EMS, Tactical, Personal, Patient, and Team Safety

Article Author:
William Gossman
Article Author:
Obinna Ndum
Article Editor:
Scott Goldstein
7/11/2019 9:16:37 PM
PubMed Link:
EMS, Tactical, Personal, Patient, and Team Safety


Emergency management service (EMS) practitioners must be aware of the many dangers which they will encounter on a daily basis. It is necessary to practice the proper safety measures to keep one's self, the team, and the patients as safe as possible at all times. During tactical EMS, the EMS practitioner has the added responsibility of promoting team and public safety as well as enhancing the probability of special operations mission success. Under this task, they are charged with implementing tactics to protect team members, victims/hostages, bystanders, as well as perpetrators. The pre-mission management of the team may be the most important but also most overlooked aspect of team care.[1][2][3]

Issues of Concern

Pre-mission planning is paramount due to the heightened level of danger faced in a SWAT/combat scenario, and the tactical EMS practitioner must undergo a more detailed level of planning for each situation to maximize safety properly. Pre-mission planning can consist of operational planning, reconnaissance missions, medical intelligence, as well as team education and training. Depending on the time allowed for planning and frequency of mission, planning can be varied. For instance, for team training that occurs regularly and at the same location, a plan can be in place and need not changing except for unprediclable variables such as weather and road closure. This planning is called a medical threat assessment and can provide invaluable information to ppersonneland the team medical provider at a moments notice. Planning also takes into account duration and exposure to the the elements. Needing to know the temperature and duration of exposure can help determine the proper clothing and resusication-type gear that may be needed. If a mission is longer than 24 hours, the tactical medic would need to consider preparing for sleep cycling and chronic medication of personnel.

Even after extensive pre-mission planning, a tactical EMS practitioner must also quickly assess the safety risk and necessary safety measures on the scene before further entry into a possibly dangerous situation. Tactical EMS works in concert with multiple public safety agencies such as the police and fire departments to make these resources readily available. Ensuring the security of the team is a top priority. Quickly assess the scene and determine the need for ancillary services to adequately secure the scene and protect yourself, the team and, the patients.This can range from clearing roads for rapid removal to local jurisdictions being aware of a mission being done as not to confuse the mission with nefarious activity. 

In combat scenarios, where there is imminent danger from possible or confirmed active shooting or a multitude of other threats, the type of care administered is dependent on the level of threat to life currently being faced in your environment. Each team member should have a minimal amount of medical gear on their persons and be well versed in its use and access. The access and use of tourniquets are life-saving and should be on all providers, regardless of the level of involvement in a mission. Having access immediate life-saving equipment (tourniquets, needle decompression, among others) is a paramount and may need to be utilized without the medical provider's involvement since there is usually a limited window for use. This type of planning and training cannot be overlooked, as human life should be one of the top considerations of mission success. 

The first step in the maintenance of safety is always ensuring that the emergency medicine provider professional and their team are wearing the proper protective equipment for the scene or environment they are preparing to encounter. Personal protective gear and scene safety is the mantra of any EMS personal. The difference in the tactical environment is that scene safety is not given, and it is not known to be satisfied. This is the main difference of a tactical medical provider and a routine medical provider. Wearing proper protective gear is important in these situations. In the chaotic environment of pre-hospital care, blood-borne exposure, and injury risks are high. This can be mitigated by wearing the proper combat protective gear for the threat (e.g., body armor) as well as assessing whether environmental factors require other equipment such as gas masks, face masks, or specialized protective clothing. Ensuring team compliance with the proper safety equipment is a major responsibility and will ultimately minimize the safety risks and ensure further success. Pretreatment and planning of proper gear and site location to maximize understanding (for example, difficult terrain, cold weather, snakes) can help ensure a successful mission.

EMS practitioners rely on the use of specialized equipment for assessment, evaluation, and transport of a patient. Ensuring they have the right equipment, the equipment is in proper working order, and that it is readily prepared for use is the EMS leader's responsibility. Within the tactical environment specialized equipment is limited as one does not have an ambulance with equipment and lighting available. All equipment needed needs to be carried and accessible to the medic, which limits usable equipment. The equipment needs to be lightweight, rugged, and easy to use regardless of dexterity and temperature. Every member of the team needs to be trained sufficiently on safe usage of all EMS equipment and all police equipment. A critical skill for the emergency medicine provider is to know how to safety all possible weapons that the team uses in case they encounter them upon treatment.[4][5][6]

Clinical Significance

Upon encountering a patient, the EMS practitioner will assess the patient’s condition, immediate necessary interventions, and the need and ability to extract the patient from the scene for further medical care. If additional equipment, personnel, or resources are deemed necessary, they must attain these items first before proceeding.

To perform the both mentally and physically demanding roles of a tactical EMS practitioner, it is imperative that these people be at their best each day. Maintaining a level of excellence in the workplace is highly dependent on the measures you take to ensure your wellness outside of the work environment. Avoiding practitioner fatigue is necessary to ensure that safety decisions are being made with the highest level of clarity possible.

Taking all the steps discussed here will ensure the safest environment for you, your team and the patient.[7][8][9]


[1] Chiarici A,Serpilli O,Andreolini M,Tedesco S,Pomponio G,Gallo MM,Martini C,Papa R,Coccia M,Ceravolo MG,Andrenelli E, An Early Tailored Approach Is The Key To Effective Rehabilitation In The Intensive Care Unit. Archives of physical medicine and rehabilitation. 2019 Feb 20;     [PubMed PMID: 30796918]
[2] Lumenta DB,Sendlhofer G,Pregartner G,Hart M,Tiefenbacher P,Kamolz LP,Brunner G, Quality of teamwork in multidisciplinary cancer team meetings: A feasibility study. PloS one. 2019;     [PubMed PMID: 30768645]
[3] Koser BW,Lee BH, EMS, Care In A Hostile Environment 2018 Jan;     [PubMed PMID: 30725902]
[4] Clark ST,Meeks RK, EMS, Crash Site Responsibility 2018 Jan;     [PubMed PMID: 30725754]
[5] Lincoln EW,Jarvis JL, EMS, Quality Improvement Programs 2018 Jan;     [PubMed PMID: 30725667]
[6] Byrne JP,Mann NC,Dai M,Mason SA,Karanicolas P,Rizoli S,Nathens AB, Association Between Emergency Medical Service Response Time and Motor Vehicle Crash Mortality in the United States. JAMA surgery. 2019 Feb 6;     [PubMed PMID: 30725080]
[7] Sprague RM,Ashurst JV, EMS, Resuscitation During Contamination While Wearing PPE 2018 Jan;     [PubMed PMID: 30475565]
[8] Eder PA,Reime B,Wurmb T,Kippnich U,Shammas L,Rashid A, Prehospital Telemedical Emergency Management of Severely Injured Trauma Patients. Methods of information in medicine. 2018 Oct 8;     [PubMed PMID: 30296809]
[9] Maguire BJ,Browne M,O'Neill BJ,Dealy MT,Clare D,O'Meara P, International Survey of Violence Against EMS Personnel: Physical Violence Report. Prehospital and disaster medicine. 2018 Oct;     [PubMed PMID: 30379125]