So does it work or not?

[meisterhau]

Thanks for the feedback so far, gentleman. It's genuinely appreciated.

Not sure if anyone actually said it, but... good on you, Todd, for seeking some fundamental first aid training. Even things like the AED in the food court at the mall now mean something. Hopefully, you'll never need this stuff, but in truth, you probably will. Wish more people were willing to man up. I think it's awesome that you're thinking this through, and putting real-world application to it.

1. I don't think our instructor was ignorant of what you're saying, she was just very clearly being held to the ARC training protocol.

... as she had to. She'd be negligent to teach you things that are outside of the scope/protocols. The First Responder level is precisely what it is - fundamental ABCs - not med-surgical stuff. That's no slight on the cert - every paramedic worth a damn knows that a good FR or EMT-B is a HUGE asset. It's not high-level, though, so only the basics are taught. Some of it, as we've been discussing, is lagging behind the change curve.

I don't know if PHTLS or ITLS require you to be an EMT-B (or higher), or if a first responder can take the class, but it is a good thought. (EMT-B is also a great course - if keeping that level of cert up here wasn't a giant ass-ache, I'd go back just 'cause...) There is a ton of "alphabet soup" here in the medical world as there is anywhere... Things like ACLS and PALS aren't going to be useful to you (both advanced life support stuff with all the cardiac meds and whatnot). I was going to strongly suggest BTLS (basic trauma life support), but then realized that it had evolved into ITLS. That class was a challenge - had some tough instructors - but it was very, very cool.

2. Didn't mean to imply that my buddy considered himself a combat medic. Far from it. When he mentioned needle decompression, e.g., it was in terms of "someone is going to have to do that" not "this is what I'd do!"

Regardless, it's not something YOU should do, unless you advance your training and are operating under those protocols, or have no recourse but an exception. It is, however, great to be familiar with what SOMEONE can do, and who that someone is and can be summoned if needed. You obviously know this already...

[Joe_Friday]

I will have to agree with TacMedic4450 and disagree with most on here on the CPR issue. I have a few Life Save ribbons and certificates to prove that CPR does work and that patients can walk out of the hospital and continue thier lives. My father-in-law is a prime example. He is retired out of the Army and has been so for around 15 years, he is very overwieght, and does not follow any type of fitness routine. While in FL for work he went into cardiac arrest in the parking lot of a restraunt and his coworkers performed CPR. Poorly I might add, as one of them even stated that he did a Precordial Thump because he saw it done on TV and they inserted a pocket knife in his mouth to open the airway. The Med Unit arrived 8 minutes later and attempted intubatiuon and IV therapy and were unsuccesful on both counts. They continued with much better CPR and O2 and transported. He walked out 9 days later. So, immediate CPR + no O2 + no Meds + total time from collapse to EC being over 20 minutes = Save. I know it's not typical but it does happen.

Another case. I ran back up to another unit where the patient went into CA in a gym. Two people began CPR immediately (Trauma Surgeon and Cardiologist, what luck huh!) and the first unit shocked on scene. We arrived and a second shock was delivered. When I went to establish an IV access point the patient tried to sit up on the stretcher and said "what the hell are you doin'!". Before leaving the scene he had told us all the info we needed and how to contact his wife. He is still alive today (happened about 5 years ago) and he is doing well. I talked with him two weeks later and he actually told me everything that had happened form the instant that he collapsed until he "woke up". Sounds crazy but I was the only person that he had talked to that had been there and when I asked the first in medics about what he said, they agreed with all of it. I now take a different approach to what I say in front of all patients, living or deceased.

[ToddG]

Not sure if anyone actually said it, but... good on you, Todd, for seeking some fundamental first aid training.

Thanks. The truth is, for years I've said that any responsible firearms instructor should have some fundamental training in dealing with GSWs and range-related injuries ... and then I immediately had to follow it up with "but I don't, and I suck." My major motivation was definitely the students in my classes.

Regardless, it's not something YOU should do, unless you advance your training and are operating under those protocols, or have no recourse but an exception.

Dude, the only way I'm sticking something sharp & pointy into someone's chest is if he's trying to kill me.

[HowardCohodas]

My class was made up of all LEOs and one civilian, me. Therefore, in addition to the basic requirements to pass the test, much of the instruction was centered around the types of things they would encounter and the equipment they carry in their duty vehicles. Our instructor was active so she related real life stories to illustrate the points. She was clear about what answers were required to pass the test, but pointed out alternatives that her team had used. Even my cousin, the physician says your questions are unresolved in the medical community.

My conclusion... Just like a SD incident, rely on your training, use your best judgment, save a life if you can, contact a lawyer to sort out the rest.

[FMF_Doc]

Todd- the traditional wisdom has always been that TK is the last resort, more recently the military has changed its mind on the immediate use of TKs and that the transport times reduce the likelihood of losing a limb due to using one. You can fix most everything but dead from bleeding out isn't one of them.

CPR- my personal and professional opinions of CPR are that it provides at least a 30% chance of survival if performed correctly and in a timely manner, keeping the blood moving and oxygenating the tissues until advanced life support arrives is better than having absolutely 0% chance at all. Yes most likely if you are doing CPR you are doing it to make the family, coworkers, bystanders and yourself feel better knowing that you did something.

I have had 6 saves (out of 100's of cases) in 20 years of providing advanced prehospital and clinical care, but I would not hesitate to do CPR even given the odds and experiences.

You do what you are trained to do and if everything works out it's a good day, if not you drive on and try to save the next one.

It gets frustrating and depressing but you still do your best.

[VTLO910]

Note on CPR:

Supposedly the newer CPR that focuses on compressions almost exclusively to deliver the needed oxygen to the body is getting higher survival rates...

I just stopped working EMS FT a lil over a year ago, so I have not done my pushies ans puffies since... But I can understand the concept.


This is also good since most folks are afraid of getting their mouth near another persons. I think this newer style may actually make bystanders more willing to get a bit dirty and help.

Just don't tell them that the majority will have broken ribs and /or have vomited from the compressions...lol

[ST911]

I will have to agree with TacMedic4450 and disagree with most on here on the CPR issue. I have a few Life Save ribbons and certificates to prove that CPR does work and that patients can walk out of the hospital and continue thier lives.

The key word is "can." No one is saying otherwise. CPR can and does work, just not anywhere near as much as people think. We'd all agree that it's better than nothing, too.

Note on CPR: Supposedly the newer CPR that focuses on compressions almost exclusively to deliver the needed oxygen to the body is getting higher survival rates...

That's what they're saying. We'll see. The science, models, and collateral stats are supportive, though.

"Pushies and Puffies." Haven't heard that one.

[Gutshot John]

There needs to be a distinction between MI survival rates, and the effectiveness of CPR.

I've never seen CPR (BASIC life support) resuscitate someone by itself though it definitely beats doing nothing.

Applying ALS techniques and definitive hospital care and survivability does indeed shoot up significantly though most people still die.

30% success rate for CPR is wildly optimistic.

[brit]

The success rate for CPR is 8%, it has been the same 8% for the last 20 years.

This information came from two paramedics that instructed both my CPR class and ECA classes

[Pathfinder Ops]

Get hold of the TCCC info and you will have the answers short and straight to your questions.

The tourniquet studies alone negate any of the historic..."apply a tourniquet, lose a limb" discussion. The studies behind TCCC clearly indicate that touniquets are APPROPRIATE immediate intervention even where there is NO ARTERIAL bleeding.

According to studies from the Vietnam conflict alone, there is an estimated 2500 Soldiers/ Marines who bled to death from wounds NOT involving an artery. Simple bleeding control and the ability to recognize and then address a pneumothorax or sucking chest wound would have resolved the life threat in those lives.

Studies since then and especially secondary to the Battle of Mogadishu and the first Gulf war through current "lessons learned" show that the immediate placement of a tourniquet in what is termed the "Care Under Fire" phase is not only prudent but it is definitive care.

My company teaches the Combat Lifesaver Course to guard units deploying to the current theaters and the TCCC curriculum is very clear about this topic.

Traumatic cardiac arrest has less than 1% response to CPR, making it a no go in the tactical setting and and not a real consideration in the conventional EMS system.

There is a difference between a "sucking chest wound" and a pneumothorax. Each has its own treatment. In a sucking chest wound there is a hole that should be addressed in the way you describe with a 3 sided occlusive dressing or a "Asherman" type chest seal.

With the closed chest injury where a pneumothorax is present you will need to vent the chest.

Here are some of the statistics straight from the Military TCCC curriculum:

About 90 percent of combat deaths occur on the battlefield before the casualties reach a medical treatment facility (MTF).
Most of these deaths cannot be prevented by you or a surgeon.
Examples: Massive head injury, massive trauma to the body.

These are stats from Mogadishu through today:

KIA: 31% Penetrating head trauma
KIA: 25% Surgically uncorrectable torso trauma
KIA: 10% Potentially surgically correctable trauma
KIA: 9% Hemorrhage from extremity wounds
KIA: 7% Mutilating blast trauma
KIA: 5% Tension pneumothorax
KIA: 1% Airway problems
DOW: 12% Mostly from infections and complications of shock

An interesting side note here is that the statistic of 12% that die from Infections and symptoms of shock is the same percentage that die for that reason since the Crimean War. Yeah no change in that number.

Also note that only 1% of deaths were "airway" problems making them almost an after thought. and in fact we teach it as a secondary consideration to bleeding control. This is something our Tactical Medic students struggle to wrap their heads around at first. For conventional EMS personnel its a new way of doing an assessment.

About 15 percent of the casualties that die before reaching a medical treatment facility can be saved if proper measures are taken.
Stop severe bleeding (hemorrhaging)
Relieve tension pneumothorax
Prevent worsening breathing status
Restore the airway
Instead of ABCs……think CABCs

The above notes are taken right from our TCCC lecture.