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Tactical Medicine
ESSENTIALS
SECOND EDITION
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This textbook is intended solely as a guide to the appropriate procedures to be employed when rendering emergency care to the sick and injured. It is not intended as a statement of the
standards of care required in any particular situation, because circumstances and the patient’s physical condition can vary widely from one emergency to another. Nor is it intended that this
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aid of legal counsel.
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23 22 21 20 19 10 9 8 7 6 5 4 3 2 1
BRIEF CONTENTS
Glossary
Index
CONTENTS
Glossary
Index
AUTHOR BIOGRAPHIES
John Emory Campbell, MD, FACEP Dr. Campbell passed away in 2018. Dr. Campbell was an excellent physician, innovator, pioneer, and
teacher with many outstanding achievements.
Dr. Campbell was known worldwide for his innovative and groundbreaking work in developing prehospital trauma education. In 1982, Dr.
Campbell founded the Basic Trauma Life Support (BTLS) program. It was the first course and curriculum dedicated to prehospital trauma
assessment and trauma care worldwide. He taught, alongside Colonel Jim Smith (his future co-author), and conducted the first BTLS course
in August of 1982. He wanted to teach paramedics the principles of advanced trauma life support (ATLS) to improve the care provided to
trauma patients. He partnered with the Alabama Chapter of ACEP to publish the first BTLS textbook in 1982. Basic Trauma Life Support has
since been renamed to International Trauma Life Support (ITLS) to better reflect its scope and mission, and it is now a global organization
offering 15 types of trauma courses and teaching over 30,000 students annually in over 40 countries.
“John did not set out to be an EMS leader,” said ITLS Editor-in-Chief Roy Alson, PhD, MD, FACEP, who has served on the editorial board
alongside Dr. Campbell for many years. “Thirty years ago, he developed a new trauma course and said, ‘Why aren’t we teaching this to
EMS?’ Along the way, he convinced countless doctors, nurses, and EMS, fire, and police personnel to share his vision. The legacy John
leaves is measured in the lives saved by those who have been ITLS trained. He will be missed.”
Dr. Campbell had a lifelong interest in the military and supported law enforcement throughout his life. Dr. Campbell, Chief Jim Smith, Dr.
Lawrence Heiskell, and Dr. John Wipfler worked together with over 120 contributors and reviewers to generate the first comprehensive
textbook on tactical medicine, Tactical Medicine Essentials, which was copyrighted and published in 2012. Endorsed by the American
College of Emergency Physicians, Dr. Campbell was able to contribute his extensive experience in the public safety prehospital arena to this
textbook. The first edition has sold over 6000 copies and is used in tactical medicine education worldwide. Dr. Campbell’s legacy lives on not
only in the form of ITLS, but also in the form of Tactical Medicine Essentials, Second Edition, written by his three co-authors.
Lawrence E. Heiskell, MD, FACEP, FAAFP Dr. Heiskell is the founder and medical director for the International School of Tactical
Medicine, the first and only state and federally approved tactical medicine school approved by the California Commission on Peace Officers
Standards and Training (POST) and the United States Department of Homeland Security (DHS). Dr. Heiskell is residency trained and board
certified in emergency medicine and family practice and has been a practicing emergency physician for more than 32 years.
Prior to attending medical school, Dr. Heiskell spent 5 years with the United States Antarctic Research Program and served on three
expeditions to Antarctica and the South Pole. He was awarded the Congressional Antarctic Service Medal in 1979. He has 29 years of
experience as a SWAT team physician beginning as a reserve deputy with the Kern County Sheriff’s Department in Bakersfield, California.
He is currently a reserve police officer and tactical physician with the Palm Springs Police Department in Palm Springs, California.
Dr. Heiskell served on an 18-agency member tactical medicine coalition under the auspices of the California Commission on Police
Officer Standards and Training and California Emergency Medical Authority (EMSA) to create the State of California Tactical Medicine
Operational Programs and Standardized Training Recommendations.
He is a graduate of Riverside Sheriff’s Office (RSO) SWAT School, National Tactical Officers Association (NTOA) School, Heckler & Koch
SWAT School, and the Federal Bureau of Investigation (FBI) SWAT School. Dr. Heiskell has lectured extensively in the United States and
abroad on tactical emergency medicine and has published over 70 articles and other publications on tactical medicine topics.
Dr. Heiskell has provided special operations emergency medical support for the FBI, Drug Enforcement Administration (DEA), and the
Bureau of Alcohol, Tobacco, and Firearms (ATF).
Colonel Jim Smith, MSS, NRP, FABCHS, CPC, CLEE Colonel Smith currently serves as the public safety director for a rural community in
the United States. He has more than 45 years’ experience in public safety as a certified police chief and has served as a bureau commander
in a metropolitan police agency supervising an FBI certified bomb squad and a clandestine laboratory entry-assessment team, 911 center
serving more than 30 agencies, responded more than 300 bomb/incendiary incidents, and more than 100 clandestine laboratories. Smith has
served as the public safety coordinator for a university with multiple campuses. Smith has developed several classes for the university
environment addressing clandestine laboratories, emergency management, WMD, and crisis management. He has been a practicing
paramedic for more than 45 years and is a certified fire instructor. Smith has a master’s degree in science in safety from the University of
Southern California and a bachelor’s degree from Troy University. He has served as a paramedic in the tactical setting for many years and
teaches classes in this arena. Smith served as a task force officer on a federal joint terrorism task force and as a senior health physics
technician and radiochemist at an operating nuclear power facility for several years. He has written several textbooks including subject matter
on bombs and bombings, response to WMD events, EMS operations in the WMD setting, and crisis management. He also serves as a peer
reviewer for several textbook publishers and professional journals, and he has more than 100 peer-reviewed articles published. Smith has
conducted research on explosion and fragment suppression leading to the production of specialized equipment and a patent issued for the
process. Smith teaches criminal justice, homeland security, and terrorism classes for the University of Phoenix and Troy University.
E. John Wipfler III, MD, FACEP Dr. John Wipfler is a board certified attending emergency physician and a Clinical Professor of Emergency
Medicine at the University of Illinois College of Medicine. In medical school, he joined the armed forces starting in 1985 and retired at the
rank of Major, U.S. Army Medical Corps (Res) after 14 years of service. In 1994 as an academic emergency physician, he obtained training
and additional military experience (Panama, multiple military bases) and started volunteering as a tactical physician for several SWAT teams
in the Midwest. Gaining valuable experience over the past 25 plus years, he continues to serve as tactical physician and TEMS medical
director for three SWAT teams and multiple law enforcement agencies in central Illinois.
Since completing his internship in surgery and residency in emergency medicine, he teaches and practices medicine with the Department
of Emergency Medicine at OSF Healthcare Saint Francis Medical Center, a Level I Trauma Center in Peoria, Illinois. Dr. Wipfler co-founded
the first tactical EMS unit in the state of Illinois, the Special Tactical Assistance Trauma Team (STATT) in 1998. He is a sworn LEO, a
Sheriff’s Physician who has been involved in tactical operations for more than 220 SWAT callouts. The STATT Tactical EMS unit (five
physicians, one nurse, two paramedics) supports three law enforcement tactical teams: Central Illinois Emergency Response Team (CIERT),
Illinois Law Enforcement Alarm Services team (ILEAS region 6/7), and the Peoria City Police Department Special Response Team (SRT). He
also supports callouts and/or training with the United States Secret Service for regional presidential motorcade escorts, United States
Marshals Service (SOG), and the Drug Enforcement Agency (DEA). He has flown SOG helicopter missions with the United States Marshals
Service Special Operations Group during high-risk prisoner transport.
As a certified firearms instructor who is also qualified expert in pistol, small-bore rifle, and high-power rifle marksmanship, Dr. Wipfler
routinely teaches firearms safety classes integrated with tactical medicine principles. He is certified by the Illinois State Police, and along with
his wife they have taught over 10 concealed carry courses. He has completed multiple military and civilian tactical/medical courses, including
the Chapman Academy (Basic and Advanced Pistol, Tactical Rifle), Combat Casualty Care Course, Counter Narcotics & Terrorism
Operational Medical Support (CONTOMS), Radiation Emergency Assistance Center/Training Site (REAC/TS) radioactive injury management
course, Heckler & Koch Basic and Advanced Tactical EMS courses, United States Army Medical Research Institute for Infectious Disease
(USAMRIID) Chemical and Biological Warfare School, Insights Training, and Strike Tactical Solutions close quarters combat courses.
Dr. Wipfler was instrumental in starting and served as medical director of the Region 2 RMERT disaster response team in central Illinois,
and has deployed on multiple real-world disasters including several large tornado strikes with mass casualties. Dr. Wipfler served with 12
others on the founding executive council for the sole state-wide disaster response agency in Illinois, the Illinois Medical Emergency
Response Team (IMERT). He served for 5 years as medical director of Life Flight, and has served as a flight physician for hundreds of air
medical rescues and transfers.
He has coauthored textbooks on emergency medicine and firearms safety, written chapters for textbooks—including the tactical medicine
chapter in the International Trauma Life Support (ITLS) text—as well as multiple tactical medicine and research papers. Dr. Wipfler lectures
internationally (Japan, Taiwan, Hong Kong, others) and teaches tactical medicine, disaster preparedness, bioterrorism/WMD response, and
advanced emergency ultrasound at the University of Illinois College of Medicine.
In 1999, Dr. Wipfler developed one of the first emergency medicine residency program tactical medicine elective rotations in the world.
This is a 2-week training session that over 90% of the EM residents at UICOMP/OSF St. Francis Residency Program complete during their 3-
year training program. Many have graduated and moved on to new communities where they now serve as tactical physicians throughout the
United States.
As the co-chair of the Illinois Tactical Officers Association (ITOA) tactical EMS committee, he has been involved in expanding TEMS in
the Midwest and instructing Tactical EMS with the Chief Jeff Chudwin and the ITOA and other law agencies, and he has co-chaired the
annual ITOA Tactical Medicine Conference for 6 years. He gained valuable experience by teaching with Dr. Heiskell at the International
School of Tactical Medicine in California for many years.
In 2005, Dr. Wipfler was asked by officials with the Department of Homeland Security to serve with an 18-agency member tactical
medicine coalition in California, representing the Illinois Department of Public Health Tactical Medicine Committee. This California committee
worked with the California Commission on Police Officer Standards and Training and California EMS Authority (EMSA) to create the State of
California Tactical Medicine Operational Program and Standardized Training Recommendations, approved in March 2010.
He continues to engage in firearm competition, 3-gun matches, advanced pistol courses, and other training, which help keep his skills
sharp. Dr. Wipfler recently competed in the 2018 U.S. National Patrol Rifle Competition in Novi, Michigan (LE only), where he scored in the
top 9 shooters of over 100 law enforcement officers. For hobbies, he enjoys scuba diving, fishing, and continues to engage in mountaineering
with friends and family, having summited the Matterhorn, Mount Rainier, Mount Shasta, Mount Baker, Long’s Peak, Hallet’s Peak, and
others. He and his wife are blessed and very proud of their six children and many travels and family adventures they have shared together.
When he initiated one of the first tactical medicine teams in the Midwest, he began teaching EM residents about tactical medicine. At that
time, in 1999, there was no formal textbook of tactical medicine, and so he was honored to serve as the lead author and join with three
trusted friends (Chief Jim Smith, Dr. Heiskell, and Dr. Campbell) to assemble a textbook that gathered the input and expertise of over 120
seasoned professionals in prehospital and tactical medicine, fire, law enforcement, disaster response, military operations, and other talented
individuals. Many members of the ACEP Section of Tactical Medicine were able to provide valuable expert input. The resulting textbook,
published by Jones & Bartlett Learning, was endorsed by ACEP, and is now used to help educate students internationally. This new second
edition was enhanced even further by additional expert reviewers and with updated information. Dr. Wipfler considers it a true honor and a
privilege to medically support the brave men and women in blue and camo uniforms.
ACKNOWLEDGMENTS
Special Thanks
The authors would like to extend a very special thanks to the following individuals who generously gave their talents, time, and extensive
knowledge to the formation and enhancement of this book:
Reviewers
Paul Abdey, Dip IMC RCS (Ed), Paramedic
Tactical Medicine Unit Manager
Kent Police
Maidstone, Kent, United Kingdom
Jeff W. Adams
Lieutenant (ret), Special Response Team Commander
Peoria Police Department
Peoria, Illinois
Sean Benson
Firearms Tactical Advisor, Bronze Commander, and Trainer
Firearms Training and Development Unit
Rotherham Police Station
Rotherham, South Yorkshire, United Kingdom
Dale Carrison, DO
Professor of Emergency Medicine
Chair, Department of Emergency Medicine
University of Nevada School of Medicine
Las Vegas, Nevada
Matthew Clark
State Registered Paramedic
Police Specialist Firearms Officer
United Kingdom
Jeff Chudwin, JD
President, Illinois Tactical Officers Association
Chief of Police (ret), Olympia Fields Police Department
Olympia Fields, Illinois
Tony Damiano
Tactical Medic
Polk County Sheriff Department
Bartow, Florida
Chris Dinsdale
Senior Lecturer, Prehospital Medicine
Tactical Medicine Specialist
Sheffield Hallam University
Sheffield, South Yorkshire, United Kingdom
Franco Dillena
Training Officer
Miramar Police Department
Miramar, Florida
George Z. Hevesy, MD
Chair, Department of Emergency Medicine
Attending Emergency Physician, OSF Healthcare Saint Francis Medical Center
Clinical Associate Professor of Emergency Medicine, University of Illinois College of Medicine
Tactical Physician (ret), Special Tactical Assistance Trauma Team (STATT)
Auxiliary Deputy Sheriff (ret), Peoria County Sheriff’s Office
Peoria, Illinois
Neil Jones
Firearms Instructor
Tactical Firearms Unit
Sussex Police
Lewes, Sussex, United Kingdom
Terry G. Kaufman
Tactical Medic, Lafayette Police Department
Manager, Flight Safety, Petroleum Helicopters, Inc.
Lafayette, Louisiana
Jacqueline E. Krajecki, RN, BSN, MSNA, EMT-LP, CEN, CCRN, CFRN, CRNA
Certified Registered Nurse Anesthetist
The Anesthesia Group of Sarasota
Sarasota, Florida
Justin M Lemieux, MD
Clinical Assistant Professor, Stanford Emergency Medicine
EMS/Disaster and Tactical Medicine
Medical Director/Field Physician San Mateo Regional Tactical EMS
Instructor, International School of Tactical Medicine
Medical Team Manager FEMA US&R CA-TF 3
Mountain View, California
David Q. McArdle, MD
Attending Emergency Physician, Georgia Emergency Associates, South East Georgia Medical Center, Brunswick, Georgia
Occupational Medicine Physician, Defense Support Systems LLC, Greenville, South Carolina
Federal Law Enforcement Training Center, Glynco, Georgia
Reserve Officer/Tactical Physician, University of Colorado Police at Boulder, Colorado
Affiliate Faculty Department of Criminology & Homeland Security, Regis University, Denver, Colorado
President, TacMedMD LLC
Medical Director, ColoradoSTAR
Centennial, Colorado
Kevin Olver
Police Tactical Firearms Trainer
Cleveland and Durham Police Tactical Training Centre
Stockton-on-Tees, Cleveland, United Kingdom
Lee Raube, DO
Attending Emergency Physician, Department of Emergency Medicine
Clinical Assistant Professor of Emergency Medicine
University of Illinois College of Medicine
Tactical Physician, Special Tactical Assistance Trauma Team (STATT)
Deputy Sheriff, Woodford County Sheriff’s Office
Peoria, Illinois
Andrew Smith
Medical Emergency Response Team Paramedic
Royal Air Force
Chippenham, Wiltshire, United Kingdom
Audrey was in alone, for the rain was falling fast, and
she and Stephen had not been together all day. The little
girl sat for some time by the window, watching the rain
which was beating mercilessly on the old tombs, and
covering the grave of the two grandchildren who died young
with the tiny blue blossoms of the forget-me-not which
Stephen had planted there.
"What's the matter with you?" she said. "Are you ill?
Have you hurt yourself?"
"Oh no," said the old man in a louder voice, "don't tell
of me. I didn't do nobody any harm—don't fetch anybody;
don't thee now—they'll lock me up if they come!"
"I'LL FETCH SOMEBODY," SAID AUDREY.
"Mr. Robin won't lock you up," said Audrey; "he's very
kind is Mr. Robin."
She could hardly tell him what she wanted, for her
heart was beating so fast with the fright she had had; but
she begged him to come with her, and to come at once, and
to bring a candle with him.
CHAPTER X
Old Joe
There, on the grass under the yew tree, lay an old man,
so small, so thin, so shrivelled, that he looked no bigger
than a boy twelve years old. His hat had fallen from his
head, and his untidy grey hair hung upon his shoulders, and
round his neck was a board on which was written the one
word—"Blind."
But just then the old man opened his eyes, and said in
a trembling voice—
"We'll take him to the fire," said Mr. Robin. "Go and get
Stephen's father to help me, Audrey; he'll be in by now."
The kettle was soon boiled, and they gave him some hot
tea, and then the colour came back a little into his ashen
face, and he said—
"Yes," said the old man. "I've slept there about a year
now. You won't tell of me, will you? I've nowhere else to go
but to the house, and I don't do a bit of harm—not a bit I
don't."
"Did you see it?" said the old man piteously. "Don't tell
of me—don't!"
"Not in the pulpit," said the old man. "I curl away in the
pulpit, and put my head on an old cushion—it's snug up in
the pulpit. Don't tell of me—now don't, there's good folks!"
"But what do you want a light for?" said Mr. Robin
gravely.
"And you may sleep on this sofa till morning," added Mr.
Robin. "We are trusting you very much by letting you stay
under our roof; but we can't turn you out in the rain. You
won't disappoint our trust, will you?"
"No, I won't, sir," said old Joe; "and thank you kindly,
sir!"
"I've been a bad, wicked old man," said Joe. "I don't
suppose He would have anything to do with such as me."
"I haven't said a prayer since I was a little lad and went
to Sunday-school," said old Joe—"not for sixty years or
more. It's too late for me to begin now."
"No, it isn't too late," said Audrey. "It's never too late to
begin to pray."
"And you can say it when you're out under the railway-
bridge, can't you?" asked Audrey.
"I think so; I'll try," said the old man humbly.
CHAPTER XI
The Hot Summer
Yet tears would often come into the old man's eyes as
he looked at the child. He had had no one to love him or to
care for him till the children had found him, and now one of
them was going to leave him.
"He is, though," said the old man; "and what's more, he
knows it hisself."
Granny Robin dried her eyes; she would not grieve the
little lad by her tears. And there was Audrey to be
comforted—poor little Audrey—who had come in crying and
full of sorrow.
"I always look out before I get into bed," said the child.
"I always have a peep at the grave of the two
grandchildren. Yes—there it is; isn't it pretty, father? I
wonder if any angels are looking at it now, and if they see
you and me up here? Shall you plant any flowers on my
grave? You will, won't you? I do wish I could be buried here,
under the window."
CHAPTER XII
White Robes