For you TacMed people

[Guest CHP medic]

http://emsresponder.com/publication/articl...d=1&id=4358

Setting the (Tactical) Scene

Scenario training delivers the physical and psychological tools tactical medics require to handle life-threatening situations

Jim Weiss & Mickey Davis

Two groups of medics crouch low behind police shields as they attempt to rescue a downed officer. The shield protects the victim and the rescuers until they are ready to evacuate.

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Jim Weiss & Mickey Davis

Hyper-realistic scenario training provides students with stress inoculation and stimulus-response situations.

Jim Weiss & Mickey Davis

After the patient was treated during the active shooter #2 scenario, the injured role player was moved from the dark house and into a waiting SWAT van. Once inside the van, the patient was replaced by a manikin.By Jim Weiss & Mickey Davis

When tactical medics encounter a sudden, life-threatening situation-also referred to as a high threat stimulus -their body's sympathetic nervous system (SNS) is likely to automatically engage, making them unable to function in the manner in which they were trained. Such a triggering crisis might be a barricaded suspect, a hostage situation, an active shooter or accompanying a SWAT team serving a high-risk warrant.

Some people react better than others to fearful or threatening situations. Tactical medic trainers understand this and often use building-block training to give students the physical and psychological tools they will need to handle these incidents. This type of training begins at slower speeds, working into faster appropriate responses and building up the tactical medic's ability to effectively respond to violent crisis situations. In martial arts, this is known as "hardening," and this is what tactical medic scenario training is all about.

Hormonal-Induced Tachycardia

The sympathetic nervous system is responsible for the massive discharge of catecholamine that leads to our fight-or-flight reaction when our mind perceives imminent danger. Unfortunately, this can result in catastrophic performance deterioration.

During hormonal-induced tachycardia, the body can reach its peak of strength and energy within 10 seconds. Within this minimal amount of time, heart rates can spike well into the mid 200 beats per minute (bpm) range. Depending on the person's training, physical fitness and exertion, the midbrain (mammilian) will take over when heart rates climb above approximately 175 bpm.

The midbrain is typically responsible for four lifesaving or life-preserving tasks: fight, flight, feeding and breeding. Unfortunately, the midbrain will not know how to react appropriately unless it is trained through hours and hours of repetitive conditioning. The body will also sensory-gait, deleting sensory skills it does not deem useful for survival. The goal to overcoming the catastrophic events that this SNS reaction can cause is to force the body to return to the way it was trained.

When hormonal-induced tachycardia occurs, a scramble of events takes place within the human mind and body. According to tactical medic Sean McKay of Clearwater (FL) Fire and Rescue, increased heart rate is an indication of survival stress reaction. Normal heart rate is 60-100 beats per minute. At 115 beats per minute, most people begin to lose fine motor skills: finger dexterity, eye/hand coordination and the ability to multitask. At 145 bpm and above, most people lose their complex motor skills-the ability of three or more motor skills to work in unison. But between 115-145 bpm, survival performance is at its highest in regard to better complex motor skills, reaction time and cognitive reaction time. Therefore, if a medic is at a high level of bpm, he needs to get his heart rate down to do skills like inserting an IV, intubating or decompressing a chest. However, the higher heart rate may be appropriate when extracting a victim.

Finally, when fear and shock force the heart rate to 175 bpm and above, there is a catastrophic breakdown in a person's ability to effectively respond, leading to freezing, irrational fight or flight, submissive behavior, voiding of the bladder, etc. The higher the beats per minute, the more a person's perception of a situation and his ability to cognitively process response options will be affected.

That is not all the biochemistry that takes place. Near vision and the ability to focus close up are also lost, leading to tunnel vision.

According to McKay, tactical medic trainers try to reproduce in their scenarios the collection of psychological and physiological effects that are likely to happen in real life. The more stress induced in training, the less stress is experienced in real-life situations. The key is creating "hyper-realistic" scenario training, thereby providing students with stress inoculation and stimulus-response situations.

Survival Stress

Reaction Scenario Training Active Shooter Scenario #1

In this scenario, rescues and bad guy suppression had to be conducted while bad guys were still firing weapons and creating a threat. Casualties needed to be evacuated. These casualties might be medics or responding officers shot while doing their rescue or suppression work. To heighten the levels of stress in the scenarios, sirens were sounded and responding medics and police officers were shot at with paintballs or Simunition training munitions. This scenario also included stress inoculation under low-light conditions.

Issues teams needed to consider were tactical planning, diversion, officer-down situations, shots fired, tactical retreats, rally points and safe areas, multiple victims, egress and evacuation. Some patients were dragged to cover and evacuated on a half Sked. Students were required to engage both existing and potential threats, and assess, triage, treat and extract any casualties. This event mirrored day-to-day special operations high-risk entries by achieving quick, aggressive control of a house or building. The threats in this scenario were unknown, and multiple victims needed to be kept alive until they could be treated further. Patients and downed team members were extracted and taken to cover.

Problems encountered by medics during the scenario were arterial hemorrhaging of extremities, chest wounds and confirmed dead. The medics had to determine who was dead and who was not by remote assessment from behind cover without exposing themselves.

Active Shooter Scenario #2-Tourniquet

This low-light scenario was conducted within a dark training house normally used for gas mask drills. The medics, working in two-medic elements, were tasked with locating a casualty, conducting any required tactical combat casualty care, and evacuating a wounded person to a waiting SWAT van.

In this scenario, the bad guy was not inside the dark house, but the building needed to be searched. The use of a flashlight or any other lighting device was not an option. Officers, in the form of the police element of the SWAT team, provided security, thereby preventing the bad guy from entering the dark house and endangering the two medics and any patients. During this threat, the bad guy was not eliminated.

Upon entering the dark house, the two medics crawled along the walls until they located their patient. They did not talk or make any noise while they searched for him. Once found, the patient had to be treated. His symptoms were slow breathing and bleeding out from a moulage leg wound, which the medics could find by feel. The medics had to apply a zero-lighting tourniquet and intubate their patient. They could not use a scope to intubate because, in the real world, the white light from a scope would give away their location. According to McKay, in Israel, two medics using a laryngoscope's light were killed by a sniper when first one medic and then the other turned on the light. The message was clear-no lights in this sort of tactical environment. In the tactical training scenario, the two medics had to use either a blind insertion airway device, such as a Combitube, or digitally intubate the patient.

After the patient was treated and a tourniquet applied, the injured role-player was moved from the dark house and into a waiting SWAT van. Once inside the van, the patient was replaced by a manikin. A 12-minute ride in the van was simulated by turning on the van's siren. Inside the van, there were some variations as different medic teams treated the patient. A basic treatment was for airway management-utilization of airway adjunct devices, NPA, etc.-to be assisted by the use of a bag-valve mask and IV administration. Preventable blood loss was the most important concern.

A follow-up critique also addressed any weaknesses.

Conclusion

This survival stress reaction training works. Not only have Clearwater Fire and Rescue tactical medics placed first or second in the International Tactical EMS Conference and Competition for the last three years-the only years they entered-but this training will carry over to their jobs on the streets, saving their lives and the lives of their patients.

For further information, McKay recommends reading On Combat by Lt. Col. Dave Grossman, who is a leading authority on the psychological and physiological reactions of the body during deadly conflicts. McKay's scenario training is modeled after Grossman's invaluable research. Sean McKay can be contacted at tacticalrescue@tampabay.rr.com.

Jim Weiss and Mickey Davis are writers specializing in safety-forces issues and technology, and have had more than 100 articles published in law enforcement and emergency services magazines. Jim is a retired lieutenant from the Brook Park, OH, Police Department and a former state of Florida investigator. Mickey is a Florida-based writer and author of an award-winning novel.

[NREMT-Basic]

Im gonna sound dumb with this post but it wouldnt be the first time and at least this time I know it in advance.

As I move toward beginning medic training sometime in the next year or so, I have been thinking about what kind of medic work I wish to do and have been very interested in tactical ems for a long time. Does a person wishing to be a tactical medic also need to be a police officer in all states or are there specialized tactical ems response teams which may be private or municipal in which the medics may perform other duties, eg 911 response and also be called into action as a contracted tactical ems team that has a working agreement with law enforcement bodies, etc. My assumption is that tact. medics are also trained in the use of tactical special weapons and tactics and are armed. Is this the case or have I missed the mark. I have come across a few school which teach tactical ems and offer courses tailored both to EMTs and Medics. I would greatly appreciate any information which you could provide. Thanks alot.

[Asysin2leads]

Some people react better than others to fearful or threatening situations. Tactical medic trainers understand this and often use building-block training to give students the physical and psychological tools they will need to handle these incidents. This type of training begins at slower speeds, working into faster appropriate responses and building up the tactical medic's ability to effectively respond to violent crisis situations. In martial arts, this is known as "hardening," and this is what tactical medic scenario training is all about.

When hormonal-induced tachycardia occurs, a scramble of events takes place within the human mind and body. According to tactical medic Sean McKay of Clearwater (FL) Fire and Rescue, increased heart rate is an indication of survival stress reaction. Normal heart rate is 60-100 beats per minute. At 115 beats per minute, most people begin to lose fine motor skills: finger dexterity, eye/hand coordination and the ability to multitask. At 145 bpm and above, most people lose their complex motor skills-the ability of three or more motor skills to work in unison. But between 115-145 bpm, survival performance is at its highest in regard to better complex motor skills, reaction time and cognitive reaction time. Therefore, if a medic is at a high level of bpm, he needs to get his heart rate down to do skills like inserting an IV, intubating or decompressing a chest. However, the higher heart rate may be appropriate when extracting a victim.

Finally, when fear and shock force the heart rate to 175 bpm and above, there is a catastrophic breakdown in a person's ability to effectively respond, leading to freezing, irrational fight or flight, submissive behavior, voiding of the bladder, etc. The higher the beats per minute, the more a person's perception of a situation and his ability to cognitively process response options will be affected.

OKAY OKAY OKAY HANG ON TIME OUT HERE

First of all, to put it bluntly, who the f--- is tactical medic Sean McKay of Clearwater Fire and Rescue to go lecturing us about the effects of motor skills vs. heart rate? I mean, shouldn't his name end with "Ph.D. in neurobiology" and be speaking about his double blind study done at the University of Costsmorethanimake? Thats f--ing BS. First of all, nearing 145 is getting into the SVT range. Anyone who is in reasonable shape and not a wussy should have a fine time keeping their heart below that level. Anyone who is above 175 bpm should be hooking themselves up to the EKG and starting an IV on themself.

Why exactly the medics are crouching low behind the police shields to rescue the downed officer is beyond me. I'm not sure what they are planning on doing to him that an ordinary officer with a basic understanding of first aid couldn't do unless he has suffered a MI while in the midst of the melee.

Can we just stop with the warrior medic, stuff, please? Its just silly.

[NREMT-Basic]

Im guessing the medics were crouching behind ballistic shields while trying to recover the downed officer to, ummm, avoid getting their heads blown off. Or at least a reasonable facsimile thereof given that this was a simulation.

Asy, if you are worried about the credentials of the McKay author, why dont you look them up. Since you are questioning an acknowledge expert in the field of tact med, the real question is what are your credentials and why dont you list them?

God, after the last couple of days I would be so happy if someone would post a thread for people to submit their favorite christmas cookie recipe.

[Dustdevil]

Can we just stop with the warrior medic, stuff, please? Its just silly.

Word.

[KSEMT122]

NREMT-Basic to answer your question about Tactical Medics, I have seen it both ways. But usually, you get your Paramedic and start working at an EMS agency somewhere, or Fire Dept that runs EMS. At some point the local SWAT team will decide they want to put Medics on their teams. This is where it can get tricky. Some departments invest in sending their Police Officers to Paramedic school. Others decide to hire Paramedics and put them through the Police Academy. Either way to answer your question, You will more than likely be put through a Police Academy. I've seen it run a million different ways though. You could end up working for EMS, but practically be working Full-Time with the Police Dept as sort of a liaison between the two, You could get hired Away from EMS to go full-time with the PD specifically in a SWAT Medical role. Or you could still work full time with EMS, and only be called to select SWAT scenes. Hope that answers your question and helps confuse you.

[NREMT-Basic]

But Dust-

I looked up to you as head of the Warrior Medic clan. Now what will I do? My world is crushed. Send me a boonie, damnit. I dont want a farby one from US Cav. I wont one with some shiite on it. Or suni, either one. And about me coming to the desert to take complete leave of my senses for $500/day, sign me up, man!

[somedic]

Asys: warrior medics? hehehe! They do exist but not at your local hick town sheriffs department.

This Sean Mckay did no research on what he is talking about. He read either "On Combat" or "On Killing" by Lt.Col Dave Grossman and now thinks he is an expert on "Killology" for

medics.

Again this another example of someone with grandiose visions of themselves killing bad guys and rescuing hot chicks, and....actually getting published for all his vast "tactical" knowlege Its all fantasy with lethal consequences. End Rant

Somedic

[NREMT-Basic]

Tactical officers can be trained to perform at the medic level while also carrying out their tactical operations and procedures ( special weapons and tactics) and Medics can be trained to function at the tactical level while also executing their paramedic protocals which have been modeled to fit the tactical role.

Very Difficult? Yes, to be sure. Impossible? No. We arent talking black ops here and we arent even talking about the military. We are, as far as I can tell, talking about a swat or cert type model. I am an emt and I also have basic level tactical weapons and operations abilities learned while training with a well known, international civilian (non-military) tactical response service.

Im getting the feeling from some of our military posters that never shall tactical and medical meet. Sure, I am trained at a basic level in both areas and wouldnt want to be put in a tactical EMS situation. Neither I nor the people I would be charged with caring for would be cared for at the optimum level possible since my training in both areas is, as I have said, at the basic level. I even have a certain amount of training in combining these two specialties. That doesnt mean I should be involved in tactical EMS. But it also doesnt mean that an individual cannot be trained to work in an intense tact. medic operation or that there is only one way to achieve such training. I must also say that what I learned from my tactical training was that tactical EMS is an extremely rare animal since there are few individuals or programs qualified to teach it and that most SWAT type organizations use municipal or private responders staged at a safe distance until they are needed. This of course does not fit the definition of tactical ems. I am fascinated by the possibilities of this concept but also know that true tactical ems is a pretty rare beast and has a long way to go before its training and execution exist in anything like a standardized form with standardized protocols. In my admittedly limited experience there is alot of table work to be done before tactical ems can be the rule rather than the exception. As for me, I will stage my rig 100 yards from the tactical folks target until I stop hearing flash-bangs and someone contacts me and tells me that the scene has been secured. Remember to keep uour chins up and your heads down.

[In2bate]

I have not taken the course in tactical Medic. In our system we only have 2 individuals that have gone through police academy and are on the SWAT team for call out. However, I am on the S.O.R.T (Special Operations Response Team). We have practiced large incidents (School shootings etc.) and train with the swat team. After the scene has been secured our team goes in and evaluates the patients and start extricating. Training includes the shooter is still at large and we hear gun fire going off. Training includes IED in place that have not been detonated. With all the training I must say I feel secure if I must lead a team of medics in to render aid.