1. Nelson Tang, M.D., FACEP Director and Chief Medical Officer Center for Law Enforcement Medicine The Johns Hopkins University

2. Collaborative initiative between JHU and partnered Agencies United States Secret Service Immigration and Customs Enforcement Bureau of Alcohol, Tobacco, Firearms & Explosives United States Marshals Service State and Local agencies Academic Center of Excellence Institutional tripartite missions of research, patient care, and medical education

3. National Tactical Officers Association (NTOA) the provision of TEMS has emerged as an important element of tactical law enforcement operation -1993 National Association of EMS Physicians (NAEMSP) Medical Support of Law Enforcement Special Operations -2001 American College of Emergency Physicians (ACEP) TEMS is an essential component of law enforcement teams and helps maintain a healthy and safer environment for both law enforcement and the public -2004

4. Highly skilled and trained medical providers Functions under the premise of scene-safety FIRST Transport-oriented approach to patient care Reliance upon maximal visibility Generally untrained for the high-risk tactical environment Staged remote from law enforcement inner perimeter

5. Tactical medical support is the provision of field medical care during high-risk, extended-duration and mission-driven law enforcement operations, often rendered under functionally austere conditions.

6. The goals of law enforcement medicine are to facilitate the success and the safety of law enforcement missions during all phases of a field operations through the delivery of preventative, urgent, and emergency medical care.

7. Mission Preplanning (Medical Threat Assessments) Coordination with EMS and local resources Remote Assessment and Triage Tactical Casualty Care Preventative Medicine and Team Health Urgent Care and Sick Call Weapons Safety Forensic Evidence Preservation

8. Tourniquets Hemostatic agents Field expedient airways Needle decompression Splints and slings Evacuation litters

9. Hydration Nutrition Sleep/Rest monitoring Environmental exposures Vaccinations Referrals Personnel advocacy

10. Medical support of law enforcement operations is a force protection mandate

11. Personnel health and safety Preservation of manpower Sustain critical law enforcement functions Liaison with EMS and established medical infrastructure Coordination of initial and follow-up care Resource to command infrastructure Inter-agency collaboration

12. Formal relationships between law enforcement agencies and JHU Establishes the responsibilities and authority of the Medical Director Medical Direction is a position not an individual Multiple core functions and supplemental support services

13. Initial medical and requalification training Didactic, laboratory and clinical education Practice standards with basis in regularly updated written guidelines 24/7 availability of Medical Control Standardized patient care records Quality assurance reviews Physician operational medical support Domestic and international deployments

14. Clinical approaches based upon current standards and practices Breadth of experience and expertise Diversity of faculty background EMS and prehospital care Disaster and emergency preparedness International and travel medicine Military medicine Mass gathering event support Depth of physician manpower

15. Clinical sites for provider skills maintenance Dedicated communications center Hospital based critical care transport services Referral and hospitalization mechanisms Specialty and sub-specialty expertise

16. Safety Quality Wellness Prevention Infection control Peer assessment Documentation

17. Agency commitment and support of leadership Clear chain of command for medical decision-making Medical direction separate from agency infrastructure Consistency of training, policies, protocols and medical command (inter- operability)

18. Inter-agency communication is variable and historically unreliable Academic partnerships foster collaboration Open exchange is routine in our Center Training methodologies Curriculum Educational venues Operational procedures Mutual aid support

19. Dynamic nature of agency leadership Fluctuation of intra-agency funding National scale of programs Evolving rosters of providers Data collection and reporting Metrics for evaluating programs