EMS training and the firearms instructor

[Josh Runkle]

^^^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]

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.

[ToddG]

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]

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]

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]

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.]

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]

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"

[Joseph B.]

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]

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.