Training For Civilians?

[Treehopr]

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]

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]

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]

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]

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]

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]

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]

I think this forum needs a chart

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]

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]

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.