Class review: Jim Amentler, Defensive Medicine, 8/19/17

[Librarian]

https://www.alphasafetytraining.com/

Great class!

Many of you have probably seen the TCCC class youtube video posted recently. This class was on the first aid skills needed before one takes that class.

In his Navy job, he trains new corpsmen, so he has the teaching methods and knowledge well in hand. Jim was careful to tell us this course was not certifying anything.

And, this class assumed a higher level of care was available - this was first responder stuff, and hope 911 response is close. That covers almost all occasions most of us see, but doesn't address a hiking trip a week away from a hospital, or collapse of civilization. Still need this stuff, but this class does not address non-professional care after first response.

There were 3 of us students - 2 LE and me. One had taken the course a couple times before, and the other had already met Jim.

Content began with tourniquets, and we practiced those lots all the way through the 8 hours - tourniquets are now a primary tool for field treatment of heavily-bleeding wounds. I didn't keep count, but we must have applied a tq to legs and arms or both about 30 times, to ourselves or a designated 'victim'.

If your last First Aid class was a couple years ago, it's likely you didn't deal with tourniquets.

We used both CAT and SOF-T tourniquets. If you have one of those - and generally, those are the preferred products, but use what you have - and you REALLY want to have a couple tqs - unwrap them now. You might want those extra seconds for something else ...

Major point: if you don't practice with the tourniquets, you're very likely to screw around reading directions and figuring things out. With a femoral artery bleed, you have about 2 minutes before the victim, who might be you, bleeds out. I'm still not fast, but I got under a minute for 1 leg with practice, and I need to work on faster than that.

Part of 'faster' access (continued) is figuring out where to keep them. Of course, having one at all is the first part, and then having it accessible to either hand is important. Instructor says he has one rubber-banded to his rifle and .mil seem to be getting trained all to carry their med stuff in the same place (at least within units).

Then we did first-level trauma assessment - here's a wound, what do you do for this? Pretty much a standard trauma first aid class after that, with some lovely photographs up for examples, and the occasional 'your right leg has been blown off below the knee, take care of that, why are you still on your chair?' thrown in.

And we finished off with some exercises - one of us was the victim, and the other two were the responders. Victims got simulated wound 'masks', complete with spurting blood, as appropriate. That was interesting, and important to integrate the parts of the content.

I'm a retired RN. I knew most of this stuff, but had never really practiced it. I knew i needed the practice, and the class met my expectations (and of course, there's the need for 'homework' ...)

Jim is a very good instructor. This class was pretty casual, but little divergences occurred and pursued if it was the right time, or deferred until the class got the right point. He knows the material, he gives good feedback and constructive criticism.

The class was worth the time, money, and bit of travel. I recommend it.

He also is working up a successor class, where it will be all scenarios and outside; no date yet, but I'm going to watch for it!

[uparmor]

If you put a T on someone you cannot take it off witout sepsis.

The T means hospital treatment or death.

[Librarian]

Originally Posted by uparmor

If you put a T on someone you cannot take it off witout sepsis.

The T means hospital treatment or death.

One applies the tourniquet because bleed-out would likely kill the victim.

It's a good idea to let the 'higher level of care' do the removal. The class was based on that assumption.

In the field, don't take it off.

[uparmor]

Originally Posted by Librarian

One applies the tourniquet because bleed-out would likely kill the victim.

It's a good idea to let the 'higher level of care' do the removal. The class was based on that assumption.

In the field, don't take it off.

Whoops...

Guess i didnt splain it right.

During shtf there is no higher level of care. So what then?

[Librarian]

Originally Posted by uparmor

Whoops...

Guess i didnt splain it right.

During shtf there is no higher level of care. So what then?

I did originally say

And, this class assumed a higher level of care was available - this was first responder stuff, and hope 911 response is close. That covers almost all occasions most of us see, but doesn't address a hiking trip a week away from a hospital, or collapse of civilization. Still need this stuff, but this class does not address non-professional care after first response.

With no advanced care? Expect US Civil War/WW1 medicine. See http://www.medicaldaily.com/war-medi...r-death-388153 for an overview of medical advances as experienced in US wars. That one doesn't say much about casualty movement to higher level care; Civil War seems to have moved casualties from place of injury to what we might call first responder care. Biggest jump was Korea's moving surgical care closer to the battlefields, so time-to-advanced-care was shortened.

Lotta people in tq-level trouble are going to die from such injuries for lack of advanced care.

Other threads have recommended 'Where there is no doctor' (1 place to get it, http://tacticalintelligence.net/blog...e-download.htm) I'll endorse that, too.

[FeuerFrei]

Good info here about what advanced medical care looked like in the 1800's.

http://www.pbs.org/wned/war-of-1812/...tary-medicine/

"Battle Wounds and Surgery
Battle injuries, of course, just compounded the misery. A bullet in the head, chest or abdomen meant almost certain death. A bullet in the limbs meant a twenty percent chance of death if the wound was cleaned and in most cases the limb amputated.
An experienced military surgeon was fast and efficient. Lee Davis, a modern-day physician and American War of 1812 re-enactor, explains what could happen to a soldier with a wounded arm:

If a soldier was injured below the elbow and the injury was such that there was a lot of bone damage and torn up soft tissue it would be life saving to amputate the arm below the elbow. And the reason for that is infection -- it would set in if you didn’t amputate, and your death rate would be a hundred percent. As it turns out if you amputate below the elbow you have literally an eighty-five percent chance of survival. So you’ve really increased this man’s chance of living."

Sent using a long string and 2 Dixie cups

[uparmor]

I should have asked this, if there is no HLC what can you do if someone is bleeding out? Alternative to the T?

Originally Posted by Librarian

I did originally say

With no advanced care? Expect US Civil War/WW1 medicine. See http://www.medicaldaily.com/war-medi...r-death-388153 for an overview of medical advances as experienced in US wars. That one doesn't say much about casualty movement to higher level care; Civil War seems to have moved casualties from place of injury to what we might call first responder care. Biggest jump was Korea's moving surgical care closer to the battlefields, so time-to-advanced-care was shortened.

Lotta people in tq-level trouble are going to die from such injuries for lack of advanced care.

Other threads have recommended 'Where there is no doctor' (1 place to get it, http://tacticalintelligence.net/blog...e-download.htm) I'll endorse that, too.

[FeuerFrei]

Originally Posted by uparmor

I should have asked this, if there is no HLC what can you do if someone is bleeding out? Alternative to the T?

This is something about proceedure or psycology once the pt is bleeding out?

Tourniquet substitute?
Or
What to say to pt when you both know they're dying?

Sent using a long string and 2 Dixie cups

[Librarian]

Originally Posted by uparmor

I should have asked this, if there is no HLC what can you do if someone is bleeding out? Alternative to the T?

You could let them bleed out.

'Bleed out', BTW, isn't losing all your blood, because your heart will start to fail to pump when the incoming volume drops too low. See http://reference.medscape.com/calcul...d-blood-volume for a tool to estimate how much blood you might have; losing about 40% of that is a really serious problem.

Sometimes, if you can see through the gore, you might be able to clamp the major bleeding vessels.

Cautery works, heat or chemical. Freezing might work.

For a femoral bleed, you have 2 minutes. What would you do?

ETA - I was on my phone, feeding my grandson his bottle, so I couldn't write as much as I would have liked...

This is the wrong thread for awful decisions required by circumstances, but consider the old story of elderly Esquimos pushing out to sea on an ice floe, to not burden the subsistence level tribe with a member who no longer could contribute.

If we get 'collapse of civilization', there would be a lot of those decisions needed, and not necessarily by volunteers.

Deeper discussion deserves its own thread.

[mindwip]

I have put on tq many times and not gotten sepsis so guess I am alive. The op put it on 30 times and is still alive.

There are many uses for a tq to put on then take off in real life. Hell you can amputate the limb above the injury and they might live. But won't bleed out. Welcome to civil war trama care.

You can clean and dress the wound properly to stop bleeding then take off the tq.

You can use a tq as a pressure bandage.ie applied a lot looser, As long as it allows for return circulation and avoids compartment syndrome.

Op congrats on the training and great review. Sounds like a combat life saver course more or less. Did you learn how to manage chest shots and comprised lungs and pressure build up?

[Librarian]

Originally Posted by mindwip

Op congrats on the training and great review. Sounds like a combat life saver course more or less. Did you learn how to manage chest shots and comprised lungs and pressure build up?

We talked about it, and specifically stated back to the instructor 'I understand I am not licensed to do it [needle thoracostomy] and I will not do it'.

As a civilian, he's not able to do it legally; since I let my RN license lapse, I'm not able to do it legally.

But we know why to insert over the 3rd rib rather than under the 2nd ...

But 'flapper valves' and occlusive bandages and chest-seals, yes, we discussed those in detail, including field expedients with plastic wrap and bandage wrappers. I also saw, and mentioned, an EMT video where he's used expired AED pads - they're already glued!

[mindwip]

Cool about the pads. Nice seems like it covered a lot. Much better then aha first aid.

Haha yeah I have 2 of the needles in my kit and a 3rd for my unit to practice with. I would use with close family and my self and fellow soldiers. But then I have a cls cert. Even if it expired I would still do it to save a life, thou we are so close to hospitals here that with a chest seal and fast response times I doubt the pt would need it with me still there.

[Citizen_B]

Thanks for the review. I need to put a class like this on my schedule somewhere.