Saturday, May 16, 2015

Shooter Self-Care Class @ NRA AM2015 (Update)

Saturday morning at the NRA Annual Meeting in Nashville this year, we attended a Shooter Self-Care Class taught by Kelley Grayson of the blog Ambulance Driver Files - A Day in the Life.

The odds are good that even a police officer who totes a gun every day will never fire a shot off of the range, let alone get shot himself or have a partner do so.  The statistics are even better for lawfully armed citizens. Nevertheless, as the amount of gun handling goes up, so does the chances of someone experiencing a gunshot wound.

The responsible citizen will know how to do more than dial 911 and wait...

I had intended to post not just a review of the class but something of a syllabus, but Shooting Illustrated magazine has published Kelly's article on the topic: Shooter Self-Care: Providing Lifesaving Care, which does a pretty good job.

Now, the classes you usually hear about on the subject tend to be "Tactical Critical Casualty Care" or something of the sort, and are all about the sort of things that a SWAT Team member will need to know to provide casualty care under Dynamic Operational Conditions while Operating Operationally. The course requirements usually include a packet of QwikClot and a thousand rounds of ammunition.

Sounds like fun, but not what I need.  Also, not what Kelly was teaching.

Here's the outline for the class:
  • Formulate a range safety plan
  • Discuss legally mandated reporting
  • Recognize and treat life-threatening injuries:
    • CPR/AED
    • Major hemorrhage control
    • Thoracic wounds
  • Recognize and treat secondary wounds:
    • Burns
    • Eye injuries
    • Impaled objects
    • Minor bleeding
After the jump, this turning into something of an uberpost, I'm just going to go into detail about a couple of things that were not in Kelly's SI article. 

We spent a  lot of time talking about a safety plan for your range, whether it's a club or a commercial entity.

From the course outline:
Range Emergencies
Factors to consider:
  • Onsite medical equipment or AED?
  • Range location and directions?
    • Remote range?
  • Adequate communications?
    • Can you get a cell phone signal?
  • Additional help/resources?
    • Unsupervised / improvised range?
The time to plan for these contingencies is BEFORE the incident.

When establishing a range's emergency plan, the address should be posted prominently next to every telephone. It should also be remembered that  the dispatchers may only give the responders "gunshot wound at 1234 Road Avenue", with no extraneous details, such as "Patient is at the Resume Speed Gun Club, wound due to negligent discharge while practicing fast draws, no threat to responders."

Which means that the EMTs may wait outside for the police to enter and clear the facility.

Note that there's a high probability that the police will show up anyway, since
In most states, every case of a wound, burn or any other injury arising from or caused by a firearm, destructive device, explosive or weapon must be reported to the law enforcement agency with jurisdiction where the incident occurred.
Failure to report such wounds may result in criminal liability.
Check your state and local laws.
So how do you avoid having a simple "Cletus shot himself in the foot trying to impress Lurleen" from resulting in a full-on SWAT response?

Responding to a Range Emergency,Slide one:
1. Call cease-fire and unload!
2. Keep your eye-pro on.
3. Evaluate the situation: major or minor injuries?
4. Call 911.
5. Designate someone to direct responders to the site.
6. Render aid.
7. Assist EMS and/or law enforcement in packaging the patient.
 By having someone meet the responders at the street or drive, you can insure that
  1. They go the the correct place.
  2. They know what to expect. 
  3. One less person crowding around trying to help, getting in the way.
Responding to a Range Emergency, Slide 2:
When calling 911, provide the following:
  • Your name
  • Facility name
  • Facility address
  • Contact phone number
  • What happened - ONLY THE FACTS
  • Location within facility of incident
  • Location of person meeting LEO/EMS
The dispatcher will put the address into the magic elf box, which will result in the EMT/Fire & Rescue in getting... GPS directions and an address.

If writing a plan for a club or commercial range you can try and coordinate in advance so that they all know that 1234 Range Boulevard is Joe's Range, Bait, and Sushi, but it just doesn't pay to be optimistic. (Maybe that's just the old NCO talking...)

Another thing to look into when establishing a range is a portable Automatic Electronic Defibrillator, or AED. In terms of business and organizational budget, they're not too expensive, and may save you on insurance.

A point I'd certainly never known: Check with your local Fire & Rescue/EMT organizations, and see what kind of AED they use. Different brands are not compatible for power leads, batteries, OR DATA PORTS. So always try to use compatible equipment...

We practiced on some trainers. (AED Trainers are real cheap. If you have an AED, get the compatible trainer.) So easy a lieutenant could do it.

The biggest surprises in the class were in how much "first aid" has changed just since I retired from the Army.

Starting when I was a Cub Scout all the way through my 20 year military career a tourniquet was the last resort. Bleeding was to be stopped by direct pressure, elevation, or pressure points. Even when a tourniquet was used, we were told that loss of a limb would result.

Now... Not so much. The difference lies partly in how tourniquet are made, but mostly in response time. With patients getting to the emergency room in an hour or less even in remotest Derkastan, tourniquets are saving lives AND limbs.

The two most common tourniquets out there today are the SOF-T and CAT. (Links go to the manufacturer's sites. Available elsewhere, maybe cheaper.) I have been told that both the SOF-T (and it's brother the SOF-T Wide, or -TW) and the CAT are the standard. I dunno. We have a bunch of SOF-TW's because I lucked onto a group buy on a forum.

In the class we practiced applying tourniquets.

Another big surprise was how much CPR has changed. As Kelly says in that SI article I referred to above:
If the victim appears unconscious and not breathing, place the heels of your hands squarely between the nipples, and compress the chest roughly two inches, 100 times per minute. There are CPR metronome apps for your smartphone, or you can just sing “Stayin’ Alive” to yourself to keep your rhythm.
It was noted that "Another One Bites The Dust" also works, but is contraindicated if the patient has any friends or family listening...

But wait! What about "rescue breathing"? Again from the SI article:
Rescue breathing, at least provided by the layperson rescuer, is not necessary. Research shows little benefit to rescue breathing in sudden cardiac arrest, and for reasons too complicated to explain here, it may even hinder your chances of a successful resuscitation.
So, chest compressions only. 

And while I'm quoting that article
There is no need to check for a pulse, either. Most laypeople do a poor job of at detecting a pulse, particularly under the stress of a resuscitation. For your purposes, unconsciousness + lack of breathing = chest compressions. If the victim opens his eyes and pushes your hands away, stop doing compressions, but otherwise keep going until the paramedics arrive.
{As an aside: After the NRAAM Mrs Drang and I spent a few days visiting my parents in eastern Tennessee. My mother is a retired registered nurse, and when we were talking about how much first aid has changed since the last time either of us took a class, she laughed and said that she had seen at least three or four different ways to do CPR alone during her career.}

Another thing that Kelly spoke of was treatment of open pneumothorax, AKA "sucking chest wounds". When I was in the Army we were supposed  to use the wrapper from the patient's first aid packet to cover that. Now there are better options, including the HALO Seal and Asherman Chest Seal. we didn't practice putting these on, but the technique was illustrated.

Kelly spent some time discussing the various Hemostatic, or clotting, agents and vehicles available these days. 
One item that makes a useful adjunct to a tourniquet, is a hemostatic dressing designed to speed clotting. Most of these dressings are infused with a hydrophilic clay or mineral compound, or a protein matrix made from chitosan, a byproduct of shrimp shells. Chitosan is safe even for those people with shellfish allergies. Hemostatic dressings got a bad rap in their early years for their difficulty in use, high price, and tendency to cause burns and other complications. However, as formulations and techniques have been refined, they have proven quite useful. They won’t stop arterial bleeding by themselves, but they will help make up for flaws in your wound care technique. Shop around for one that fits your budget, and use it according to manufacturer’s directions.
It may be desirable to repeat part of that:
Chitosan is safe even for those people with shellfish allergies.
Hemostatic dressings got a bad rap in their early years for their difficulty in use, high price, and tendency to cause burns and other complications. However, as formulations and techniques have been refined, they have proven quite useful.
One point mentioned by someone was that, while these things are required by Big Brother to have a "Pull Date" on the wrapper, they don't actually expire as long as the seal is not broken,  so you may be able to find QuickClot or Celox cheap, but still usable.

Caveat Emptor, make sure the seal is not broken!

Things that don't seem to have changed since Last Time included treatment for shock, burns, and eye wounds.

Included with the class was a blow out kit as described in Kelly's SI article. He gets his from Bound Tree Medical; other sources of similar kits include Tactical Medical Solutions and North American Rescue.Not included in the kit was a clotting agent, such as QuickClot or Celox. when we got home I added two pouches of QuickClot to each of ours. Since getting some direction, I have added SOF-TW tourniquets and HALO Chest Seals to the Trauma Kits I had built for my range and our "go" bags.

After the class I asked Kelly about another time, which I had been chided for NOT including in my blow out kits, which was an airway of some sort, "preferably" some sort of Nasopharyngeal Airways, or NPA. Kelly told me that these are not for untrained personnel, since "you could potentially insert it into a person's brain..."

I bet there's a good story there.

Assisting Kelly in teaching his class were EMS Artifact, Jeff, and Maureen (who do not have blogs, that I am aware of.) (Not going to put their full names out there unless I know that they have published same.)

After Kelly's class LawDog  gave a brief -- all too brief! -- talk on "physiological stress factors in defensive shootings, and the law enforcement response in the aftermath." (He calls it "Critical Incident Stress."

And I lost my blasted notes. Grr.

Okay, Bottom Line Up... er, Down Last: If you have an opportunity to take this class, do so.

If Law Dog's portion is available, I may take it again. (Discount for not needing a new Blowout Kit...?) If possible, and LD's talk is going to be added, efforts to make the venue available longer so that no one feels rushed when presenting their material ("Gonna need a wider fire hose here!") would be nice. That assumes that the venue is available, and affordable.

I do NOT think this should be a class available as an official item on the NRA Annual Meeting schedule: The instructor to student ratio of 1:4 worked well, you'd need a battalion of EMTs, ER/ICU nurses, or Combat Medics to make that work.

This definitely falls into the realm of "Stuff I hope I never need to know", but it is also certainly well into the realm of "Glad I learned that."



Old NFO said...

That was very well recounted sir! Thanks! And it's a damn good class!

Momma Fargo said...

Excellent post! I shared it with many of my Facebook friends.