Is emergency medical training on your New Years Resolution list?
The likelihood of needing emergency medical training is much greater than needing your firearm
Have you taken a Stop The Bleed class?
With the start of the New Year, we were once again reminded of the threat of vehicle borne attacks with the incident on Bourbon St in New Orleans. While the totals have been adjusted, at this time most report 15 people lost their lives with 35 more injured. According to the publicly posted timeline, the terrorist drove off the road into the crowd at approximately 3:15 am. After striking dozens of people he crashed into a large 'hi-lift' (manlift) machine, exited then engaged law enforcement in a gun battle. It was over by 3:17 am.
Two minutes. Nearly 50 casualties, with the terrorist very clearly dead and dozens if not hundreds of police officers on scene plus more en route. What is more needed here - a trauma kit or your concealed carry handgun? It's not that the gun isn't useful, it's just that the likelihood of needing a trauma kit to help yourself or others vastly outweighs the chances of needing a defensive handgun in most circumstances. Unfortunately, many people don't train or carry the equipment that would save lives. While CPR has become ubiquitous and widely accepted, the top cause of preventable death remains uncontrolled bleeding. I've written about this before, whether it's a man on a bladed attack spree in Massachusetts or an active shooter in the NYC subway system, the need for medical training & equipment is always important.
It's been noted that the most dangerous thing many of us do every day is travel on the road - whether in a car, truck, bus or even bicycle. According to some National Highway Safety Data, there were 5.2 MILLION injuries on US roads - in 2022 alone. Additionally, people suffer all kinds of injuries which result in severe bleeding - heavy equipment accidents, recreational activities, and life in general can result in injuries. The ability to recognize life threatening bleeding then taking aggressive steps to stop it should be a priority for everyone, but especially those looking to protect themselves and others. So what steps are there to stop people dying from preventable bleeding? As with many areas I believe knowledge, skill, and equipment are all required. First is gaining the knowledge on what to do.
First - and no, this isn't just face value - evaluate the scene safety. If you're going to become a casualty yourself by treating someone else, you just increased the problem for other responders. Is it an active threat? Are there other hazards - fire, explosives, hazmat, electrical? Your best option may be to self-extract out of the scene if it's too dangerous. If the injured party is in the middle of the road with traffic still flying by, it's not safe for you to treat them there.
Next, get more help - in the US, either call 911 yourself or if others are around then pick a person and direct them "Call 911". Do not just yell "someone call 911" - pick one person to do it if you're going to start treatment. You don't have to be a cop or firefighter - research suggests that when a person is specifically directed to a simple task, they are much more likely to do it. If you need help moving (ie dragging) an injured party away from a hazard, do the same. "You, help me move him!"
What is life threatening bleeding? Look for steady, heavy blood flow. This includes 'spurting' blood, however with severe bleeding blood pressure drops quickly. Pooling blood is another indicator of large volume bleeding. An adult will have approximately 4.5 to 5.7 liters of blood; a child can have half that, with a circulation rate of roughly 5 liters per minute. Once you lose more than 1.5 liters of blood, bad things start happening very quickly. As the blood pressure plummets, the breathing rate skyrockets and the heart rate increases in an attempt to make up for it. Once you lose over 2 liters of blood, or roughly 40% of your blood volume, the likelihood of survival is near zero. Hence it is absolutely vital to identify life threatening bleeding then aggressively stop it. Once you recognize there is life threatening bleeding, we must address it.
Locate the source of the bleed(s) - yes, there may be more than one, especially in a motor vehicle crash or vehicle attack. In New Orleans when the attack happened at 3 am on New Years day the average low temperature is in the 30's, meaning heavy clothing is going to obscure some injuries. Determine where the injury is, how severe it is, and if it's treatable. The major areas of bleeding are the head, the extremities (arms and legs), groin/juncture areas, and the body (to include the upper and lower torso).
If there is life threatening bleeding from an extremity, immediate pressure (compression) is required to stop the blood flow. This can be from direct pressure, such as folding up gauze/piece of cloth and pushing down on the injury until it stops bleeding. With larger injuries, or even some small ones, it can be more effective to put the pressure directly on the brachial (arms) or femoral (legs) arteries. If direct pressure doesn't work, a tourniquet or wound packing is most likely required. With junction/groin injuries, tourniquets are not very effective - direct pressure and proper wound packing is more applicable. In the body/torso, we have to be careful with too much pressure due to organs we may damage as well as inhibiting the patient's ability to breath. Thus wound packing is usually not advised for torso injuries and we have to rely on direct pressure while we monitor the patient. Severe neck and head bleeding are extremely serious, and unfortunately very difficult to treat without proper high level medical training and equipment.
Next is to apply that knowledge in skill building. A one hour Stop the Bleed course is a good basic introduction to these concepts and provides the equipment to practice with direct pressure, wound packing, and tourniquet use. More advanced classes are even better - FCS adds to the basic Stop The Bleed in the Stop the Bleed Plus class that continues to include additional knowledge, skills and equipment discussion after the standardized STB class. Once you have the training, practice! When I teach active shooter response classes to first responders, the medical portion is near the beginning and everyone has a practice tourniquet issued for the training. Throughout the 16 hour course in various learning blocks, one of the instructors will yell out "you've been shot in (insert extremity here)" or "Your partner was just shot in the (shoulder, torso, etc)". They all must stop whatever they are doing, secure weapons, retrieve tourniquet/gauze/etc and treat the injury. We expect the tourniquet to be properly applied within 20 seconds. This is a good way to ingrain the importance of knowing what to do, having the proper equipment readily available, and be able to put it to use. I incorporate that same drill in with the more advanced firearms training as well.
After knowledge and skill, the proper equipment is needed. Remember that we are preparing for life saving incidents - do not buy the cheap imported medical kit and think that you're good to go. Counterfeit tourniquets are the most obvious and worst choices. I'm trained with and teach the use of the Combat Application Tourniquet generation 7 (CAT-7) and while there are other models out there these are the most widely used - and the most widely copied. Learn to spot a counterfeit tourniquet, and only carry legitimate CAT-7's which are only sold through North American Rescue or authorized resellers. If you're paying less than $25 for a CAT-7, it's not real. The $4/each kits available are ONLY good for training - and should be clearly marked as such. Learn to use the equipment you will carry, but also others such as the SOF-T or the ETQ system which though not approved by the major certification boards has held up quite well in my training classes. In short, don't skimp - the preassembled kits are tempting, but even those should be broken down, gone through, and items updgraded/added/discarded as you need. It is also vital that you have the kit with you at all times - just like a concealed carry gun, it won't do you any good if you don't have it with you. Always.
The top cause of preventable death in the US remains uncontrolled bleeding. Get the knowledge, training, & equipment - then get the mindset to help yourself and others.
Posted: to First Circle News on Sun, Jan 5, 2025
Updated: Sun, Jan 5, 2025
