First Aid Training For Gun People

[Paul Gomez]

This is an area that has begun getting more attention in recent years and I think this is a very good thing.

FIRST: Get take a local Red Cross or OSHA 1st Aid/CPR class. Just like in shooting, it's the basics of 1st aid that are critical. Then, take a specialized class geared towards 'Care Under Fire'.

SECOND: Understand the problem.

If you carry a gun, you can probably envision a situation where you might need to use it, right?

If you can envision a situation where you use your gun, can you imagine someone getting shot in that situation? Probably so.

Potentially, you or someone you care about, could get shot in that situation, couldn't they?

What do you do? Activating the EMS system is great and should be done, but what is the response time in your area for EMS? Also, what are their protocols when responding to a 'shots fired' call? Generally, it's 'sit back and wait until the cops tell us it is safe' before they enter the scene.

How long does it take for an arterial bleed to render you unconscious?

How long does it take for an untreated tension pneumothorax to become fatal?

Oh, and, what about the skel who did this to you? Is he down? Is he still up and moving? Is he still an active threat? Just because you took a round or two doesn't mean you get to stop the fight and request a do-over.

This situation is what is referred to in the military Tactical Combat Casulaty Care doctrine as "Care Under Fire" and this is the 'worse-case' medical scenario for us.

You have a threat to deal with, or at least keep covered. And you have to render aid to yourself or parner to give EMS a live body to work on. If you cannot provide immediate, on-scene treatment, EMS becomes a corpse transporting service.

THIRD: What are the likely injuries and how do we deal with them.

Bleeding - Tourniquet, Hemostatic Agents, Direct Pressure, Field Dressing

PneumoThorax - Occlusive dressing

Tension Pneumothorax - Needle Decompression!!

Airway Obstruction - HeadTilt/ChinLift and Nasopharyngeal airway

Four of the most common life-threatening injuries can be addressed at this stage. The treatments are not the common EMS answers because of the particulars of the situation. However, they become viable due to the situation.

FOURTH: How do you treat the injuries? By getting the requisite training and then by maintaining a personnal BlowOut Kit with you to ensure that you have the basic tools necessary to be able to render aid for a GSW.

 

[Paul Gomez]

Oops, forgot the contents list for the pic:

Starting in the Upper Left of the photo, we have a One Hand Tourniquet, a packet of QuikClot, 2-PriMed compressed gauze rolls [each one is 4" x 4yds], 14g angiocatheter for Emergency Chest Decompression, 4-inch Israeli Bandage, Nasopharyngeal airway, GI cravat, 4x4 gauze pad and petroleum gauze. The only thing not shown in the photo is the pair of nitrile gloves and the quart sized ZipLoc Freezer Bag that all this rides in.

 

[NukemJim]

Paul, I like it. I had not thought of using an angiocath that way. Been out of the ER too many years I guess.

I am not sure that the majority of people are going to be able to fully utilize such a kit immediatly after a shooting though.

You might want to check local laws as well most states consider an angiocath as an "intravenous needle" and carrying it without a physcians order can get you arrested.

Nice kit.

NukemJim

 

[Paul Gomez]

Using the angiocath for chest decompression was incorporated into the military training model as a standard component in the Tactical Combat Casualty Care model following the Bakara Market battle in Mogodishu in 1993. It's just about the only way to deal with a tension pneumothorax under austere conditions.

As to being able to use the kit immediately following a shooting, will it be difficult? Yep. But given the alternatives, what choices do you have? Of course, this is why there has been a move towards realistic, stress-inoculation type med training in the private sector [much like doing padded aggressor training for unarmed skills and simunition work with handguns], to expose the students to the skills in a stressful environment in the belief that this will better allow the skillset to transfer to the 'real world'.

If you are interested in the legalities of carrying an angiocath, discuss it with you doctor, explain what you are after and get him to write you a perscription. If your personal physician is disinterested, find one that is used to working with peopl who regularly engage in outdoor activities and traveling. They will generally work with you to get you appropriate meds and other perscription-only items for your med/travel kit, in my experience.

Good point, Jim.

 

[444]

What are you using for the one way valve on the angiocath ?
It has been my experience that using the finger of a glove leaves a lot to be desired.
Also, if you have access to a bigger angiocath, get it. Once you needle someone's chest and remove the needle from the catheder, it is hard to keep the catheder from folding over. The bigger the catheder, the stiffer the plastic.

If someone has a GSW to the chest, you can also try to use the hole that is already there instead of needling the chest. Check for an exit wound, then cover the hole with an occlusive dressing. If you can see the patient is developing a pneumothorax, you can try "burping" the dressing: sometimes the air comes out, sometimes it doesn't.

 

[deej]

Asherman chest seal:

http://www.firstrespondersupplies.com/acs.htm

Also...an improperly sized NPA can do more harm than good.

 

[444]

I like it.
I have never seen that before. Good idea.

Of course I suppose you would have a hard time getting it to stick if you had much blood and the patient was diaphoretic, but that item should be a must in a first aid kit like the one being described.

 

[Blackhawk 6]

Paul,

Great kit. I carry something similar on my chest harness. I recently added a McMillan tourniquet from CSM Gear. I can not recommend it enough and Chief McMillan is a great guy.

I agree that having such a kit available after a shooting would be valuable. I just have my doubts about the practicality of carrying one. It is fairly large. Perhaps such a kit in the car, to augment the standard first aid kit.

 

[LawDog]

Check your local community college for a First Responder course, or a Basic EMT course.

The EMT course in my area involves more than a few hours observing/helping in E.R., three ride-along in the back of an ambulance and sitting in on two surgical procedures along with the classroom stuff.

The First Responder course is more condensed than the basic EMT, only stresses the basics, and doesn't involve any of the observing stuff -- which is a pity because the observation portion was at least as informational as the classroom portion.

After you get your cert., check with your local hospital. Ours will let anyone affiliated with the volunteer Rescue Service stock their crash kits for free. If you're a Certified EMT or First Responder, but aren't affiliated with any local volunteer services, our hospitals will let you fill your crash kit and charge you hospital cost for the equipment.

Which is a damned sight cheaper than Gall's, I'm here to tell you.

LawDog

 

[sm]

Excellent Thread !

Another place I have restocked or rec'd supplies is from my Doctor buddy, and his clinic. He is a shooter/ CCW/ hunter. Sometimes the Reps have free First Aid kits avail , so ask and suppliment. Bandage scissors to tape. He and his partners do us a favor by doing this, they understand the realities of firearms, be it afield or well...

 

[SMLE]

Great thread!

I started EMT-B school yesterday, will have my cert by December and my license ASAP after that.

BTW; Galls has some interesting med-kits available, including GSW and OB emergenct stuff.

www.galls.com

 

[El Tejon]

Excellent idea and I strongly advocate this type of training. Most people think that they will never get shot since they carry a gun. Talk about delusional!

I think if coorindated First Aid/EMT training could be a genius PR move. Imagine if say the Indiana State Rifle and Pistol Association would offer this training at a reduced tuition! "No training required by law, but we care so much we're taking the extra step."

People would come to see CCWers as lifesavers in more than one way!

 

[hso]

deej,

Nice gizmo!

Paul,

Good kit. No needle in mine, but most everything else.

 

[Glock-A-Roo]

I think its great to bring up this topic amongst us. I just picked up my NREMT-Intermediate ('85) cert. In my state, pleural decompression is a paramedic-only skill, and even then you have to be affiliated with an EMS service.

I suppose you could consider the untrained use of the angiocath in light of the "carried by 6 vs. judged by 12" framework. But consider this: do you have the assessment skills to know when decompression is indicated? Do you know the anatomy and physiology of the chest to know how not to make the patient worse off? Do you know which surface of the ribs to keep the catheter away from, so you don't puncture nerves & vessels?

How many seriously injured people have you assessed in your life?

Here's the real deal: the true skill attained with EMS work is not textbook knowledge, or even procedural skills. The golden key is assessment skills, combined with the experience of being in chaotic situations.

Get all the medical training you can. You'll use it in real life a whole lot more than your guns. Then bite the bullet and get some time on the ambulances. Even the simplest BLS calls will open your eyes, and make you a lot better prepared for the biggest challenge during a medical emergency: keeping your head clear and making good decisions.

 

[444]

Along the same line: For many years I have seen people (mostly gun people) who buy these extensive medical kits often including surgical intruments. I see this stuff for sale in the high speed low drag catalogs, "survival" type catalogs and websites etc. Yet I have to wonder how many of these people have any idea at all what they are doing with it ? Or did they just buy it because it is cool looking ? Then there are the people who buy these medical realated books. Stuff like Special Forces Medic this and that. Again, I have to wonder what they plan on doing with it ? Have they read it ? Do they think they are going to reference it when someone is suffering a medical emergency ? Have they ever actually worked on a real patient ? Have they ever perfromed any of the skills that they are talking about ?

I have worked full time in EMS for over 20 years in a high call volume EMS system. I have gone on 10s of thousands of EMS calls. I have worked at stations where I personally was running over 200 calls a month and worked there for years. I have no idea what to do with a surgical kit. I do know that I don't want anyone touching me with one that they don't know what they are doing with and one that isn't sterile.
I have my own ideas about first aid kits and it is usually just the opposite of what most people would think. My first aid kit contains very little gear. I realize that there isn't much I can do. If they need anything more than a few bandages they need to be in a hospital. I realize that is an oversimplification, but you get the idea.

 

[Paul Gomez]

Gentlemen,

Thanks for the many replies. I'm glad to see that this thread struck a chord.

I'm not reccomending that anyone carry any gear that they are not trained in. I simply used my kit as an illustration of what could be included in a GSW kit.

On the civil liability of needle decompression [EMT-P level skill], you have to make your own decisions, obviously. In the current military model, Combat Lifesavers are being taught needle decompression. Combat Lifesavers are roughly equivalent to 1st Responders but they are given much greater leeway and are taught some skills that are not covered in the civil EMT program until EMT-I and EMT-P. Once again, I am not reccomending that anyone perform any medical techniques that they have not been trained in and are comfortable in their ability to perfom.

444, I liken the guys who buy all the 'cool med gear' to the same guys who buy all the 'cool gun gear' and own all the 'cool guns' but never train. They are obsessed with equipment, rarely devlop skill and almost never learn approriate tactics or develop an appropriate mindset.

 

[444]

There is no reason why anyone, with about 10 minutes of training couldn't do a needle chest decompression.
Of course knowing when to do it, as was mentioned, takes some experience.
A lot of the skills learned in paramedic school and considered to be "paramedic level skills" could be done by a chimp.

 

[Bix]

When I took Farnam's basic/intermediate pistol earlier this summer, we got an unadvertised bonus lecture on tactical treatment of gunshot wounds.

His basic premise was: There's a lot of stuff we can do nothing about - let's not worry about that. There are, however, a few conditions that may present themselves where a bit of training and the right tools can make a huge difference. We should prepare for those.

Paul, the kit in your pic is very similar to what John recommended.

 

[444]

"There's a lot of stuff we can do nothing about "

This is a point I have tried to bring up in these discussions in the past. There is very, very little we can do about a significant gunshot wound. Even as a paramedic with a truck full of equipment, education, and experience there is very little you can do for a significant gunshot wound. The thing that makes it significant is the damage done INSIDE the body. Controlling external hemmorage does something, but not much. Trauma is a surgical disease. In other words, it requres surgery to repair the damage. This is where the concept of the "Golden Hour" comes into play. In the pre-hospital care of the trauma patient, it has been proven by studies, that if you can get the patient to a surgeon (a trauma center: not just a doctor, not just a hospital, but a hospital staffed and equipped to take the patient immediately to surgery) within an hour after the insult took place, the patient has a significantly better chance of survival. There is very little we can do in the field, so the protocol is to load and go. Do what you can enroute, but don't delay transport for half measures that arn't going to correct the real problem. Unfortunately, like a lot of other subjects, people base their thoughts on something they saw in a movie. Things like getting the bullet out. Have the patient drink some whiskey and then dig around for the bullet with a pair of pliers. Having the bullet inside your body is NOT the problem: the damage it did in getting there IS the problem. Frequently, bullets are not even removed from the body: they are a non-issue. Repairing the damage done by the bullet is the issue and this requires opening the patient up in surgery.

This is where I run into difficulty with people asking me for advice on first aid kits. You don't need much, because there isn't much you can do.