This chapter presents key features in the initial training and continuous education of the tactical medical provider. A principal consideration in this work is that each individual assigned to participate in a tactical incident bears medical responsibilities of some type, thus requiring appropriate training to be able to carry out those responsibilities. Therefore it may be said that the tactical medical provider represents a key link in a continuum of safety and care

This work identifies key areas of training for those offering the spectrum of medical care in the tactical environment. In many areas reference is made to areas in which specific training should be sought, rather than covering the specifics of the training in these procedures, for example, endotracheal intubation (ETI) and needle decompression of the thorax. Ample references in the medical literature are available to the tactical provider that provide this training in detail. Rather, this chapter provides the margins and material comprising the spectrum of training for those involved in tactical emergency medical support.

Medical needs during a tactical event cover a broad realm. Injuries can be as minor as simple lacerations or minor burns and as serious as penetrating wounds that may be immediately life-threatening or even fatal. All personnel assigned to a tactical scenario must have been trained in basic assessment techniques that allow for identification of acute injury or illness on the part of any member of the
team (1). In a dangerous setting such as being under fire, the first medical help will most likely come from another member of the tactical team before the tactical paramedic or physician becomes available to initiate further evaluation and treatment (1).

The most essential link in the chain of field survival is not the fully trained and certified medic. Knowing how to apply “self-aid” and “buddy aid”—teaching fighters to take care of themselves and those on their right and left—will allow initial assessment and treatment to occur much sooner than the care that will come later from medics, in many circumstances. Whether the mission is one of running a combat logistics patrol on a highway, running dismounted combat patrols in a military theater, or delivering a warrant to a suspected drug haven, the number of shooters will often outnumber the available medics.

In this regard, training should be focused substantially on the individual who will provide initial care. This care is not definitive but rather is stabilizing and temporizing. Medical providers will step forward later with advanced skills and patient sustainment efforts. Instructors and trainees in these initial skills must fully embrace the well-documented understanding that when skills are not used regularly, proficiency will decline. Thus, the authors believe that the teaching of a smaller skill set with frequent refresher training will achieve better results than the teaching of a large initial skill set with only yearly refresher training.

The type of training needed for tactical emergency medical support has been a subject of some debate. National experts in the field indeed have stated that “law enforcement agencies who attempt to apprehend dangerous, heavily armed criminals with a special operations team that lacks the expertise to treat the medical consequences that may arise from such a confrontation may be negligent of deliberate indifference” (1).

Specific points of the initial training for the tactical emergency medical provider include that the course (a) must be hands-on and based on the experience of the provider and (b) must include physician responders and minimal training to allow physicians to become members of the special weapons and tactics (SWAT) efforts.

Finally, recognizing the growing need for standardized education for the tactical emergency medicine provider. An initiative is currently underway to standardize this training. This initiative is being lead by academia and industry (2).