Posted: 10/10/2010 11:27:59 AM EDT
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I'm looking for info on tactical medic courses out there. "personal experience" from those of you that have attended these classes and how you are using your skills now. Quick info on me, im a 10 yr firefighter/paramedic with no LE or Military experience. Looking to set myself up for possible future programs that may come about.
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The sine qua non of TEMS course is CONTOMS. http://www.trueresearch.org/contoms/
Originally created for DEA and Military adivsory folks doing counter drug work in tropical climes they really pioneered advanced directives and team maintenance. While they were the victims of budget cuts for several years (authorized, but unfunded) they're back and running. When the absence turned from "not this year" to "not this decade", several CONTOMS graduates opened their own schools based on similar austere medicine principles and the concepts of Tactical Combat Casualty Care (TCCC, or T3C) developed over the last decade by .Mil. One of those schools - Rescue Training Inc - offers the class I just finished taking - the Emergency Medical Technician - Tactical class. http://www.emtt.org/ They were reviewed in the September '08 (IIRC) issue of SWAT magazine, and let me say that the description of RTI's CS gas lab as "unparallelled" is accurate.  
Another reportedly good class is the Tactical Medicine class offered by the International School of Tactical Medicine http://www.tacticalmedicine.com/index.html. In fact, Sully of Defensive Edge reccommended them to be several years ago, but I could never convince the powers that be to send me to Sunny California. IIRC they're the folks that took over the old Heckler and Koch school that predated CONTOMS, but don't treat that as gospel. Here's my limited understanding. CONTOMS (and thus the RTI class and other successors), being intended for DEA and .MIL, assume you have some basic firearms knowledge. In a turnphrase? They seem more like medical class for operators (oooh, I used the "o" word  ) The RTI class had a very basic "render safe" class concerning securing of firearms from injured parties, as well as a very basic introduction to small unit movement and tactics. As they repeatedly said - we're teaching you a way of doing things, not the way... the weapons and methods used by your home unit or department may very well be different. Learn those methods, SOPS and equipment and work according to them.
As an example, compare the loadout requirements... CONTOMS: Uniform
The uniform of the day is the tactical uniform of your department. If you do not have a department-issued uniform, then you should wear standard black or camouflage BDU fatigues. General Items Tactical boots, portable hydration system, sun block, insect repellant, flashlight and rain gear are essential items for you to bring with you. Tactical Equipment It is recommended that you bring and train with your own tactical gear. Items that will be needed for training include: ballistic helmet, eye protection, duty belt, gloves, body armor, knee pads, elbow pads and gas mask. If you do not have these items, please notify CONTOMS staff upon acceptance into the course so that we may provide them. Medical Equipment While you may bring your own medical equipment for comparison and discussion, all medical training supplies for the class will be provided. Prohibited Items Realistic but safe training is a fundamental tenet of this program. No weapons, guns, knives, cutting tools, Leatherman tools, OC spray or other similar items will be permitted onsite at this course. If you are required to have duty equipment with you as part of your official responsibilities, please notify CONTOMS staff upon acceptance into the course so that we can coordinate appropriate secure storage. Possession of these items at any point during the training is grounds for immediate dismissal from the course. Which is remarkably similar to RTI: Each student is required to wear the tactical uniform of his or her department. Standard work uniforms do not usually provide adequate protection for the field environment. If your department does not have a tactical uniform, military style BDU's, "combat" style boots, and rain gear are acceptable.
Each student is to bring their own tactical equipment (body armor, helmet, eye protection, medical kit, etc.). We feel the best training occurs when students are training in the same gear and using the same equipment they will utilize during actual missions. Weapons, ammunition, magazines, knives, etc. must not be brought to the EMT-T course. A limited amount of tactical gear will be available for those that cannot bring their own. Minimum recommended Equipment (Bring all of your gear) •Tactical Body Armor •Helmet •Eye protection •Hydration system •Flashlight •Gloves •Protective mask WEAPONS EMT-Tactical training is law enforcement training and involves scenarios and role play. In order to ensure a safe training environment, there is an absolute prohibition on weapons possession at the course. The possession by tactical medic students of any personal (or department) weapons of any kind is strictly forbidden. We provide all firearms necessary for familiarity. There is no shooting lab during this course. Now compare the requirements for the ISTM class: Equipment Requirements:
Tactical Uniform Tactical Footwear Gloves Elbow Pads Knee Pads Hat Duty Belt Issued duty weapon (pistol) and holster Dual Magazine Pouch Body Armor Hydration System Flashlight with holster and extra batteries (Surefire G2 system with holster and laynard can be purchased at the school) Personal Hearing and Eye protection Note: Palm Springs has a dry sunny desert climate and for those not acclimated or familiar with desert training should prepare themselves for this environement by having a hat, sunscreen, and an adequate hydration system at all times. Ammunition Requirements: You may purchase ammunition at the school for your convenience. We only stock 9 mm, 40 cal, and 45 ACP. We do not stock .223 ammunition. Module A: 100 rounds handgun, 350 rounds subgun Module B: 100 rounds handgun, 350 rounds subgun No hand loads, lead, or remanufactured ammunition may be used at the school. If you have any questions regarding ammunition requirements or the firearms training portion at the school please contact us via email or phone. So dare I hazard a guess that the ISTM course seems more for medics with limited weapons knowledge? With the exception of the RTI EMT-T course which I have personally attended, all these are suppositions and guesses based on limited research of word-of-mouth, and should not constitute gospel, "reliable information" or anything other than well intentioned bullsh*t. As always, getting your own information and/or confirmation is suggested. Strongly. 
ETA - as far as actual use? I was one of three FF/medics asked by the PD to become a "SWAT medic" back in 1996. Well, the SWAT commander backed the wrong mayoral candidate, and was put on patrol on midnights. The TEMS thing was on hold until a few years ago when a few other guys - including my Shift Commander, one of the original 3 - were asked to resurrect the program. The group of 5 got pared to two, and I signed up to be part of a second offering which never manifested, but I used the possibility to get approved to go to class. Sadly, between the issue of needing to modify an ordinance (re-authorizing part-time officers, which had actually been constructed and approved by the City attorney) and actually having to pay for training and equipment the Police Chief suddenly got cold feet, and the Fire chief, despite his "official support", used the hesitation to abandon the concept by claiming it "wasn't his to advance" if the Police Chief wasn't going to. Ironic, especially given that he was the third individual asked about starting the program back in '96. 
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Thank you much for the large amount of info,
From what ive read and been told so far. CONTOMS looks like a good starting point. I have a defensive handgun course and a carbine/CQB class under my belt. Im really looking for the medicine side, so i can justify my department paying for it and set myself up for a spot on a possible team in the future. The county i work for in WA tried to set up a team, but failed for the same reasons you stated. |
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Cypress Creek EMS in Houston, TX has an awesome program. The advanced course is really intense.
http://www.ccems.com/basic-tactical-operational-medical-support-course |
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All of our classes are ran by one of the docs on our team. He is a trauma surgeon and does some classes for the fireweenies also. One of the best pieces of advice - get a doc (MD) if you can. Whether he winds up doing entries or just gets a "physician" department badge and dinner at the team party every year, it's well worth the ego-stroking to be able to get XSOPs (eXpanded Scop Of Practices) that supersede your local EMS protocols given the right criteria (SWAT deployment) and the additional skills that can be performed under his license. |
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CONTOMS was the original, and is considered the standard by a lot of departments. Josh Vayer used to be the Director, and is still on the faculty list from what I can see (including some folks who I personally know, and have trained with).
(old-school CONTOMS grad here) That's probably where I'd start. With that as a foundation, you can pick up other regional or national courses (like the NTOA or others) to help hone your skills. That combined with a SWAT school and attending training days (most injuries are during training) should set you in good stead. |
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CONTOMS was the original, and is considered the standard by a lot of departments. Josh Vayer used to be the Director, and is still on the faculty list from what I can see (including some folks who I personally know, and have trained with). (old-school CONTOMS grad here) That's probably where I'd start. With that as a foundation, you can pick up other regional or national courses (like the NTOA or others) to help hone your skills. That combined with a SWAT school and attending training days (most injuries are during training) should set you in good stead. I sent them an email to see if i qual for the class. I'm just looking to get myself set up for the possibility of a team being put together or a spot. Will have to see if they will let me in with only Fire Department creds |
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+1 to everything tango said. (I have moved since this, so when I say "my area" i mean "my area a year ago".) In my area in south Texas we had very limited access to anything beyond a level 4 rated hospital facility. What this means is that anything which fell into the major "trauma" category had to fly 30 minutes to Corpus Christi or go 1 hour by ground. Anyone who has seen a good trauma knows that leaking humans do not live that long without serious support. In Texas most PD's and FD's play nice, but are still two independent organizations. The lines do get blurred sometimes: for example a fire marshal in Tx has to be a peace officer and often times the local PD or SO holds the fire marsal's commission. Texas is divided up into RAC or regional area councils which act as a focal point for grants, classes, and overall area organization. So at some point the RAC polled PD's and found that while they almost all had swat teams, few had medical units in place. In light of our WTF, LONG transport times to the nearest trauma surgeon the RAC coordinated with Rescue, Inc to come put on their EMT-T class in Corpus. I had always been interested in tactical medicine so when my FD offered to pay for the class (assuming we passed it), I jumped at the chance. After completing the class I talked with some contacts I had in made in PD during a hazardous materials class and found them quite receptive to the idea of putting medics on their team. Showing them the quickclot video where the pig femoral is severed helped to illustrate my point. So after running the same tryout as everyone else, myself and three others were chosen to join the PD's swat team. (This was kind of funny because the PD guys sucked at the dummy drag portion and the FD guys had trouble with the obligatory do shitloads of push-ups part.) The team was laid out with a commander, assistant commander, then two working teams of four officers. So with the addition of the four of us each team had 6: 4 officers, 2 medics. After well thought out presentations to both chiefs we had full support. The police chief knew his guys were going to be safer and the FD chief knew that the odds of having that "why did your ambulance not go into a hot scene" PD vs FD friction was gone. The PD's team was a little anorexic, as all civil services are in the area due to the budget problems, thus this was a great thing: they got medical coverage AND 2 extra per team. The plan was to be a fully armed, fully kitted, fully functional member of the team. Then the trouble started. While I usually totally abstain from trash talking old jobs I will say that my old chief and I do not share a lot of common ground in the command department. At some point it hit him that two of his 6 paramedics were now on the swat team. In other words if I got a call out while my fellow shift medic was on vacation, the city would drop down to an EMT-basic staffed ambulance. Once this realization hit restrictions on training and callouts were put into place. As your primary job should always take precedence we were all OK with it and I took a shift change so that PD would always get at least two medics no matter when a situation developed. So problem number one was FD staffing and job priority: Depending on your FD's size and staffing you might be restricted. The second problem developed when the FD chief decided that he would not allow the medics to be armed. PD and legal had already cleared the way for it, whereas we would all have to take a use of force class and would fall under roughly the same burden as a CHL: I was in fear for my or another person's life. The FD chief wanted no part in any of that and ruled no guns. Well needless to say we were pissed, not because we wanted to shoot someone, but because what had just been done is equivalent to being asked to go into a fire without bunkers or scotts on. The two of us who were CHL's made a very good case to the chief but were shot down. So problem number two was the weirdness which developed about medics having even "defensive" weaponry. This problem developed after about a month of training, so the PD guys were quite happy with our shooting and were very unhappy about the idea of being rescued by an unarmed target. Undaunted and having a mutal shitload of fun, the program continued with the idea that we would be used for all the less than lethal munitions. I got to be pretty good with the old 38 mm launcher as well as the new rolls royce 40mm setup, shooting every kind of round under the sun. My personal favorite was the exact impact munitions out of the GL or the marking beanbag out of the 12ga. Can you say racquetball of pain? This idea was nixxed a month after that since via several training evolutions we found that what a medic really really need was a sidearm and a subgun (or something compact), not a bandoleer and multibarrel GL. Even when we ran the evolutions with one of the pointman's 12" m4's they got annoying to deal with while doing medical shit. Since this all happened I had spoken with several people from across the country about swat medic work and apparently this is the largest problem in the field when the medic's are not peace officers. Plans were made to send myself and another guy to the SO's year long reserve officer class to become peace officers, but as you read on it never happened. By the end of our run I was being utilized as a "breakers and raker" while an officer port and covered. The other medic on my team was built like a 5'6" brick shithouse and made a perfect shield carrier. Even though we had been downgraded to the lowest denominator of usefulness, we still were "all in" although the annoyance was beginning to build.... and I quote myself "I am armed when I go to buy milk and eggs, but not when serving papers in the shitty part of town. FML." As with almost every attempt at creating this kind of program, our program failed due to money. About seven months in and just as we were getting our own custom fit level 4 armor ordered, the FD chief decided he wanted PD to pay for not only all the gear and callouts, but the weekly four hours of training. After heated discussions the program went into hiatus for 2 months and then was canceled. I was out of energy and had personal reasons just to let the program die. I moved away for family reasons about three months later. If I had remained in the area my plan was to put myself through peace officer school since I want to be a fire marshal eventually, then become a reserve officer/swat medic with PD. So that is the story of my cities attempt at a swat medic program. I have to stress again that this is a common occurrence: common sense when it comes to dangerous police work breaks through the bureaucracy and some type-a people make it happen, only to have bean counters and nay-sayers break it down. To have a program like this is going to require a LOT of energy to set up and keep running until it becomes established. You are going to need to a medical director who will let you do things not normal to the EMS profession. For example I had protocols on how to distribute Sudafed and other stimulants to my team in the field and hydrate the dogs via SQ . (Long standoffs are a bitch.) |
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Second post deals with once you find a team or get a program stated: Be ready to learn, ALOT. As FF's or paramedics we take much of our fundamental training for granted. When I started to train with the swat team I was shocked: WOW, there is a lot which goes into that crap. I am not talking about simple maneuvers like a crossover upon entering a centerfed door. I am talking potentially painful lessons about buffer zones, having lethal coverage on a suspect before going hands on, the fatal funnel, etc. (Dead people do extra PT.) While the RTI class will give you an intro to swat tactics, your specific team will explode that knowledge. This is similar to how you are taught in paramedic school but told that things will change when you get hired by a department and protocols take effect. Speaking of PT: the worst thing you can do is get a program set up and then screw yourselves by not going 100%. Make sure that you set up your program such that you give just as much as all the other members. Force the issue where instead of being added to the team via some administrative tomfoolery you run the same physical as the other team members AND PASS. A muzzle sweep by a medic should yield just as much pushing as a muzzle sweep by a officer. (same goes for failure to neutralize, etc.) As a medic you can expect to have twice the kit as the others and missing a piece is IMO worse. Be ready to push, 50 was the starting cost. I think one of the reasons our group worked so well was because we medics came in humble, took our lumps, learned, and taught. On a mental note I will say that you need to understand that police work is not for everyone. I went to two callouts in six months, plus about 3 "be ready to put your crap on and leave your ambulance" standbys while I was working (I hated having callouts while I was on my 24 at work.) Both of these callouts went great and bad guys went to jail. I felt great afterwards because I knew that if anything bad had happened I would have had a very positive influence on the situation. With that said there were several situations which could have potentially came up, all dealing with use of force on a possibly hostile target and "officer safety", which would have kept me up at night. While some SOP's and actions will be correct on paper and to 90% of the field, they might not set well with you personally and they might be SOP's which you do not have the option not to follow. I hope my two walls of text have got your mind thinking in the correct direction to take the class then join a team (or start your own.) |
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problem number two was the weirdness which developed about medics having even "defensive" weaponry. BTDT. Like you, the cops didn't have a problem with it - most of the noise actually came from the FD side, from people who had no interest in participating, but somehow felt that if we took part then they could be compelled to enter a scene and make a grab.  
The whole idea of a voluntary detail seemed completely foreign to them. Of course, this is the same person(s) who seems to be able to find problems with anything, but is conveniently short of solutions. We also got a hassle from the union concerning the method by which folks were selected (basically cherry picked). They tried to hassle me when I was the only person who signed up in the face of a "union boycott". When two of the officers spoke to me about it, I replied with the following - find me a person who meets two of these three conditions: 1) a person who has been the only off-shift person at the station the night of a union meeting more times than I have as president or secretary in the past 16 years who's objecting to the program. 2) a person who was asked to do this previously in their career here who's objecting to the program. 3) a medic who has actually performed a patient extraction under cover of arms while working for this department. (the only other person is my old partner, and he wasn't bitching). Otherwise, STFU. 
I'm still keeping the faith - eventually I'll get to play, be it with the FD or if I can score a PT LE gig. Unfortunately, those are tough to find in NE IL. |
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+1 to everything tango said. The two of us who were CHL's made a very good case to the chief but were shot down. So problem number two was the weirdness which developed about medics having even "defensive" weaponry. That's derailed more than one TEMS program. I was even told by a Chief that he didn't want me armed... and that was as the team's only physician, and after a full academy, LE certification, and all the qualification courses. It happens. If you're not comfortable with it, wait for a change in leadership, or move on. |
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Tango.....Check with the local Sheriffs office in your area...down here Will county still has Auxillary personnel. It might be a good way to get your foot in the door. Appreciate the direction but I'm afraid it's a dead end. 
Up here the Lake County Sheriff's Reserve Deputy corps evolved from a neighborhood watch group in the late 70's... it transformed in "Mobile Eye 1", a citizen's CB club along the line of ARES (the amateur radio group) ... as an example of that heritage causing problems, there were a number of RD's who were former LEO's who, despite carrying for several years were prohibited from carrying by decision of the County Board. The RD's are traffic control, SAR and disaster assistance only up here, and the "full time" v. "volly" attitude seems pretty prevalent - at least among the full timers I've talked to. Even among the FT Deputies, there's the SWAT team and the "Emergency Response Unit". The former is the crew that goes in, the latter is the crew that acts as perimeter and performs crowd and riot control, and no, the two don't intermingle job functions. Seems like lots of "doesn't play well with others" in effect in this corner of the state. |
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http://deploymentmedicine.com/home.html
If you can get into a live tissue, OEMS type of training course I highly suggest it. I was able to attend a SOF Combat Medic Course that came to a final day of live tissue trauma, to include edged, gunshot and blast wounding. It was held as a closed course on a military base and it was pretty hush hush because of the PETA people, but it was by far the best training I ever attended. |