TPF area of work · Training · Protocols · Consulting · Evaluation
Austere and operational medicine for wilderness, event, tactical and disaster care
Austere care is shaped by what you have on hand, wherever you happen to be. When the usual emergency medical services (EMS) system is absent, overwhelmed or out of reach, the medical and practical demands change. Protocols written for a system with a hospital twelve minutes away stop working. The Paramedic Foundation (TPF) works in three practice areas here. Each has its own buyers, protocols and evidence base.
How austere care differs from rural EMS
Rural and frontier EMS systems are fragile because of geography, governance and the way EMS is paid. That is a systems problem. It is also TPF’s largest area of consulting, covered on the rural health page. Austere care is a clinical and field problem. It is what a paramedic or physician faces when evacuation is delayed or impossible and the patient is still in their care.
The two overlap. Picture a frontier paramedic working a cardiac arrest ninety minutes from the nearest hospital. That paramedic is in a rural system and an austere setting at the same time. Even so, the two are different things, and a design for one does not cover the other. TPF has both skills and keeps them apart, because a protocol written for one fails in the other.
Three practice areas
Find the practice area that fits your work
Each has its own page, because each serves different organizations that work in different ways.
Wilderness, search and rescue, and wildland fire
Protocols, training design and reviews of operations for places where evacuation time, hazards and limited equipment shape patient care.
Wilderness and SAREvent and expedition medicine
Medical planning, protocols and equipment standards for mass gatherings and ultra-endurance events. Also support for expeditions where resupply and evacuation are limited. TPF is not offering these services at present, though that could change for the right project.
Event and expeditionTactical, military interface, and disaster
Program design for Tactical Emergency Medical Support (TEMS). Military clinical practice adapted for civilian use. Disaster medical planning within incident command.
Tactical and disasterClinical leadership
The specialists TPF calls on for austere care
Austere and operational medicine is one of the fields where TPF keeps a standing group of specialists. Each project in this area of work draws on the fields below. TPF scopes each team to the work instead of using a fixed roster.
Board-certified emergency medicine and EMS medical direction. Wilderness and mountain medicine, including Diploma in Mountain Medicine faculty. Critical care flight paramedicine. Tactical and operational medicine, including combat casualty care instruction. Wildland fire work, from EMS medical direction for wildland firefighters to wildfire response with a county sheriff’s office. Fire-based EMS leadership. Prolonged field care and prehospital blood program design. Austere medical training design and simulation-based instruction. Adapting military scope of practice for civilian use.
Names, credentials and current roles for all of these specialists are on the team page. TPF names the people proposed for a project in its proposal for that project. That way you can match each name to the scope.
How TPF works in austere care
TPF’s role in austere care is advice, planning and education design. It develops protocols and designs programs. It writes training frameworks and curricula, reviews operations and advises on policy. TPF can act as the primary consultant, training framework developer, evaluation partner or policy advisor. It can also take on any mix of these roles that a program needs. Anyone Not Ready, TPF’s austere and operational medicine partner, teaches the hands-on courses. Field medical support at events sits with the Ultra Medical Team (UMT), a TPF initiative that is currently paused.
Projects follow the same approach as the rest of TPF’s consulting work. Each is scoped to the real problem and built from how the client actually operates. The work is delivered to a standard that holds up when field staff and medical directors check it.
For each project, TPF builds a team from its network of subject matter experts. Austere care work draws on principals with direct field experience in wilderness EMS, tactical medicine, mass gathering operations and disaster medical response. They have worked in these settings, unlike generalists who have studied them from a distance.
Free financial modeling tools for related rural EMS system planning are on the financial modeling page. A first consultation is free. If TPF is not the right fit for your work, TPF will say so directly and point you to someone who is.
For research and evidence on austere and event medicine, two resources help. One is Ultra-Endurance Sports Science & Medicine (UESSM). The other is the International Roundtable on Community Paramedicine (IRCP). The IRCP’s Second Generation Paramedic (G2P) framework describes expanded-scope practice outside the usual EMS structure. It applies directly to care in austere and remote places.
For the field side of event medicine, see the Ultra Medical Team on the TPF partners page.
About austere and wilderness care
Common questions
Who leads TPF’s austere and wilderness care clinical work?
TPF’s austere care work draws on a standing group of clinical advisors. One field is board-certified emergency medicine with EMS medical direction, including faculty standing for the Wilderness Medical Society Diploma in Mountain Medicine. Another is critical care flight paramedicine, with international field experience in snakebite, tactical and community paramedicine. A third is austere and tactical medicine teaching. Advisors have lectured at the Special Operations Medical Association conference and the Australian Tactical Medicine Conference. They have also lectured to U.S. Army units. Several advisors are U.S. military combat veterans. Names and credentials are on the team page. TPF names the advisors proposed for a project in its proposal for that project.
What is the difference between rural EMS consulting and austere care consulting?
Rural EMS consulting deals with the structural problems that make rural and frontier EMS systems fragile. These are governance, reimbursement, governance structure and coverage design. Austere care is a clinical and field term. It describes what a paramedic or physician faces when the usual EMS system is absent, overwhelmed or out of reach, in any kind of place. The two overlap. A frontier paramedic managing a cardiac arrest 90 minutes from the nearest hospital is in both at once. TPF has both skills and can address them separately or together.
What types of organizations does TPF serve in the austere care domain?
TPF serves wilderness EMS programs and search and rescue (SAR) organizations. It serves federal land management agencies: the National Park Service (NPS), U.S. Forest Service (USFS) and Bureau of Land Management (BLM). It also serves wildland fire groups, law enforcement agencies with TEMS programs, and, when it offers event medicine, directors of mass gathering and ultra-endurance events. Military and defense-related groups are on the list, as are state and local emergency management agencies. TPF also serves international nongovernmental organizations (NGOs) with field operations where resources are limited.
Does TPF provide austere care training directly, or only consulting?
TPF designs training, and its partner delivers it. As consulting work, TPF provides protocols, training framework and curriculum design, and reviews of operations. Anyone Not Ready and affiliated organizations teach the hands-on courses in TEMS, prolonged field care, austere emergency care and wilderness medicine. Their instructors include TPF’s clinical advisors. A first consultation is free. The right setup for a project depends on what the program needs.
If you work in an austere setting, Start a free conversation →
Talk with TPF about care in austere settings
TPF can help you design a wilderness EMS program. It can also help you build TEMS capacity or prepare for disaster medical operations. Event and expedition medicine is not offered at present, though that could change for the right project. A first consultation is free, with no obligation.