Should the Commission approve amendments to Commission Regulation 1084 relating to minimum hours and minimum required topics for tactical medicine training courses?

At its July 23, 2009 meeting, the Commission approved a proposal to amend Regulation 1084 - Standardized POST Training Curriculum - that created new subsections (c) and (d) to add minimum hours and minimum topical areas for tactical medicine training courses.  The amendments became effective on May 21, 2010, following completion of the rulemaking process.

Subsection (c) enumerated 46 topics for an 80-hour Tactical Medicine Course.  Subsection (d) identified 24 topics for a 40-hour alternative Tactical Medicine Course intended for medical support personnel who have successfully completed the SWAT Basic Course, are currently licensed as an EMT and have met the LERT or Federal AWR-160 training requirements.

The amendments to Regulation 1084 were proposed in order to comply with content requirements of Section 5.5 of the POST Special Weapons and Tactics (SWAT) Operational Guidelines and Standardized Training Recommendations released in 2005 in response to Penal Code Section 13514.1.  The Guidelines directed SWAT teams “…to incorporate medical emergency contingency planning as part of a SWAT operational plan and “…where resources allow, consideration should be given to integrating Tactical Emergency Medical Support (TEMS) personnel within the structure of the SWAT team.”

A companion guideline manual, Tactical Medicine Operational Programs and Standardized Training Recommendations, was developed by POST in collaboration with the California Emergency Medical Services Authority (EMSA) and published in March 2010.  The guidelines, anchored by Regulation 1084, were designed to complement the SWAT Guidelines and provided comprehensive baseline training and implementation standards for tactical medicine programs.

The amendments to Regulation 1084 and the companion guideline manual, relied heavily on content from a tactical medicine course developed, in part, by Heckler & Koch and presented nationwide by the International School of Tactical Medicine since 1995.  The International School of Tactical Medicine, as a POST presenter, continues to deliver such high level training and has been recognized for its pioneering efforts and expert leadership in this field.

There have been significant advancements in tactical medicine and an increased urgency for law enforcement to apply tactical casualty care in the treatment and transfer of care of the injured at active violent incidents.

An esteemed SME (subject matter expert) committee (Attachment A) that included medical doctors who are also reserve peace officers, members of SWAT, EMS practitioners, fire service personnel, law enforcement and EMSA representatives, convened October 6 - 8, 2015, and recommended amendments to regulation 1084 as outlined in Attachment B.

The committee also drafted initial modifications to the Tactical Medicine Operational Programs and Standardized Training Recommendations guideline manual.  Upon approval of the proposed amendments to Regulation 1084, final modifications to the manual will be completed and presented to the Commission at a later date.

On October 29, 2015, the California TEMS (Tactical Emergency Medical Services) Advisory Committee unanimously endorsed the proposed amendments to Regulation 1084.  This committee, formed in 2013 was designed to collaborate and harmonize the efforts of State and local agencies, groups, individuals and training programs representing law enforcement, fire and emergency medical services.  POST, EMSA, CalOES and the State Fire Marshall serve as sitting State representative agencies. 

Since April 2012, 15 mass shootings have occurred in the United States, five (San Bernardino, Isla Vista, Santa Monica, Los Angeles and Oakland) in California alone.  The complexities of these active violent incidents, challenged first responders with the tasks of rapid, tactical responses to mitigate the threats, integration of law enforcement, fire and EMS and the critical importance to treat traumatic injuries in a dynamic environment.  Casualties in these tragic events included civilians, peace officers and first responders.

Thanks to advancements in tactical casualty care, many lives have been saved by heroic actions of peace officers trained in tactical medicine who treated the predominate causes of death in mass casualty incidents - external bleeding, the inability to breathe and chest trauma. POST regulations and the companion tactical medicine guidelines provided the training framework to significantly improve the tactical skill sets of responding officers.

In addition to the aforementioned advancements in medical treatment, the SME committee also considered the impact of two significant events:

1. Regulatory changes to Title 22, Division 9, Chapter 1.5 that revised the First Aid/CPR/AED training requirements and scope of practice for first responders and highlighted specific training criteria concerning tactical casualty care; and
2. Passage of AB 1598 (Rodriguez) 2014 that made several important additions or changes to statutory language found in H&S Code 1797.116, 1797.134, Government Code 8588.10, Penal Code 13514.1 and 13519.12 to better prepare public safety personnel to provide tactical casualty care and coordinate emergency medical services during terrorism events that include, active shooter incidents.

The intent of the legislation was to establish procedures to enable first responders to tactically secure the scene of an emergency and expedite lifesaving medical care to the injured.  Further, the legislation required the Director of EMSA to designate a committee to consult with POST regarding EMS integration and coordination with peace officer training.  Legislation also requires POST guidelines and training standards to address tactical casualty care and coordination with emergency medical service providers.

The amendments to Regulation 1084 were recommended to align with evolutionary changes and increased interest in emergency medicine, regulatory changes in peace officer scope of practice, legislative enactments and terminology to ensure essential awareness of SWAT operations and how first responders provide initial trauma care to the injured in a tactical environment.

An important change was to revise the titles for subsections (c) and (d) from Tactical Medicine Course to Tactical Medicine for Special Operations Course to be consistent with Penal Code 13514.1 and Section 5.5 of the existing SWAT guidelines.  Additionally, the title change will distinguish these courses from other training courses under development that focus on emergency medical training for peace officers, not within the structure of SWAT operations, such as Tactical Life-Saver, Tactical First Aid Provider & Tactical Operations.

The 80-hour course was modified to 34 topics to focus on training personnel in a combination of tactics and medical response while the 40-hour alternative course was modified to 19 topics to concentrate primarily on the medical aspects.

Key topic additions included “Special Populations Management in the Tactical Environment” to address the needs of pediatric and other special populations such as K-9.  CBRNE was condensed and blast injuries separated out.

In an effort to update certain topics to contemporary language, new titles included Medical Aspects of Chemical Agents, Pain Management, Hemorrhage Recognition and Control, Transfer of Care, Airway and Respiratory Management in the Tactical Environment and Medical Aspects of Less Lethal Weapons.

Modifications stressed the importance for student (participant) assessments (either written or performance-based) to pursue mastery of skills.

Given the comprehensive work of the highly qualified SME committee, it is proposed that the amendments to Regulation 1084 (c) and (d) – Standardized POST Training Curriculum be approved.  The text of the proposed regulatory language is included as Attachment B.

This item supports Strategic Plan Objective - B.1 - POST Regulations are relevant, comprehensive, and consistently applied.