Tactical EMS

PRESENTATION

Muhammad Afif bin Nordin

Muhammad Zahid bin Sapie
Haikal Huzaifi bin Zulkefli
Jeyakuhan a/l Jeyraman
Mohamad Aidie bin Salleh
 TACTICAL

1 2 3
Disaster Civillian Military
Disaster Field Tactical Emergency Tactical Combat Casualty
Casualty Care (TECC) Care (TCCC)
 Tactical

Tactical military operations or weapons are used to achieve specific goals.

Relating to the methods used to achieve a particular result.
https://dictionary.cambridge.org/dictionary/english/tactical

Tactical Medicine, or Tactical Emergency Medicine, is the medical specialty that

involve the services and emergency medical support necessary to preserve the safety,
physical and mental health, and overall well-being of military and law enforcement
(SWAT) special operations (tactical) personnel and others at the scene of critical
incident deployments and training.
Datuk Dr. Mohamed Alwi bin Hj. Abdul Rahman
Disaster Management Consultant
 Disaster

D NEW UPDATE
TLS

Medical
R
HAEMORRHAGIC
CONTROL FIRST

A
B
C
 Tactical

Tactical Emergency Tactical Combat

Casualty Care Casualty Care
(TECC) (TCCC)

involve civillian military / team

have 3 position can carry weapon
-child (to protect
-geriatric yourself)
-pregnant woman
 Tactical

TCCC TECC

Medical
 THE THREE OBJECTIVES OF TCCC/ TECC

Treat the Prevent Complete the

casualty additional mission
casualties
 Principles and Application

M
Item 1
MASSIVE BLEEDING
1ST
PRIORITY
P PAIN

A
100%

Item 1
100%

A
AIRWAY
Item 1
ANTIBIOTICS

R
100%

Item 1
100%

RESPIRATION
Item 1

W WOUNDS
C
100%

CIRCULATION Item 1
100%

Item 1

S
H
100%

HYPOTHERMIA / SPLINTING
HEAD INJURIES
Item 1
100%

Item 1
100%
 TCCC PHASE OF TECC

CARE UNDER FIRE (CUF) / DIRECT THREAT / HOT ZONE

THREAT CARE
1 Return fire and take cover 1 Minimize public harm

TACTICAL FIELD CARE INDIRECT THREAT / WARM

2 (TFC)
Work under cover and concealment
2 ZONE CARE
Stabilize the casualty as required

TACTICAL EVACUATION EVACUATION (EVAC) /

3 CARE (TACEVAC)
More deliberate assesment and pre-
3 COLD ZONE CARE
Provide rapid and secure extraction to a
evacuation procedures. appropriate level of care
OUR ROLE
TECC
 Direct
Threat Care (DTC) / Hot Zone Care

Principles
1. Establish tactical supremacy and defer in depth medical
interventions if engaged in ongoing direct threat (e.g. active fire
fight, unstable building collapse, dynamic post-explosive scenario,
Tourniquet application
etc.).
2. Threat mitigation techniques will minimize risk to casualties and
the providers. These should include techniques and tools for rapid
casualty access and egress.
3. Triage should be deferred to a later phase of care. Prioritization
Tactical casualty movement
for extraction is and extraction
4. based on resources available and the tactical situation.
5. Minimal trauma interventions are warranted.
6. Consider hemorrhage control
a. TQ application is the primary “medical” intervention to be
considered in Direct Threat.
Rapid placement in recover
b. Consider instructing casualty to apply direct pressure to the position
wound if no tourniquet available or application is not tactically
feasible.
7. Consider quickly placing or directing casualty to be placed in
position to protect airway.
 Indirect
Threat Care (ITC) / Warm Zone Care
Principles Hemorrhage Control
1. Maintain tactical supremacy and complete the overall mission.
2. As applicable, ensure safety of both first responders and casualties by
rendering Airway
3. weapons safe and/or rendering any adjunct tactical gear safe for handling
(flash
4. bangs, gas canisters, etc).
5. Conduct dedicated patient assessment and initiate appropriate life-saving
Breathing
6. interventions as outlined in the ITC guidelines. DO NOT DELAY casualty
7. extraction/evacuation for non life-saving interventions.
8. Consider establishing a casualty collection point if multiple casualties are Circulation
9. encountered
10. Unless in a fixed casualty collection point, triage in this phase of care
should be
11. limited to the following categories:
Wound management
a. Uninjured and/or capable of self-extraction
b. Deceased / expectant Prepare Casualty for
c. All others
12. Establish communication with the tactical and/or command element and Evacuation
request or verify initiation of casualty extraction/evacuation.
Perform Hasty Decontamination
13. Prepare casualties for extraction and document care rendered for Other Skills Initiate Casualty Monitoring
continuity of care purposes. Establish Casualty Collection Point
 Evacuation (EVAC) / Cold Zone Care

Principles
1. Reassess the casualty or casualties. Familiarization with
2. Utilize a triage system/criteria per local advanced monitoring
policy that considers priority AND techniques
destination.
3. Utilize additional resources to maximize
advanced care.
Familiarization with
4. Avoid hypothermia. transfusion protocols
5. Communication is critical, especially
between tactical and non-tactical EMS
teams. 6.Maintain situational awareness- In
Ventilator and advanced
dynamic events, there are NO threat free airway management
area
(e.g. green or cold zone)
OUR ROLE
TCCC
CMC: Combat Medic / Corpsman
At least:
Individual First Aid Kit (IFAK)

ONLY FOR
HIS/HER
SELF
Massive Bleeding Kit SKID BOARD
STRETCHER
 In TECC

DIRECT INDIRECT
PHASE PHASE
Trauma Beg
 Disaster TCCC TECC

Between Green &

Zone Red Zone Red Zone
Yellow Zone

IFAK & Massive IFAK & Massive

Equipment Setup Medical Camp
Bleeding Kit Bleeding Kit

Type 1-3 Based on At least Bullet proof At least Bullet proof

PPE
disaster vest & helmet vest & helmet

can carry weapon

Weapon can't carry weapon can't carry weapon
(just for protection)

Victims Civillian Military Civillian

Principle RPM / DRABC MARCH / PAW MARCH / PAW

ANY QUESTIONS?
THANK YOU
 Referrence
Committee on Tactical Combat Casualty Care (CoTCCC)

Committee Tactical Emergency Casualty Care (C-TECC)

https://dictionary.cambridge.org/dictionary/english/tactical

Datuk Dr. Mohamed Alwi bin Hj. Abdul Rahman

Disaster Management Consultant