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Planning Activities International School of Tactical Medicine Student Guide Rancho Mirage, California Tactical Medicine Module A Training Support Package Student Guide Tactical Medicine Module A - Introduction We are committed to ensure that you receive the most intense and up to date tactical medical training available. Our instruction technique is based on the building block approach to training with a proven track record of success. Our tactical instructors have many years of experience as tactical commanders and operators. All physician instructors are reserve law enforcement officers, active on tactical teams, and are residency trained in emergency medicine, trauma surgery and critical care medicine. The instructors are experts in their field with experience and knowledge unlike that found anywhere else. To ensure high quality training, ISTM complies with the California Peace Officer Standards and Training (POST) and the California Emergency Medical Services Authority (EMSA) regulations and guidelines for continuing education for pre-hospital and law enforcement professionals. Finally, our faculty strictly adheres to current tactical law enforcement accepted standards and emergency medical care guidelines that conform to the civilian EMS system and the practice of emergency medicine. We promise you an outstanding academic training program that upon completion will enable you to effectively integrate with your tactical team as a tactical medical provider. We will make every effort to see that you get the most out of your 2 weeks of training and our instructors will work closely with you to help you reach your goals. It is our sincere hope that with this training you will be able to provide state of the art tactical medicine for your team and may perhaps one day save a life during a tactical operation. Lawrence E. Heiskell, M.D., FACEP, FAAFP Founder and Medical Director ISTM “It should be borne in mind that there is nothing more difficult to handle, more doubtful of success, and more dangerous to carry through than initiating changes... The innovator makes enemies of all those who prospered under the old order and only lukewarm support is forthcoming from those who would prosper under the new. Their support is lukewarm partly from fear of their adversaries, who have the existing laws on their side, and partly because men are generally incredulous, never really trusting new things unless they have tested them by experience.” Niccolò Machiavelli, 1514 Copyright Page i All Rights Reserved Tactical Medicine Module A Training Support Package Student Guide Disclaimer The ISTM does not guarantee that participants who attend or successfully complete the Tactical Medicine Course will be able to perform Basic or Advanced adult or pediatric life support in an actual emergency. Our role is to provide you, the student with the highest quality Tactical Medicine education available anywhere. Although our courses are designed to teach students how to perform in certain situations, the course does not guarantee that the participants will use this training appropriately in emergency medical or tactical situations outside the classroom. Law-enforcement tactical operations are an evolving craft and what is best today may or may not be the best tomorrow. Beyond this course, it is incumbent on the student to keep abreast of emergency medical and tactical options and issues. Finally, your tactical commander, department policies, county EMS protocols and your own skill level will be the ultimate determinant as to what techniques, tactics and treatment you will use in the field. Copying Course Materials The student manuals, digital photographic images, PowerPoint presentations, teaching scenarios, training evolutions and other instructional materials are the intellectual property of ISTM and are protected by copyright and other intellectual property laws. You may not reproduce or copy the materials, in whole or in part, in any manner, without the prior written consent from ISTM. ISTM P.O. Box 2609 Rancho Mirage, California 92270 Copyright Page ii All Rights Reserved Tactical Medicine Module A Training Support Package Student Guide Continuing Medical Education Continuing medical education is an ongoing dynamic process. We make every effort to stay current with the medical literature as well as changes in the standard scope of practice in emergency medicine. Candidates that successfully complete the Tactical Medicine Module A Course are awarded the following CE and CPT credits: The Sacramento County EMS Authority designates the Tactical Medicine, Module A Course as a continuing medical education activity for: 20 hours CE The State of California Commission on Peace Officer Standards and Training (POST) has certified the Tactical Medicine Module A Course for continuing education for law-enforcement for: 20 Hours CPT Trademarks The ISTM logo is a trademark and is registered with the United States Patent and Trademark Office. Only International School of Tactical Medicine faculty and its licensees may use these trademarks. This trademark is the identity of ISTM and when placed on publications, apparel, course materials and other items serve to distinctly identify the materials as having originated from ISTM. Copyright Page iii All Rights Reserved Tactical Medicine Module A Training Support Package Student Guide Table of Contents SECTION 1 – PRINCIPLES AND CONCEPTS OF TACTICAL MEDICINE 1 TRAINING YOU TO SAVE LIVES 2 CRITICAL TO SWAT OPERATIONS 4 SECTION 2 - TACTICAL MEDICAL EQUIPMENT 26 TACTICAL MEDICAL GEAR 27 EQUIPPING THE TACTICAL MEDIC 29 SECTION 3 - TACTICAL GEAR AND EQUIPMENT 45 HAND ARMOR ADVANCEMENTS 48 SECTION 4 - TACTICAL TEAM CONCEPTS AND PLANNING 55 MEDICS ARMED AND READY 67 SECTION 5 - SLOW AND DELIBERATE TEAM MOVEMENT 69 SECTION 6 - INTRODUCTION TO THE TACTICAL PISTOL 87 TACTICAL PISTOL TRAINING SAFETY RULES 88 SECTION 7 - MEDICAL ASPECTS OF DISTRACTION DEVICES 99 USE OF DISTRACTION DEVICES 100 SECTION 8 – DYNAMIC BUILDING CLEARING TECHNIQUES 118 TYPES OF BUILDING CLEARING 119 SECTION 9 – TACTICAL CASUALTY CARE 127 ASSESSMENT AND TREATMENT GUIDELINES 128 Copyright Page iv All Rights Reserved Tactical Medicine Module A Training Support Package Student Guide BATTLEFIELD OCULAR INJURIES 135 SEAL A SUCKING CHEST WOUND 137 NEEDLE THE CHEST 139 SECTION 10 – MEDICAL ASPECTS OF WOUND BALLISTICS 155 CSI OF WOUND BALLISTICS 156 SECTION 11 – HEMOSTATIC DRESSINGS AND TOURNIQUETS 179 STOP THE BLEEDING 180 SECTION 12 – TEAM HEALTH MANAGEMENT 193 20 TIPS FOR WEIGHT CONTROL AND HEALTHY EATING 194 LIFESAVING PERSONAL MEDICAL INFORMATION 196 SECTION 13 - MEDICAL ASPECTS OF CLANDESTINE DRUG LABS 208 MEDICAL MANAGEMENT OF CLAN LAB EMERGENCIES 209 CLANDESTINE DRUG LABS 213 SECTION 14 – FORENSICS AND EVIDENCE PRESERVATION 236 SECTION 15 - INTRODUCTION TO THE M4 LAW ENFORCEMENT CARBINE 256 M4 CARBINE SAFETY RULES 257 COLT M4 LAW ENFORCEMENT CARBINE 266 DANGEROUS DECIBELS 271 SECTION 16 – CHEMICAL MUNITIONS IN THE TACTICAL ENVIRONMENT 279 SECTION 17 – MEDICAL THREAT ASSESSMENT & BARRICADE MEDICINE 292 Copyright Page v All Rights Reserved Tactical Medicine Module A Training Support Package Student Guide SECTION 18 - MODULE A WRITTEN FINAL EXAM 300 APPENDIX A – RESOURCE EQUIPMENT LIST 301 APPENDIX B – REFERENCE MATERIAL 304 Copyright Page vi All Rights Reserved Tactical Medicine Module A Training Support Package Student Guide Section 1 – Principles and Concepts of Tactical Medicine Duration 1.5 hours Scope Statement This section provides students with an in depth understanding of the principles and concepts of providing medical support for law-enforcement special operations teams Terminal Learning Objectives (TLO) At the end of this section the students will understand the tactical medicine concept and the roles and responsibilities of the tactical medical provider. Enabling Learning Objectives (ELO) At the end of this section, the students will be able to describe: 1. The historical development of Tactical Medicine 2. Tactical medicine training program goals 3. The roles and responsibilities of the tactical medic 4. Differences in the military and civilian model 5. Team structure and function 6. Problems facing tactical teams 7. Injuries and illnesses common to tactical operations 8. Accessibility and civilian EMS interface 9. Legal considerations 10. Operational standards Resources See Appendix A Instructor to Participant Ratio 2:30 Reference List See Appendix B Assessment Strategy Pre and post testing, end of course critiques, subjective evaluations, and instructor comments. Copyright Page 1 All Rights Reserved Tactical Medicine Module A Training Support Package Student Guide Training You to Save Lives Despite the increasing nationwide awareness of the value of having an on-scene specialized medical team, the medical consequences of tactical operations are often overlooked or completely left out of the operational plan. Unfortunately, there are some law enforcement agencies that still deploy S.W.A.T. teams for high-risk warrant service and other operations with no further medical plan other than to call 911 if someone is shot or injured. In today's litigious world this practice is certain to come under close legal scrutiny by the courts. Civilian EMS Constraints During tactical operations involving a barricaded hostage or active-shooter situations, tactical commanders will often stage civilian EMS personnel remotely for their personal safety. The traditional EMS crew is reluctant to enter the scene because they are not convinced that the area is absolutely safe to enter, during
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