Mass casualty incidents involving active shooters are becoming more common, and many involve special weapons and tactics team responses. Standard of care is to have tactical emergency medical services paramedics or physicians direct triage and administer immediate interventions. In these situations, a clinical and ethical value is to do the greatest good for the greatest number of people. Cases in which beneficence and justice are at odds are particularly complex. This commentary on such a case argues that directing resources to patients most likely to survive accords triage principles and explores ethical complexity in resource allocation decisions. CaseAfter hours of talking, negotiations break down and, in the worst possible scenario, bullets ring as a shooter indiscriminately fires several rounds in a local business place and takes hostages. Law enforcement officers immediately make emergent entry into the building and engage the shooter. The shooter collapses, gunfire ceases, and officers rush to ensure that the shooter is contained. Additional law enforcement personnel begin to search and secure the scene. Due to staging until the scene is determined safe, combined with lack of protective armor and helmets, the nearest ambulance is 2 blocks away and stays back until ordered in by law enforcement.The tactical emergency medical services (TEMS) physician, Dr M, who is embedded within the special weapons and tactics (SWAT) team, enters and begins performing rapid triage of the patients who lie at the scene. Dr M notes 6 dead; 1 law enforcement officer who sustained a gunshot wound to the chest is unconscious, not breathing, and has a weak pulse; 1 civilian who sustained extensive injury by a gunshot wound to the right side of the neck is unconscious, with heavy bleeding, agonal respirations, and weak pulse; and 1 suspect who sustained a gunshot wound to the high right lateral chest is awake with minimal bleeding and significant respiratory distress. Dr M's heart sinks. Clinical and ethical principles of triage and protocol in this case suggest that lifesaving efforts should first be directed towards the suspect according to the Sort-Assess-Lifesaving Interventions-Treatment and/or Transport (SALT) mass
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The 21st century has seen an enormous growth in emergency medical services (EMS) information technology systems, with corresponding accumulation of large volumes of data. Despite this growth, integration efforts between EMS-based systems and electronic health records, and public-sector databases have been limited due to inconsistent data structure, data missingness, and policy and regulatory obstacles. Efforts to integrate EMS systems have benefited from the evolving science of entity resolution and record linkage. In this chapter, we present the history and fundamentals of record linkage techniques, an overview of past uses of this technology in EMS, and a look into the future of record linkage techniques for integrating EMS data systems including the use of machine learning-based techniques.
Law enforcement (LE) use of force (UOF) is a complex social, medical, and legal issue. In recent years, highly visible and publicized UOF incidents have sparked public outrage about racial inequity and motivated broad institutional reflection on sanctioning violence in the name of protecting communities. A public health approach to violence and to LE-UOF is required to develop 21st-century policing recommendations. Tactical emergency medical services physicians are uniquely positioned to convene and to serve as advisors, educators, and advocates to LE departments, community leaders, and public policy developers in order to improve UOF policies.In Plato's vision of a perfect society … the greatest amount of power is given to those called the Guardians. Only those with the most impeccable character are chosen to bear the responsibility of protecting the democracy.
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