View Full Version : Trauma Training
With all this gun play I seem to be involved in lately, one of my greatest fears is being near someone who was just shot and not having the skills this take care of the person. Lord knows I have the gear.
Can anyone suggest a medical training program designed for dealing with traumatic injuries? Something that would teach one how to really use their blow out kits? The example would be securing a gunshot wounded subject long enough to hand off to more qualified persons.
I don't have $2k for some special operations class held in the high mountains, I'm looking for something designed for civilians in a typical urban setting.
Thanks in advance.
You don't need to spend $2K, and you don't need any spec ops class. Call the Red Cross, the local volunteer fire department/rescue squad, or community college...see if you can get a basic first aid, first responder, or basic EMT class. The price will ne negligible and you will get a foundation of the fundamentals. Also, look up National Association of EMTs...the have a course called trauma first responder, and you can see if they have on in your area.
You don't need to spend $2K, and you don't need any spec ops class. Call the Red Cross, the local volunteer fire department/rescue squad, or community college...see if you can get a basic first aid, first responder, or basic EMT class. The price will ne negligible and you will get a foundation of the fundamentals. Also, look up National Association of EMTs...the have a course called trauma first responder, and you can see if they have on in your area.
This is great intel. Are these classes expensive? Of course that's relative. I guess I should ask if you have any experience with any one particular group that offers these classes and can recommend the most cost effective.
Thank you!
TacMedic556
11-14-12, 22:14
After that, find a good TCCC- Tactical Combat Casualty Care course. Great class that will offer you some very applicable skills. It helps to have some medical and or prehospital backround. I would be happy to PM you some stuff.
This is great intel. Are these classes expensive? Of course that's relative. I guess I should ask if you have any experience with any one particular group that offers these classes and can recommend the most cost effective.
Thank you!
The NAEMT class is usually $50-$150, depending on location, overhead, etc. First responder or EMT is often set by the community college, but here in NC not more than a couple hundred bucks. A good ol' fashion ARC first aid is often found around $50, maybe less.
TCCC ain't bad info (now watered-down as it been pre-packaged for the masses), but you should have some fundamental knowledge under your belt.
To me the best 'bang for the buck' is the NAEMT trauma first response course...good fundamentals, focuses on trauma until a more competent authority shows up, and doesn't mess with the EMT stuff that most people will never use if they do not work in the back of a bus (i.e., child birth, overdoses, etc.).
The NAEMT class is usually $50-$150, depending on location, overhead, etc. First responder or EMT is often set by the community college, but here in NC not more than a couple hundred bucks. A good ol' fashion ARC first aid is often found around $50, maybe less.
TCCC ain't bad info (now watered-down as it been pre-packaged for the masses), but you should have some fundamental knowledge under your belt.
To me the best 'bang for the buck' is the NAEMT trauma first response course...good fundamentals, focuses on trauma until a more competent authority shows up, and doesn't mess with the EMT stuff that most people will never use if they do not work in the back of a bus (i.e., child birth, overdoses, etc.).
Great intel! I have emailed the listed POC's.
TCCC is excellent. Still strongly suggest getting your EMT-B. Rapidly identifying a Heart Attack or Stroke in someone you love is prolly more likely a scenario.
Suarez Int'l offers some classes for tactital medicine. They have a website called www.warriortalk.com where you can read the after action reports on their classes. See if that might be what you are looking for.
Suarez Int'l offers some classes for tactital medicine. They have a website called www.warriortalk.com where you can read the after action reports on their classes. See if that might be what you are looking for.
You are joking right? Shady past and rather questionable present.
You are joking right? Shady past and rather questionable present.
Details please.
this is gonna sound kind of ignorant, but youtube is a great resource for this topic.
for ex.. NAR (north american rescue) have a youtube channel with "how to use properely" vids on there.
of just search youtube using the name of the piece of kit your trying to learn how to use and you can usually find a well done how to vid on its use and application.
I hate being the guy who brings a little black cloud in, but keep in mind that performing medical procedures on someone else opens you up to legal actions. It's unfortunate, but it's reality.
Even if you're trained & certified, if you're acting on your own without medical direction, you're liable (hell, even with med direction you can be sued).
Not saying it's not good stuff to know, just keep in mind that there could be consequences to your actions even if you save someone's life.
not a whole lot to learn...
plug the holes or apply tourniquet to stop bleeding....transport to trauma center.
If someone is having fantasies about performing cric's or sealing sucking chest wounds .....then it's just that...fantasies.
not a whole lot to learn...
plug the holes or apply tourniquet to stop bleeding....transport to trauma center.
If someone is having fantasies about performing cric's or sealing sucking chest wounds .....then it's just that...fantasies.
This.
As a physician I certainly recommend pursuing some sort of education on first aid, at least a CPR course. There lots of others out there, such as wilderness first aid or tactical courses where you would get some more hands on experience with splinting, wound care, etc. Not sure how practical some of these skills would be though to non-medical folks. Honestly, knowing good CPR will probably be more useful to average person as opposed to going through a tactical medic course.
I've needle decompressed a few tension pneumothoracies in the hospital, don't really see a situation where I would do one outside the hospital though.
If I'm involved in a shooting situation in public there's not a whole lot me or anyone is going to be able to do besides very basic supportive care and getting that person to a definitive care.
This.
As a physician I certainly recommend pursuing some sort of education on first aid, at least a CPR course. There lots of others out there, such as wilderness first aid or tactical courses where you would get some more hands on experience with splinting, wound care, etc. Not sure how practical some of these skills would be though to non-medical folks. Honestly, knowing good CPR will probably be more useful to average person as opposed to going through a tactical medic course.
I've needle decompressed a few tension pneumothoracies in the hospital, don't really see a situation where I would do one outside the hospital though.
If I'm involved in a shooting situation in public there's not a whole lot me or anyone is going to be able to do besides very basic supportive care and getting that person to a definitive care.
Here's my 2 cents on knowing CPR....good for people who have cardiac arrest from heart disease.....essentially worthless in a shooting situation.
You obviously know as well as I do that traumatic arrests (ie from massive exsanguination) has essentially a zero survival rate outside of a hospital...no point in thumping on their chests other than to make yourself feel like you're doing something.
Now if someone has a heart attack from seeing someone bleeding out, then ones knowledge of CPR may be beneficial.
Lots more MI's ou there in my daily living than gunshot wounds.
:)
Lots more MI's ou there in my daily living than gunshot wounds.
:)
Was kind of my point. With a traumatic arrest from a gunshot wound or hemorrhage there's really not much you're going to be able to do. Survival is basically nil at that point.
More likely to run across an MI in public where CPR and knowledge about how to use an AED would be helpful.
Thanks everyone for the replies. Just can't seem to ignore the lack if a skill set. Need to have a plan. Sued or not, I refuse to let someone die if I can help, or could have.
Good on you, Frank. Everyone should have some first aid training. Chances are you'll use that training at some point, and not at the range, either.
Robert M Miller
12-06-12, 01:35
Friend,
60% of all preventable deaths in this scenario occur from bleeding to death from extremity wounds
30% from a condition known as a Tension Pneumothorax (progressive build-up of air within the pleural space, usually due to a lung laceration)
1-2% from airway occlusion (they guys most likely will need an intervention know as cricothyroidotomy
So if you get your self a good tourniquet (modern COTCCC Approved) some chest seals and a needle decompression device. You could potentially decrease preventable death up to 80-90%.
If you are interested I can provide you with some information and a few other things that would be of great help.
Rob
Friend,
60% of all preventable deaths in this scenario occur from bleeding to death from extremity wounds
30% from a condition known as a Tension Pneumothorax (progressive build-up of air within the pleural space, usually due to a lung laceration)
1-2% from airway occlusion (they guys most likely will need an intervention know as cricothyroidotomy
So if you get your self a good tourniquet (modern COTCCC Approved) some chest seals and a needle decompression device. You could potentially decrease preventable death up to 80-90%.
If you are interested I can provide you with some information and a few other things that would be of great help.
Rob
please give reference for the above statistics.
Thanks everyone for the replies. Just can't seem to ignore the lack if a skill set. Need to have a plan. Sued or not, I refuse to let someone die if I can help, or could have.
I also believe it is important to have some basic first aid skills, tactical/firearm related or not. As far as being sued goes, check your state's laws. In FL, we have 'Good Samaritan' language that covers a lot of scenarios. Basically, it grants immunity to legal action when aid was attempted to be rendered in good faith (with victim consent, expressly given or implied) in a situation where professional care was not immediately available.
Friend,
60% of all preventable deaths in this scenario occur from bleeding to death from extremity wounds
30% from a condition known as a Tension Pneumothorax (progressive build-up of air within the pleural space, usually due to a lung laceration)
1-2% from airway occlusion (they guys most likely will need an intervention know as cricothyroidotomy
So if you get your self a good tourniquet (modern COTCCC Approved) some chest seals and a needle decompression device. You could potentially decrease preventable death up to 80-90%.
If you are interested I can provide you with some information and a few other things that would be of great help.
Rob
I think you are talking overkill for a dude who wants basic first aid/trauma training. Chest needles for a layperson? Most range shooters have no need for TCCC-type training....basic first aid will suit him just fine.
I think you are talking overkill for a dude who wants basic first aid/trauma training. Chest needles for a layperson? Most range shooters have no need for TCCC-type training....basic first aid will suit him just fine.
As an eagle scout I have the basic stuff. I'm looking for trauma training.
Friend,
60% of all preventable deaths in this scenario occur from bleeding to death from extremity wounds
30% from a condition known as a Tension Pneumothorax (progressive build-up of air within the pleural space, usually due to a lung laceration)
1-2% from airway occlusion (they guys most likely will need an intervention know as cricothyroidotomy
So if you get your self a good tourniquet (modern COTCCC Approved) some chest seals and a needle decompression device. You could potentially decrease preventable death up to 80-90%.
If you are interested I can provide you with some information and a few other things that would be of great help.
Rob
100% interested. Please send them
Frank, do what you want to do...needling someone's chest when you don't need to, not knowing when not to...good samaritan laws won't cover you for that as those are advanced skills. Tourneys, fine...training for a procedure which you will likely never do, and therefore botch when you do it, will never end up a good scenario. You have a higher chance of being struck by lightening than having to use TCCC-type skills.
Best of luck...Most sincerely, I do hope you find what you are looking for and get some good training.
First off, I commend you for wanting to get some training. But this is something you should really think hard about how you are going to employ. By that I mean are you just looking out for the remote possibility that you are going to be there when something goes wrong, or are you looking to place yourself in a situation where you may be employing skills regularly? If the former, I would maybe go with a first-responder level class that gives you the basics. That is after all what would most likely be needed in most situations-basic skills. By that I mean ABCs. If you have the opportunity to volunteer for an EMS service or some such situation where you might have the chance to use a larger skill set, it might be worth going for an EMT cert. Otherwise its a bigger investment that probably won't pay off for you.
I volunteered for a rural ambulance service & mountain rescue team for around 10 yrs & did a lot of training for various scenarios in that time, but 99+% of the time what I was doing was the basics. Even now as an RN working in an acute care inpatient setting most of what I do relies on the more basic stuff. Somewhere along the line during my EMS days a Paramedic with far more experience than myself or anyone I was working with made the comment that it was usually the EMT Basics who saved the Paramedic's ass because they weren't all wrapped up in their advanced skills & didn't overlook the ABCs.
Robert M Miller
12-06-12, 12:19
Guys,
Did not mean to start a firestorm I was under the impression it was a tactical related scenario. All the things I'm reading are correct about training competency and direct support available. If anyone ever needs slides or videos of TCCC related material I have a stock pile and very willing to share if it would help. Rob
...needling someone's chest when you don't need to, not knowing when not to...good samaritan laws won't cover you for that as those are advanced skills.
This is true. The laws were designed to protect an 'amateur' aid giver when doing reasonable things like CPR, stop bleeding, etc. Once you go breaking out the PT needles, scalpels, IV drugs, etc., 'in good faith' comes in to question if you don't have the proper training/certification required.
Agree with the general consensus here, certainly worthwhile to get some level of training. I'd recommend at least CPR and some level of basic first aid. From there I'd look at maybe a wilderness first aid type of course as that's going to give you some more practical skills accessible to a lay person in dealing with injuries when help isn't immediately available. Just not sure how practical a tactical course is if you're not going to be working or constantly in that environment.
Certainly think a skill such as tourniquet use is worthwhile to learn and it would be a part of a wilderness medicine course. Beyond that there's not much else I'd suggest doing, I certainly don't think advanced interventions such as advanced/emergency airways and needle decompression would be worthwhile, practical, or appropriate for someone not actively working in that field.
In regards to knowing how to use a blow out kit, it should be pretty simple stuff. If they can teach the LCD in the Army to use it anyone can. A tourniquet, chest seal, and nasopharengeal air way are all pretty dummy proof, even the NCD is pretty simple (legal implications not withstanding). If you have these and some combat gauze and trauma dressings your set. Also, Robs stats while possibly out of date, are probably found in the Army FM for TCCC, which is also a good resource for this information.
Robert M Miller
12-06-12, 14:27
You might think they are out of date by there are the resent trauma guidelines for tactical usage. As I said previously I thought the scenario was austere. If a casualty has penetrating Chest trauma with increased resp distress needle decompression could save his life and shouldn't be a problem since he already has a whole in his chest. I say this because I was on the COTCCC and helped write these guidelines. I was also the guy that developed all the medical equipment and training at North American Rescue. Like I said,, I thought this was a tactical scenario where someone needed the science behind decreasing preventable death at the Assaulter and medic level. I apologize for not seeing that a boo-boo kit was needed.
You might think they are out of date by there are the resent trauma guidelines for tactical usage. As I said previously I thought the scenario was austere. If a casualty has penetrating Chest trauma with increased resp distress needle decompression could save his life and shouldn't be a problem since he already has a whole in his chest. I say this because I was on the COTCCC and helped write these guidelines. I was also the guy that developed all the medical equipment and training at North American Rescue. Like I said,, I thought this was a tactical scenario where someone needed the science behind decreasing preventable death at the Assaulter and medic level. I apologize for not seeing that a boo-boo kit was needed.
do you have the primary reference on your statistics?
You quoted 30% incidence of tension pneumothorax.....seems too high to me...from experience and from literature...although I'm 8 years out of the military and out of academics.
Prevalence of Tension Pneumothorax from Journal of Trauma out of USHSU
http://www.ncbi.nlm.nih.gov/pubmed/16531856
Tension pneumo prevalence grossly exaggerated?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658372/
not a whole lot to learn...
plug the holes or apply tourniquet to stop bleeding....transport to trauma center.
If someone is having fantasies about performing cric's or sealing sucking chest wounds .....then it's just that...fantasies.
My point....and I guess we should add "field needle thoracentesis" to the list
Just to add some flavor to the soup I'll throw this in.
There is a local 911 Service out here (Texas) that uses bilateral Needle Thorocostomy + Pericardiocentesis on trauma arrests in the field AKA "The 3 Hole Punch". I recently attended an EMS Advanced Skills Verification Lab put on by them in conjuction with a hospital system. There I learned that they are looking to transition to bilateral finger thorocostomy over the needle version.
I still stand by my earlier suggestion of obtaining EMT-B Cert.
Just to add some flavor to the soup I'll throw this in.
There is a local 911 Service out here (Texas) that uses bilateral Needle Thorocostomy + Pericardiocentesis on trauma arrests in the field AKA "The 3 Hole Punch". I recently attended an EMS Advanced Skills Verification Lab put on by them in conjuction with a hospital system. There I learned that they are looking to transition to bilateral finger thorocostomy over the needle version.
I still stand by my earlier suggestion of obtaining EMT-B Cert.
Did these guys EVER save anyone with that maneuver?
Traumatic arrests have a next to zero chance of survival regardless of what you do....the ONLY chance is if it happens right next to a trauma center.
You might think they are out of date by there are the resent trauma guidelines for tactical usage. As I said previously I thought the scenario was austere. If a casualty has penetrating Chest trauma with increased resp distress needle decompression could save his life and shouldn't be a problem since he already has a whole in his chest. I say this because I was on the COTCCC and helped write these guidelines. I was also the guy that developed all the medical equipment and training at North American Rescue. Like I said,, I thought this was a tactical scenario where someone needed the science behind decreasing preventable death at the Assaulter and medic level. I apologize for not seeing that a boo-boo kit was needed.
With respect, I saw those numbers in a TM so i just figured they were vietnam era stats, you know how TM's can be. North American Rescue makes some great prodicts. WALK kits are great, if a bit heavy. NAR makes the FOX II litters as well right? I know my unit loved those...
Did these guys EVER save anyone with that maneuver?
Traumatic arrests have a next to zero chance of survival regardless of what you do....the ONLY chance is if it happens right next to a trauma center.
Nope never. Their Medical Director just enjoys the needless mutilation of human flesh. :rolleyes:
Yes they have had success. No I do not have the stats. They are a very large, progressive and very well respected provider.
This is EMS. Things are always changing/improving. Keep an open mind.
Nope never. Their Medical Director just enjoys the needless mutilation of human flesh. :rolleyes:
Yes they have had success. No I do not have the stats. They are a very large, progressive and very well respected provider.
This is EMS. Things are always changing/improving. Keep an open mind.
My mind is only open to data published in peer reviewed journals.
Without that....this is just a story on the internet posted by anonymous posters.
Here is a tiny bit of data...
http://regionstraumapro.com/post/4415764711
Seriously....we have too many people who are gung ho about doing stuff that is just not necessary....and which amounts to rearranging deck chairs on the titantic.
If you feel that you must stick needles into dead patients...then feel free to feel good about it....
but I'm just stating the facts...and asking for data to prove me otherwise.
Thanks everyone for the replies. Just can't seem to ignore the lack if a skill set. Need to have a plan. Sued or not, I refuse to let someone die if I can help, or could have.
How about if you ended up making them worse, or killing them, because you tried to apply an imperfectly understood set of perishable skills based on an imperfectly understood or remembered set of diagnostic criteria.
Non-medical people obsessing over chest cavity decompression in the field. Sheesh. 30 years as a trauma surgeon covering the ERs at two hospitals one-in-three and I can think of ONE instance where a patient MIGHT have needed a needle thoracostomy outside the ER. I can count the number of tension pneumothoraces I've seen in my life on the fingers of one hand.
I agree with the above posters...focus on CPR and the use of automated defibrillators that are springing up like mushrooms in public venues. Don't forget that you need to do that every couple of years or you WILL forget that stuff.
How about if you ended up making them worse, or killing them, because you tried to apply an imperfectly understood set of perishable skills based on an imperfectly understood or remembered set of diagnostic criteria.
Non-medical people obsessing over chest cavity decompression in the field. Sheesh. 30 years as a trauma surgeon covering the ERs at two hospitals one-in-three and I can think of ONE instance where a patient MIGHT have needed a needle thoracostomy outside the ER. I can count the number of tension pneumothoraces I've seen in my life on the fingers of one hand.
I agree with the above posters...focus on CPR and the use of automated defibrillators that are springing up like mushrooms in public venues. Don't forget that you need to do that every couple of years or you WILL forget that stuff.
Not a surgeon ....just a gas passer with fellowship training in critical care medicine...with time in the gulf....and 15 years of practice...
My experience mirrors yours.
Here is a tiny bit of data...
http://regionstraumapro.com/post/4415764711
...and asking for data to prove me otherwise.
Thanks for the link. To be clear you haven't actually asked for anything. You have just been condescending.
Thanks for the link. To be clear you haven't actually asked for anything. You have just been condescending.
sorry if you think I'm "condescending"....I'm just stating what I know to be true based on training, experience, and data.
If you feel or (better) know otherwise, please let the rest of us (who don't know any better) know.
Thanks for the link. To be clear you haven't actually asked for anything. You have just been condescending.
I wouldn't call that condescending. There have been several physicians here, myself included, attempting to get the same point across.
TCCC is excellent. Still strongly suggest getting your EMT-B. Rapidly identifying a Heart Attack or Stroke in someone you love is prolly more likely a scenario.
Just to add some flavor to the soup I'll throw this in.
There is a local 911 Service out here (Texas) that uses bilateral Needle Thorocostomy + Pericardiocentesis on trauma arrests in the field AKA "The 3 Hole Punch". I recently attended an EMS Advanced Skills Verification Lab put on by them in conjuction with a hospital system. There I learned that they are looking to transition to bilateral finger thorocostomy over the needle version.
I still stand by my earlier suggestion of obtaining EMT-B Cert.
The above are my 2 posts. At no point do I recommend any advanced proceedures to the OP or anyone. I suggest EMT-B Certification, twice. My second post was not to suggest a better way of doing anything. Merely pointing out that someone was doing something a little different. I don't have stats simply because I don't work for them. If you were really interested in the stats related to the mentioned proceedure you could of simply asked for the name of the service and gone and done the leg work yourself. Instead you dismiss it as a just a "story on the internet posted by anonymous posters." Respectfully, you would qualify as one of those "anonymous posters" yourself.
Robert M Miller
12-06-12, 23:52
Guys,
Not trying to be a argue with anyone but here is the most relevant data I found on Managing casualties in a tactical environment. The first is a link to the most updated TCCC guidelines. I realize that standards of care and peoples options vary by training, position and support. This was just to get some folks thinking in a tactical environment. I believe this was probably my mistake. All the best- Rob Miller
http://www.naemt.org/Libraries/PHTLS%20TCCC/TCCC%20Guidelines%20120917.sflb
1. Holcomb JB, et al. Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001Y2004. Ann Surg. 2007;245:986Y991.
2. Eastridge BJ, et al. We don’t know what we don’t know: prehospital data in combat casualty care. US Army Med Dep J. 2011:11Y14.
3. Holcomb JB, et al. Understanding combat casualty care statistics.
J Trauma. 2006;60:397Y401.
4. Butler FK. Tactical combat casualty care: update 2009. J Trauma. 2010;69(Suppl 1):S10YS13.
5. Carey ME. Learning from traditional combat mortality and morbidity
data used in the evaluation of combat medical care. Mil Med. 1987;152:6Y13.
6. Bellamy RF, Maningas PA, Vayer JS. Epidemiology of trauma: military
experience. Ann Emerg Med. 1986;15:1384Y1388.
7. Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149:55Y62.
8. Champion HR, et al. Improved characterization of combat injury.
J Trauma. 2010;68:1139Y1150.
9. Mabry RL, et al. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma 2000;49:515Y528;discussion 528Y529.
10. Esposito TJ, et al. Analysis of preventable trauma deaths and inappropriate trauma care in a rural state. J Trauma. 1995;39:955Y962.
11. Kelly J.F, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003Y2004 versus 2006. J Trauma. 2008;64(suppl 2):S21YS26; discussion S26YS27.
12. Medicine IO. Reducing the Burden of Injury: Advancing Prevention andTreatment. Washington, DC: National Academy Press; 2003.
13. Champion HR, et al. A profile of combat injury. J Trauma. 2003;
54(suppl 5):S13YS19.
14. Hardaway RM 3rd. Viet Nam wound analysis. J Trauma. 1978;18:
635Y643.
15. Hardaway RM 3rd. Care of the wounded of the United States Army from1775 to 1991. Surg Gynecol Obstet. 1992;175:74Y88.
16. Champion HR, Holcomb JB, Young LA. Injuries from explosions:
physics, biophysics, pathology, and required research focus. J Trauma.
2009;66:1468Y1477; discussion 1477.
17. Dismounted Complex Battle Injury, Report of the Army Dismounted Complex Blast Injury Task Force for the Surgeon General. Fort Sam Houston, Texas, June 18, 2011. Available at: http://www.armymedicine.army.mil/reports/
DCBI%20Task%20Force%20Report%20(Redacted%20Final).pdf. Accessed July 2, 2012.
18. Savage E, et al. Tactical combat casualty care in the Canadian
Forces: lessons learned from the Afghan war. Can J Surg. 2011;54:
S118YS123.
19. Eastridge BJ, et al. Died of wounds on the battlefield: causation and
implications for improving combat casualty care. J Trauma. 2011;
71(Suppl 1):S4YS8.
20. Bellamy RF. The medical effects of conventional weapons. World J
Surg. 1992;16:888Y992.
21. Blackbourne LH, et al. Decreasing killed in action and died of wounds rates in combat wounded. J Trauma. 2010;69(Suppl 1):S1YS4.
22. Kotwal RS, et al. Eliminating preventable death on the battlefield. ArchSurg. 2011;146:1350Y1358.
23. Maughon JS. An inquiry into the nature of wounds resulting in killed
in action in Vietnam. Mil Med. 1970;135:8Y13.
24. Alam HB, Koustova E, Rhee P. Combat casualty care research: from
bench to the battlefield. World J Surg. 2005;29(Suppl 1):S7YS11.
25. Morrison JJ, et al. Military Application of Tranexamic Acid in Trauma
Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147:
113Y119.
26. Roberts I, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377:1096Y1101, 1101.e1Y1101.e2.
27. Mabry RL, et al. Fatal airway injuries during Operation Enduring Freedom and Operation Iraqi Freedom. Prehosp Emerg Care. 2010;14:272Y277.
28. Kragh JF Jr, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(suppl 2):S38YS49; discussion S49YS50.
29. Kragh JF Jr, et al. Battle casualty survival with emergency tourniquet useto stop limb bleeding. J Emerg Med. 2011;41:590Y597.
30. Kragh JF Jr, et al. Survival with emergency tourniquet use to stop
bleeding in major limb trauma. Ann Surg. 2009;249:1Y7.
31. Butler FK Jr, et al. Tactical combat casualty care 2007: evolving concepts and battlefield experience. Mil Med. 2007;172(Suppl 11):1Y19.
Good luck to all
Robert M Miller
12-06-12, 23:58
Just some food for thought. I seen a post that discussed working a traumatic arrest. One should ask how did this happen? why no pulse or respirations? if penetrating trauma was involved you should ask yourself how did he get this way. Likely from hypovolemia. Do you really think CPR or AED is the solution here?
Thank you for the spirited discussions
V/R
Rob
RearwardAssist
12-07-12, 00:06
I am not sure where you are located. I have no affiliation with this service, nor have I researched or checked it out, I have heard good reviews by members of a local board that have attended, but that is it.
www.specopsts.org
Apologies to the OP...it seems my post was one of those that started getting this thread re-routed off its original intent.
I am all for the OP, or anyone, having TCCC (or any other training) if he is going to be in a position to use the skills and critically think through the material when the poop hits the fan. The problem is that although some of the TCCC skills are now considered fundamental, most of us on this forum see 'fundamental' from a different perspective. The OP is not in the militray, nor a LEO...of course we teach this stuff to regular trigger-pullers, but the likelihood of a Marine (in my case) or a soldier using this skill set is significantly higher than that of a Private Citizen. In the mil the rules/regs and laws governing what we do is vastly different than in civvyland, and to complicate, each state is different as well. To wit, if the OP ****s up, he will be dealt with more harshly than if Private Jones, US Army, screws up the same procedure.
The statistics of efficacy will likely change as more data becomes available, just as most every other medical procedure and treatment. The wheels of bureaucracy turn slowly and eventually the mil will change treatment modalities as the data suggests changes are needed. Many of us are viewing the same data through different lenses and losing sight of what Private Citizen needs as far as trauma training.
I advocate for any and all training (medical, shooting, etc.), but also educate non-medical folks that medical skills are perishable skills, and need to be used judiciously and in the right context. If someone at the range has a headache, an aspirin will likely be good enough, you do not need to whip out nuerology assessments or pull out an EVD.
OP, get what you need, but what you need, not necessarily what you want. The two can be very different.
The above are my 2 posts. At no point do I recommend any advanced proceedures to the OP or anyone. I suggest EMT-B Certification, twice. My second post was not to suggest a better way of doing anything. Merely pointing out that someone was doing something a little different. I don't have stats simply because I don't work for them. If you were really interested in the stats related to the mentioned proceedure you could of simply asked for the name of the service and gone and done the leg work yourself. Instead you dismiss it as a just a "story on the internet posted by anonymous posters." Respectfully, you would qualify as one of those "anonymous posters" yourself.
I am no doubt an anonymous posters, but my links are to peer reviewed publications with references.
Your sarcastic reply to my question about efficacy of treatment indicates to me that you know better, so I'm simply asking for your references.
Obviously you feel insulted when questioned...why is that?
This all started with Rob M Miller's assertion that up to 30% of combat casualties are a result of tension pneumothoraxs...a claim which I don't believe without data to support it because it contradicts my training, experience, and published data.
I would submit that TENSION penumothorax is a phenomenon that cannot even exist unless the patient is being mechanically ventilated....something that is not going to happen on the battlefield.
Just some food for thought. I seen a post that discussed working a traumatic arrest. One should ask how did this happen? why no pulse or respirations? if penetrating trauma was involved you should ask yourself how did he get this way. Likely from hypovolemia. Do you really think CPR or AED is the solution here?
Thank you for the spirited discussions
V/R
Rob
Maybe not but...traumatic arrests as a result of penetrating trauma is the one subclass that is MOST likely to survive according to the American Heart Association (http://circ.ahajournals.org/content/112/24_suppl/IV-146.full).
I would submit that TENSION penumothorax is a phenomenon that cannot even exist unless the patient is being mechanically ventilated....something that is not going to happen on the battlefield.
Based on my experiences I would respectfully disagree. I would say, however, that the number of real and true tension pneumo's have been significantly less than advertised or assumed.
I believe the benefit of modern trauma medicine, and better outcome, is in the rapid recognition and rapid transport to closer definitive care (specifically on the battlefield), not the addition of chest needles or other doo-dads (caveat is that this is based on MY experiences and anecdotal, non-published or researched data).
Maybe not but...traumatic arrests as a result of penetrating trauma is the one subclass that is MOST likely to survive according to the American Heart Association (http://circ.ahajournals.org/content/112/24_suppl/IV-146.full).
IF the patient can get an emergency thoracotomy...
IF the patient can get an emergency thoracotomy...
I should have added...with proper care.
Based on my experiences I would respectfully disagree. I would say, however, that the number of real and true tension pneumo's have been significantly less than advertised or assumed.
I believe the benefit of modern trauma medicine, and better outcome, is in the rapid recognition and rapid transport to closer definitive care (specifically on the battlefield), not the addition of chest needles or other doo-dads (caveat is that this is based on MY experiences and anecdotal, non-published or researched data).
The classic "Tension" pneumo means that there is supra atmospheric or supra central venous pressure inside the chest leading to loss of preload and mediastinal shift.....How does that happen without positive pressure ventilation.
Very large pneumo's can and do occur and can lead to physiologic embarrassment and is treated essentially the same way but without the same urgency.
Anyways, there is talk out there about the phenomenon.
I would submit that TENSION penumothorax is a phenomenon that cannot even exist unless the patient is being mechanically ventilated....something that is not going to happen on the battlefield.
I also am inclined to disagree. Certainly mechanical ventilation will make it worse, or make it more likely, but I think any pneumothorax can allow normal ventilatory mechanics to pump up intrathoracic pressure high enough to cause some degree of mediastinal shift. More often that not, when I put in a chest tube I get a significant gush of air, even in non-traumatic pneumothorax on patients not being ventilated.
I also am inclined to disagree. Certainly mechanical ventilation will make it worse, or make it more likely, but I think any pneumothorax can allow normal ventilatory mechanics to pump up intrathoracic pressure high enough to cause some degree of mediastinal shift. More often that not, when I put in a chest tube I get a significant gush of air, even in non-traumatic pneumothorax on patients not being ventilated.
like i said...its debated...
and every tube I've seen go into a chest (and that's a lot) is associated with a gush of air, blood, or pus....doesn't mean it's a tension.
Basically the gist I am getting is that, unless you work in a clinical setting or in a direct tactical/battle environment, the odds of coming across these types of wounds is going to be pretty far and few between. I would imagine that this type of 'perishable skill' is very 'perishable' if one isn't likely to encounter scenarios where such a skill is needed.
While I find it very fascinating and would love to learn such a skill, it seems that the practicality of doing so (along with the requirement to re-certify on a regular basis) is not be there. My wife is a former USAF medic, she worked in an ER setting for much of her time, currently works as a dialysis tech (but still holds an EMT cert) as well as being a trad. reservist. (Mental Health Tech.) She has pretty much conveyed that message when we've talked about what is prudent for me to know and what is beyond a reasonable expectation of what I (or she, now) would likely ever encounter.
Maybe I've just been lucky for the last 46 years, but beyond basic stopping of bleeding (some pretty deep, but nothing arterial,) some 2nd degree burn care (one pretty serious, large affected area,) and wrapping a few sprains in the woods, I've not had to use too much of what I have learned, including CPR and the Heimlich.
like i said...its debated...
and every tube I've seen go into a chest (and that's a lot) is associated with a gush of air, blood, or pus....doesn't mean it's a tension.
Yes. I agree. But since mean intrathoracic pressure is normally negative, it does demonstrate that normal ventilatory mechanics can pump a fair amount of air in there, even in non-traumatic situations and where mechanical ventilation isn't being used. As we've already agreed, tension pneumothorax is generall rare in ANY situation.
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