“Fate of the wounded soldier is determined by the hand which applies the first dressing.”
-Nicholas Sin Spanish American War, 1890's
“Leading Confederate General Albert S. Johnston died due to a popliteal artery injury in the Battle of Shiloh. He bled to death...ironically, he died with a tourniquet in his pocket.”
April 7th, 1862 Civil War
The past decade has shown an increasing emergence of violence requiring advanced tactical interventions. Increases in school shooting incidents, active shooters, and drug and clandestine lab incidents have increased the need for organized tactical operations. With each of these activities comes unique, but predictable injury risks, however the standard civilian EMS approach to treating these injuries cannot be followed in the “tactical context.”
Prior to 1996, the standard approach to traumatic injury care was based on the guidelines established by Advanced Trauma Life Support (ATLS). These treatment tenets were applied during police and military operations. In 1993, during Urban Operations in Mogadishu, numerous US Soldiers of the elite US Army Rangers sustained multiple combat injuries during complex emergency operations in that area. From that incident was borne the Committee for Tactical Casualty Care. The committee composed of providers of all levels, military and civilian who reviewed the prior ATLS guidelines and took an epidemiological look at the injuries sustained in Mogadishu and developed a scientific approach to tactical casualty management. The committee concluded that the ATLS approach was not applicable to the management of pre-hospital, tactical casualties, military or civilian.
Shortly after, the first set of tactical care guidelines were established. These guidelines are known as Tactical Combat Casualty Care (TC3) guidelines which are reviewed and updated periodically by the committee. These are the standards of care for the provision of tactical trauma care. These standards focus on decision making and early intervention under austere conditions.
Currently, there are numerous tactical operational teams functioning in the U.S. both in major cities and surrounding areas. For the most part, many of the medical personnel assigned are either EMS cross-trained career police officers, or are traditional EMTs and paramedics that take an inactive “stand-by” role for medical support. In most cases, these personnel desire a forum to “bridge the gap” between their professions where they can share “common ground” specifically when it comes to tactical casualty care.
The goal of these programs is to “bridge the gap” and establish standardization of protocol and practice, borne from injury science and real-time epidemiology. All reference materials used are properly credited (to the authors) and distributed to attendees of these courses because of the science from which they were derived.
Course Descriptions for Tactical Operations Medical Support Programs
Operator’s Course The TOMSP-Operators course was designed for the non-medical tactical operator. Not all entities operating in the tactical or the complex environment are able to engage the use of traditional medical providers. By "pushing forward" critical, life-saving skills to the tactical operators at the forward line of operations, morbidity and mortality due to "treatable" injuries can be significantly reduced. In addition, this program will help orient the tactical operator to the capabilities of trained tactical medical personnel.
Course Dates: June 12, 2010; October 16, 2010 Cost: $150.00 Course Length: 1 day (8 Hours) PA DOH Course#: Pending Prerequisites: Non-medical responders such as police, security and military personnel. Contact: Leon Jaskuta, Tactical Programs Leader
Basic Course The Tactical Operations Medical Support Program (TOMSP) - Basic level is designed for the medical provider who has been newly assigned to the tactical mission. It is also designed for tactical personnel who have been cross-trained by their teams as the medical provider, regardless of their level of medical experience.
Core Competencies: Hemorrhage Control, Basic Airway Management, Casualty Evacuation, Triage, Movement, Basic Toxicology, Preventive Medicine, Medical Intelligence, Pain Control, Basic Team Movements, Ballistics and Explosives injuries, as well as Sports Medicine.
Course Dates: November 4-7, 2010 (Click to Download Course Flyer) Cost: $600.00 Course Length: 4 Days (32 Hours) PA DOH Course #: 004253 Prerequisites: Medical providers of various levels, or non-medical responder requiring initial medical familiarization training above the operator's level. Contact: Leon Jaskuta, Tactical Programs Leader
Advanced Course The TOMSP-Advanced Course was designed to complement skills presented in the TOMSP-Basic Course. Students are taught more advanced medical procedures and more attention is paid to integration into tactical operations and planning.
Core Competencies: To complement the Basic Course – CBRNE casualty management, advanced triage techniques, psychological aspects of tactical operations, basic veterinary field care, basic management of dental emergencies, and team movements.
Course Dates: May 13 - 16, 2010 Cost: $600.00 Course Length: 4 Days (32 Hours) PA DOH Course #: Pending Prerequisites: Completion of the Tac-Med TOMSP-Basic Course Contact:Leon Jaskuta, Tactical Programs Leader
Medical Director’s Course The TOMSP-Medical Director’s Course was designed to provide an introduction to the tactical medicine specialty. Focused on the objectives established by the American College of Emergency Physicians (ACEP), the medical director’s course provides the attendee the proper introduction to the administrative and operational intricacies of the tactical medical support mission.
Core Competencies: Establishment of the scope of practice for tactical medical providers, establishment of treatment and evacuation protocols, integration into the mission planning phase of operations, team support, medico-legal and administrative considerations of tactical medical support.
Historical development of institutional response tactical medicine:
On the campuses of America’s institutes of higher learning, over the last 15 years, there have been 50 violent incidents leading to 121 casualties and 142 deaths (does not include drive bys and gang violence). Throughout America’s corporations, over the last 15 years, there has been an average of 1000 homicides every year in office environments (does not include Sept 11th, 2001).
Some of the more recent events on campuses across America include:
Virginia Tech- April 2007- gunman goes on shooting spree Northern Illinois University, February 2008, gunman goes on shooting spree Arkansas University, Oct 2008, gunman goes on shooting spree Radford University, April 2009, gunman kills another man on campus Hampton University, Apri 2009, murder suicide on campus Wesleyan University, May 2009, girl murdered on campus Texas Southern University, July 2009 gunman goes on shooting spree
The above events and their related media coverage has impressed upon the public that you & your security staff train on critical incident response. More often than not, many institutions are requiring their responders to be CPR/First Aid certified. Unfortunately, traditional medical training does not provide any level of tactical training that institutional staff should have. Institutional and coporate security staff should have in place, response SOPs for all types of incidents: CBRNE, shooting incidents, natural disasters, etc. If you don’t currently have a plan, Tac-Med can help design one specifically for you. In short, there are many unanswered questions out there, we at Tac-Med are ready to help fill in the blanks
Educational Institution & Corporate Security Course The Tactical Operations Medical Support Program (TOMSP)- Institutional Level is designed for the institutional security forces such as Universities and corporations. These institutions will deploy a varying range of security forces ranging from basic private security guards to sworn police officers. These personnel typically make up the first line response to incidents on campus and universities and corporations. Their initial training may range from a two-day basic familiarization course to police academy training, but involve very little tactical and medical training.
The goal of the TOMSP-Inst course is to provide the necessary tactical and medical skills for any level of institutional security force to respond to incidents on their campus. The training focus for this course will include:
- Proper reporting & information dissemination during crisis events. - Tactical movements for both offensive and defensive maneuvers. - Hostile response theories - Tactical and Medical equipment suggests & deployment recommendations - Basic medical care in hostile environments - Triage of MCI patients in hostile environments - CBRNE issues on campus - Command center set up
Course Length: 16 – 32 hrs, 2 - 4 days (depending on training requested)
This is a fully customizable template to meet your needs: Day 1: Classroom- Campus threats, CBRNE, terrorism, equipment reviews, NIMS overview. Day 2: Classroom- CPR- First Aid certification. Optional Add On Training: Day 3: Classroom/Field- First Aid, Triage, patient extrication, Casualty Collection Point selection, ICS Day 3: Field-Tactical movements, deployments, tactical operations in residential & urban areas Day 4: Capstone exercises: Triage, hostage, shooter response, CBRNE practicum
Course Dates: Call to schedule for your company / school. Cost: $150.00 per student/day Course Length: up to 32 Hours (4 Days) PA DOH Course #: Pending Prerequisites: Company level training. Contact:Jeremy Burke, Institutional Program Developer Continuing Education Topics
Sports First Aid and Injury Prevention This six-hour course gives providers an in-depth understanding and assessment tools valuable in assessing and treating sport-related injuries or injuries in "high performance" occupations such as athletics, law enforcement, EMS, FireFighting, as well as others. Text references and "certification card" are provided through Emergency Care and Safety Institute(ECSI).
Course Dates: Call to schedule for your company / group. Cost: $100.00 Course Length: 6 - 8 hours (1 Day) PA DOH Course #: Pending Prerequisites: None Contact: David P. Neubert, MD
