I went back to Gunsite in Northern Arizona, so it was a trip to the range, but I didn’t do any shooting, so it was only kind of a trip to the range. And no, it wasn’t because of that stupid restraining order. I went for their three-day class in Tactical Medicine, which is really a class in emergency trauma first aid, with an emphasis on wounds from gunshots and explosions.
Why would I do such a thing? Several months ago, I was upgrading my gear for their shotgun class, and bought a very nice battle belt from Armored Republic (seriously, its really nice), and they had a kind of throw-in sale on their IFAK with supplies (individual first aid kit), so I bought one as well as a tourniquet. When I cracked open the IFAK, I realized I had no clue how to use almost everything in it, and could probably use something more than a YouTube on how to use the tourniquet as well. First aid classes that cover much more than CPR are really hard to find, but Gunsite has this class on Tactical Medicine, so off I went.
The class is a mix of lecture and hands-on. But what makes this class exceptional is the instructor, Dr. Temerlin. He’s boarded in internal medicine and emergency medicine, and was in the Navy for 22 years as an emergency physician working with Marines and SEALs (he’s a Marine at heart, even though he’s technically Navy), with 6 tours in Iraq and Afghanistan in some of the worst hellholes they had to offer (such as, for example, Nawzad). How it didn’t break him, I don’t know, but I got the impression it came close. He’s just the nicest guy, and I can’t imagine there is anyone in the world more qualified to teach a class like this.
The class was structured around the M.A.R.C.H. algorithm used by combat medics:
Massive Hemorrhage
Airway
Respiration
Circulation
Head/Hypothermia
You go through the algorithm in that order, and when you get done, you do it again in that order. I won’t even attempt to summarize everything I learned, not only about emergency trauma treatment, but about how abysmally prepared the military was, how it is already backsliding from what was learned, how you will react in a combat or similarly stressful situation, and so on. A few things to pass along, though:
Tourniquets. These have been around for thousands of years, and we seem to forget what we know about them between active conflicts. They won’t cause amputation, they don’t need to be loosened every so many minutes, etc. A sufficiently massive hemorrhage (either the stereotypical spurting artery or the probably more common flowing venous hemorrhage) can kill in 90 seconds, which is why its first on the algorithm, and why you should pack your tourniquet for rapid deployment and periodically check on it and practice with it.
There are several kinds of tourniquets on the market. The CAT is the most common, and a fine choice that nobody will argue with, although the Velcro on it was prone to getting in my way at the worst times. The RAT tourniquet is controversial and not approved by the CoTCCC (the official body for such things), but it works and I found it easier to put on consistently, especially one-handed. There is some doubt about how well the RAT will work in extreme cold, or how long they will last in your kit in extreme heat. I have both now. Dr. Temerlin told us, if we had a SWAT-T tourniquet (I did), it should be thrown away (which I did).
Wound Packing. Get the clotting gauze, not the powder (which is useful only in a narrow range of wounds), as well as regular gauze. The clotting gauze is apparently a miracle worker. Where (other than YouTube, EMS training, or, well, Gunsite) you might get training in wound packing, I have no clue. The class had silicon blocks with wounds, including one with a “vein” of rubber tubing with water pumping through it, to learn on. The Israeli pressure bandage was recommended as the wrap once the wound is packed.
For wounds that didn’t need packing, or couldn’t be packed (mainly scalp wounds), we had a nifty gizmo called an ITClamp that we learned to use.
Airway Management. We learned this on a couple of practice dummies – head placement, and insertion of nasopharyngeal tubes (surprisingly easy) and the down-the throat Igel tubes (also surprisingly easy).
Chest Wounds. We also learned how to deal with sucking chest wounds using chest seals, and even how to handle a pneumothorax (one side of your chest begins filling up with air which, unlike a sucking chest wound, can’t escape). These are apparently on the short list of preventable causes of death, and are handled by punching a catheter through the chest wall to bleed off the pressure.
Burns and Broken Bones. We also covered field treatment of burns and broken bones, with some nifty portable all-purpose kinds of splints (one of which can also be used to make a C-collar to stabilize the head if you have a neck injury).
I believe I am most likely to use this training if I am first on the scene at a car accident. Which has happened to me twice, three times counting the accident I was in (fortunately, no major injuries at any of them). I’m currently building my car kit for emergency trauma, which will have everything referred to above, on the theory that I won’t be able to live with myself now that I know how to use it, but somebody dies in front of me because I was too cheap to buy the gear to do it right. As an aside, if you are looking for an IFAK, the one from Armored Republic is first-rate – everything you need and can practically carry on your belt, and no fluff (except the SWAT-T tourniquet).
My IFAk, which lives in my car until I get the full kit built out. The CAT tourniquet attaches to the side.
The class finished with three scenarios, with moulaged role players and everything. I’m not going to tell you about them, because Dr. Temerlin was very clear that they need to be done “cold” to get the maximum value from them, and I’m hoping some of you take the class. You have to make a lot decisions very fast in a highly stressful situation, and I can tell you from doing just these staged scenarios, you will second-guess yourself relentlessly.
If you have any interest in being trained to respond to an emergency trauma situation, I can’t recommend the class enough.
you will second-guess yourself relentlessly
Get out of my head!
Did that Moulage have any rouge ?
Friend of my dad was a Vietnam combat medic in the Marines aka Doc. It did break him. Struggled with alcohol and relationships. Mostly better now, but still dealing with the PTSD.
Mr Dean,
Sorry you haven’t gotten more interest, but thanks for writing it up an I thought it interesting.
Thank you for the article.
Much to take in here.
RC, I need your email address. In case of an emergency I’m emailing you.
A few years ago when I fell down the first thing I checked was to see if there was any bleeding. No blood so I had to figure out what to do. Fortunately I was only 50 feet from the house but still took 15 minutes get back and inside.
When I read that “most accidents happen within 5 miles of home” I decided it was time to move.
“Mic drop”
HEY YUFUS!
Tall Cans from the (216)
Cheers from the 619!
Tall Cans!
HELP! I’ve fallen and I can’t get up! featured in LifeAlert’s 1987 Commercial
The acting is what makes it so believable.
The stuff we learned in the army was rudimentary compared to what you went through. Thanks, good article.
I was just going through my bug out bag, and that kit looks perfect.
Great writeup,
Cheers
It’s got a tourniquet, clotting gauze, regular gauze, an Israeli bandage, chest seals, combat tape, gloves, a naso-tube and lubricant, an emergency blanket, and combat shears. The pack attaches with Molle straps, but has a tear away Velcro thing. I lucked into a nice one.
112$ plus shipping, will order, thanks!
The CAT tourniquet is separate. They sell those, and a pouch for it that Molles onto the side of the IFAC.
Excellent write-up, counselor.
Poking around to see if anyone offers such training a bit closer to home.
There are some excellent medical trainers who travel the country. I can personally recommend Dark Angel Medical (https://darkangelmedical.com/) and Caleb Causey/Lone Star Medics (https://www.lonestarmedics.com/about/).
Also, if nothing else you could look at a Stop The Bleed class, either in-person or online. https://www.stopthebleed.org/
Also also, Greg Ellifritz/Active Response Training teaches an excellent medical class that focuses a little less on battlefield injuries, and a little more on medical care under austere conditions (no hospital, no ambulance, no wound management protocols.) Greg is also probably the single smartest person in the gun school industry. He’s had some nasty health problems in the past few years, so I would prioritize training with him if at all possible.
https://activeresponsetraining.net
If you’re not reading his blog, you’re missing a lot of really great knowledge.
(Jesus, can you tell I haven’t had my coffee yet?)
Added to favorites list. Thanks, NA. Looks like he’s doing his first aid class at various places around the country.
RC, I would love to take some of the classes you’ve written about, but Ohio is a fur piece from Arizona.
Take two weeks, schedule back-to-back classes. With luck you could get carbine, rifle and shotgun all in one go.
I mean, carbine, handgun and shotgun all in one go.
Sorry for the late sign in, I really enjoyed the article. I remember the joys of first aid class, that is first aid on steroids.
he’s a Marine at heart, even though he’s technically Navy
Corpsmen for the Marines have always been sailors.
Quite a few of them are Marines at heart.
Indeed. I had the privilege of working with a number of different marines with their attach naval support over the years. Doc blended right in, except for the US Navy tag on their BDUs, er cammies.
Very interesting RC. I have long shied away from anything medical. But I admit this sounds interesting.
It seems similar to what we learned in the Marines, only your was more intense.
I have a basic IFAK in all my vehicles, but no tourniquets.
Need to rectify that.
Thanks for the article, really good stuff.
Excellent article, brother Dean.
Dang Mexican Sharpshooter – can’t believe I’m older than you.
This article reminds me I picked up a few items from Solatac.com a few weeks ago. Been on the list of needed backup items for a while. Nice small business run by some crazy midget offshore driller/medic I follow on twitter and his wife.
Got their Diplomat Kit, the backpacker kit, solid color BOK (filled), and a koozie ;p
Think I may still need to pick up a one handed/bar tourniquet though.
I took CLS years ago before it became de facto basic first aid for every swinging dick. A number of the things taught were acceptable in a military setting but went well beyond what a lay civilian rescuer could do or still enjoy Good Samaritan protections.
Very much this. Chest darting someone to relieve a tension pneumothorax is practicing medicine without a license, full stop. Still handy to know how to do, but I don’t think I’d try it on anyone except myself. Inserting a nasophangeryal airway is a question mark. Be cognizant of your local laws!
Consult your local laws, and your conscience, of course. This stuff is all “If I don’t do it, they will likely die”, after all.
Great article. It sounds like you went through a good and thorough version of Combat Lifesaver Training. Your training topics are the same and your kit looks almost exactly like their aid bag. I found CLS to be a very worthwhile course. In SF we got some decent training in the course, but it was up to the ODA medics to cross train us and boy did they.
There is no downside to getting the training. So good on ya!
I’m pretty sure Dr.Temerlin was involved in developing the CLS training.
Somebody mentioned Good Sam laws. We have a pretty good one in AZ, but I have hard time with saying “Well, Ima watch them die on the off chance I might catch a lawsuit.”
Cool. Thanks for the write up.
Many moons ago I was an EMT-D in the Tacoma/Puyallup Washington area.
Gun shot wounds are no fun.
Any projectile based trauma is no fun. Short of artillery/mortar/IED fragmentation one of the worst is an old round lead ball hitting bone. Modern ammo tends to cause splinter type wounds. An old round ball or minnie ball turns a major bone into a half inch to inch of bone meal between two segments of relatively intact bone. It is very time and hardware extensive to put back together with modern medicine, in the old days it was a quick reach for a surgical saw.
And hopefully some whiskey.
Thankfully, I never had to deal with the exploding stuff.
Did get to work with some of the boys out of Madigan Army hospital, which is (was? Don’t know if it is still there) on Fort Lewis.
Some of those MAST pilots were very brave. They’d land just about anywhere.
JBLM 🙄
Thanks for the article. I always seem to be stumbling into other people’s first aid crisis and would probably end up using this training if I got it. Something I should probably consider. As my dad is happy to remind all Marines, Marines fall under the department of the Navy. He once said “the Marines are just a division of the Navy” to my cousin’s husband at a family function. The cousin’s husband responded gruffly “yeah, the men’s division.” Haven’t heard it from my dad since.
I don’t need guns. My First chakra when channeled into an energy pulse can punch a hole through a whale.
I don’t need to be first, as long as I’m last, thanks guns!
When I’m First, I’m always last. There’s nothing else that comes after that matters.
Also, from the IFAK ‘supplies’ link – “…a plethora of important first response tools.” Nice call back to the afternoon links.
Good morning, my combat prepping peeps!
😲🌞☕
Let’s go with some more mellow music this morning.
https://m.youtube.com/watch?v=_mDxcDjg9P4
🎶🎶
Good morning, Sean!
I can live with more prepping for the end of the world.
But we need more prepping to be First.
I don’t need a battle belt…I don’t need a battle belt…
“If you read most first aid guides, the last step in treating someone who’s gotten injured or sick is always: get the victim to professional medical help.
“But what if you found yourself in a situation where hospitals were overcrowded, inaccessible, or non-functional? What if you found yourself in a grid-down, long-term disaster, and you were the highest medical resource available?”
https://podcasts.apple.com/us/podcast/the-art-of-manliness/id332516054?i=1000652719531
Look for a priest instead? 😕
“and you were the highest medical resource available?”
Right away I see a serious problem.
Finds the bottle of whiskey, takes a drink, looks at the injured, takes another drink.
Gee, you could at least offer some to the injured person.
Contact a lawyer and draft some liability waiver forms.
I went to a Catholic high school. On the back of our ID cards it said ‘in case of accident, call a priest.’ we scratched out priest and wrote ambulance.
Finally a good use for Axe Body Spray.
https://www.wsj.com/lifestyle/axe-deodorant-spray-sheep-rams-fighting-9283eaad?st=bnbuyxvzonk8i35&reflink=article_gmail_share
::suffers flashback to stepson’s overuse of same::
I bet that’s the foul flavor they all wear. 🤮
😒
Barely made it to the office before start of shift.
That’s what I get for waking up at the time I’m normally leaving the house.
Yikes! At least you made it!
If you didn’t have time to pick up breakfast…does any place nearby deliver?
I had time to pick up a breakfast salad.
Now I just have the problem that wednesdays are when the noisy people are in the office.
😖
Stay classy, Rio.
https://www.dailymail.co.uk/news/article-13317919/woman-wheels-corpse-bank-loan-staff-dead.html
There seems to be a lot of that going around. Is it trending on TikTok or something? A remake of Weekend at Bernie’s in the works?
It was a sloppy attempt for sure. In her defense she was in a hurry to get to the speedboat because she was being chased by a mafia hitman.
“Supercharged Spying Provision Buried In “Terrifying” FISA 702 Reauthorization”
https://www.zerohedge.com/political/supercharged-spying-provision-buried-terrifying-fisa-702-reauthorization
It’d be nice to prevent this kind of craziness but I fear the ship sailed long ago. A society that lives via social media and conducts social introductions via dick pic or the female equivalent just doesn’t care about privacy.
The provision is there to make legal something they are already doing.
Trash panda commando training:
https://twitter.com/buitengebieden/status/1779761467132153944
Those things are a laugh riot. Our ancestors really should have domesticated raccoons instead of cats.
There is debate on if cats even fit the definition of domestication. More of a symbiotic relationship with our overlords.
Racoons don’t cull rodents out of the grain stores.
🦝He identifies as an otter 🦦 but couldn’t find a muddy river bank! 😄
It must be nice to be able to fall from several times your own height without injury.
Mrs OBE and I like to rewatch a show after we finish a season so see the story from ‘what we know now’ perspective and to see if we missed something early on. Fallout definitely needed a second time around. There were some small details that helped fill out the characters or world building a bit more because they were so subtle.
I HAVE NOT YET BEGUN TO FIRST
Bwahahahahaha – sound familiar?