AAR: FLETC Basic Tactical Medical Training Program, Hardin MT, Apr 21-23 2015

[ST911]

Course: FLETC Basic Tactical Medical Training Program (BTMTP), https://www.fletc.gov/training-progr...aining-program
Date: April 21-23, 2015
Location: Hardin, MT
Cost: Tuition Free

Course Description:

The Basic Tactical Medical Training Program (BTMTP) is a highly intense training program requiring a physical demand on the student and consists of lecture, labs and skill practice. The law enforcement officer will gain knowledge and skills necessary to mitigate the loss of their life or the life of another while in an active threat environment. The skills will address treating life threatening injuries in an austere environment with limited equipment, lack of medically trained personnel and prolonged time to evacuation.

Tactical Medical is a systematic approach to dealing with casualties in a tactical environment. It is strongly influenced by the model used by the Department of Defense called Tactical Combat Casualty Care (TCCC). As the name implies, TCCC incorporates tactical problem solving into any situation in which casualties are incurred from an armed, hostile opponent. The TCCC system focuses on saving “preventable deaths” while achieving three primary goals: Treat the Casualty, Prevent Additional Casualties and Continue the Mission.

Administrative
This course was restricted to federal, state, and local LEOs. All enrollment and notifications were electronic through the FLETC online system and email communications with staff. A simple packing list was provided suggesting rough duty clothing, duty gear, hydration source, and comfort items such as bug spray and sunscreen. A local host POC was also included, who was helpful with lodging, travel, and other area information.

Instructors
The course was instructed by four (4) members of the FLETC Physical Techniques division. Their backgrounds included service in the US Secret Service Uniformed Division, National Park Service, Pentagon Force Protection Agency, corrections, with some prior military service as well. Instructor conduct was friendly, interactive, and professional. They demonstrated genuine interest in students throughout the course. Instructors were also able to relate to students and conduct themselves without need for crude humor or foul language.

Students
There were a total of 24 students from various agencies, most of whom worked somewhere in the surrounding area. There were also students from Colorado, Wyoming, and Washington DC. Some had special unit backgrounds such as SWAT, K9, SAR, EMS, and prior training varied. Students were interactive and supportive of one another. All seemed to be there voluntarily and approached the material enthusiastically.

Facilities
Class was conducted in a well maintained classroom at the local LE center. Refreshments were provided by the host. A large fairgrounds facility was used for additional physical skills and scenario training.

Course Supplies
Students were issued a training IFAK each day. The IFAK contained one each of CAT and SOFTT-W tourniquets, combat gauze training pack, two cravats, a Hyfin chest seal, tape roll, and H-bandage. All were contained in a drop-leg Mojo Medical pouch each student wore throughout the day. The training equipment was in good condition and replaced when worn or fouled as needed. For scenarios, students were issued Sig or S&W ASP red guns on paddle holsters.

A wide assortment of other training aids, moulage, limb sections, etc were available and in good repair.

Students received two manuals. The first, a 25 page student text on tactical medicine dated 04/2012. The second, a 19 page student text on critical incident stress dated 09/2011. The tac med manual was in outline form, had few illustrations, and was minimally useful as a student resource. The critical incident manual was narrative in form and unillustrated. They sat mostly unused and most students didn’t appear to have them in class after TD1.

At the conclusion of training, each student was given a new IFAK for use at their home station. That IFAK contains a flat-fold H-bandage, Hyfin chest seal two-pack, NPA w/ lube, SOFTT-W tourniquet, and protective gloves, contained in a Tactical Medical Solutions Operator IFAK black pouch.

Course Activities
At the start of class a breakdown of each day’s training and timeline was provided and then adhered to. Enabling Performance Objectives (EPOs) were outlined. Students were broken down into three groups of eight and remained in those teams throughout class. A start and end brief were held each day with appropriate reviews or pre-planning. Classroom breaks and meal periods were timely and adequate, gauged by student needs.

Safety was emphasized in course activities. Firearms were excluded from the classroom. Instructors also took care to mention that exclusion applied to BUGs or CCW guns of any type as well as obvious primary guns.

All instruction occurred either as a large group, or in smaller skill-specific skill stations students rotated through. Specific skills included medical assessment (hands-on and remote), manufactured and expedient TQ application, wound packing, pressure points, NPA insertion, shock treatment, drags and carries, and loading and treating in different types of vehicles. After initial instruction students performed progressive classroom and field drills of increasing complexity that combined skills. Drills also included blind self- and partner applications of IFAK components, malfunctioning gear, missing equipment, and uncooperative partners. At different points throughout the day(s), spontaneous TQ application drills were conducted as well.

Instruction included some use of vendor, manufacturer, and TCCC videos.

On TD2 student groups of 2-4 were tested against instructor-created field scenarios integrating teamwork and core skills. Role players in moulage added to realism. Post-scenario debriefs after each scenario, then later as a large group were conducted.

The small groups of eight previously mentioned also created scenarios for other teams to experience on TD3. This added an instructor-development element for those who will redeliver the training at their home station.

Throughout the class, students shared their own equipment, tips and tricks, and experience with the large and small groups. Several had significant experience in EMS, tactical unit, or backcountry operations.

A detailed discussion of the Oak Creek, WI Sikh temple shooting, and injuries to Lt Brian Murphy was held. This included review of previously released and unreleased video.

All course activities were consistent with TCCC guidelines, industry standards and recommendations, and the local protocols of most students. Any differences between BTMTP and TCCC were largely inconsequential for the scope of this class.

At the conclusion of the applied medical concepts, a lecture on post-incident critical stress was given.

High Points

• Large quantity of hands on activity with minimal lecture. No death by PowerPoint.
• Students were provided with everything they needed for the class. If they had arrived with only the clothes on their back, they could successfully complete all tasks assigned.
• Purposeful and progressive drills.
• Quality instructors that conducted themselves professionally.
• Quality students. No obvious clowns, malcontents, or those volun-told to attend.

Druthers
There were no student introductions. A brief period of disorganized introduction was offered when students were broken into small groups but it was inadequate. Taking time at the start for students to know more about each other would have saved time and effort through the remaining days.

Some additional foundational anatomy and physiology would have been helpful to bolster the hows, whys, and timing of managing the traumatic conditions taught in class.

The curriculum does not contain any triage or prioritization tools for multiple casualties. Faced with multiple patients, students can default to controlling bleeding, then airways, etc, but there is nothing else to help them work through accumulating tasks.

Use of a pneumonic such as MARCH or something similar would be helpful as a learning aide.

The course manual should be revised to include more comprehensive visuals for each skill area, quick-reference tables or algorithms, and narrative explanations. A less institutional product would appeal to more types of learners, and be more likely to be retained for reference. Administration might also consider producing a student CD with all classroom presentations and training videos, along with the student manuals. That is a norm in several other FLETC export programs.

An evening session using outdoor ambient, flashlights, and emergency lighting would have significant added value.

Students that plan to use their regular duty gear should bring their own inert training guns in case FLETC provided models don’t fit.

This course was...
…high quality, well-executed TCCC based training on the most life threatening but actionable traumatic injuries officers might experience while on-duty or off. This course is valuable to the student regardless of their assignment, level of experience, or prior training.

…functional as an instructor course for officers and agencies if there is no requirement for a formal certification or other credential.

This course was not…
…a comprehensive team-medic course. Team health, injury prevention, med ops planning, protocols, EMS/medical direction interaction, ground/air ambulance ops, and related topics are not discussed at all and are beyond the scope of BTMTP.

…a tactics course, but a trauma course utilizing some tactical concepts.

…an ALS course. Surgical airways, needle decompression, IVs/IOs, meds and fluids, are not taught. These are also beyond the scope of BTMTP.

With the above in mind, I confidently recommend this course to those with a need for such training.

[Gadfly]

I have spent close to a year at FLETC (off and on over 16 years).

Some days, I came out of training thinking "what a waste of a day". Many days, I walked out thinking "my God, THAT was good training".

I am glad you had the latter. There are plenty of hard working and motivated instructors up there. And there are a few who are just treading water waiting to retire.

Sounds like you had a good group.

[ST911]

I've had really good luck through a stack of FLETC classes. All were training I sought rather than compulsory, which is helpful. What few issues I've had have been combinations of 1) knowledgeable instructors that were not good teachers, 2) lagging curriculum that big gov was slow to update, 3) class clowns. Assclowns, not the funny kind. All in manageable quantities.

Have several others on my list I'll do in the next year or two, so I hope my luck holds.