All of us in this field, as a “Protector”, understand the need for training. Most of us have attended one or the other of the basic Executive Protection courses. We take classes in Driving, Surveillance Detection, as well as Firearms training. All these courses or programs require some type of follow-on training to maintain skills or to remain proficient. But what types of training you are taking is dictated by what environment you would be working in. You really don’t need to take a course about the M240 machine gun if you are working Residential Security in the United States. That may change if you are securing a compound in a more non-permissive environment. The same goes for what types of medical training you are taking and what certifications you obtain. I hope to address some of those questions here. I will focus on training that should be considered for what we will call the domestic, which would also work for overseas travel depending on where you are going, and the hostile or non-permissive environments.
Bare bones minimum everyone should at least take and maintain training dealing with CPR, use of an AED or Automated External Defibrillator, Stop the Bleed, and some Basic First Aid. Many of these courses are available to take some portions online and then test in person to show skill knowledge. You can check in your local areas with Fire Departments, Community Colleges or Community Centers about what is available to you. Once you have taken this initial training, you need to recertify regularly and maintain your proficiency. Maintaining the skill is a must.
Domestically the higher levels of certification beyond the basics are governed by the National Registry of Emergency Medical Technician or NREMT. They offer four levels of certification, Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), which replaced the old Intermediate and then Paramedic (NRP). There are other levels of certification or endorsement beyond these, but they deal more in critical care and transport, and we will not address them here. Again, these courses are offered locally through your Fire Departments or Community Colleges. There are some strictly online options for EMR and EMT, but with the needed hands-on skills required, I would not recommend an online only class.
EMR: This is usually a two week, or 40-hour class given locally and addresses immediate life-threatening care and interventions. These are such skills as CPR, AED, and Basic First Aid, as well as Stop the Bleed. EMR’s are usually first on scene awaiting additional EMS providers of higher level.
EMT: This course builds on what is learned in EMR, is usually one semester long and is the first certification level that would enable you to work on an ambulance service. Introduction to Anatomy and Physiology (A&P), as well as some underlying causes of medical disorders. EMT’s can give some basic medications such as Oxygen and assist with Nitroglycerin and Epi-Auto Injectors. Depending on State protocols, an EMT can start IV’s and insert Advanced Airways such as a Supraglottic Airways.
AEMT: This is an additional semester of education and deals with more detailed A&P as well introduction to Pathophysiology. The AEMT receives a greater understanding of medical disorders and is introduced to advanced lifesaving skills. They have a larger scope of medications, varied by State, and can attach and utilize cardiac monitors. They are yet to interpret cardiac rhythms but can intervene in cardiac issues with the monitor in AED mode. They can start IV’s and IO’s, and place Advanced Airways.
NRP: The Paramedic has a very broad scope of practice. They attend another three to four semesters of training and can operate independently under guidelines set by their State accreditation agencies. Advanced medications, cardiac medications, narcotic pain medications and Endotracheal Intubation are within the scope of a Medics abilities. Identifying medical disorders, interpreting cardiac rhythms and lifesaving interventions are all taught and applied during a Medic’s training.
All four levels of training are geared towards developing basic understanding and skills in a progressive sequence from the very basic First Aid to Invasive Life Saving Interventions. Developing knowledge and critical thinking are essential. Classroom study, lab skills and off-site clinical training are included in all levels. I am attaching a web link to the NREMT site that clearly defines each of the levels and the testing requirements, both written and hands on.
The programs and skills outlined above are established for your more Domestic care needs. The need for more Tactical training and knowledge continues to be developed and is based on lessons learned within our military. Programs that have been developed are grouped under the Tactical Combat Casualty Care (TCCC) and Tactical Emergency Casualty Care (TECC). These programs are ideal for anyone dealing with Tactical situations such as SWAT Medics or Private Military Contractors. Lately your Basic Paramedics and EMT’s are taking these courses as well, as many of the skills taught are very helpful in Trauma situations for right here at home. These programs are regulated by the Defense Health Agency (DHA) Joint Trauma System within the Department of Defense and overseen by the National Association of Emergency Medical Technicians. While a lay person could take one of these programs, they are more geared towards someone who already understands medical training and skills, such as the EMT, AEMT and NRP.
TECC: Geared toward existing EMS providers, this program deals with Hot and Cold zones for care, hemorrhage control, mass casualty, Active Shooter, treatment in threatening environments, and the MARCH assessment system. The course us usually a 16-hour program with lots of hands-on skills.
TCCC: These programs are broken down in to 7-, 16-, and 40-hour courses depending on skill level, and your assigned duties. Basic to Advanced skills in a Tactical or Hostile environment are taught.
There are also TEMS, and Tactical Medic programs offered to Paramedics that are assigned to or working with SWAT teams. These deal more with operating as part of an element and care under fire. I will also be attaching a web link guiding you to more information on TCCC and TECC programs.
In conclusion, there are all kinds of medical training out there available to you, depending on your needs and the needs of your mission or client. Do your due diligence when choosing a training program, some are great, and some are a lot of show. NREMT offers “certification”, and each State varies if you just need that certification or if you also need a State “license”. In Alabama I have both, as well as several additional endorsements. Check with what your State requires and what is required where you may be traveling. Also, each EMS provider operates under guidelines set forth by your state, a written scope of practice or protocols. We also operate under direct medical supervision or medical control of a Doctor, that either being online medical direction or a Service Medical Director. Know your local policy and laws. Just because you have been to a training class does not give you free reign to be out pushing medications.
Brian C. Selke AAS NRP PPS