Interesting NAEMSP Abstracts

January 23, 2007

Effectiveness of Tactical Emergency Medical Support (TEMS): A Systematic

Review J. Feldman, Laurie J. on, Schwartz,

Sunnybrook-Osler Centre for Prehospital Care, Toronto, Ontario

Introduction: Tactical law enforcement operations pose an increased risk of

injury or death to civilians and officers. As many as one third of missions

result in injuries. There are no current systematic reviews of the

effectiveness of TEMS. Objective: To systematically review the evidence for

the effectiveness of TEMS on patient outcomes. Methods: Medline (1966-2005)

and EMBASE (1980-2005) were searched for citations indexed using one of the

subject headings " emergency medical services, " " police, " " law enforcement, "

or the keyword " tactical. " Three blinded authors independently conducted a

hierarchical selection based on title and then abstract. Agreement between

reviewers was calculated at each level of the review. In addition, a hand

search of The Tactical Edge, the official publication of the National

Tactical Officers Association, was conducted for 1989-2005 for all articles

on TEMS. Articles were selected for inclusion if they pertained to outcomes,

effectiveness, best practices, or guidelines in civilian TEMS. Results: The

literature search yielded Medline 184 citations and 135 from EMBASE. Of

these, 15 articles were selected for full review. An additional 18 articles

were identified in the hand search. The kappa statistic between the authors

was 0.51 ± 0.03 for titles and 0.63 ± 0.04 for abstracts selected. Study

quality was limited. Only four studies examined outcomes, and none were

randomized or blinded. One evaluated tactical awareness training for

emergency physicians, and three reported outcomes in psychiatric patients to

which police responded. There were three position statements by major U.S.

or international organizations. The remaining articles reported on standard

practices in specific areas of TEMS, team configurations, and training. No

articles specifically addressed tactical considerations for disasters, and

only one discussed issues pertaining to terrorism or hazardous materials

events. DISCUSSION: A large body of TEMS literature exists, which describes

team configuration, training, planning, preventative and emergency care,

communication, weapons safety, specialized equipment, hazardous materials,

terrorism, evidence preservation, considerations for austere environments,

medicine across the barricade, medical intelligence, response to psychiatric

emergencies, and postmission support. Despite this, there is little evidence

on effectiveness of TEMS.

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