Training

Medicines to keep on hand

One thing that people who prepare for emergencies frequently overlook is medicine for “routine” medical problems. There are a couple of over the counter medications that I consider to be essential. When you are in a situation where medical care is not readily available, these medications can literally be lifesavers.

Acetaminophen: This one is good for pain and for control of fever.

Benadryl: This drug is good for allergic reactions, and also works well as a sedative and sleeping aid.

Ibuprofen: This is a non steroidal anti inflammatory. Anyone who has ever been in the military will tell you that this drug is used by them for everything from headaches to broken bones.

Immodium: Diarrhea is a killer because losing fluids and electrolytes can be dangerous. In a survival situation, take some as soon as the second incident of liquid bowel movement occurs.

Meclizine: This one is sold under many brand names. It’s good for mild nausea and can prevent vomiting. Like diarrhea, vomiting causes a loss of fluids and electrolytes that can be life threatening. It’s best to take this as soon as you feel queazy. If you wait until you are vomiting, it may be too late. Just remember that it can make you drowsy.

I’m sure that there are others I have forgotten. I am open to suggestions on what you may feel is essential.

By Divemedic, ago

New Manual

I just added a new training manual to the Training Manuals page (link at the top of this blog).

The manual is FM 3-39.40 Internment and Resettlement operations.

Take a look at the training manuals. If they are worth a couple of bucks to you, there is a Patreon link at the bottom of the page. If there are manuals you would like to see, let me know in comments below.

By Divemedic, ago

Treating gunshot wounds

This is the written form of a bit of training that I did for the Florida Blogshoot back in March. This is not intended to be a replacement for actual training from a quality instructor. This is a quick summary of what I have been trained to do, trained others to do, and have done during my more than 30 years’ experience as a street medic and educator. This is also not a comprehensive guide to treating gunshot wounds. What this is, is a way to make a difference in a scenario where you are the witness to a person getting shot, first aid, as it were. I hope that it is useful, just as I hope that it won’t be necessary.

You have a limited amount of time to carry out the steps below. A serious wound can cause your patient to bleed to death in less than one minute. If you have the means, practice this skill. You don’t want to have the first time you do it to be when it is needed.

Stop the hazard

When a person is shot, your first priority is to make the scene as safe as you can for yourself, the person shot, and any other rescuers. If on a range, immediately call for a cease fire. If in a violent encounter, return fire. Suppress that incoming, eliminate the others shooting, whatever you need to do to make the incoming fire slack off so that you can get yourself and the victim out of the line of fire and to cover. That includes having the victim fire his weapon at the enemy, if possible.

Call for help. Call 911, call for a medical unit, whatever. You are not gonna want to stay here forever with this casualty. Eventually they will need more care than you can provide. Call for it now.

Quick Assessment

Once the victim is out of the immediate line of fire and help is on the way, do a quick assessment. Where are they shot? How many times were they shot? Are they bleeding? Are the still breathing? If, seconds after being shot, they have already stopped breathing, the OVERWHELMING stats say that no matter what you will do, they won’t make it. Sorry, but those are the facts. Now, if you are not under fire, it doesn’t hurt to do CPR at this point, but if you are in a firefight, performing CPR has just eliminated at least two people from the fight.

If they are breathing, look at where they are shot: the torso, or an extremity? Be thorough. Don’t let the obvious, gruesome wound distract you from one that is less obvious. Don’t overlook the fact that one bullet can leave two holes: an entry wound, and an exit wound. That same bullet can pass through one body structure and strike others. I have seen a bullet pass through a person’s leg, and strike the other leg. Likewise, pass through an arm and enter the chest. Expose the wound area. That means cutting off the victim’s clothes. EMTs are taught to get their patients “trauma naked.” That means strip them down to their underwear (or less, if indicated)

Extremity wounds

If they were shot in an extremity, press a bandage impregnated with a clotting agent (preferably QuikClot, but Celox is also acceptable) to the wound. Press firmly. If the bleeding stops, put a dressing over it, like the Israeli Combat dressing, so that it stays in place. Don’t try to remove the dressing once you get the bleeding stopped- there is a clot there, and we want it to stay in place.

If that Quikclot dressing doesn’t stop the bleeding within 30 seconds, put a tourniquet on the extremity. Quickly. The one that I carry is a CAT. I like them for the ease and speed of use, and I own probably 6 or 8 of these. I have actually used them on people who have been shot, and they work. Place it at least 4 inches closer to the torso than the gunshot wound, if possible. Crank it tighter until the bleeding stops. Yes, it will hurt.

I once treated a woman who was shot 13 times with a 9mm, and had a total of 48 bullet holes in her (some bullets went through both legs). After being shot and left for dead, she crawled to a neighbor’s house and begged for help. I didn’t have enough QuikClot bandages to plug all of the holes, so she got a pair of tourniquets, a handful of trauma bandages, and an air evac. She was rushed to trauma surgery and made a full recovery.

Torso/Neck wounds

If the wound is on the torso (the neck is part of the torso, for this purpose, but the head is not) then you need to be aware of the possibility of air being sucked into the torso. This sets up other problems, so we want to avoid that. Bleeding control is less of a problem, because most bleeding in the torso is going to be internal bleeding that isn’t controlled with pressure or tourniquets.

So in the case of a torso wound, put an occlusive dressing on it. I really like the Hyfin Chest seal. (It comes in packs of two- entry and exit wound, remember?) Just put the center of the dressing on the hole, and press the glue down onto the skin. If the patient has a sucking chest wound, you may have just saved them. If he doesn’t, the occlusive dressing won’t hurt them or make things worse.

The head

So at this point, you might be saying to yourself, “What about wounds to the head?” and that is a great question. Head injuries are tricky, and are even worse when those injuries are caused by high speed projectiles. A gunshot wound to the head is survivable, especially if the bullet doesn’t enter the brain cavity. Many wounds to the face, while disfiguring, are survivable. You can also write a book with all of the things and ways that head injuries need to be treated. I myself have seen a few cases where bullets wrecked teeth, facial bones, and more, but the patient was alive and awake. It can happen.

The main treatment here is to stop the bleeding while making sure that the person’s airway doesn’t fill up with debris: blood, tissue, and teeth can all block the airway and make things tricky. Try to use the Quikclot dressing on facial injuries, keeping in mind that the airway needs to be open.

For God’s sake, don’t use a tourniquet and be careful with the use of pressure because there is a possibility of skull fractures. For that reason, controlling bleeding of the face is a great idea, on the skull, not so much. A person isn’t likely to bleed to death from a skull injury. If a bullet has hit a major artery in the skull, they are more likely to die from other things than they are from blood loss.

As usual, my disclaimer: I have no profit motive or stake in the products that I recommend here. The only reason that I recommend them is because I use them and consider them to be quality products at a reasonable price. I don’t make any money if you buy them, nor does anyone that I know, to the best of my knowledge.

We in the medical field have a tendency to criticize and critique. Before any of my medical brethren take a crack at this post, I ask that you do a couple of things: Review the recommendations of the Committee on Tactical Combat Casualty Care (CoTCCC) and the National Association of Emergency Medical Technicians. They are two of the leading agencies for prehospital care of trauma victims.

QuikClot impregnated Combat gauze is recommended by the CoTCCC and the NAEMT as the first choice for hemostatic dressing of uncontrolled hemorrhage. Celox Gauze & ChitoGauze may be used if Combat Gauze is not available. They worked as effectively as QuikClot Combat gauze in laboratory testing, but neither ChitoGauze nor Celox Gauze have been tested in the USAISR safety model. Chitosan-based hemostatic dressings have been used in combat since 2004 with no safety issues reported.

Since the two largest bodies recommend the use of QuikClot as the first line clotting agent, that is what I recommend when I conduct training.

Remember also that medical doctors and nurses don’t think like prehopsital providers because they aren’t. What happens in the field, especially in situations where bullets are flying, is a completely different kind of medicine than what happens in a hospital.

By Divemedic, ago

Blinders

Watch this video here and see how they are all focused on the small alligator and totally miss that they are being stalked by a ten foot one that they didn’t even see.

The woman says she was born and raised in Coral Gables and therefore knows Florida wildlife. Coral Gables is a large city attached to Miami. She is a city girl and obviously knows Jack Shit about wildlife.

I grew up playing in the woods and swamps of Florida. We were taught to not stand near bodies of water like that. Gators are at the top of Florida’s fresh water based food chain for a reason.

This is a great example of how people walk around with blinders on and easily forget that there are predators everywhere.

By Divemedic, ago

Child, felon, killer

News in the Orlando area about two kids, ages 14 and 12, who committed a burglary, stole some guns, then engaged in a shootout with responding police. The two kids ran away from a local foster home, the Florida United Methodist Children’s Home. The home has a history of trouble, with the police responding there as many as 200 times a year. In March, one of the foster kids residing there beat and murdered one of the home’s security guards.

The pair used a shovel, a crowbar and large rocks to break windows to break into the home, where they then used baseball bats to destroy furniture, toilets and a tub. They soon located the homeowner’s guns — an AK-47, a pump shotgun, and a handgun, along with 200 rounds of ammunition.

The older one, a girl, was recorded saying, “I’m gonna roll this down like GTA.” They fired on police for over 90 minutes while police tried to negotiate. Police finally returned fire, striking the girl in the chest. Video of parts of the shootout can be found here as well as here.

The 14 year old girl has been arrested for stealing puppies in 2018 and for setting several fires when she was at another facility in Flagler County. The 12 year old boy has been in foster care since 2016 and just a month ago threatened “to kill a student and spread his guts all over the bleachers” while at school.

Both of them now face felony charges of attempted first-degree murder of law enforcement officers and armed burglary. Sheriff Mike Chitwood has this to say about the juvenile justice system:

“The brainiacs in Tallahassee, they want to do this restorative justice stuff. They need to take a deep look and say, ‘Something’s not right here,’ because where the rubber meets the road, these kids are killers. They’re capable of killing. This juvenile citation (expletive) that you hear from these faith groups, they need to worry about what’s going on in the pulpit in their church, not worried about what’s going on on the (expletive) streets when you have 14-year-olds and 12-year-olds arming themselves,” Chitwood said.

I have layers of security. Cameras. Alarm system. Gun safe. All of it is designed to prevent amateur attempts and slow down more professional attempts. Please secure your weapons in a safe. Even a cheap gun safe would have prevented the teens from accessing the weapons, and one can be had for less than $150. If long guns won’t fit in a small safe, remove the bolts from the long guns and lock THEM in the safe.

By Divemedic, ago

Press supports weapon sales

The quote of the day comes from Rolling Stone magazine:

“When safety is on the line, you want the absolute best product in your hand” 

Of course, they aren’t talking about guns. The funny part is that some of their advice can get their readers tossed in jail. One of their quotes:

A stun gun, Angorn explains, is an easy — and legal — way to carry protection without having to carry an actual weapon.

So a Taser isn’t a weapon? This would reinforce the belief of some people that using a Taser on someone isn’t really that big of a deal.

Their “weapons expert” is an idiot. Some states, like Florida define a stun gun thusly:

“Electric weapon or device” means any device which, through the application or use of electrical current, is designed, redesigned, used, or intended to be used for offensive or defensive purposes, the destruction of life, or the infliction of injury.

“Dart-firing stun gun” means any device having one or more darts that are capable of delivering an electrical current.

This becomes a problem when you look at the laws concerning the carrying of electric weapons:

(b) A person who willfully and knowingly possesses any electric weapon or device, destructive device, or other weapon as defined in s. 790.001(13), including a razor blade or box cutter, except as authorized in support of school-sanctioned activities, in violation of this subsection commits a felony of the third degree

I am assuming that the readers of Rolling Stone are not any more familiar with the maze of laws concerning the carrying of weapons than are the people who advise and write articles for them.

By Divemedic, ago

Training materials

BCE has a post about training manuals. Please remember that the link at the top of this page, labelled “Training Manuals” has a lot of pdfs, including copies of The Soldier’s Manual. Now, some of them are worthy of buying in hardcopy, and I would use his link to do so (might as well have him get some coin out of the deal). But there are plenty of training manuals and technical manuals on that page, and I will add more to them as I get time.

By Divemedic, ago

First aid

Yesterday at the blogshoot, we did a bit of training on gunshot wounds. Several people in attendance asked me to do a post on the contents of a first aid kit. Let me start by saying that the way paramedics can tell the new guy from the experienced medics is in the amount of gear they tote around. Medics, fishermen, and gun owners have a trap that they commonly fall into, and that is the tendency to buy tons of gimicky crap when it comes to equipment.

Remember that serious trauma is first and foremost a surgical emergency. Trauma patients don’t need a tricked out first aid kit- they need a trauma surgeon. All they need you to do in the field is keep them alive and prevent them from furthering their injury until they can get on the operating table. So with that in mind, I take a minimalist approach to trauma first aid equipment. Please see the end of this post for disclaimers and conflict notice.

First aid kits that are filled with bandaids, sting ease, and other supplies are not good for this sort of work. Sure, I have one of those in the car, but band aids are not going to do you any good with a serious injury. Likewise, don’t get one that has suture kits and everything else, because you aren’t gonna need that and will likely screw it up anyway. Remember: simple. minimal. Stay in your lane.

The basics:

A pair of trauma shears. Most often used for cutting off your victim’s clothes. Don’t bother with the ones that have built in carabiners, bottle openers, glass breakers, or any of that other nonsense. You will likely throw these out once they are soaked in blood, so don’t waste a lot of money on a tricked out pair.

A compressed space blanket. Trauma patients need to be kept warm. After you treat them, wrap them in one. I used to keep the back of my unit heated to 90 degrees for trauma patients. Since we can’t do that, a space blanket is a great way to help with that.

A couple ( 2 or 3) packs of gauze soaked with a clotting agent. QuikClot is best, any of the other commercial alternatives (Celox for example) are acceptable. Many doctors will trash talk QuikClot, but every time one has told me that, the only reasons they can give are anecdotal. The plural of anecdote is not data.

A quality tourniquet. I prefer the CAT. Try to get one with the NSN number printed on it, that way it is more likely to be MilSpec and not a Chinese knock off.

A nasopharyngeal airway with a pack of KY to aid insertion.

An Israeli combat bandage. I like these because they can also be used as an ACE bandage, or (in conjunction with a triangular bandage) to stabilize arm/shoulder injuries, and other uses. Use your imagination.

A Hyfin Chest seal.

A pair or three of exam gloves.

If you don’t want to assemble a kit piece by piece, this is a good one. I just throw out the cheap tourniquet, then add a CAT, a Hyfin kit, and that handles most of what you will need in an emergency.

I follow the CoTCCC (Committee on Tactical Combat Casualty Care) Guidelines (see below) very closely and have designed trauma kit around them. All of the trauma treatment training I conduct is based on those guidelines.

Tactical Combat Casualty Care (Pronounced “T-Triple C”) is a set of guidelines developed by USSOCOM (United States Special Operations Command) to properly train non-medics to deal with the preventable causes of death in the field. With that in mind, remember that the single most important piece of gear that you have is the knowledge that you carry in your head. Seek out and get some training. Do not attempt to do any of this or use any of this stuff without knowing what you are doing.

Supporting documentation from the National Association of EMTs:

Basic Management Plan for Care Under Fire

  1. Return fire and take cover.
  2. Direct or expect casualty to remain engaged as a combatant if
    appropriate.
  3. Direct casualty to move to cover and apply self-aid if able.
  4. Try to keep the casualty from sustaining additional wounds.
  5. Casualties should be extricated from burning vehicles or buildings and moved to places of relative safety. Do what is necessary to stop the burning process.
  6. Airway management is generally best deferred until the Tactical Field
    Care phase.
  7. Stop life-threatening external hemorrhage if tactically feasible:
  • Direct casualty to control hemorrhage by self-aid if able.
  • Use a CoTCCC-recommended limb tourniquet for hemorrhage that is anatomically amenable to tourniquet use.
  • Apply the limb tourniquet over the clothing clearly proximal to the
    bleeding site(s). If the site of the life-threatening bleeding is not
    readily apparent, place the tourniquet “high and tight” (as proximal
    as possible) on the injured limb and move the casualty to cover.

Disclaimers and conflicts:

I have no financial conflicts to disclose, other than the fact that I do make money for training people in various aspects of trauma and medical care. I do not have a financial stake or interest in any of the products mentioned or linked in this post.

This post is not a substitute for training, knowledge, or does it imply that you should practice any of the techniques on this page without the necessary training, experience, and clinical judgement to apply these techniques. The writer assumes no responsibility for anyone who attempts to practice any of the actions on this page without first receiving training in the use or application of any of the procedures mentioned on this page.

By Divemedic, ago