Improving global prehospital and emergency medicine, public health, and disaster health care and preparedness

Tactical Emergency Medical Support

Posted by: Joseph Cuthbertson; 4 May 2016; 10:16 pm

The nature and type of risk to responders in both developed and developing countries is evolving and increasing. In the humanitarian setting this has led to programmes such as the “Health care in Danger” (HCID) initiative, intended to raise awareness and concern, and improve field practices and international response to acts of violence towards health care workers.

In other nations the increasing impact of urban violence, illicit drug trafficking, crime and terrorism has resulted in the development and implementation of the subspecialty of Tactical EMS1. Furthermore, whilst this increase has evolved as a global issue the international implementation of Tactical EMS roles has not been explored as such and primarily operates in North American countries.

Designed to provide medical support in high risk environments this skill set is in many ways reflective of origins of Emergency Medical Service from Military Medic models. The role provides medical care and support to responders within the threat area, and has evolved to meet the specific needs of civilian law enforcement2.

Utilising the PPRR Disaster cycle model as framework for assessment, the role of Tactical EMS appears to fit predominantly in the “preparedness” and “response” phase of the available literature3, 4, 5. From a “recovery” viewpoint, the future health impact of these roles on EMS professionals does not appear to have been thoroughly investigated to date.

Collaborative, international research on potential health effects of the role, the effectiveness of Tactical EMS and what prehospital systems are most appropriate for its use are needed to support this speciality as it develops.


  1. Heiskell, L. E., & Carmona, R. H. (1994). Tactical emergency medical services: an emerging subspecialty of emergency medicine. Annals of Emergency Medicine, 23(4), 778-785.
  2. Callaway, D. W., Smith, E. R., Cain, J., Shapiro, G., Burnett, W. T., McKay, S. D., & Mabry, R. (2011). Tactical Emergency Casualty Care (TECC): guidelines for the provision of prehospital trauma care in high threat environments. Journal of Special Operations Medicine, 11(3), 104-122.
  3. Tang, N., & Kelen, G. D. (2007). Role of tactical EMS in support of public safety and the public health response to a hostile mass casualty incident. Disaster Medicine and Public Health Preparedness, 1(S1), S55-S56.
  4. Metzger, J. C., Eastman, A. L., Benitez, F. L., & Pepe, P. E. (2009). The lifesaving potential of specialized on-scene medical support for urban tactical operations. Prehospital Emergency Care, 13(4), 528-531
  5. Jacobs, L. M., Wade, D. S., McSwain, N. E., Butler, F. K., Fabbri, W. P., Eastman, A. L., & Burns, K. J. (2013). The Hartford Consensus: THREAT, a medical disaster preparedness concept. Journal of the American College of Surgeons, 217(5), 947-953.