Friday, June 10, 2016

Medical Training: It's Not Always About the Gun

Often when folks talk about personal defense and personal defense scenarios the conversation revolves around tools. Mostly about the firearm and maybe a little bit about other self-defense tools like OC spray, kubatons, knives etc… These are all tools we use in the context of a dynamic critical incident. Pre-incident avoidance is another subject talked about quite frequently.  How can we avoid being involved in these incidents in the first place? Pre-incident indicators and other things are discussed.
Another item that needs emphasis are post incident actions. These actions may include rendering some kind of medical aid to yourself or others. I often tell my students that the number one self-defense skill I believe they need is medical training. Medical training can be used in all aspects of your life. From your child skinning a knee to you assisting at a motor vehicle accident. Knowing what to do and when to apply life saving measures is a vital part of being “every day ready.”
A good starting point is to get certified through the American Heart Association or the American Red Cross in basic first aid, Cardio Pulmonary Resuscitation (CPR) and Automated External Defibrillator (AED) use. The quick application of high quality CPR and AED use during a cardiac arrest has been proven to enhance survival rates. Cardiac arrest can happen subsequent to other injuries and is a definite life threatening issue. Just like for any other incident we need to have a plan to bridge the gap until more experienced providers or law enforcement arrives on scene.
Once you have basic skills in place, individuals interested in using medical skills as part of a holistic personal defense training regime need to look at mitigating the most common traumatic injuries. According to the US Army study on Fundamentalsof Combat Casualty Care the three primary causes of preventable death on the battle field were, airway obstruction, tension pneumothorax, and hemorrhage from extremity wounds. These will potentially be the same issues faced by the concealed carrier should they be involved in an incident were shots have been fired.
Lay persons can use the Tactical Combat Casualty Care acronym MARCH to help them assess and treat victims post incident.
M- Massive Hemorrhaging: The early application of a tourniquet to extremities whether it be prepackaged such as a C.A.T or improvised tourniquet can go a long way towards keeping blood in the body where it is needed. The use of hemostatic gauze or agents to pack a wound, pressure dressings and bandages are also essential to controlling hemorrhage.
Airway- Without an airway survival chances are low. Basic Head-Tilt-Chin lift or Jaw thrust maneuvers can be used to ensure a patent airway. If properly trained and equipped, individuals can employ nasal or oral pharyngeal airways to keep the airway open if the victim cannot maintain their own airway.
Respirations- Agonal or absent respirations may indicate the need for CPR. Elevated or rapid respirations may indicate that the victim is going into shock or has internal bleeding. A tension pneumothorax results when air enters the chest cavity and puts pressure on the lungs causing one of them to collapse. This could happen if the chest wall is compromised by a projectile or broken ribs. If possible the application of a non-occlusive dressing to cover the entry and exit wounds will help slow this process.
Cardiac- The theory that pulse presence at different anatomic locations correlates to blood pressure has come under some scrutiny in the last few years but the presence of a radial pulse, taken at the wrist, is a good indicator that the brain is being perfused with oxygen.
Head injury/Hypothermia- Gently disarm any confused/disoriented or unresponsive patient if necessary. Avoid further injury. Take cervical spine precautions if needed by stabilizing the patient’s head and neck. Avoid hypothermia or low body temperature by covering the patient with a warm blanket or clothing.

Medical training can go a long way towards giving the concealed carrier the confidence and skills needed to manage the post incident scenario, should they ever be involved in a self-defense shooting. Medical training is important, get some.