What do you expect out of a potential medical course?

[SamuelBLong]

People have been bugging me for a while, and Im really focused on getting stuff up and running, so here we go:

Business rule number 1: Listen to the customers needs;

I have ideas on what to include for a course targeted at the guys with little to no medical training, but I'd like to get input on what y'all would like to see included or get out of a medical course (taught in accordance with TCCC & PHTLS standards, with curriculum reviewed and approved by Emergency Medicine MD's and Trauma Surgeons).

Heres what Im planning on cramming into a 6hr block:

Rapid trauma assessment
Pathophysiology of Shock, Penetrating Injury (GSW, Knife)
Bleeding Control Skills - Tourniquet use, Hemostatic use, Improvised Methods
Gunshot Wound Management
Laceration / Abrasion Wound Management
Thoracic Injury Management
Management of Shock
Communicating effectively with a dispatcher and other responders
Building and using your kit

Lab time to practice skills and experience based learning (scenarios)

Discuss.

[TGS]

I like the "Building and using your kit" component. One of the things I notice is people who've had a basic crash course really don't have any familiarity with the various types of gauze, abd pads, ect. They usually ask the question, "Is this a good kit to buy?" indicating that they don't know what they need to bandage a wound, even if they're know they're suppose to bandage the wound. Be sure to include thinking about how many patients you can realistically treat and having a balance of items for such, versus having 16 abd pads and only 2 rolls of kling.

Just some musings I had....I see people ask that question, "Is this a good kit?" and it just tells me that they really hadn't learned anything. If you know how to use the basic implements for various wounds, you should be able to put together your own first aid kit without asking that question.

[ToddG]

... and Im really focused on getting stuff up and running ...

We really need a "holding my breath" smiley.

Beyond that, I'd throw the questions back at you:

What is the purpose of the course? Is it solely treating GSWs in a range environment? Or will it cover other common injuries/dangers on the range? Or will it cover other injuries/dangers in other environments?

How long do you expect the course to be? What I'd expect to learn in 4hr is different than what I'd expect to learn in five days.

How much theory do you think students need to have to perform the required tasks?
How much practice do you think students need to perform the required tasks?

As examples, the formal training I've received to date has all been very heavy on lecture/theory and light on practice & simulations. I've got absolutely no interest in the history of medicine or the names of all the bones in the foot. I don't need a list of the 84 different potential signs of heat disease... especially when 79 of them are also signs of "normal guy in normal condition on the range all day." I'm not going to remember them all, anyway. I don't need to learn how to take blood pressure unless you tell me I should keep a sphygmomanometer in my range bag.

Of the things you listed as topics, one that I see as left out (perhaps simply assumed) is pre-event planning. I've got a certain methodology I use for classes, for example, which you've seen. I'm a huge believer that having that plan has been beneficial in the past. Your ideas on what that plan should entail (and how to go about implementing any precautionary steps) would be a very important aspect of a "range emergency" class IMHO.

[SamuelBLong]

We really need a "holding my breath" smiley.

Beyond that, I'd throw the questions back at you:

What is the purpose of the course? Is it solely treating GSWs in a range environment? Or will it cover other common injuries/dangers on the range? Or will it cover other injuries/dangers in other environments?

How long do you expect the course to be? What I'd expect to learn in 4hr is different than what I'd expect to learn in five days.

How much theory do you think students need to have to perform the required tasks?
How much practice do you think students need to perform the required tasks?

As examples, the formal training I've received to date has all been very heavy on lecture/theory and light on practice & simulations. I've got absolutely no interest in the history of medicine or the names of all the bones in the foot. I don't need a list of the 84 different potential signs of heat disease... especially when 79 of them are also signs of "normal guy in normal condition on the range all day." I'm not going to remember them all, anyway. I don't need to learn how to take blood pressure unless you tell me I should keep a sphygmomanometer in my range bag.

Of the things you listed as topics, one that I see as left out (perhaps simply assumed) is pre-event planning. I've got a certain methodology I use for classes, for example, which you've seen. I'm a huge believer that having that plan has been beneficial in the past. Your ideas on what that plan should entail (and how to go about implementing any precautionary steps) would be a very important aspect of a "range emergency" class IMHO.

As I have it set out currently is a core class, its set for a 6 hour format - with a balance of 3-4 hrs lecture and the rest practice and lab.

The "core" is designed to cover management of traumatic injuries that may be encountered by individuals, not necessarily specifically focused on shooting range employees; Simply adding an additional 2 hours of time could add additional topics that those entities (commercial ranges, or shooting programs) may see - diabetic emergencies, environmental emergencies,etc as well as establishing response plans and procedures.

Having taught first responder through the paramedic level, as well as providing first aid training for the general public through various university supported events, I'm confident that the allotted hours provide plenty of time to cover the essentials. I am stripping down everything to the essential topics and skills - so no discussion on the names of all the bones in the foot, or differential diagnosis between pericardidits and a heart attack - just a simple "Press and Hold Here", use this item from your kit, ABC 123 approach

[Josh Runkle]

As every EMS course goes: BSI, scene safe...

Scene safety at a range includes everyone clearing their weapons and putting them away, and not reporting "a shooting at a gun range" but rather a "firearms training accident". The importance of gloves before pressure can't be understated.

I would rather someone be really good at those things than actually know how to properly apply a pressure bandage, tourniquet, etc.

Also, most people don't know a lot of the "simple" things that are actually learned in lecture like wet bandages for abdominal eviscerations, three-sided occlusive dressings for chest wounds, occlusive dressings for neck wounds, etc. As good as hands on is, there is a lot that can be learned out of some simple lecture.

[MDS]

I want to echo the practical piece. I love hearing lots of good info, but would almost rather not hear it in the lecture if I can't practice it under a trained eye. In the same vein (Haha, get it? Vein.) I'd love to hear about how to keep those skills from degrading - is there such a thing as dry fire for these skills?

[ToddG]

\Scene safety at a range includes everyone clearing their weapons and putting them away, and not reporting "a shooting at a gun range" but rather a "firearms training accident".

Why? I've never seen that at any firearms training class, event, or complex. In my (thankfully limited) experience, both EMS and police had no problem with people on scene at a firing range who had holstered guns.

Also, most people don't know a lot of the "simple" things that are actually learned in lecture like wet bandages for abdominal eviscerations, three-sided occlusive dressings for chest wounds, occlusive dressings for neck wounds, etc.

I get what you're saying, and perhaps it's just a function of how different people learn differently, but at least for me none of that stuff is likely to sink in unless I practice it. Sure, I could regurgitate it for a written test six hours later but in terms of real retention in case I need to utilize the skills six months later?

[Josh Runkle]

Why? I've never seen that at any firearms training class, event, or complex. In my (thankfully limited) experience, both EMS and police had no problem with people on scene at a firing range who had holstered guns.

As a paramedic, I can say that in nearly all of my limited experience, EMS will stage outside until the scene is safe. A shooting at a gun range could be a madman with a gun he just rented killing people. EMS will not respond until law enforcement has cleared the scene to be safe. This wastes valuable time that the patient is not getting care. There are of course other EMS models, tactical EMS, public safety, etc, but the national model is based upon scene safety. A phone call should reflect no doubt that the scene is indeed safe. Additionally, EMS is specifically trained that any guns in any environment are unsafe, they need to leave the scene and law enforcement needs to be called to secure the weapons. About half of the people I've met in EMS are pro-gun people who go shooting themselves, and the other half are scared of guns, and would indeed leave a gun range and call law enforcement before treating a patient.

[TGS]

Additionally, EMS is specifically trained that any guns in any environment are unsafe, they need to leave the scene and law enforcement needs to be called to secure the weapons. About half of the people I've met in EMS are pro-gun people who go shooting themselves, and the other half are scared of guns, and would indeed leave a gun range and call law enforcement before treating a patient.

This is true. I know someone like this, who basically treats seeing a shotgun rack in a hunters house the same as being at the scene of a shooting. I worked a shift with him last week, when we heard the police on their net talking about two shots fired outside a house....it's a well-to-do small town in an area with a ton of hunters and high gun ownership rates. I commented that it'd be "quite atypical to have a shooting out here," to which he replied, "Yeah, but there's lots of guns around here. You definitely see lots of guns out here!" as if just seeing a gun is something strange. You can't fix stupid.

On the other end of the spectrum, most of us are pro-gun. Some of us very pro-gun. On my first day of work, my boss and I stopped at his house so we could look over his AR-15s. One of our tour chiefs listens to gun-related podcasts outloud at his desk. Our former medical director (a doctor) visited us a couple weeks ago, and was using one of those gun apps on his iPhone to shoot us. But, you still get idiots.

If you can stabilize the patient and move them to the road, and tell dispatch such, it might be helpful. Given most outdoor shooting ranges are in rural areas, I would hope you get sensible crews....but don't be surprised if they do indeed stage until LE arrives.

There can also be a disparity between what is actually happening and what dispatch tells us. Sometimes a dispatch center has protocols to only dispatch certain calls as a certain category. The protocol might be to give a narrative, or where I work they're too busy so everything get's condensed. Where I work, no matter what, an accidental shooting, or "range training accident" will be dispatched as, "Ambulance XXX, City Of Todd Green, 555 Range Road for the shooting. Time 10:09." That's all we'll get. Then, we'll stage until the police tell us it's safe for us to enter, because we don't know otherwise. Maybe if you get a good dispatcher, they'll tell us to wait for a call-back for more information, and then we might get told that it's an accidental shooting. At the same time, it could be interpreted as a self-inflicted gunshot, at which point we're definitely staging!

So, go ahead and try to make clear to the dispatcher that it's an accidental shooting during training, that a range official is on scene, and that the scene is safe. Just don't be surprised if it doesn't happen the way you want.

[MikeyC]

1) Airway
2) How, When and Why to move a patient
3) Getting the patients gear off if needed. While the EMS response to a shooting a range will vary from department to department, of you bring a patient into the ER all tacticooled up, most ERs are gonna flip.
4) As much hands on as possible. You can talk about tourniquets and occlusive dressing and such all day, but if you've got to think your way through the process of using it while your buddy is flopping around in the dirt it's gonna be a very bad day
5) Refresher exercises. Nothing extensive, just a couple of hours of hands on to remember all of the stuff you were taught, but forgot since the last time you were shown it.