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O perational P rograms
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S tandardized T raining R ecommendations
C a l i f o r n i a P O S T — i n c o l l a b o r at i o n w i t h —
Emergency Medical Ser vices Authority
Intentionally Blank
2
TACTICAL
California POST
MEDICINE
O perational P rograms
and
S tandardized
T raining R ecommendations
produced in
c o l l a b o r at i o n w i t h
Emergency Medical Services Authority
POST2009EXE- 0390
Copyright
n ��������������������������������������������Tactical Medicine
Operational Programs and Standardized Training Recommendations
Copyright 2009
California Commission on Peace Officer Standards and Training (POST)
All rights reserved. This publication may not be reproduced, in whole or in part,
in any form or by any means electronic or mechanical or by any information
storage and retrieval system now known or hereafter invented, without prior
written permission of the California Commission on Peace Officer Standards and
Training (POST), with the following exception:
California law enforcement agencies in the POST peace officer program and POST-
certified training presenters are hereby given permission by POST to reproduce any
or all of the contents of this manual for internal use within their agency/school.
All other individuals, private businesses and corporations, public and private
agencies and colleges, professional associations, and non-POST law enforcement
agencies in-state or out-of-state, may print or download this publication for non-
commercial use.
Infringement of the copyright protection law and the provisions expressed here
and on the POST website under Copyright/Trademark Protection will be pursued
in a court of law. Questions about this copyright information or about obtaining
permission to use POST-developed publications may be addressed to:
POST2009EXE-0390
tactical medicine
Operational Programs and Standardized Training Recommendations
The Mission
n �������������������������������������������of the California Commission On Peace Officer Standards and Training
(POST) is to continually enhance the professionalism of California Law
Enforcement in serving its communities.
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Operational Programs and Standardized Training Recommendations
Commissioners
n �������������������������������������������� Michael Sobek Sergeant
Chair San Leandro Police Department
Robert T. Doyle Sheriff
Vice-Chair Marin County Sheriff’s Department
Anthony W. Batts Chief
Long Beach Police Department
Lai Lai Bui Sergeant
Sacramento Police Department
Collene Campbell Public Member
Bonnie Dumanis District Attorney
San Diego County
Floyd Hayhurst Deputy Sheriff
Los Angeles County Sheriff’s Department
Deborah Linden Chief
San Luis Obispo Police Department
Ronald Lowenberg Director
Golden West Criminal Justice Training Center
Jeffrey Lundgren Deputy Sheriff
Riverside County Sheriff’s Department
Henry T. Perea Councilman
City of Fresno
Laurie Smith Sheriff
Santa Clara County Sheriff’s Department
Gil Van Attenhoven Senior Special Agent
Department of Justice
George Anderson Director (representing the Attorney General)
Division of Law Enforcment, Department of Justice
Jerry Brown Attorney General, Ex Officio Member
Department of Justice
Paul A. Cappitelli Executive Director, POST
iv
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Operational Programs and Standardized Training Recommendations
Acknowledgments
n ������������������������������������������� This guideline manual for Tactical Medicine Operational Programs and
Standardized Training Recommendations could not have been developed
without the combined efforts of a number of dedicated individuals and interested
parties.
POST and the Emergency Medical Services Authority (EMSA) would like to
extend its gratitude to the law enforcement and emergency medical service
professionals who gave of their time and expertise to contribute to the success of
this project.
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Operational Programs and Standardized Training Recommendations
Foreword
n ����������������������������������������������The tactical incident response environment presents unique challenges to law
enforcement personnel and for the personnel providing emergency medical care and
support services in that environment. Tactical medical care providers must have a
clear understanding of and consideration for law enforcement response and tactics
and the mission-specific objectives of a tactical operation when planning for and
providing medical support. The primary goal of tactical medicine is to support and
assist a tactical team in accomplishing its mission during a deployment or response
to a critical incident.
Penal Code Section 13514.1 directs the Commission to develop and disseminate
guidelines and standardized training recommendations for law enforcement officers,
supervisors, and administrators, who are assigned to perform, supervise, or manage
Special Weapons and Tactics (SWAT). Those guidelines were released in 2005.
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Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SECTIONS
1.0 Definition of Tactical Medicine . . . . . . . . . . . . . . . . . . . . . . 3
2.0 Tactical Medicine Operational Programs . . . . . . . . . . . . . . . . . 5
3.0 Tactical Medical Planning and Threat Assessment . . . . . . . . . . . 11
4.0 Tactical Medicine Operational Equipment Recommendations . . . . . . 13
5.0 Tactical Medicine Training Programs . . . . . . . . . . . . . . . . . . 17
6.0 Tactical Medicine Required Course Content Description . . . . . . . . 27
7.0 Tactical Medicine Clinical Core Competencies – Psychomotor . . . . . 51
8.0 Tactical Medicine Scenarios . . . . . . . . . . . . . . . . . . . . . . . 55
9.0 Tactical Medicine Final Competency Testing . . . . . . . . . . . . . . 59
10.0 Tactical Casualty Care Assessment and Treatment Model . . . . . . . . 61
APPENDICES
A Authorized Scope of Practice for EMS Personnel Reference . . . . . . . 67
B EMS Legal Authorities for EMS Personnel Reference . . . . . . . . . . 71
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Operational Programs and Standardized Training Recommendations
Introduction
n ������������������������������������������� This guide is designed to provide baseline development and implementation standards
for Tactical Medicine programs developed as required by POST and described in the
SWAT Guidelines approved in 2005. The California Emergency Medical Services
Authority (EMSA) is responsible for setting the statewide medical standards utilized
by POST. As such, this guide is intended to serve as a template for operational
programs that are developed by any public safety agency in California, and to serve
as the minimum standard for initial tactical medicine training. The POST SWAT
Operational Guidelines and Standardized Training Recommendations (2005)
identified the need for tactical medicine as an integral part of the law enforcement
tactical team. Under Chapter 5, Planning, the guidelines state:
n ������������������������������������������� This guide is also meant to serve as a companion document to the POST SWAT
Operational Guidelines and Standardized Training Recommendations (2005).
It describes the critical role that tactical medical planning and threat assessment
plays in the overall contingency planning as part of the SWAT operational plan.
n ������������������������������������������� The public safety agency developing a tactical medicine operational program
should conduct a needs assessment to determine the level of emergency
care required by the SWAT team to support the mission and operations. The
operational program should address medical oversight and coordination with the
local EMS agency, medical direction, use of Emergency Medical Technicians
(EMTs), paramedics and other advanced life support personnel, and minimum
training and equipment standards.
n ������������������������������������������� The agency should develop policies and procedures for medical support during
tactical operations. The assignment and/or deployment of any emergency medical
support personnel during a tactical response shall be at the sole discretion of the
agency or department in accordance with established policies and operational
procedures.
n ������������������������������������������� Legal authority and proper training to carry a firearm is a prerequisite to arming
emergency medical support personnel. Armed medical support personnel must
have statutory authority to carry a firearm and should be trained and tested to the
standard for law enforcement personnel.
n ������������������������������������������� Approved tactical medicine training programs, which provide initial and refresher
or update tactical medicine training to personnel, shall adhere to the training
guidelines and standards outlined in this document. The goal of this guidelines
manual is to describe minimum core competencies and define the written and
skills testing necessary to achieve the standards prescribed by POST and EMSA.
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Operational Programs and Standardized Training Recommendations
1) Medical Oversight
2) Medical Contingency Planning
3) Operational Support/Tactical Emergency Support (TEMS)
4) Quality Improvement
5) Team Health Management
6) Training and Education
7) Medical Equipment Acquisition and Maintenance
1
Medical
Oversight
7 2
Medical Equipment Medical
Acquisition & Contingency
Maintenance Planning
Tactical
6 Medicine 3
Training Operational
& Education Support / TEMS
5 4
Team Health Quality
Management Improvement
1.2 ��������������������������������������� Tactical Medicine operational programs should be developed to ensure that all
components are developed to a level that allows for full integration within the
SWAT operational program.
1.3 ��������������������������������������� Identification of personnel to lead, manage, and coordinate a tactical medicine
operational program are required. Additionally, trained Tactical Emergency
Medical Support (TEMS) personnel to provide operational support are necessary.
Overall, strong medical leadership should be incorporated within the operational
program.
1.4 ��������������������������������������� Operational tactical medical support programs also provide a necessary and
significant linkage between law enforcement personnel and EMS services during
dangerous or sustained operations.
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Operational Programs and Standardized Training Recommendations
Tactical Medicine
2.0 Operational Programs
POST and EMSA recommendations specific to operational programs for tactical
medicine are outlined below.
(3) Maintain a minimum equipment and supply list, a drug and solution
inventory, and the equipment and supplies commensurate with the authorized
scope of practice of the tactical emergency medical personnel.
(4) Must comply with all applicable Federal and State regulations and local
medical policies and procedures.
(d) No law enforcement agency shall advertise itself as providing tactical medicine
services unless it does, in fact, routinely provide these services as part of a tactical
medicine operational program that meets the minimum requirements of these
guidelines.
(f) Tactical Medicine programs and their medical personnel shall be integrated
into the local EMS system, in coordination with the local Emergency Medical Services
(EMS) Agency.
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Operational Programs and Standardized Training Recommendations
At a minimum, all personnel who are tactical medical providers should have
certification at the basic life support level. Optimally, tactical medical programs
should utilize personnel licensed or certified at the advanced life support level.
This may include any combination of physicians, mid-level providers, registered
nurses, paramedics, and Advanced EMT/EMT-IIs operating under their authorized
scope of practice. See Appendix A for scope of practice. All personnel must have
tactical medical training, as defined within the POST and EMSA guidelines.
(h) Agencies should develop policies regarding the use of firearms by tactical
medical personnel. It is a desirable goal to enable each tactical and medical officer
to safely function as a team member. It is recognized that liability concerns are a
challenging issue, and each department should evaluate their needs individually.
2.2.1 ������������������Medical Oversight. Medical oversight refers to advice and direction provided
by the program director and/or the Medical Director to trained tactical medical
personnel who provide medical care in all aspects of tactical operations.
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Operational Programs and Standardized Training Recommendations
Tactical Medicine recurrent Core Competencies fall within three general categories:
n Maintaining skill proficiencies and professional licensures/certifications
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Operational Programs and Standardized Training Recommendations
resources, and coordination at all levels with the overall operational mission and
response plan.
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Operational Programs and Standardized Training Recommendations
The lists on the following pages identify the applicable items for each type of
tactical emergency teams.
1 Medical Bag
1 Chest Seal
1 Medical Bag
2 AED Patches
2 Chest Seal
continues
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Operational Programs and Standardized Training Recommendations
1 Shears (trauma)
1 Suction (hand-held)
6 Triage Tags
1 ETT Restraint
continues
2 IV Constriction Band
1 Laryngoscope Kit
1 Glucagon (1 mg/unit)
1 Naloxone (2 mg)
1 Ondansetron (4 mg)
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Operational Programs and Standardized Training Recommendations
(b) Tactical medicine training may be offered only by training programs that are
pre-approved and certified by POST and Cal EMSA. Eligibility for program approval
shall be limited to:
(2) Medical training units of a branch of the Armed Forces, including the Coast
Guard of the United States,
(5) Private training programs, when affiliated with a law enforcement or public
safety agency,
(b) POST shall review and approve the following prior to approving a tactical
medicine training course:
(2) Samples of any written and skills examinations used for periodic testing,
(6) The name and qualifications of the program director, program clinical
coordinator, tactical coordinator, and principal instructor(s),
(10) The location at which the courses are to be offered and their proposed
dates,
(11) Table of contents listing the required information listed in this subsection,
with corresponding page numbers,
(c) In addition to those items listed in subdivision (b) of this section, POST and the
EMS Authority shall assure that a training course meets the following criteria in order
to approve that agency as qualified to conduct a tactical medicine training program:
(A) POST and EMSA shall ensure that a training program designates a liaison
to local EMS agency for the county in which the training is conducted; and
(B) Consult with the local EMS agency for the county in which the training is
located if the program is developing an EMS system orientation portion of the
tactical medicine course.
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Operational Programs and Standardized Training Recommendations
(C) Course contains all topical areas as required in POST regulations and
procedures.
(2) The request contains or does not contain the information required in
Section 5.2 of this Chapter and POST Regulations 1005(f) and 1084,
(c) POST shall establish the effective date of course approval in writing upon
the satisfactory documentation of compliance with all program requirements. No
retroactive certifications will be approved.
(d) Course approval shall be for one (1) year following the effective date of program
approval and may be renewed annually subject to the procedures for program
approval specified in this section.
(a) Each tactical medicine training course shall have a program director
who shall be qualified by education and experience in methods, materials, and
evaluation of instruction.
(b) Duties of the course director, in coordination with the course clinical
coordinator and tactical coordinator, shall include but not be limited to:
(2) Developing course content pursuant to POST and EMSA regulations and
procedures.
(3) Developing all written examinations and the final skills examination.
(4) Coordinating all clinical and field activities related to the course.
(7) Assuring that all aspects of the tactical medicine training program are in
compliance with these guidelines and other related laws.
(c) Each training course shall have an approved program clinical coordinator who
shall be either a physician, registered nurse, physician assistant, or a paramedic
currently licensed in California, and who should have two (2) years of academic or
clinical experience in emergency medicine or prehospital care in the last five (5) years.
Duties of the program clinical coordinator shall include, but not be limited to:
(1) Responsibility for the overall quality of medical content of the course;
(d) Each training course shall have an approved tactical coordinator who shall have
experience and education in law enforcement special operations, and who should have
two (2) years of academic or law enforcement experience in the last five (5) years.
Duties of the course tactical coordinator shall include, but not be limited to:
(1) Responsibility for the overall quality of tactical content of the course;
(e) Each training course shall have a principal instructor(s), who may also be the
program clinical coordinator, program tactical coordinator, or program director, who
shall be qualified by education and experience in methods, materials, and evaluation
of instruction in medical or tactical topics.
(f) Each training course may have teaching assistant(s) who shall be qualified by
training and experience to assist with teaching of the course and shall be approved by
the program director in coordination with the program clinical coordinator or tactical
coordinator as qualified to assist in teaching the topics to which the assistant is to be
assigned.
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Operational Programs and Standardized Training Recommendations
(b) All course presentations shall be subject to periodic on-site evaluation by POST
and the EMS Authority.
(c) Any person or agency conducting a tactical medicine training course shall
notify POST, in advance when possible, and in all cases within thirty (30) days of, any
proposed changes in course content, hours of instruction, program director, program
clinical coordinator, tactical coordinator, and instructors. No presenter is authorized
to modify or revise any part of the course without prior written approval by POST and
EMSA. This request shall be submitted electronically through the POST EDI system.
(2) The training course, including psychomotor skills and tactical medical
scenario experience;
(b) POST may approve a training program that offers only refresher or update
course(s) through the POST Course Certification process.
(b) As an alternative to the full initial course, an alternative initial tactical medical
course, consisting of no less than forty (40) hours, may be approved and certified by
POST and EMSA, when that course admits only students that are all pre-qualified, and
have all of the following prerequisites:
(3) Completed required WMD training, including medical care for WMD, and
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Operational Programs and Standardized Training Recommendations
ADMINISTRATIVE
1 Course Administration and Safety 1 1
MEDICAL
2 Introduction to Tactical Medicine 2 2
13 Pain Management 1 1
22 CBRNE Environments 1 *
80-Hour 40-Hour
Course Course
Module Course Topic (Full) (Alternate)
TACTICAL
30 Tactical Equipment 1 *
a) Tactical Pistol –
COMPETENCY TESTING
40 Tactical Medical Scenarios 3 *
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Operational Programs and Standardized Training Recommendations
(3) Type of tactical medicine course completed (i.e., Initial or refresher), and
the number of hours completed.
(6) The name and location of the training program issuing the record.
(c) This course completion record is valid to apply for certification for a
maximum of two years from the course completion date and shall be recognized
statewide.
(d) The name and address of each person receiving a course completion
record and the date of course completion shall be reported in writing to POST
within fifteen days of course completion using the POST Course Roster Form
2-111 as required by Regulation 1022.
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Operational Programs and Standardized Training Recommendations
6.2 ��������������������������������������� The topics identified in Section 6 have been approved by the Department of
Homeland Security (DHS), and the course is POST-certified and approved by the
Emergency Medical Services Authority (EMSA).
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Operational Programs and Standardized Training Recommendations
Continues
30
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Operational Programs and Standardized Training Recommendations
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Operational Programs and Standardized Training Recommendations
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Operational Programs and Standardized Training Recommendations
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Operational Programs and Standardized Training Recommendations
n Communication equipment
n Illumination tools
n Entry tools
n Breaching equipment
n Personal gear
n Breaching hazards
n Target analysis
n Documentation and liability
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Operational Programs and Standardized Training Recommendations
n Trigger control
n Front sight
n Safety / Selector
n Shooting positions
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tactical medicine
Operational Programs and Standardized Training Recommendations
n Single suspect
n Multiple suspects
n Conflict resolution
n Medical components
• Airway management
• Treatment of hemorrhage
• Chest trauma
• Nerve agent exposure
• Clandestine lab exposure
• Extremity/facial/neck injuries and penetrating wounds
• Blast injuries
• Gunshot wounds
• Mass casualty incident (MCI) response/treatment
• Extraction techniques
Continues
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Operational Programs and Standardized Training Recommendations
5. Hemorrhage Control*
n Direct pressure
n Inflow compression
n Tourniquet application and use
n Hemostatic agent application
6. Wound Management
n Trauma dressing application
n Lacerations
n Ocular injuries
n Open chest wounds
n Burns / Blast injuries
* If applicable within Authorized Scope of Practice based upon current license or certification.
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Operational Programs and Standardized Training Recommendations
* If applicable within Authorized Scope of Practice based upon current license or certification.
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Operational Programs and Standardized Training Recommendations
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Operational Programs and Standardized Training Recommendations
Tactical Casualty Care Assessment and Treatment Model – Conditions and Components
Tactical Scenario Components
Warrant Barricaded Hostage Active
Tactical Scenario Medical Conditions Service Subject Rescue Shooter
External bleeding
MCI / Triage
Chemical / Gas
Heat casualties
Extremity fractures
Explosion injury
Burns
Difficulty breathing
Chest pain
Shock
Pediatric trauma
Ocular injury
Anaphylactic shock
Snake bite
Special problems
STUDENT: Date:
TACTICAL Medical
INSTRUCTOR: Instructor:
n Tactical Components
– High risk warrant service
– Barricaded subject(s)
– Hostage rescue
– Active shooter(s)
n Medical Components
– Airway management
– Bleeding/hemorrhage control
– Chest trauma
– Nerve agent exposure
– Clandestine lab chemical exposure
– Extremity/facial/neck injuries and penetrating wounds
– Blast injuries
– Gunshot wounds
– Mass casualty incident (MCI) response/treatment
– Extraction techniques
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Operational Programs and Standardized Training Recommendations
The current law enforcement Tactical Casualty Care Assessment and Treatment
Model is based upon the military Tactical Combat Casualty Care (TCCC)
Committee recommendations and modified for civilian application. Periodic
updates to this model based upon current medical practice should be expected
and utilized. The table on the following page contains current TCCC information
as of February 2009.
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Operational Programs and Standardized Training Recommendations
Tactical Casualty Care Assessment and Treatment Model - PHASES I, II, AND III
PHASE I – Basic Management Plan for Care, Situational Awareness, and Scene Safety
3. Direct patient to move to cover and apply self-aid if able and try to keep the patient from sustaining
additional wounds.
4. Airway management is generally best deferred until the Tactical Field Care phase.
7. Extract patient from unsafe area (to include using a soft litter as needed).
► Call for tactical evacuation (ground or air ambulance).
PHASE II – Basic Management Plan for Assessment, Evaluation, and Tactical Field Care
2. Airway management
a. Unconscious patient without airway obstruction:
• Chin lift or jaw thrust maneuver.
• Nasopharyngeal airway.
• Place patient in recovery position.
b. Patient with airway obstruction or impending airway obstruction:
• Chin lift or jaw thrust maneuver.
• Nasopharyngeal airway.
• Place unconscious patient in recovery position.
• If previous measures are unsuccessful:
– King tube or combitube.
– Endotracheal nasotracheal intubation or blind nasotracheal intubation
– Cricothyroidotomy (needle or surgical)
continues
PHASE II – Basic Management Plan for Assessment, Evacuation, and Tactical Field Care continued
3. Breathing
a. Consider tension pneumothorax and decompress with needle thoracostomy if patient has torso
trauma and respiratory distress.
b. Sucking chest wounds should be treated by applying a chest seal or three-sided occlusive
dressing during expiration, then monitoring for development of a tension pneumothora.
4. Bleeding
a. Assess for unrecognized hemorrhage and control all sources of bleeding.
b. Assess for discontinuation of tourniquets once hemorrhage is definitively controlled by other
means. Before releasing any tourniquet on a patient who has been resuscitated for hemorrhagic
shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in
character and normal mentation if there is no traumatic brain injury (TBI).
6. Fluid resuscitation
a. Assess for hemorrhagic shock; altered mental status in the absence of head injury and weak or
absent peripheral pulses are the best field indicators of shock.
• If NOT in shock:
– No IV fluids necessary
– PO fluids permissible if conscious and can swallow
• If in shock:
– Normal saline (500-mL IV bolus)
– Repeat once after 15 minutes if still in shock
– Titrate to systolic BP of 90–100
• If in shock:
– Elevate lower extremities
• If a patient with traumatic brain injury (TBI) is unconscious and has no peripheral pulse,
resuscitate to restore the radial pulse.
7. Prevention of hypothermia
a. Minimize patient’s exposure to the elements. Keep protective gear on if feasible.
b. Replace wet clothing with dry if possible.
c. Apply Ready-Heat Blanket to torso.
d. Wrap in Blizzard Rescue Blanket.
e. Put Thermo-Lite Hypothermia Prevention System Cap on the patient’s head, under the helmet.
f. If above gear is not available, use dry blankets, poncho liners, sleeping bags, body bags, or
anything that will retain heat and keep the patient dry.
8. Monitoring
► Consider Pulse oximetry if available as an adjunct to clinical monitoring.
continues
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Operational Programs and Standardized Training Recommendations
PHASE II – Basic Management Plan for Assessment, Evacuation, and Tactical Field Care continued
9. SECONDARY EXAM
a. Check for additional wounds or conditions.
b. Inspect and dress known wounds.
16. Documentation
a. Document clinical assessments, treatments rendered, and changes in the patient’s status.
b. Forward this information with the patient to the next level of care.
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(1) Evaluate the ill and injured. Perform all EMT-I skills, plus: All EMT-I and IIs skills and
medications, plus:
(2) Render basic life support, (1) Perform pulmonary ventilation
rescue, and emergency medical by use of the esophageal airway. (1) Laryngoscope.
care to patients.
(2) Institute intravenous (IV) (2) Endotracheal (ET) intubation
(3) Obtain diagnostic signs to catheters, needle or other (adults, oral).
include, but not be limited to, cannulae (IV lines), in peripheral
(3) Glucose measuring.
the assessment of temperature, veins.
blood pressure, pulse and (4) Valsalva’s Maneuver.
(3) Administer intravenous glucose
respiration rates, level of (5) Needle thoracostomy.
solutions or isotonic balanced
consciousness, and pupil status.
salt solutions, including Ringer’s (6) Cricothyroidotomy
(4) Perform CPR, including the lactate solution.
use of mechanical adjuncts to (7) Nasogastric intubation (adult).
(4) Obtain venous blood samples
basic CPR. (8) Use glucose measuring device.
for laboratory analysis
(5) Use the following adjunctive (9) Utilize Valsalva maneuver.
(5) Apply and use pneumatic
airway breathing aids:
antishock trousers (10) Monitor thoracostomy tubes.
(A) oropharyngeal airway;
(6) Administer, using prepackaged (11) Monitor and adjust IV solutions
(B) nasopharyngeal airway; products where available, the containing potassium, equal to
following drugs: or less than 20 mEq/L.
(C) suction devices;
(A) sublingual nitroglycerine (12) Administer approved medica-
(D) basic oxygen delivery
preparations; tions by the following routes:
devices; and
(B) syrup of ipecac; intravenous, intramuscular,
(E) manual and mechanical subcutaneous, inhalation,
ventilating devices designed (C) lidocaine hydrochloride; transcutaneous, rectal, sublin-
for prehospital use. gual, endotracheal, oral, or
(D) atropine sulfate;
(6) Use various types of stretchers topical.
(E) sodium bicarbonate;
and body immobilization (13) Administer, using prepackaged
devices. (F) naloxone;
products when available, the
(7) Provide initial prehospital (G) furosemide; following medications:
emergency care of trauma. (H) epinephrine; and 1. 25% and 50% dextrose;
(8) Administer oral glucose or sugar 2. activated charcoal;
(I) 50% dextrose.
solution. 3. adenosine;
(7) Defibrillate a patient in 4. aerosolized or nebulized
(9) Extricate entrapped persons. ventricular fibrillation. beta-2 specific
(10) Perform field triage. (8) Cardiovert an unconscious bronchodilators;
patient in ventricular tachycardia. 5. aspirin;
Continues
Manual Defibrillation, under direct Endotracheal (ET) intubation Local EMS agencies may add
supervision of a paramedic. additional skills and medications if
Laryngoscope
approved by the EMS Authority.
Esophageal-tracheal airway device
Use glucose measuring device.
(combitube)
Gastric suction
Bronchodilators
Additional medications
Epi-pen
Establish IV access under direct
supervision of a paramedic.
Naloxone
Mark 1 Kit
Glucagon
Aspirin
Activated Charcoal
60
Appendix A. Authorized Scope of Practice for EMS Personnel Reference
u Public safety first aid and CPR trained individuals do not have a defined
scope of practice in regulations. Because there is such a wide range of training
available to public safety personnel, from a 15-hour first aid and CPR course
up to a 60-hour first responder course, public safety personnel who do not have
at least an EMT-I certification are limited to basic first aid or a scope of practice
approved by a LEMSA medical director which is dependent on the level of
training.
61
Intentionally Blank
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Operational Programs and Standardized Training Recommendations
First Aid and CPR Training Standards for Public Safety Personnel
EMT-I
EMT-II
Continues
EMT-II continued
Paramedic