providers to receive fire, but due to the nature
of the incident.
“We reminded them that our priorities were
safety first, action second and everyone goes
home,” adds Captain Carr.
When the paid staff got more comfortable
with TEMS theory and the equipment, everyone signed on. They didn’t mind the additional
risk if it meant better serving the community and saving lives. As for the volunteers, the
leadership at JHFEMS decided they wouldn’t
initially ask them to be part of an RTF that
made entry. However, they would train volunteers to play a key role during these incidents
by setting up and running a CCP along with
triaging patients, providing care and transport.
Within months, the first tactical EMS team
in the state of Wyoming was fully operational
and JHFEMS personnel was back at the middle school for an all-department MCI training.
There were both paid firefighters and volunteers in attendance, along with personnel
from Grand Teton National Park, the sheriff’s
office, police department, as well as dozens of
children and adults who had volunteered to
act as moulaged, mock patients.
When Chief Coe announced over the radio
for the training to begin, dozens of emergency
vehicles pulled into the school parking lot with
their lights flashing. Although the agency names
and badges were different, on that afternoon,
they became a rescue task force (RTF), with
one team and one mission: to save lives.
In the ensuing years, the TEMS program at
JHFEMS has continued to grow. Ongoing
updates to the program have kept pace with
the recommendations from the Committee
Many of the changes have mirrored the
evolving TCCC recommendations, including
administration of ketamine for sub-dissociative
pain dosing and chemical restraint for excited
The department added prehospital administration of tranexamic acid (TXA) for a
patient suffering from a serious hemorrhage.
Conversion guidelines for extended tourniquet
use have also been developed for prolonged
field care situations and the TEMS instructors are also encouraged to integrate more
complex scenarios after the initial training
to better approximate real-world situations.
The department has also worked hard to
keep everyone at the same heightened level
of preparedness for one of these “high-risk,
low-frequency” events by having large scenarios
in July and December (when school children
are on break) and training frequently throughout the year in: 1) bleeding control (
tourniquet use, wound packing, pressure dressings);
2) penetrating chest trauma, (needle decompression, chest seals); 3) IFAK check; and 4)
protocol review. Having mastered the setting
up and implementation of a CCP, many volunteers are now interested in serving their community to the fullest extent by getting RTF
training to operate in the warm zone.
“Our folks have been incredibly willing to
look at it from a practical point of view; there
are so many lives we could potentially be saving,” Chief Coe says. “We’re going to take the
appropriate amount of risk to save as many
lives as we can.” JEMS
Will Smith, MD, NRP, FAWM, is the physician medical director for Jackson Hole ( Wyo.) Fire/EMS. He’s a clinical assistant
professor for the University of Washington School of Medicine’s WWAMI regional medical educational program, is the
medical director for the U.S. National Park Service and runs
Wilderness & Emergency Medicine Consulting LLC. Visit him
Kevin Grange, EM T-P, is a firefighter paramedic with Jackson
Hole Fire/EMS and author of Lights and Sirens: The Education of
a Paramedic. Visit him at www.kevingrange.com.
Learn more from Will Smith and Kevin
Grange at the EMS Today Conference, Feb.
21–23 in Charlotte, N.C. EMSToday.com
1. Smith WR. Integration of tactical EMS in the National Park Service. Wilderness Environ Med. 2017; 28(2S):S146–S153.
2. Prepared for anything: EMS response to tactical and active shooter
threats (abstract). (April 2016.) International Association of Fire
Chiefs. Retrieved Nov. 27, 2017, from www.iafc.org/topics-and-tools/resources/resource/prepare-for-anything-ems-response-to-tactical-active-shooter-threats—(abstract).
3. Firefighters Support Foundation Inc. (n.d.) Fire Engineering.
Retrieved Nov. 27, 2017, from www.fireengineering.com/
4. Holcomb JB, Stansbury LG, Champion HR, et al. Understanding
combat casualty care statistics. J Trauma. 2006; 60( 2):397–401.
5. Overview. (n.d.) Committee for Tactical Emergency Casualty Care.
Retrieved Nov. 27, 2016, from www.c-tecc.org/about/overview.
6. Smith ER, Shapiro GL, Callaway DW: Integrated response to terrorist attacks. In Cittone GR, editor, Cittone’s Disaster Medicine,
2nd edition. Elsevier: Philadelphia, pp. 407–415, 2016.
7. Counter narcotics and terrorism operational medical support
(CON TOMS). (n.d.) National Park Service. Retrieved Nov. 27,
2017, from www.nps.gov/subjects/uspp/contoms.htm.
8. KleinmanD,Kastre T.Beyondthetape:Lawenforcementofficersmake
major impact as initial care providers. JEMS. 2012; 37( 5): 38–40.
9. Somashekhar S, Hor witz S. (Jan. 21, 2011.) First-aid kits credited with saving lives in Tucson shooting. The Washington Post.
Retrieved Nov. 27, 2017, from www.washingtonpost.com/
Rescue task force EMS providers don ballistic protection gear not because they’re expected to receive fire, but
due to the potential danger of treating patients in the warm zone and extricating them to casualty collection
points to receive definitive care. Photo David Bowers