Tactical Emergency Medical Services in Copenhagen, Denmark: A mixed methods design study introducing a new concept

Aims and Objectives: The purpose of this study was to introduce the concept of Tactical Emergency Medical Services (TEMS) in Denmark and to explore the TEMS providers' and the Danish Police Forces' confidence in the TEMS concept in case of a terrorist attack within the Capital Region of Denmark. Background: Terrorist attacks pose a major challenge to prehospital emergency medical services when it comes to reaching trapped victims. The threat to healthcare professionals limits access and creates a so-called therapeutic vacuum, leading to delayed treatment and evacuation of victims and ultimately increases mortality. Methods: This study used a mixed methods triangulation approach, integrating qualitative data from an interview study and quantitative data from a register study. The interview study consisted of 18 semistructured interviews conducted across three interview groups (Copenhagen TEMS physicians/paramedics, senior on-site commanders, and tactical and medical officers from the Copenhagen Police Department) with six participants in each group. Data from the interview study were analyzed using thematic framework analysis. The register study used data from the TEMS database, including 61 assignments from 2019 to 2020, that were analyzed using descriptive statistics. Results: The interview study found three core themes in each interview group. The main findings included insights on the advantages of having healthcare professionals in the warm zone, the prerequisites for the concept's success, TEMS's cooperation with the Danish Police Force, and challenges concerning healthcare providers inside tactical zones. The participants expected TEMS' presence inside the warm zone could improve triage and medical treatment, free police resources, increase police safety, optimize preparedness of the health sector, and significantly reduce the therapeutic vacuum. Data from the register study demonstrated that TEMS have had prior assignments in the warm and hot zones. Conclusion: All participating groups have high confidence in TEMS to close the gap of the therapeutic vacuum and deliver advanced physician and paramedic-based tactical medicine inside the warm zone in case of a terrorist attack in Copenhagen, Denmark. Editorial Comment: This study includes both provider interviews and registry data to support insight into processes of Tactical Emergency Medicine. The authors discuss possible advantages of having emergency medical personnel in the major incident area early to support a coordinated response.