A tactical emergency medical services (TEMS) element was on a hostage rescue call-out when things went bad, very bad. The lead TEMS medic at that time was assigned a role on the rescue team as an armed and fully commissioned operator/medic. (The debate of armed versus unarmed is a whole other can of worms for later discussion.) Upon the emergency rescue, due to the suspect shooting the hostage, the rescue team (including the TEMS medic) was fired upon, and the medic was hit in the neck. Fortunately, his body armor stopped the round in his upper collar. If the bullet had hit a mere 1 mm higher or the medic hadn’t had body armor with an appropriate level of protection, this would have been a very different story.

With the long-overdue acceptance of TEMS as a component of emergency and out-of-hospital medicine, there has been an evolving discussion and debate about the real danger that TEMS providers face and what level of protection should be required. This debate has primarily hinged on the issue of costs associated with providing expensive protective equipment to TEMS providers and Rescue Task Force (RTF) personnel. While there is no specific limit to funding issued regarding personal protective equipment, just like with any other entity, the bottom dollar and cost association is often a driving factor in the upstart and/or continuation of the TEMS and RTF units. Included in this debate is the discussion of the threat facing medical providers on active-shooter response teams or RTF teams and the threat to TEMS personnel supporting tactical teams.

A tactical physician works with a police officer during a potentially dangerous encounter.

First, one must realize that TEMS is a very different animal than a RTF. Yes, there is overlap between the two. However, they are not one and the same. For example, RTFs have little to do with high-risk warrant service, hostage rescue, or barricaded subjects; they specifically deal in active-shooter response only. These concepts have evolved to minimize delays in immediate lifesaving medical care provided to victims in active-shooter events, particularly those with the top-three causes of preventable death in penetrating trauma (hemorrhage, tension pneumothorax, and airway compromise).¹ Conversely, TEMS units are not unique to active-shooter events only, and TEMS personnel may not even be among the first arriving responders in an active-shooter event. (Most events are over prior to SWAT’s arrival.)² RTF personnel are composed of traditional EMS and fire personnel escorted by a force protection element of law enforcement personnel. TEMS units, on the other hand, are composed of EMS and fire personnel trained above and beyond the traditional EMT and paramedic curricula and are integrated with tactical teams specifically. While TEMS elements may be included on RTF teams, the teams do not depend on general TEMS personnel/training specifically. Therefore, to assume that TEMS units and RTFs are one and the same, and thus the risk and danger involved in each is the same, is a misunderstanding of the two concepts.