Medical Training

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.

Some sobering/single point statistics on rifle gunshot victims. DC sniper, 223, single shot killed 10, 3 survived mostly in urban areas where medical attention both pre-hospital and Trauma/hospital care was readily available.
 
I always preferred the Erwin Hirsch approved surgical tubing and Kelly clamp method. Of course that was for short distance to the ED transports.

Pretty much everything he pushed has been validated in the past couple years. I remember seeing that rig in the trauma room, pretty cool.
 
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.

If you're looking for a bare-bones first aid course the best wait to go is the American Red Cross. They are the best way to get certified for CPR and first aid from both a practical and legal standpoint. In the situation of an extremity wound rip off your shirt tie off the circulation proximal to the source (calf wound - tie above the knee) and apply pressure on the wound directly to mitigate bleeding as much as possible. If you hit the chest or torso apply pressure and hope to god you can get a med-evac from a tertiary care hospital (Major surgical capabilities) with a Heli-pad like MGH or BWH. Like others have said "trauma pads" with cellulose and other clotting agents are never a bad thing to have around.

As much as a firearm specific course may help - unless it's taught by a service medic or emergency room trauma specialist (M.D.) the level of knowledge you will take away will be no different than from a ARC course.

I suggest going with american red cross - http://www.redcross.org/lp/take-a-class

At the end of the day the MOST useful knowledge ANYONE outside of the medical field can have is CPR training as it has the LARGEST efficacy for saving lives bar none. Because unless you really are mentally challenged, the likelihood of your buddy going into cardiac arrest at the range should be far higher than you shooting him in the chest and compromising the thoracic cavity.
 
He was pushing that in the mid 1980s, before anyone else I know of was doing it. He yelled at more than one EMS crew down in the trauma rooms for not putting on tourniquets soon enough. He actually told me that I did a good job one time when I brought in a guy with bilateral traumatic AKAs with tourniquets on.



Pretty much everything he pushed has been validated in the past couple years. I remember seeing that rig in the trauma room, pretty cool.
 
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.

Eh, best to have two tourniquets in your bag and use two on lower limb bleeds if needed.
 
....(calf wound - tie above the knee)....

just to add to this, i was always taught that tourniquets get placed between the heart and the wound, as close to the wound as possible but not directly on a joint. tourniquets are NOT to be used on neck wounds (duh) or head wounds. a "T" is marked on the victim's forehead with the time the tourniquet was applied.
also, if using an occlusive dressing (chest seal) it should be placed just after the victim has exhaled and before victim inhales.

disclaimer-my latest training took place 2 years ago, new methods may have come out since that time.
 
CPR is OK, but in reality, you aren't bringing anyone back to life with it. You're just staving off metabolic death until they can start pumping drugs into them.
 
I was tempted more than once, but controlled myself. The whole mark with a "T" thing is from like WWI or something. No one teaches it any longer and no one has done it in my memory.

If you were 10-12 hours away from definitive care and the patient was going to be handed off a number of different providers, that might be useful, but more likely not.

just to add to this, i was always taught that tourniquets get placed between the heart and the wound, as close to the wound as possible but not directly on a joint. tourniquets are NOT to be used on neck wounds (duh) or head wounds. a "T" is marked on the victim's forehead with the time the tourniquet was applied.
also, if using an occlusive dressing (chest seal) it should be placed just after the victim has exhaled and before victim inhales.

disclaimer-my latest training took place 2 years ago, new methods may have come out since that time.
 
CPR is OK, but in reality, you aren't bringing anyone back to life with it. You're just staving off metabolic death until they can start pumping drugs into them.

Metabolic death as you refer to it will prevent the drugs from having any efficacy. Dead cardiac myocytes don't just come back to life with epinephrine and xylocaine. You need perfusion of the coronaries to keep the heart is a state in which is still can be resuscitated into V-Fib then shocked into rhythm
 
Metabolic death as you refer to it will prevent the drugs from having any efficacy. Dead cardiac myocytes don't just come back to life with epinephrine and xylocaine. You need perfusion of the coronaries to keep the heart is a state in which is still can be resuscitated into V-Fib then shocked into rhythm

I'm sure that works well for you... You sound like a pro. My only point is that for the average dude, they are going to deal with blood loss mitigation before CPR.
 
I'm sure that works well for you... You sound like a pro. My only point is that for the average dude, they are going to deal with blood loss mitigation before CPR.

Oh, wait. I'm talking about the fact that rather than shooting your friend its more likely that hes going to have an episode of cardiac arrest haha.

I was not thinking in the moment of you've shot your friend in the leg and now hes gone into cardiac arrest!

That's funny though. But yeah, with no blood what good is a heart anyways?
 
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

Youre coming up on 4 years outdated on that http://newsroom.heart.org/news/1139

trach tubes are not 1st responder nor EMT-B/I level skills, it's paramedic.

Chest compression's need to be at least 100 per minute, not 60.

OP, if you are worried about being useless in a medical situation in general you should hit up a modern CPR course (CAB, not ABC) and also take a 1st responder course. After you have a semi stable foundation on not how to be beyond useless in an emergency scenario you can go out into trama at the range type classes that will build on your basic knowledge.

It all depends on how important it is to you. Advice on what to do on NES is usually very poor in terms of what to do. Go to a class, get taught the correct way and stay up to date with continuing education as it evolves (which it will continuously).
 
Internet is not translating well this morning I guess. I mean that your average person in their life, is WAY more likely to save someone's life by stopping significant blood loss (no matter what causes it) than CPR. My point is that I think its a good resource to spend time on, and I think the average citizen gets fed a lot of CPR cool aide.

I get that you're talking about a range specific sucking chest wound. I'm talking just in general terms.
 
Internet is not translating well this morning I guess. I mean that your average person in their life, is WAY more likely to save someone's life by stopping significant blood loss (no matter what causes it) than CPR. My point is that I think its a good resource to spend time on, and I think the average citizen gets fed a lot of CPR cool aide.

Sure. If there is no blood to oxygenate the persons brain, than that's that. It doesn't matter if hes breathing or has a heart rate. If there's no blood to transport O2 than it wont matter. Heavy bleeding must be controlled immediately.

And yes, CPR success rates aren't to high either, unfortunately. Depends on the situation especially.
 
Internet is not translating well this morning I guess. I mean that your average person in their life, is WAY more likely to save someone's life by stopping significant blood loss (no matter what causes it) than CPR. My point is that I think its a good resource to spend time on, and I think the average citizen gets fed a lot of CPR cool aide.

I get that you're talking about a range specific sucking chest wound. I'm talking just in general terms.

People generally quote 5-10% "success" for civilian CPR, but it's higher for cases where an AED is needed and used. Worth knowing IMHO. But tourniquets are super useful as well.

Probably, the best thing you can do is have some aspirin to give a buddy when he's having a heart attack, as it confers a dramatic survival advantage.
 
I think the average citizen gets fed a lot of CPR cool aide.
CPR can be a lifesaver, but the cool aid is the perception that CPR is likely to make a difference. In practice, most cases in which CPR is administered do not result in an eventual hospital discharge.

but it's higher for cases where an AED is needed and used
It's like saying that the effectiveness of chicken soup for septicemia is higher when an antibiotic is needed and used.
 
Really depends on how fast you catch the cardiac arrest. If it is a witnessed arrest, there is a reasonable chance that HIGH QUALITY CPR (mainly chest compressions) can keep the person from being permanently dead. Most lay-persons do not do chest compressions hard enough and fast enough. Of course being able to restart the heart depends on the original cause(s) of arrest. In my educated opinion/experience listed in order of most likely to reverse to least likely (WITH hospital care at some point):

HYPOXIA (low oxygen, probably the easiest to fix: drowning, compromised airway, allergies; in the hospital I've seen a lot of people come back from this);
HYPOVOLEMIA (bleed out, you didn't put that tourniquet on fast enough or effectively; kinda screwed unless you have IV access and fluids/blood, easy to fix in hospital, nightmare to fix outside);
TOXINS (wide range of possibilities; poisonous snakes, insects, etc. Needs toxin specific medication/care),
MI (myocardial infarction/heart attack; this is where the AED comes in, though you might get shockable rhythms at any point during CPR regardless of the cause);
SEPSIS (infection, once you get multi-organ involvement the prognosis is very bad).

I'm sure of missed a bunch (hypo/hyperthermia etc.), and this is all assuming the person is already pulseless. The best way to PREVENT cardiac arrest is to treat the underlying conditions early/quickly. This is where training comes in. Learning how and when to open an airway: chin thrust/head tilt, recovery position, nasopharyngeal airways. Putting on a tourniquet quickly (10-20 seconds), or even possibly on your own leg/arm after being shot is not easy even if you practice frequently. Keeping one or more well designed tourniquets on your person/vehicle saves time you may not have to improvise a solution, though in some cases (multiple limbs, multiple casualties) you will run out and need to improvise.

I recently took the Bullets and Bandages I course at Sig and I definitely thought it was worth the money as a medical professional that does NOT often deal with trauma. If you are an EMT/paramedic much of the training would be redundant. For the lay person / recreational shooter it is a lot of material but also worth it. The NES Summit is also having a medical course on the first night.
 
I'm not sure where the majority of you are getting your statistics from. I personally suggest you disregard ANY and ALL medical statistics that have not been published in a peer reviewed journal, yes that's right NOT any WedMD garbage, EMT hearsay or even classes you have taken (Unless they cite their statistics).

For those people saying that you might as well forget about CPR.... well there's a damn good reason you're not making these decisions, and if any of the CPR naysayers are EMT's shame on you.

Here you can see a meta-analysis of in-hospital CPR having a discharge rate of 15%.
http://www.ncbi.nlm.nih.gov/pubmed/8452077

For those of you who want to get fired up about the mentioned statistics being from an in-hospital standpoint you can direct your further reading to;
http://www.ncbi.nlm.nih.gov/pubmed/...y+lay+people+and+by+health+care+professionals

Bystander CPR has been proven to increase survival rates of those is cardiac arrest by over 120% from situations in which no bystander CPR is provided. When that bystander CPR is administered by a "professional" the rate of survival is increased by over 400% from those situations in which bystander CPR is either terminated or not given.

The truth is in the numbers here. Think what you want, but just remember your decreasing the chance someone has to survive a cardiac arrest by over 2-fold by choosing to not provide CPR. Maybe you can live with that - I know I can't.

disclaimer; I am a second year med student with over 10 years of exposure to both surgery and emergency medicine, I've worked many donor heart harvests and have a relatively educated scientific view on the cardiovascular system.
 
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Dude,

I applaud you using literature to support your points, and I certainly agree that CPR should definitely be administered following stabilization of any massive hemorrhage (assuming the arrest wasn't due to exsanguination), but you should get off your high horse. You're not a board-certified MD either, and a few of the guys here are professionals with decades of practical experience; you really have no place talking down to them.

In the .mil, there's a reason why soldiers and Marines will often prefer the experienced medic or independent duty corpsman to the newly minted medical officer, and you're not even at that level yet. Certainly your knowledge is welcome here but you should present it in a more tactful manner.

The tactical medicine courses they are talking about are predominantly teaching pre-hospital trauma treatment in a combat environment, not in the civilian world, and those that are saying that CPR in combat is not encouraged are in fact correct, as #1) the probable cause of cardiac arrest in combat is massive hemorrhage which is impossible to treat when under fire. and #2) attempting to do CPR while under fire on a patient who is unlikely to survive, much less return to the fight is pointless especially if you can be getting someone else back into the fight, and #3) may needlessly expose the provider to additional, and that is how tactical med and combat casualty care is taught.
 
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Dude,

I applaud you using literature to support your points, and I certainly agree that CPR should definitely be administered following stabilization of any massive hemorrhage (assuming the arrest wasn't due to exsanguination), but you should get off your high horse. You're not a board-certified MD either, and a few of the guys here are professionals with decades of practical experience; you really have no place talking down to them.

In the .mil, there's a reason why soldiers and Marines will often prefer the experienced medic or independent duty corpsman to the newly minted medical officer, and you're not even at that level yet. Certainly your knowledge is welcome here but you should present it in a more tactful manner.

To each their own. I'm not trying to talk down to the vast majority of EMT's or whatever health professionals you're referring to. Maybe that's the way it came off, but I'm simply stating that - the vast majority of the responses I've seen in here since I brought up CPR are DEAD WRONG. If you take issue with me talking down to those who have stated that CPR is "useless" that's fine, but just because I'm not a tenured attending with two letters following my name doesn't mean that they are right and I am wrong.
I may not yet be board certified, I am however bringing a level of knowledge into this thread that most likely surpasses that of your EMT/Medic/First Responder. It may not all be field knowledge, but what happens in the feild is what goes into the literature and statistics which I am well versed in and have actually contributed too.

I just don't take things too lightly when people are contemplating how to deal with life threatening situations when many of them (in this thread) are grossly mis-informed.
 
The tactical medicine courses they are talking about are predominantly teaching pre-hospital trauma treatment in a combat environment, not in the civilian world, and those that are saying that CPR in combat is not encouraged are in fact correct, as #1) the probable cause of cardiac arrest in combat is massive hemorrhage which is impossible to treat when under fire. and #2) attempting to do CPR while under fire on a patient who is unlikely to survive, much less return to the fight is pointless especially if you can be getting someone else back into the fight, and #3) may needlessly expose the provider to additional, and that is how tactical med and combat casualty care is taught.


Not arguing this - but I was certainly not discussing combat and or the value of experienced field personnel.

There is a reason the interns and Med students go to the old nurses when the SHTF - they've seen it all.
 
Not arguing this - but I was certainly not discussing combat and or the value of experienced field personnel.

There is a reason the interns and Med students go to the old nurses when the SHTF - they've seen it all.

At least a few of the people who were talking about CPR not being taught in their courses were talking about tactical courses, so not all of them really deserve your ire.
 
I'm not sure where the majority of you are getting your statistics from. I personally suggest you disregard ANY and ALL medical statistics that have not been published in a peer reviewed journal, yes that's right NOT any WedMD garbage, EMT hearsay or even classes you have taken (Unless they cite their statistics).

Pre hospital cardiac arrest survival rates have been well studied using the Utstein Template for well over 10 years. The Utstein criteria requires survival to discharge with a neurological function, preferably a CPC score of 1 or 2. Utstein also looks only at VF/VT as the presenting rhythm, not Asystole or PEA with any underlying rhythm.

Traumatic cardiac arrest is a whole other ballgame. Survival for blunt trauma arrests is less than 1%, where survival for penetrating trauma arrests hovers between 2-3% when there are signs of life at EMS arrival. Signs of life being defined as respiratory effort, no matter how weak or ineffective. Patients with good pulses, but no respiratory effort have very poor outcomes.

That's why many EMS systems will not treat or transport patients in traumatic arrest, the risk to the public and the providers far outweighs the benefit to the patient. CPR on patient with no blood to circulate is pretty futile, as is CPR on someone with blunt force trauma serious enough to put them into cardiac arrest. That's been well studied and is not anything new in EMS.

I spent 35 years in EMS with medical control coming from one of the major teaching hospitals in Boston. I've seen literally hundreds of medical students and residents come through various hospitals in Boston. Generally a MS2 is considered just a bit less knowledgeable than an experienced housekeeper.
 
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