Friday, 2 February 2018

Selecting Tactical Medicine Course

I have read many articles about how to select a firearms academy or tactical instructor. But, I have yet to see one on the selection of a tactical medicine program or course. There are similarities in the selection process but there are a few distinct differences that are very important. How do I know this is a successful recipe for this type of training? I was part of the CAF TCCC program that taught thousands of soldiers Combat First Aid and TCCC for their deployments to Afghanistan. The Canadian Armed Forces had an unheard of 100% preventable death save rate during that conflict.

First, it is important to discuss the similarities; a good tactical shooting program needs to be realistic and relevant to the context to which you will likely use your firearm. This concept applies to a tactical medicine course! If you are a school teacher, taking an military style Tactical Combat Casualty Care (TCCC) course is neither realistic nor relevant. A civilian based program with an emphasis on little self defense possibilities and pediatric trauma would be more relevant.

What worked yesterday would be fine if it was yesterday!

 Another facet of relevance is the expiration date of the information taught. Shooting has changed significantly since Jeff Cooper et. al codified the concepts of modern combat pistol. Tactical medicine changes constantly, based on emerging evidence based medicine (EBM). However, unlike firearms training, there are peer reviewed published guidelines to follow. Military and LEO standards for tactical medicine are determined by the Committee on Tactical Combat Casualty Care (CoTCCC) and the Committee for Tactical Emergency Casualty Care (C-TECC). CoTCCC meets twice a year and typically publish updates soon after.  C-TECC publish a series of different guidelines based on provider scope of practice. A quality tactical medicine curriculum should meet or exceed the minimum standards set forward in current guidelines. Teaching 2006 standards in 2017 is not acceptable and may not be associated with positive outcomes.

You don’t know what you don’t know

Another similarity is the training and experience of the instructor. A good tactical firearms instructor should have some tactical experience, whether LEO or Military, to be considered for selection. This is going to ruffle some feathers.  I believe that much can be learned from competition shooters in the mechanics and ability to shoot fast and accurately. However, actual experience in tactical application is required to integrate those aspects effectively into a combat environment. Additionally, formal education in methods of instruction is important as well. Same goes for tactical medicine. A good tactical medicine course will employ well trained and experienced staff. This information should be share openly and forthrightly as well. Beware the course that doesn’t openly discuss the staff’s curriculum vitae or claim that it is ‘classified’.

Same, Same but Different!!

Now for some of the differences. The types of medical devices taught should have some bearing on your course selection. As previously mentioned, tactical medicine is structured around EBM. This means that the techniques and medical devices used have been researched, evaluated, field tested, evaluated again. This research is then peer reviewed and best practices are developed and tested. After all that, if the new technique or device demonstrated efficacy it is added to guidelines. What does this mean to you as a consumer of both medical gear and tactical medicine training? Beware the course touting medical devices that lack efficacy. Teaching or recommending the use of unproven medical devices would make me question not just the curriculum, but the ethics of the staff.

Tactical medicine is medicine and medicine is a science. This means any tactical medicine course should have a didactic portion. This can be accomplished through distance learning, e-learning or by conventional classroom instruction. I believe that the practical vs didactic time ratio should be, at least,1:1. A course that does not have sufficient didactic would be suspect to me. Either, the staff does not know the subject or they lack the skill to teach the required principles before moving onto the practical portion.

Perfect Practice makes Perfect

Skill development is an important part of any tactical medicine course. Sufficient time needs to be provided for students to develop the proper skills that they can continue to develop after the course. This means step by step instruction of practical skills including a perfect demonstration that they may imitate to develop their own skillset. It also means a great deal of iterations. This cannot be emphasized enough, each student needs several iterations and skills practice. After skill stations, simple scenarios that reinforce the principles of tactical medicine are required to cement skills to concepts of operation. Rushing into unrealistic scenarios before this is simply training to fail.

A course should have a realistic and relevant up-to-date curriculum taught in the proper context for the student by well-trained and experienced staff. The techniques and medical devices need to be tested and proven effective by independent researchers. The course should have two portions including a didactic followed by practical skill development. These are some of the most pertinent points in selecting a good tactical medicine course.

This is how we did it….

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