First Aid Training

[444]

This doesn't really add anything to the discussion, but my path to where I am now began in a very similar way to what you guys are talking about. When I was in the military, we had to learn CPR. In the reserves we had some civilians from the Red Cross come and teach us an abreviated CPR class. They told us that this wasn't a full CPR class, but only covered what we were required to know. I am amazed now, but even at that young age it occured to me that if I ever needed to know this, it was worth one day of my time to learn it, so, the next week I called the Red Cross and asked about taking the full CPR class. I lived in a small town and they told me that they would put my name on a list and when they got enough people together for a class, they would call me. Months went by and I didn't hear anything. I called them a few times and they didn't have enough people yet. One day I was driving around and saw a sign on a volunteer fire station for an EMT class. I called and asked if they taught CPR as part of the course. They said yes, so I took it. Part of the course was riding along with an ambulance. I really enjoyed it. Someone mentioned that they were going to go to paramedic school. I asked what a paramedic was, I thought paramedic was just another word for someone that worked on an ambulance. Being single and having a job that required me to travel throughout much of the state meant that I wasn't tied down to any one area, so I asked where the best paramedic school was. I studied up on my EMT stuff and went and took the enterence exam, and passed. I took the paramedic course at night and worked during the day. It took me over a year for the paramedic course and also took every spare moment I had between studying, class, and my clinicals. The course was well over 2000 hours, the minimum at the time was 1500 hours. I had no real ambition, I just enjoyed it for some reason and did well in the class. I started getting trade publications and noticed ads for paramedic jobs. I wondered what paramedics made, so I called a couple of them. One of them, Mercy Ambulance of Las Vegas said that they would be in my area doing a test for potential employees. I decided to see how well I would do on the test, so I went and took it. They offered me a job. I told them that I wasn't interested but thanks anyway. About a month later, it was supposed to be spring, but I went outside and there was a foot of snow on the ground. I was so sick of snow/cold/overcast skys that I called up Mercy and asked them for a job. I went to Las Vegas having never been there in my life. I thought I was hot stuff but quickly found out that this was the super bowl of EMS. We had cutting edge equipment and extremly high call volume. At that time, the people I was working with were some of the best paramedics in the world. They had the experience, they had cutting edge equipment, and they had a very progressive attitude. In Las Vegas we have a duel response system; a private ambulance and a fire department rescue respond on all 911 calls and the private ambulance transported all the patients. I quickly saw that the money, benefits, and job satisfaction lay with the fire department, but I continued working for the private service for seven years before I got on the fire department. Now, I make more than all my friends with college degrees. Today, application for the fire department requires at least a basic EMT certification prior to being hired and every rookie school class has to be made up of at least 50% certified paramedics.
And the whole thing started with me wanting to take a CPR class. My whole education cost me $535.

 

[Billy Sparks]

444, who do you work for now?

 

[7677]

Paul,
I have to agree that most of the first aid training taught does not address gunshot wounds. I received first aid training when I was a city police officer, then as a county police officer and when I went to FLETC and none of them really went into how to treat gunshot wounds effectively. When I was in the Army I took the Combat Lifesaver course but my real training for gunshot wounds came in the Gulf War treating Iraqis. When I worked for the county, they bought us AED and told us that CPR rarely restarts the beating of the heart again. They told us that it take a shock to restart it beating again. However, CPR buys the person the time necessary for the EMTs or someone with a AED to get there and jumpstart them. Also excellent advice "We time lined it from my house in the city to the nearest Level I trauma center and it ran over an hour. From the nearest range, it ran over two hours." We do the same thing when we serve search or arrest warrants.

 

[OF]

Great thread folks. Keep it coming.

- Gabe

 

[tommytrauma]

WT

The one thing they don't tell you in CPR class is how many times it doesn't work. Most of the time its an exercise in futility.

Good way to catch AIDS, hepatitis, and various other life canceling diseases.

Ask a lot of questions.

What an astounding load of...malarky. CPR is a holding move until more advanced care can be rendered. With the introduction of lay person defib, we're seeing save rates climb dramatically. What are the chances if no one does anything? Even if a 'save' isn't accomplished, CPR increases the window of time for organ donation.

With basic body substance isolation precautions (you can carry a CPR microshield on a KEYCHAIN, and they cost less than 10 bucks), the risk of contracting something from a pulseless, non-breathing patient is lower then the risk of being killed in a car accident on your way home that night. By my rough count, I've worked on hundreds of pulseless non breathers in the past 15 years. Haven't contracted anything yet. Saying CPR is a good way to contract something is right up there with saying that having a gun in your home is a good way to have an accidential shooting.


I'm a Paramedic (NREMT-P), an instructor in several things including BLS and ACLS, and have averaged somewhere around one pulseless non breather call every two weeks for the past 15 years. What experience causes you to run down the idea of bystander CPR?

444, how do you like the tiered response? Are your private guys all medics as well? Do you send an engine crew with a medic on board, or a dedicated paramedic fly car? Do you send both units on everything, or only ALS? Wanna swap t-shirts?

 

[444]

Billy Sparks
I work here: http://www.co.clark.nv.us/fire/firedept.htm Our response area goes from Arizona to the north and California to the south. We cover most of the area that most people consider to be Las Vegas (which is actually in Clark County, and is not in the city) including the Las Vegas strip.

tommytrauma: Yes, the private ambulances are all ALS. At least one paramedic or a nurse. We have both ALS engine companies and paramedic rescues. The goal of the department is to staff every unit on the department at the ALS level. At stations with both and ALS engine and a rescue, the rescue is first out on medicals. Every unit we have is at least ILS including the truck companies.
Sure, I will send you a T-Shirt, PM me with your address.

Think this isn't gun related, I am at work and went on a GSW within the last couple hours.

 

[Ian Sean]

I'm pretty lucky, work pays for all training (Industrial Environment) current CPR, First aid, AED (the new portable defibs) all kinds of hazardous training chemical etc.. confined space rescue and have been to several firefighting schools.

As far as liability. Here in Pennsylvania you are protected by the law if rendering aid and getting sued.

My CPR microshield thingy is in my glove box and there is room in the case for a pair of latex gloves as well.

I will second the motion someone mentioned on being a volunteer EMS or Fireman. I did the EMS thing for about a year and learned a lot (I sadly had to quit because of my wacky shift work rotations) . Training was free and I made many good friends. I worked with a bunch of civic and community minded people that really care. Volunteer Fire and EMS people are the some of the best in my book.

 

[c_yeager]

Just last week i finished my CPR cand AED reffresher course for my workplace. This was the "advanced" course that includes 2 person CPR and a few other things that arent covered in the most basic course. I also got my "first responder" certification through the red cross a couple of months ago. The CPR class was pretty informative. As far as the first aid class i learned a heck of a lot more in boy scouts. I wont say it is by any means useless but really dont expect to learn anything that you most likely hadnt already figured out, mostly common sense.

And Tommy is absolutly correct. CPR isnt used to "bring people back" like in the movies. The entire purpose of CPR is to keep "hold" a person long enough for medics to provide advanced care (defib). The idea is to simply buy time before brain damage starts occuring. The part of CPR class that i think would be most valuable was that concerning choking hazards. There is a lot more to it than just the heimlic (sp?). Definatly worth taking and honestly i cant see a down side to learning new things anyways.

 

[mormonsniper]

Great thread folks! Very useful information.
444,
How about some more useful stuff like, what would you carry if you wanted to have a minimal GSW first aid kit? Something to plug entry and exit wounds while the medics are on their way. Sunken chest (sorry, old Army terms) wounds and so on. What caliber tampons should we carry? Plastic wrap? Kidding... sorta. Seriously though, a very good kit would be good to have at the range or at an "altercation".

Mormonsniper

 

[444]

Well, the thing about trauma is that "it is a surgical disease". There really isn't a whole lot you can do about it in the field. For example, you seem to be talking about a gunshot wound to the chest. Yeah, you can bandage it to stop the external bleeding, but the primary life threatening problem is inside the chest; which we can't do anything about. So, about all you could do for a GSW to the chest is to cover the holes with a non-porus dressing. If you had plastic wrap, that would certainly work. From a practical standpoint, you need to wipe off the blood on the chest to get tape to stick to the skin. Then tape the dressing on three sides only. When the patient inhales, it will suck the plastic into the wound. When the exhale, the open side of the dressing will allow air to escape that would otherwise be trapped in the chest. The chest cavity is air tight. When you breathe you diaphram flattens out and creates a vacume that causes air to be inhaled. When the chest wall is open to outside air, this vacume will suck air into the chest cavity. This air takes up space and doesn't allow the lungs to fill to their normal size which means that you won't be getting enough oxygen which is further compounded by the fact that you don't have as much blood cirulating to carry the oxygen due to the GSW/Bleeding. This is called a pneumothorax. If this is allowed to continue, the air inside the chest cavity will produce pressure against the big blood vessels and the heart which is a very bad thing; this is called a tension pneumothorax. Even as paramedics there is only a little more we can do; put the patient on high flow oxygen, start two large bore IVs and if the patient appears to have a tension pneumo, we can needle the chest to relieve the air pressure. The main thing is to get them to a trauma center ASAP, this is far more important than any treatment we can offer.

 

[Billy Sparks]

444, do you have any experience with stuff similar to TraumaDex or what ever the stuff is called? It is a powder that you pore into a wound and it helps it clot (for lack of a better term). I talked to one of my members who is a OR nurse and she hasn't heard anything about it. I know local EMS doesn't know anything about it. My guy feeling is that it is a not a very useful item but a lot of marketing hype.

 

[OEF_VET]

Like several others here, I recieved most of my first aid training in the Army. Since then I've also attended a Red Cross CPR/AED class. It's always good to know how to save another persons life. You never know who'll need saving.

 

[goalie]

I am an RN in the critical care float pool of a large inner-city hospital. I work often in the ER. I see too much stuff to want to treat anyone outside of the hospital, but I do have a nice EMT bag in my car for "just in case" scenarios, especially when my wife and I are out of town at the lake cabin. I am not too sure that I would treat someone I shot. I would use my lack of protective barrier devices (gloves, mask etc.... they would be "lost" in the commotion after the shooting) as a legitimate reason to not deliver emergency care to any scumbag who attacked me or my family.

 

[mormonsniper]

An emergency CSW kit could be used to help a friend at the firing range or an innocent bystander. I was kinda serious about using a tampon like device to at least stem the flow of blood out of the body. Long ago in the Army we were trained to use a sheet of plastic to seal up chest wounds as 444 covered.... So Goalie, what is in YOUR bag? Can anyone provide a list of items that would help in the case of a GSW, simple stuff that anyone can use, even on themselves? How about just some recommendations?

 

[444]

goalie: I believe that the idea is keeping some kind of first aid kit for injuries recieved by friends, families, or maybe at the local range.
Billy, I don't know anything about it. Somewhere, I heard something about it. It might have been on television somewhere.

As far as a first aid kit, I would just go with something simple. I personally don't have a first aid kit and have never needed one, but if I was going to put one together for myself I would probably have some 4x4s, waterproof tape, bandaids, OTC pain relievers, Benedryl, some type of CPR faceshield, latex gloves, kerlix; stuff like that. There really isn't a whole lot you can do for a critical trauma patient outside the OR, so there isn't much stuff to carry. I hesitate to get into all this in much detail because in our society you are always at risk for liability etc.

 

[Paul Gomez]

I'm a big believer in having a small, simple traumatic injury kit with me whenever I'm training and no farther than my vehicle regardless of what's going on.

The simple & easy route is to pick up one of Ian McDevitt's kits from www.realfighting.com. I think they go for less than $20 (vacuum packed Blood Stopper, gloves, cravat & two gauze rolls).

The Battlepack from QuickClot is another option. It's slightly larger and contains a packet of QuickClot, an Israeli filed dressing & two gauze rolls in a cordura nylon pouch designed to fit a BDU cargo pocket. There's space to add items also. Mine was retrofitted with a one-hand TQ, petroleum gauze, 4X4 pad, gloves & a cravat.

TraumaDex has been less than impressive according to most reports. QuickClot has preformed very well, as long as the directions are followed.

There was an article in SWAT a few months back by Ralph Mroz dealing with a tac med class put on by Bill Lewitt. Lewitt also has some small kits for sale.

 

[tommytrauma]

Billy Sparks

444, do you have any experience with stuff similar to TraumaDex or what ever the stuff is called? It is a powder that you pore into a wound and it helps it clot (for lack of a better term). I talked to one of my members who is a OR nurse and she hasn't heard anything about it. I know local EMS doesn't know anything about it. My guy feeling is that it is a not a very useful item but a lot of marketing hype.

My service looked into hemostatic dressings like traumadex and Quik-Clot, and ended up adopting traumadex. I've only used it twice, but have been impressed with it both times. I spoke in depth with medics on the St. Paul FD who have used it more extensively, and they back up my impressions. I'm glad to have it on the rig, but really wouldn't feel underequipped if they took it away tomorrow. I carry an extensive personal kit, but I haven't bothered to put any in it. Instead of spending money on something like that, you're better off spending it on 4x4s, a couple of trauma dressings and a SAM splint.

Quik-Clot has a slightly better track record at controlling hemorrhage, but it also produces an exothermic reaction, badly burning viable tissue. Worth it with massive, I mean massive trauma, but not for 99%+ of what you'll see. Almost all bleeding can be controlled with direct pressure, pressure points and elevation. Things to remember are never to pull the dressing off the wound (resist the temptation to look and see if it's stopped), assess your whole patient, not just the wound, and prioritize. Scene safety before airway before breathing before pulse before even bothering to look at the hole that's leaking so much blood.

Mormonsniper, GSW's can be treated with a couple of field dressings. Any hole in the chest ( a hole in the belly is a hole in the chest until proven otherwise) should be sealed with an occlusive dressing, but the package off a field dressing or blood stopper works fine. Exit wounds from chest wounds also get occlusive dressings. If you want to spend the money, Ascherman dressings have a built in valve meant to mitigate the severity of a pneomothorax, but taping three sides of any plastic cover is almost as effective. Duct tape works better than medical tape. Any used bookstore will have a shelf full of EMT textbooks, all of which will cover occlusive dressings.

 

[Tim Burke]

goalie writes:

I am not too sure that I would treat someone I shot. I would use my lack of protective barrier devices (gloves, mask etc.... they would be "lost" in the commotion after the shooting) as a legitimate reason to not deliver emergency care to any scumbag who attacked me or my family.

444 writes:

goalie: I believe that the idea is keeping some kind of first aid kit for injuries recieved by friends, families, or maybe at the local range.

Actually, the original poster suggested the possibility of treating "the aggressor." I don't think it is necessary to have a "legitimate reason" to not deliver emergency care to someone you just shot, as it is virtually impossible to do it safely.

tommytrauma writes:

Scene safety before airway

Bingo!

 

[atk]

Tim,

I (as the original poster) whole-heartedly agree that it's virtually impossible to treat the agressor safely. That being said, I really don't want to kill anyone, so if it is safe, I'd think about treatment. Additionally, it can't hurt to tell the jury, "Yes, I tried to treat him/her, but to no avail."

In the end, though, if it's not safe, treatment will be withheld (as tommytrauma put it: scene safety comes first).

--
atk

 

[Spieler]

What a timely topic as I just renewed my CPR/AED/First Aid certification with the Red Cross. This time I was fortunate enough to have my employer foot the bill. Since high school I have tried to stay current and even took the basic EMT course...just wish I would have stayed current on that! My motivation these days comes from trying to be prepared to treat my children and family if the need should ever arise. Basic first aid and CPR are definitely something that everyone should try to learn if time and moeny permit.

 

[USAFA]

Got to thinking...

Working on putting togehor my first aid kit. One for each car, small one in the bedroom next to the shotgun, and a big one in the basement with the other emergency supplies. Does anyone know where I can find the individually sealed surplus bandages, we were practically tripping over them in Kuwait and now I can't find a one. They're sealed in the thick plastic like MRE's. I just want to pick up a case of field dressings and share them around.
Thanks

 

[444]

Billy Sparks: I haven't forgotten your request for a T-Shirt. I ordered new shirts about six months ago and was waiting to get my new ones. I finally got them within the last week. I am going to be out of touch for the next week while I am at Gunsite. PLEASE contact me next weekend and I will send you several shirts.
The guy that was going around (on his own time) selling the shirts for the union is a friend of mine, so I didn't have any problem expressing my feelings about him taking six months to get them to me.

 

[Paul Gomez]

I'm heading out the door to spend the next three days up at the state pen at Angola for a class entitled "E.M.S. in the Hostile Environment: Introduction to Tactical Emergency Medical Services". It's put on by the Louisiana Tactical EMS Society. Their site is www.latems.org. I'll post a brief review when I return.

 

[asdaf]

Alaska has a course/certification called ETT- Emergency Trauma Technician. It was a 40 hour course similar to the more common "First Responder" but with a different target audience and modified content that would make it an ideal course for the purposes of the people on this site. It was designed to be taught to lay people who were working in isolated areas of the state: fisherman, loggers, USFS, etc. These people were expected to be pretty healthy in general and working hazardous field jobs, so the medicine (illness) side of the course was toned way down and response to trauma was emphasized. Because of the prevalence of anti-bear guns in Alaska GSWs were specifically included.
Unlike the First Responder course's emphasis on meshing with and assisting EMS the ETT spends all of their time learning what is best to do before EMS arrives. No need to learn your way around the back of an ambulance or how to assist on scene if you're never going to be in or on one.
It has been 10 years since I left Alaska, so my information is dated, but at the time that I left we had given complete course content packages to several other state EMS offices that had expressed keen interest in the idea. Ask around with local EMS authorities, especially if you live in the rural northwest, this may be just the thing that you are looking for.

 

[sm]

OOPs , I let my certs expire
This thread a good reminder.
Need to re-supply, my kit used , breather dealie I let other person use...when we switched off I used surgical gloves with a hole punched in them...besides raiding my Dr. buddies office, any good kits available/ recommended? I keep one in my vehicle.