BF4R

Dis­tinc­tive and Deadly

Recoil - - Beyond Bullets -

What med­i­cal gear do you con­sider the ab­so­lute bare min­i­mum re­quire­ments for daily carry? Why?

KD: As stated above, the very bare min­i­mum equip­ment I would carry would be a tourni­quet and pair of ni­trile gloves. If I could add to that, I would add a small pres­sure ban­dage and a hemo­static agent (QuikClot Com­bat Gauze or Chi­toGauze) and a pair of com­pact chest seals. The difference in wound­ing pat­terns in civil­ian mass ca­su­alty/ac­tive shooter sit­u­a­tions is dif­fer­ent from mil­i­tary sce­nar­ios in that the wound­ing pat­terns in civil­ian set­tings are typ­i­cally tho­racic and cra­nial in­juries. Those ar­eas are typ­i­cally pro­tected with mil­i­tary per­son­nel; thus, their in­juries tend to be mainly deal­ing with the ex­posed ex­trem­i­ties. How­ever, our main em­pha­sis re­mains on stop­ping the hem­or­rhage first and ex­trem­ity in­juries do still oc­cur in the civil­ian pop­u­lace, so our treat­ment al­go­rithm re­mains un­changed.

GS: I would say that there are five trauma kit es­sen­tials: tourni­quet, ban­dage, gauze, tape, and oc­clu­sive seal. These items al­low me to handle the most se­ri­ous life-threat­en­ing wounds that may hap­pen to me (yes, my kit is for me — if I can help other peo­ple then so be it), such as mas­sive bleed­ing or a com­pro­mised chest cav­ity. They also al­low me to handle less se­ri­ous (and more com­mon) in­juries, such as a nasty cut, a bro­ken bone, or a strain/ sprain. If pos­si­ble, I would add an­other five items: shears (5.5-inch are TSA ap­proved), ni­trile gloves, emer­gency blan­ket, hemo­static gauze, and a light source. These ad­di­tional items help me handle the afore­men­tioned wounds and re­duce the risk of shock, which is a se­ri­ous threat in any med­i­cal emer­gency.

How do you carry/con­ceal all that gear on your per­son? Do any of the women in your life (wife/sis­ter/daugh- ter/mother) carry an EDC med kit? If so, how do they carry it?

KD: Where to carry the gear is a very com­mon ques­tion and one that we believe we have the an­swer to through of­fer­ing sev­eral ver­sions of low-pro­file/ low-vis­i­bil­ity trauma kits. Car­ry­ing “enough” med­i­cal gear is ba­si­cally up to the end-user, and it de­pends on what their mis­sion re­quire­ments are. We have an an­kle kit, three very small pocket kits, a flat kit that will fit eas­ily into purses, soft ar­mor, cargo pants, and we have a small belt-mounted kit. For those who want ad­di­tional, off­body carry, we of­fer a back­pack with a pocket specif­i­cally made for a full-size D.A.R.K. (Di­rect Ac­tion Re­sponse Kit) insert and a tourni­quet. My daugh­ters carry Pocket D.A.R.K. Mini kits and Com­bat Ap­pli­ca­tion Tourni­quets (CAT) in their purses and school back­packs.

GS: I carry all of my med­i­cal gear in an an­kle kit, ev­ery day of my life. I chose the AFAK from Ryker Ny­lon Gear due to its abil­ity to carry all 10 of the items that I men­tioned be­fore in a com­fort­able way that is also fully con­cealed. The kit it­self is also very adapt­able to be used around a back­pack shoul­der strap, range bag handle, dog col­lar, seat­belt, tossed in a bag, etc. I fly ev­ery­where with my kit and go into gov­ern­ment build­ings and other re­stricted ar­eas with­out any is­sues at all.

My wife and kids carry the same sup­plies but vac­uum-sealed in a bag that is the same length as an M4 mag and the same width as two M4 mags put to­gether. This al­lows the kit to be small enough to put in a purse or a back­pack, which is how they mostly carry it. I find that a kit put to­gether in that man­ner or setup in an AFAK from Ryker Ny­lon Gear are the two most com­mon ways our stu­dents end up car­ry­ing a kit once they have trained with us. Just re­mem­ber, skills trump tools and tools en­hance skills.

For those with­out cur­rent knowl­edge on how to treat trau­matic in­juries, what’s the best way to seek out a train­ing class? Short of ac­tual train­ing, are there books or web­sites you can rec­om­mend as re­li­able sources of in­for­ma­tion as a primer?

KD: Gen­er­ally, us­ing any search en­gine for the in­ter­net will bring up quite a few classes nowa­days. This wasn’t true sev­eral years ago, but I will add a word of cau­tion that there are a lot of “me too” type classes. En­sure that you vet the in­struc­tors and course of in­struc­tion for these classes. Just like with qual­ity firearms train­ing, qual­ity med­i­cal train­ing will not be cheap. Our classes are na­tion­ally rec­og­nized in that each stu­dent re­ceives BCON (Bleed­ing Con­trol) cer­ti­fi­ca­tion and EMTs or paramedics re­ceive con­tin­u­ing ed­u­ca­tion hours to­ward their re­fresher train­ing.

There are a lot of good books and videos out there that can be uti­lized as a primer or ref­er­ence, like the LEFR-TECC (Law En­force­ment and First Re­spon­der-Tac­ti­cal Emer­gency Ca­su­alty Care) site, the Stop the Bleed (bleed­ing­con­trol.org) site and sev­eral oth­ers. As far as the proper use of the com­po­nents of the kits, one can al­ways source videos from the ac­tual man­u­fac­tur­ers of the prod­ucts on YouTube. As al­ways, a video or a book are not a re­place­ment for a class with “hands-on” train­ing. A great start­ing point is to con­tact your lo­cal hos­pi­tal or Red Cross or Amer­i­can Heart As­so­ci­a­tion and see when and where the next AED/CPR/first-aid class will be held. Short of go­ing to a lo­cal com­mu­nity col­lege and en­rolling in the EMT course, these are some of the eas­ier things to seek out.

GS: Any­thing be­yond a ba­sic first aid/CPR class is go­ing to be help­ful! There are a lot of great places to get train­ing these days; just re­mem- ber to al­ways check the va­lid­ity of what you are learn­ing. For ex­am­ple, learn­ing from some­one who comes from a clin­i­cal back­ground may not be as ap­pli­ca­ble to you if you spend most of your time away from clin­i­cal set­tings. Learn­ing from a com­bat medic who left the mil­i­tary 10 years ago and hasn’t stayed cur­rent on new tech­niques and con­cepts will still be use­ful, but not as use­ful as learn­ing from some­one who is more cur­rent on their in­for­ma­tion and can ap­ply it to your every­day life.

Med­i­cal train­ing is like firearms train­ing — ré­sumés and “been there done that” is nice; how­ever, cur­rent and mod­ern ex­pe­ri­ence is much more help­ful, as is ac­tual teach­ing abil­ity. There are lots of free classes out there, specif­i­cally the Stop The Bleed classes, which are of­ten taught at no cost through hos­pi­tals and com­mu­nity col­leges. There’s also lots of info avail­able on­line via so­cial me­dia and

YouTube, but again, be aware of who you are learn­ing from and where they draw their ex­pe­ri­ence or ma­te­rial from.

In­de­pen­dence Train­ing, whom I work for, has sev­eral med­i­cal in­struc­tors who come from dif­fer­ent back­grounds, giv­ing us a broad spec­trum of in­for­ma­tion and ex­pe­ri­ence to draw from; some of our team are still work­ing in the med­i­cal field. We also have sev­eral con­sul­tants work­ing in the med­i­cal and tac­ti­cal fields and pro­vid­ing us con­stant feed­back, as well. This helps us to make sure we are on the ra­zor’s edge of the most valid, most cur­rent, and most ef­fec­tive tech­niques and equip­ment.

Be­sides car­ry­ing a med­i­cal kit and ob­tain­ing the knowl­edge to use it prop­erly, is there any­thing else you rec­om­mend to help peo­ple pre­pare for re­spond­ing to a mass-ca­su­alty event, should they find them­selves in that sit­u­a­tion?

KD: One of the best things to do, af­ter ob­tain­ing the proper train­ing and equip­ping your­self, is to prac­tice and be­come, as we call it, “sub­con­sciously skilled.” This is prob­a­bly one of the most im­por­tant as­pects of be­ing able to re­act in a pos­i­tive man­ner dur­ing a mass ca­su­alty in­ci­dent. The other im­por­tant as­pect is hav­ing the proper mind­set. Prac­tic­ing with one hand, or the non-dom­i­nant hand, in a sen­sory de­prived en­vi­ron­ment al­ways helps. Think of ap­ply­ing a tourni­quet to your right leg with your left hand in the dark, with gloves on — and the gloves are slathered in hand lo­tion and on a timer.

Per­form­ing these tasks over and over un­til you are do­ing them in your sleep is key to be­ing able to per­form them un­der duress. Learn how your body will re­act to duress and how your prac­tice can help mitigate the neg­a­tive ef­fects of the body alarm re­sponse. LTC Dave Gross­man’s books, On Killing and On Com­bat, are re­ally good re­sources on how the body will re­spond, both phys­i­o­log­i­cally and psy­cho­log­i­cally, to stress.

Tak­ing care of your­self af­ter a crit­i­cal in­ci­dent is paramount, as well. Con­sult a coun­selor as soon as pos­si­ble, hope­fully less than 72 hours af­ter an in­ci­dent has oc­curred. Talk­ing with some­one will help in the heal­ing process. Talk with pre-hos­pi­tal health pro­fes­sion­als about how you can prop­erly in­ter­act with them should you be the first to ren­der aid to a trauma vic­tim and then trans­fer care to EMS. Most im­por­tantly, get solid med­i­cal train­ing, carry top-notch kit, and be pre­pared to use it.

In any trau­matic event, the best thing to you can do is fo­cus on the types of in­juries you know you can help and not the ones you can­not.

The goal is to ren­der fast, ef­fec­tive aid to as many peo­ple as quickly as pos­si­ble in or­der to in­crease over­all sur­viv­abil­ity. Keep your eyes open and your head on a swivel in or­der to in­crease not only the sur­vival rate of your ca­su­al­ties, but your­self also. Hav­ing solid sit­u­a­tional aware­ness can be an in­valu­able tool in in­creas­ing your sur­vival rate and, in this day and age of tech­nol­ogy, it seems to be one in which many are lack­ing. In the end, our goal in teach­ing peo­ple how to help them­selves and oth­ers is all about em­pow­er­ment; be­ing a “by­doer” and not a by­stander.

GS: Aware­ness is not a verb, so merely be­ing aware of a prob­lem isn’t enough. We like to teach our stu­dents the old Sesame Street game of “one of these things is not like the other; one of these things just doesn’t be­long.” Look for peo­ple or things that don’t be­long and then act ac­cord­ingly. Leav­ing the area may be your best op­tion; alert­ing au­thor­i­ties may be pos­si­ble, or per­haps in­ter­ven­ing in a phys­i­cal and/or vi­o­lent man­ner may be nec­es­sary. Start pre­par­ing and prac­tic­ing now on what to do if you find your­self and those you care about in harm’s way: how will you com­mu­ni­cate? How will you move? What tools do you and those who may be with you have avail­able? What tools can you make/im­pro­vise? How can you ex­pect your friends/fam­ily/kids/co­work­ers to re­act in an emer­gency?

Talk with your lo­cal fire and po­lice per­son­nel about what you can ex­pect from them when they come on scene. Write every­thing down once the vi­o­lence has ended and you have ren­dered the best pos­si­ble med­i­cal aid to your­self and ev­ery­one else — what you saw and heard, what you did, what aid you ren­dered and to whom. This kind of in­for­ma­tion can be very use­ful to pro­fes­sional re­spon­ders once they are on scene. Over­all, re­mem­ber that when sec­onds count, help is just mo­ments away — it’s up to you to save you, so pre­pare and train ac­cord­ingly.

CON­CLU­SION

While this ar­ti­cle is by no means a com­pre­hen­sive primer on med­i­cal equip­ment or train­ing, we hope that some of you will heed this as a call to seek pro­fes­sional ed­u­ca­tion on the topic. If you’ve al­ready taken that step, we hope this af­firms your con­fi­dence in that de­ci­sion. Even for those with prior pro­fes­sional ex­pe­ri­ence or re­cent class­room train­ing, do your best to keep cur­rent through what­ever means are avail­able to you. Near con­tin­u­ous feed­back from both the bat­tle­field and the ur­ban jun­gle mean that best prac­tices are con­stantly be­ing re­vised or al­tered. While sink­ing hard-earned coin into a med kit may not be as flashy as cut­ting win­dows in your slide or get­ting a fluted ti­ta­nium ni­tride bar­rel, it’s much more likely to save your life if you ever do need that sweet-ass blaster.

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