Quality assurance (QA) encompasses all actions taken to ensure that the standards and procedures of tactical prehospital emergency medical care are adhered to and the delivered services meet performance requirements set by an organization and its national certifying bodies. QA is executed by planned systematic activities ensuring that the organization’s system performance conforms to its established technical and operational requirements (1). The goal of tactical emergency medical services (EMS) system quality improvement (QI) is to design and implement practical and efficient processes to measure and evaluate the quality of tactical emergency medical services leading to continuous and measurable improvements. QI occurs when new, previously unattained, levels of performance are achieved (2). For any tactical EMS organization to be successful, QA and QI must be integral components of the organizations routine operations. Successful QA and QI programs result in benchmarking outcomes and allowing the identification of best practices and the shaping of standards. Specific areas that must be covered in any successful EMS program include certification of skill set, oversight of training and medical care delivered, documentation of training, and integration of medical training within tactical operations, both exercise and real-world.

The first step of QA is ensuring that your tactical prehospital care providers are certified and licensed by your organization’s recognized body, either a state agency and/or the National Registry of Emergency Medical Technicians (NREMT). This is sometimes dictated by the local area policy. Whether the system is composed of providers who are First Responders (FRs), Emergency Medical Technician—Basic (EMT-B)’s, Emergency Medical Technician—Intermediates (EMT-I), Paramedics (EMT-P), or any combination of these, certification and licensure, and their sustainment, are a must.