In both the war on drugs and the current war on terrorism, CONTOMS (Counter Narcotics and Terrorism Medical Support) has been the leading training program for federal, state, and local Tactical Emergency Medical Support (TEMS) programs.¬† Created in 1989, CONTOMS has evolved its training curriculum to meet ever-changing terrorist threats.¬† Tactical emergency medical technicians (T-EMTs) of the 21st century require highly specialized skills to deliver lifesaving medical care in dangerous environments ‚Äď and CONTOMS training will provide those skills. Moreover, today‚Äôs threats involve not only conventional weapons such as firearms but also mass-casualty weapons such as¬† explosive, chemical, biological, and even radiological systems and devices. Standard emergency medical services deliver patient care in relatively safe and secure environments.¬†¬†

TEMS training is the key to providing patient care in dangerous and unstable environments. In short, the very best of today’s rare breed of protectors and first responders receive their training through the CONTOMS program. The CONTOMS program, created in 1989-90 during the height of the war on drugs, provides exceptional training for medical support personnel attached to police tactical teams. Facing extreme violence often associated with narcotics interdiction, state, local, and some federal agencies recognized the value of TEMS training as an integral component of the tactical team package. 

However, embedding emergency medical skill sets within tactical team operations requires highly specialized training. Leveraging the trauma medical skills developed under the auspices of the Department of Defense’s Casualty Care Research Center (CCRC), the CONTOMS program established a much-needed but previously missing link between military units possessing combat medical expertise and domestic law-enforcement tactical teams. The CONTOMS curriculum reflects the military’s need for medical preparedness and response capabilities required to counter the array of unconventional weapons facing The very best of today’s rare breed of protectors and first responders receive their training through the CONTOMS program U.S. and allied service personnel in the Middle East. In October 2004, the CONTOMS program was transferred from DOD to the Department of Homeland Security (DHS).  

Today, the Protective Medicine Branch of the Federal Protective Service is in charge of CONTOMS training programs. However, nearly 40 states have embraced the CONTOMS curriculum as their adopted standard certification for local TEMS programs, so the CONTOMS concepts and methods are replicated on the state level as well. NTOA Endorsement and Continuing-Education Credits Described as ‚ÄúSEAL training‚ÄĚ for T-EMTs, CONTOMS has been hailed as the premier tactical medical training program for civilians. The cornerstone of the CONTOMS courses is the EMT-Tactical program, which in 1993 received the strong endorsement of the National Tactical Officers Association (NTOA). Within one very long week (56 hours) of training, the T-EMT trainee learns and and/or strengthens his or her lifesaving skills through both room work and practical instruction.¬†¬†

The T-EMT must then demonstrate these learned skills during rigorous field exercises carried out under extreme conditions. He or she also gains a deeper understanding of the TEMS system and rationale.   The EMT-T program, it should be noted, is not a basic certification course. It builds, rather, on the individual student’s previously acquired EMT (or higher) certifications.  As a prerequisite to admission for the EMT-T program, a prospective candidate must already be certified as an EMT or higher and have the endorsement of a supervisor from his or her sponsoring department or agency. EMT-T training covers a broad range of inter-related topics, including but not limited to preventive medicine, sustained team care, patient assessment and stabilization under fire, officer rescue, medical intelligence, operations planning, special and protective equipment, airmobile medical operations, and operations in toxic hazardous environments. Successful completion earns the tactical medic 45.5 continuing-education hours through the Continuing Education Coordination Board for EMS.  

EMT-T certifications are valid for three years. With fewer than half a dozen offerings each year and sizes of about 40 students, the competition for space is fairly rigorous. Keeping the EMT-T curriculum up to date has been a major challenge for the CONTOMS faculty and board. For one thing, the TEMS knowledge base is constantly expanding.  In the late 1990s, CONTOMS released an EMT-T advanced course, a 36-hour program that covers, among other topics, specialized extraction-and-rescue methodologies, veterinary medical skills for K-9 partners, and forensic science. Numerous Specialized Courses Available Another specialized course, for medical directors, is unique to the TEMS system. The Medical Directors Course focuses primarily on issues unique to the physician’s oversight of tactical medical teams. Concepts of TEMS practice are covered from a physician’s perspective, and include the command responsibilities of a tactical medical team and current medico-legal issues. This robust program is covered in eight hours of lecture and practicum instruction. CONTOMS also provides a 16-hour program, specifically designed for medical-services providers, on topics related to chemical, biological, radiological, nuclear, and explosives (CBRNE) issues.  

This course, also delivered in a lecture-plus-practicum format, addresses the health care implications of CBRNE hazards in enough depth to meet OSHA (Office of Safety and Health Administration) regulations if they are to be in compliance with JCAHO (Joint Commission on Accreditation of Healthcare Organizations) standards. The CBRNE course certifies students to what is called OSHA Level C. The program’s Tactical First Responder course develops and enhances the lifesaving skills of law-enforcement and/or military students in a compressed 40-hour curriculum.  Students who have no prior medical training are taught basic patient assessment, preventive medicine, and medical equipment requirements and utilization; they also are certified in CPR.  Through lectures and training at practical skills stations, students learn, apply, and demonstrate their ability to carry out an array of essential first-responder procedures, with emphasis on the tactics and operations specifically applicable to dangerous and difficult operational environments. 

Over the past 18 years, CONTOMS has provided critical TEMS training to over 7,000 tactical medics from federal, state, and local agencies.  CONTOMS programs are financially self-sustained, relying on course fees to cover all program expenses.  Course fees remain quite reasonable.  For example, the last EMT-Tactical course (conducted in September 2006) charged a fee of $600 per student. This relatively low cost for such a rich course of instruction represents a real value of exceptional, state-of-the-art TEMS training. Empirical Evidence and Epidemiological Research Preventive medical monitoring, intervention, and care are the hallmark attributes of the TEMS program.  CONTOMS training stresses the role of the tactical medic in caring for the team’s well-being even between operations and during sustained deployments.  In one major operation involving local and federal emergency-services personnel, CONTOMS-trained medics proved indispensable in an unexpected way.  

During a protracted interagency operation involving a high-risk terrorist trial, an alarming number of officers and agents were afflicted with flu-like symptoms. The number of people reporting themselves sick was disproportionately high compared to the size of their departments.   To determine the cause of whatever illness they were suffering from, CONTOMS-trained medics monitored their symptoms, provided on-site patient assessments, recommended appropriate personal and clinical care, and conducted some essential epidemiological research. Eventually, the tactical medical team briefings, combined with the continuing care that was provided, allayed the concerns of interagency team-members, particularly when the CONTOMS team was able to report that the cause of the illness was Rota virus, a highly contagious disease producing a rapid onset of symptoms, including debilitating diarrhea, vomiting, and corresponding dehydration. 

The interagency team members had expressed concern that there might have been some relationship between the assignment and these illnesses. CONTOMS medics provided assessment briefings to command staff and carried out frequent monitoring of each team member; that combination not only restored confidence but also sustained operational effectiveness. Preventive medical skills also honed and perfected through CONTOMS training have proven equally indispensable to team members and commanders by addressing the effects of exposure to the elements and fatigue before those effects could have an impact on team safety. To summarize: The CONTOMS program leads the way in providing and promoting TEMS training. Living up to the program‚Äôs motto, Medicina Bona, Locus Malis ‚Äď i.e., ‚Äúgood medicine in bad places‚ÄĚ ‚Äď CONTOMS-trained tactical medics already have saved countless lives under the most difficult operating conditions.¬†

The program’s curriculum is frequently updated through the incorporation of leading-edge procedures and techniques. Thanks to the program’s widespread networking within the Department of Defense, as well as with TEMS-trained physicians and medics at the local, state, and federal levels, the CONTOMS faculty members represent a repository of tactical medical knowledge that is unsurpassed in any other program of its type. What is particularly helpful is that CONTOMS faculty members are tactical medical operators in their own right. They not only teach their own specialized subjects but also are frequently working in the field with their former students, now tactical medics applying the techniques embodied in the CONTOMS programs.  For more information about the CONTOMS program courses, see http://www.casualtycareresearchcenter.org/education_section_homepage.htm

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Joseph Steger

Joseph Steger is the pseudonym of a senior law-enforcement commander whose undergraduate background in a pre-medical program led to initial certification as an EMT in 1981. He retained that level of certification for eight years and across three states while serving as a federal law-enforcement officer. Over the years, Steger has worked closely with CONTOMS-trained tactical medics and physicians in numerous situations.

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