title: Integrated model for providing tactical emergency medicine support (TEMS): analysis of 120 tactical situations.
abstract: BACKGROUND
  Various models for organising tactical emergency medicine support (TEMS) in law enforcement operations exist. In Helsinki, TEMS is organised as an integral part of emergency medical service (EMS) and applied in hostage, siege, bomb threat and crowd control situations and in other tactical situations after police request. Our aim was to analyse TEMS operations, patient profile, and the level of on-site care provided.
  
  
  METHODS
  We conducted a retrospective cohort study of TEMS operations in Helsinki from 2004 to 2009. Data were retrieved from EMS, hospital and dispatching centre files and from TEMS reports.
  
  
  RESULTS
  One hundred twenty TEMS operations were analysed. Median time from dispatching to arrival on scene was 10 min [Interquartile Range (IQR) 7-14]. Median duration of operations was 41 min (IQR 19-63). Standby was the only activity in 72 operations, four patients were dead on arrival, 16 requests were called off en route and patient examination or care was needed in 28 operations. Twenty-eight patients (records retrieved) were alive on arrival and were classified as trauma (n = 12) or medical (n = 16). Of traumas, two sustained a gunshot wound, one sustained a penetrating abdominal wound, three sustained medium severity injuries and nine sustained minor injuries. There was neither on-scene nor in-hospital mortality among patients who were alive on arrival. The level of on-site care performed was basic life support in all cases.
  
  
  CONCLUSIONS
  The results showed that TEMS integrated to daily EMS services including safe zone working only was a feasible, rapid and efficient way to provide medical support to law enforcement operations.
authors.affiliation: Helsinki EMS, Helsinki University Central Hospital, Helsingin Kaupunki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Vainionpää
authors.forename: K
authors.initials: K
authors.lastname: Peräjoki
authors.forename: T
authors.initials: T
authors.lastname: Hiltunen
authors.forename: K
authors.initials: K
authors.lastname: Porthan
authors.forename: A
authors.initials: A
authors.lastname: Taskinen
authors.forename: J
authors.initials: J
authors.lastname: Boyd
authors.forename: M
authors.initials: M
authors.lastname: Kuisma
mesh_terms: D000328:Adult; D000552:Ambulances; D054042:Bombs; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000458:organization & administration; D004635:Emergency Medicine / Q000379:methods* / Q000458:organization & administration*; D005260:Female; D005387:Finland; D006801:Humans; D035846:Law Enforcement / Q000379:methods*; D008020:Life Support Care / Q000379:methods* / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D016495:Police; D012189:Retrospective Studies; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy; D014948:Wounds, Gunshot / Q000628:therapy; D014951:Wounds, Stab / Q000628:therapy