Learning How to Provide Tactical Medical Support Under Fire

At 8:16 a.m. on 16 September 2013, a shot was fired (the first of many) in Building 197 of the Washington Navy Yard. During the next 69 minutes, while at least 117 officers from eight law enforcement agencies attempt to neutralize the threat, two U.S. Park Police tactical medics and a Navy surgeon triage and treat the wounded.

In 1989, the U.S. Park Police (USPP) and the Casualty Care Research Center (CCRC) in the U.S. Department of Defense founded the Counter-Narcotics and Terrorism Operational Medical Support (CONTOMS) Program based on the recognition that:

“Law enforcement and the military needed tactical medical support of special operations to enhance mission success. Most emergency medical services (EMS) systems in the United States and abroad can handle individual patients in controlled situations but in some locales, local emergency medical technicians have been pressed into service to support counter terrorism, drug interdiction and other law enforcement activities without any additional training. These activities are specialized in nature; characterized by prolonged operations, organized opposing forces, use of military-type weapons, and increasing death and injury among law enforcement officers, perpetrators and innocent citizens.”

Medical Training for the “Hot Zone”

This specialized medical training has been termed “tactical emergency medical support” (TEMS). TEMS is widely known as an established sub-specialty of pre-hospital care and emergency medicine. The military and the civilian law enforcement community work in cyclic rotations to define and develop the wounding trends and medical needs of soldiers and police officers, respectively. The military makes strides in medical care during times of war, then civilian law enforcement agencies refine these lessons learned to apply to care in the street.

For a number of years, medics specially trained to work in the “hot zone” – the most dangerous area during an active incident – have effectively supported specialized response or SWAT teams. Indeed, the ability to provide SWAT teams with medical care in the hot zone has grown exponentially over the last 25 years. However, with the current trends in active threats, law enforcement officers are finding that these specialized teams are typically not the first officers on the scene. This realization was highlighted during the September 2013 incident at the Washington Navy Yard. In that active shooter incident, a USPP patrolman who had been trained in basic TEMS tactics administered lifesaving care to one of the survivors of the shooting.

With the growing number of active shooter incidents, the CONTOMS Program (now a co-sponsorship between USPP, U.S. Health and Human Services, and the Chesapeake Health Education Program) has expanded to include TEMS training for the frontline law enforcement officers as well. Members of the USPP patrol force have received basic TEMS training, as well as medical “go bags” to be able to handle casualties encountered in active shooter situations. During an incident, USPP officers may find themselves in the hot zone as the only responders able to provide care to victims, since EMS responders typically must wait on the perimeter until the scene is secure.

Ensuring Officers’ Safe Return Home

This incorporation of TEMS has become a force multiplier for the USPP and a proven lifesaver. It has been learned through past events that approximately 20 percent of those wounded by penetrating trauma die from readily treatable causes. The Number 1 cause of preventable death is exsanguinating hemorrhage. One basic tool given to these officers is a tourniquet. On several instances after teaching officers the proper technique in tourniquet application, they have put it to use effectively and without issue. By setting up the go bags in a similar fashion and having them in a consistent area on the officer’s person, each officer knows where to find the lifesaving gear in a stressful environment.

By providing street officers with an additional tool in their toolkit, TEMS puts additional caregivers in the fight that would not normally be there. Although it is understood that the main goal of the law enforcement operators is to stop the threat, those officers who are in the fight also have the ability to provide “buddy care” for fellow officers who may become injured. The ultimate goal of this TEMS initiative is to ensure that all officers go home safely each night to their families.

For more information about the USPP TEMS Training or CONTOMS Program, visit the website at http://www.nps.gov/uspp, click on CONTOMS.

Philip J. Beck

Captain Philip Beck has been with the U.S. Park Police since December of 1988. He has served in many roles to include detective sergeant, SWAT/K9 commander, central station patrol commander, and watch commander. Along with these responsibilities, he has developed and presented a course on active shooter for civilian employees and is a principal instructor for the CONTOMS (Counter Narcotics & Terrorism Operational Medical Support) Tactical Medical Training Program. He revamped the U.S. Park Police policy on mass arrests, now commonly referred to as high-volume arrests, to ensure compliance with the law and a person’s ability to exercise their First Amendment rights.



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