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General Conditions

  • Medic Team1Depending on the situation, limitations may arise due to extreme general conditions/ tactical situations
  • Delayed evacuation, or long evacuation times
  • Prolonged phase of preclinical care
  • Working with limited equipment, and possibly in isolation
  • (Danger) zones of emergency care (hot – warm – cold)
  • Mainly trauma care with a high percentage of ballistic wounds

Tactical emergency medicine requires frequent assessments of the overall situation, considering not only a potential threat situation but also the operational requirements of the mission/ operation during which the emergency has occurred. This may even imply that medical care must be postponed for the sake of continuing the mission, or that even limits to the medical care for an individual patient must be accepted. Tactical emergency medicine aims at the best possible outcome


for the patient


for the mission, because the life and limb of other personnel can be put at risk if the mission cannot be continued.


Background of TREMA

In emergency medicine, standardisation and a team-oriented line of action according to established algorithms, and also the the resulting “common language” have been instrumental in improving patient care. It is appropriate that the principles and procedures are geared to the situation in the rescue service as well as to the anticipated patient population. This particularly applies to the duration of pre-hospital care and to evacation times, which are both usually short.


In military or other tactical operational situations, and whenever emergency care is provided under enemy threat, and hence the prevailing conditions are totally different. In extreme situations, for instance, even a proper implementation of the ATLS guidelines and of “civilian” algorithms and procedures may cause deterioration both of the casualty’s condition and of the rescuers’ situation.
This is why the “Tactical Combat Casualty Care” (TCCC) concept in the military and the “Tactical Emergency Medical Support” (TEMS) concept for police special units have been developed during the past 12 years.

This concept and training system reflects:

  • The respective specific mission environment,
  • The impact of the respective situation in operational phases on the kind of emergency care that can be provided,
  • The prevalence of primary battlefield trauma as well as mission-specific injuries/ diseases, and
  • The extended duration of pre-hospital care that is required until patients can be evacuated to medical facilities.

However, such conditions can also be found in civilian environments, for instance with regard to workers operating at sites to which access is difficult (height workers or industrial climbers, or personnel employed in off-shore missions), to personnel working in regions with an underdeveloped medical infrastructure, and to individuals engaging in risky sports and potentially requiring emergency medical care within the scope of “wilderness medicine”. .
This is the background for the establishment of the Tactical Rescue and Emergency Association (TREMA).


Tasks & Goals

To promote the further development and advancement of emergency medicine –particularly of preclinical care and of specific rescue techniques in extreme and/or tactical environments, respectively.

  • FlyerPic1Analysis of findings, guidelines & recommendations of other emergency medicine specialist organisations in order to find out whether an how these findings, guidelines & recommendations can be applied in our specific environments
  • Exchange and Evaluation of Experience
    • Military, police and civilian organisations
    • national & international
    • Medical & tactical aspects
  • Evaluation of material advances & processing of the results for our members
  • Development of Recommendations and guidelines (pertaining to medical techniques, mission planning, algorithms, training, equipment)
  • Support of training and advanced vocational training projects and events
  • Support & organisation of scientific conferences
  • Promotion of cooperation at national and international levels and across organisations
  • Advice with regard to planning and extending emergency medical care in particular environments
  • Promotion of the reputation and interests of assets working in this field
  • Extending the best emergency medical care possible despite the limitations associated with particular environments/
    tactical situations
  • Development of an independent expert basic working document in order to give the operators working in extreme/ tactical environments more confidence of action.