Author Topic: Beyond First Aid  (Read 3854 times)

AZRedhawk44

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Beyond First Aid
« on: April 08, 2010, 03:02:26 AM »
I'm looking to get training for my own personal use and safety, in the use of Asherman chest seals, airway tubes, 1st response of tension pneumothorax conditions and other situations/treatments that might be necessary in a GSW environment with EMT response greater than 20 minutes away.

This is obviously outside the scope of a 1st aid class.  However, it doesn't seem to be something covered by a course like Wilderness 1st responder, judging by other folks I've talked to.

Any suggestions?
"But whether the Constitution really be one thing, or another, this much is certain - that it has either authorized such a government as we have had, or has been powerless to prevent it. In either case, it is unfit to exist."
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dogmush

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Re: Beyond First Aid
« Reply #1 on: April 08, 2010, 06:12:21 AM »
It sounds to me like you want a Combat Life Saver class.

We give them out free if you join the Army.  The books and PE's I'm pretty sure are unlimited distro, so you can probably find them on the web, I'll try and find mine if I can.  As for the hands on part, do you have any EMT/Paramedic buddies you could trade some beer to for training?

Devonai

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Re: Beyond First Aid
« Reply #2 on: April 08, 2010, 11:21:00 AM »
CLS class was good stuff, but our version was eight hours a day for four days.  If you are good at self-study then by all means check out the material.  Dogmush is right, it is all available for unlimited distribution so I'm sure you could find it on the web.
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Jamisjockey

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Re: Beyond First Aid
« Reply #3 on: April 08, 2010, 11:49:29 AM »
Is this in conjunction with your appleseed participation?  I'd bet dollars to donuts you could get one of the Armed services to help out and conduct some free CLS classes.
JD

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mtnbkr

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Re: Beyond First Aid
« Reply #4 on: April 08, 2010, 11:59:16 AM »
FWIW, I was listening to a gun related podcast a few months ago and they talked about this subject.  The EMT, who was also a dedicated shooter, make the point that unless you are going to train often and intensely in this sort of thing, you're better off learning good First Aid techniques to keep a person alive until the EMTs arrive. 

If I have time, I'll try to dig up the podcast.  It's the Handgun Podcast if anyone else is a listener.

Chris

AZRedhawk44

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Re: Beyond First Aid
« Reply #5 on: April 08, 2010, 12:09:53 PM »
Jamis hit it.  Yep, in conjunction with Appleseed.

Some of the ranges are a healthy distance away from any first responders.  At least 10 minutes by speeding fire truck.  Maybe 20+ in actual 80mph driving time, or on bumpy dirt and rock roads.  Add in time to call 911 and get information for dispatch, or even time for someone to drive to a location with better cell reception or to a landline, and you start looking at 30 minute responses. 

My first goal at any shoot is to find out if any of my shooters are medically trained beyond myself (multiple 1st aid classes over the years, sports medicine classes in high school... not much, but more than most folks).

But, if not, I'm not opposed to increased knowledge, even if it remains largely theoretical rather than applied.  I understand advanced techniques require practice.  Hopefully I remain 100% unpracticed in regards to this issue, other than any classroom instruction and dummy-practice I may find.  I'm also not opposed to going to a class myself, and then sharing that information with other instructors in my program.  That gets us to communicate and discuss treatment, and also helps out if I am the person shot rather than someone else.

I've got some NG contacts in the state.  I'll see if they know anyone certified in CLS, or any interest by NG/Army to offer that training to civvies.

Do RSO's typically get offered this type of training?  I didn't when I took my RSO class, and it was never discussed.
"But whether the Constitution really be one thing, or another, this much is certain - that it has either authorized such a government as we have had, or has been powerless to prevent it. In either case, it is unfit to exist."
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41magsnub

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Re: Beyond First Aid
« Reply #6 on: April 08, 2010, 12:28:00 PM »
I would love to be able to take a refresher cls course.

sanglant

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Re: Beyond First Aid
« Reply #7 on: April 08, 2010, 12:51:16 PM »
the first thing to do is ask your local ems team if they will station a unit(is that what they call then still?) at the range, it's the cheapest and easiest even if they charger you(if you[as a group] can afford what they want to charge you ;)) if you really want to assume the risk,(you couldn't pay me to [tinfoil]) you might look into classes at your local community collage. [popcorn] here's one down the road from me. :angel:

vaskidmark

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Re: Beyond First Aid
« Reply #8 on: April 08, 2010, 01:16:16 PM »
Tension pneumothorax, while a killer, is not an instant killer.  Breaching the skin barrier with anything (needle, scalple, etc.) opens you up [sorry for the unintentional pun] for liability, so you better have either a really good Good Samaritan law or up-to-date credentials before you go poking between somebody's ribs.

BTW - Good Samaritan laws generally protect the untrained/uncertified, not those who venture beyond their training levels.

Chest seals generally try to prevent tension pneumothorax.  Theres a whole raft of them out there besides Asherman's.  Halo http://www.itstactical.com/2009/07/13/halo-chest-seal/ are supposed to adhere through/in spite of bodily fluids being present.  ITSTactical has a full blow-out kit for $99.00, but you better know what you are doing with much of it.  Google for other blow-out kits.

Cellox-A http://www.tacmedsolutions.com/07/products/product_detail.php?pic_id=181&prod_id=26&pageNum_get_pics=0&totalRows_get_pics=5 gets deep into GSW channels, and is the less-burning formulation.

One last comment - actually 3 --

1) Have GPS coordinates written, as well as the non-911 phone number to the nearest rescue squad.  If you need a helo medivac coordinates beat the heck out of giving road directions.

2) check your cellphone availability at your range.  Also consider either ham or GRMS backup.  Learn how to use them.  There is an exemption in the FCC laws for using a ham radio without a license during an emergency.

3) brief EVERYONE on the location of your FAK, the dedicated cell phone for 911 calls, the GPS coordinates of the range, and how to use ham/GRMS radio if you are going to have them available.  A laminated sheet with a pre-written message can be your best buddy when everybody is running around panicing.)

Per my Gunny - "You, you and you - panic.  Everybody else come with me."

stay safe.

skidmark
If cowardly and dishonorable men sometimes shoot unarmed men with army pistols or guns, the evil must be prevented by the penitentiary and gallows, and not by a general deprivation of a constitutional privilege.

Hey you kids!! Get off my lawn!!!

They keep making this eternal vigilance thing harder and harder.  Protecting the 2nd amendment is like playing PACMAN - there's no pause button so you can go to the bathroom.

MillCreek

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Re: Beyond First Aid
« Reply #9 on: April 08, 2010, 01:22:00 PM »
Hmm. I used to be a paramedic, and I am not sure that I would be doing these techniques unless I was current.   You can do a lot with just a 4x4, pressure and a sandwich bag, if needed.
_____________
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MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
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AZRedhawk44

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Re: Beyond First Aid
« Reply #10 on: April 08, 2010, 01:24:25 PM »
RE: your 3 comments.  Already done as SOP at each shoot, skid.  But thanks.

I've got Celox, and a blow-out kit.  There are things in the kit that I definitely do NOT know how to use and won't use without appropriate training and knowledge. (My kit is here: http://www.promedkits.com/immediate_response.html  Mouse over the "ALS Loadout" and you will see the contents.)

Right now, the stuff in there is for "someone else" who knows better than I know, to use.

I'm not interested in the obligations/liabilities involved in getting "certified" as an EMT or paramedic.  I am interested in the knowledge.  I go shooting with family, too.  I will go farther with loved ones in an injury situation than i will with a stranger at an Appleseed shoot.  I would also go farther for a friend at an Appleseed shoot than I would with a stranger.  The joys of civil suits.   :'(
"But whether the Constitution really be one thing, or another, this much is certain - that it has either authorized such a government as we have had, or has been powerless to prevent it. In either case, it is unfit to exist."
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I reject your authoritah!

vaskidmark

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Re: Beyond First Aid
« Reply #11 on: April 08, 2010, 01:34:45 PM »
The stuff in the ALS version vs. the "standard" version are overkill for your situation.  Whoever comes to the rescue will have that stuff, plus much more, on hand in their own kits.

Knowing the symptoms of tension pneumothorax and basic use of a chest seal are pretty much the worst-case scenario you will need to address (based on nothing more than anecdotes and a SWAG).

I applaud your desire to prepare, but there is a point beyond which it just gets excessive.  Your feelings on this obviously differ from mine and I'm not here to dispute your stance.  Just as my comments on liability were based on discussion, not persuasion.

Seriously, the only thing I have not read is that you have already mapped out your location with the nearest rescue squad and invited them to shoot with you.  BTW, asking them and their truck, or just a member with his crash bag, to the next Appleseed for volunteer recruiting might put your EMS on site.

stay safe.

skidmark
If cowardly and dishonorable men sometimes shoot unarmed men with army pistols or guns, the evil must be prevented by the penitentiary and gallows, and not by a general deprivation of a constitutional privilege.

Hey you kids!! Get off my lawn!!!

They keep making this eternal vigilance thing harder and harder.  Protecting the 2nd amendment is like playing PACMAN - there's no pause button so you can go to the bathroom.

sanglant

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Re: Beyond First Aid
« Reply #12 on: April 08, 2010, 02:41:04 PM »
just so you know, you don't have to take the ems classes. you can audit them your there for the class but have no tests, or benefits from taking the class. [popcorn]

Jamisjockey

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Re: Beyond First Aid
« Reply #13 on: April 08, 2010, 02:47:22 PM »
Jamis hit it.  Yep, in conjunction with Appleseed.

Some of the ranges are a healthy distance away from any first responders.  At least 10 minutes by speeding fire truck.  Maybe 20+ in actual 80mph driving time, or on bumpy dirt and rock roads.  Add in time to call 911 and get information for dispatch, or even time for someone to drive to a location with better cell reception or to a landline, and you start looking at 30 minute responses. 

My first goal at any shoot is to find out if any of my shooters are medically trained beyond myself (multiple 1st aid classes over the years, sports medicine classes in high school... not much, but more than most folks).

But, if not, I'm not opposed to increased knowledge, even if it remains largely theoretical rather than applied.  I understand advanced techniques require practice.  Hopefully I remain 100% unpracticed in regards to this issue, other than any classroom instruction and dummy-practice I may find.  I'm also not opposed to going to a class myself, and then sharing that information with other instructors in my program.  That gets us to communicate and discuss treatment, and also helps out if I am the person shot rather than someone else.

I've got some NG contacts in the state.  I'll see if they know anyone certified in CLS, or any interest by NG/Army to offer that training to civvies.

Do RSO's typically get offered this type of training?  I didn't when I took my RSO class, and it was never discussed.

My suggestion:  Call your state's NG PA* office.  If that doesn't work, call the PAO at MCAS Yuma.  From there, try the Army bases.  You might even be able to get some kind of program going where they send out shooters to either help train or to even get training. 


*PA=Public Affairs.

Quote
Seriously, the only thing I have not read is that you have already mapped out your location with the nearest rescue squad and invited them to shoot with you.  BTW, asking them and their truck, or just a member with his crash bag, to the next Appleseed for volunteer recruiting might put your EMS on site.

Thats fantastic advice. 
JD

 The price of a lottery ticket seems to be the maximum most folks are willing to risk toward the dream of becoming a one-percenter. “Robert Hollis”

kgbsquirrel

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Re: Beyond First Aid
« Reply #14 on: April 08, 2010, 02:51:08 PM »
+1 to the CLS courses. I also would recommend Navy Stretcherbearer training. There are bits in each that aren't covered in the other. Some of the Stretcherbearer stuff includes how to use numerous different transportation devices (reeve sleeve for the win!), how to evacuate a casualty out of different situations/positions, and also covers improvised devices, such as if you don't have an Ashermen chest seal handy.

BobR

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Re: Beyond First Aid
« Reply #15 on: April 08, 2010, 03:02:19 PM »
Quote
Chest seals generally try to prevent tension pneumothorax.  Theres a whole raft of them out there besides Asherman's.  Halo http://www.itstactical.com/2009/07/13/halo-chest-seal/ are supposed to adhere through/in spite of bodily fluids being present.

Wow, those are so much better than tape and the cellophane off of a pack of cigarettes.  =D

As far as airway, go take a basic EMS class, maybe intermediate, and you can learn to use a King Tube or Combi-Tube. In your case the best thing would probably be a Bag,valve,mask (BVM or Ambu Bag) and proper airway control while waiting for EMS.

It is comendable to be prepared for the worst case, but often the worst case is much worse than you prepared for. EMS on scene is a great suggestion. Along with the number for the local EMS, keep the number of the nearest Aeromedical Evacuation (Lifeflight, etc.) group handy. They will often dispatch on your word if you can make a convincing argument, at least they would in the part of Montana I lived in. But then again, all of them knew me so if I called from the side of the road they knew it was probably needed.

bob

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Re: Beyond First Aid
« Reply #16 on: April 08, 2010, 08:27:01 PM »
Hrm.  I think I should weigh in on this one.  :)

Dunno about AZ, but here in OR, anything beyond basic first aid/CPR, even if performed absolutely correctly, opens you up to legal liability.  Here's the legal issues involved:

Good Samaritan laws only protect you up to the level of your training.  Take one step past your training, and you're no longer covered.

Now, let's say that you are an EMT, be it Basic, Intermediate, or Paramedic.  You are only allowed to act within your scope of practice when under the supervision of a physician adviser.  This is the Dr. that signs your orders allowing you to practice medicine.  Essentially, you are practicing under his or her license.   Those standing orders ONLY apply when you are on duty.  Do anything above basic first aid while not on duty, and you are practicing medicine without a license.   

So here's the quandary.  You can get training, such as a EMT-Basic or higher class that would train you how to handle more advanced equipment in order to more effectively deal with an emergency.  But if you were to do so, you wouldn't be able to use any of your skills legally unless you were on duty. 

And the real crapper is that lets say something does happen.  Something serious.  Thoracic GSW, for example.  Let's make it a really crappy scenario.  Young kid, .30 cal, through and through.  You put on a couple bioclusive bandages, one taped on all 4 sides, one on three, to help prevent a worsening pneumothorax.  But the kid is crashing fast.  EMS is at least 20 mins away.  Left chest, you start hearing markedly decreased breath sounds on the left, and start seeing significant tracheal deviation.  This kid is gonna die unless you do something.  Grim enough picture yet?   So you do something.   You have the equipment and training to do a needle decompression.  You punch in the needle in the 2nd intercostal space, and you hear that classic "sigh" from the needle.    Kid starts to show some improvement on scene.  EMS shows up, kid is packaged, loaded up, and off they go.

Two days later, you find out the kid died a few hours later.  Just too much damage was done by the bullet's passage.  You find this out because the county sheriff is on your doorstep to serve you with a lawsuit.  And a couple days later Fred gets one too at the Appleseed home office. 

Believe me, I completely understand the desire to be prepared.  I've got a trauma bag that I take with me to Appleseed shoots.  And yes, I'm an EMT.  I'm trained to do some of the more invasive procedures that might just save a life.  But I don't even CARRY anything sharper than trauma shears in my kit.  But when I'm off duty, I'm nothing more than a really good first-aider.   No IV fluids.  No IV catheters.  No needles.  No drugs other than OTC stuff (Tylenol, Advil, etc.).  Because as much as I wanna help people, I really don't wanna lose everything I have because I was trying to help someone.
Are you a cook, or a RIFLEMAN?  Find out at Appleseed!

http://www.appleseedinfo.org

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vaskidmark

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Re: Beyond First Aid
« Reply #17 on: April 08, 2010, 10:17:15 PM »
But ...  But ...   But...

AZRedhawk says
Quote
I'm not interested in the obligations/liabilities involved in getting "certified" as an EMT or paramedic.  I am interested in the knowledge.  I go shooting with family, too.  I will go farther with loved ones in an injury situation than i will with a stranger at an Appleseed shoot.  I would also go farther for a friend at an Appleseed shoot than I would with a stranger.  The joys of civil suits.

He's going to do it no matter how much advice he gets not to.  So where can he go to learn how to do it in a way that does not screw the pooch any worse than absoluyely necessary?

BTW - is applying a chest seal beyond basic first aid?  Never inquired about that before.

stay safe.

skidmark
If cowardly and dishonorable men sometimes shoot unarmed men with army pistols or guns, the evil must be prevented by the penitentiary and gallows, and not by a general deprivation of a constitutional privilege.

Hey you kids!! Get off my lawn!!!

They keep making this eternal vigilance thing harder and harder.  Protecting the 2nd amendment is like playing PACMAN - there's no pause button so you can go to the bathroom.

MillCreek

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Re: Beyond First Aid
« Reply #18 on: April 08, 2010, 10:29:27 PM »
I would consider the application of an external chest seal to be within advanced first aid.  It is certainly not an invasive procedure, unlike a crico or a needle thoracotomy.
_____________
Regards,
MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

sanglant

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Re: Beyond First Aid
« Reply #19 on: April 08, 2010, 10:33:31 PM »
i already posted the cheapest and fastest route, at least short of enlisting. [popcorn]
you might look into classes at your local community collage. [popcorn] here's one down the road from me. :angel:
just so you know, you don't have to take the ems classes. you can audit them your there for the class but have no tests, or benefits from taking the class. [popcorn]
=D this will also cover your liability if you decide to act as an, um amateur? no unlicensed Dr. [tinfoil]



or you could watch a mash 10 or 20 times >:D

Regolith

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Re: Beyond First Aid
« Reply #20 on: April 08, 2010, 10:36:06 PM »
BTW - is applying a chest seal beyond basic first aid?  Never inquired about that before.

stay safe.

skidmark

We were taught how to do those during the first aid class I took a couple of years ago, so maybe "advanced first aid" as suggested by Mill Creek.
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sanglant

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Re: Beyond First Aid
« Reply #21 on: April 08, 2010, 10:39:12 PM »
anybody ever watch "Playing God"? ??? don't know what made me think of it. [popcorn]





the first operation(the one in the bar) is inspiring, luckily i'm in no way connected to the health care industry. =D

red headed stranger

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Re: Beyond First Aid
« Reply #22 on: April 09, 2010, 11:39:09 AM »
There is a thread over at the Arizona shooters forum about putting together a class/training along the lines you are thinking:

http://www.arizonashooting.com/v3/viewtopic.php?f=37&t=97081
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AZRedhawk44

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Re: Beyond First Aid
« Reply #23 on: April 09, 2010, 12:18:54 PM »
But ...  But ...   But...

AZRedhawk says
He's going to do it no matter how much advice he gets not to.  So where can he go to learn how to do it in a way that does not screw the pooch any worse than absoluyely necessary?

BTW - is applying a chest seal beyond basic first aid?  Never inquired about that before.

stay safe.

skidmark


Quote
ARIZONA GOOD SAMARITAN LAW
Article 4, Emergency Aid
32-1471. Health care provider and any other person; emergency aid; non liability. Any health care provider licensed or certified to practice as such in this state or elsewhere, or a licensed
ambulance attendant, driver or pilot as defined in 41-1831, or any other person who renders emergency care at a public gathering or at the scene of an emergency occurrence gratuitously and in good faith shall not be liable for any civil or other damages as the result of any act or omission by such person rendering the emergency care, or as the result of any act or failure of act to provide or arrange for further medical treatment or care for the injured persons, unless such person, while rendering such emergency care, is guilty of gross negligence. As amended Laws 1978, Ch. 205,1.

Gross negligence is defined in courts of law such as "assault and battery" when a patient does not want help, an inexperienced person adminstering medication to someone who does not need it (i.e. insulin, ntiro, etc..).

Not as big an issue as you make it out, at least in AZ.

Prolly need to check North Carolina too, since RWVA is based out of there.  Just to cover Fred's *expletive deleted*ss.

Again... I'll do a lot more for my GF or little brother out in the desert than I will for "vaskidmark" on an Appleseed line.

RHS:  I posted in that thread on AZS.  Thanks.
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CNYCacher

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Re: Beyond First Aid
« Reply #24 on: April 09, 2010, 05:09:14 PM »
Purely out of curiosity:

In a tension pneumothorax situation like AD described,  assuming you have the leaks stopped and have constructed a one-way valve on one of the openings, why can't you breath into the person's lungs as in old versions of CPR to re-inflate the lung and drive out the intrapleural air?
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