I went back to Gunsite in Northern Arizona, so it was a trip to the range, but I didn’t do any shooting, so it was only kind of a trip to the range.  And no, it wasn’t because of that stupid restraining order.  I went for their three-day class in Tactical Medicine, which is really a class in emergency trauma first aid, with an emphasis on wounds from gunshots and explosions.

Why would I do such a thing?  Several months ago, I was upgrading my gear for their shotgun class, and bought a very nice battle belt from Armored Republic (seriously, its really nice), and they had a kind of throw-in sale on their IFAK with supplies (individual first aid kit), so I bought one as well as a tourniquet.  When I cracked open the IFAK, I realized I had no clue how to use almost everything in it, and could probably use something more than a YouTube on how to use the tourniquet as well.  First aid classes that cover much more than CPR are really hard to find, but Gunsite has this class on Tactical Medicine, so off I went.

The class is a mix of lecture and hands-on.  But what makes this class exceptional is the instructor, Dr. Temerlin.  He’s boarded in internal medicine and emergency medicine, and was in the Navy for 22 years as an emergency physician working with Marines and SEALs (he’s a Marine at heart, even though he’s technically Navy), with 6 tours in Iraq and Afghanistan in some of the worst hellholes they had to offer (such as, for example, Nawzad).  How it didn’t break him, I don’t know, but I got the impression it came close.  He’s just the nicest guy, and I can’t imagine there is anyone in the world more qualified to teach a class like this.

The class was structured around the M.A.R.C.H. algorithm used by combat medics:

Massive Hemorrhage

Airway

Respiration

Circulation

Head/Hypothermia

You go through the algorithm in that order, and when you get done, you do it again in that order.  I won’t even attempt to summarize everything I learned, not only about emergency trauma treatment, but about how abysmally prepared the military was, how it is already backsliding from what was learned, how you will react in a combat or similarly stressful situation, and so on.  A few things to pass along, though:

Tourniquets.  These have been around for thousands of years, and we seem to forget what we know about them between active conflicts.  They won’t cause amputation, they don’t need to be loosened every so many minutes, etc.  A sufficiently massive hemorrhage (either the stereotypical spurting artery or the probably more common flowing venous hemorrhage) can kill in 90 seconds, which is why its first on the algorithm, and why you should pack your tourniquet for rapid deployment and periodically check on it and practice with it.

There are several kinds of tourniquets on the market.  The CAT is the most common, and a fine choice that nobody will argue with, although the Velcro on it was prone to getting in my way at the worst times.  The RAT tourniquet is controversial and not approved by the CoTCCC (the official body for such things), but it works and I found it easier to put on consistently, especially one-handed.  There is some doubt about how well the RAT will work in extreme cold, or how long they will last in your kit in extreme heat.  I have both now.  Dr. Temerlin told us, if we had a SWAT-T tourniquet (I did), it should be thrown away (which I did).

Wound Packing.  Get the clotting gauze, not the powder (which is useful only in a narrow range of wounds), as well as regular gauze.  The clotting gauze is apparently a miracle worker.  Where (other than YouTube, EMS training, or, well, Gunsite) you might get training in wound packing, I have no clue.  The class had silicon blocks with wounds, including one with a “vein” of rubber tubing with water pumping through it, to learn on.  The Israeli pressure bandage was recommended as the wrap once the wound is packed.

For wounds that didn’t need packing, or couldn’t be packed (mainly scalp wounds), we had a nifty gizmo called an ITClamp that we learned to use.

Airway Management.  We learned this on a couple of practice dummies – head placement, and insertion of nasopharyngeal tubes (surprisingly easy) and the down-the throat Igel tubes (also surprisingly easy).

Chest Wounds.  We also learned how to deal with sucking chest wounds using chest seals, and even how to handle a pneumothorax (one side of your chest begins filling up with air which, unlike a sucking chest wound, can’t escape).  These are apparently on the short list of preventable causes of death, and are handled by punching a catheter through the chest wall to bleed off the pressure.

Burns and Broken Bones.  We also covered field treatment of burns and broken bones, with some nifty portable all-purpose kinds of splints (one of which can also be used to make a C-collar to stabilize the head if you have a neck injury).

I believe I am most likely to use this training if I am first on the scene at a car accident.  Which has happened to me twice, three times counting the accident I was in (fortunately, no major injuries at any of them). I’m currently building my car kit for emergency trauma, which will have everything referred to above, on the theory that I won’t be able to live with myself now that I know how to use it, but somebody dies in front of me because I was too cheap to buy the gear to do it right.  As an aside, if you are looking for an IFAK, the one from Armored Republic is first-rate – everything you need and can practically carry on your belt, and no fluff (except the SWAT-T tourniquet).

My IFAk, which lives in my car until I get the full kit built out. The CAT tourniquet attaches to the side.

The class finished with three scenarios, with moulaged role players and everything.   I’m not going to tell you about them, because Dr. Temerlin was very clear that they need to be done “cold” to get the maximum value from them, and I’m hoping some of you take the class.  You have to make a lot decisions very fast in a highly stressful situation, and I can tell you from doing just these staged scenarios, you will second-guess yourself relentlessly.

If you have any interest in being trained to respond to an emergency trauma situation, I can’t recommend the class enough.