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Redneck19
10-28-10, 11:48
What are some recommendations you guys could give a newbie in terms of medical training?

I think civvy's should have a level of medical training for the same reason that one would take tactical firearms classes: police can't be every where at once. Neither can first responders. Especially out in the boondocks where I live.

I am currently CPR certified (big deal, right?:sarcastic:)
Where should I progress from there?

What are ya'll's thoughts on the subject?

(I worded this post the best that I could. I have a HUGE amount of respect for the expertise on this forum and if I come across as belligerent or disrespectful, that was NOT my intention. Thanks, guys!)

ra2bach
10-28-10, 12:55
you could try CERT - Citizens Emergency Response Team. this is set up to train and keep a cadre of volunteer first responders in the event of an emercency - tornado, earthquake, flood, etc...

along with the next level up of medical training, you get training on triage, fire suppression, disaster response, radio communication, etc.

my local Fire Dept gives this training free a couple times per year as well a refresher courses. definitely worth the time...

rsgard
10-28-10, 13:31
EMT basic class
i took mine for 600 dollars and it was 4 hours 2 evenings a week for 4 months or so. That will pretty much cover anything you can do on your own.

chuckman
10-29-10, 12:14
First Aid or First Responder.

MechEng
10-29-10, 13:34
EMT basic class
i took mine for 600 dollars and it was 4 hours 2 evenings a week for 4 months or so. That will pretty much cover anything you can do on your own.

+1

Even if you don't plan on becoming an EMT, the EMT Basic Class (EMT-B) is a great first aid class. Probably an overkill as a first aid class but then you can't really have too much first aid training.

http://en.wikipedia.org/wiki/Emergency_medical_technician_%E2%80%93_basic

Many comunity colleges teach an EMT-B class also sometimes called EMT-A for Ambulance tech.

zacbol
10-29-10, 18:26
Well, I've struggled with the same question. Not sure how much it'll help but I took this and it was truly outstanding:
http://www.insightstraining.com/view_course.asp?courseID=11

I know some other places offer similiar courses. Here are the instructors credentials:


Mike Shertz, MD has attended all InSights courses and multiple courses from DTI, Gunsite. He is a qualified Special Forces Medic and is certified by the US Army as a Combatives Instructor. He is a member of the International Wound Ballistics Association and the American Society of Law Enforcement Trainers. Mike has finished in fifth place or higher in nearly every NTI since 1997.

Mike is an instructor for Handgun, Rifle, Unarmed, Knife, and Tactical Emergency Medicine. He is a coach for Shotgun, Tactics, Handgun Retention, and Close Quarters. Mike serves as the Chief Medical Officer and leads a team of Tactical Medics for the Washington County, Oregon, SWAT team.

Redneck19
11-01-10, 10:17
Thanks guys!

I'll do some research into those ideas.

The main problem I had with the first aid class I took, and I suspect this may be a problem with many if not most civilian classes, is the lack of proper mindset. The instructor was like, "ok guys, all you gotta do to get the certification is complete this action." And we went through the procedure once. I felt like it was more like a math class than learning how to possibly save a person's life.

Especially since a recent incident where I thought I was going to have to help someone, (thank God someone from the nearby medical college was on the scene) I've been thinking alot about how to prepare myself for a situation where there are no professionals in the immediate area.

Gutshot John
11-01-10, 20:17
A little bird told me to tell you guys to look for some new offerings for this type of training in the new year.

J_Hernandez
11-01-10, 23:49
http://www.magpuldynamics.com/training/medical.shtml

http://www.magpuldynamics.com/training/images/training_med.png

MD Tactical Operations.
Medical.
Private Citizens, LE, MIL
Focused on life sustaining, trauma management skills for shooters in high risk environments, where the mission cannot be compromised.

Decon
11-03-10, 21:54
Disregard

Treehopr
11-04-10, 04:08
I just finished Day 1 of the TCCC (Tactical Combat Casualty Care) course taught by Condition Red. I believe they are the only certified trainers for civilians (non-military) on the east coast. Instructors have extensive experience on the LE and civilian side including the tactical unit of a nearby big city.

Great class so far, we went through a non-ballistic shoot house with airsoft to remove casualties under "fire" for the afternoon of Day 1. Day 2 is scheduled to have practical skills training to include needle decompressions and use of Combat Gauze (hemostatic agents).

Will try to post an AAR once class is over.

www.conditionred.us

Barbara
11-04-10, 05:31
The biggest mistake I see in people wanting medical training is that they want to know how to help with gunshot wounds. That's for sure an important skill for people who shoot but very few civilians are ever going to see anyone shot. You're going to be a lot more likely to come across someone with a diabetic emergency or involved in a motor vehicle accident.

I'd check your local fire department or community college for a First Responder or maybe EMT-B class. By all means, take the gun shot trauma training, but don't make that the be all and end all of your training.

drrufo
11-04-10, 18:06
I would agree about the CERT training, our neighborhood association took the full course of the classes offered by the local fire department. Part of the training was "first aid" given by the Red Cross, very helpful and for free.

Gutshot John
11-04-10, 21:18
I just finished Day 1 of the TCCC (Tactical Combat Casualty Care) course taught by Condition Red. I believe they are the only certified trainers for civilians (non-military) on the east coast.

Statements like these really throw up red flags for me.

I don't doubt your sincerity as I'm sure that's what the course was labeled as but TCCC isn't just a program of training, it's a philosophy of evacuation and continuum of care. Anyone who is marketing their training as TCCC for civilians is very probably not legit. I don't see how they could be certified trainers for civilians, who certified them? Teaching untrained civilians to do needle decompression is a recipe for a lawsuit. Most EMTs aren't even authorized to do that.

The individual techniques don't vary from TCCC to PHTLS or whatever. You still apply direct pressure the same way, you use the same hemostatic agents etc. Civilians hear "TCCC" and they think they're being taught some high-speed super ninja medic skill and that's not really the case.

TCCC is really only valid assuming that you have echelons of care backing you up. TCCC starts at the self-buddy aid and works its way past the corpsman/medic, to the BAS and up through Collection and Clearing hospitals until you finally get to the Evacuation hospitals and then back stateside to places like Walter Reed. If you don't have those levels of care than you don't have TCCC. There is no such thing as TCCC for civilians. TCCC is by definition military.

When selecting these courses that you're going to pay good money for, verify that there is a medical director or at least some form of certifying body.

Treehopr
11-05-10, 07:32
Gutshot John,

I appreciate your concerns and hopefully I can address some of your points. I'm not great at cutting and pasting so bear with me.


Statements like these really throw up red flags for me.

I don't doubt your sincerity as I'm sure that's what the course was labeled as but TCCC isn't just a program of training, it's a philosophy of evacuation and continuum of care.

The Condition Red instructors covered that and explained the differences between a "normal" trauma case that one may encounter vs. something that would fall in to the TCCC spectrum.



Anyone who is marketing their training as TCCC for civilians is very probably not legit. I don't see how they could be certified trainers for civilians, who certified them?

www.naemt.org

The TCCC training is not a substitute for other medical training but a supplement. In some cases you may have very highly trained and experienced medical professionals but haven't been exposed to "tactical" scenarios such as an active shooter or terrorist attack.



Teaching untrained civilians to do needle decompression is a recipe for a lawsuit. Most EMTs aren't even authorized to do that.

That's what the training is designed to address, we had EMT/Paramedics in the class who had not previously been trained to do some of these tasks. Having the training to do so is not open license to practice on someone but rather having the tool in the toolbox if needed.

The choice is not whether you'll be sued for doing something outside your normal duties but whether the casualty/patient will live or die if something isn't done.



The individual techniques don't vary from TCCC to PHTLS or whatever. You still apply direct pressure the same way, you use the same hemostatic agents etc. Civilians hear "TCCC" and they think they're being taught some high-speed super ninja medic skill and that's not really the case.

That's one of the points the instructors really hit home is that nothing they were showing was "high speed", it boils down to accomplishing basic skills efficiently under duress. What may change in a TCCC environment is what type of care provided in different phases, e.g. Care Under Fire vs. Tactical Field Care.



TCCC is really only valid assuming that you have echelons of care backing you up. TCCC starts at the self-buddy aid and works its way past the corpsman/medic, to the BAS and up through Collection and Clearing hospitals until you finally get to the Evacuation hospitals and then back stateside to places like Walter Reed. If you don't have those levels of care than you don't have TCCC. There is no such thing as TCCC for civilians. TCCC is by definition military.

TCCC is a valid philosophy regardless of who came up with or what it's labeled. Instructors went over the origins of TCCC from the military side as well as the current TCCC committee which includes medical professionals from the military and civilian side.

Medical facilities such as Walter Reed, Bethesda and BAMC may be the last stop on the military side of "echelons of care" but the same level of care already exists in almost every major city on the civilian side.

The biggest difference in the echelons is distances from the location of injury to that final echelon of care. In other words, a soldier can be shot in Sadr City where SABC starts, brought to a CCP by the medic and passed on to the BAS, medevaced to the CSH or AFTH and then airlifted out of theatre to Ramstein/Landstuhl before being flown to Andrews and ground transported to Bethesda. All that can happen in 24-48 hours on the mil side.

On the civilian side that can happen in much less time since the site of injury to Level 1 trauma center could be minutes away and would skip many of the intermediate steps.



When selecting these courses that you're going to pay good money for, verify that there is a medical director or at least some form of certifying body.

In addition to the 2 "certifiers" from NAEMT we had 2 MD's present, the Medial Director for the course and a Level 1 trauma doc who also supervises the tactical medicine program for a large urban police department. I don't think any of the instructors was less than an EMT-P.

I was extremely happy with the course, I learned things I previously had not known and was able to practice some skills that I will hopefully never need. The instructors were professional and knowledgeable and I would recommend this course to others.

fyrediver
11-05-10, 13:23
I'd suggest a very good Wilderness First Aid course, or if you're really gung ho, a Wilderness EMT course. Both courses emphasize stabilizing the patient without an urban EMS system's tiered response.

EMTs are merely a rung in a tiered system. The next tier is Advanced Life Support (Medics) followed by the ER Physician and team. You'll be trained to use equipment you probably won't have access to in a field environment and there's a strong protocol system on how you'll accomplish some given task.

And yes, I have stayed at a Holiday Inn and am a paid, professional EMT firefighter.

Gutshot John
11-05-10, 14:53
The Condition Red instructors covered that and explained the differences between a "normal" trauma case that one may encounter vs. something that would fall in to the TCCC spectrum

www.naemt.org

Please understand I'm not doubting your sincerity or genuine desire to learn. I applaud you for your efforts.

I am questioning the judgment of a company that would take your hard-earned money with the implication that they are credentialed to teach/certify civilians and that you are now certified in its techniques. Finally I am also questioning the wisdom of offering this training to just anyone who hasn't AT LEAST had significant medical training already.

The philosophical issue I have with TCCC for the civilian shooter is that you don't have access to the evacuation system of TCCC. Sure you can call 911 but the only thing you're going to be doing is patching up wounds and waiting for EMS to arrive then they take it from there.

If you look at the NAEMT website regarding TCCC you'll see it's taught as an adjunct class to PHTLS and exclusively to the military. You have to already have the PHTLS cert or taking the class in order to also get TCCC.

From NAEMT's website: "The TCCC course is the companion course to PHTLS for the military and for the warriors who are preparing to be deployed in support of combat operations."

The clear implication is that this is a military only curriculum and one that requires at least PHTLS. PHTLS is not really a civilian/lay class, you have to be at least a First Responder (LEO/FIre) and far more likely to be EMT or EMT-P. Nowhere does it talk about credentialing anyone to instruct civilians in TCCC.

If the above description means you, than that's all well and good but it's not appropriate for your average civilian looking for medical training.


The TCCC training is not a substitute for other medical training but a supplement. In some cases you may have very highly trained and experienced medical professionals but haven't been exposed to "tactical" scenarios such as an active shooter or terrorist attack.

What other training have you had? PHTLS covers a great deal of "tactical" scenarios including scene security etc. Certifying joe blow in this way really makes me wonder what they're thinking.


That's what the training is designed to address, we had EMT/Paramedics in the class who had not previously been trained to do some of these tasks. Having the training to do so is not open license to practice on someone but rather having the tool in the toolbox if needed.

I don't dispute that it may be appropriate for civilian Paramedics/EMS (and I emphasize may) but if you haven't even had at least the baseline EMT training I'm not sure that it's appropriate or even relevant.


The choice is not whether you'll be sued for doing something outside your normal duties but whether the casualty/patient will live or die if something isn't done.

Actually you might very well be sued even if you do everything right and actually pull out a save, but it's not really YOU I'm worried about, you'll get some level of protection assuming you do everything right, if you don't? well.... It's actually the school that will be sued if they taught you something that they weren't qualified or licensed to teach to a lay person. If you get sued doing this to someone on the street you can correctly point the finger at your instructor. They've opened themselves up to huge liability, especially if they're claiming that you're now "TCCC certified."

That said, for civilian EMS, there are very very few times when needle decompression is needed or appropriate, in more than a decade of military and civilian EMS, I've seen it done maybe 3-4 times. For civilian laypersons you have to be waayyyy outside of accessibility to EMS before this should be even considered.

These skills are perishable and require constant training/practice. I'm a trained paramedic who has had all the above training but I'm not sure I'd even feel comfortable doing this cold.


That's one of the points the instructors really hit home is that nothing they were showing was "high speed", it boils down to accomplishing basic skills efficiently under duress. What may change in a TCCC environment is what type of care provided in different phases, e.g. Care Under Fire vs. Tactical Field Care.

I'm still not understanding how this is appropriate for the average civilian/shooter. A SWAT team or Tactical EMS sure I'll buy that but not for the layperson. Needle decompression isn't a "basic" skill.


TCCC is a valid philosophy regardless of who came up with or what it's labeled. Instructors went over the origins of TCCC from the military side as well as the current TCCC committee which includes medical professionals from the military and civilian side.

It's a very valid philosophy that presumes a chain of evacuation. If you don't have access to that chain of evacuation than you're better off taking a First Responser class.


On the civilian side that can happen in much less time since the site of injury to Level 1 trauma center could be minutes away and would skip many of the intermediate steps.

Exactly, so what are you getting from TCCC that you wouldn't get from a First Responder class?


In addition to the 2 "certifiers" from NAEMT we had 2 MD's present, the Medial Director for the course and a Level 1 trauma doc who also supervises the tactical medicine program for a large urban police department. I don't think any of the instructors was less than an EMT-P.

It's not a function of the instructors qualifications, it's a function of who has vetted the program and certified the credentials of the instructors/organization.

For the average civilian/layperson which is what the OP specified I don't think this training is appropriate, and I'm deeply skeptical of a school that would teach this.

What you're describing to me is akin to offering shoothouse/indoor CQB training to someone who hasn't even attended a firearms class.

vaspence
11-05-10, 16:05
I think this forum needs a chart:D

Seriously, there is a difference in the types of training available to civilians out there and the question on what to take seems to come up a lot.

On the practical application of the TCCC course for civilians, I think it has merit. Danger zones, patient movement, patient assessment and bleeding control as taught in the TCCC as I understand it are very different from a First Responder or EMT course. And very applicable to a civilian who finds themself at the scene of a mall, workplace or college shooting that is still active.

Other than needle decompression which everyone finds controversial, what do you object to civilians being taught? Specifically.

The course you referred to that may be upcoming soon, does it incorporate any of the TCCC principles?

No disrespect to anyone with these questions, great discussion so far and I look forward to the opinions.

Treehopr
11-05-10, 16:18
Please understand I'm not doubting your sincerity, I am questioning the wisdom of offering this training to just anyone who hasn't AT LEAST had significant medical training already.

Gutshot John, no worries about offending me. I understand your concern but I think that your definition of "significant medical training" may be a bit subjective.



The philosophical issue I have with that is that as a civilian shooter, you don't have access to the evacuation system of TCCC. Sure you can call 911 but the only thing you're going to be doing is patching up wounds and waiting for EMS to arrive then they take it from there.
I think we may have a misunderstanding of what TCCC entails, as you stated in a previous post, TCCC is a philosophy and guideline- it does not necessarily require that you have to do anything more than patch up wounds and wait for EMS and do a hand off.

What TCCC training may provide for the layperson/civilian with limited medical training is enough information to realize that a patient/casualty may not survive long enough to be evacuated without the use of something like a tourniquet or hemostatic agent.



If you look at the NAEMT website regarding TCCC you'll see it's taught as an adjunct class to PHTLS and exclusively to the military. You have to already have the PHTLS cert or taking the class in order to also get TCCC.

From NAEMT's website: "The TCCC course is the companion course to PHTLS for the military and for the warriors who are preparing to be deployed in support of combat operations."

The clear implication is that this is a military only curriculum and one that requires at least PHTLS. PHTLS is not really a civilian/lay class, you have to be at least a First Responder (LEO/FIre) and far more likely to be EMT or EMT-P. Nowhere does it talk about credentialing anyone to instruct civilians in TCCC.

If this means you, than that's all well and good but it's not appropriate for your average civilian looking for medical training.

I looked at the NAEMT site and was unable to locate your cited references. Based on your citations I will disagree that TCCC requires PHTLS as a prerequisite.




What other training have you had? PHTLS covers a great deal of "tactical" scenarios including scene security etc. Certifying joe blow in this way really makes me wonder what they're thinking.

I don't dispute that it may be appropriate for civilian Paramedics/EMS (and I emphasize may) but if you haven't even had at least the baseline EMT training I'm not sure that it's appropriate or even relevant.
I have not taken any PHTLS courses. There may be some confusion about what Condition Red offers. I can see how my original post may have been misinterpreted due to a poor choice of words on my part- they are authorized by NAEMT to teach TCCC. The terms appropriate and relevant are also subjective and I will say that those EMT's and Paramedics in the class felt that the information was useful


Actually you might very well be sued, but it's not really YOU I'm worried about. It's the school that will be sued if they taught you something that they weren't qualified or licensed to teach to a lay person. If you get sued doing this to someone on the street you can correctly point the finger at your instructor. They've opened themselves up to huge liability, especially if they're claiming that you're now "TCCC certified."
I'm sure Condition Red has considered the liability exposure of teaching just as they have weighed the benefits of passing along information to help the good guys be better prepared. If I "do this to someone on the street" it will be because they were in danger of loss of life and I believed a lack of action would result in death, just as if I took a CPR class and had to use an available AED to deliver shocks. Allow me to clarify, nowhere have I claimed to be TCCC certified- just that I completed the course and now have information that will help me make better decisions if needed.


That said, for civilian EMS, there are very very few times when needle decompression is needed or appropriate, in more than a decade of military and civilian EMS, I've seen it done maybe 3-4 times. For civilian laypersons you have to be waayyyy outside of accessibility to EMS before this should be even considered.

These skills are perishable and require constant training/practice. I'm a trained paramedic who has had all the above training but I'm not sure I'd even feel comfortable doing this cold.

Agreed, again- this is not a replacement or substitute for other training. If its not needed than its a moot point, if it is then I will be glad that I had some training.


I'm still not understanding how this is appropriate for the average civilian/shooter. A SWAT team or Tactical EMS sure I'll buy that but not for the layperson.
I don't understand how its not appropriate? Have you taken a TCCC class?
Imagine a scenario where a civilian layperson witnesses a motor vehicle accident- after pulling over and activating the EMS system this person sees a person with a partial amputation of an extremity- let's say an arm. Not knowing how long it will take EMS to arrive the civilian makes an improvised TQ to stop the hemorrhaging. EMS arrives 5 minutes later and is able to apply a higher level of care enroute to the nearest definitive care facility.


It's a very valid philosophy that presumes a chain of evacuation. If you don't have access to that chain of evacuation than you're better off taking a First Responser class.
From what I gathered in the class, TCCC was developed based on the concept that the normal chain of evacuation is not readily available and that certain life saving actions not normally performed such as a needle decompression would be necessary to keep the patient/casualty alive until they can be evacuated. I will reiterate that TCCC does not replace or substitute FR, EMT, CPR or any other medical training.


Exactly, so what are you getting from TCCC that you wouldn't get from a First Responder class? I made the statement to address your point about the echelons of care. First Responder may be enough as far as skills or it may not be, TCCC just provides you with more skills if needed. It can be argued that no medical training is needed if you have a cell phone and can activate EMS but we can train for the best case scenario or the worst case- limited only by motivation, time and money.

It's not a function of the instructors qualifications, it's a function of who has vetted the program and certified the credentials of the instructors/organization.

You made a statement in a previous post about "verify that there is a medical director or at least some form of certifying body." I posted the certifying body and the presence of the medical director as well as another MD. In addition, the class was predominantly EMT's and EMT-P's so I think that if any of the information put out was contrary to what is common sense, common practice or otherwise good medicine they would have challenged the instructors on it.

What you're describing to me is akin to offering shoothouse/indoor CQB training to someone who hasn't even attended a basic firearms class. I disagree and think it is a huge leap to suggest that. What specific part(s) of the TCCC course is it that you think should be restricted from civilians?


For the average civilian/layperson which is what the OP specified I don't think this training is appropriate, and I'm deeply skeptical of a school that would teach this.
I am still unclear about what is taught in TCCC that you think is irrelevant to civilians?

To clarify, I did not intend for my first post to be a direct response to the OP but as another option to anybody who might be looking for other medical training such as the links provided to Magpul and Insights. I apologize to the OP if I took the thread too far off track.

Gutshot John
11-05-10, 17:14
On the practical application of the TCCC course for civilians, I think it has merit. Danger zones, patient movement, patient assessment and bleeding control as taught in the TCCC as I understand it are very different from a First Responder or EMT course. And very applicable to a civilian who finds themself at the scene of a mall, workplace or college shooting that is still active.

Elements of TCCC may have relevance beyond the military, however TCCC is a military specific program. It's a very specific certification, my concerns were not to question the value of training (even higher speed medical training) for civilians, my concern is an organization that markets the certification for civilians.


Other than needle decompression which everyone finds controversial, what do you object to civilians being taught? Specifically.

I don't really object to "civilians" being taught any specific skills so long as they have the practical training and practice to remain current on them. I am skeptical however that anyone could and should be "certified" to perform needle crikes, decompression, entubation, IVs, Defibrillators etc. Certification is more than just a piece of paper that says you CAN do something, it's a legal qualification TO do something.

Gutshot John
11-05-10, 17:49
I think we may have a misunderstanding of what TCCC entails, as you stated in a previous post, TCCC is a philosophy and guideline- it does not necessarily require that you have to do anything more than patch up wounds and wait for EMS and do a hand off.

Actually back in 1996 when I was still a lowly corpsman we were starting the implementation of TCCC. As you correctly point out it's a philosophy that presupposes a dedicated evacuation chain. I'm very confused as to how that benefits a civilian.


What TCCC training may provide for the layperson/civilian with limited medical training is enough information to realize that a patient/casualty may not survive long enough to be evacuated without the use of something like a tourniquet or hemostatic agent.

That's not really accurate or rather it's not specific to TCCC. Having done and taught quite a bit of other medical training, that's covered as well. Tourniquets and Hemostats are covered in PHTLS (presuming you're a paramedic) as well as other first aid classes. Blood loss falls under "C" in most programs. The only real difference in TCCC is that you'll hit "C" before A and B in the case of a severe extremity wound but again that's only relevant in very specific cases.


I looked at the NAEMT site and was unable to locate your cited references. Based on your citations I will disagree that TCCC requires PHTLS as a prerequisite.

http://www.naemt.org/education/PHTLS/TCCC.aspx

First paragraph, last sentence.


I have not taken any PHTLS courses. There may be some confusion about what Condition Red offers- they do not "certify" students. I can see how my original post may have been misinterpreted due to a poor choice of words on my part- they are authorized by NAEMT to teach TCCC. The terms appropriate and relevant are also subjective and I will say that those EMT's and Paramedics in the class felt that the information was useful.

They are authorized to teach TCCC to military members as an adjunct to PHTLS training, whether they are authorized to teach TCCC to non-medical lay persons is where I'm skeptical.


I'm sure Condition Red has considered the liability exposure of teaching just as they have weighed the benefits of passing along information to help the good guys be better prepared. If I "do this to someone on the street" it will be because they were in danger of loss of life and I believed a lack of action would result in death

I think you're misunderstanding what I'm saying and this is part of the problem. You can get all the necessary information from another First Responder class to do all the same things but with an appropriate level of certification and significant "good samaritan" protections as well. You can still do everything "right" and still get sued. If you've taken a class that you weren't prepared for and didn't meet the prerequisites for, than your potential liability is that much greater. The burden of proof would then be on you to show that they were in danger of loss of life rather than on them to show that you acted out of your scope of training. In the military you can't get sued which is why this training can be offered even though it deviates significantly from civilian EMS protocols.


I don't understand how its not appropriate? Have you taken a TCCC class?

Yes, though admittedly not recently, in fact we were testing the curriculum back in the 1990s, I was in the first class of Corpsman/Marines who received the training in 3rd Marine Division. I was also a PHTLS instructor. Needle decompression is not appropriate to the lay person who has no other medical training. There are a slew of complications that can go wrong. Add to this needle crikes and other higher speed techniques and I'm deeply concerned with the judgment of your instructors.


Imagine a scenario where a civilian layperson witnesses a motor vehicle accident- after pulling over and activating the EMS system this person sees a person with a partial amputation of an extremity- let's say an arm. Not knowing how long it will take EMS to arrive the civilian makes an improvised TQ to stop the hemorrhaging. EMS arrives 5 minutes later and is able to apply a higher level of care enroute to the nearest definitive care facility.

It's a false premise. Tourniquets are not exclusive or specific to TCCC.


From what I gathered in the class, TCCC was developed based on the concept that the normal chain of evacuation is not readily available and that certain life saving actions not normally performed such as a needle decompression would be necessary to keep the patient/casualty alive until they can be evacuated. I will reiterate that TCCC does not replace or substitute FR, EMT, CPR or any other medical training.

That is not really correct. Military sometimes has extended transports in excess of the "Golden Hour" (though that's still a statistical anomaly) that you're almost never going to find in the civilian side, this is why it is more relevant to them than you. That said it is absolutely about moving patients through the echelons of care.

You say it does not substitute for other forms of training, but then you also say you haven't had that training. This is maybe where a lot of the disconnect between us is occurring.


You made a statement in a previous post about "verify that there is a medical director or at least some form of certifying body." I posted the certifying body and the presence of the medical director as well as another MD. In addition, the class was predominantly EMT's and EMT-P's so I think that if any of the information put out was contrary to what is common sense, common practice or otherwise good medicine they would have challenged the instructors on it.

You're confusing instructors with a certifying body. In the case of PHTLS or TCCC the "certifying" body is the NAEMT. They spell out clear prerequisites and criteria. A medical director assures that the students and the instructors are consistent with that training. If you're talking about Doctors, you may get a degree from Med School, but you're not licensed to practice medicine until you are board certified.

Medical training also incorporates a significant amount of legal training as well, you're not understanding what I'm saying because they haven't taught you what you should know to protect yourself from liability. I'm genuinely looking out for your best interests, if you think I'm not than disregard what I'm saying.


I disagree and think it is a huge leap to suggest that. What specific part(s) of the TCCC course is it that you think should be restricted from civilians?

You're allowed to disagree although in this case I think my analogy is valid. I don't think the entire TCCC program should be taught to any non-military person who hasn't had at least First Responder training and very probably EMT training. If you want significant medical training, go get it but I would be skeptical of instructors who didn't have significant prerequisites for this class as I would be skeptical of CQB instructors who didn't have significant prerequisites for theirs.


I am still unclear about what is taught in TCCC that you think is irrelevant to civilians?

I'm not sure how much more clear I can be. Medical training for civilians is perfectly valid and indeed necessary. There are however better forums for that training to be realized.


To clarify, I did not intend for my first post to be a direct response to the OP but as another option to anybody who might be looking for other medical training such as the links provided to Magpul and Insights. I apologize to the OP if I took the thread too far off track.

That's fair enough and honestly the Magpul classes I don't think are relevant/appropriate to civilians either (in fact they label it as a "hostile environment") but that class does not offer a specific certification whereas yours did.

Gutshot John
11-05-10, 19:12
I think you're taking my critiques of your instructors as a critique of you personally when nothing could be further from the truth.

You strike me as someone who is honest and sincere. I understand your need to believe that you're qualified for this training and that you're instructors were acting ethically. If you were to believe otherwise than I doubt you could in good conscience continue. I ask you to step back from the emotional investment you have made and think about what I'm saying on an intellectual level.

If you're taking this class for your own edification and won't be using these skills on anyone but yourself or those in your family not likely to sue you, than disregard my concerns.

I am genuinely trying to help you and look out for your best interests if that advice is neither wanted nor appreciated this will be the last thing I have to say on the topic.

browningboy84
11-06-10, 01:01
I am gonna step in this shit with both feet.....

Allow me to present my experience and certifications. Been in EMS 5 years now, as a EMT-P 3.5 years now. I was a volunteer firefighter for 2 years prior to that. I am an Asst Director for a county based EMS Department. I hold Instructor ratings in BLS, ACLS, PALS, AMLS, ITLS,PITLS. ITLS stands for International Trauma Life Support, and is basically the same thing as PHTLS..... I CANNOT TEACH TCCC due to the fact that I AM NOT MILLITARY!!!!!!!!!!!!! Treehoppr, here is the link.
http://www.naemt.org/education/PHTLS/TCCC.aspx

Tree,
you have been treed. That company has opened a serious can of worms by what they let you learn. I would not let one of my guys go to them for continuing ed based on the fact that they let an untrained person through there. You need to chill out, John is just trying to help ya out tree. Take a chill pill and relax. I could report these guys and they would lose their Instructor licenses, every one of them if the NAEMT found out about this!!!!

Chris@conditionred.us
11-06-10, 11:22
Gents, Your concerns are justified. Let me provide some key facts.

The TCCC Program has recently come available to "civilians" within the last year. The concepts are drawn from Military "Evidence Based" Medicine. All information provided is backed by statistics and studies.

The program, offered by NAEMT is ACCREDITED by the American College of Surgeons. It is being provided to EMS, Law Enforcement, Etc. in response to and preparation for scenarios that will force providers to render care in "not so safe" environments. As you are aware, typically the threats are neutralized prior to EMS responding in. Unfortunately, there is anticipation that a prolonged scenario, where multiple agencies are needed, where the threat is continued for an excessive period of time, that involves large civilian casualties, as well as responder casualties, will one day come to fruition.

PHTLS is a recommended prerequisite for the class. It is not mandatory. Having participated in the class, and successfully completed the Final Exam, DOES NOT permit you to run around with body armor, and render aid to ANYONE! For the professional EMS providers, LOCAL PROTOCOL dictates exactly what you can and cant do to a patient. There is an overlap with the skills, but the great benefit of the class is the overall mindset of providing care in a hostile environment. Limitations are explored, basic skills are identified and highlighted. The concept of treating a wounded officer, and getting them "back on the gun" is discussed. The role of the Medic is to support the Team, to accomplish the mission, and neutralize the threat.

Anyone is welcome to take the class. You do not have to be a professional responder or LE. Skills such as tourniquet application and Quickclot application may be beneficial to a Camper, Hunter, Etc. These items are available for purchase at any Outdoor sports supplier.

Once again, Attending the class, and receiving the cert DOES NOT permit you to treeat patients outside your scope of practice.

And, for the record, Condition Red, Inc. is a New York State Corporation, does in fact have a Medical Director, (It is a prerequisite to become a training facility), Is one of four sites approved by NAEMT to teach the class, and has five Instructors, all Paramedics, with a minimum of 14 years Paramedic experience, some with LE experience, some with Military background, and we all take our job seriously.

Thank You for your interest. It is great to see such passion regarding the topic.

Treehopr
11-06-10, 19:53
I am gonna step in this shit with both feet.....

Allow me to present my experience and certifications. Been in EMS 5 years now, as a EMT-P 3.5 years now. I was a volunteer firefighter for 2 years prior to that. I am an Asst Director for a county based EMS Department. I hold Instructor ratings in BLS, ACLS, PALS, AMLS, ITLS,PITLS. ITLS stands for International Trauma Life Support, and is basically the same thing as PHTLS..... I CANNOT TEACH TCCC due to the fact that I AM NOT MILLITARY!!!!!!!!!!!!! Treehoppr, here is the link.
http://www.naemt.org/education/PHTLS/TCCC.aspx

Tree,
you have been treed. That company has opened a serious can of worms by what they let you learn. I would not let one of my guys go to them for continuing ed based on the fact that they let an untrained person through there. You need to chill out, John is just trying to help ya out tree. Take a chill pill and relax. I could report these guys and they would lose their Instructor licenses, every one of them if the NAEMT found out about this!!!!

browningboy84,

Based on previous posts in this thread I am aware that people are skeptical of the training offered and the folks offering it.

I believe that Gutshot John is sincerely looking out for the best interests of people who are seeking out medical training.

While I understand your point based on the link provided, I would say that since the majority of the students in the class had no military background or experience and the fact that 2 reps from NAEMT were there to witness/validate the class there won't be anybody losing any licenses due to how this class was conducted.

As others have pointed out, I am not as familiar with the various types of certifications so I don't want to make too many assumptions.

As one who was actually in the class I can say that while I was encouraged to ask as many questions and learn as much as possible in the relatively short time frame, I was never told to do anything (outside of the training environment) that I was not comfortable with or that could not be resolved with other techniques or by trained medical professionals.

Treehopr
11-06-10, 20:12
I think you're taking my critiques of your instructors as a critique of you personally when nothing could be further from the truth.

You strike me as someone who is honest and sincere. I understand your need to believe that you're qualified for this training and that you're instructors were acting ethically. If you were to believe otherwise than I doubt you could in good conscience continue. I ask you to step back from the emotional investment you have made and think about what I'm saying on an intellectual level.

If you're taking this class for your own edification and won't be using these skills on anyone but yourself or those in your family not likely to sue you, than disregard my concerns.

I am genuinely trying to help you and look out for your best interests if that advice is neither wanted nor appreciated this will be the last thing I have to say on the topic.

Gutshot John,

Let me start by saying that if anything I have posted came across as emotional or defensive it was unintentional.

I respect the points you have made and the noble intent behind it but don't necessarily agree with them.

I understand that some of the techniques taught in TCCC presumes a lack of "standard" medical care and that attempting those techniques, regardless of the amount of medical training, can still be dangerous and result in a negative outcome.

I also realize that if I were ever in a situation where I even thought it was necessary for me to attempt some of those techniques that the circumstances would be extreme.

As I stated in earlier posts, if all it takes is a phone call to 911 and to be a good bystander then great, I have no desire to seek out an opportunity to apply any of this training in real life.

Your points about liability are valid and in my mind I correlate them to firearms training. Having a gun and having the training to use it does not automatically translate in to me looking for a gunfight.

In the event that I would ever have to use a gun to protect my life or those of others, I can expect to have the same burden of proof and exposure to civil and criminal liability. I am under no illusions that any of this is desirable.

I stand by my belief that there is nothing taught in the TCCC class that I attended that would encourage me to make irresponsible decisions, skip over medical techniques taught in other classes or otherwise make me a danger to the public.

In fact, my experience in this class has given me an even deeper appreciation of the amount of training, experience and skill that medical professionals such as yourself have in order to do their jobs.

The TCCC class taught by Condition Red was well organized and illuminating. The instructors were highly experienced professionals and took every opportunity to help students learn. I suspect that you (Gutshot John) probably have a lot more in common with the Condition Red instructors than you may realize.

Respectfully,

treehopr

Treehopr
11-06-10, 20:21
Gents, Your concerns are justified. Let me provide some key facts.

The TCCC Program has recently come available to "civilians" within the last year. The concepts are drawn from Military "Evidence Based" Medicine. All information provided is backed by statistics and studies.

The program, offered by NAEMT is ACCREDITED by the American College of Surgeons. It is being provided to EMS, Law Enforcement, Etc. in response to and preparation for scenarios that will force providers to render care in "not so safe" environments. As you are aware, typically the threats are neutralized prior to EMS responding in. Unfortunately, there is anticipation that a prolonged scenario, where multiple agencies are needed, where the threat is continued for an excessive period of time, that involves large civilian casualties, as well as responder casualties, will one day come to fruition.

PHTLS is a recommended prerequisite for the class. It is not mandatory. Having participated in the class, and successfully completed the Final Exam, DOES NOT permit you to run around with body armor, and render aid to ANYONE! For the professional EMS providers, LOCAL PROTOCOL dictates exactly what you can and cant do to a patient. There is an overlap with the skills, but the great benefit of the class is the overall mindset of providing care in a hostile environment. Limitations are explored, basic skills are identified and highlighted. The concept of treating a wounded officer, and getting them "back on the gun" is discussed. The role of the Medic is to support the Team, to accomplish the mission, and neutralize the threat.

Anyone is welcome to take the class. You do not have to be a professional responder or LE. Skills such as tourniquet application and Quickclot application may be beneficial to a Camper, Hunter, Etc. These items are available for purchase at any Outdoor sports supplier.

Once again, Attending the class, and receiving the cert DOES NOT permit you to treeat patients outside your scope of practice.

And, for the record, Condition Red, Inc. is a New York State Corporation, does in fact have a Medical Director, (It is a prerequisite to become a training facility), Is one of four sites approved by NAEMT to teach the class, and has five Instructors, all Paramedics, with a minimum of 14 years Paramedic experience, some with LE experience, some with Military background, and we all take our job seriously.

Thank You for your interest. It is great to see such passion regarding the topic.

Chris@conditionred.us,

Thanks for clarifying some of the concerns brought up by others. I apologize if I spoke out of turn or otherwise added to the confusion.

I enjoyed the class immensely and learned a great deal.

Welcome to the forum,

treehopr

Chris@conditionred.us
11-06-10, 20:40
No apologies necessary. This program is very new, and is attracting a lot of attention. Many people have raised an eyebrow, but as more information, factual information, comes available, people have become more and more receptive to the concept.
NAEMT is in the process of a revision, gearing the course to non-military providers. Also, Condition Red, Inc. is developing a TCCC-Advanced class. A four hour accredited certification in Bomb Blast Injury from the Center for Disease Control, Skill Performance and Evaluation, and Scenario/Roleplay. Thank You for your participation and feedback. Stay Safe.

Gutshot John
11-06-10, 22:42
Disregard.

Gutshot John
11-07-10, 10:31
My apologies to both Tree and Chris I misunderstood the "apology" context and that's completely on me. Thanks and apologies also to Spence for trying to point out the error of my ways.

I should know better than to respond half-cocked at midnight after being in class all day. No excuses I was an asshole.

I remain skeptical of the program as described but I also should have read much closer than I did.

Chris@conditionred.us
11-07-10, 11:00
Mr. John- As stated earlier, I completely understand your concerns.

I will be running a class in Fairfax, VA in January. My offer to you is, come for free. At the end of the program, if you did not learn anything, and did not enjoy the class, you keep your money in your pocket. If you happen to add a thing or two to your knowledge cache, meet some great people and have fun while learning, ante up, and receive your certificate and 16 hours of Continuing Medical Education credits. Also, you will be tasked with posting an after action report on the Forum. What do you say?

Gutshot John
11-07-10, 11:09
Mr. John- As stated earlier, I completely understand your concerns.

I will be running a class in Fairfax, VA in January. My offer to you is, come for free. At the end of the program, if you did not learn anything, and did not enjoy the class, you keep your money in your pocket. If you happen to add a thing or two to your knowledge cache, meet some great people and have fun while learning, ante up, and receive your certificate and 16 hours of Continuing Medical Education credits. Also, you will be tasked with posting an after action report on the Forum. What do you say?

That's a very gracious offer but much of it will depend on scheduling as I'm in grad school and getting away can be tough. If I can get away I will.

What are your dates?

Chris@conditionred.us
11-07-10, 13:23
Mr. John,

I am currently in process of securing host facility. I will provide details as soon as they are available. Be safe out there.

C-

Chris@conditionred.us
11-08-10, 14:07
Ladies and Gentlemen,

For those of interest, I am offering a TCCC Class in Manassas, Virginia, January 24th and 25th 2011.

Please contact me for more information.

C-

chuckman
11-10-10, 18:14
I have been following this with some interest. I was in Mark 1 Mod 0 TCCC many moons ago when it was being offered, at the time, to limited servicemen, and only Navy. I was a corpsman and happened to piggyback a class through a contact. I have since taken it a couple iterations later now that everyone takes it. We knew then that it was a matter of time until it hit Civvyland, and although good information, it is very limited in scope and need. It even needs to be modified for TEMS and the LEO community from its original intent. Having said that, I am a fan of 'knowledge is power' and have taken classes that I knew I would never 'need' aside from the sake of learning. I am glad to see this kind of discussion; however, for someone with limited medical training and/or limited need to find himself in a tactical situation, it is a bit overkill. It happens to be the 'in' thing now, just as CONTOMS was back in the day. Just my two drachmas

Chris@conditionred.us
11-11-10, 11:36
Chuckman,

First, Thank You and God Bless for your service to our Country.

Re: TCCC-although it is presently a Military Course, It is under revision and will be updated in 6-8 months with Civilian applications.

As certified Instructors, we are tasked with covering the existing curriculum, but have the liberty to discuss present day civilian world applications.

Additionally, this thread began with a controversial heading. Without disclosing students' personal information, I can assure you that the attendees all have the possibility to apply this knowledge, with local protocols in mind, as professional caregivers, or in the LE environment.

Again, a hot topic, with a multitude of ideas and injects. I thank you for your interest.