CALIFORNIA TACTICAL MEDICINE GUIDELINES POST and EMSA

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CALIFORNIA TACTICAL MEDICINE
GUIDELINESPOST and EMSA

• TREXPO WEST 2010
• March 29, 2010

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POST/EMSA TACTICAL MEDICINE PROGRAM

• Daniel R. Smiley
• Chief Deputy Director
• EMERGENCY MEDICAL SERVICES AUTHORITY
• DAN.SMILEY_at_EMSA.CA.GOV
• Kenneth L. Whitman
• Special Consultant
• COMMISSION ON POST
• KEN.WHITMAN_at_POST.CA.GOV

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(No Transcript)
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POST Operational Guidelines for SWAT (2005)

• POST Operational Guidelines for SWAT (2005)
  identified the need for tactical medicine as an
  integral part of the law enforcement tactical
  team. Chapter 5 Planning section of the SWAT
  Guidelines states
• 5.5 SWAT teams should incorporate medical
  emergency contingency planning as part of the
  SWAT operational plan.
• Where resources allow, consideration should be
  given to integrating Tactical Emergency Medical
  Support (TEMS) personnel within the structure of
  the SWAT team.

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POST Operational Guidelines for SWAT (2005)

• Additionally, a Basic SWAT Team Operational
  Component has been identified as medical
  support under the Command and Control Element in
  the guidelines.
• This guide is also meant to serve as a companion
  document to the POST Operational Guidelines for
  SWAT (2005). It describes the critical role that
  tactical medical planning and threat assessment
  plays in the overall contingency planning as part
  of the SWAT operational plan.

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POST/EMSA TACTICAL MEDICINE PROGRAM

• TACTICAL MEDICINE IS DEFINED AS THE DELIVERY OF
  MEDICAL SERVICES FOR LAW ENFORCEMENT SPECIAL
  OPERATIONS

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TACTICAL MEDICINE PROGRAM GOALS

• ENSURE TACTICAL TEAMS IN CALIFORNIA HAVE AN
  APPROVED TACTICAL MEDICINE SUPPORT COMPONENT
  AVAILABLE DURING ALL RESPONSES
• PROVIDE A STANDARDIZED TRAINING COURSE FOR
  TACTICAL MEDICAL TEAMS
• DEVELOP CORE COMPETENCIES FOR TACTICAL MEDICINE
• PROVIDE ADDITIONAL TRAINING AND UPDATES AS NEEDED

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WHY WAS THIS NEEDED ?

• Varying levels of training ranging from 8-80
  hours
• No standardized curriculum
• No standardized core competencies
• No standardized written or skills testing
• Not integrated with EMS system
• Sometimes practicing without medical direction or
  oversight

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I am a Tactical Medic?

• What does that mean?
• What do you know?
• What training do you have?
• What medical skills can you do?
• What equipment should you have?
• Are you integrated with the EMS system?
• Are you part of a program with medical oversight?

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POST/EMSA TACTICAL MEDICINE PROGRAM

• DEVELOPMENT WORKGROUP
• CALIFORNIA AMBULANCE ASSOCIATION
• CALIFORNIA FIRE CHIEFS ASSOCIATION
• CALIFORNIA EMS MEDICAL DIRECTORS ASSOCIATION
• CALIFORNIA EMS ADMINISTRATORS ASSOCIATION
• CALIFORNIA EMERGENCY MEDICAL SERVICES AUTHORITY
• COMMISSION ON PEACE OFFICER STANDARDS AND
  TRAINING
• STATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH EMS
  COUNCIL
• INTERNATIONAL SCHOOL OF TACTICAL MEDICINE (ISTM)
• LAW ENFORCEMENT TACTICAL EXPERTS
• (LASD, LAPD, CHP, SDPD, SJPD, SFPD, PSPD)

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PROGRAM DEVELOPMENT
• PHASE ONE
• COMPLETED TACTICAL MEDICAL GUIDELINES,
• APPROVED BY POST COMMISSION (JULY 2009) AND EMSA
  COMMISSION (DECEMBER 2009
• FINALIZING REGULATIONS/PROCEDURES TO BE INCLUDED
  IN THE CALIFORNIA CODE OF REGULATIONS (CCR) 1084
  AND SUBJECT TO APPROVAL BY THE OFFICE OF
  ADMINISTRATIVE LAW (OAL)

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PHASE TWO
• DEVELOPING 40-HOUR REFRESHER COURSE (FALL 2010)
• DEFINE TACTICAL MEDICAL CARE TRAINING LEVELS
• ESTABLISH ANNUAL COURSE REVIEW PROCEDURES

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POST/EMSA TACTICAL MEDICINE PROGRAM

• TACTICAL MEDICINE COURSE
• PALM SPRINGS POLICE DEPARTMENT
• INTERNATIONAL SCHOOL OF TACTICAL MEDICINE (ISTM)
• MODULE A 40 HOURS
• MODULE B 40 HOURS
• (ESTABLISHED IN 1996)
• STATE FEDERAL APPROVALS
• POST-CERTIFIED FOR CPT CREDIT
• EMSA APPROVED
• DHS APPROVED3 YEAR REAPPROVAL IN PROCESS
• (USE OF FEDERAL GRANT FUNDS)

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POST/EMSA TACTICAL MEDICINE PROGRAM

• REMEMBER
• COMPLETION OF THE TACTICAL MEDICINE TRAINING
  COURSE DOES NOT AUTOMATICALLY QUALIFY YOU TO
  BECOME A SWAT TEAM MEMBER
• LAW ENFORCEMENT AGENCY POLICY WILL DICTATE HOW
  TRAINED TACTICAL MEDICAL TEAM MEMBERS WILL BE
  DEPLOYED OR UTILIZED

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THE TACTICAL MEDICINE GUIDELINES
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WHAT IS IN THE GUIDELINES DOCUMENT?

• 1.0 Definition of Tactical Medicine
• 2.0 Tactical Medicine Operational Programs
• 3.0 Tactical Medical Planning and Threat
  Assessment
• 4.0 Tactical Medicine Operational Equipment
  Recommendations
• 5.0 Tactical Medicine Training Programs
• 6.0 Tactical Medicine Required Course Content
  Description
• 7.0 Tactical Medicine Clinical Core Competencies
  Psychomotor
• 8.0 Tactical Medicine Scenarios
• 9.0 Tactical Medicine Final Competency Testing
• 10.0 Tactical Casualty Care Assessment and
  Treatment Model

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Two Parts to the Guidelines

• Description of Tactical Medicine Operational
  Programs
• Standards for Approved Tactical Medicine Training
  Programs

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Tactical Medicine Operational Programs

• At the Law Enforcement Agency Level

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KEY INTRODUCTORY POINTS

• The public safety agency developing a tactical
  medicine operational program should conduct a
  needs assessment to determine the level of
  emergency care required by the SWAT team to
  support the mission and operations.
• The operational program should consider the need
  for medical oversight and coordination with the
  local EMS agency, medical direction, use of
  Emergency Medical Technicians (EMTs), paramedics
  and other advanced life support personnel, and
  minimum training and equipment standards.

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KEY INTRODUCTORY POINTS

• The agency should develop policies and procedures
  for medical support during tactical operations.
• The assignment and/or deployment of any emergency
  medical support personnel during a tactical
  response shall be at the sole discretion of the
  agency or department in accordance with
  established policies and operational procedures.

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KEY INTRODUCTORY POINTS

• Legal authority and proper training to carry a
  firearm is a prerequisite to arming emergency
  medical support personnel.
• Armed medical support personnel must have
  statutory authority to carry a firearm and should
  be trained and tested to the standard for law
  enforcement personnel.

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Formation of Tactical Medicine Operational
Programs

• LE Agencies should develop policies regarding the
  use of firearms by tactical medical personnel.
• It is recommended that tactical medical team
  members should minimally obtain reserve peace
  officer status.
• Reserve peace officers that are members of the
  tactical medical team should maintain proficiency
  levels with all firearms deployed by SWAT, as
  determined by the LE Agency.

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And Now EMSAs turn

• For the Medical Aspects
• Yes, Tactics before Medicine

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Formation of Tactical Medicine Operational
Programs

• Tactical Medicine programs and their medical
  personnel shall be integrated into the local EMS
  system, in coordination with the local Emergency
  Medical Services (EMS) Agency.
• This shall be in accordance with applicable
  statutes and regulations found in Health and
  Safety Code 1797 et seq.

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Formation of Tactical Medicine Operational
Programs

• Optimally, each Tactical Medicine program should
  have a Medical Director, who shall be a physician
  currently licensed in California, to provide
  medical direction, continuous quality
  improvement, medical oversight, and be the lead
  for medical contingency planning.
• The Medical Director shall acquire and maintain
  competency in tactical medicine, and may also
  serve as the program director.

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Formation of Tactical Medicine Operational
Programs

• All personnel who are tactical medical providers
  shall be minimally certified at the EMT level.
• Tactical medical programs should utilize
  personnel licensed at the advanced life support
  level. This may include physicians, mid-level
  providers, registered nurses, paramedics, and
  Advanced EMTs operating under their authorized
  scope of practice.
• All personnel must have tactical medical
  training, as defined within the POST and EMSA
  guidelines.

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Tactical Medicine Operational Program Domain
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Medical Oversight

• Medical oversight refers to advice and direction
  provided by the program director and the Medical
  Director to trained tactical medical personnel
  who provide medical care in all aspects of
  tactical operations.
• Each tactical medical program shall ensure
  medical oversight is available.

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Medical Contingency Planning

• Medical Contingency Planning is the inclusion of
  medical personnel in pre-event planning and
  preparation.
• Tactical medical personnel should participate in
  the development phase of mission planning and
  risk assessment to ensure appropriate assets are
  in place for the identified mission parameters.
• Considerations should include appropriate
  resources and trained medical personnel, and may
  include, but are not limited to ground ambulance
  standby, air ambulance availability, and
  transport to specialized hospital facilities,
  including trauma centers.

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Operational Support (TEMS)

• TEMS refers to Tactical Emergency Medical
  Support, which is the operational support
  component of the discipline of Tactical Medicine.
  
• If available, tactically trained medical
  personnel should be deployed and utilized during
  SWAT operations, at the direction of the LE
  Agency.
• This operational unit is a designated group of
  medical personnel, preferably at the advanced
  life support level, specifically selected,
  tactically trained, and equipped to provide
  medical care during critical law enforcement
  incidents.

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Quality Improvement and Post Incident Analysis

• Quality improvement is the ongoing and active
  review of all medical involvement in tactical
  operations for the purpose of improved patient
  care and operational outcomes.
• Tactical medical personnel should participate in
  post-incident analysis and debriefings.

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Team Health Management

• Team health management is the supervision and
  implementation of the general health and
  well-being of all members of the tactical team.
• Team health management strives to maintain and
  enhance the total well being of the SWAT team
  member through physical conditioning, diet,
  mental health and preventive care.
• Overall health assessment and fitness evaluation
  should be conducted on a regular basis.
• In conjunction with the tactical medicine
  program, it is incumbent on tactical team members
  to meet the physical fitness standards set by
  their LE Agency, in accordance with POST SWAT
  guidelines.

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Training and Education

• Tactical Team members should not be deployed in
  the role of tactical medical provider until
  successful completion of an approved Tactical
  Medicine Course,
• AND
• ?ompletion of any additional requirements as set
  forth by the law enforcement agency.

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Medical Equipment Acquisition and Maintenance

• Tactical medical providers should be equipped to
  meet the mission identified by the LE Agency.
• The tactical medical provider should be equipped
  with the necessary basic and advanced medical
  supplies and equipment for their level of
  licensure.
• Medical equipment used by the tactical medical
  providers should be agency-issued and approved by
  the program director and/or Medical Director,
  including any modifications, additions, or
  attachments.
• Equipment shall be maintained regularly to ensure
  it is in good working order prior to deployment.
  Expiration of supplies, including medications,
  should be checked regularly.

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Tactical Medicine Training Programs

• At the Training Program Level

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Tactical Medicine Training Standards

• Minimally, the Tactical Medicine Course shall be
  80 hours in length and conform to the core
  competencies.
• An Alternate method to complete, is a 40 hour
  course, when ALL students have prerequisites of
  80 hour Basic SWAT Course, EMT or above, WMD
  training, and Current LE/Public Safety
  designation.

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APPROVAL OF THE TACTICAL MEDICINE COURSE

• The course of instruction shall be jointly
  approved by the Commission on Peace Officer
  Standards and Training (POST) and the California
  Emergency Medical Services Authority (EMSA).
• 60 Days Prior to Course Advertisement and
  commencement.

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REFRESHER TRAINING

• Tactical medical providers should successfully
  complete a minimum of 24 hours of POST-certified
  tactical medicine refresher training every 3
  years to maintain competency and proficiency.

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Full Tactical Medicine Course - 80 Hours
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Alternate Tactical Medicine Course - 40 Hours
(Prereqs SWAT Basic, EMT, WMD training, LE)
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Clinical Core Competencies Cognitive

• Medical
• Patient Assessment in Tactical Environment
• Airway Management, Bleeding Control, Shock
  Management, WMD, etc.
• Advanced Care
• Tactical
• General Topics to Operate as part of Tactical
  Team
• Team Movement
• Safety and Integration

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Clinical Core Competencies Psychomotor

• Safety and Personal Protective Equipment (PPE)
• Tactical Assessment and Treatment (TC2)
• Basic Airway and Ventilation Techniques
• Advanced Airway and Ventilation Techniques (N/A
  for BLS personnel)
• Wound/Hemorrhage Control
• Intravenous Access Techniques (N/A for BLS
  personnel)
• Medication Administration Techniques
• Cardiac and Circulatory Support
• Patient Extraction and Evacuation

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Tactical Casualty Care Assessment and Treatment
Model

• Modeled after TCCC but adapted for the Civilian
  Environment
• Basic Management Plan for Care, Situational
  Awareness, and Scene Safety (Care Under Fire)
• Basic Management Plan for Assessment, Evaluation,
  and Tactical Field Care (Tactical Field Care)
• Extraction, Evacuation, and Transportation
  (Tactical Evacuation)

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Tactical Casualty Care Assessment and Treatment
Model
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Tactical Medical Scenarios Practice

• Basic Scenarios (6)
• Tactical Casualty Care
• Assessment and Basic Treatment
• Operating as part of/with Tactical Team
• Advanced Scenarios (12)
• Advanced Life Support Care in Tactical
  Environment
• Special Cases (WMD, Environmental, Low Light,
  Conditions, etc)
• Refinement of Tactical Medical Operations

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Competency Testing

• Cognitive Written Test
• Designed to test Knowledge
• Psychomotor Skills
• 9 Medical Clinical Core Competencies
• Tactical Medicine Skills Testing (6)
• Integrative Skills Evaluation

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DEFINING TACTICAL CASUALTY CARE TRAINING LEVELS
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DEFINING TACTICAL CASUALTY CARE TRAINING LEVELS

• Confusion over terminology
• Training standards for various levels
• Scope of Practice (basic life support vs.
  advanced life support)
• Redefined into 3 levels
• Tactical First Aid
• Tactical Life-Saver
• Tactical Medicine

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TACTICAL CASUALTY CARE TRAINING LEVELS
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TACTICAL CASUALTY CARE TRAINING LEVELS
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Summary

• Goal is to protect the public and law
  enforcement personnel
• Design Tactical Medicine program and have
  reproducible, standardized training
• Continue to look to the Future to ensure standard
  programs and training that set high quality
  standards

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Questions?