Tuesday, July 05, 2011

It can happen just like *that*.

How many of you carry a blowout kit in your range bag? I do.

How many have had formal training in how to use it? I haven't. I need to remedy that. I mean, I have some exceedingly rusty basic first aid training, but it would be nice to get some specifically related to treating gunshot wounds.

Why? This is why.

Did you see how fast that happened? But he kept his head, called 911, and even had himself patched up by the time the paramedics got there. That's impressive. I hope I never find myself in that position, but if I do, that's how I want to react.

47 comments:

Bubblehead Les. said...

Thank you for showing that. I better check my gear and see if there any classes in my area. Also, it might not happen to you, but if it happens to your Range Buddy, and he/she/they doesn't have Blow Out gear with them...

Gregg said...

Yes, I carry a blowout kit in my range bag. I do not have one permanently in the jeep, which I really should. Sadly, my training is rusty and not focussed on gunshot trauma. I need to look again to see if anyone local is offering some.

DirtCrashr said...

The club has a blow-out kit in the med-kit at the range, and a few guys have taken LMS Defensive Medicine. I carry QuikClot in my bag.
Maybe I'll sign-up for the August course. It's heatstroke-hell in Livermore in August, so maybe that's part of the course.

DirtCrashr said...

And JEEBUS that happens fast!

og said...

Many teaching hospitals will let you audit an ATLS course

http://en.wikipedia.org/wiki/Advanced_Trauma_Life_Support

The course doesn't cost a lot, relatively speaking, but you learn a lot about how to deal with extremely difficult situations. You can't "legally" carry a bag, but you'd be surprised how much you can do with a well equipped first aid kit.

Most of the time you have to take a regular first aid/CPR as a prerequesite.

Jake (formerly Riposte3) said...

That's a good reminder that I need to refresh the EMS bag I keep in my car. The bandages and so forth are still good, but stuff like tape and gloves do go bad both with age and from being in a non-temperature-controlled environment. My stethoscope and BP cuff are probably toast, too.

There's a reason my squad radio comes to the bench with me. If something happens - to me or to anyone else - I am the EMT on scene, and the response time from the station to the range is a good 10-15 minutes in light traffic.

Thomas Smith said...

If you've never screwed up with a gun, you haven't owned one long enough. I'm too embarrassed to mention my messups here, but they've happened, and thank god without anything more than embarrassment and minor (personal) property damage to show for them.

Ed Foster said...

My brother used to teach the course at UCLA Medical Center. Actually, he wrote most of the training sylabus the L.A. County EMS people use. And, of course, I've never bothered him for pointers. Stupid.

Let's see, my last course in first aid was back in 1968, and I don't remember much except the pressure bandage and the Navy Corpsman telling me that he used tampons for temporary patches...

Seriously good point here folks, and I'll pester brother Ray for a course date if he's still giving them, or have him find out who is.

Like finding a carry gun to stick in my sock, it's a really necessary part of a citizen's responsibility, and one I've been neglecting for far too long.

Anonymous said...

In addition to carrying an Army issue IFAK in my range bag, I have two cellophane wrapped applicatorless tampons, from OB I believe. At SWCS we learned to control bleeding in extremity GSWs with a rapid application of, preferably, a pressure dressing wrapped tight. The thing you often don't learn in these courses is that most wounds (excluding arterial, obviously) don't bleed much when they first happen. But, don't be complacent! Get that dressing on as quickly as possible because the red indicating fluid is coming and you want to want to help the body along until natural swelling processes staunch the flow of blood.

Also, if it's bad enough that you don't feel like you have time to put gloves on and protect yourself, it's probably bad enough that the best you can do is keep the wounded calm for the relatively short period of time it will take to bleed out. In other words, take time to put latex or nitrile gloves on. Protip: nitrile gloves will last longer than latex.

Stay safe.

Mad Saint Jack said...

Off on a tangent:

Two guns two holsters.

Makes the argument for picking one system and sticking with it.

Tremaine said...

What Saint Jack said ^

Switching gear systems is not a good idea. If he had gone from his 5.11/glock rig to a serpa/glock rig this wouldn't have happened. If he had gone from a 5.11/1911 rig to a serp/1911 rig this wouldn't have happened. Combining two different systems that require two different kinds of muscle memory are what lead to this accident. Keep your gear similar.

Back on topic: I've seen quick clot available in stores and have bought a couple packs for my range bag. I think those would help in a situation like that.

RevGreg said...

You can't beat the combination of Celox clotting agent and Israeli Trauma Bandages...but even just a Celox trauma kit will do.

http://www.redflarekits.com/celox-quikclot-israeli-bandages

I think we had three medical response kits available when we shot yesterday...and that was with four people shooting. My buddy's son can get away with claiming he's covered by dad's kit until he's old enough to drive his own vehicle!

God, Gals, Guns, Grub said...

Tam,

I'm not an expert, but working as an NRA, CCW and 4H shooting instructor, I've had the basic and advanced Red Cross first aid training, the REAL training I received for gunshot wounds was from a Trauma Certified ER Doctor who I invited to one of our 4H Club Advisor meetings. You might check in your area and see if anyone like that provides training.

Also, I'm working on my own blog post about Range Bag and CCW first aid items, but here is what is always in my range bag:

Hunters First Aid Kit:
http://www.adventuremedicalkits.com/product.php?catname=Sportsman&prodname=Hunter&product=101#

Tactical Medical Packs with QuikClot:
http://www.tacticalmedicalpacks.com/

The Tactical Medical Packs are small, vacuum packed, and include QuikClot which is almost essential in a "blowout" kit and does far more than just a large compression bandage. The packs are part of my Every Day Carry and also have one in every car, the house, and the barn along with one in my Maxpedition Jumbo.

The fellow in the video kept a cool head, and was lucky it was and FMJ and not a Hollow-Point.

Best,

Dann in Ohio

RevGreg said...

Can't believe I didn't add one more item:

You really, REALLY shouldn't be shooting alone! Some injuries won't give you the option of taking care of yourself.

Robin said...

This is why I'm really cautious about the kind of holsters I use and recommend. Remember that hang from the bra holster Bitter reviewed? Made me real hinky.

docjim505 said...

I think that og's suggestion is an excellent one. I'd wager that we are all rather more likely to need to know how to keep somebody alive until the ambulance arrives than how to clear leather faster than Matt Dillon.

Anonymous said...

+1 RevGreg

Accidents happen faster than one thinks. I'm glad the fellow was able to get himself some help in time. When I was shot, I didn't have enough time to move more than 15 feet before my leg gave out.

Good idea to train in near the future, Tam.

Ulises from CA

Boat Guy said...

Bit of "overkill" (or hopefully "underkill") in my bag; issue IFAK with tourniquet etc, extra Israeli dressing or two. There are still "battle dressings" scattered around in various other shooty-kinda-bags. I've been well trained over the years.
That said, I'll shoot alone, if need be. If I violate all four rules that badly AND manage to do it to myself so grieviously that I can't repair it...then serves me right. One thing I never do when shooting by myself is fail to have at least one ready piece in my hand or holster (c.f. Platt and Mattix firearms acquisition plan).

Anonymous said...

I carry a basic and advanced med kit in the car. I've touched up scrapes and booboo's on run and gun matches and one pretty impressive car wreck.

I was warned off Quickclot Gen 1 years ago but have heard 2nd gen does not damage tissue like the original version.

Israeli Battle dressing are a must. They can be used as splints or slings as well as pressure bandages. I used to buy them by the case and gave them out at work or on the range.

Paul Gomez had a problem with Serpa holsters several years ago. You'll find his article somewhere on the net.

Gerry

Boat Guy said...

+1 on avoiding both Quik-Clot and Serpa. YMMV.
The Israeli dressing is much improved over our old dressings which had to be tied. They're expensive enough ('bout $6 per is the best I've seen) that I'll use other purpose-made stuff for splints and slings

Boat Guy said...

Another COOL piece of kit is the Asherman Chest Dressing. Not cheap but very comforting to have in case of pneumothorax. Much improved over the old Corpsman's advice "Well, you can also use the cellophane from a cigarette package for a sucking chest wound".

Jake (formerly Riposte3) said...

Given all the mention it's gotten in the comments, I should point out for those that might not be familiar with it that Quik-Clot is a last resort to stop bleeding. Direct pressure, elevation, and tourniquets should be tried first (if possible).

One problem is that Quik-Clot generates significant heat, and can actually cause tissue burns, complicating recovery. This (as it was explained to me in training) is the main reason it should only be used on life-threatening wounds.

+1 on the Asherman Chest Seals - this is what we carry on our ambulances. I have used them on actual patients, and they are wonderful.

If it has been even just 5 years since your last first-aid course, I would urge you to take it again, since there have been changes. Also, CPR has changed drastically just in the last 2-3 years - in fact, I think there were some significant changes just last year - so updating that (and keeping up to date) is a good idea, too.

OK, I'll get down off my soapbox, now. :)

God, Gals, Guns, Grub said...

I'm not really interested in a lot of back and forth Tam, but check into a TCCC (tactical combat casualty care) course in your area. That's what our ER doc friend teaches at Wright Patt. AFB by Dayton, Ohio. He specifically addressed gunshot would triage and care with our 4H shooting sports folks. He recommended the civilian Quikclot sponges/packs among other things. Some asked about harmful effects and he said the new Quikclot sponges/packs work fine. Early granule versions caused some minor tissue damage from the heat generated by the reaction, but that was literally years ago. I'm not sure what everyone else has read or heard, but I trust this guy who works in the E.R. every day, provides TCCC training, and served in Iraq and in the Air Force reserves as a medical professional.

You can find out more about TCCC training here:
http://www.health.mil/Education_And_Training/TCCC.aspx
There are military and private options for civilians to receive this training.

Dann in Ohio

Dann in Ohio

Odysseus said...

+1 on the non-applicator plastic wrapped tampons included with the first aid kit. I'll admit I initially heard of it through a novel(Oh John Ringo No!) but we did do some followup research.

Also even if you follow all four rules perfectly that doesn't stop Cletus from shooting himself(though if Darwin were just you would be too late to save his ability to reproduce).

Geodkyt said...

Jake --

Depends on which version of Quik-Clot you use. Later stuff was specifically designed NOT to burn.

Combat Gauze is really good, too, if you can find some.

But, by and large, "immediate aid" with clotters is really intended for people who are waiting for trasport -- so, yeah, it's probably a "last resort" if you ARE the transport and there are ANY possible bad side effects.

OTH, from where I do the overwhelming majority of shooting, I could be waiting up to an hour for the Woo-Woo box to show up and trained professionals assume care, given the likely delay in even getting on the phone in the first place beacuse I'm busy keeping the red stuff in and the invisible stuff moving both In and out (if I even get signal from the incident spot, and don't have to jog to a landline or clear point to start the 911 process), making sure both ends of a frantic phone call agree on the street location (street signs don't always match the databases around here), etc.

So my range bag kits are designed to keep someone alive for up to an hour, and include TWO C-A-T TKs, FOUR Israeli field dressings, a nasal trumpet, among other sundries (including such "nonmedical" stuff as a decent dynamo flashlight AND a tiny little battery powered one - both dummy corded to the kit, a Sharpie fine tip, a casualty card, a couple of big-ass safety pins, and 100-mph tape).

Why two TKs and four pressure dressings? Honestly, that dude who caught a .30-06 ball round through both legs beacuse of someone else's dumbassery -- one bullet resulting in two major wounds with an entrance and exit hole each.

Geodkyt said...

Oh, one of the "sundries" is a pre-packaged trauma kit. This is the one I use right now:

http://www.amazon.com/Adventure-Medical-Kits-Packwith-QuikClot/dp/B003BS2PW4

(I didn't get mine from Amazon, but I thought a reliable link would be helpful.)

RevGreg said...

The heat issue is one of the reasons I didn't suggest QuikClot. The Gen 2 stuff apparently creates less heat but I just stick with Celox because it doesn't really generate any. I have no experience with HemCon and currently none of our local EMS units are using it so I don't have any first hand knowledge on it's usage but it seems to be very similar to Celox.

In any case, the best bet is to get these in the sponge form rather than as packets of powder/granules/flakes as they are MUCH easier to deal with and there is less chance of it migrating into the bloodstream.

While our shooting yesterday was only about 5 miles from a major hospital trauma unit, the location where we do our machinegun shoot is quite some distance from adequate medical care...thankfully our strict range procedures and vetting of shooters has led to no injuries that required anything more than a bandaid and some mom spit in about 18 shoots.

greg said...

Well done on the gentleman for sharing his painfully earned experience with the rest of us...there has to be some urge in that circumstance to destroy the evidence and pretend none of it ever happened.

Glad he was just using hardball for his practice work...

Davidwhitewolf said...

The Packing Rat reviewed LMS Defensive Medicine a couple years back. Based on his enthusiasm the wife and I plan to attend the Livermore class in August. Hope to see you there, DirtCrashr!

Sport Pilot said...

I went through an EMT-IV course years ago and have used the skills I learned a number of times. At this stage I'd recommend a good first responder course and that you do some ride alongs with some ambulance crews. Check and see if your local emergency management offer CERT training and go through that as well. You'll be a part of a CERT team and able to justify the ride alongs.

Anonymous said...

That boy is tough! And more important, cool as a cuke under stress. There's a fair amount of shock inherent with even a non-bloodletting ND, to which I can attest from my 3(!) :(, so I can only imagine adding the elements of physical pain and the need to assess and doctor the physical damage. I'd rather not find out for reals but if I do I hope I handle it as well as this gentleman did.

Now they just need to come up with something to keep in your kit to handle the very real mental trauma that comes along with any ND, and maybe a little something to treat the stupid that is invariably to blame.

AT

global village idiot said...

Current Combat Lifesaver here. Aid bag (much better than the one I was issued) is in the car, so it always goes to the range.

The case against hemostatics (QuickClot, Hemcon, etc) isn't that it produces heat and damages tissue. In the kind of wound it WAS made for (the "Blackhawk Down" wound as it's called), that unfortunate Ranger would have taken any amount of tissue damage over death. Hemostatics are for those rare occasions when you can't get direct pressure on a wound and a tourniquet won't work, and there are only a few of those types - brachial and femoral artery wounds near or just inside the torso.

The real reason I don't carry one, whereas I carry everything from Ashermans, 14ga t-pneumo needles, saline locks, Gorilla Tape/tincture of benzoin, tourniquets and suture kits, is that trauma surgeons stateside don't yet have much in the way of competence with their use. Removal of a hemostatic is a specific skill which hasn't quite filtered back from the battlefield completely.

I had occasion to ask the chief of surgery at our county's hospital (he was part of a tabletop exercise at our County's EMA) about hemostatics. He was unfamiliar with them and he said quite explicitly that the surgeons on his staff have no experience or training with their removal.

Having said all that, compromising the femoral artery inside the torso is VERY rare but not difficult to visualize in the situation of this unfortunate shooter.

gvi

WV: cantsha.....No, just don'wanna.

Cormac said...

You might check with local reserve units to see if they're running Combat Lifesaver anytime soon. If you're lucky, they'll let you sit in. We learned how to use the gear plus some improvised techniques (don't assume you'll have what you need) a shoelace, pen and key ring (or even the plastic ring from the top of a soda bottle) is all you need for a tournaquette. A driver's license can be used for a sucking chest wound (if it's me, just put a lit cigg in the hole).

alcade said...

Don't know how they do things in IN, but if you've got 6 months to spare you could probably take an EMT-basic course free of charge through a sponsoring hospital. The only cost would be the book, which of course can be kept for future reference.

I've been an EMT now for about nine years, and frankly I feel that most first aid kits are practically worthless. Yeah, tiny band aids come in handy sometimes, but more than likely if it only needs something that small I'm probably just going to ignore it. Stick with 4x4's, abdominal pads, trauma dressings, gauze rolls, etc.

As for celox and IBD's and what have you - all very well and good, but I think a caveat would be to not place complete faith in gadgetry and remember the basics such as applying pressure, never remove a soaked bandage to apply another (apply it over), learn and know your pressure points to retard bleeding further down the pipe, elevate massively bleeding limbs, etc.

Mark said...

Thanks for sharing that, Tam. As I posted on the chap's YouTube page, ownership of a firearm is one of the most responsible things most people will ever do in this world. Knowing the dangers and prices to pay is of utmost importance - that way, we can carry weapons responsibly, and every negative happenstance like this is a lesson we all can learn from.

It's a privilege in our over-civilised world to carry a weapon. Globally, this is true. I wish it weren't so, but them's the facts. The safer we can carry them depends on fact-sharing like this chap's tale - I'm thankful to both of you for the truth.

(Like not carrying a 1911 pattern weapon in that particular holster).

Woohoo said...

Sometimes my black sense of humor picks the exact wrong moment to shine through. My first reaction to seeing the shot was a grimace but when he said "I just ****ing shot myself"... the giggle just came out. It was wrong, I know but it just... happened. I think it's because he vaguely sounded like me after I've done something really dumb.

TrueBlueSam said...

There has been many a farmer killed when driving an unfamiliar tractor in years past. Minnies and John Deeres had hand clutches, other brands had foot clutches. Go help a neighbor put up hay, and before you know it you have driven his tractor through a fence, through a barn, or over a cliff. Tex has given all of us a valuable lesson.

DirtCrashr said...

Since you can buy Quikclot Sport 50 at REI, I figure the lawyers must have worked out the heat-bugs or else all the over-lawyered Googleoids around here would have taken them downtown and emptied their pockets and drawers and everything else...

word:airache - airheads have hurts too~

Dropkick said...

The mythical use of tampons and maxi-pads to plug up bullet wounds has been perpetuated by Navy SEALS fanboys that heard that the BUD/S go out and get all shot up, jam themselves full of kotex'es, in the middle of a misson where they have to hump a 75 lb rucks up hill BOTH to and from the LZ, in monsoon rain, shooting full auto from the hip, killing bad guys in a hail of bullets, all the while chewing on a snake like it is beef jerky.

Justthisguy said...

Dropkick, the Kotex pad was actually invented by a US Army nurse in 1918 who just appropriated battle dressings to the purpose. You can no longer buy the original pads in grocery stores; it's all stick-to-the-panties stuff these days. Bobbi has said you can still get the original kind a places which cater to new mothers.

God, Gals, Guns, Grub said...

Tam,

You've generated some good discussion with this post. If you're interested or have any feedback, I posted my thoughts on this topic over at my new blog:

First-Aid and Thinking Ahead with Guns.
http://godgalsgunsgrub.blogspot.com/2011/07/first-aid-and-thinking-ahead-with-guns.html

Any feedback or thoughts are welcome. If it is inappropriate to post the link back to my post, just delete my comment - thanks.

Dann in Ohio

FatWhiteMan said...

I had a class in combat first aid in May. This class was not basic first aid but rather combat first aid on how to quickly stop bleeding and sucking chest wounds. It is basically the same thing that every grunt being deployed is now taught. I now carry tourniquets, Quickclot gauze and Israeli pressure bandages with me in my day and range bags.

There is another being taught in October. Let me know if you want me to hook you up but your drive to Columbus would be longer than the class.

Dropkick said...

Justthisguy: Interesting trivia, but you have to agree there are better (and more modern) bandage options available.

DirtCrashr said...

Wouldn't a Tampax applicator be better than a Kotex pad for through-and-through shots?

global village idiot said...

This isn't really the forum for it, but absent real training (which you ought to get before you use ANYTHING on someone - yourself included) here are some general rules-of=thumb:

o Tourniquets don't work well below the elbow or the knee. With a tourniquet, you're compressing all the tissue against the bone. There are two bones below the elbow and the knee. You won't get good compression with them. The solution: Elevation and lots of gauze.
o Tourniquet use was strongly discouraged because the thinking was always "save the life at the cost of the limb." I've actually had trainers in the past say, in effect, "The second you put that tourniquet on you can kiss the rest of that limb goodbye." This is flatly untrue. It takes a good two hours before serious damage to tissues will occur, and limbs have been saved even after six hours of tourniquet use. They shouldn't be used all the time but if the wound is REALLY catastrophic, put the tourniquet on and get the patient to definitive care.
o Last word on tourniquets. Good ones are cheap enough to where you can afford one or two to have in your aid bag. Field expedients don't work as well at all. I'm a big fan of the "SFOT" Tourniquet. Its windlass bar is aluminum, unlike the "CAT" tourniquet currently issued in IFAKs. You only need one or two and you'll only probably need them once if you ever do, but they may as well work.
o Israeli dressings are terrific. Carry twice as many as you think you'll need. Exit wounds are often worse than entry wounds. I have some dressings from Czechoslovakia that come with two gauze pads. Only example I've ever seen that was set up that sensibly.
o If you haven't been trained on something - as in, you've sat physically in a class with a human trainer and used a real example of the thing and proven proficiency - don't put it in your aid bag.
o If you can't afford Israeli dressings (they're not THAT expensive), get as much gauze and ACE wrap from the Dollar Store as you can. You've got essentially the same thing.
o Don't worry overmuch about sterile technique. The wound, by definition, isn't sterile. Do no additional harm to the patient, get the ABCs covered and get the patient to definitive care. Let them worry about cleaning up.

gvi

Geodkyt said...

Because of the 2 hour time before damage kicks in and the tib-fib/ulna-radius issues, you should apply TKs above the knee and elbow for lower limb hits.

The "tampons in bullet holes" things isn't a "SEAL wannabe" thing, and it has been around a while -- I first heard it (1987?) from a medic Master Sergeant (who learned it while doing his schtick in Vietnam, and who had used it in combat). Provides packing and easier deep direct pressure options than trying to jam a field dressing in the hole. The use of tampons (albeit purpose-made for wounds) for battlefield wound treatment PREDATES (1885 and earlier) the modern design with carboard appicator and string for menstruation (1929 patent).

Also, they are a good troop motivation tool for line NCOs during field problems -- when PVT Snuffy starts whining about climbing the hill, just wordless reach in your asspack (I carried a couple in a ziplock baggie, primarily for wounds "if and when"), and hand him a Tampax. Works everytime.

If you can't get Combat Guaze, I suggest the sponge or bag types of QuikClot -- the loose granules are simply too hard to apply (moving patient, breezy day, bad angle, etc). As pointed out, the granular stuff is also harder to remove.

Also, that's (removal by the docs) one of the things the safety pins are for -- pin the damned wrapper (with generaly has removal instructions for the docs) to the patient -- somewhere it won;t be missed (I've even heard "pin it to the dressing, so they know WHICH wounds have it", but I'm not convinced yet on that one). Otherwise, they might not even REALIZE there is a bloodclotter in play right away, much less which type and how to remove it.

Dropkick said...

Keyword: "perpetuated"