Announcements
The Tactical Medical Operators Group (TMOG) wants to keep you informed about our activities and those we are aware of. Training opportunities are listed on the training page. If you know of any activities relevant to tactical medicine please let us know so that we may post them. If you are interested in any of these opportunities and would like more information please let us know.
Next Training Opportunity
- EMS for the Operator
Date: 26 October 2004
Place: FBI Range and class room located at MHP Training academy.
Time: 0800-1700
This class is for Law Enforcement Officers and will provide them with basic EMS skills.
 Patches Available!
- Mike Ellis has TMOG patches
Contact him for details or come to the next meeting
Email: pres@tmog.org
TMOG Update
TEMS is moving fast and there is much to do. We are poised to step in and make some significant contributions. I want to cover several key things that have happened during the last part of this year and discuss our next meeting.
[1] ACEP TEMS Section
This year the American College of Emergency Physicians recognized TEMS by creating and sanctioning a section dedicated to TEMS. Todd Carlson and Karle Kelly head up the new section. Its first meeting was in Boston in October. Dr. Croushorn serves as the communications officer for the section . A lot of interest has been created within ACEP simply from the creation of the Section.
[2] SOMA officially pursues TEMS
This year's Special Operations Medical Association meeting in Tampa, FL was great. The Association officially made a tie between the civilian TEMS community and the SOF community by electing a civilian TEMS person as Vice President of the Association. Additionally a full day breakout session for TEMS was organized. Direct support of TEMS will be pursued by SOMA although that has not been further specified at this point.
[3] Research from Military SOF Medics in OEF and OIF
A lot has come out of the recent activity in Afganistan (Op Enduring Freedom - OEF) and Iraq (Op Iraqi Freedom - OIF). This is being presented at meetings and research is being published. There are several things that have already impacted civilian TEMS.
TRAUMA PILL PACK: Each SOF operator will soon be given a pill pack containing 4 pills: Gatofloxicin, Compazine, Tylenol 1g, and Vioxx 50mg. If they become wounded they take all four, often before a medic reaches them. For penetrating trauma they instantly have rec'd the equivalent of preop antibiotics, antiemetic and initial pain control. This was deployed in Iraq with a great deal of success. It was not effective pain control for Blunt injuries (i.e. broken ankles on parachute drops) but it was very effective for mild penetrating injuries.
HEMOSTATIC DRESSINGS: USASOC explored several new battlefield dressings. The two that have come out on top and are able to stop arterial bleeding are the chitosan dressing and Quick Clot. If you are interested in reading more about them take a look at the following links:
http://www.armymedicine.army.mil/news/mercury/03-05/chitosan.htm
http://www.ariastechltd.com/arias_tech_english/quikclot/index.htm
FBI HRT is now using QuickClot exclusively. Army SpecOps is sold on the Chitosan dressing. The Navy/Marine Corps is going with QuickClot. The Air Force...well they don't get hurt so they didn't need anything... ;-) he, he. Just kidding...the PJ's have used both from what I'm told.
REGIONAL BLOCKS WORK: Marcaine regional blocks... DOCUMENT NEUROVASCULAR EXAM - median nerve - femoral block - axillary - ankle block (50-75% best rate). This provides use of an injured extremity without pain for 6-9 hours. This is something we need to push for training. I'm looking into ways of getting this education out. This was a big plus in OIF and OEF SOF ops.
FENTANYL LOLLIPOPS: This was extremely effective for non-complicated extremity trauma, but it will probably a while before it is integrated into TEMS. Unless extraction is likely to be greatly delayed the use of this in our setting is not as practical.
[3] Topics in Emergency Medicine Vol.25 No.4
Last but by no means least. I have been working with Rich Carmona and we have finally released the first collection of peer-reviewed medical literature dedicated to TEMS. It was 10 articles in an issue of Topics of Emergency Medicine dedicated to TEMS.
The following was an email I sent to the newly formed ACEP TEMS section:
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I wanted to announce a project that several in our section have been apart of for the last year. After much hard work it is now published. It is an Issue of Topics in Emergency Medicine dedicated to TEMS. It is Volume 25/Number 4. It should be shipping out to subscribers this week. The authors received the first copies a few days ago. I will be at SOMA next week and will bring a couple of copies with me if anyone would like to see it. The contents are as follows:
Contents
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Tactical Emergency Medical Support Introduction
Issue Editors: John Croushorn, MD, and Richard H. Carmona, MD, MPH, FACS
The Antecedents of Tactical Emergency Medical Support: A Personal Perspective
Col Craig H. Llewellyn, MD, MPH, MS, FACPM, MC, USA (Retired)
The History and Evolution of Tactical Emergency Medical Support and Its Impact on Public Safety
Richard H. Carmona, MD, MPH, FACS
Developing a Tactical Emergency Medical Support Program
Joshua S. Vayer, BA, and Richard B. Schwartz, MD, FACEP
The Role of Preventive Medicine in TEMS
Joseph J. Heck, DO, FACOEP, FACEP
The Clinical Practice of Tactical Medicine and Care Under Fire: Medical Decision Making and the Role of the Tactical Emergency Medical Support Provider
David J. Rathbun
Patterns of Injury, Recognition, and Treatment for Less Lethal Law Enforcement Techniques
Lt Don Kester, and Major Steve Ijames
Medical Direction and Integration With Existing EMS Infrastructure
Nelson Tang, MD, FACEP, and William Fabbri, MD, FACEP
Operational Planning for the Law Enforcement Medic
Frederick L. Dressler, EMT-I/T
Future Technologies and Strategies for Operational and Disaster Medicine
Col Anthony M. Rizzo, MD, USAF, MC, SFS
Controversies in Tactical Emergency Medical Support
Richard H. Carmona, MD, MPH, FACS
Copies can be obtained through Lipincott Wilkins and Williams. Their editor forwarded the following to me for interested individuals:
"Our customer service number is 1-800-638-3030. A single copy may be
purchased there as a 'book' for $49. If you know of larger orders (such as
your own) forward them to me (bguthy@lww.com) and I can quote special
prices. LWW.com also carries a list of single copy issues for sale under
the journals button. Thank you!"
This was shared both at ACEP and at SOMA and the response has been tremendous. A text book is in discussion at this time.
...and just to prove I'm not making this up...he really is a great man. It has been reported that he is the second most requested speaker in the nation. He is only behind the president in this regard. He rec's on average 700-1100 requests a month to speak.
One recent success in TMOG sponsored training activities was the NTOA Basic TEMS course. This was put on by Dr Rich Carmona, a physician at the heart of the TEMS movement for nearly 20 years. He brought a team of operators from Pima County S.O. and L.A. County SWAT. They covered the BASIC TEMS curriculum being taught throughout the nation. It was sponsored in part by FBI SWAT Jackson Division and was held at their range facilities.
Stay tuned for more TMOG announcements.
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