Medical Training

[tacticalpanda]

I've picked up shooting on a friends land that is fairly rural for MA. I began thinking that should anything happen we are a good distance from a hospital so I started thinking about picking up a med kit to leave in the truck. When I started looking into med kits I realized I have A) no first aid training and B) don't really know how to use most of the stuff in the kit effectively. Does anyone offer trauma training as it something that I want to learn and feel could be useful. I saw SIG academy does a pistol and trauma class but the dates don't work for me.

 

[Deleted member 12999]

Bill Lewitt. Look him up here

 

[92G]

i am a physician so i will give you wound 101:


two ways for round to kill you:
#1: hits vital organ (in this case you are SOL)
#2: bleeding until hypovolemic shock (aka "blood loss")

If #1,
hope a friend is present to get you to care

If #2,
-apply firm pressure
-drive to hospital

the single most important tool is a tourniquet.
many lives have been lost because a round hit a peripheral artery and the person bled to death. A round going through your wrist that hits your radial artery coiuld result in fatal blood loss in <2 min. torniquet on the arm can prevent bleeding until they get to full medical care.

 

[grizquad]

Sig Academy has a "bandages & bullets" course. Its not cheap, but I am sure its a great course as is the ones I have taken there. The Doc's Wound 101 was pretty good and to the point!
http://www.sigsaueracademy.com/Courses/ShowCourseDetails.aspx?CourseID=211
Stay safe!

 

[tacticalpanda]

Bill Lewitt. Look him up here

Thanks just looked up the classes and they seem to be what I was looking for. Will drop him an email.

Thanks for the 101 but I guess I undersold myself as I am looking more for the 201 class

Wish I could do the Bandages and Bullets class at Sig but the dates won't work for me.

 

[Rob Boudrie]

torniquet on the arm can prevent bleeding until they get to full medical care.

Doc -

When I was in the pre-reserves (a/k/a boy scouts) the first aid training was "direct pressure only, with emphasis never to use a tourniquet unless a limb was severed. That's obviously not really the case, but I was wondering - how long does it take for tissue damage to set in downstream from a tourniquet once applied?

A round going through your wrist that hits your radial artery coiuld result in fatal blood loss in <2 min. torniquet on the arm can prevent bleeding until they get to full medical care.

I can attest to the speed of the blood loss. I had my radial artery attached to my cephalic vein, and if the bandage slips when I pull an IV the blood gush is amazing (squirts out like a fountain).

 

[Deleted member 12999]

Doc -

When I was in the pre-reserves (a/k/a boy scouts) the first aid training was "direct pressure only, with emphasis never to use a tourniquet unless a limb was severed. That's obviously not really the case, but I was wondering - how long does it take for tissue damage to set in downstream from a tourniquet once applied?

Doctors and medics I've been in class with lately are saying 6-8 hours wouldn't be an issue. Not a DR though. Just an amateur

 

[Marcus5aurelius]

Doc -

When I was in the pre-reserves (a/k/a boy scouts) the first aid training was "direct pressure only, with emphasis never to use a tourniquet unless a limb was severed. That's obviously not really the case, but I was wondering - how long does it take for tissue damage to set in downstream from a tourniquet once applied?


I can attest to the speed of the blood loss. I had my radial artery attached to my cephalic vein, and if the bandage slips when I pull an IV the blood gush is amazing (squirts out like a fountain). Gets me in trouble with the wife as well.

I was taught the same thing, I would also like to know. Obviously if blood loss is life threatening, it's a moot point because even if they ended up losing the arm, leg, etc it would be the best available option.

 

[Martlet]

I was taught the same thing, I would also like to know. Obviously if blood loss is life threatening, it's a moot point because even if they ended up losing the arm, leg, etc it would be the best available option.

That's old training. It's crazy how much things have changed over the years. Now their saying you're good with a CAT for AT LEAST 2 hours, and usually more than 4. In CLC it's the go to.

Keep a few CATs and Israeli bandages in your range bag.

 

[Asaltweapon]

If direct pressure doesn't control bleeding you have no choice but to cut off the blood flow. They do make "blow out patches". These are pads with clotting agents for major wounds.


Best plan of attack is to be a safe shooter and practice safe gun handling at all times. Don't ever get lazy about it.

 

[92G]

Torniquet on a limb turns minute into hours.

of course its not an overnight solution we are talking about buying an hour or so until they can get blood products, iv fluid, etc.

 

[92G]

Thanks just looked up the classes and they seem to be what I was looking for. Will drop him an email.

Thanks for the 101 but I guess I undersold myself as I am looking more for the 201 class

Wish I could do the Bandages and Bullets class at Sig but the dates won't work for me.

if you are talking about a round going through someones, head, neck, thorax or abdomen, forget about a bandage or anything else. again firm pressure and get their ass to treatment.

again i'm convinced a large number of gun enthusiasts are a little naive as to what happens when a round carrying over 300 ft-lbs flies through a human. it gets ugly very fast. bandages and dressings and topical antibiotics don't do squat. "first aid kits" are for scratches or sprained ankles, not a .308 hitting your belly.

anytime a serious injury occurs its pretty much the same routine.
the person will lose consciousness quickly.
ABC is basically trying to keep someone alive
Airway - secure airway ideally with a endotracheal tube
Breathing - ventilate, either by mouth or whatever device you got
Circulation - meaning if pulse is absent or weak, then vigorous chest compressions at least 60/min
"D" - defibrillator if you got one. again you aren't gonna have one based on being in remote area

all of this is preventable with the 4 rules of gun safety.

 

[Garys]

In every war, we seem to have to relearn the lesson of tourniquets. This happened again in Iraq and Afghanistan. 99% of what EMTs, paramedics, doctors, nurses, and everyone else learns about tourniquets is wrong. Not only is it wrong, it's based on experiences from the Civil War. Got that? The Civil War. Interestingly, the military was up until a few years ago way ahead of civilian medicine in this regard.

In the operating room it is routine to put a tourniquet on for several hours during complex operations involving the extremities. It will take more than a the time you are likely to have a tourniquet on for permanent damage to occur.

You don't do anyone any good if you let them bleed to death. The the alternative is losing a limb or bleeding to death, I know which one I'd want.

BTW, a friend of mine and I are doing a trauma class at the NRA show in April. To be accurate, it's coinciding with the NRA show, we are not sponsored by or affiliated with the NRA. Other than both being members, that is. Limited space and it filled up within hours of his posting it on his blog. If it works well, we might start doing them in other places.

Between the two of use we have over 50 years experience in EMS.

 

[Garys]

A defibrillator is a waste of time the cause of cardiac arrest was from exsanguination. You're right about prevention being a much better course of action.

if you are talking about a round going through someones, head, neck, thorax or abdomen, forget about a bandage or anything else. again firm pressure and get their ass to treatment.

again i'm convinced a large number of gun enthusiasts are a little naive as to what happens when a round carrying over 300 ft-lbs flies through a human. it gets ugly very fast. bandages and dressings and topical antibiotics don't do squat. "first aid kits" are for scratches or sprained ankles, not a .308 hitting your belly.

anytime a serious injury occurs its pretty much the same routine.
the person will lose consciousness quickly.
ABC is basically trying to keep someone alive
Airway - secure airway ideally with a endotracheal tube
Breathing - ventilate, either by mouth or whatever device you got
Circulation - meaning if pulse is absent or weak, then vigorous chest compressions at least 60/min
"D" - defibrillator if you got one. again you aren't gonna have one based on being in remote area

all of this is preventable with the 4 rules of gun safety.

 

[bandaid bandit]

In every war, we seem to have to relearn the lesson of tourniquets. This happened again in Iraq and Afghanistan. 99% of what EMTs, paramedics, doctors, nurses, and everyone else learns about tourniquets is wrong. Not only is it wrong, it's based on experiences from the Civil War. Got that? The Civil War. Interestingly, the military was up until a few years ago way ahead of civilian medicine in this regard.

In the operating room it is routine to put a tourniquet on for several hours during complex operations involving the extremities. It will take more than a the time you are likely to have a tourniquet on for permanent damage to occur.

You don't do anyone any good if you let them bleed to death. The the alternative is losing a limb or bleeding to death, I know which one I'd want.

BTW, a friend of mine and I are doing a trauma class at the NRA show in April. To be accurate, it's coinciding with the NRA show, we are not sponsored by or affiliated with the NRA. Other than both being members, that is. Limited space and it filled up within hours of his posting it on his blog. If it works well, we might start doing them in other places.

Between the two of use we have over 50 years experience in EMS.

Would this friend be an EMS/gun blogger from Louisiana? If so, I'm in if you two ever do a class together in this neck of the woods.

 

[Mass-diver]

Doc -

When I was in the pre-reserves (a/k/a boy scouts) the first aid training was "direct pressure only, with emphasis never to use a tourniquet unless a limb was severed. That's obviously not really the case, but I was wondering - how long does it take for tissue damage to set in downstream from a tourniquet once applied?


I can attest to the speed of the blood loss. I had my radial artery attached to my cephalic vein, and if the bandage slips when I pull an IV the blood gush is amazing (squirts out like a fountain).

IME, after 2hrs the risk of nerve damage is going to start to go up pretty fast, most of the military stuff that shows a very low rate if complications, is for less than 2hrs. Obviously, wider tourniquets (like those used in the OR) are much safer than narrow, improvised tourniquets.

BTW, if they are still bleeding, it isn't on tight enough -crank it down or add a second one.

 

[DrRansom]

A good friend and 20+ year EMT/medic and I have been introducing condensed TCCC classes to the area - we've run one so far at Harvard, have another one scheduled (and full), and plan on continuing the effort. It's a one day course focusing on trauma management while awaiting EMS, and includes skills for dealing with massive hemorrhage and other traumatic injury without trying to turn the student into a doctor or surgeon. If you are a member of Harvard Sportsmen's Club, or if you'd like to propose a new venue for the class (and think we could round up 15+ people), PM me.

 

[MaverickNH]

I took this 4-day course last summer http://www.suarezinternationalstore.com/tactical-trauma-medicine.aspx

We had military medics in the class and a Ranger medic co-teaching with a trauma surgeon. A combination of self-care under fire and triage care for a team. Final exercise was done with flash-bangs, smoke and automatic weapons fire to lend an element of intensity. I learned a lot!

 

[Garys]

Would this friend be an EMS/gun blogger from Louisiana? If so, I'm in if you two ever do a class together in this neck of the woods.

Hmmm, could be rabbit, could be.

 

[Garys]

I always preferred the Erwin Hirsch approved surgical tubing and Kelly clamp method. Of course that was for short distance to the ED transports.

IME, after 2hrs the risk of nerve damage is going to start to go up pretty fast, most of the military stuff that shows a very low rate if complications, is for less than 2hrs. Obviously, wider tourniquets (like those used in the OR) are much safer than narrow, improvised tourniquets.

BTW, if they are still bleeding, it isn't on tight enough -crank it down or add a second one.

 

[bandaid bandit]

Hmmm, could be rabbit, could be.

Good to know. Unless I am mistaken, I've taken a class or two when KG has spoken in the area, and I had met the two of you together at a gathering of bloggers a few years ago on Rt 1 in Saugus.

 

[vellnueve]

Doc -

When I was in the pre-reserves (a/k/a boy scouts) the first aid training was "direct pressure only, with emphasis never to use a tourniquet unless a limb was severed. That's obviously not really the case, but I was wondering - how long does it take for tissue damage to set in downstream from a tourniquet once applied?

6 hours.

 

[Garys]

Good to know. Unless I am mistaken, I've taken a class or two when KG has spoken in the area, and I had met the two of you together at a gathering of bloggers a few years ago on Rt 1 in Saugus.

I thought it was that other Italian place up that way, but can't recall the name. Yeah, that would be the guy.

 

[Nuke8401]

This happened again in Iraq and Afghanistan. 99% of what EMTs, paramedics, doctors, nurses, and everyone else learns about tourniquets is wrong.

I taking an EMT=B class now. At least in CT and the Nation Registry now teach tourniquets as the way to go. The reasons given in class; since remote is a relative term 2-3 hours to an ER is about the max, permanent limb damage doesn't occur for 3-4 hours and even if it is damaged it's better than dying. Not sure where/when you got the "99% of" information since all EMTs and medics have to past the National registry exam to be certified. From what my instructor (35yrs in EMS) says goes right along with what doc (Squib308)says; stop/reduce the bleeding you can see, ABC, load and go. Before I took this course I would have thought I would want more gear with me but now my “range” first aid kit will have a tourniquet, Israeli bandage, gloves and a CPR mask (barrier for mouth to mouth) and maybe a vented chest seal for a lung puncture. Big flick in my mind now: if gunshot to the “body” direct pressure/occlusive bandage (chest seal) ABC and get to the ER ASAP. Gunshot to a limb; direct pressure/tourniquet, ABC and get to the ER.

 

[bandaid bandit]

I thought it was that other Italian place up that way, but can't recall the name. Yeah, that would be the guy.

I think it was carabbas one year, Polcari's the next year since the carabas room was a bit cramped

 

[Garys]

This is a very recent change. As little as three years ago most EMS classes and most EMS services still clung to old and wrong model of tourniquet use. If you instructor has been around that long, you can ask him and he'll tell you the same thing.

I taking an EMT=B class now. At least in CT and the Nation Registry now teach tourniquets as the way to go. The reasons given in class; since remote is a relative term 2-3 hours to an ER is about the max, permanent limb damage doesn't occur for 3-4 hours and even if it is damaged it's better than dying. Not sure where/when you got the "99% of" information since all EMTs and medics have to past the National registry exam to be certified. From what my instructor (35yrs in EMS) says goes right along with what doc (Squib308)says; stop/reduce the bleeding you can see, ABC, load and go. Before I took this course I would have thought I would want more gear with me but now my “range” first aid kit will have a tourniquet, Israeli bandage, gloves and a CPR mask (barrier for mouth to mouth) and maybe a vented chest seal for a lung puncture. Big flick in my mind now: if gunshot to the “body” direct pressure/occlusive bandage (chest seal) ABC and get to the ER ASAP. Gunshot to a limb; direct pressure/tourniquet, ABC and get to the ER.

- - - Updated - - -

I think it was carabbas one year, Polcari's the next year since the carabas room was a bit cramped

That sounds right too.

 

[vellnueve]

That's old training. It's crazy how much things have changed over the years. Now their saying you're good with a CAT for AT LEAST 2 hours, and usually more than 4. In CLC it's the go to.

Keep a few CATs and Israeli bandages in your range bag.

DMRTI instructors were teaching 6 hours before significant risk of irreversible damage when I went through Camp Bullis back in 2012.

Torniquet on a limb turns minute into hours.

A defibrillator is a waste of time the cause of cardiac arrest was from exsanguination. You're right about prevention being a much better course of action.

Good things to note... at my last duty station there was a shark attack. The attack removed the bottom 80% of the thigh including all the vessels, broke the femur, and severed several arteries in the left arm. It took at least fifteen minutes from pulling him out of the water to arriving at the clinic and tourniqueting, and with that much damage exsanguination and arrest probably happened in under a minute, despite everyone's efforts. Most gruesome thing I ever saw. The only way the guy could have been saved is if someone trained had had a tourniquet and applied it within seconds of the attack. There is no time to waste and there is no point in worrying about ischemic damage. I always carried one (unfortunately that day had already left the beach) but after seeing that damage I picked up several more. Always have one in my backpack and one in the car, just in case.

As an aside, our turnaround from patient arrival to delivery to a properly outfitted hospital was a 22-40 hour round trip air ambulance... so worrying about ischemic damage was sort of pointless.

 

[Martlet]

DMRTI instructors were teaching 6 hours before significant risk of irreversible damage when I went through Camp Bullis back in 2012.

One of my instructors said 6, the other said 4. Both said "who gives a shit, since if you CAT him he'd better be getting better treatment that you doucheheads can provide pretty quickly."

 

[vellnueve]

One of my instructors said 6, the other said 4. Both said "who gives a shit, since if you CAT him he'd better be getting better treatment that you doucheheads can provide pretty quickly."

Yeah... they basically told us to screw the limb and make sure the guy lived first. I remember them talking about CATs that were staying on from time of application through arrival at Landstuhl and that even with that length of time there was still a chance that the limbs could be saved.

 

[MRE]

Thorax/"Chest Wounds": 3 sided occlusive dressing, don't tape one side to allow some air to escape while limiting what comes in. Saran wrap and tape can work in a pinch, the Asherman chest seals w/1 way valve are ideal. Have a few on hand if possible, the improvised way works too.

Good point, I was going to bring those up if nobody else did. For those not in the know, occlusive dressings do not allow air to pass through them. The improvised one way valve cja mentioned as well as the chest seals are designed for chest wounds that penetrate the space that the lung occupies and/or the lung itself. If this happens you need to get/keep air out of the space the lung occupies or it will collapse. Unfortunately blood in this space can do the same thing and you will likely have a lot of it if you have a gunshot wound to the chest.

One other note on tourniquets. If you have a wound on an arm or a leg where the bleeding cannot be controlled with direct pressure, etc. You can apply a tourniquet, but may not need to completely stop the bloodflow to the limb. Just tighten it enough that you can control the bleeding with direct pressure. Often this will still allow some bloodflow to the limb, greatly reducing the chance of permanent damage. One other thing I didn't see mentioned yet. If you apply a tourniquet, note the time it was applied and the location and make sure that info gets passed along to the ambulance/hospital. Often times this info is written onto the person's forehead with a marker so it doesn't get lost. Remember, all of their clothes are going to be removed.