Improvised Medicine Part 1

As mentioned in earlier entries, one of the keys to success in the tactical environment is flexibility. A Medic’s ability to improvise with his equipment or other items greatly increases their level of flexibility. Improvising can allow you to reduce in size and lighten your load, or to treat an injury you didn’t think you had the ability to treat.
While these solutions are generally not definitive treatments, they are often better than nothing at all. If you have the right gear, use it. The point is to be prepared for when you don’t.

In this first entry, we will cover some basic principles:

1. Think ahead- know the equipment you have and think of other ways to use it.

2. Don’t “pre-improvise”-Yes it can save time, but chances are if you modify a supply or component it is a permanent change that will either eliminate its ability to perform its original task or at least reduce that ability. This does not apply to everything so use your head and do what makes sense.

3. Don’t improvise with highly specialized items unless you have no other choice- It makes little sense to use a 14ga angiocath to improvise a trach-hook if I can do the same thing with a safety pin. There are few ways to improvise an angiocath, none of which I’d want to try or have tried on me. That’s an item that is specialized.

4. Don’t bury your head in your aid bag- The great thing about improvising is that you have the world at your disposal. Just because an item in not labeled “medical” does not mean you can’t use it.

Planned improvisation
An example of planned improvisation is the decision to not carry scalpel handles or full-sized disposable scalpels. I can carry 10 blades of differing design to one disposable scalpel that only offers me one blade choice. By using the blade wrapper to create a handle (see the video for a demo) I now have a functional instrument that I can use to perform just about any procedure that requires a scalpel. The control of the blade is not as fine, but it is more than acceptable (if practiced) for the majority of emergency procedures conducted in the field.

Developing a Tactical Emergency Medical Support Program

This post is geared toward TEMS Medics. We will be posting a video in two weeks detailing medical equipment improvisation techniques for the field. Dr. Schwartz recently published a book that examines TEMS programs in greater detail. There is a link to it in the right margin of the page, under the heading Recommended Readings.

By Joshua S. Vayer, BA; Richard B. Schwartz, MD, FACEP

The development of a tactical emergency support (TEMS) program is an involved process. Multiple TEMS models effectively function and there is no “best model” for every agency. This article summarizes common components that must be considered in the development of a TEMS program. Components discussed include: goals of TEMS program, structure of the TEMS element, training for TEMS providers, law enforcement status, TEMS provider skill level, arming of TEMS providers, operating location, liability issues, insurance issues, and equipment for TEMS units. The proper development of a TEMS program will meet the primary goal of enhancing the tactical unit’s mission accomplishment. Key words: CASEVAC, explosive ordinance disposal, hostage rescue team, special weapons and tactics, special response team, tactical combat casualty care, tactical emergency medical support, tactical medicine.