In our last post we discussed the maxim “Si vis pacem, para bellum”, which is a Latin maxim adapted from a statement of Latin author Publius Flavius Vegetius Renatus. It is generally translated as, "If you want peace, prepare for war". In preparing for ‘war’, we generally consider arming ourselves with various weapons – guns, tanks, aircraft, etc. and training to use these tools to their maximum effect. However, we don’t seem to forego much thought to other essentials - food, water, medicine and other logistical concerns.
Much news of late has included stories about terrorist attacks, active shooters, and home invasions. Many innocent lives have been lost and others changed forever. Many of these incidents were ended by law enforcement but others were decided by individuals who were prepared to deal with critical situations. These individuals had made preparations to insure they would not become a victim.
In the recent past, the ‘prepper’ has been getting significant attention. A ‘prepper’ is an individual who is actively preparing for emergencies, including possible disruptions in social or political order. They often acquire emergency medical and self-defense training, stockpile food and water, and may even build a survival retreat or an underground shelter that may help them survive a catastrophe.
There are those who may discount the ‘preppers’ as a nut-cases and/or paranoid – individuals who should be wearing tin foil hats and scanning the skies for black helicopters. There may be some who fit that description, but the large majority are serious about short and long term protection in the event of a crisis. But what about the immediate crisis? Active shooter, home invasion, serious physical assault - We should all be prepared for these types of scenarios.
Most, if not all who are reading this, either go armed daily or are considering it. In either case, you are aware that the potential for injury – to you or somebody else – is relatively high. Are you prepared to deal with a gunshot injury? In addition, the potential of bombing attacks, such as that at the Boston Marathon and elsewhere, should give you another reason to prepare for the kinds of injuries you might encounter.
Trauma Care Training
As stated, there are many compelling reasons for people to pursue advanced first aid/trauma care training. I discovered early on in my law enforcement career that I needed a higher level of training than just the Red Cross CPR/First Aid I had received in the police academy. Because of two incidents where my training fell well short of what was needed, I became an EMT in 1979 and later worked for a county ambulance service. (Note: One of my partners on the ambulance later opened his own business – Rescue Training, Inc. - and we co-developed a Tactical Medic Program that is still going strong. He was also the first tactical medic we had on our SWAT team.)
Since then, there have been many times my training was used to ‘cure’ everything from a twisted ankle to a child who just had a seizure. From the usual bumps and bruises to the occasional broken bone and nose bleed, my training has helped with all. However, my main thrust has always been to encourage all law enforcement officers and legally armed civilians as well, to seek out additional medical training.
The ‘active shooter’ and terrorist events that have occurred are beyond the comprehension of many of us. Those responsible have inflicted untold pain and suffering on thousands of innocent people. Many who died at their hands may have been saved if only they had received emergency care sooner. The ability to stop massive blood loss or open and maintain an airway could go as far as saving 66% of those injured by gunfire.
In an article by Frank K. Butler, Jr., MD, CAPT, MC, USN (Ret) and Lorne H. Blackbourne, MD, COL, MC, USA, they state;
Maughon reported in 1970 that 193 of a cohort of 2,600 casualties that were killed in action in Vietnam died of isolated extremity hemorrhage. The percentage of fatalities that resulted from exsanguination from extremity wounds was 7.9%; this was the leading cause of preventable death among US military casualties in the Vietnam War… A sobering postscript to Maughon’s observations in 1970 is found in the preventable death analyses done by Holcomb et al. and Kelly et al. in the current conflicts. Holcomb et al. found a 15% incidence of potentially preventable fatalities in his article that reviewed all Special Operations deaths in Iraq and Afghanistan from the initiation of hostilities until November 2004. He found that 25% (3 of 12) fatalities with potentially survivable injuries might have been saved by the simple application of a tourniquet. The larger causes of death analysis by Kelly et al. studied 982 fatalities from the first 5 years of the conflicts in Afghanistan and Iraq. He documented that 77 of 232 potentially preventable deaths from the Armed Forces Medical Examiner records resulted from failure to use a tourniquet; exsanguination from isolated extremity wounds thus caused 7.8% of the combat-related deaths reported in the article of Kelly et al.
The Committee on Tactical Combat Casualty Care created a three-phase framework based upon the environment and current threat levels. That framework is called Tactical Combat Casualty Care (TCCC), and it has become the standard for providing immediate medical care in a hostile environment. The Committee’s stated goals are to 1) treat the casualty, 2) prevent additional casualties, and 3) to complete the mission. This template is designed for anyone providing medical care, whether he or she is a professional medical practitioner or a teammate providing basic first aid.
The principles of Tactical Combat Casualty Care have been constantly refined and have been in widespread use among military and civilian tactical teams for over a decade, with a track record of saving lives. Further incorporation of these guidelines and practices into teams not yet using them will help ensure the safety, health, and survivability of its members.
In many cases, the actual first responders in a critical incident are not our traditional first responders. Fire, EMS and law enforcement have to be notified, dispatched and then get to an emergency scene. All this takes time. In his article, Robert Lang, discusses the need for having trained ‘immediate responders’ at the scene for the reasons already mentioned. Lang says;
“There's a growing recognition that, in the case of a so-called "active shooter" (that) individuals should always be prepared to take action to save their own lives, not simply wait for others to arrive and take charge of the situation. … “
Lang also states:
“Statistics have shown that most active shooter scenarios are over within the first three minutes. That's roughly the amount of time, sometimes less but often more, it takes for the first responder to reach the crisis scene. What can be done in those first three minutes? Do your occupants and staff have the skills or experience (from drills and exercises) to be able to respond quickly?”
“The question isn't limited to shootings. … What other incidents occur that usually are over within the first three minutes before the first responders arrive? … For example, in a bombing, police and firefighters would race to the scene and might soon arrive in overwhelming numbers. But the initial response would still depend on how close a roving patrol is to the site of the explosion. Until those first responders arrive, those on the scene would still be on their own for the first few minutes to assist victims.”
“Or consider the aftermath of severe weather such as a tornado. The harm and devastation are more widespread than with a shooting or a bomb. In fact, it might take in such a large area that first responders would be stretched too thin to be able to assist all who were injured.”
In addition, Lauran Neergaard states, “Whether in combat or civilian life, hemorrhage is the leading cause of preventable trauma death. Panelist James Robinson, assistant chief at the Denver Health EMS, said that's one reason bystanders begin "the chain of survival." … the biggest opportunity to save lives occurs well before reaching a doctor. About half of deaths occur at the scene of the injury or en route to the hospital.”
In the Orlando Pulse nightclub shooting, one of the responders, Captain Jeff Tambasco (Kissimmee PD SWAT), said because of the many injuries, his team ran out of CAT™ tourniquets, chest decompression needles and chest seals. While we can’t say definitively that more tourniquets would have saved more lives, that fact cannot be discounted.
Preparing for War
It seems from the research and actual experiences, that immediate care to gunshot/blast trauma victims is the key to saving lives. Having the proper training and resources available is crucial to this end as well. The main concerns when either developing or conducting this type of training are costs and time.
Investing thousands of dollars in ‘first aid kits’ that are inadequate to meet the needs of a real trauma situation is foolish. Band Aids won’t work on bullet wounds. Additionally, the time it takes to get trained even as a basic EMT is beyond what many people care to invest or even need. More training is better but not always necessary.
A recent solution to these dilemmas has been addressed with the introduction of RECKit™.
The RECKit™ is a small (see photo), personal trauma kit that the average person, having minimum training, can use to address severe traumatic injuries, major blood loss, and shock. The RECKit™ contains the essential equipment to stop significant blood loss, control bleeding, and prevent shock - all major causes of pre-hospital death – SWAT-T™ tourniquet, a 5”x9” trauma pad and a survival blanket.
The contents were designed to have multiple uses:
The SWAT-T™ tourniquet can be used on Adults, Pediatric and Canine patients and be used as:
· Tourniquet - When bleeding is severe (arterial) and loss of life is of greatest concern.
· Pressure Dressing - When bleeding is controlled or for venous and capillary oozing.
· Elastic Bandage - Hold ice near sprains and strains, stabilize a twisted knee/ankle, sling a shoulder, etc.
· The dressing can be used to apply pressure across the chest or abdomen helping close and protect wounds, contain abdominal contents in evisceration, or to assist in stabilization of the pelvis in blunt pelvic trauma.
· Can be used to splint an extremity to the body, other leg, or to a rigid object for immobilization.
The large trauma pads are extremely absorbent and sterile dressings are ideal for treating large wound areas (avulsions, eviscerations, abrasions, etc.). The trauma pad can be used to stop bleeding associated with deep lacerations, burns, penetration wounds and fractures. They are useful in helping to stop severe bleeding, as they easily cover large wound areas. The absorbent pad can also be used as a pressure dressing to assist in stopping severe bleeding.
The survival blanket also has multiple uses:
· Wrapping in it for warmth and preventing shock
· Use as a compression bandage.
· Create a sling.
· Use as a tourniquet.
· Use as a strip to tie splints for broken or sprained bones.
· Use as cushion material for improvised splints.
· Use as material to write on.
The RECKit™ was designed to be used in emergent situations by individuals with little or no training. It is small enough that several could be kept in a single location (co-located with fire extinguishers/AED), classrooms, vehicles, or other common locations to be available in a critical situation.
Training for using the contents of the RECKit™ is not technically intensive nor time consuming. A video training program is in development to augment the hands-on classes that are available.
As stated in the beginning, I have used my medical training many times over the years. Fortunately, most of the injuries were minor. However, I felt much more confident in ‘treating’ my ‘patients’ because of the training I had. I cannot recommend strongly enough the need to get additional medical training. In today’s world the cost of not knowing could be catastrophic.
I trust you will take what is offered here and prepare for war but only have the need to use it in peace.
BE SAFE • BE EFFECTIVE • BE READY
 Butler, F. and Blackbourne, L. Review article. Battlefield trauma care then and now: A decade of Tactical Combat Casualty Care.  Torrey, L. (2015). http://www.ems1.com/ems-products/incident-management/articles/500316-Why-Tactical-Combat-Casualty-Care-is-the-standard-for-medical-care-in-hostile-environments/  Ibid. Torrey, L. (2015).  Lang, R. (2011). http://www.facilitiesnet.com/security/article/Trained-Immediate-Responders-Can-Provide-Swift-In-House-Action-When-Trouble-Strikes-Facilities-Management-Security-Feature--12524.  Neergaard, L. June. 18, 2016. Up to 1 in 5 Trauma Deaths Could be Prevented, http://bigstory.ap.org/article/60edc1db2da547cba8ea7c01779ef74f/1-5-trauma-deaths-could-be-prevented-study-says.  http://reckit.care