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Post subject: First Aid and Combat Life Saver
Post Posted: Wed Jan 21, 2009 7:04 pm
Hey everyone...

I was speaking with a friend of mine over the weekend who is an Army medic and an EMT-B in civilian life...
We were discussing how important it is for those who own firearms to know how to provide effective life saving care from gunshot wounds and similar trauma...
Normal first aid doesn't discuss this much, but the Combat Lifesaver course does quite a bit....
This could be important if you or someone you love is ever wounded, or if there is (God forbid) a range accident or any other possible things.

I am not a doctor or nurse, I am however involved with CERT, am CPR/First Aid certified and spend a lot of time studying the matter.

Obviously this would be for personal study only, caveat emptor, I am not a doctor or a lawyer, blah blah blah don't sue me if you screw up.

If you are interested in self-study some topics you are going to want to search out are:

-Learn the First Aid ABC's (Airway, Breathing and Circulation) and CPR
-Standard treatment of wounds (acheiving hemostasis, stopping bleeding, wound care) (basic first aid type stuff)
-Pneumothorax treatment (sucking chest wounds)
-Tension pneumothorax and catheter based chest depressurization
-Hemothorax treatment
-How to use an Asherman chest seal or create a flutter valve
-The use of a nasopharangyl airway (tube down the nose)

Obviously this can be as simple or as complex as you want to go, and I would encourage professional training in this as well....


I am going to share a bit of what I have learned...

Call 911 and get EMS and police rolling as soon as possible when an incident happens.

Before doing anything else make sure that your efforts are not going to endanger your own life (such as an active shooter situation), and if you don't feel comfortable rendering aid then don't - the last thing you want to do is make a situation worse. Obviously you don't want to move someone who is wounded if possible, but if it is an active shooter situation and you can drag them to behind cover without endangering yourself than that might be the best thing to do. It is all situational dependent. If there are multiple armed people on your side, then they can provide suppressing fire or over watch while wounded are recovered. Obviously, this is risky and highly unlikely, but its good to know.

That being said there, there are some time tested things that even the most untrained layman can do to increase the survivability of an injured person. The most basic thing to do when someone is wounded and bleeding is to apply direct pressure to the wound (using a sterile bandage if possible). Cut away the clothing around the wound if possible, unless the clothing is adhering to the wound in which case apply dressing over top of it. If the wound is a gunshot, check for an exit wound, as that will need to be dressed as well.

If you haven't been trained in the use of tourniquets you should not use one unless it is a life or death situation (massive bleeding from an amputated limb, etc) because they can cause more harm than good. A belt tightened around a limb several inches about a massive wound can serve as a tourniquet.

Pressure should be held until the bleeding subsides (this could take upwards of 10 minutes depending on the severity) at which point the pressure dressing can be secured in place with a roller bandage. The knot in the roller bandage should be tied directly over the dressing, and you should check for feeling and blood flow below the wound at regular intervals to make sure it is not so tight as to cut off circulation.


The second thing that is important to know, especially with gunshot wounds, is the treatment of pneumothorax. Pneumothorax occurs when a lung has been damaged and allows air to escape into the pleural cavity (chest cavity) and out through a wound. This is also known as a sucking chest wound. Some symptoms are (in an individual with a penetrating chest wound) shortness of breath, cyanosis (turning bluish) and gurgling or sound of air coming from the wound.

First aid treatment of pneumothorax is to create a flutter valve over the chest (or back, or both if it is a through and through shot) that allows are to exit, but seals to allow the patient to breath in air. You can buy these commercially in the form of an Asherman chest seal, or something like saran wrap can be used. To apply, clear the area of all the blood that you can, and tape down the covering on three sides, allowing the fourth side to act as the flutter valve. You need to have enough material that the entire wound is covered plus more, so that when it sucks down it won't break the seal. If the bullet exited and the exit wound is showing gurgling, or if the original covering doesn't improve the symptoms then covering will need to be done on both sides VERY CAREFULLY.

Symptoms should begin to improve very quickly after treatment, if not, there may be other problems.


The Combat Life Saver course teaches soldiers to do something that most of us aren't qualified to do, and that is to treat tension pneumothorax. This is a dangerous situation where air pressure builds up inside the pleural cavity but isn't vented out through the wound. This can cause death quickly as the patient won't be able to breathe, and the air pressure will push the heart and lungs out of place, and cause the heart to not be able to pump properly.
The first aid treatment for that, is to use a 14 gauge needle with catheter to vent the chest cavity.
The needle is inserted in the second intercostal space from the midclavicular line until it reaches the pleunal cavity.
In English, that means the needle is inserted in the second gap down in the ribs from the middle of the clavical. You can find this spot on yourself by placing your index finger on your clavical and then feeling down from there, the second place there is meat instead of a rib bone is where it goes. It is inserted until it hits open chest cavity, and you will know it did by a rush of air out of the catheter, if you only get one burst of air it may have went in too far, so back it up a bit and see if it is more continuous. The patients symptoms should improve immediately when you insert the catheter.

Obviously I only recommend trained medical staff to perform this, but its good knowledge to have as some day it might save a life. If you have to do it, don't be afraid of doing it, this person will likely die if not treated soon. Even if you poke something with the needle and catheter that you shouldn't have, any resulting injury is going to be several orders of magnitude better than death by asphyxiation.



Thats all for now... Feedback appreciated.

Molon Labe!
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Post Posted: Thu Jan 22, 2009 10:51 am
Thanks for the info....I'm a football coach for my local school and we have to go through a lot of first aid training, but I have never thought about first aid for the shooting range.

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Post Posted: Thu Jan 22, 2009 6:06 pm
Thanks for the info Nick, This is very helpful.

Please keep us updated on any additional medical/first aid knowledge you acquire and would like to share.

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Post Posted: Thu Jan 22, 2009 8:15 pm
Excellent post Nick. One point you may have missed though. To prevent deadly infection, a condom should be used to shield a sucking head wound.

Well done :roll:

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Post Posted: Thu Jan 22, 2009 9:09 pm
tampons ( aka ovarian tube plugging devices)work great for bullet holes..............

i know from personal experience............ :cry:
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Post Posted: Thu Jan 22, 2009 9:42 pm
I know a lot of people talk about using those but from what I have heard professionals don't really encourage that because it isn't a sterile sort of thing.... Its in a wrapper but its not a sterile product I guess you could say...

Did you have one used on you?

Molon Labe!
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Post Posted: Thu Jan 22, 2009 10:01 pm
I have also heard that they are treated to prevent clotting which is just the opposite of what you want. Just carry a proper medical pad and if you need to improvise, use your shirt or other natural fiber.

JLE
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Post Posted: Mon Jan 26, 2009 12:06 am
I am absolutely sure there is a story here :!: but I don't think I want to know..... :shock:

rich wrote:
tampons ( aka ovarian tube plugging devices)work great for bullet holes..............

i know from personal experience............ :cry:

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Post Posted: Wed Jan 28, 2009 12:20 am
Not too sure what all to ad but this link and a thought. A little bit of knowledge can be a bad thing, know what you are doing.
http://www.ssrsi.org/911.htm
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Post subject: Re: First Aid and Combat Life Saver
Post Posted: Wed Jul 08, 2009 2:47 am
OhioLibertarian wrote:
Hey everyone...

I was speaking with a friend of mine over the weekend who is an Army medic and an EMT-B in civilian life...


And as such, he should be well aware of this, http://www.hemcon.com/

I have one in every vehicle, and in every tool box at the shop. They are ridiculously expensive compared to Band Aids, but do so much more.

Yeah, I have a vested interest. My nephew (by marriage) is a high up in this company. These bandages have saved numerous lives in Iraq and Afghanistan.

You can register and download a video from the web site. Last video I saw was about a year ago, they sliced open a live pig and stuffed this bandage in the wound. Bleeding stopped immediately and pig lived.

Brett Anderson
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Post subject: Re: First Aid and Combat Life Saver
Post Posted: Wed Jul 08, 2009 5:15 am
I don't know about the clotting issues, but a tampon is likely to be clean if not sterile, unlike any other rag or whatever you might want to stuff a wound with except sterile gauze....

The tricky part is having a girl along who's young enough to carry them, or dealing with your wife's suspicions if she finds 'em.... :)

"Pads" are also useful in the same sense - again, likely to be clean, but there might be some talc or some such on/in 'em. I swear the ones my sisters (and wife) used to use, years ago, with the special belts, are identical to the bandage + gauze thing that was once (and maybe still is) packaged in a GI First Aid belt kit. Used to find them at about every surplus store....

I did my last First Aid course back before CPR was invented, although I did get to study mouth-to-mouth. (OPOTA course - a couple of the guys found a couple of hookers and brought them into the class. The instructor about turned purple.... The girls were paid and sent off, but it was hilarious.)

I'm not sure blood had been invented yet, either. :mrgreen:

Just happened to think.... All of the CHL instructors out there already have the mechanism set up to offer a First Aid course that's CHL friendly, although it may not pass Red Cross muster. (I'm not sure how CHL friendly they are, not to mention holding classes in CPZ's & such. No direct evidence, just a thought....) Might be a way to make a few bucks.... I don't think there really are any standards other than Red Cross certification, and we really don't care.

Wanna laugh? I did the Basic First Aid course by way of a Red Cross certified instructor twice. The first was required by the Civil Defense office, and the second was within OPOTA. The first one was in a Class D location's back room, too. I was armed in both cases....

I don't remember the year of the first course - 1964, maybe, but the second was in 1967. Nobody cared about the sidearm except one lawyer who showed up to guest lecture one night to the OPOTA group. I'm not sure he was all that happy about 30+ armed students....

Regards,

Stu

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Post subject: Re: First Aid and Combat Life Saver
Post Posted: Thu May 13, 2010 1:36 pm
I have taken basic first aid and advanced first aid many times over the years, things do change, like the current method of CPR or that you should have latex or nitril gloves with you.

I need to take the CPR training again, because my certification expired a few years ago.

There is much to know and much to learn, but the Golden Hour is the key to saving a life.

Jerry

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Post subject: Re: First Aid and Combat Life Saver
Post Posted: Thu May 13, 2010 2:18 pm
miestro_jerry wrote:
things do change, like the current method of CPR or that you should have latex or nitril gloves with you.


I just took First Aid/CPR again yesterday, as mine has been expired for a few years. Changes surprised me. Our instructor even offered the opinion that soon, even rescue breathing will be done away with - only rapid chest compressions and AED if available.

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Post subject: Re: First Aid and Combat Life Saver
Post Posted: Thu May 13, 2010 4:43 pm
Skip:

The way Nobamacare is going, a First Aid kit will consist of a toe tag....

(Gotta re-certify myself one of these days. Last time I did it, we were just using drums and magic bones.... :mrgreen:)

Regards,

Stu

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Post subject: Re: First Aid and Combat Life Saver
Post Posted: Fri May 28, 2010 4:54 pm
I have other things in my kit other than immediate trauma materials. I have allergy pills, a big bottle of Aspirin (it is a Wonder Drug), regular bandages, a set of fishermans needle nose pliers, tweezers, antibiotic cream (TriBiotic type), a jar of Vasoline, antidiarrhea meds, as well as anticonstipation meds, foot powder, hand creams, there are afew other things, because unless the disaster is going to be over rather quickly, we must think of normal every day problems/maladies that every suffers from. Plus a medics handbook, which I haven't found one yet, but I will one of these days.

If there are any diabetic amoung you, how are you going to handle that medical need? Anyone have other chronic problems?

Jerry

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