Medical Training

92G

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the OP was simply asking how he can get more medical training.
it's a very good question that he asked.

EMS trashing MD, MD trashing EMS, EMS trashing med student, RN trashing med student, med student trashing RN, etc. ->

none of this is useful to the OP (or anyone else). the trash talk reveals only the size of chips one wears on the shoulders.

you folks all have a great deal of knowledge so it is unfortunate to end up in a bantering crap-fest.

it might be worthwhile to re-read the OP's questions and help the dude out.
 
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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.

1) My argument stands for isolated cardiopulmonary arrest the vast majority of which are caused by massive MI. I'm not talking about the induction of cardiopulmonary arrest from drivers of penetrating or blunt trauma.

2) I'm very familiar with the Utstein template, but for all intents and purposes felt it a waste of time to bring up as there may only be about 1% of those viewing this thread that would have any idea what I'm talking about.

3) No one ever made the statement that CPR is effective in cases of hypovolemia caused by trauma.

Just out of curiosity, do you find it necessary to object to every statement I make in threads? I can clearly see how your "getting off" by trying to de-value my opinion here. I hope it helps you sleep at night. Then again maybe your just sore because you never got that acceptance letter to allopathic medical school.

You are just further perpetuating the tangent in which this thread has taken.
 
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Meh, med students are made to be trashed. It's an important part of their education.
Right, but after what we endure from the attendings, do you really think that we get butthurt from an EMS operator trying to tell us whats what? Nope.
 
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Meh, med students are made to be trashed. It's an important part of their education.
I know in some threads I come on pretty strong but I still believe in basic respect for each other and each other’s opinions. Med students are doing something most of us haven’t done and I’ll dare say most of us couldn’t do, myself included and I respect them for that. And as an Old Guy EMT student right now I’m being taught unless there is an active DNR and they aren’t already dead (ricky, decap, mid-section severed) I am supposed to CPR the hell out of them until the doc says stop which is what I’ll do if I find myself in that position even if there isn’t a drop of blood left in them.

Reps to anyone taking a legit first aid, CPR or other class/course to gain knowledge.
 
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OP. Take a red cross class to cover all first aide basics. Then take a tac med class. Then, if you're really serious, work skill sets into dry fire course of fire with trusted friend. Then live fire. None of these skills matter unless you do something Kinesthetic with it. IMHO
 

je25ff

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Good thread. I've been hunting for a good first aid/trauma course for a while.
 

Mass-diver

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Here's a real life example:

Cop gets shoot in the groin by his partner, major vascular injury. He quickly bleeds out and arrests in route to the hospital. Arrives in the ED, excellent CPR in progress. Anesthesia places a CVL and it's off to the OR. I saw the cop on TV yesterday, he looks great. While the team at MAH deserves a ton credit, it was high quality CPR that gave anesthesia and the surgical team a chance to save him.
 
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My 2 cents...
Once a tourniquet is placed, never remove it or loosen it until in the OR.

If you get sued because the patient ended up with amputation, do not use the term " tourniquet" . . . It was a "tight bandage"
 

DrBurnsides

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Tourniquets are stupid cheap. 30 bucks for something that you can put on an arm or leg in 20s and cut off all blood flow to a limb. I've heard a dozen people say "I can do it with mah belt and a screwdriver".. not in 20s. How long until a fem bleed renders you unconscious?

2 TQ, a bag of celox, z-gauze and an Israeli bandage, a few chest seals and you're GTG.. At least that's whats in my range kit..
As for the vital organ thing, hope your buddy has a fast car and a GPS pre-programmed to the nearest OR..
 

Garys

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To the OP.

Take a first aid course, first. Red Cross or just about any other one out there. Then you can take a short course on trauma care. I don't think you'll need a four day course quite frankly. You might not need any additional course, for that matter.

Then buy some simple supplies to treat wounds. There are good suggestions in this thread.

Assess your risk. If you do most of your shooting at the range, that's one set of risks. If you go out into the deep woods, you have a different risk. Plan accordingly.

If you are at your regular range, know the address, know the direct (non 9-1-1) number to whoever answers the 9-1-1 calls. That's usually the PD, but not always. If you call 9-1-1 from a cell phone, currently that goes to one of two Mass State Police answering points. In other states it's different, so try to find that out. If the range has a gate that is usually locked, find out if whoever is going to respond has access. If not, plan for that.

If you're way out in the woods, having a GPS receiver is a good idea. Know the number to get in touch with someone who will respond. Know where the nearest hospital is in case no one will respond.

From what I've seen at my club, you're more likely to have a none shooting injury or illness. Keep that in mind too, don't focus solely on the idea of someone getting shop. I have a friend who was using his chop saw at a club work party and almost amputated a finger. I know another member who had a heart attack during a monthly meeting.
 

MaverickNH

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I started with the 1st Aid Merit Badge in the early 1970s. A lot of what I learned is still quite valuable. Sure, it can be updated, but most of it won't kill anyone faster than just standing by waiting for help to arrive.

I take Red Cross 1st Aid and CPR w/AED courses biyearly and have done so through 3 renewal cycles. The CPR w/AED is pretty good but the 1st Aid pretty minimal. The courses are designed for those who MUST take them as part of work requirements, so many participants view it as an unnecessary waste of their time. That rubs off on the instructors and makes it all less useful.

As a diver, I take the DAN courses, which are SCUBA-oriented, but students and instructors are much more engaged.

So-called Tactical Combat Medicine courses come in many flavors. And yes, many add some "tacticool" stuff to spice up an otherwise bland topic. I thought it useful to hear combat medic instructors talk about the strengths and weaknesses of different tourniquets, chest seals, compression bandages, etc., then slapping them on others to see how easily I could do so in a rush. And how easily I could do so on myself when shot in my dominant arm or a leg.

Drills included countdowns to loss of consciousness in getting a tourniquet on myself. Some brands suck and others are better. Same with compression bandages. It seems that when the USG puts out a supply bid request, plenty of companies are suddenly formed to make products that are lowest bid but minimally acceptable. While some of that gear might be "what the combat medics carry", it's not the stuff you want to carry or have applied to you, it turns out. A lot of people chuck out what Uncle Sam gives them and buy good stuff to save those they care about. Maybe civilian EMTs do that too?

I've worked in the medical industry for 25+ years trying to make things that actually work well and don't hurt people. It's easy to do one or the other, but hard to do both. Only recently have ERs, hospitals, MDs had to reveal statistics on success and failure - it's always been "internal" reviews hidden from view due to legal liability. But insurance reimbursement has pushed safety and efficacy of devices and procedures into more review, even if not open public view. Sometimes for the better, sometimes not.

A lot of ER, Trauma and Burns medicine is "that's the way we do it here" - the MDs come and go and the nurses & EMTs stay on. And "that's the way we do it here" sometimes isn't the best way, or even one of the better ways, to do it. Because a lot of those folks are focused on doing it, not evaluating themselves compared to everyone else.

So I'm a fan of meta-analysis in medicine. It sometimes tells us what might seem to be a great idea really is better, isn't really better, or is actually worse. If that's telling others who know their jobs what to do, sorry about that.

Some might say that sounds condescending (that's a big word that means talking down to people) but I don't agree.[wink]
 
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Thanks for all the information. Probably going to skip any of the tactical oriented classes and do a first aid class and a CPR class then put a small first aid kit together leave it in the truck and hope I never have to use it.
 
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Thanks for all the information. Probably going to skip any of the tactical oriented classes and do a first aid class and a CPR class then put a small first aid kit together leave it in the truck and hope I never have to use it.
This is better.

I will say that according to my instructors, who are all active duty medics and corpsmen with combat experience, the CATs work really well on the arms but should always be applied in pairs on the legs as they can break if you try to lock a leg down hard enough with one. There's another one with a metal locking mechanism that is supposed to be much better for legs. I think it's the SOF-T.
 
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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.
2 hours. Then we drop the tourniquet. Fwiw

Realized already said. Put one one, call EMS.
Learn first aid and CPR as someone said. Agreed, no need for fancy classes
 
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DrRansom

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Thanks for all the information. Probably going to skip any of the tactical oriented classes and do a first aid class and a CPR class then put a small first aid kit together leave it in the truck and hope I never have to use it.
Doesn't seem like these will meet the goals you stated in your OP; don't count out tactical courses just because they aren't always geared toward civilians. There's a lot of valid training there - even if all you take with you is how to apply a tourniquet or apply a chest seal, that can still save someone's life.

I have one more slot open for the May 4th Trauma First Responder Course at Harvard Sportsmen's. You should come and give it a try.
 
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I've worked in the medical industry for 25+ years trying to make things that actually work well and don't hurt people. It's easy to do one or the other, but hard to do both. Only recently have ERs, hospitals, MDs had to reveal statistics on success and failure - it's always been "internal" reviews hidden from view due to legal liability. But insurance reimbursement has pushed safety and efficacy of devices and procedures into more review, even if not open public view. Sometimes for the better, sometimes not.

A lot of ER, Trauma and Burns medicine is "that's the way we do it here" - the MDs come and go and the nurses & EMTs stay on. And "that's the way we do it here" sometimes isn't the best way, or even one of the better ways, to do it. Because a lot of those folks are focused on doing it, not evaluating themselves compared to everyone else.

So I'm a fan of meta-analysis in medicine. It sometimes tells us what might seem to be a great idea really is better, isn't really better, or is actually worse. If that's telling others who know their jobs what to do, sorry about that.

Some might say that sounds condescending (that's a big word that means talking down to people) but I don't agree.[wink]
+1

This is the last thing anyone EVER wants to hear but it's very true. Third party analysis from the eyes of those not directly immersed within the practice in question is an invaluable tool to improvement of care.


I also second the suggestion of Dr.Ransom's First Responder course. You will find there will not be a better all-inclusive course for general first aid in all facets of emergency care.
 
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I've taken B&B I, II, and the refresher. Kerry teaches a set excellent courses w/ very realistic scenarios. Do it.
 
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