I see. So if I'm not willing to devote -- what's enough, residency? A full internship? -- several years to training, I shouldn't even bother thinking that I could assist myself or another?Originally Posted by Josh Runkle
I see. So if I'm not willing to devote -- what's enough, residency? A full internship? -- several years to training, I shouldn't even bother thinking that I could assist myself or another?
Not at all, as long as you know your limits. For bystander first aid, this basically should consist of BLS, basic hemorrhage control, and calling 911.
This is why I am not so big on most people carrying around carry chest seals, NPAs, etc. Even though these items seem relatively simple, my concern is the false confidence that these can create and the potential hazards this can cause. NPAs, for example, can be misused or inappropriately used if you don't know what to look for or how to use them. i.e. intercerebral placement of an NPA or destabilizing a C-spine fracture because you did not do a proper trauma survey (because that's not your job.)
The most thing I learned in my first 100 hours in the ER was the limits of my knowledge. They are many. In medicine, even the simplest of techniques requires hundreds of repetitions to do correctly - even something as basic as CPR. It is a rite of passage for every medical student to deliver ineffective chest compressions. There is a reason they have us work people who are (basically) already dead for the first few go arounds - and I can promise you I was convinced I knew what I was doing until I put my hands on them.
I think Josh's analogy is accurate - if you're going to carry around something lifesaving, you should have practiced its use dozens of times. It will still be scary when you have to put it into use but the odds of you doing so correctly are much higher with practice, practice, practice.
Josh said that 40 hours of medical training is equivalent to a CCW class. Lots of us, maybe me included, would tell someone who wasn't willing to train past a CCW class that they'd be better off leaving the gun at home. Was Rich mistaken, as Josh asserted, in asking whether his FAK was appropriately configured without pursuing further training? If I'm not willing to invest in some amount more than 40 hours -- I guess from your answer 100 is just adequate to show me what I don't know? -- should I not bother carrying medical tools? Do you agree with Josh in that respect?
I make sure to play doctor at least once a week. Can I add that time to my medical training resume? The patient always seems happy...
For a civilian gun owner/enthusiast, I disagree about needing extensive training to be able to get value/benefit out of having a medical kit and having a rudimentary knowledge of what's in it and how to use it. The most likely scenario you'll be involved in is that someone shoots themselves or someone else by accident at a range or match, with no malicious intent. You can probably get some valuable reps in on the basic concepts below in a 1 days class format:
For gun shot wounds, your top priority is to stop the bleeding. If it's a gun shot wound to an extremity, apply pressure, apply a tourniquet as high up on that extremity as possible, and then plug the wound. If it's a gun shot wound to the core (chest, stomach, back, pelvis, etc), pack it with as much gauze as you can and put a seal on it. Burp the seal if they show signs of troubled breathing. After that, check to make sure their airway stays clear, check their pulse and do chest compressions if their pulse stops, and keep them warm until professional care arrives. In either case, get them to a level 1 trauma center as fast as possible.
If you're in law enforcement (or a civilian who wants to be trained on doing care under fire), I recommend seeking out some kind of Tactical Combat Casualty Care (TCCC) course to learn how to apply these basic principles in a gun fight and to make good tactical decisions regarding self aid, buddy aid, etc.
If you want to take it further, you probably should look at becoming an EMT-B. This is overkill though for a civilian in my opinion.
EDIT: I used to teach a TCCC course to SWAT officers. One of the officers in the course was in a gun fight about 1.5 years later and was shot in the leg. He applied a tourniquet to himself and waited for EMS to arrive and credited his survival with learning that in the course. He certainly didn't get more than a handful of reps, role play scenarios, and a few lectures in the course, but he used it to save his life.
Last edited by Gio; 03-14-2017 at 01:06 PM.
Personally I don't agree that someone who takes a CCW class should just leave the gun at home. I do think they should be acutely aware of what their skill level is and is not with a pistol and what that means for their ability to use it in practice, and need to be especially aware of when not to use their gun. I have done a lot of shooting. I still understand that my ability to use a gun under stress is extremely limited vs. a professional and would never, for example, make an effort to stop an active shooter (unless they were between me and the door).
Similarly, you clearly do not need an MD to take an ibuprofen. You also don't need 10 years in EMS to apply a bandage - or, for that matter, a TQ. However, you do need basic BLS training to be able to do effective CPR. Taking the class once is the right start but needs to be repeated annually at minimum.
TQs you can fortunately get lots of practice applying on yourself at home - checking for distal pulses is a great way to see if you've done this correctly. Bandages and such are fine, but I would not want someone who doesn't know what they are doing trying to pack a wound on me and I am not enthusiastic about that technique being taught to non-professionals. Something like an NPA or chest dart - which many tactical medical classes will let you try once or twice, on a dummy - frankly the average person just has no business carrying.
Can't speak for Josh but that is my 0.02USD on the matter.
Last edited by Nephrology; 03-14-2017 at 01:21 PM.
I'm not saying that someone who only has a CCW class under their belt shouldn't be allowed to carry a gun. Similarly, I wouldn't say that someone shouldn't carry a med kit with them to the range.
I advocate that the thing that be added be more training. I have recommended more training to every single person who has taken a CCW class that I have met.
As far as how much training is sufficient: I am a paramedic, and I constantly take as much continuing education as I can get my hands on. This means that I took 130 hours of EMT school, about 5,000 hours of training to become a paramedic, and I average about 100 hours of continuing medical education a year. I certainly don't have the training of a doctor, and while I have treated gun shot wounds and various other things at gun ranges, I feel that my several thousands of hours of training is still insufficient. I'm sure that there are emergency physicians who still feel insufficiently prepared for some scenarios that they might run into.
For a firearms person, I would recommend basic safety and basic legal class(es) (CCW), then some fundamentals training, and then some books, videos, lectures or classes to cover mindset.
I would recommend the same for medical: take a CPR class. Learn some first aid, AED and then take a basic bleeding control class. Take TCCC. All of that training will prepare you to use a tourniquet fairly well, and handle basic hemorage control for a catastrophic event.
Skip the chest seals, 14ga, etc, unless you have Advanced Life Support training. The lowest levels for this would be a nurse or paramedic. You can cause just as much trouble by the improper usage of either of these.
Lastly, I'd preach that people should take some mindset training. I've treated 2 GSW's off duty while at a Range. Neither were remotely life threatening. One was through the outer aspect of the thigh (reholstering), one was through the top of the foot (unholstering). Neither required a tourniquet. I didn't remove his boot, and laced the shoe up very tight and sent them off. It was no big deal. In the background, 5 other people had their GSW kits open and were trying to tourniquet the guy. (Not saying it can't BECOME life threatening, just that it wasn't at the moment, and there was little to no bleeding.) However, I have seen 6-8 very, very serious cases of dehydration or heat related illnesses, and 2 very serious cases of hypothermia related to cold exposure. There are a lot of people who take gun classes who haven't run 10 steps in the last 10 years and then they run a Defoor Pistol Test at maximum effort. Gatorade Packets, Aspirin and Duct Tape will solve far more uses in emergencies. Plus, Duct Tape + Ziplock bag = chest seal in a pinch.
Gear is good. Training is better.
Last edited by Josh Runkle; 03-14-2017 at 01:58 PM.
Then you have a problem that more training isn't going to fix.
Josh.....what? A chest seal is not an ALS level intervention in any way shape or form, and by various bodies within the medical field is considered a lay-person skill. I learned chest seals in the boy scouts. Their use with minimal training has proven both effective and safe. The idea that someone needs to be a nurse or paramedic to apply a chest seal is contrary to TCCC/TECC guidelines, NAEMT and pretty much every state EMT curriculum/standards, various other lay person curriculums, and directly disproven by the vast amount of casualty care provided by lay persons over the last 2 decades.
I think that comparing 40 hours of medical training to taking a CCW class (which I'm assuming would be the classroom ones needed to get a permit) is inaccurate. I do agree that asking if you have the right stuff in your kit is evidence that you don't know what you need/what to do in the first place, but to say that anyone on this board who has dedicated 40 hours or less to medical training is only equivalent to taking some state mandated CCW class is aloof, insulting to those that have made efforts to get training, and sounds with an aire of superiority that is counterproductive to motivating people.
Last edited by TGS; 03-14-2017 at 03:12 PM.
"Are you ready? Okay. Let's roll."- Last words of Todd Beamer
Interesting thread, and timely, as I really should up-grade a bit. Really, I should assemble two kits; one for me to carry when alone, and another for when my wife is with me. (Though a retired medico-legal death scene investigator, she does have an ancient, little-used M.D. at the tail end of her name.)
I got shears in my ankle kit. Shears are first line, I need to get to the wound to treat it. From experience, don't cut through a down jacket, take that off.
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