Major violent incidents can sometimes result in litigation involving millions of dollars. Law-enforcement agencies can no longer view tactical medical personnel as an expensive luxury, but as an essential and vital component of their department and the tactical team.

To prepare for future high risk incidents, adequate and appropriate training for these SWAT medical support teams has become paramount to ensure a reduction in morbidity and mortality associated with critical incidents and training. Once trained, the tactical medic can provide a solid risk benefit assessment to the tactical commander and function safely in the tactical environment while caring for victims.

The Advanced Tactics and Medicine (ATM) Course, Module B is part two of the 2 week, 80 hour training program. This segment of the course was specifically designed to provide tactical medical personnel from military and law-enforcement agencies with additional training and skills in both tactics and advanced medical care. The advanced course is built upon the fundamentals which are taught in the Basic Tactics and Medicine (BTM) course, Module A.

Students are not permitted to take the Advanced Tactics and Medicine Course (ATM), Module B unless they have successfully completed the Basic Tactical and Medicine Course (BTM), Module A.

Other tactical medicine courses, including CONTOMS, are not recognized as a valid substitute for Module A. To create more realistic scenarios, Simunitions and Airsoft are used extensively during the week in simulated tactical situations.

Day 1 Monday 0800 After opening remarks and introduction of the staff and students the morning of Day 1 the didactic material begins with an in depth presentation on Pediatric Trauma Management in the Tactical Environment. Tactical operations sometimes involve barricade situations that stem from domestic violence and children are often involved. It is incumbent upon the tactical medical to recognize and effectively manage pediatric injuries in the tactical environment. The remainder of the morning is devoted to Trauma Anesthesia and the many options for providing appropriate and adequate pain control in the operational and tactical setting. After a break day one resumes in the classroom for additional didactic material addressing Medical Management of Blast Injuries as well as the types of injuries that may occur for those tactical teams utilizing explosive entry techniques. There is a brief Review of Building Clearing Techniques and safety procedures to ensure all students are up to speed with entry tactics in preparation for the afternoon session of Tactical Medical Scenarios. Each scenario consists of a tactical and medical problem in which each team will need to establish a tactical plan, address the medical problems encountered and carry out and solve all tactical and medical issues. Students rotate between tactical and medical positions on their teams to enhance their learning and training experience.

Day 2 The morning on Day 2 is at the range with Advanced Tactical Pistol and MP5 Submachine Gun instruction. Students practice shooting on the move, barricade shooting and engaging multiple targets. Students are expected to demonstrate gun handling and proficiency as well as marksmanship skills. There is a high expectation by the range instructors for surgical precision shooting by all students. Nothing but your best will be accepted here. After a lunch break, the afternoon didactic material begins with an introduction to Bio-Terrorism with Biological Weapons Part I and Biological Weapons Part II. Students will learn how to clinically recognize the signs and symptoms of the more common potential biological agents and will learn and become comfortable with the current treatment modalities. This block of instructional material is focused on precisely what a tactical medical officer needs to know to care for members of the tactical team should they become involved in a criminal act act of bio-terrorism. Students are also given classroom instruction on felony high risk car stops and the techniques involved in extraction of hostages. Students practice these techniques later at the range while assaulting and shooting into vehicles containing targets in order to evaluate their shooting skills

Day 3 The program resumes with Tactical Deployment of Less Lethal Weapons. Students learn the capabilities, limitations and the injury patterns associated with their use. Advanced Airway Management is next with didactic material in the classroom followed by a three hour Airway Management Workshop. Having the skills to establish an airway under austere conditions is paramount. Students receive in depth hands on training in the skills needed for advanced airway management skills and techniques in the tactical environment. Students have the opportunity to rotate skills stations and practice surgical airway techniques using swine tracheas and become familiar with other options including retrograde intubation, fiber optic, ViewMax and orotracheal intubation techniques. The Combitube, Lighted Stylet, Laryngeal Mask Airway (LMA), King and Intubating LMA are also demonstrated and practiced. The program resumes in the afternoon on Day 3 to allow time for nightfall with preparations for low light and night operations later in the evening. As nightfall begins the students suit up for the Low Light Tactics and Team Movement training. For the next four hours students participate in multiple Tactical Medical Scenarios under low light and conditions of darkness. Many tactical operations occur at night and the tactical medical provider must develop the skills to provide medical assessment and care under darkness and low light stressful conditions. Day 4 The entire morning of Day 4 consists of Advanced MP5 Submachine Gun Tactical field exercises. Here students gain more experience using the Tactical Pistol and the MP5 Submachine Gun through extensive field exercises. Explosive Entry Techniques are demonstrated at the range. Here students learn the techniques of impulse charges, strip charges as well as oval and hinge charges used in explosive breaching. Police tactical teams are likely to be one of the first law-enforcement units responding to a Weapons of Mass Destruction (WMD) event. The afternoon of day 4 begins with classroom material addressing weapons of mass destruction specifically Chemical Weapons and Nerve Agents as well as Nuclear & Radiation Injuries. The Advanced Tactics and Medicine (ATM), Module B Course does not focus on mass casualty management but instead addresses those important WMD issues specific to law enforcement tactical operations. Special operations teams are sometimes deployed in remote areas and the teams are at risk for Environmental Injuries. The remainder of the afternoon is devoted to the many issues surrounding Environmental Injuries in the tactical environment and how to avoid, prevent, and effectively treat these types of injuries. Upon completion of the day's activities, the ISTM faculty treat the students to the traditional second week class dinner in the evening at a local restaurant.

Day 5 On the morning of day five and before getting suited up for the final day of Tactical Medical Scenarios students must take a one hour multiple choice written examination. The examination fulfills requirements for the State of California EMSA, POST, and ACEP continuing medical education (CME) and self-assessment. The Tactical Medical Scenarios each last approximately 30 minutes. Simunitions and Airsoft are also utilized during some of the training scenarios to enhance the force on force learning experience. Upon completion of the tactical exercises the students return to the classroom for equipment return, debriefing, graduation and closing remarks. Each school session historically fills about 90 days before class dates. Interested agencies and individuals are urged to contact the International School of Tactical Medicine administrative office early to secure a seat in a class at (760)325-2591 or email info@tacticalmedicine.com.