Best of the Web 5/4/12

Another week, and some more great posts.  Here are my favorites from the past 7 days.

Training vs Experience (thetruthaboutguns.com) – The Truth About Guns republished an article from Active Response Training that points out that not all bad guys are untrained slackers; many in fact do have training on their side as well.  Even more thought-provoking, they ‘train’ in the environment in which they operate, not the square range like many of us.  To top it off, they have more experience as well.  Maybe our opponents are training harder than us after all.

Real World Usage of the EDC Trauma Kit by a First Responder (ITS Tactical) – One of ITS Tactical’s readers wrote a detailed account of his usage of his ITS Tactical EDC Trauma Kit in a real situation.  Immediately it points out how important it is to have some medical training (and carry the tools of the trade).  This story also shows that training scars can affect things outside of combatives.  Bottom line: if you carry any piece of medical gear with you, make sure you know how to use it.  Opening your tourniquet and looking at it for the first time while someone is bleeding to death might be too late.

Course Review: Bill Lewitt’s Basic Trauma Management for Shooters

A couple of weeks ago I discussed reasons why you should get medical training. What it basically comes down to is being prepared for the situations you hope never to be in. I carry a gun hoping I never need to use it. Knowing how to deal with trauma, especially the trauma that results from violence, is a good skill set to have even though hopefully you will never need to use it.

Following my own advice, I thought it was time to upgrade my own medical training beyond the CPR/AED training I have. I headed down to Woburn, MA to Down Range Firearms Training which hosted Bill Lewitt and his Basic Trauma Management for Shooters (BTMS) class.

Bill Lewitt is a Paramedic and RN with over 15 years of EMS experience. He taught Tactical First Aid at Sigarms Academy for four years starting in 2001. Bill has also trained many Special Operations units and law enforcement groups. You can find out more about his background on his website here.

Class Overview

Bill started the class with the history of trauma management starting all the way back at the battle of Thermopylae and advancing to the modern day. Like everything through the class, this had a purpose, and provided some great learning moments.

Bill also had slides for many of the modern major bombings and shootings. He demonstrated how catastrophic one of these events can be, and how overloaded EMS could be as a result. Another great reason to be prepared if you ask me.

After this we moved on to the medicine. The class was geared toward trauma management, more specifically the simplest things we can do with the highest likelihood of successfully preventing death after a traumatic incident, whether that be a gunshot wound, a stab wound, or even just a car accident. The three big causes of preventable death on the battlefield after a traumatic incident are blood loss, tension pneumothorax, and loss of airway. Bill spent the rest of the class discussing these three problems, recognizing them, and more importantly techniques and algorithms to follow to handle them.

Blood Loss

We covered three methods of controlling bloodloss or hemorrhage: pressure dressings, tourniquets, and hemostatic agents. Depending on the situation, pressure dressings are generally applied first. If they don’t work, go to a tourniquet, and finally if the blood wont stop coming hemostatic agents like Quick Clot or Celox should be used.

Bill discussed his personal preferences for various equipment. He recommended the CAT-T and SOFFT tourniquets, but the SWAT-T tourniquet is a cheap and space efficient spare to keep in an aid kit. Bill also prefers Celox over quick clot. His reasons were pretty simple: Celox is all natural, and doesn’t have a history of heating up (and causing burns) when applied like Quick Clot does. Bill also recommended the Celox gauze which is a made of Celox and can be used in the same situations more precisely than the powder.

Tension Pneumothorax

Tension Pneumothorax is the second most common cause of death that is preventable. Essentially any penetrating chest wound has the potential to allow air to be sucked in and trapped with each breath. This air pushes the lungs and heart to the other side of the body cavity and makes further breathing and circulation more difficult. Basically any penetrating wound from belly button to the neck needs to be covered. The best tool for this: a chest seal. A good chest seal will allow air out but not in. Care must be taken to make sure both the entry wound and the exit wound are covered.

Obstructed Airway

Obstructed airways are the last of the three preventable killers. Essentially when someone is unconscious, he/she is unable to protect their own airway and may need assistance. This can be as simple as moving the person into the recovery position. Bill taught us how to use a nasal airway which is inserted through the nose and helps preserve a clear airway.

The last part of the class was an exercise in learning to apply tourniquets to ourselves. Bill cited research that found that tourniquets can be safely applied for up to 6 or 8 hours with no ill effects. We were able to try both the CAT-T and SWAT-T tourniquets using both one handed and two handed methods. Bill also brought out what looked like a Halloween prop to demonstrate how to tend to a traumatic leg amputation. After the demonstration students in the class were allowed to try it as well.

My thoughts on the class

Bill does a great job of taking material that is potentially very technical and making it accessible to those of us who have no background in it. Prior to this class the sum total of my medical and first aid training consisted of a CPR / AED class I took a few weeks ago. Bill broke things down and presented material with a great sense of humor that made it nearly impossible to fall asleep in the class. Quite frankly I’m amazed that after an 8 hour class, I really feel like I am armed with the skills I would need to deal with a traumatic injury if I had to.

I hope never to need these skills, but now I can feel confident that I’m prepared to use them. If you ever have the opportunity to take Bill’s class, don’t hesitate. You’ll be entertained and informed at the same time, and you will learn skills that really could be the difference between life and death for you or someone you love.

How to Deal With Training Injuries

Photo by jynmeyer

Injuries are a fact of life, especially if you train. These injuries can range from the dings and dents you get practicing partner drills in a contact martial art, or they can be everything else from pulls and strains to broken bones. If you are training in a serious way, it is only a matter of time before you pick up some sort of injury.

These injuries can be debilitating. Most small cuts and scrapes won’t prohibit you from training, but a broken bone or major muscle pull can easily put a damper on your training activities. One of your goals in training should be to limit these injuries as much as possible. Nothing will slow your progress like needing to stop training all together.

Dealing with injuries once you have them

Since it is inevitable that you will receive some sort of injury at some point, you need to know how to deal with them. If I stopped training every time I had a minor injury, I probably would have spent more time not training than training.

The key is knowing which injuries you can train with, and knowing how to train with those injuries.

If I hurt my x, can I still train?

You can usually continue training with most injuries, so long as you modify what you do. A few years ago I broke my wrist in a fall while training. It took a few weeks to realize that was what happened, but even once I determined it was injured I still found ways to train.

If you can train without re-injuring or exacerbating the situation, then you should probably keep training. On the other hand, if there is no way to train without the risk of causing more harm, you might just need to take a break. I have found that most injuries just require avoiding the injured area.

How to train with an injury

When I broke my wrist they put on a nice cast for me. It was a forearm length cast, and it was very itchy. It made showering difficult, and it wasn’t all that fun to wear. I kept training, but a few things had to be modified. Obviously with a broken wrist doing pushups is a bad idea. I also avoided any sort of serious contact due to risk of re-injuring myself as well as injuring others. Casts are hard, and I’m sure my training partners wouldn’t appreciate getting bonked on the head with a cast.

These modifications allowed me to maintain most of my fitness and skills but forced me to focus on things that did not involve the injured area. This would have been a perfect time to work on one-handed drawstrokes and shooting skills as well.

I’ve trained with many other injuries. Dings and dents are common and only really impact your training when working with a partner. The thing to be careful about with these kinds of injuries is that you will often naturally modify your technique to avoid more impacts where you have been hurt. Learn a “correct” alternative or risk creating bad habits this way.

Similarly, training with muscle pulls is still possible. A few times a year I usually manage to pull a hamstring or groin muscle. When this happens I usually modify any kicks I might throw on that side of my body to limit the potential for re-injuring. Unless you are fighting for your life or are in competition it usually is not worth the risk of full speed and power.

Injuries suck. Minimize their impact by finding ways to keep training, but don’t take unnecessary risks when you don’t have to. Making an injury worse can make the downtime worse. Take advantage of time while you are injured to work on other areas you generally don’t focus on, or catch up on your reading. But remember that the best way to deal with an injury is to not get one in the first place, so train safe and train smart.

How do you deal with your training injuries?

5 Reasons You Should Get Medical Training

Picture by UNC - CFC - USFK

When we train for self-defense we are often concerned primarily with the encounter. If you are smart, you train for everything leading up the encounter – handling the ‘interview’, taking a dominant position, and picking up pre-assault cues. You should also train for everything following the encounter, which may include surveying the scene, dealing with first-responders and bystanders, applying medical aid to those who need it, and possibly escaping if the scene is not secured.

Medical training is a huge part of dealing with the aftermath of a violent encounter, but it can even be useful during the event, depending on the scope of the encounter. It would be good to not bleed out during a prolonged shootout while waiting for help to arrive.

Getting medical training is a good idea for a number of reasons, here are 5 of them:

First aid skills are an asset in many situations

At the local gym where I teach karate, a gym member collapsed about a month ago after getting off an elliptical machine. Heart failure can happen anywhere, and so can a variety of other medical situations. You never know where or when your first aid skills might come in handy. Thankfully this woman survived thanks to the quick action of several staff members at the gym, and their CPR and AED skills. Even if you don’t ever need to defend yourself, basic first aid can be an asset.

You might be injured in an encounter

If you are ever attacked, your opponent might have the drop on you. Even with the best training we can get, there is still a good chance of becoming injured. We could get stabbed or shot in a fight. Being prepared to deal with these calamities includes being able to manipulate your chosen tools with either hand, and learning to operate them with a single hand.

You also want to know how to apply first aid to yourself. The goal is to keep yourself alive and conscious while waiting for first-responders to arrive on the scene. These skills can be the difference between going home to your family or not.

A friend or bystander could be injured in an encounter

When we prepare for a violent assault, we put great emphasis on making sure we don’t spray and pray. We make sure to know where our rounds are going to ensure we hit the threat, and no one else. Our attacker might not be so conscientious. This means that upon resolving a threat, we might have injured people that need aid.

While it may not be your responsibility per se to be prepared to help those around you who may be harmed by a violent assault, are you prepared to look into the eyes of your wife, husband, son, or daughter as they lay bleeding on the asphalt, unable to do anything about it?

Your attacker could be injured

If you are successful in thwarting an assault, it is highly likely your attacker is at a minimum wounded. You could say “screw him” and let him die (and in some localities this might be legally the best option you can take). I would like to think that if I used deadly force on another human being, I would also make my best effort to apply aid to that person if they needed it. Using deadly force is not something to take lightly, so having the ability to help someone and turn a deadly self-defense shooting into just a self-defense shooting is a good skill to have.

Injuries in training

In training, whether just a trip to the range or at an organized shooting class, injuries can happen. Put a bunch of new acquaintances in a confined area, give them weapons and have them move and shoot while under pressure. Accidents can happen. Gun shot wounds have happened at classes before, and I’m sure they will happen again. Be prepared for it, and reduce the risk that you have to watch someone die because you weren’t ready.

If you shoot alone this is even more important. Something could happen while you are alone, and you won’t be able to count on anyone else for aid. Knowing how to stabilize yourself while you wait for help to arrive could easily be the difference between this being your last trip to the range or just one of many to come.


*** warning: explicit language ***

Violence can happen just about anywhere. It goes without saying that injuries including gunshots, knife wounds, and even just heart failure can happen just about anywhere. Get some training, and be prepared for these occurrences so if they ever happen in your life, you’ll be ready for them.

What medical training do you have? Let us know in the comment section below!

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