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TACTICAL EMS PROTOCOLS TACTICAL SUPPORTIVE CARE A supportive care protocol should be adopted by any agency operating in the tactical environment. This protocol should address topics such resuscitation decision-making, the concept of remote assessment, the challenges of triage and the dangers of introducing oxygen into the tactical environment. It is important to address here the impracticality of spinal motion restriction (SMR) during most phases of TCCC and the opinion that SMR is not necessary for penetrating trauma.10 Cardiopulmonary resuscitation: Performing cardiopulmonary resuscita- tion (CPR) in the tactical environment is likely not to be practical. This must be evaluated on an individual basis while giving consideration to the avail- able resources and access to definitive care. It is, however, widely accepted that battlefield victims with explosive trauma or other penetrating trauma with no signs of life should not be subjected to resus- citation attempts.10 Remote assessment: The tactical environment has many inherent chal- lenges for the tactical medic. Effective incoming fire may prevent the tactical medic from reaching the patient, and thus the tactical medic may need to assess a potential patient and determine the patient's viability from a distance.2 This concept, known as remote assess- ment, may be accomplished with the use of binoculars, spotting scopes, rifle scopes or night-vision goggles. It may also be necessary for the tactical medic to coordinate with negotiators during a hostage situation involving sick or injured hostages.2 Triage: Tactical operations have the potential to involve a significant number of casualties. The process of sorting through these casualties and quickly determining the extent of their injuries is known as triage. The goal of this process is to do the greatest good for the greatest number of people. In the tactical setting, this process might be complicated by the need to extract patients from an area where care cannot be safely rendered.17 Tactical situations have the poten- tial to become mass casualty incidents (MCIs) but local resources may be able to mitigate the situation. This was the case at the Columbine school shooting. While there were a great number of patients to be triaged, there were adequate resources available to treat and transport the injured.18 Oxygen: Oxygen may be an essential therapy in conventional EMS, but it has very little use in the tactical environment. Among the dangers is the risk of explo- sion of an oxygen cylinder if struck by a bullet. For this reason, oxygen should remain in the cold zone.19 ;OPUR -HZ[ *90;0*(3 05-694(;065 (; @6<9 -05.,9;07: ;HSR [V \Z MHJLIVVR JVT PUMVYTLKW\ISPZOPUN [^P[[LY JVT PUMVYTLKN\PKLZ 05-694,+ 76*2,; .<0+,:! -,+,9(3 4,+0*(3 PUMVYTLKN\PKLZ JVT 8\HU[P[` WYPJPUN H]HPSHISL -09, 7630*, ,QIRUPHG *XLGHV $OO ULJKWV UHVHUYHG L3KRQH LV D UHJLVWHUHG WUDGHPDUN RI $SSOH ,QF UHJLVWHUHG LQ WKH 8 6 DQG RWKHU FRXQWULHV For More Information Circle 14 on Reader Service Card 28 FEBRUARY 2012 | EMSWORLD.com