An Cosantóir

of Israeli field dressings, needle chest decompression, and we were given introductions on how to do IV cannulation and suturing open wounds. Once we had grasped the basic skills, we were introduced to our tactical instructors for the week, four gentlemen from the USA with military and SWAT backgrounds, who represented Medic Up Inc, a company that specialises in teaching tactical medical training. From that point onwards, the tempo of the course changed. "Good medicine is bad tactics," was the first lesson they taught us. From that point on, the rules had changed. Tourniquets went from last resort to first response for traumatic limb haemorrhage. We were then introduced to the SALT (supraglottic airway laryngopharyngeal tube), a simple, albeit blunt looking, airway opening device that facilitates blind endotracheal intubation. The transition from clinical to tactical was beginning to come together. The second day saw us in Wicklow, where we began with morning PT. After a good session of burpees, press-ups, sit-ups and flutter kicks, we were ready to start the day. However, PT featured regularly throughout the course, as increasing the heart rate during training allows a student to experience the loss of fine motor skills required during first aid, which in turn demonstrates the requirement for controlled breathing in stressful situations We were taught how to secure weapons, basic 'greenfield' tactics, casualty assessments, counter-mine and counter-IED training. Later that evening we were brought to a school where we began our 'active shooter' training, which is based on a scenario similar to the mass-shootings at Columbine high-school, Utoya Island, and the more recent Aurora cinema shooting. Here we began to learn room clearance drills, working in small teams, and clearing classrooms and corridors under the direction of our SWAT instructors. The next two days had us in Tallaght in a three-storey tactical training facility where we began to hone our room clearance and CQB drills, along with the introduction of variables such as friendly and enemy casualties, prisoners, panicked civilians, hostages and active shooters. While this was going on, separate stalls were set up to run us through sensory deprivation and overload exercises, as well as assessing our abilities to work as pairs under pressure while delivering first aid to various casualties. The exercises throughout the training were brilliant, and one of the key issues I see as a reservist is that our exercises aren't dynamic enough and often the set piece exercises we do don't allow for much initiative and failure. On this course, whenever we 'stacked up' and entered the arena, it was a force-on-force exercise and we'd often be competing against the wit of our 'enemy', sustaining casualties along the way; just as you would expect in a real situation. After each action, we'd then be debriefed by our instructors. As the course continued we as a class were better able to critique our own mistakes. On the whole, I believe we progressed from organised chaos to a fairly cohesive team. At the end of the fourth day we said goodbye to our Medic Up instructors. It was an absolute privilege to have been taught by the two Mikes, Rusty and Stephen. Next came our assessment day when, after a written exam, each student was assessed on individual skills learnt in the week. This involved suiting up into body armour, loading a replica pistol, then entering a room, identifying and neutralising the threat before dealing with three separate casualties. All in all, I thoroughly enjoyed the course. What gave the course its realism were the US instructors as their depth of knowledge and experience in the subject matter is something that isn't really organic to Ireland, which is what makes this course potentially ahead of its time. It did, in my own opinion, weigh more on the tactical side as opposed to the medical side, but as it is the first privately run course of its kind in Ireland, it is understandable that with the amount of civilian paramedics, gardaí and military involved it would be a little difficult to find the balance of skillset straight off. This course really should be compulsory learning for anyone in the business of carrying a weapon or working domestically or overseas with those who carry weapons, whether military, police, or private security. Many thanks to all the instructors and support staff at ESTI and Medic Up; I learnt a lot of skills that I will try to keep up while hoping I never have to use them. | 25 www.military.ie the defence forces magazine

• Cover