In this issue of Wilderness & Environmental Medicine, an article by Warden et al1 provides a timely overview of various specialized operational emergency medical service (EMS) programs that serve in either tactical, hazardous, or austere environments as part of the entry level medical care in the US health care system. These specialized EMS programs function in unique environments and provide, in most cases, point of injury medical care beyond what can be provided by traditional EMS agencies. These programs include classic programs in rural and wilderness settings, for example, ski patrol, water rescue, and wilderness search and rescue (SAR).
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