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TACTICAL COMBAT CASUALTY MEDICINE – BE PREPARED

By a Tribesman who is an experienced US Navy Corpsman


For every coin, there are two faces, always remember this. If you’re reading this, that means you’re more than likely versed in some of the tactical or firearm communities, or something in a similar field, or at least peripherally aware of this sort of work. Firearms are fun, tactical training is probably one of the coolest things that you’ll ever get to do; and if you’re training for high-risk use, be it military, law enforcement, security, and/or personal self-defense, always keep in mind that your High-Speed Wireless Hole Puncher has incredible potential to cause serious bodily harm or injury to yourself, or someone else. If the situation dictates that you are considering using, or actively engaging in the use of a firearm for its intended purpose, there is an extremely good chance that what you are using is getting used against you in kind, or a similar action utilizing an edged weapon. What interventions can you do to bridge the gap from your point of injury to definitive healthcare? How do you survive? How can you help others survive these injuries?


That brings us to Side Two of the coin: the cause and effect. We train to stop the threat, and how a firearm stops the threat is causing severe damage to anatomical structures and/or blood vessels. Since firefights are never one-sided, there are steps that you should take to give you, your family, and your friends the best chances of survival.

Ask yourself this question next time you are about to go LARP in your mom’s basement, or when you do a gear check on your kit “What do I do if I get hit?” Do I have the right medical assets in my kit? Do I have a medical kit? Is it easily accessible? And most importantly ask:


“DO I KNOW HOW TO USE THIS?”


I’m now going to address some of the considerations from the Tactical Combat Casualty Course and its curriculum that are currently used today. This multi-part series will follow the M.A.R.C.H Algorithm in each step. Today we are starting with “M:” Massive Hemorrhage.


Scenario: It’s a Saturday morning in the Christmas/Yule Season and you and your family, and a friend and their family have some much-needed gift shopping to do to catch up. You hear the last thing anyone could want or expect to hear. The all familiar *POP-POP-POP* of an intermediate cartridge being sent out indiscriminately around the packed mall. Your worst nightmare has come to life, and you decide to protect your family and engage the threat. Your training has paid off, after a brief exchange of gunfire you manage to take down the attacker, but not before something happened. The adrenaline dump starts wearing down and your right leg has a warm feeling flooding around your leg, you look down and notice a small perforation in your jeans and a massive growing red stain. You’ve just been hit, and it doesn’t look good.


Let’s break this down. Massive Hemorrhage is defined as any bleeding that, if not controlled quickly enough, will cause death. Recognition of this kind of bleeding is an incredibly important skill. Life-threatening bleeding signs include, but are not limited to,


· Bright red, squirting blood: This is an indicator of an arterial laceration or injury. The arterial system is pressurized, and if a hole is poked in any of the pipes, blood will squirt out.

· Large, steady flow that is dark in color: This shows venous blood. Its darker color is due to lack of oxygen because it is returning to the heart to go through the lungs to get more oxygen. It is less pressurized than arteries, so it won’t squirt out.


· Victim lying in a large pool of blood for a relatively short time after sustaining the injury: This shows an unidentified injury that is causing a substantial amount of blood loss.


In the scenario above, you can notice the massive hemorrhage due to the rapid growth of the blood stains on the clothing. If you were to cut the clothing and expose the area it would be more apparent. Now that you can recognize this, how do you treat it?

Treatment for massive hemorrhage is ultimately very simple, however it is extremely critical. Arms and legs can be isolated and blood-flow to the area entirely stopped through a simple tourniquet.


I’m going to stop right here for a moment and clear something up:


TOURNIQUETS DO NOT CAUSE LIMB LOSS.

TOURNIQUETS DO NOT CAUSE LIMB LOSS.

TOURNIQUETS DO NOT CAUSE LIMB LOSS.


This is an old wives tail that has unfortunately permeated way to far. After over twenty years of combat medicine data and literally thousands of tourniquet applications, there have been ZERO INSTANCES of limb amputation where the tourniquet was the direct cause of the necessity of amputation.


Alright, let's get back to it. A tourniquet is a simple design, an inch to two-inch wide strap connected to a windlass with a locking mechanism to hold the windlass in place. As the windlass is spun, it takes up slack and tightens the strap. The more it is turned, the tighter it gets. A tourniquet works by adding so much pressure around the limb that it squeezes everything against the bone and ultimately prevents any flow further from the body than it is located. There are tactical tourniquets that can be operated with one hand. The Combat Application Tourniquet (CAT) more on that later.


Going back to our scenario, you are prepared, and you have your handy dandy tourniquet available. Since you’ve taken a first aid, or even a TCCC course, you know how to use it appropriately. You wrap it around your leg two to three inches above your injury, thread it through the device, pull out all slack and turn the windlass over and over until the bleeding from your injury has stopped. You secure the windlass in the locking mechanism, Velcro the tail of what is left onto itself, put over the securing strap, and write the time you put it on. [applying a tourniquet to someone else is the same process.] Because of the extremely critical indication of using a tourniquet, depending on location, you have NO MORE than 90 seconds to get the bleeding controlled before such a large volume of blood is lost where death would be extremely likely.


For our scenario, let's move the injury up a few inches more on the hip/pelvis area. A tourniquet isn’t an option here, so what do we do? As I always say in the TCCC classes that I teach “One metric f--- load of pressure” on the area. Another massive hemorrhage tool that is increasingly available is called “Combat Gauze” or another called “Quik Clot.” This gauze is impregnated with a chemical called Chitosan which removes the liquid component of blood extremely quickly. To use this, it’s not like the movies, and does require a substantial amount of training to apply appropriately. Making a small ball at one end and digging in the wound bowl to find the point of the bleed, you press it against the point and hold pressure. Using a one-for-one trade technique, while constant pressure on the injury is kept, you Z-fold the gauze back-and-forth trading one finger for the opposite to fill the entire wound bowl, keeping pressure. Once you’re out of space, take the rest of the gauze and put it over the top of the injury site and keep applying pressure. You must hold pressure for THREE MINUTES. Then you take out a pressure dressing, applying the sterile pad over the injury site, and wrapping around the victim keeping the bandage taught to ensure it holds pressure over the injury.


Ask yourself this question next time you are about to go LARP in your mom’s basement, or when you do a gear check on your kit “What do I do if I get hit?” Do I you have the right medical assets on your kit? Do you have a medical kitsible? And most importantly ask:k:in mind is that some designs are just substandard, or severely outdated, or gimmicky. This gear has a no-fail mission, because if it does, people die. By now you must be asking “But internet guy, where do I find this stuff?” Glad you asked! Start out by selecting your gear from this list:



https://books.allogy.com/web/tenant/8/books/f94aad5b-78f3-42be-b3de-8e8d63343866/


All these devises are approved by the Committee of TCCC. These have passed rigorous testing, and have well proved themselves to perform, even in the worst environments and circumstances. When talking about the limb tourniquets, the only two that I will use are the Combat Application Tourniquet (CAT) or the SOF Tactical Tourniquet (SOF-T); these devises have proven themselves more than any other design both on and off the battlefield. These are standard issue in many combat units. For the Hemostatic Dressings, all will perform, but the most common you’ll see are the Combat Gauze and the Celox Gauze. I’d seriously discourage ordering anything from Amazon as it is not uncommon for cheap copies to be sent to you rather than what you intended to order. The best place, in my opinion, is direct from manufacturer or through North American Rescue. (This is NOT a paid partnership, nor is there any official endorsement of, or between this company, nor do I, or OWT hold any financial obligations to or from North American Rescue.)


Whenever you put your gear for Massive Hemorrhage on your kit, ensure that it is easily accessed by both hands. One or the other may be taken completely out of commission due to injury. Learn how to do these with only one hand and practice it. If you train and/or work in teams, ensure they know what you have and how to use it; similarly, you for them. Have it marked. In a tactical setting, all pouches look the same, so notate a “TQ” or a red plus sign; something to identify what is in the pouch. You could very well become unconscious or unable to speak for whatever reason.


Lastly, go out there, and get training. Don’t over-focus on one discipline and branch out. Just because medical can be boring at times to practice and learn makes it no less important than the rest of everything else.


*Everything discussed herein does not represent any endorsement in any way by the Department of Defense. This SHALL NOT be considered any official training, licensure, nor authorization or definitive training on control of massive hemorrhage.

Referenced from: https://deployedmedicine.com/market/226


From the Chieftain:


Be Prepared it is an essential Tribe Value. In our Tribe we have Navy Corpsmen, RN’s. EMT’s and Combat Medics. Beyond that all our Tribe members who aspire to join our Odinic Shamanic Warrior Cult must complete numerous physical, knowledge, and spiritual tasks. These are prerequisites even before entry into the rigorous training process. We emphasize is medical training and that is because of the high-adventure, martial arts, and wilderness aspects of the Warrior Cult. All who aspire must have both Red Cross Basic First Aid/CPR/AED and Wilderness First Aid (WFA) certifications. This is just the starting point. Even though I have had this same training many times before, and equivalent and/or higher-level military medical training, we require that those aspiring to the Cult have the WFA current certification.


Wilderness First Aid is a 16-hour, 2-day entry-level course for outdoor enthusiasts looking for basic first aid training and backcountry medical skills. It is a recognized standard for many civilian outdoor and adventure courses. We highly recommend it for those who spend a lot of time in the wild. Two members of the Tribe have saved lives since receiving this training and several others have rendered emergency first aid to accident victims. BE PREPARED!


#beprepared #combatcasualty #tacticalmedicine #wildernessfirstaid #militaryheathen #warriorfirstaid #firstaid







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