In 2017, we launched our ‘Growth Through Choices’ Competition – an opportunity for employees to enter for a chance to win sponsorship money to do something that helps them grow as an individual in an area they are passionate about outside of work. At the end of October, we selected 10 winners and awarded them with prize money to achieve their goals. Now, as they complete their activities we will be sharing this blog series where each posts discusses what our winners did and what they learned from it.
Many people feel helpless in the face tragedies like terrorist attacks (Boston marathon bombing, Fort Hood, or San Bernardino); criminal violence (Las Vegas); or even terrible motor vehicle accidents. But, with proper trauma care mindset, skillset, and equipment, everyone can be part of the solution and help provide emergency first responder care to people hurt and bleeding in traumatic situations.
Back in the 1990s, I was a licensed EMS First Responder in 2 different states. But, those skills are perishable and new tools and protocols have emerged since my last certifications and training. Therefore, I requested consideration for a $250 sponsorship to help me “grow through my choices” to help provide emergency first responder care in times of traumatic events. North Highland graciously awarded me this opportunity and I attended the FieldCraft LLC, Active Shooter Trauma Course at the beautiful Reveille Peak Ranch in Burnet, Texas on 3 December 2017. This course was taught two U.S. Army Special Forces veterans (Mike and Kurt) and a U.S. Marine Corps veteran and current paramedic (Kevin).
Reveille Peak Ranch in Burnet, Texas
We began the training with a briefing by Instructor Mike on the realities of traumatic events and what he more accurately refers to as “active killer” scenarios (not just shooting, but attacks using explosives, vehicles, or other weapons). He explained that emerging analyses of these active killer events is starting to recommend a response he calls “OFF”. This is a departure from the formerly recommended approach of Run, Hide, Fight. Instead, OFF stands for: Observe, Fight, Flee; or sometimes, Observe, Flee, Fight. Therefore, before addressing any trauma first aide care, it might be better to fight back or to flee rather than render aid immediately and expose yourself to deadly circumstances.
Nevertheless, if it is safe and appropriate to provide care, the specific trauma training can be summarized using the acronym of MARCH and Instructor Kevin picked up the training here. Each letter indicates an order of response and addresses crucial lifesaving actions. Here they are in brief:
- Massive bleeding: First we must address major arterial bleeding, as indicated by spurting, bright red blood from a gunshot wound (GSW), traumatic amputation, or other major injury. The average human will lose consciousness from a severed artery in one minute, and die after just two minutes if blood loss is not stopped. Therefore, the essential tool and response is the tourniquet. For years, tourniquets were all but forbidden by first responders, but today (given lessons from the modern battlefield) there are considered extremely effective in stopping patients from bleeding out due to extremity trauma and can safely remain in place for 2 hours without risk to the limb. We received extensive instruction and practice in applying tourniquets to each other and to ourselves (often in timed evolutions). Fortunately with a bit of practice, anyone can learn to perform this lifesaving action!
Instructor Kevin Demonstrating the Combat Application Tourniquet (CAT)
- Airway: The next focus of trauma response is to confirm and protect a patent airway in your patient. If there is some blockage (blood, tongue, foreign object) that must be removed and the patient placed in a position that the airway remains open and protected.
- Respiration: With a patent airway, the patient should be able to breathe, but if there are no signs of respiration, the next step is to check for a collapse lung and tension pneumothorax. These conditions may occur when there is penetrating trauma to the chest from a GSW, knife wound, or impalement that allows blood or air to enter/collect in the chest cavity and impede inflation of the lung and compromising respiration. Treatment for this situation is a very advanced technique using a decompression needle to make an escape hole in the chest to allow the lung to inflate. For obvious reasons we couldn’t actually practice this exercise on each other.
- Circulation: Next, it is essential assess the patient for blood flow throughout the body. You can check for a pulse (at the wrist or neck) and check for capillary refill in the fingernails. The response if you find no pulse is traditional cardiopulmonary resuscitation (CPR). We didn’t spend much time on CPR since that is a dedicated class unto itself and our focus was on the trauma response skills.
- Hypothermia: Finally, the patient needs to be assessed and protected from environmental risks, either being too hot (hyperthermia) or, very likely, hypothermia as a result of shock and when the patient’s body temperature can fall below safe levels. The response can be a simple blanket or other covering to help maintain body heat.
After learning the MARCH approach, Instructor Kurt took us all through practical scenario-based exercises where we had to respond to simulated patient injuries in an active killer environment. These were surprisingly stressful, even in a practice event. Afterwards, Kurt provided a critical assessment of our performance and shared detailed feedback on what we did well and what should have been done better.
This was an outstanding class and it resulted in the award of a Tactical Combat Casualty Care (TCCC) certification from the National Association of Emergency Medical Technicians (NAEMT). I certainly pray I never have to use the new skills (and equipment I always carry), but if it ever comes to it, I now feel far more prepared to respond to provide urgent trauma care in a tragedy.
If you’d like to learn more or get similar training, visit: www.naemt.org.