Initially, some of the leadership and a few
of the providers felt like this wasn’t part of
the job description they signed up for,” Chief
There was also the matter of being a
department made up of both paid staff and
volunteers. Should volunteers be asked to incur
this risk and enter the warm zone?
To address the “Why this?” and “Why
now?” questions of some of the members, Chief
Coe, Captain Carr and Paramedic Tobey reiterated the specifics and safety precautions of
the program—the ballistic gear, the warm zone
and indirect threat care, an armed police officer as force protection, the use of CCPs—and
reminded them that the tactical ballistic protection gear wasn’t because leadership expected
A Fire Chief’s Perspective on Tactical EMS
Before becoming fire chief of Jackson Hole
Fire/EMS, Brady Hansen worked as assistant fire chief in Logan, Utah. Along with
firefighting and EMS, Hansen has extensive experience with hazardous materials
response, SWAT, arson investigation, bomb
mitigation and technical rescue. In this conversation, he gives a fire chief ’s perspective
on why he believes a tactical EMS (TEMS)
program is essential for every community.
Why do you think a TEMS program is
necessary in this day and age?
It’s clearly evident that no community is
immune from the risk of a mass shooting
(or some other form of mass violence). We
all have a need to face the facts and prepare our organizations for this risk. Without preparation, our organizations will be
terribly limited in how we can respond to
provide for our own safety. We also have a
duty to provide care for law enforcement
officers and citizens. If we equip our personnel and train them alongside law enforcement, the outcome for that fateful event will
be immeasurably better for our EMS personnel, law enforcement, and the citizens.
Why do you think it’s important for
EMS providers to incur a bit more
risk to enter the warm zone and treat
We must make every decision with our per-
sonnel safety in mind. However, an active
shooter event could put our EMS personnel
in place where some risk must be taken in
order to gain access to patients who are truly
needing immediate lifesaving care. A review
of the outcomes from active shooter events
show that much faster access to patients
may greatly improve patient survivability.
Not addressing this active shooter scenario, or taking a position that EMS will
stay in the cold zone until the threat is mitigated, actually increases the risk for the victims and for law enforcement. Partnering
with law enforcement to develop a protocol, then training on TEMS, and providing appropriate levels of PPE will improve
outcomes for everyone.
How does having a TEMS program
fit into our model as an all-hazards
We invest a lot of time, money and energy
training on events that we hope will never
happen to our community. However, we
would all be naïve to think that our community is not at risk. We owe it to our personnel
to help them be prepared. As an all-hazards
fire and EMS agency we cannot underestimate the chance that our personnel will
be paged to an active shooter call. Before it
happens we must prepare them.
Any last thoughts?
I remember as a young captain in the mid-
1990s watching the news and commenting
on all the violence, chaos and mass killings
that were taking place in other countries. A
wise fire officer told me then that one day
that similar violence would come to the states.
I can’t say that I entirely believed him. Now,
with hindsight, it seems he is correct. The
preparation we do now to develop protocols
and to train and equip our departments is
preparing for a fast-growing trend of per-son-on-person mass violence. This violence
is not going away. There’s every indication it
is going to get worse. So, we must prepare.