EMS training and the firearms instructor [Archive]

Josh Runkle

11-05-2013, 04:57 PM

In 2010 I was attending an instructor's conference when there was that time where people went around the room and introduced themselves. We were supposed to say who we were, what our shooting backgrounds were, if we were with any departments/organizations, what we were looking to get out of the course and what we were working on/what skills or certifications we were pursuing back home. Everyone in the class addressed very specific firearm skills, and finally one guy broke from the groupthink and stated that he was working on becoming an EMT. The course instructor kind of said, "Ok, moving on..." and little more was mentioned. On day 4 or 5, I was speaking with the instructor who said he was working on becoming an EMT and I sort of said, "Oh, what made you want to become an EMT?" His explanation puzzled me.

He explained that things can and do go wrong at ranges and that if you were going to spend most of your time on a firing range, you would be wise to mitigate the possibility of complications (or even death) from a wait in medical response time.

My response was something to the effect of, "Err, ok."

Several weeks later, his words finally sunk in. I spent a TON of time shooting. Getting a small amount of medical training (preparing) for an event that may never happen was the exact same logic I had used every day when I strapped on a firearm. I had prepared myself to carry every day, I owned a fire extinguisher and regularly changed the batteries in my smoke alarms...how was this any different?

I eventually signed up for an EMT course that was a few nights a week for a few months. Not only was I well prepared in terms of understanding a full overview of what is happening to the body when someone has been shot, I understood various ways to treat it and then how to interact with other rescuers, all the way from police and EMS responding, all the way into the hospital and then interacting with hospital personnel. In addition to attaining my main goals of being able to respond to a catastrophic accident at a range, I suddenly realized that I knew a lot of medical things that had unintentionally enriched my life.

Later, for the sheer enjoyment of enriching my life with more medical knowledge, I finished paramedic school, which is after EMT school or Advanced EMT school and is like EMT school on steroids, with less sleep for a much longer time.

I don't know that every shooter needs to become a nurse, doctor or paramedic, but if you find that you go shooting often, you really should consider adding some medical response training to your skill list.

I would highly recommend at bare minimum, taking a class that teaches dynamic responses to stop hemorrhage. The type of class where you're stopping bleeding on a goat or pig. As gruesome as this sounds, the pig or goat suffers for a very real cause: to save lives. Usually, there's a BBQ at the end too. ;) These types of courses are usually 4-16 hours long. These are usually through private organizations - many of them are shooting schools, and generally a certificate of training at the end is for your own enrichment.

Beyond that, the first level of EMS is called Emergency Medical Responder (which used to be called "first responder", and may still be called that in some states). It is generally a 40 hour course covering all of the very basic skills needed to support life in most situations until help can arrive. These courses can usually be found by private organizations, but occasionally at a community college.

Another option would be to take a Wilderness First Responder course. This is the first 40 hours of the EMR course usually followed by 40 hours of teaching you how to improvise and think like a person who may need to improvise. These are usually taught in a long, outdoor one-week format through backpacking and outdoors companies.

An EMT course is generally 120-180 hours long, it is the first level of EMS that is a little more "official" meaning, you could actually work in a hospital or in an ambulance if you wanted to. This covers everything that is considered "basic life support" (usually not using multiple drug types, IVs etc...usually non-surgical, non-invasive) at the most in-depth level. This type of course is usually offered at most community colleges, some universities and some private companies.

The longer you shoot and the more rounds you put downrange, the more likely you are to have or see an accident, despite how "safe" you may be. Please consider preparing yourself to deal with a medical injury. You might be the only person around to save someone's life!

jlw

11-05-2013, 05:02 PM

Emergency trauma care such as TCCC is a good idea for shooters and instructors.

***Your post just reminded me of something I left out of my FBI Instructor class write-up, we had a block of instruction trauma care.

ToddG

11-05-2013, 05:39 PM

jlw

11-05-2013, 06:09 PM

Getting my First Responder cert was an early self-requirement when I began teaching full time. Prior to that, I used to give a $100 discount to the first two students who signed up and had EMT (or more advanced) training and committed to bringing trauma gear to class. I'm seriously considering going back to that again next year, too.

I'd like to do EMT-B next, schedule permitting. But I think the dedicated "gunshot wound & range injury" classes are where it's really at for most shooters. I sure do wish a certain forum member would get his butt in gear so we could bring him out...

I did a 40 hour first responder course as part of a career track certification through POST. On my second duty day after that, I was the first person in on a legit cardiac event. We ended up bringing her back. That situation made me realize how much I didn't know; so, I jumped in on Fire Rescue's 80 hour class that had an additional 24 hours riding with an EMS crew. Keeping all of that stuff in memory without it doing it all of the time is the problem.

The Sheriff went through the 80 hour course as well. We wrote into our policy that any SO personnel who also join Fire Rescue can use their SO vehicles to run medical/fire calls even when off duty.

John Hearne

11-05-2013, 07:21 PM

I became an EMT back in 1987 and was a Basic until 1997 or when I picked up my EMT-I and then Park Medic skill sets (ACLS, incubation, etc). I worked a lot of trauma the four years I was in the Las Vegas area. During the summer I flewout 2-3 patients a weekend. I eventually became a PHTLS instructor. All this to say I was not a "paper EMT." When I changed duty stations EMS was not a component of the job and I let my certs lapse.

Two years ago, I had a four-hour of TEMS taught at our annual refresher. I was amazed to see how much relevant information was packed into those four hours. I learned more about treating really injured people in that four hours than I had anywhere else in my life.

Based on my background, I would have to say that a short well-focused course is way more valuable than some nebulous "ems" class.

Tamara

11-06-2013, 09:09 AM

Excellent post, and a much-needed kick in the rear for me. :o

Totem Polar

11-06-2013, 12:15 PM

TGS

11-06-2013, 12:22 PM

What do you all find is the biggest thing keeping you from a 1 or 2 day (max) medical course?

PT Doc

11-06-2013, 12:33 PM

ToddG

11-06-2013, 12:48 PM

What do you all find is the biggest thing keeping you from a 1 or 2 day (max) medical course?

Their non-existence in this area, especially insofar as real "GSW & range injury" classes are concerned. Finding someone who has the ability to teach relevant material in a retainable way and who actually understands the realistic issues & circumstances that might be faced during an otherwise calm day at a shooting range is tough.

Josh Runkle

11-06-2013, 12:57 PM

^^^This. Something I have been contemplating, but not acting upon. Thanks for the post.

ETA: opinions on first 3 local calls to make to find a good 40-hour course? Police buddy, Fire dept, community college?

I'd just google EMS and your city or call the nearest community college or career center. Tell them what you are interested in and ask what's in the area. Most places will tell you their program is awesome and then also tell you about 5 other places in the area, 2-3 of which are also excellent. Call one or two and you'll end up with a consensus that 2-3 of the 5 local are excellent, and the other 2 local are just "good".

Or, call your local fire department. I wouldn't ask a cop buddy unless he has some training of his own.

Also, one huge difference between a 40 hour class and a two-day range class is that the range will be more in-depth and hands on about gunshots and hemorrhage, but not a whole lot of other stuff, whereas an Emergency Medical Responder course will cover any of the major types of emergencies: delivering a baby, cardiac arrest, etc, with only a few hours spent on hemorrhage, but you will probably learn a lot more on other stuff to do after hemorrhage has been treated, like treating for shock, and will have a better understanding of "medical concepts" like: "This person's heart rate is usually 70, he says, but he was shot 10 minutes ago and his heart rate is 160. This is telling me that he's in compensatory shock, and that he has lost too much blood and his body is trying to send oxygen all over the body with less blood by elevating his heart rate. I need to mention this to EMS or the hospital first, so that they start two large bore IV's before they do a history and remove the bandaging, etc...or so that they send me an Advanced Life Support rather than a Basic Life Support vehicle."

If it's in your budget, I might also consider taking a two day class first, and then asking the guys at the class for tips on taking a 40 hour class. (As they will have different focus' of information, you won't necessarily "re-learn" a lot of the same thing, so you might want to do both)

Totem Polar

11-06-2013, 01:15 PM

I'd just google EMS and your city or call the nearest community college or career center. Tell them what you are interested in and ask what's in the area. Most places will tell you their program is awesome and then also tell you about 5 other places in the area, 2-3 of which are also excellent. Call one or two and you'll end up with a consensus that 2-3 of the 5 local are excellent, and the other 2 local are just "good".

Or, call your local fire department. I wouldn't ask a cop buddy unless he has some training of his own.

Also, one huge difference between a 40 hour class and a two-day range class is that the range will be more in-depth and hands on about gunshots and hemorrhage, but not a whole lot of other stuff, whereas an Emergency Medical Responder course will cover any of the major types of emergencies: delivering a baby, cardiac arrest, etc, with only a few hours spent on hemorrhage, but you will probably learn a lot more on other stuff to do after hemorrhage has been treated, like treating for shock, and will have a better understanding of "medical concepts" like: "This person's heart rate is usually 70, he says, but he was shot 10 minutes ago and his heart rate is 160. This is telling me that he's in compensatory shock, and that he has lost too much blood and his body is trying to send oxygen all over the body with less blood by elevating his heart rate. I need to mention this to EMS or the hospital first, so that they start two large bore IV's before they do a history and remove the bandaging, etc...or so that they send me an Advanced Life Support rather than a Basic Life Support vehicle."

If it's in your budget, I might also consider taking a two day class first, and then asking the guys at the class for tips on taking a 40 hour class. (As they will have different focus' of information, you won't necessarily "re-learn" a lot of the same thing, so you might want to do both)

Awesome; more than enough to get started, thanks a million. Google turned up enough white noise in my region that I wanted an experience filter, which you have most adroitly provided.
:cool:

ToddG

11-06-2013, 01:27 PM

Also, one huge difference between a 40 hour class and a two-day range class is that the range will be more in-depth and hands on about gunshots and hemorrhage, but not a whole lot of other stuff, whereas an Emergency Medical Responder course will cover any of the major types of emergencies:

I'd echo the same thing but with a different spin: the 40hr "First Responder" class I took taught me a ton of things I don't particularly care about and spent extremely little time on the problems I'm most concerned about like GSWs. I don't need to know how to tie someone down to a stretcher because I'm not going to have one. We spent more time on organizing mass casualty care than we did on stopping hemorrhages. Ditto AEDs, etc.

Those skills might be useful some day, no question. But if my primary concern is learning how to deal with serious accidents on a firing range, treating frostbite and delivering babies is taking away from the time, money, and effort I could be spending on range injury care.

My main point is that folks shouldn't think that the 40hr FR course is "Advanced" compared to a GSW class. It covers a lot of different things, but doesn't cover GSWs in as much detail as a 1-day GSW course would.

Also, things may have changed recently but at least here in MD, both the Red Cross and AHA discounted the use of TQs, wound packing, etc. in the classes I took. Given that a close friend's life was just saved by the timely use of a TQ to her upper leg, I remain less confident about generic classes compared to range/field-specific classes taught by folks with both experience and understanding of the actual environment.

Totem Polar

11-06-2013, 01:37 PM

Also, things may have changed recently but at least here in MD, both the Red Cross and AHA discounted the use of TQs, wound packing, etc. in the classes I took. Given that a close friend's life was just saved by the timely use of a TQ to her upper leg, I remain less confident about generic classes compared to range/field-specific classes taught by folks with both experience and understanding of the actual environment.

It would seem that the .mil community would be dumping such people into the marketplace over the last decade, in similar fashion to team stack room clearing instructors, yes?

TGS

11-06-2013, 02:45 PM

It would seem that the .mil community would be dumping such people into the marketplace over the last decade, in similar fashion to team stack room clearing instructors, yes?

There's no money in it.

So they either get a decent gig teaching to the people who need it most, or they go on and do other things in life.

Example: At my agency of 215 (about 200 of those being on the street or instructors), we have a grand total of zero prior or reserve military medics on our staff. 1 Vietnam helicopter pilot, 1 Vietnam platoon commander, 2 Vietnam intel guys (1 who went career), 1 Army MP, 1 Marine radio tech and myself are the only veterans on staff that I can think of right now.

ST911

11-06-2013, 03:24 PM

I teach EMS stuff to public safety and citizens, including cert courses, initial and continuing ed. I also crew a bus.

EMT and FR courses teach broad-base, pre-hospital care of patients to providers that are working in a light-clinical or public safety setting. These are generalist courses and curriculum that offer the LE, LEFI, and CCW some carry over for the shared principles. However, events like GSWs and sudden major trauma benefit greatly from additional focused training and one-button solutions for populations that aren't doing regular care...especially care under stress or fire.

Nothing wrong with taking the NREMT courses in some form, but is the cost:benefit there? For most, no.

In the last couple of years, most training I've attended in combative skills (and even op planning) has included some sort of discussion, demo, or exercise in associated trauma. Sometimes it has been impromptu when a provider is in the class or the question comes up. Some have written it into curriculum.

Simple training in managing a bleed, tension pneumo, shock, and some basic assessment is easy to do within any space, time, or financial constraint. That more are not doing it is disappointing.

Joseph B.

11-06-2013, 04:55 PM

Getting my First Responder cert was an early self-requirement when I began teaching full time. Prior to that, I used to give a $100 discount to the first two students who signed up and had EMT (or more advanced) training and committed to bringing trauma gear to class. I'm seriously considering going back to that again next year, too.

I'd like to do EMT-B next, schedule permitting. But I think the dedicated "gunshot wound & range injury" classes are where it's really at for most shooters. I sure do wish a certain forum member would get his butt in gear so we could bring him out...

I tend to agree with your statement here, a good CLS, TCCC, or First Responder course that is dedicated to trauma management (I.e. controlling bleeding, keeping the airway open and shock control) is probably the best options. EMT basic, really doesn't cover enough to be a catch all, and even with a basic cert, you would still need ALS, TCCC, etc. However, EMT basic is the stepping stone to an intermediate and advanced certification. I won't say EMT-B would be a waste of time for a firearms instructor trying to become more prepared for a possible medical emergency. But I think it has to be with the mindset that follow training is a must.

TCCC, doesn't require an EMT cert, and is about a million times more relevant IMHO.

$.02

TGS

11-06-2013, 05:13 PM

Joseph B.

11-06-2013, 05:51 PM

Questions for instructors in here:

In your entire career of instructing,

1) How many medical emergencies have you had in your courses?

2) How many of them were GSW specific, compared to some other sort of medical emergency; diabetic, cardiac, respiratory, heat/cold injury, allergic, ect.
-
"Medical emergency" meaning someone had a problem that warranted any amount of attention, not "!OMGZR call 911!!!1"

I have never had a student injured by GSW, in any of my classes, military or civilian. However, just about every class I've taught has had some form of mechanical injury or minor cut/abrasion. Heat injury, is controllable by the instructor and I have not had anyone actually fall out to heat stroke. I've never had any cardiac or diabetic issues, as I normally ID students with those issues and keep close watch.

What I've seen most is knee/ankle sprains, cuts and abrasions on hands and arms, and dehydration. All of which are easy to deal with and I would not consider "medical emergency" but all the same most common.

I've been pretty fortunate to have received some really good trauma training (CLS, ADV CLS, TCCC, and several specific task classes), I have also dealt with quite a bit of real world trauma during my deployments. What I've learned is stop the bleeding, keep the airway open and control the shock. GSW to extremities are pretty simple and straightforward, however, torso and head/neck GSW's become very difficult and require good training and equipment.

The only "Range GSW" I've seen personally, has been a lower leg through and through. IDPA match at a local club, guy shot himself through the holster, with a HK USP 45 C. I was not involved with his treatment, but was a bit amazed they try to use a sweat rag to control the bleed, instead of slapping a tourniquet on it. But whatever, it was not my problem and dude was in a transport within 20 minutes.

TGS

11-06-2013, 05:58 PM

First, thanks for the input. After a few more data points I'll be able to write what I've been meaning to lay out.

The only "Range GSW" I've seen personally, has been a lower leg through and through. IDPA match at a local club, guy shot himself through the holster, with a HK USP 45 C. I was not involved with his treatment, but was a bit amazed they try to use a fowl to control the bleed, instead slapping a tourniquet on it. But whatever, it was not my problem and dude was in a transport within 20 minutes.

"Fowl"? As in a bird?

Not trying to start an argument, but from what you just described, that's not the sort of wound a tourniquet should be applied to, anyway. I'd probably be fired if I did that, at the very least demoted, stuck on a non-emergency transport truck, and get ass-raped by the Clinical department on a daily basis.

Josh Runkle

11-06-2013, 06:36 PM

ST911

11-06-2013, 06:44 PM

Joseph B.

11-06-2013, 07:16 PM

First, thanks for the input. After a few more data points I'll be able to write what I've been meaning to lay out.

"Fowl"? As in a bird?

Not trying to start an argument, but from what you just described, that's not the sort of wound a tourniquet should be applied to, anyway. I'd probably be fired if I did that, at the very least demoted, stuck on a non-emergency transport truck, and get ass-raped by the Clinical department on a daily basis.

Misspelling.

Yeah I can agree that packing a through and through and applying a dressing/pressure dressing wouldn't be a bad idea/better way to go with a good trauma kit/IFAK. However, there is significant data available supporting the put a tourniquet on it theroy as well. Especially if you may not be a medic, or have received training in ID'ing if the bleed is starting to clot or not, etc. A tourniquet is an easy/quick fix for the extremity GSW, that doesn't take a lot of training or skill. So I do think its a good option and method for that specific type of trauma.

Not arguing the issue, just presenting in a context of a person without any special training, treating an extremity GSW long enough for the medics to show up, etc.

John Hearne

11-06-2013, 07:25 PM

I had to sit through a one-day first aid course this year and the use of a tourniquet was mentioned. It's not rocket surgery....

TGS

11-06-2013, 07:49 PM

In attending or instructing... Falls, exertion injuries (sprains, strains), heat or cold exposure, dehydration, diabetic issues, small cuts and abrasions. When shooting steel, the occasional fragment return. No GSWs, knock on wood. A partner instructor had a student ND into his leg on a remote range.

Your normal outdoor-activity type injuries are far more common, along with any inherent medical conditions the shooter brings to the line.

You're stealing my thunder, bro. ;)

That is basically what I was stepping in. While TCCC is contextually relevant given the increased probability of a GSW in a course, I have a hard time equating it as a million times more relevant than general medical training. Our demographic is far more likely to need a cath lab than a trauma center.

TCCC courses are great. They're very focused and the tradecraft is usually at a very high level. However don't think an NAEMT course like RoyGBiv hosted is not going to teach you what you need to know. In addition, not everything in a TCCC course is 100% relevant to us, either. Unless you're infantry or a tactical medic in a stack, you don't really need to learn care-across-the-barrier or how keeping up the fight is the best form of first aid....and those are the two biggest things that differentiate TCCC from everything else.

If you're really that interested in being top-notch on this stuff, the best way of learning is doing. Even just going for a ride-along as an observer with an urban EMS agency will do you wonders, because I'm convinced that GSW's are placed on some sort of a pedestal by most people which causes anxiousness because you've simply never seen one before. Personally, I don't get the allure that many people have with GSW's. In my experience, all they do is clog the entrance to the hospital with gang members and their larvae. The exciting stuff is high speed car wrecks, and the truly scary clinical decisions where you need to be on your game is with general medical cases. A person on anti-coagulants with a GI bleed isn't a very interesting patient...until they crash unexpectedly.

vaspence

11-06-2013, 07:56 PM

Here in VA I always worry more about a heat or diabetic related injury than an actual GSW.

I think this has been covered before, but I cannot recommend taking a Wilderness First Aid class enough. The assessment skills you'll get are a great foundation. I know the RC has included TQ use in their WFA course but SOLO has not as of yet, I recerted through SOLO in March.

I took the WFR in 2009 when I decided to become a basic skills instructor and upgraded to a WEMT-B later that summer. I also took a Trauma/GSW class from Doc K (did he teach at the Tac Conference this year?) and he along with Doc Mike did a great 2day class on this. This class also emphasized assessment of the victim. My understanding talking with him earlier this year is that he has his own thing now and is game to teach a class. Any interest from the NOVA/RVA crowd, hit me via PM. I can probably host in the RVA area.

Jason F

11-06-2013, 08:04 PM

Check out Dark Angel Medical. Kerry is a shooter and a damn good dude. He does a two day classroom course that covers using a blow out kit as well as every day emergencies. Tuition includes a well designed IFAK. He also does a class at SIG that includes range work.

FYI Georgia / Tennessee area folks - Kerry will be in the area twice in January 2014. 1/4-5 he's in Atlanta, and 1/25-26 he'll be in Tennessee.

I'll be attending the Atlanta class. I've been wanting to get in to one of his courses for a while. It'll probably be my first step though, I've also been wanting to do some other basic medical so I'm going to look in to the Wilderness First Aid for later in the spring.

PT Doc

11-06-2013, 09:36 PM

FYI Georgia / Tennessee area folks - Kerry will be in the area twice in January 2014. 1/4-5 he's in Atlanta, and 1/25-26 he'll be in Tennessee.

I'll be attending the Atlanta class. I've been wanting to get in to one of his courses for a while. It'll probably be my first step though, I've also been wanting to do some other basic medical so I'm going to look in to the Wilderness First Aid for later in the spring.

Good on you dude. You will get more than your moneys worth. Jeff Franz (Aesir Training) is working out scheduling to host a live fire course in NC for spring 2014.

Josh Runkle

11-07-2013, 12:03 AM

You're stealing my thunder, bro. ;)

That is basically what I was stepping in. While TCCC is contextually relevant given the increased probability of a GSW in a course, I have a hard time equating it as a million times more relevant than general medical training. Our demographic is far more likely to need a cath lab than a trauma center.

TCCC courses are great. They're very focused and the tradecraft is usually at a very high level. However don't think an NAEMT course like RoyGBiv hosted is not going to teach you what you need to know. In addition, not everything in a TCCC course is 100% relevant to us, either. Unless you're infantry or a tactical medic in a stack, you don't really need to learn care-across-the-barrier or how keeping up the fight is the best form of first aid....and those are the two biggest things that differentiate TCCC from everything else.

If you're really that interested in being top-notch on this stuff, the best way of learning is doing. Even just going for a ride-along as an observer with an urban EMS agency will do you wonders, because I'm convinced that GSW's are placed on some sort of a pedestal by most people which causes anxiousness because you've simply never seen one before. Personally, I don't get the allure that many people have with GSW's. In my experience, all they do is clog the entrance to the hospital with gang members and their larvae. The exciting stuff is high speed car wrecks, and the truly scary clinical decisions where you need to be on your game is with general medical cases. A person on anti-coagulants with a GI bleed isn't a very interesting patient...until they crash unexpectedly.

I find myself agreeing with 100% of anything you keep posting in this thread. Couldn't have said it better.

cclaxton

11-07-2013, 12:24 AM

Fairfax Rod and Gun Club IDPA members attended a one-day GSW, CPR, AED, Trauma-oriented Training which they all raved about. (I had a schedule conflict.) It was taught by Baltimore County Fire and Medical Training, and specifically Scott Goldstein. http://www.bcfmt.com/ You get your CPR and AED card as well. They also included some bloodborne pathogen content for your own protection as a provider. They used a dummy with fake blood for teaching purposes. (But that wouldn't stop them from ordering barbeque.)

It was so popular that they have scheduled another one in January at Fairfax Rod and Gun Club. Me and Bill at Anne Arundel Fish and Game are hosting one in Annapolis, MD and likely to be Sun, Dec 8. If anyone is interested, please PM me, but there are limited slots. Also, you can just email BCFMT at training@bcfmt.com and Scott will respond (pun intended.). Typically 8-12 in a class, $75 for the day, materials included.

Ever since I took Todd's AFHF class, I have been wanting to take a GSW first aid class...finally getting it done. But like shooting, I am sure it will require practice and continued learning.

CC

cclaxton

11-13-2013, 12:50 PM

We still have openings for the Dec 8 GSW, CPR, AED, First Aid Class at AAFG in Annapolis, MD.
$80/person, 8-3:15. Taught by Baltimore County Fire and Medical Training.

Let me know if interested.

Thanks,
Cody

BillP

11-18-2013, 10:50 PM

I sure do wish a certain forum member would get his butt in gear so we could bring him out...

TLG,

I will echo what is being said regarding NAEMT's TCCC and its lack of direct applicability here. TCCC teaches skills that are permissive in a military environment because the military is exempt from the laws and regulations governing the practice of medicine CONUS. Case in point: any 17 year old Private can take a razor sharp 3.25" 14 gauge needle and jam it into another soldier's chest to relieve a tension pneumothorax. Do that in the US without being a licensed advanced skill provider, and it opens the door to litigation and prosecution for practicing medicine without a license. "But I learned it in a TCCC class" doesn't relieve liability.

In contrast, the new NAEMT Law Enforcement/First Responder Tactical Casualty Care course ideally addresses your needs, in my opinion. It teaches, in a tactical context, how to take immediate life saving steps to control hemorrhage, manage an airway, prevent tension pneumothorax, and recognize and prevent shock. It was designed for first responders in an active shooter scenario, but would be very applicable to a range incident as well. It is an 8 hour course, and an intelligent instructor would include a blowout kit with the course. The LE/FR course is taught by an NAEMT PHTLS/TCCC Instructor. I happen to know one if that other guy doesn't come around...

ST911

11-19-2013, 09:49 PM

TLG,

I will echo what is being said regarding NAEMT's TCCC and its lack of direct applicability here. TCCC teaches skills that are permissive in a military environment because the military is exempt from the laws and regulations governing the practice of medicine CONUS. Case in point: any 17 year old Private can take a razor sharp 3.25" 14 gauge needle and jam it into another soldier's chest to relieve a tension pneumothorax. Do that in the US without being a licensed advanced skill provider, and it opens the door to litigation and prosecution for practicing medicine without a license. "But I learned it in a TCCC class" doesn't relieve liability.

Can someone provide a reference to a statute which makes it a criminal violation to relieve a ptx in that way?

Odin Bravo One

11-20-2013, 01:33 AM

Josh Runkle

11-20-2013, 09:19 AM

Obviously "Good Samaritan" laws vary state to state.............but by the definition of "Emergency Care" and "Good faith", one would be hard pressed to make a case for injury caused by needle thoracenteses.

An unlikely scenario to begin with, but the "Golden Hour" starts to rapidly disappear with the onset of a TPX. Unless I am otherwise required by law, I can do nothing and let dude die in short order, or as a Good Samaritan with no legal obligation to assist, I can stick a needle in his chest until either dude reaches appropriate level of care, or appropriate level of care reaches dude.

Since the NT technique is widely regarded in the medical field as the only method of preventing death from a TPX in the "field", and a TPX is understood to be an immediate life threatening emergency, I too would be interested in a statute, law, or case law that would prohibit it's use, or show of an actual case where a non-medical professional provided care via NT for TPX and was held liable for a subsequent death or injury to the patient.

Don't solve the problem, and quickly, dude is dead anyway.

There are some important pieces of information being left out here. Obtaining a needle for a chest decompression is part of the issue. It's kind of like how you could buy all of the sear parts online to illegally make a gun full auto...you "can" do it in the sense that no one may physically stop you before the fact, but you "can't" do it in the sense that it is illegal. IV needles are "controlled" the same way that other medical gear is. You need a medical director (doctor) to approve your "need" for it. EMS can only buy it because they're technically buying it on behalf of the doctor, who they are agents of. This, in the same way, is like the sear, you could still find and order it online, but you're really supposed to have reason for ordering it.

If you ran into a person that needed their chest decompressed with a 14ga IV, and they were a medical sales person who happened to have a box of them in their hands when they crashed, well, rock on, you're covered by Good Samaritan laws. If you work for an Agency or the military and your SOPs made you keep a go bag or travel bag for a deployment, and you grabbed it out of that, again, rock on. In these cases, you found what you needed to help, but the gear wasn't "purposed" to help beforehand in that specific case.

On the other hand, if you went and bought a medical kit to help others in emergencies, and you kept it in your car, and you're a civilian or EMS not in their jurisdiction (unless the SOP for the agency was to keep their kit in your car) or if you were a nurse, etc, and you help someone using a kit that you kept in case someone was in an emergency, then when it comes to the gear that you used, you would be guilty of practicing medicine without a license (as the doctor didn't order the gear, and you need his protocols, SOPs and gear) and the gear wasn't there because it is purposed for something else.

Good Samaritan laws stop applying when you specifically buy a kit with controlled items out of your own volition with the original intent of using that kit to help others without medical direction and oversight.

If the kit just happens to be there for some other reason, meaning, you didn't buy it without medical direction with the purpose of helping others, then you're cool. So, I keep a VERY large, additional IFAK with those items in my trunk and also one attached to my range bag. As I have purchased the items with the intent of using them on myself, then Good Samaritan would still apply if I were forced to use them on someone else, as my original intent is self-aid and not practicing medicine without a license.

You are absolutely right that Good Samaritan laws do change from state to state. What I wanted to point out was really how you're not just covered in all circumstances if it's an emergency. A LOT of people put kits in their car to help in an emergency, and regardless of training, it's still not legal to use that stuff on others...unless you can claim that you bought it for yourself or it's for another purpose and happened to be there.

I am not an attorney, but I recently completed a few college courses that were specifically about EMS and the law and we have had probably 15-20 classes covering Good Samaritan laws. Not saying you're wrong, just wanted to point out some things to be aware of.

Josh Runkle

11-20-2013, 09:32 AM

Can someone provide a reference to a statute which makes it a criminal violation to relieve a ptx in that way?

The issue isn't really what was done, but why the needle was there. Then, when someone without training does something so advanced, it's even harder to make the case for why the needle was there, because it seems like someone wanted/hoped to try the procedure. Practicing medicine without a license is a criminal act, and if that occurs, Good Samaritan laws no longer apply and all kinds of litigation for damage that occurred could follow despite the fact that you saved someone's life.

Basically, if you always try to help without gear or with makeshift gear, you'll always be fine, even if you caused injury but were trying to help. An example would be if you broke someone's ribs while giving them CPR. You saved their life, your only goal was to help, and you're protected.

If on the other hand you used gear, then you better be darn sure how to back up your argument for why gear was there.

Odin Bravo One

11-20-2013, 11:42 AM

Josh Runkle

11-20-2013, 11:57 AM

I'll take my chances and do the right thing any time I have the means to do the right thing. People who develop a tension don't last very long without intervention, and die extremely animated, loud, and painful deaths.

No one's claiming you shouldn't. I'm just advocating understanding, foreknowledge and preparation to deal with the aftermath, rather than blind bravado.

Odin Bravo One

11-20-2013, 12:51 PM

Josh Runkle

11-20-2013, 01:55 PM

No, no one claimed anything the contrary.

But after a quick Google search, I was able to easily find for purchase IFAK + 14ga cath for NT without any restrictions whatsoever from a variety of vendors throughout the US. Certainly one should have well thought out justifications for possessing any life saving equipment (Gun, less lethal, IFAK/TQ/NT Cath, good tires, etc.), and understand not just how, been when, where, and why to use it. But if they are that readily available to the public as COTS items, they are obviously not too "restricted".

My point was that they are "restricted" like a sear. You could buy a trigger pack from an mp5 kit and throw it on an HK94. It is against the law to do so, but there is no physical barrier restraining you from doing so in many cases. So you could use the same argument to say that using a sear is not "restricted"?

If you had a class II, the whole point about the sear would be moot. In the same way, if you have a plan that's well-thought out to buy gear only for your own self-care, and then you just happen to use it to save someone else, again, the point is moot.

If you don't know the difference and purchase a kit to save others, you could be in for a world of hurt.

Odin Bravo One

11-20-2013, 02:57 PM

I'll take my chances.

cclaxton

11-20-2013, 02:57 PM

We have one opening left for the Dec 8 GSW, CPR, AED, First Aid Class at AAFG in Annapolis, MD.
$80/person, 8-3:15. Taught by Baltimore County Fire and Medical Training. Complete with dummy that bleeds you can practice on.
Includes bloodborne disease precautions. You get your CPR and AED card.
CC

Joseph B.

11-20-2013, 03:12 PM

TGS

11-20-2013, 04:05 PM

Can someone provide a reference to a statute which makes it a criminal violation to relieve a ptx in that way?

No, because it's not criminal to decompress a tension pneumo.

It is criminal to practice medicine without a license, however. Since doctors are the only people who are allowed to practice medicine.....and ALS skills are performed as a personal assistant to a doctor under his/her license.....

I guess you see where I'm going.

Here's what one state has to say (http://www.dhss.delaware.gov/dph/ems/files/paramedicstandingorders2012.pdf). I'd highlight the pertinent parts, but that would pretty much mean highlighting the entire thing!

Paramedics are not authorized, in the State of Delaware, to function as independent providers of advanced life support services.

Paramedics function as physician extenders and, as such, participate in the practice of medicine. Paramedics may only perform advanced life support procedures when functioning as members of an on-duty ALS unit. Such a response unit must be from a state approved paramedic service whose paramedics are functioning under the license of the State Emergency Medical Service's Medical Director.

The prehospital provision of ALS services by a paramedic in any other situation constitutes the unlawful practice of medicine. Off duty paramedics who respond to a scene are considered Good Samaritans and are only expected to perform at the level of a first responder unless activated by an authorized employee of their employing agency.

These situations include but are not limited to: performing ALS skills while serving on BLS units, carrying ALS equipment in personal vehicles for the purpose of responding to medical emergencies, and offering or providing paramedic services in settings other than those described above.

Josh Runkle

11-20-2013, 04:34 PM

Where are you getting IV catheter is a "restricted "medical device or item? I just spent 20 MIN or so digging around and I can't find anything in my state or in a federal law. Not saying it doesn't exist, just can't find anything and I would very much like to read it.

I've never heard of catheters being restricted, I know some IV bags are, but the catheter is a new one to me. Regardless there are ways around it for relieving TPX, but damn a 14g catheter makes it a whole bunch easier/safer.

Again, like I said before, just like an auto-sear it's not restricted until you've used it. In my understanding, it's not illegal to own a sear as a paperweight if you don't own any guns. Own a gun and a sear for that gun and it's an issue. Same with a 14 ga IV. It's perfectly fine to have one as a paperweight. If you buy one with the intent of helping others, now it is a device that is restricted by multiple boards of pharmacy, the FDA and DEA. Once you cross that boundary, you need medical direction/medical authorization from someone with a DEA license to have it, and you have to be following SOPs/Protocols/medical direction to use it.

Like a sear it's not the ownership that's the issue, it's ownership + intent. What is your intent when you buy a 14 ga iv? Is it as a paperweight that is conveniently stored in your medical kit? Is it for self-care? Or did you buy it to help others without medical oversight and therefore without a medical license during an emergency?

You can buy all the IVs you want. They're only restricted when used as a medical device. Intent is the issue.

MDS

11-20-2013, 04:47 PM

If you buy one with the intent of helping others, now it is a device that is restricted by multiple boards of pharmacy, the FDA and DEA.

Interesting. Could you link to a sample such restriction? Not knowing what to look for, I can't find any...

Odin Bravo One

11-20-2013, 05:03 PM

Again, like I said before, just like an auto-sear it's not restricted until you've used it. In my understanding, it's not illegal to own a sear as a paperweight if you don't own any guns. Own a gun and a sear for that gun and it's an issue. Same with a 14 ga IV. It's perfectly fine to have one as a paperweight. If you buy one with the intent of helping others, now it is a device that is restricted by multiple boards of pharmacy, the FDA and DEA. Once you cross that boundary, you need medical direction/medical authorization from someone with a DEA license to have it, and you have to be following SOPs/Protocols/medical direction to use it.

Like a sear it's not the ownership that's the issue, it's ownership + intent. What is your intent when you buy a 14 ga iv? Is it as a paperweight that is conveniently stored in your medical kit? Is it for self-care? Or did you buy it to help others without medical oversight and therefore without a medical license during an emergency?

You can buy all the IVs you want. They're only restricted when used as a medical device. Intent is the issue.

I suppose, if someone is a complete moron, they could find themselves in a bind based on your arguments.

ToddG

11-20-2013, 05:50 PM

It is criminal to practice medicine without a license, however. Since doctors are the only people who are allowed to practice medicine.....and ALS skills are performed as a personal assistant to a doctor under his/her license.....

I'm not seeing how that relates to Good Samaritan actions which would almost certainly encompass any life-saving activity taking place on a firing range after a ballistic accident.

My CPR certification is expired. If someone is dying in front of me, is anyone here suggesting I stand back because I am no longer "licensed" to perform CPR?

I've got a needle in my IFAK. It didn't come with one, a surgeon (who was a student in one of my classes) put it there. I told him I'd never been trained to do a needle decompression. He said it was better to have the needle (and hope someone knew how to use it) than not have it. I'm quite certain he wasn't risking his medical license by "transferring" that needle to me with the very explicit intent of having it used by a random stranger on another random stranger in the event of a ptx.

I think this discussion is blurring the line between what, say, a paramedic can do on the job (legally) and what a private citizen can do in an emergency (without liability).

TGS

11-20-2013, 05:56 PM

I'm not seeing how that relates to Good Samaritan actions which would almost certainly encompass any life-saving activity taking place on a firing range after a ballistic accident.

My CPR certification is expired. If someone is dying in front of me, is anyone here suggesting I stand back because I am no longer "licensed" to perform CPR?

I've got a needle in my IFAK. It didn't come with one, a surgeon (who was a student in one of my classes) put it there. I told him I'd never been trained to do a needle decompression. He said it was better to have the needle (and hope someone knew how to use it) than not have it. I'm quite certain he wasn't risking his medical license by "transferring" that needle to me with the very explicit intent of having it used by a random stranger on another random stranger in the event of a ptx.

I think this discussion is blurring the line between what, say, a paramedic can do on the job (legally) and what a private citizen can do in an emergency (without liability).

1) CPR is not an invasive skill that requires a medical license.

2) A CPR certification is not a license, just like a SCUBA diving certification is not a license.

ETA:

The general rule of thumb we use as to what is covered by the concept of a Good Samaritan law is non-invasive. Bandaging, splinting, ect. Anything invasive is a no-go, because it requires a license to perform. Now, I do not have any court opinions to support that (paging Josh), but it's a general rule of thumb exercised by pretty much the entire medical community.....and I'm going to danger that's for a reason. I really don't feel like challenging that rule of thumb by being the test case for that precedent, either :) The idea of someone losing their life at a range because I didn't have a chest dart doesn't strike me as a reason to risk the well-being of myself and my family. Dead people happen.

ToddG

11-20-2013, 06:03 PM

1) CPR is not an invasive skill that requires a medical license.

I'm not being snarky, this is a genuine question: Can you provide a reference to someone performing a ptx decompression in an emergency as a Good Samaritan who was prosecuted for practicing medicine without a license?

2) A CPR certification is not a license, just like a SCUBA diving certification is not a license.

Perhaps I misunderstood when I got certified, but they seemed to think that keeping the cert up to date was important for legal reasons.

Joseph B.

11-20-2013, 06:07 PM

TGS

11-20-2013, 06:13 PM

IDK, I feel pretty confident that my Army medical certs will hold up as a defense to prosecution for having a decompression needle in my IFAK/First aid bag, and I am willing to take a day in court over saving someones life vs waiting on a paramedic who has legal authority to use the same equipment and training I have.

Day in court?

Court never happens for more than a day? Lawyer costs cannot add up to the cost of a new G-Wagon? Suits cannot add up to millions of dollars, or even jail time?

I'm not comfortable with assuming it's only going to be a day in court, and betting the rest of my life plans (as well as my family's) on that notion.

I stitched my own arm up about a year ago, b/c I had the equipment and training and did not feel like sitting in an ER for hours. Hell I showed my wife and oldest daughter the how's and why's while I did it. I guess I should be paying a fine or on probation for practicing medicine without a license.:eek:

If you can't recognize the difference between suturing yourself and suturing someone else, well.......I'll stop now. Todd gives me infractions when I write what I'm about to write.

TGS

11-20-2013, 06:19 PM

I'm not being snarky, this is a genuine question: Can you provide a reference to someone performing a ptx decompression in an emergency as a Good Samaritan who was prosecuted for practicing medicine without a license?

Nope. I've heard a lot of old wive's tales, but never bothered to look for a substantiated reference. I figured it best just to err on the side of caution, as advised to me by many doctors, nurses, and paramedics; combined medical experience being hundreds of years.

Feel like being the test case? Genuine question.

Perhaps I misunderstood when I got certified, but they seemed to think that keeping the cert up to date was important for legal reasons.

Still not a license. It gives you no power/duty as officiated by a government, which as Matt Streger, Esq (http://barmak.com/matthew-r-streger-esq/) lectured to me last week is the difference between a license and a certification.

Joseph B.

11-20-2013, 06:31 PM

Day in court?

Court never happens for more than a day? Lawyer costs cannot add up to the cost of a new G-Wagon? Suits cannot add up to millions of dollars, or even jail time?

I'm not comfortable with assuming it's only going to be a day in court, and betting the rest of my life plans (as well as my family's) on that notion.

If you can't recognize the difference between suturing yourself and suturing someone else, well.......I'll stop now. Todd gives me infractions when I write what I'm about to write.

LOL, I think this is the same old argument I've heard hundreds of times from medics and nurses who can never.provide any factual documentation, or reference material that supports "that my life will be over" b/c I saved someones life using skills and equipment I obtained from my military service. Furthermore I think its absolutely crazy that anyone with the training and skill would allow a person to pass away and refuse to help when they can, b/c they are afraid of explaining / defending their actions. That just not the cloth I am cut from. Thanks for the advice/opinion, but if one of my student just so happens to receive a life threatening GSW, I'm going to do everything in my power to save or keep them alive.

Erik

11-20-2013, 06:37 PM

TGS

11-20-2013, 06:54 PM

I'm going to do everything in my power to save or keep them alive.

I can totally respect that.

The other side of the coin is the yahoo who took a 1-2 day course described as "TCCC inspired", of suspicious quality, trying to dart people. Especially today, because there's no Walter Middy's out there living out their weekend warrior dream in Gun Culture 2.0. (sarcasm)

Kinda like the whacker coming up to us flashing his CPR card as we're starting a 12-lead, and tries to jump right in on the patient....

..."can you please stand in the corner" is something I really hate to ask at a scene.

ETA:

Here's another data point to consider: administering emergency oxygen. You can do such as a layperson, without medical direction, because "emergency oxygen" does not require a doctors order. This is how DAN (http://www.diversalertnetwork.org/training/courses/EO2) is able to teach and certify recreational divers for oxygen therapy. See how the distinction is made that a layperson can do it because it doesn't require a doctors order?

So, taking that logic, you are not allowed to do something that requires a doctors order (well, unless you have a doctor ordering you!). Right?

Odin Bravo One

11-20-2013, 07:04 PM

The other side of the coin is the yahoo who took a 1-2 day course described as "TCCC inspired", of suspicious quality, trying to dart people. Especially today, because there's no Walter Middy's out there living out their weekend warrior dream in Gun Culture 2.0. (sarcasm)

Like I said............a complete moron could find himself in a bind by chest darting someone.

Like JB, I'll take my chances. If the legal side wants to make a big giant issue of it............I'll choose to leave the reservation completely, and wish them the best of luck. Because if that is what it has come down to, I don't want to live here anymore. Especially given the very specific circumstances of a TPX.......guaranteed fatal if left untreated.

ToddG

11-20-2013, 07:06 PM

Nope. I've heard a lot of old wive's tales, but never bothered to look for a substantiated reference. I figured it best just to err on the side of caution, as advised to me by many doctors, nurses, and paramedics; combined medical experience being hundreds of years.

So again not trying to be as snarky as this sounds, but "hundreds of years of combined medical experience" without a single concrete instance doesn't sound very persuasive to me. We're not talking about the best way to decompress a ptx (medical), we're talking about the legal ramifications of doing it in an emergency (legal). If I've learned one thing over the past year it's that most docs & nurses & EMTs think they know a lot more about the law than they actually do. Which shouldn't be surprising, because so do most firearms instructors, most plumbers, most Presidents...

Feel like being the test case? Genuine question.

If it's a choice between that and letting a student die in front of me? Yes, I volunteer to be the test case. Of course, that presupposes that no Good Samaritans have done similar "practicing medicine" things in the past without legal ramifications. In other words, I don't think I'd actually be the test case. But yes, it's a risk I'm willing to accept under the circumstances. I'd hope everyone else would feel the same way.

Still not a license. It gives you no power/duty as officiated by a government, which as Matt Streger, Esq (http://barmak.com/matthew-r-streger-esq/) lectured to me last week is the difference between a license and a certification.

Then why did both the AHA and RC make a big deal about the importance of recertification not just for technical reasons but for liability reasons?

ST911

11-20-2013, 07:17 PM

Perhaps the better approach to my question...

For pre-hospital and hospital care providers, procedures (like NT of a PTX) are regulated and permitted within certain scopes of practice. This language is usually quite clear. If Joe Citizen is not one of those care providers, is he so constrained? To an extent that performing that procedure is criminal? That's the reference I'm looking for.

and further...

When does the execution of a certain procedure become the "practice of medicine"? What is the controlling language for that threshold?

UNM1136

11-20-2013, 07:24 PM

I used to have a supervisor that was so terrified about being sued he loudly complained about having to take CPR because "some folks in some agencies got sued for injuries they sustained while their lives were being saved." No citations were available as to who, where, or when. Knowing the supervisor as I do he was repeating internet rumor.

Good Samaritan laws in my state cover you as long as you don't attempt a procedure that you are not trained for or licensed to perform. A battery requires an action and intent. Negligence requires indifference and/or a disreguard for the life/welfare of another.

Bottom line in my mind is that a victim has to survive to sue you, and a victim's estate has to show you acted negligently, or that the injury was survivable until your intervention. I will intervene.

Locally a few years back a field services sergeant was shot in the head by a crazy guy (no gun contol support; he attacked her and took her pistol away). An off duty Air Force NCO witnessed it, and medically intervened. He was rightly heralded as a hero.

Yes, possession of a needle/catheter without a perscription is a federal crime, but who is going to enforce it? Federal law also requires you stay within view of the nozzle when you pump your gas...but who enforces it? Most local cops won't know how to get you in front of a federal judge (who would have jurisdiction), or care. Locally, possession of a needle at most would be considered drug paraphernalia, a misdemeanor charge. Locally, the feds are too busy to investigate a 14 guage angiocath in a first aid kit, which would require consent or a warrant to access under most conditions. So could you be charged? Sure. Not bloody likely without a major screwup.

Most of us who carry guns have an attorney that we plan to call in the event we need to shoot somone. You may get some piece of mind by consulting with them. A personal insurance policy to pay for attorneys and settlements would likely to be helpful as well. I have both.

Another thing I have is experience being sued in my official capacity and as an individual. I eventually won, and it was a long, stressful, scary experience. I was told almost 20 years ago that if I feared being sued that I needed to find another line of work. After that lawsuit, I fear them less. I learned by having a VERY good, specialist attorney who kept me in the loop the whole time. I learned alot about how the system worked, and the processes involved and how they interacted. I fear being sued much less nowadays.

pat

TGS

11-20-2013, 07:28 PM

So again not trying to be as snarky as this sounds, but "hundreds of years of combined medical experience" without a single concrete instance doesn't sound very persuasive to me.

Not snarky at all. I agree, which is why I came forward and chose to point out the lack of substantiation.

Still, the fact that we can't find a lawyer to actually come out and say, "You're Good!" and give us a thumbs up is reason enough for me.

Dude, I'd love to add a Combitube to my range kit! I'd love to carry around a few liters of IV fluids for the remote(!) cave diving sites I go to. Saving lives, preferably with high quality outcomes, is something I have a vested interest in. I just can't reason doing things beyond a certain level because of the risk I put myself and family at.

Really, not any different than choosing to be a good witness instead of getting in the middle of whatever hypothetical incident was brought up in the last "What would you do" conversation.

Then why did both the AHA and RC make a big deal about the importance of recertification not just for technical reasons but for liability reasons?

I don't know. Money making scheme? Being able to prove recent, relevant competency?

In any case, your original statement was:

My CPR certification is expired. If someone is dying in front of me, is anyone here suggesting I stand back because I am no longer "licensed" to perform CPR?

The point I was making is that it's not a valid comparison. While having a current CPR cert may help prove you were competent in it if something were to be brought against you, it's no where near the same to operating without a medical license for things that require a medical license.

ST911

11-20-2013, 07:30 PM

Perhaps I misunderstood when I got certified, but they seemed to think that keeping the cert up to date was important for legal reasons.

Then why did both the AHA and RC make a big deal about the importance of recertification not just for technical reasons but for liability reasons?

AHA and ARC are risk-averse and rigid. They promote continued recertification for

-quality of care, for genuine interest in patient outcomes
-quality of care, for best defensible technique in a litigious world (even with good sam laws)
-legal compliance for credentialed care providers
-keeping the money flowing to AHA and ARC

Hand wringing has become as common in healthcare education as hand washing.

TGS

11-20-2013, 07:36 PM

I used to have a supervisor that was so terrified about being sued he loudly complained about having to take CPR because "some folks in some agencies got sued for injuries they sustained while their lives were being saved." No citations were available as to who, where, or when. Knowing the supervisor as I do he was repeating internet rumor.

No, that's way different than what we're talking about here. It's widely accepted that you can injure someone in the performance of a live-saving procedure, and that you're not held liable for it. That's the entire point of the Good Samaritan law. I can injure a person while trying to extricate them from a car, but if I did what I was suppose to then I cannot be held liable.

I'm sorry your supervisor was a blubbering idiot, but he's on a whole'nother level and not what we're talking about here.

Good Samaritan laws in my state cover you as long as you don't attempt a procedure that you are not trained for or licensed to perform.

Essentially what I was saying.

Yes, possession of a needle/catheter without a perscription is a federal crime, but who is going to enforce it? Federal law also requires you stay within view of the nozzle when you pump your gas...but who enforces it? Most local cops won't know how to get you in front of a federal judge (who would have jurisdiction), or care. Locally, possession of a needle at most would be considered drug paraphernalia, a misdemeanor charge. Locally, the feds are too busy to investigate a 14 guage angiocath in a first aid kit, which would require consent or a warrant to access under most conditions. So could you be charged? Sure. Not bloody likely without a major screwup.

Obama.

Just like they got Capone on tax evasion instead of his murder charges, Obama will imprison all of the gun owners by getting them for their angiocaths.

Muhahahaha. Order 66, exposed.

Joseph B.

11-20-2013, 07:58 PM

I'm not attempting to argue the issue anymore, I'm trying to hunt down where it is made illegal by federal law to possess a needle. Can someone post a link or name the code it falls into. Thanks.

TGS

11-20-2013, 08:10 PM

I'm not attempting to argue the issue anymore, I'm trying to hunt down where it is made illegal by federal law to possess a needle. Can someone post a link or name the code it falls into. Thanks.

If true, I think it might be on a state-by-state basis:

From AIDSLAW (http://www.aidslaw.org/legalguide.php):

Louisiana classifies needles and hypodermic syringes as drug paraphernalia and makes it illegal to possess or use them unless you have a prescription for a licit, injectable drug (La. Rev. Stat. Ann. § 40:1033). On the other hand, regulations of the state pharmacy board permit pharmacists to dispense hypodermic syringes if they see a "medical need" to do so. (La. Admin. Code tit. 46, § LIII(5)). Note, however, that pharmacists have to keep a record of the buyer's name and address, and the quantity of needles purchased.

No idea if the law differentiates between an angiocath and hypodermic needle.

cclaxton

11-20-2013, 08:13 PM

Even Doctors can be sued for malpractice. Anybody can be sued for just about anything.
Whatever the action you take as a citizen you need to do responsibly and it should be reasonable.
That is not to say some attorney isn't going to make it sound unreasonable in court, but your action should be reasonable given the circumstances.
A Good Samaritan law may help you in court, but probably won't stop you from having to go to court.

Is it worth it?...That depends on the situation and my assessment of it.

I am taking this first aid training so I know how to do these basic procedures responsibly and with good reason. If you can show that you followed standard practice as taught by a trained medial professional, THAT is your best defense against a lawsuit.

CC

joshs

11-20-2013, 08:21 PM

A battery requires an action and intent. Negligence requires indifference and/or a disreguard for the life/welfare of another.

The only intent required to commit battery is an intent to touch. Anyone acting as a "good samaritan" commits a potential battery, the question is whether there is consent to the touching, either express or implied.

Negligence does not required indifference or disregard for the life or welfare of another, it only requires duty, breach, causation, and damages.

I think a big part of the confusion in this thread is that people are talking about two different things; 1. whether a person can sued (for either battery or negligence) and 2. whether a person can be charged with the crime of unauthorized practice of medicine, battery (some states unhelpfully call this assault), or reckless/negligent homicide.

Also, good samaritan statutes vary greatly from state to state. For example, Virginia's is very broad when treating life-threatening emergencies.

"Any person who [i]n good faith, renders emergency care or assistance, without compensation, to any ill or injured person (i) at the scene of an accident, fire, or any life-threatening emergency; (ii) at a location for screening or stabilization of an emergency medical condition arising from an accident, fire, or any life-threatening emergency; or (iii) en route to any hospital, medical clinic, or doctor's office, shall not be liable for any civil damages for acts or omissions resulting from the rendering of such care or assistance." Va. Code Ann. § 8.01-225(A)(1).

"Any person who [i]n good faith and without compensation, renders or administers emergency cardiopulmonary resuscitation (CPR); cardiac defibrillation, including, but not limited to, the use of an automated external defibrillator (AED); or other emergency life-sustaining or resuscitative treatments or procedures which have been approved by the State Board of Health to any sick or injured person, whether at the scene of a fire, an accident, or any other place, or while transporting such person to or from any hospital, clinic, doctor's office, or other medical facility, shall be deemed qualified to administer such emergency treatments and procedures and shall not be liable for acts or omissions resulting from the rendering of such emergency resuscitative treatments or procedures." Va. Code Ann. § 8.01-225(A)(6).

Possession of hypodermic needles also seems to be treated differently in certain states. Virginia requires that the Commonwealth prove the defendant's intent to use the needle to the dispensing of a controlled drug. Va. Code Ann. § 54.1-3466. New Jersey seems to have no such intent requirement.

UNM1136

11-20-2013, 08:36 PM

TGS,

I agree with you, largely. I have run EMS for years and understand scope of practice. Then I became a cop and had to provide my own fan club.

My main point was that with what I know, I can elect not to get involved, or I can take a chance to save a life, knowing that if things go sideways, I knew the risk and acted anyway. Kinda like defending a stranger with a firearm. I can't claim ignorance after the fact, and intervening, while appearing to be the right thing to do, can in fact end badly. Risks can include life and limb, or future earning ability even if I elect to do the right thing.

I tell my rookies that you can be sued for doing the right thing correctly, the wrong thing, or nothing at all. A skilled attorney can turn things inside out, with a quickness. That is the nature of civil case law. Doing the legal thing correctly will generally save your tail, but not always. Some suits are decided by issues other than the facts

There is something to be said for doing the legal thing, even when it doesn't coincide with the right thing.

Most people in the firearms community use the term "big boy rules". Without opening that can of worms, in day to day life big boy rules can apply to making decisions that go against a textbook, SOP, or directive, and then dealing with the consequences.

And you were correct... the supe was an idiot.

pat

TGS

11-20-2013, 08:50 PM

We need more of your input in this conversation, Josh.

Also, good samaritan statutes vary greatly from state to state. For example, Virginia's is very broad when treating life-threatening emergencies.

So, it looks like it would cover guys using invasive procedures. Looked up PA's, and it looks starkly different, limited and directly related to Todd's questions about his CPR cert:

(2) In order for any person to receive the benefit of the exemption from civil liability provided for in subsection (a), he shall be, at the time of rendering the emergency care, first aid or rescue or moving the person receiving emergency care, first aid or rescue to a hospital or other place of medical care, the holder of a current certificate evidencing the successful completion of a course in first aid, advanced life saving or basic life support sponsored by the American National Red Cross or the American Heart Association or an equivalent course of instruction approved by the Department of Health in consultation with a technical committee of the Pennsylvania Emergency Health Services Council and must be performing techniques and employing procedures consistent with the nature and level of the training for which the certificate has been issued.

And then there's NJ, which doesn't really define anything....essentially leaving it up to precedent, as far as I can tell.

TGS,

I agree with you, largely. I have run EMS for years and understand scope of practice. Then I became a cop and had to provide my own fan club.

My main point was that with what I know, I can elect not to get involved, or I can take a chance to save a life, knowing that if things go sideways, I knew the risk and acted anyway. Kinda like defending a stranger with a firearm. I can't claim ignorance after the fact, and intervening, while appearing to be the right thing to do, can in fact end badly. Risks can include life and limb, or future earning ability even if I elect to do the right thing.

I tell my rookies that you can be sued for doing the right thing correctly, the wrong thing, or nothing at all. A skilled attorney can turn things inside out, with a quickness. That is the nature of civil case law. Doing the legal thing correctly will generally save your tail, but not always. Some suits are decided by issues other than the facts

There is something to be said for doing the legal thing, even when it doesn't coincide with the right thing.

Most people in the firearms community use the term "big boy rules". Without opening that can of worms, in day to day life big boy rules can apply to making decisions that go against a textbook, SOP, or directive, and then dealing with the consequences.

And you were correct... the supe was an idiot.

pat

Gotcha. Thanks for the follow-up, Pat.

Josh Runkle

11-20-2013, 10:06 PM

I'm not seeing how that relates to Good Samaritan actions which would almost certainly encompass any life-saving activity taking place on a firing range after a ballistic accident.

My CPR certification is expired. If someone is dying in front of me, is anyone here suggesting I stand back because I am no longer "licensed" to perform CPR?

I've got a needle in my IFAK. It didn't come with one, a surgeon (who was a student in one of my classes) put it there. I told him I'd never been trained to do a needle decompression. He said it was better to have the needle (and hope someone knew how to use it) than not have it. I'm quite certain he wasn't risking his medical license by "transferring" that needle to me with the very explicit intent of having it used by a random stranger on another random stranger in the event of a ptx.

I think this discussion is blurring the line between what, say, a paramedic can do on the job (legally) and what a private citizen can do in an emergency (without liability).

The entire point has been missed. You can ABSOLUTELY have a needle in your IFAK for yourself. You can absolutely REPURPOSE that needle to save someone else's life. A doctor can ABSOLUTELY recommend that you keep a needle with you. Barring specific state laws, If a doctor sent you to do any procedure and left you specific instructions on how and when you could do it (IE: when you could use that needle and for what) you could do it as his helper. You can't however see a man with a heart attack and attempt to cut open his chest and implant a pacemaker and then say that you bought the pacemaker just in case that happened and the Good Samaritan laws protect you.

Needle Thoracostomy is nowhere near as simple as second intercostal space, midclavicular line. There are arteries that can be punctured, causing the person you just saved to bleed out and have a hemothorax, you could buy the wrong length 14 ga needle, etc, etc...

I can completely understand the thinking of guys like SeanM, who may actually find themselves in a scenario where the alternative to helping is death when the response time may be severely extended. Totally get it. On the other hand, people who can have EMS response on the way have almost ZERO business attempting this procedure. I find it appalling that the guys in the discussion that have actual training are semi-hesitant and seem to view it as a last resort, and everyone else without specific training in pleural decompression thinks they're some Grey's Anatomy ninja.

Josh Runkle

11-20-2013, 10:22 PM

I'm not being snarky, this is a genuine question: Can you provide a reference to someone performing a ptx decompression in an emergency as a Good Samaritan who was prosecuted for practicing medicine without a license?

I'm not an attorney. I have however sat in a lot of classes governing good samaritan laws in the US (which vary greatly throughout the US). I don't have any cases in front of me. I know that 25-50 specific cases on practicing medicine without a license were covered and gear in conjunction with good samaritan laws was covered. I remember one specific case included a mother in childbirth who was on the way to the hospital and crashed and died... it was regarding EMS who performed a cesarian section to remove the baby under the doctors orders and they were found guilty, even though what they did was the only possible way that the baby could have lived. That took place in Cleveland. Another I remember from (I think) Colorado involved a pelvic examination following a motorcycle crash (the pelvis is an area blood can pool) but the charges were more of a "lifting the skirt" type.

Contact your state medical board. I have no specific instance that I walk around with. They probably have hundreds of cases and could point you in the right direction. I could contact my instructor from the legal course for EMS I finished this spring. He is an attorney and could probably cite many very specific cases.

UNM1136

11-20-2013, 10:25 PM

I'm not attempting to argue the issue anymore, I'm trying to hunt down where it is made illegal by federal law to possess a needle. Can someone post a link or name the code it falls into. Thanks.

Angiocaths, commonly used to give IV fluids, drugs, or in emergecy (needle) crichs or thoracostomies (chest dart) if I recall correctly are class 2 medical devices, regulated under the Medical Devices Act of 1976, an amendment to the Food, Drug, and Cosmetic Act of 1938. FDA has regulatory authority. Private citizens can own them with a perscription. Most dealers/manufacturers will not sell them to you without either a perscription or a medical device authorization signed by a physician authorizing you, as an agent of that physician to have them.

This appears to be a largely regulatory measure, with criminal penalties to give it teeth. Kinda like starting a gas pump and climbing back into your car, or fueling with your engine running. I don't know if the FDA has sworn agents with enforcement powers, but ANY fed with a folicle in his/her rectum could theoretically make an arrest and file a criminal complaint if so inclined. I don't know of any that would waste the time for one in a med kit, but there is potential for issues.

When I was running EMS, decades ago, EMTs were not allowed to introduce anything but airwlays into a patient (NPA/OPA, class 1 medical devices, regulated the same as dental floss). When you went to EMT-I you stepped into the realm of Advanced Life Support, separated from Basic Life Support by invasive procedures, like advanced airways, IV therapy, or injectable drugs. But, unless you had a MD authorizing you to perform these more advanced procedures, normally in the form of your Medical Director providing you with written Protocols, who was essentially allowing you to practice medicine under his/her license, with his/her guidance, to his or her standard, you could only practice to the basic level. Despite what your state license said, your Director could permit fewer advanced procedures than the state allowed, but they could not authorize you to do more than your licensure level.

I have a couple of drip sets, caths, and fluids, but the use of them is not something I take lightly, and would be very hard pressed to use them in a non-wilderness emergency.

pat

Josh Runkle

11-20-2013, 10:29 PM

Is there a distinction that should be made here between what a paramedic is permitted to do when on duty and what a good Samaritan, including an off-duty paramedic, is permitted to do, and protected in doing? The Delaware guidelines that were quoted say that an off-duty paramedic is only expected to perform at the level of a first responder. They don't say that they aren't permitted to respond using more advanced skills (at least not the snippet that I read). I don't have the time to dig into this at the moment, but it seems absurd to me, as a policy matter, that getting more advanced training and using it to save someone's life would put you at risk for prosecution for the illegal practice of medicine in a circumstance where an untrained person could do the same thing and be protected by a state's good Samaritan laws. The result does not make sense. Not that the law does not create perverse incentives left and right, mind you.

Good Samaritan laws are designed to have people help in a situation, not to allow people to suddenly become doctors without training. So a guy gets a shard of glass stuck deep in his eye…it's one thing to try to help him wash it out or help calm him down or cover both of his eyes so that the sympathetic movement from the other eye doesn't cause the glass to scratch his eye…it's entirely different to pull out a scalpel or a laser to try to cut the glass out of his eye. Same with decompressing the chest.

Josh Runkle

11-20-2013, 10:35 PM

If it's a choice between that and letting a student die in front of me? Yes, I volunteer to be the test case. Of course, that presupposes that no Good Samaritans have done similar "practicing medicine" things in the past without legal ramifications. In other words, I don't think I'd actually be the test case. But yes, it's a risk I'm willing to accept under the circumstances. I'd hope everyone else would feel the same way.

I would hope that you would only attempt this if your class is in wyoming, 2 hours from the nearest soul, and not if you were at a range in Fairfax, VA.

There is literally no reason to do this unless the person will absolutely die immediately if you do not help.

UNM1136

11-20-2013, 11:09 PM

I would hope that you would only attempt this if your class is in wyoming, 2 hours from the nearest soul, and not if you were at a range in Fairfax, VA.

There is literally no reason to do this unless the person will absolutely die immediately if you do not help.

The line in the sand I have set for myself before I would attempt a chest decompression is one where decompression is necessary, and as a last resort. Cyanosis, deviated trachia, and 5+ minutes or so eta on on an ALS rig, and I need to have my stuff with me; all of those would need to be met before I could consider doing this in my work environment.

I put this very low on the list of treatments, because many pneumos can quickly become a pneumo/hemo or a hemo depending on circumstances, and while I have seen several chest tubes placed, and can probably come up with the equipment to drop one, it is much more invasive and not something I would want to screw up.

Refer to my big boy rules reference. There may come a time and a place where I decide I might need to take one of these actions, but it will require a lot of deliberation, and quite possibly some uncomfortable conequences.

pat

Odin Bravo One

11-21-2013, 03:33 AM

Slavex

11-21-2013, 05:49 AM

incredibly interesting to see how good intentions can really cause a headache for someone. I find it absolutely amazing that possession of a hypodermic needle can constitute a crime under any circumstances, but hey I'm a Canuck. I can walk into my local pharmacy and buy them, or even better my local farm store where I can buy all sorts of stuff from needles to IV fluids for no reason other than I want to. As far as I can find, having and using any of that stuff in an emergency situation is acceptable, generally. I'm sure if it could be shown that you did something far beyond your knowledge and training that caused a situation to be worse, and you did it knowing that would be the outcome, you could be charge, but man, that would be tough to do I expect. But then again, nothing would surprise me.

joshs

11-21-2013, 07:34 AM

Good samaritan laws don't "let" people do anything. They provide immunity from civil liability if a person falls within the terms of the law. If a person acts outside of the terms of their state's good samaritan law, their act is not necessarily illegal, it is just possibly tortious.

Drang

11-21-2013, 11:58 AM

The general rule of thumb we use as to what is covered by the concept of a Good Samaritan law is non-invasive. Bandaging, splinting, ect. Anything invasive is a no-go, because it requires a license to perform. Now, I do not have any court opinions to support that (paging Josh), but it's a general rule of thumb exercised by pretty much the entire medical community...

So, this "we" is "the medical community" offering legal advice?

UNM1136

11-21-2013, 12:36 PM

This topic has certainly brought out mindsets of several of our members, and provided no shortage of examples of the sad state of affairs in this country. Not just the "legalities" and what may or may not be regulated/enforced, but at the individual level, priorities, and what drives the decision making process.

Sean,

If I seem hesitant, or conservative on this issue, it is because I am. I saw my first cutdown IV access when I was 16 years old. I have watched surgical and needle chrics, chest tubes placed, interossious access, and other cool guy things. What was driven home is that most of those techniques are in extremis, and to be used when the chance of the patient dying is greater than the risk of the invasive procedure. Hence my reference above to deviated trachea and a wait for an ALS rig. Tracheal deviation is one of the last SxS of a Pneumo, and my previous training has me wait for that indicator before trying to relieve the pressure. Most of the pneumos I have dealt with in the field already had a port to decompress through. An occlusive dressing taped on three sides with the untaped side facing down was our first line of treatment for a Pneumo. A chest dart (I think I still have at least one 12 ga 3.5 inch angiocath sitting around somewhere) was our last ditch, the patient is gonna die if we don't do this move. I know where the lines are drawn legally, since I have in the past been trained to a specific standard and to stay within that standard for the patient's benefit, and I am comfortable when I decide to cross those lines because of the facts and information I am presented with. I have a great intellectual understanding of many advanced field medical techniques, and little to no experience applying them. For a while I was with an ambulance crew for the second largest city in the state, and we dropped IVs on almost everybody but the opportunity for even the medics to practice the more exotic ALS techniques just did not present themselves often outside of training simulations. So my experience and capabilities to apply the cooler stuff don't match my understanding of the cooler stuff. And improperly accomplished, the cooler stuff has more of a risk to the patient.

Ultimately, my situation is different from many folk's situation, and my decisions need to be made within that arena. My jurisdiction is small,and I have a Level I Trauma Center 24/7 in the middle of it, and at any given time between 2 and 12 paramedics just minutes away. 90%ish of my calls have a three minutes or less response time. If I decide to do a scoop an run with my unit, I can likely get the patient to the Trauma Room faster than waiting for an ambulance to arrive and begin assessment and treatment. I even have couple of entries in my personnel file for disregarding SOP and transporting victims myself to the hospital. I have some neat ALS tools at my disposal, many of which are labeled in their wrappers that it is a violation of federal law to possess without a prescription. I have not ruled out using them absolutely, because I still carry them, and have created mini algorithms with which I will use them. [Edit: I just pulled out my emergency angiocaths and this set is not labeled. I looked up the manufacturer, and was referred to distributors, 5 of whose websites I checked require ID verification of eligibility to order these items. One of the sites indicated this was a prescription item requiring a copy of the Director's DEA license or State License prior to ordering. The same authorization is required to purchase IV fluids.] I have some co-workers that I would trust more than others in using them, but in my arena collecting the patient and boogying on down the road is more likely to ultimately help patient.

If I were a deputy sheriff, I would also likely be a volunteer as an EMT with the local fire department and be have the initial and sustainment training to loosen up my decision to use some of those cool ALS toys.

Every one needs to make their own decisions. Everyone's circumstances are different. I tell my rookies to do SOMETHING. If it is wrong, then there will be time to deal with the consequences of that decision later. But doing nothing almost guarantees a bad outcome for someone.

pat

UNM1136

11-21-2013, 01:18 PM

Sean,

I was also just reading your posts again, and my post, and it would appear that we are discussing the same thing with a different time frame. I have seen pneumos that did not develop tension, and treated them. You are absolutely 100% correct that a tension pneumo needs to be sorted out immediately. I was applying a grander timeline to the situation. I just clued in (late night, fighting with the teenager, and dealing with the wife's recent trip to the ER) that every reference you made was to a tension pneumothorax. By definition, that is late in the cycle and needs immediate attention. There are also correct observations that decompression is not necessary in all instances, depending on initial injury and treatment. A self burping dressing, Asherman Chest Seal, or other device may be the correct tool for the job, and monitoring the patient can head off problems. Some people have caused tension pneumos by not monitoring the patient after dressing the wound. Heck, I recall medics using surgical gloves to make one way valves on the needles for darting the chest. I am sure that the treatments have been modernized, and have changed, but I can only fall back to my previous training and experience. I guess some updated training is in order.

pat

Josh Runkle

11-21-2013, 02:31 PM

Chuck Whitlock

11-21-2013, 05:01 PM

Joseph B.

11-21-2013, 06:04 PM

Yeah I was trained to use the glove finger as a valve. Works really well and it is an easy solution.

joshs

11-21-2013, 07:58 PM

Veering hard out of my lane here.....

Some of the statutes copied specified, "without compensation". I was of the impression that receiving compensation was part and parcel of the, "Practicing medicine....." thing.

I am also wondering just how many of the laws restricting needle possession stem from the war on drugs rather than proper medical care and protocols.

I'm assuming you were talking about the VA statute I posted. I only posted the provisions governing non-practitioners since that is what we were discussing. It's actually quite a long statute and there are different provisions that apply to various different professional healthcare providers.

Many of the needle possession laws seem to be focused on those who are using the needles for controlled substances. I looked into the FDA regulation of angiocaths a little bit last night, and they seem to be Class II medical devices. However, that seems to affect how they are marketed and sold more than criminalizing their possession.

UNM1136

11-21-2013, 08:56 PM

Many of the needle possession laws seem to be focused on those who are using the needles for controlled substances. I looked into the FDA regulation of angiocaths a little bit last night, and they seem to be Class II medical devices. However, that seems to affect how they are marketed and sold more than criminalizing their possession.

Joshs,

Thank you for clarifying what I have been struggling to say. The examples I gave were not terribly clear. That succinct statement is makes much more sense than the mare's nest I have between my ears.

It would appear that I have misconstrued much of what has been presented to me. Thank you for helping clarify my understanding.

I did find that the DEA website lists paraphernalia almost identically to most state statues...http://www.deadiversion.usdoj.gov/21cfr/21usc/863.htm The difference is that locally it is a petty misdemeanor, and federally it is a sentence of up to three years.

Good to know the glove valve is still considered valid. 20 years ago I was told that it was on the way out because we were testing a valve that snapped onto the hub of the catheter. It was much more expensive and was not functionally better, so of course the ambulance service was pushing those.

pat

FailureDrill

11-22-2013, 05:29 AM

As an instructor at my agency, I believe my primary responsibility in regards to a medical trauma emergency which occurs during firearms training is to execute THE PLAN I have established prior to starting the training day.

The medical brief is not just telling people to raise their hands if they need a drink of water or got a cut on their finger. It needs to be comprehensive and ASSIGN responsibilities to fellow instructors and students so that you’re not trying to think of all that stuff when dude takes one through the femoral because of his SERPA holster (yes, I went there).

My medical brief before each training day includes
Personnel Responsiblities
Who’s in charge?
Who’s the primary medical personnel?
Who’s the secondary medical personnel?
Who will drive the vehicle if evacuation is necessary?
Who will drive or run down to the entrance of the main access road to waive in medical personnel?

I also post a medical info sheet somewhere nearby that is visible to everyone. It contains the pertinent range information: address, phone number for POC and latitude/longitude if there is a possibility of a life flight response for a serious injury. Any aid bags / IFAK’s / blow out kits are staged somewhere near this poster so that all the students know where they are. Any TQT's or similary IFAK's worn on student gear will also be identified. Adjacent this poster will also be an agency radio if available which is on and tuned to the right channel.

Our training is specific to firearms and the bottom line is that the worst thing that could happen, can happen in a split second. While someone may have a gradual degradation in condition due to heat injury, a shot to the leg can cause someone to bleed out in 90 seconds. You have to have some capability to assist with that.

As far as the medical side of training, I have the fortune to go through TCCC courses and new TECC (tactical emergency casualty care) through our agency which doesn’t involve NPA’s or darting chests. Lot of reps for tourniquets, pressure dressings (including in inguinal and axial areas) and bandaging tough areas liked heads. We also covered occlusive dressings, MARCH protocol and treating for shock.

My intent with the training isn’t to fix anything, but it is to delay the dying until I can get more qualified medical resources to the scene or get the patient to the medical resources. I would absolutely dart a dudes chest if I thought he was developing a tension pneumothorax and no other means were available to take action about it before aid arrived. I know how to do it, I won't sit and watch my student/peer die a preventable death if I have the means to stop it.

Personally, I think firearms instructors should have the training to handle these injuries on the range and at least deal with the most common preventable deadly injuries that can occur. Hand and hand with that is having a plan to execute as your students look to you as a guide and leader on the range when they are under your tutelage.

UNM1136

11-22-2013, 09:52 AM

As an instructor at my agency...

Excellent, excellent post.

pat

Joseph B.

11-22-2013, 11:10 AM

So now that ptx has been beat to death, shall we move on to emergency tracheotomy?:D

ETA: Standing bye with a KBAR, NPA & roll of duct tape....lol

Chuck Whitlock

11-22-2013, 02:21 PM

Joshs,
I did find that the DEA website lists paraphernalia almost identically to most state statues...http://www.deadiversion.usdoj.gov/21cfr/21usc/863.htm The difference is that locally it is a petty misdemeanor, and federally it is a sentence of up to three years.

Not sure about other jurisdictions, but here for paraphernalia to be paraphernalia is has to be found with the controlled substance or residue thereof. i.e.-needles, rolling papers, scales, etc. are not paraphernalia unless they are found in conjunction with a controlled substance.

UNM1136

11-22-2013, 02:57 PM

Not sure about other jurisdictions, but here for paraphernalia to be paraphernalia is has to be found with the controlled substance or residue thereof. i.e.-needles, rolling papers, scales, etc. are not paraphernalia unless they are found in conjunction with a controlled substance.

I agree with that and that is the rule of thumb that I follow, generally. Probable cause goes a long way, though, and the courts here don't require them to be together. I feel my case is much stronger when I have PC to show the use of the paraphernalia. My cursory reading of the federal statute indicates that the feds are under no such requirement, either. I wonder what the case law says...

pat

joshs

11-22-2013, 03:25 PM

I agree with that and that is the rule of thumb that I follow, generally. Probable cause goes a long way, though, and the courts here don't require them to be together. I feel my case is much stronger when I have PC to show the use of the paraphernalia. My cursory reading of the federal statute indicates that the feds are under no such requirement, either. I wonder what the case law says...

pat

The federal statute you linked doesn't cover possession. Also, the definition of drug paraphernalia requires proving that the item was designed or intended to be used with a controlled substance.

Surf

11-24-2013, 02:06 PM

The federal statute you linked doesn't cover possession. Also, the definition of drug paraphernalia requires proving that the item was designed or intended to be used with a controlled substance.Not to kick start this thread again in a negative way, I will stick to the original gist of this thread.

With training primarily LE and Military, I have had a clean track record so far. Nothing more than joints, sprains, cuts, heat etc...With our unit, someone with TEMS training or better is always present. We obviously have first responders in addition we have TEMS, EMT-B, and individuals who have ALS training via the US Army and their combat medic (live tissue) course.

My background is first responder, TEMS and the US Army combat medic course which I have been able to attend twice. I did not have the time to dedicate to the Federal EMT-B course that some of our guys go through and quite frankly I am not too disappointed in that. What I have taken away from all of the combined training is that some training is better than none. I also know that I am a hands on type of learner and the live tissue course (Swine) was BY AND FAR THE most valuable medic type training, possibly THE best training in any topic, that I have ever attended. It is one thing to read books and go through practice or "dry" training, but nothing can replace live tissue training, so if you ever have the opportunity for ALS live tissue training from a reputable organization, which is rare, go for it! I would sacrifice ALL other training I have been through on this topic, even any EMT, MICT, etc course for a high quality live tissue ALS course.

In the 11 day Army combat medic course, I learned more on the live tissue final, than I did in ALL of my prior training combined. I mean the practical application on live tissue completely blows away everything else. It is one thing to read it, stitch dead tissue, etc, but gun shot, knife wounds, blast wounds, suture, bleeders, amputated limbs, evisceration, femoral artery, decompression, chest tubes, carotid IV, buddy to buddy transfusions, chest crack and heart massage, etc, etc... is hard if not impossible to truly replicate on anything other than live tissue.

My experience with live tissue training was not "painful" to the animal as veterinarians and doctors being present monitoring the anesthesia, however indeed the animals were ultimately euthanized and for good reason. And no they would not let anyone use the meat for BBQ. Too much chemical and trauma to the animal. Unfortunately PETA made a big stink over the entire program which IMO is invaluable to those entrusted to save lives while potentially under fire. I would say without a doubt those who attended that course would be far less effective from the start if they did not get the live tissue portion of the training and without a doubt it saves lives. I would sacrifice many many swine if it allowed me to save but one human life.

ETA - One huge thing I took away from this and was amazing to me, is that the human body can sustain incredible amounts of damage / trauma and still survive. Prior to the training, I would have literally bet the farm that those animals COULD NOT survive the wounds inflicted. This etched in my mind to never give up and if initial treatment is obtained quickly and evac to a trauma center can follow in a reasonable time frame, the human body can survive a lot of damage. Of course after more than a decade of war, we really understand this.