POST and EMSA

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POST and EMSA

• CALIFORNIA TACTICAL MEDICINE GUIDELINES
• TREXPO WEST 2008
• FEBRUARY 19, 2008

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POST/EMSA TACTICAL MEDICINE PROGRAM

• Dan Smiley
• Interim 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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POST/EMSA TACTICAL MEDICINE PROGRAM

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

• Varying levels of training ranging from 24-80
  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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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

• 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 APPROVED
• (USE OF FEDERAL GRANT FUNDS)

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PROGRAM DEVELOPMENT
• PHASE ONE
• TACTICAL MEDICAL COURSE
• PHASE TWO
• DEVELOP CORE COMPETENCIES AND STANDARDIZED
  TRAINING REQUIREMENTS FOR TACTICAL MEDICINE
  PROVIDERS

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PHASE TWO - CONTINUED
• DEVELOP COURSE SUPPORT MATERIAL
• TRAINEE SKILL TASK BOOK
• MINIMUM EQUIPMENT LIST
• SCOPE OF PRACTICE FOR EMT-P AND EMT
• ADDITIONAL COURSE TRAINING SCENARIOS
• ESTABLISH PRE REQUISITE TRAINING REQUIREMENT
• ESTABLISH EQUIVALENCY PROCESS

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PHASE THREE
• PROPOSE STANDARDS, REGULATIONS AND PROCEDURES FOR
  PUBLIC REVIEW AND INPUT
• STANDARDS, REGULATIONS AND PROCEDURES FOR EMSA
  POST COMMISSION REVIEW AND APPROVAL
• FINALIZED REGULATIONS/PROCEDURES TO BE INCLUDED
  IN THE CALIFORNIA CODE OF REGULATIONS (CCR) AND
  SUBJECT TO APPROVAL BY THE OFFICE OF
  ADMINISTRATIVE LAW (OAL)

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PHASE FOUR
• DEVELOP TACTICAL MEDICINE ADVANCED COURSE(S)
• DEVELOP TACTICAL MEDICINE UPDATE COURSE(S)
• ESTABLISH ANNUAL COURSE REVIEW PROCEDURES

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PROJECT TIMETABLE
• PLENARY MEETING
• NOVEMBER 11-12, 2007
• DEVELOPMENT MEETING
• DECEMBER 17-18, 2007
• COURSE INSTRUCTOR MEETING
• FEBRUARY 20, 2007

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PROJECT TIMETABLE
• WORKGROUP DEVELOPMENT MEETINGS
• MARCH 2008
• MAY 2008
• STAKEHOLDER MEETINGS/BRIEFINGS
• JUNE 2008
• STATUS REPORT TO POST COMMISSION
• JULY 2008
• COMMISSION HOLDS PUBLIC HEARING
• NOVEMBER 2008

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POST/EMSA TACTICAL MEDICINE PROGRAM

• PROJECT TIMETABLE
• REVIEW OF COMMISSION ACTION BY OFFICE OF
  ADMINISTRATIVE LAW
• REGULATION CHANGE EFFECTIVE MARCH 1, 2009
• REGULATION 1084
• STANDARDIZED POST TRAINING CURRICULUM

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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
  UTILIZED

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THE TACTICAL MEDICINE GUIDELINES
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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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Tactical Medicine Guidelines

• Intended to serve as a template for the medical
  coordination with the local EMS agency, medical
  direction, use of paramedics and other advanced
  life support personnel, and minimum training and
  equipment standards.
• The law enforcement agency should conduct a needs
  assessment to determine the level of emergency
  medical care required by the SWAT team to support
  the mission and operations.
• The agency should develop policies and procedures
  for medical support during tactical operations.

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Process to Develop Tactical Medicine Standards

• Small Working Committee
• DRAFT Standards
• Public Input
• Review by POST
• Review by EMS Commission

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Two Parts to the DRAFTGuidelines

• Description of the Tactical Medicine Operational
  Program
• 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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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

• At a minimum, all personnel who are tactical
  medical providers shall have certification at the
  basic life support level.
• Optimally, tactical medical programs should
  utilize personnel licensed at the advanced life
  support level. This may include any combination
  of physicians, mid-level providers, registered
  nurses, paramedics, and EMT-IIs 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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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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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.
• The course of instruction shall be jointly
  certified and approved by the Commission on Peace
  Officer Standards and Training (POST) and the
  California Emergency Medical Services Authority
  (EMSA).
• Tactical medical providers should successfully
  complete 24 hours of POST-certified tactical
  medicine refresher training every 3 years to
  maintain competency and proficiency (under
  discussion).
• The Tactical Medicine program should include
  training to non-medical team members in basic
  medical care procedures in a tactical environment
  (Buddy Care).

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Tactical Medicine Course Hours
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Clinical Core Competencies Cognitive

• Medical (20 Hours)
• Patient Assessment in Tactical Environment
• Airway Management, Bleeding Control, Shock
  Management, WMD, etc.
• Advanced Care
• Tactical (9 Hours)
• 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 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 (12)
• Integrative Skills Evaluation

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Summary

• Goal is to protect the public and law
  enforcement personnel
• DRAFT Standards
• Public Input and Revisions
• Design Tactical Medicine program and have
  reproducible, standardized training
• Look to the Future to ensure standard programs
  and training that set high quality standards

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Questions?