The purpose of this Training Needs Assessment (TNA) is to evaluate the current attitudes, training needs, and challenges faced by law enforcement agencies in the State of California regarding advanced pre-hospital medicine in tactical and austere situations. The course design will be based on the results of the training needs assessment.
High risk medicine is a rapidly growing area in law enforcement. This focus on advanced pre-hospital medicine in a tactical or austere environment is the result of the current risks associated with law enforcement activities and the ever-growing war on terrorism. Furthermore, Federal Bureau of Investigation has released the ‘2012 Law Enforcement Officer’s Killed and Assaulted’ report online. This report states 52,901 officers were assaulted while performing their duties. They also reported that 45 law enforcement officers were feloniously killed in the line of duty in California alone between 2003 and 2012.
As TEMS (Tactical Emergency Medical Support) has grown in popularity, so have the number of programs offering instruction for this specialty. The challenge has been in the varied ways these programs are conducted. With a lack of a nationwide standardized competency based programs, such as is used with Pre-Hospital Trauma Life Support (PHTLS), the programs that do exist are producing a wide range of understanding, capabilities and expectations of performance. An individual who has completed a Tactical Medicine training program may or may not be competent to perform any number of medical procedures. This is based on complex issues such as licensure, state and county laws, and the broad background that TEMS operators come from, beginning at the certified First Responder, including licensed personnel such as EMT’s, paramedics and nurses, and ending by encompassing the physician level. At this time, a certificate is not a validation of competence. It is this gap that should be addressed and with current movements toward standardization. There appears to be strong position from which to embark on utilizing the recommendation supported by the National Tactical Officers Association (NTOA). In the article ‘Tactical Medicine-Competency-Based Guidelines’ the framework to develop a standardized program is outlined as well the guidelines set by the Committee of Tactical Emergency Causality Care.
The basis for most trauma care is adapted or adopted from The Committee on Tactical Combat Causality Care and outlines the best practices for trauma care in a combat environment. It is not all inclusive of all the needs of a law enforcement operation. The Committee on Emergency Causality Care had developed a set of guidelines that are adapted to the civilian environment. It is these guidelines that would be used in the development of the course. In addition, the California Emergency Medical Services Agency (CAEMSA) and Police Officer Standardized Training (POST) have released a collaborative ‘Guidelines for Tactical Medicine.’ It is from this position and the competency based program guidelines that a POST-approved Law Enforcement Casualty Course (LECC) would be created. This course can be developed for all law enforcement officers, and from that course, advanced courses can easily grow that meet both CA-EMSA and POST guidelines. These state guidelines are currently being reviewed by the California State Tactical EMS advisory Committee to ensuring the guidelines are current and evidence based. I would like to ensure the course is developed to meet or exceed those standards.
What Medical equipment should each officer carry? As in any job, the tools you take with you dictate how much one will be able to accomplish while completing the job assigned to you. To have impractical tools, unnecessary tools or the wrong tools not only inhibit, but impedes mission completion. Therefore, deciding what tools a law enforcement officer carries or has available indicates how independent they are and how effective they will be while providing medical care. Equipment including tourniquets, hemostatic agents, pressure dressing and airway support equipment all need to be evaluated. These items are also being discussed on a state level. The current Title 22 regulation have been revised and will change the framework of medical training for law enforcement officers.
How often should each Law Enforcement officers be required to perform these skills in a training environment? Professional licenses and certifications have to be renewed every 2-6 years, depending on a provider’s level of training and licensure. No standard currently exists for tactical medicine. It is well documented that skill degradation occurs without practice, and this is a key area that needs to be addressed. Insight for this can be garnered from air ambulance programs, which have a broad scope of practice and regimented training schedules. This course will focuses on the non-medically trained patrol officer who is on the front line of any law enforcement activity, from a traffic stop to those whose job puts them at greatest threat, such as Explosive Ordinance Disposal (EOD) or a Special Response Unit (SRU).
Licensed professionals have a scope of practice defined and often limited by the licensing body, such as the American Medical Association (AMA), California Board of Registered Nursing (BRN), and the CAEMSA. Currently an officers medical education may begin in the academy with Learning Domain 34 (LD34: Basic First Aid for the Professional Rescuer) as defined by Title 22 of the State of California, as well as the First Responder course which is a non-licensed certification whose scope of practice is defined by the United States Department of Transportation (DOT).
These licensing and certification bodies have standards of practice, assessments, procedures and tests that each level of licensure is required to prove competence through written and skills testing. If competency requirements were utilized within these different and well-defined levels of care, the tactical team leader, the medical team leader and all tactical team members will have clear expectations of services provided at each level, thereby furthering legitimization of the Casualty Care providers and their integration into interoperable environment.
When inquires have been made of law enforcement officers regarding the tactical medicine courses they have taken, one similar concern was voiced: programs seemed too often be geared toward medical personnel with no law enforcement or military background, and not towards experienced law enforcement officers. This subtle yet profound difference means that many program’s curricula included topics such as weapons, tactics and range time. Officers stated they did not need nor want these topics because these were covered in their academies, SWAT schools and were governed by their specific agency’s policies. Some programs did not delineate between licensed and not licensed students and students attended classes and were trained in skills that they could never use and according the Deputy Director of EMSA are crimes. This validates the need to target specific training audiences.
This course will focus on the line officer, the curriculum should be a required course for every recruit in the academy to every two years for all officers in CPT
This would equate to CLS (Combat Life Saver) course with EVERY solider is required to take.
This class could be given two to four times per year. The Alameda County Sheriff’s Officer is interested in hosting this course when it becomes available. I also see that portions of the course will be amenable for insertion to LD34 as well as Basic SWAT classes and High-risk Warrants classes. Requirement as a recertification course every two years would be recommended as it is a perishable skill and is a frequently updated.
Suggestions include the following:
‘ Develop a visionary and forward thinking curriculum that approaches the topic of tactical medicine from the view of law enforcement officers.
‘ Law enforcement leaders need to be at the forefront in advocating for and ensuring that the expertise, training and equipment to support our first line of defense is available.
‘ Law enforcement agencies need to define the qualification requirements for all officers.
‘ Periodic formal and informal meetings among law enforcement and medical leaders are essential for unit cohesion and clear communication prior to an incident.
The suggestions listed above provide a good framework for creating a Law Enforcement Casualty Care course. On a micro-level, this provides the law enforcement community an alternative to currently available method of having an ambulance on standby unavailable to provide immediate casualty care, thereby delaying care to wounded officers, civilians or suspects. On a global scale, this type of program provides incredibly valuable alternatives to current training programs that are tactical and weapons focused in training, and further providing a medically focused and competency based program, as opposed to one based only in theory or one that is focused on licensed personnel with an advanced scope of practice. It is very important to convey the importance of offering a quality standard bases curriculum that includes specific performance based standard that are divided by performance level of function.
The following is a summary of several of the key recommendations provided for law enforcement:
‘ Law enforcement needs to learn more about the available resources of the communities they serve as well as capabilities of other agencies involved in emergency response.
‘ Law enforcement leaders must develop relationships and networks with medical and EMS agencies before a crisis occurs.
‘ Law enforcement leaders must assure a strong institutional commitment to officer safety and providing the resource allocation to provide the necessary skills and equipment.
‘ Line officers should be trained and equipped to address emergency medical issues in high risk environments.
Just like a corporate culture, each agency will define the roles and responsibilities of their officers, as well as expectations of basic training standards and operational expectation. The information provided was intended as a starting point for law enforcement and medical leaders to develop a collaborative, proactive and problem solving approach to combat future knowledge deficits and ensure a well-trained and well equipped first line of defense.
Methodology Results and Analysis
Course Design Worksheets
CDWS Task One ‘
CDWS Task Two ‘
CDWS Task Three ‘
CDWS Task Four ‘
Subject Matter Resources (SMR) In-Progress Review
Post Course Evaluation Plan
...(download the rest of the essay above)