Tactical Emergency Medical Services (TEMS), is a relatively new area of pre-hospital care. It requires specific attention to planning, including selection, training, equipment, procedures and continuing professional development, CPD to maintain competence. This session will describe the development of a small team of Critical Care Paramedics, who undertake a short, but intense programme, based at the Metropolitan Police Specialist Training Centre, MPSTC in England. CCPs are trained to work alongside firearms teams, who respond to criminal and terrorist incidents involving the use of firearms. The task of CCP's is to reduce the time between wounding and advanced resuscitative care, ensuring that Police Officers, members of the public and others receive a high standard of care without incurring unnecessary delays. They work outside the “hot zone”, but further forward than traditional ambulance operations. When these capabilities are available within the Emergency Ambulance Service, they are likely to improve patient care and firearms teams mission success. Delegates will be able to: (1) Identify the rationale, threat, risk and policy considerations driving the development of specially trained Paramedics working in a Police Firearms support role; (2) Describe the anticipated spectrum of incident types that might be encountered by CCPs in respect of tactical support; (3) Consider the range of triage, treatment and other capabilities, that can be provided in the field, including a review of associated education and training models; (4) Review the specialist personal protective and response equipment that is required to carry out this role; and (5) Reflect upon the viability of such capabilities within their own EMS environments.

This paper reviews terrorism in Canada, assessing the incidence and nature of terrorist activity, the potential targets of terrorist attacks, risk factors to Canadian nationals and institutions, and the responses of the Canadian government in dealing with the threat and the effectiveness of those responses.

Despite the fact that there have been no recent high-profile terrorist events in Canada, this country has a serious terrorism problem, the key manifestation of which is the multitude of terrorist organizations that have designated Canada as a base of operations. In addition, Canadians have been attacked overseas and Canadian organizations, both local and abroad, are potential targets of terrorist activity. Canadian attempts to deal with terrorism through foreign and domestic policy have been ineffective, primarily because the policies have been poorly enforced. Until recently, terrorist organizations legally could raise funds in Canada, in direct contravention of international treaties signed by Canada. It is possible that the ineffectiveness in enforcing the anti-terrorism legislation stems from hope that placating terrorist organizations, and the countries that support them, will prevent Canada from becoming a target. Unfortunately evidence from other countries has shown this strategy to be ineffective.

In spite of extensive research, the question of fluid therapy for hemorrhagic shock is still controversial. Certain drawbacks in the experimental models are among the reasons for this controversy. These drawbacks are mainly related to the animal species used, to the way the shock insult is initiated and to the effects of deep anesthesia on the response to shock.

Dogs were used in more than 90% of shock studies—although their response to bleeding is different from the human response. The dog has a large, contractile spleen, which can modify its cardiovascular response to bleeding.

Successful management of a mass casualty situation involving 45 injured marines following a fire in Japan demonstrates the important principles of triage, patient movement, quality patient care, logistics, communication and medical direction.

Following the accident, the US Army Institute of Surgical Research assembled a burn team consisting of three surgeons, three nurses, one microbiologist and eleven clinical specialists (three of whom were inhalation therapy technicians) and the equipment and supplies necessary to treat and transport these patients. The US Air Force Military Airlift Command transported the team and equipment to Japan in a C–141 Starlifter Medevac plane and pre-positioned a second C–141 in Japan for the return flight. Additional ventilators and supplies were mobilized from Japan, Okinawa, the Philippines and Alaska.