Date of Award


Document Type

Honors Thesis (Open Access)


Colby College. Science, Technology and Society Program


James R. Fleming

Second Advisor

Steve Diaz, MD, FACEP, MaineGeneral Medical Center


Violent crime causes death and injury regularly in the United States. Some events such as the Newtown shootings, the Oklahoma City bombings, or the Washington, DC sniper case acutely focus the entire nation’s attention while other, less contemporary events fade away. The public safety apparatus – police, fire, and emergency medical services – always respond to save lives. On December 11, 2012 a man opened fire at a mall in Clackamas County, Oregon. The 9-1-1 dispatchers sent units to a shooting at the mall and then quickly reported that the shooter was still firing in the mall. One of the police officers responded with apprehension in his voice to confirm that he was arriving to an active shooter. Officers next confirmed that the subject was firing with an automatic weapon and wearing body armor. Police established a team to enter the building and a team to secure the perimeter. All of the emergency responders knew they needed medical help at the mall. Ultimately, three people died in this shooting. High-risk incidents like this active shooter incident change standard emergency medical services. Despite the calls coming in from officers about dead and injured people throughout scene, paramedics and emergency medical technicians cannot enter the mall to treat and rescue victims. It takes time to organize teams and to understand the chaos of a major incident especially a tactical incident that can only be entered by highly trained law enforcement officers. Tactical Emergency Medical Support (TEMS) units attempt to hybridize law enforcement and emergency medical services to bring medical care into these types of chaotic situations.

TEMS providers are trained to bring patient care capabilities into the fray of a tactical incident before the scene has been secured. Unlike their colleagues on an ambulance, tactical medics work “during high risk, extended duration and mission-driven law enforcement special operations,”which demand a skill set beyond that of traditional prehospital emergency care. In order to save both law enforcement and civilian lives during violent events such as execution of warrants, hostage situations, and active shooter scenes, public safety officials must implement a standard and functional TEMS curriculum. TEMS training courses have been developed by numerous organizations but no nationally adopted standard and functional TEMS course exists in the United States. Medical and tactical experts have adapted many of the lessons learned from foreign wars and continued violence at home to create usable medical protocols. The curriculum included in this paper combines these findings and conclusions with research on human performance under stress to create an effective tactical emergency medical curriculum designed specifically to meet the needs of the law enforcement community nation-wide.


medical training, emergency medicine, tactical medicine

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