Gutshot John
02-23-11, 08:16
This is a follow-up on the "Training for Civilians (https://www.m4carbine.net/showthread.php?p=811630)' thread in the Emergency First-Aid forum from several months ago. For those who aren't familiar with the context of the discussion please refer to the above link.
Definitions: When I say "civilian" I'm talking about joe blow on the street, maybe/maybe not a CCW holder. When I say first-responder I'm talking about firefighters, EMTs and police officer who are often the first to respond to a scene.
Perhaps the biggest misconception I've seen over the years about TCCC is that it's about medical treatment and this is one I bristle at as I've seen various organizations use "TCCC" as a marketing gimmick for civilian shooters who want "high speed low drag" even though the content was never intended for that audience. I won't rehash those arguments other than to refer anyone who is interested to the above thread.
Where PHTLS is a "medical" class dealing with a variety of techniques for the trained EMS provider to respond to trauma incidents, TCCC is more about "mindset." I was very happy to see that Condition Red has maintained a commitment to the original intent and focus of TCCC. Despite the confusion of the linked thread, the class is not marketed towards, nor intended for civilian shooters and Chris and the other instructors focus their efforts on those in Public Safety who might be called to respond to active shooters, terrorist attacks and other scenarios that are the "new normal" for our global situation.
Background: I am a certified EMT-P with several years of active experience and an ex-USN Hospital Corpsman (8404, Field Medicine) attached to the USMC infantry on active duty. I have been inactive for several years but have reactivated and am in the process of renewing my certs and getting spun back up for command as a medic for a volunteer fire/rescue organization and the Medical Training Director of a close/executive protection company here in Pittsburgh.
TCCC (refered to as T-Triple C or TC3) Way back in the mid-1990s while I was still active-duty I was in the first group of Corpsmen in 3MARDIV (Okinawa) to receive the newly introduced TCCC curriculum which was taught as a companion course to PHTLS. I have not taken the curriculum since as it was generally not offered in the non-military context. In the last year the NAEMT and Committee on TCCC have decided to transition the content to the non-military world.
Based on my responses to the "Training for Civilians" thread Chris at Condition Red challenged me to take a class and decide for myself what was involved with TCCC and write a review of the class. This class was held Feb 21-22 in Bethesda Maryland at the NIH's Fire/Rescue company. The class was made up of primarily firefighters and other first responders. I was one of two EMT-Ps in the class and the only one (so far as I know) with a background in military medicine.
While it gives some medical information, this content does not teach any "high speed" ninja medical skills and is more about shifting mindset away from the ABCs of traditional emergent care and prioritizing casualties and evacuation within the context of a larger mission and the exigencies of tactical realities. Indeed the medical content is wholly consistent with anyone who has taken an EMT-B/I/P program. While TCCC covers fluid rescuccitation (IV and IO), Surgical Crics and Needle Decompression certainly a paramedic (and often an EMT-B) is not going to learn any medical technique he has not already seen or performed.
Condition Red's TCCC:
I stand by my original assessment that this program is not appropriate for civilians. While there are certainly elements that are useful in the civilian context this class is not a substitute for first-aid, first responder or any number of other courses that cater to that audience. Even an PHTLS course (if you can get into one) is more appropriate for teaching management of traumatic injuries to civilians. TCCC is geared towards responders who have an entire evacuation/supply chain supporting their efforts and the "luxury" of multiple responders, backup personnel and shooters as well as medics. Since this doesn't apply to the civilian CCW, focus your training dollars elsewhere.
That said for the firefighter, paramedic/EMT, LEO (ESPECIALLY SWAT/Tactical officers) this course is of profound benefit, importance and has the potential to save a lot of lives. While the content dealt primarily with a military context, the applicability to the non-military world was apparent. If your department is looking for this type of training, I highly recommend this course and if your department isn't looking I highly recommend you take this to your superiors and make sure it gets on the training schedule/budget. As a Pittsburgher, when I think about the three police officers who were gunned down in April 2009 I can't help but think this program would have at least given responders the tools/mindset they needed.
The main takeaway from TCCC (and indeed your primary tool) is the division of treatment into situational rather than medical components. Where EMTs have the ABCs of patient assessment pounded into their heads, TCCC discards this model. Instead care is divided into three phases: 1. Care Under Fire, 2. Tactical Field Care and 3. Tactical Evacuation Care. The priority is on aggressively treating/managing hemorrhage to prevent shock while avoiding becoming a casualty yourself and achieving the mission objectives.
Care Under Fire is exactly what it sounds like, you've got a casualty you have to stabilize rapidly and move to cover while under imminent threat, taking fire or significant potential for further casualties. Tactical Field care is treatment where you have cover/security even if members of your element are still engaged. Tactical Evacuation Care is the final phase where you've brought in more definitive resources to treat/evac the casualty to "bright lights and cold steel" while the mission continues.
Your two primary medical tools in this regard are the tourniquet and the hemostatic agent (Quik-Clot/Combat Gauze). This lesson was repeatedly pounded home by Condition Red's instructors. Different tourniquet types were discussed (CAT-T, SOF-T and SWAT-T) and used. All of which were effective with each providing different advantages and disadvantages. Combat Gauze was the standard for hemostats for its cost-effectiveness, ease of use and efficacy.
The medical highlights for me as a paramedic were getting practice on a surgical cric (on a pig trachea) and needle decompression. The practical/mindset highlights for me was the scenarios we practiced on the last day of class that opened my eyes to many of the realities involved with responding to active-shooter and other scenarios faced by Fire/EMS/LEO. I will not get into detail of the curriculum as bad guys monitor this type of posting as well but suffice to say that they have a monster job with very little room for error and so it behooves the average citizen to present the least possible threat to any First Responder and comply with orders given. The course does quite a bit to raise awareness on the part of responders, especially those that are armed that they have to be very selective even as they treat everyone they come across as a potential threat. It behooves everyone to keep this in mind if they are faced with such a situation.
All in all I enjoyed this class and found it quite beneficial. Condition Red did a fantastic job conveying the material and explaining the realities/hiccups that might be faced and how it applies to the non-military first responder. The instructors were all very professional with years of real world tactical, medical and military experience between them. The benefits of this experience more than any other single facet of this class are the real selling points of Condition Red and it's TCCC program. They are blazing new trails expanding this curriculum beyond the traditional confines of the military, and bringing it to the Public Safety. There is direct applicability to the non-military world and I wouldn't hesitate to recommend this class (as well as Condition Red) to any individual Firefighter, Paramedic and LEO as well as their respective departments. I genuinely hope that it becomes a standard part of these training curriculums as the information has the potential to save many thousands of lives over the course of years.
Definitions: When I say "civilian" I'm talking about joe blow on the street, maybe/maybe not a CCW holder. When I say first-responder I'm talking about firefighters, EMTs and police officer who are often the first to respond to a scene.
Perhaps the biggest misconception I've seen over the years about TCCC is that it's about medical treatment and this is one I bristle at as I've seen various organizations use "TCCC" as a marketing gimmick for civilian shooters who want "high speed low drag" even though the content was never intended for that audience. I won't rehash those arguments other than to refer anyone who is interested to the above thread.
Where PHTLS is a "medical" class dealing with a variety of techniques for the trained EMS provider to respond to trauma incidents, TCCC is more about "mindset." I was very happy to see that Condition Red has maintained a commitment to the original intent and focus of TCCC. Despite the confusion of the linked thread, the class is not marketed towards, nor intended for civilian shooters and Chris and the other instructors focus their efforts on those in Public Safety who might be called to respond to active shooters, terrorist attacks and other scenarios that are the "new normal" for our global situation.
Background: I am a certified EMT-P with several years of active experience and an ex-USN Hospital Corpsman (8404, Field Medicine) attached to the USMC infantry on active duty. I have been inactive for several years but have reactivated and am in the process of renewing my certs and getting spun back up for command as a medic for a volunteer fire/rescue organization and the Medical Training Director of a close/executive protection company here in Pittsburgh.
TCCC (refered to as T-Triple C or TC3) Way back in the mid-1990s while I was still active-duty I was in the first group of Corpsmen in 3MARDIV (Okinawa) to receive the newly introduced TCCC curriculum which was taught as a companion course to PHTLS. I have not taken the curriculum since as it was generally not offered in the non-military context. In the last year the NAEMT and Committee on TCCC have decided to transition the content to the non-military world.
Based on my responses to the "Training for Civilians" thread Chris at Condition Red challenged me to take a class and decide for myself what was involved with TCCC and write a review of the class. This class was held Feb 21-22 in Bethesda Maryland at the NIH's Fire/Rescue company. The class was made up of primarily firefighters and other first responders. I was one of two EMT-Ps in the class and the only one (so far as I know) with a background in military medicine.
While it gives some medical information, this content does not teach any "high speed" ninja medical skills and is more about shifting mindset away from the ABCs of traditional emergent care and prioritizing casualties and evacuation within the context of a larger mission and the exigencies of tactical realities. Indeed the medical content is wholly consistent with anyone who has taken an EMT-B/I/P program. While TCCC covers fluid rescuccitation (IV and IO), Surgical Crics and Needle Decompression certainly a paramedic (and often an EMT-B) is not going to learn any medical technique he has not already seen or performed.
Condition Red's TCCC:
I stand by my original assessment that this program is not appropriate for civilians. While there are certainly elements that are useful in the civilian context this class is not a substitute for first-aid, first responder or any number of other courses that cater to that audience. Even an PHTLS course (if you can get into one) is more appropriate for teaching management of traumatic injuries to civilians. TCCC is geared towards responders who have an entire evacuation/supply chain supporting their efforts and the "luxury" of multiple responders, backup personnel and shooters as well as medics. Since this doesn't apply to the civilian CCW, focus your training dollars elsewhere.
That said for the firefighter, paramedic/EMT, LEO (ESPECIALLY SWAT/Tactical officers) this course is of profound benefit, importance and has the potential to save a lot of lives. While the content dealt primarily with a military context, the applicability to the non-military world was apparent. If your department is looking for this type of training, I highly recommend this course and if your department isn't looking I highly recommend you take this to your superiors and make sure it gets on the training schedule/budget. As a Pittsburgher, when I think about the three police officers who were gunned down in April 2009 I can't help but think this program would have at least given responders the tools/mindset they needed.
The main takeaway from TCCC (and indeed your primary tool) is the division of treatment into situational rather than medical components. Where EMTs have the ABCs of patient assessment pounded into their heads, TCCC discards this model. Instead care is divided into three phases: 1. Care Under Fire, 2. Tactical Field Care and 3. Tactical Evacuation Care. The priority is on aggressively treating/managing hemorrhage to prevent shock while avoiding becoming a casualty yourself and achieving the mission objectives.
Care Under Fire is exactly what it sounds like, you've got a casualty you have to stabilize rapidly and move to cover while under imminent threat, taking fire or significant potential for further casualties. Tactical Field care is treatment where you have cover/security even if members of your element are still engaged. Tactical Evacuation Care is the final phase where you've brought in more definitive resources to treat/evac the casualty to "bright lights and cold steel" while the mission continues.
Your two primary medical tools in this regard are the tourniquet and the hemostatic agent (Quik-Clot/Combat Gauze). This lesson was repeatedly pounded home by Condition Red's instructors. Different tourniquet types were discussed (CAT-T, SOF-T and SWAT-T) and used. All of which were effective with each providing different advantages and disadvantages. Combat Gauze was the standard for hemostats for its cost-effectiveness, ease of use and efficacy.
The medical highlights for me as a paramedic were getting practice on a surgical cric (on a pig trachea) and needle decompression. The practical/mindset highlights for me was the scenarios we practiced on the last day of class that opened my eyes to many of the realities involved with responding to active-shooter and other scenarios faced by Fire/EMS/LEO. I will not get into detail of the curriculum as bad guys monitor this type of posting as well but suffice to say that they have a monster job with very little room for error and so it behooves the average citizen to present the least possible threat to any First Responder and comply with orders given. The course does quite a bit to raise awareness on the part of responders, especially those that are armed that they have to be very selective even as they treat everyone they come across as a potential threat. It behooves everyone to keep this in mind if they are faced with such a situation.
All in all I enjoyed this class and found it quite beneficial. Condition Red did a fantastic job conveying the material and explaining the realities/hiccups that might be faced and how it applies to the non-military first responder. The instructors were all very professional with years of real world tactical, medical and military experience between them. The benefits of this experience more than any other single facet of this class are the real selling points of Condition Red and it's TCCC program. They are blazing new trails expanding this curriculum beyond the traditional confines of the military, and bringing it to the Public Safety. There is direct applicability to the non-military world and I wouldn't hesitate to recommend this class (as well as Condition Red) to any individual Firefighter, Paramedic and LEO as well as their respective departments. I genuinely hope that it becomes a standard part of these training curriculums as the information has the potential to save many thousands of lives over the course of years.