Clinical care in the warm zone: a responder's perspective upon clinical practice in support of UK tactical medical operations

Abstract

Active shooter incidents both nationally and internationally have embedded significant cultural reforms within emergency medical services response frameworks. The deployment of specialist responders within specific pre-identified areas or ‘zones’ of an active shooter incident is unprecedented, and reflects the level of public expectation now required of the ambulance service. As seen within the recent 2015 Paris attacks, the delivery of effective clinical practice in tactical medical operations (TMO) facilitates a range of unique challenges for clinical responders. Conflicting priorities between operational tactics and clinical priorities, especially within multiagency working, has historically led to ‘Good medicine becoming bad tactics, and bad tactics leading to further casualties' ( Butler, 2001: 625 ). Although situational dynamics may make it impossible to ever achieve an absolute equilibrium of safety and tactical efficiency within this sphere of practice, this article intends to contribute toward achieving this ideal by reviewing the Tactical Emergency Casualty Care (TECC) guidelines to establish if this framework would be compatible for use within the UK's TMO response framework.