Last week (March 7th-9th, 2017), I had the opportunity to travel to Glynco, GA to participate in the Basic Tactical Medical Instructor training program. The course cost and all materials were paid through a Federal grant, which set aside money to train state, local, and tribal law enforcement on TCCC programs. This was my first trip to a FLETC facility, so I had no prior knowledge about the facilities or resources available.
My initial (and continuing) impression is that FLETC has the nicest training facility I’ve ever seen. The classrooms are well maintained, the equipment and props are top notch, and the training areas are separated into specific geographic areas on the campus. Once you know where you’re going, it’s easy to navigate from one area to the other. In my classroom alone, there were a host of extremely lifelike wound trainers that could be used to simulate traumatic amputations, gunshot wounds, stab wounds, airway obstructions, junctional arterial bleeding, and a host of other injuries. The human-sized wound trainers weighed 200 pounds and cost $50,000 each. Those trainers move, spray blood, and breath on their own to add realism and give the correct stimulus to the students. They also had wound packing stations, and a number of objects that measured the constriction of tourniquets applied to a “limb”. The mock houses that we were using for scenario testing were actual fully-furnished houses. The Federal Government didn’t spare any expense and it shows.
Day 1 began with a medical assessment due to the physical nature of the class. Following that, we were each issued an Individual Field Aid Kit (IFAK), and dove into the TCCC coursework and the MARCH pneumonic. MARCH is a simple way of assessing and treating preventable life-threatening injuries. In plain English, MARCH tells you what to do, where to do it, and when to do it.
M: Massive Hemorrhage
By the end of Day 1, we’d used everything in our IFAKs. We’d placed manufactured and improvised tourniquets on ourselves and others, packed latex wound trainers to stop bleeding, placed Nasopharyngeal airways, stuck chest seals on each other, wrapped trauma dressings, and rolled people up in mylar blankets. It was a very comprehensive course, and could easily have been used as a one day class.
Day 2 began with a review of MARCH with a focus on how to teach this at our respective agencies. Having been through the practitioner course, the focus began to shift to refining instructional skills. Then it was on carry and vehicle loading techniques for extraction from a warm zone. We spent a few hours carrying and dragging each other around and loading each other into vehicles. When grouping up for carry exercises, pick your partners wisely. Skinny kids are a good place to start.
After lunch, we went to the mock village and ran through scenarios. The props used varied from simple fake blood to expensive wound trainers, and also varied in complexity. We worked through a traumatic amputation during a vehicle accident, an officer shot within a house with a suspect still at large, and a person stabbed in an abandoned building. Two of the scenarios required you to work in near-dark conditions.
Having worked through all of that, Day 2 ended with the class being made into two teams to develop scenarios for the other half of the class. Again, the focus shifted to applying what we’d just learned towards the training of other officers.
We started our last day at 6:45 AM, setting up our scenarios. Our scenario was a domestic dispute gone bad. The male on scene had been shot. Arriving officers had reported shots fired and then could not be reached by radio. There was a neighbor on scene, who reported that the female suspect had fled. Our setup had one officer down at the residence door, a male victim with a superficial injury in the yard, and a second officer with a heavy arterial bleed down behind the rear of the patrol vehicle. We also used a LOT of fake blood. Our treatable injuries, in priority, were: Arterial Bleeding on cop behind patrol vehicle, sucking chest wound on cop at door, and the superficial bleeding on the male victim. There were also a host of weapons on scene that needed to be secured for safety, and the possibility of a suspect on scene. We also staged an additional IFAK in the patrol vehicle for their use if they looked for it. After taking the Talon Defense / Ditch Medicine C-2 course last month, I was channeling a little injured shooter. I immobilized the dominant hand of one person on each team, telling them that they had been involved in an accident just prior to reaching the scene. This gave each team three hands to work with, and two medical kits. The scenario was over when all preventable injuries had been treated and the officers had been loaded into a vehicle for extraction.
For those students waiting for their turn at the scenario, we had wound trainers and tourniquets so that they could practice their skills in the down time. We then worked them through teach-backs for the test later that day.
Each team worked through the scenario differently. However, there were a few trends. Most officers got sucked into the cop at the door they saw first. Even though they knew they were looking for two officers, they immediately went to him and began treatment. Without a thorough search of the scene, they missed the cop with the most life-threatening injuries and often did not find him until prompted by the witness / neighbor. Only two of the groups communicated with the cop on the porch to gather information prior to entering the scene. The medical treatment was all performed well. In most groups, the officer with two working hands held a cover position while the officer with one hand applied the tourniquets or chest seals. No one looked for the medical kit in the vehicle.
At that time, we had a group debrief and covered the importance of that process to ensure student comprehension and address any issues in the scenario training. Following that, we swapped out and participated in the other group’s scenario. We then broke for lunch.
The afternoon consisted of teach-backs to the instructors and students. There were approximately 30 teaching points that we needed to explain and perform during the evaluations. This took the better part of two hours, but didn’t bog down due to each person having their own teaching style. One of the staff members ran his own nasal airway during the demonstration and volunteered to let everyone practice on him. Everyone passed their teach-backs and demonstrated an excellent grasp over the material for such a short course.
The last order of business that day was a “graduation” ceremony from the program. I was surprised by how many folks from the FLETC administration showed up to speak with us. Directors and Assistant Directors spoke at length of how to bring this program into our local areas and how to keep the grant going. At that time, we were given our certificates and a full IFAK to take with us.
1. “Tactical Medicine” is still just medicine. You’re as likely to need this training on an accident scene with injuries or around the house as you are at a call for service. Everyone should have this training.
2. Stick with things that work. During the class, I busted out a RATS tourniquet a number of times to see how easy it was to use and if it would stop the bleeding. It doesn’t. I’m much stronger than the average person, but I still couldn’t get enough pressure to stop an arterial bleed on the leg, whereas the CAT and SOFT-T did it in seconds.
3. Have your med kit on you. No one is coming to save you in a crisis. For those of us who work in rural areas, your problems are yours. If you don’t have it with you, it doesn’t do you any good.
4. Hands down, some of the best training I’ve had from a Law Enforcement organization in 10 years. The elaborate nature of the facility and resources available made this top notch. That said, there wasn’t anything in this class that I hadn’t experienced in the Ditch Medicine / Talon Defense course the previous month. Just because you can’t make it to FLETC doesn’t mean that this training isn’t out there and available.