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t 0430 hours we meet at the station to check and double-check all our equipment, including our tactical gear. Our PPE is loaded: ballistic vests with gear attached—not with weapons, but with life- saving tactical medical gear at the ready. EMS, fre and police radios are included. We drive to the briefing location and join the SWAT team to review elements of the incident action plan (IAP). The IAP discloses all the potential dangers of the operation (e.g., guns, drugs, gang suspects or all three), and the tactics the team plans to use. As medics, we factor in which hospitals, trauma centers and landing zones can be utilized given the location of the operation. Two of us roll to the operation location with the SWAT team in the armored response vehicle (ARV), while the third medic follows in the ambulance as part of the caravan. Our primary purpose is to ensure the operators are safe given all the potential dangers. On site, medics stay in the ARV and the team makes entry. We follow the operation on the radio for possible problems. We are prepared, but this operation, like most, lasts about 10 minutes with no injuries and suspects detained. In every opera - tion there is always the potential for significant combat-type injuries, but the immediate presence of tactical medics allows for the best chance of survival to every member of the operation. Tactical paramedicine is certainly not new, especially in California. Going back to the 1970s, the Los Angeles County Sheriff's tactical team included law enforcement paramedics on their full-time team. However, tactical para - medicine has come more into promi- nence over the last decade, especially from paramedics and other emergency responders outside of law enforcement. This progress has been bolstered by evidence-based advances in tactical emergency casualty care born out of a decade of combat, as well as the estab - lishment of guidelines for scope of prac- tice and initial and continuing education in this specialized area. Through the hard work of schools like the International School of Tactical Medicine (ISTM) and organizations like the Committee for Tactical Emergency Casualty Care (C-TECC), tactical medi- cine has been greatly advanced and made more readily available to emer- gency care providers. The result is that across the country, highly trained para - medics, EMTs, RNs, MDs and PAs are supporting tactical teams. The San Mateo County Tactical Emergency Medical Services (TEMS) team is a unique and highly trained group comprised of responders from both the local private ambulance service, American Medical Response (AMR), and the fire departments of San Mateo County, CA. The team serves and responds with the county's four SWAT teams and its Terrorism Counter Assault Team (TCAT). The 20 paramedics and PartnEring UP for a tactical response Although the consolidation was seamless, the joint team is not without challenges 38 May 2014 | EMSWORLD.com