Resident And Faculty Involvement In Tactical Emergency Medical Support: A Survey Of U.S. Emergency Medicine Residency Programs

摘要

Introduction: Tactical Emergency Medical Support (TEMS) is defined as "comprehensive out-of-hospital medical support of law enforcement tactical teams during training and special operations," We attempted to determine faculty and resident physician involvement with TEMS at U.S. E.M. residencies. Methods: A 12 question email-based survey was sent to all 126 accredited E.M. Response data was analyzed using descriptive statistics. Results: 82 programs replied to the email survey, for a response rate of 65%. Of these 51% and 28% reported faculty and resident involvement with TEMS respectively. 37% of TEMS-affiliated programs reported using TEMS opportunities as a residency-recruitment tool. Nine programs expressed an interest in developing TEMS opportunities within their residencies within the next 1 - 3 years. The most frequently cited advantages of TEMS exposure were community service, improved interactions with law enforcement, and expanded educational opportunities within emergency medicine. The most frequently cited disadvantages were time commitments, expense, and the hazardous nature of TEMS. Several program directors responded that TEMS offered no advantages, and one felt that TEMS conflicted with "sound physician ethics." Conclusions: More than half of responding programs report current faculty involvement in TEMS, and another 11% expressed interest in developing TEMS at their institutions. As such, it appears that resident education opportunities in TEMS will continue to increase. However, it is clear even within the respondents that strong negative feelings exist towards TEMS. Abstract Presented at the 2004 BTLS International Trauma Conference. Chicago IL October 2004. Introduction The origins of modern tactical emergency care arguably date back to 1792 and the work of Baron Dominique Jean Larrey, Surgeon-General to Napoleon's Army of the Rhine [1]. In addition to developing the guiding principles of modern field triage, Larrey developed a dedicated corps to treat and evacuate casualties during battle. At Konigsberg, Larrey personally led the ambulance volantes into the field. Unfortunately, this innovative approach was not adopted in the United States, and in 1862, approximately 3000 wounded troops were left untreated for 3 days during the second battle of Bull Run [1].By Vietnam, the concept of casualty care under fire and rapid evacuation and resuscitation, coupled with appropriate field triage, help reduce mortality rates to 1%, down from 4.7% in World War 2 [2]. Despite both advances in military casualty care and the development of civilian law enforcement tactical units, little thought was provided towards dedicated medical care under fire in the civilian setting. In a survey of special weapons and tactics (SWAT) teams operating in the 200 largest U.S. metropolitan areas, 69% of unit commanders indicated that casualty care was managed by civilian ambulance crews on stand-by in a secure location [3]. In 94% of cases, prehospital care providers had no specialty training and were unable to enter the so-called “hot-zone”. During the Columbine tragedy, tactical operators were forced to extract victims to a more secure location for EMS triage and treatment [4]. Tactical emergency medical support (TEMS) has been defined as “comprehensive out-of-hospital medical support of law enforcement tactical teams during training and special operations” [5]. The first formal TEMS training course was held in 1989, and co-sponsored by the Los Angeles Sheriff's Department and the National Tactical Officer's Association [6]. Since that time, there has been a tremendous growth in the field, including the development of the Department of Defense-endorsed Counter Narcotics Tactical Operations Medical Support Program (CONTOMS), numerous private TEMS training programs at the national and international levels, and the development of the emergency medical technician – tactical (EMT-T) standard [7,8,9,10]. TEMS has become an integrated aspect o