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High-Risk Lifesaver Course
Everyone in law enforcement ought to be able to move his partner 20 yards to safety. This premise sets the tone for the casualty carry and drag drills during a combat medic course.
The term “combat medic” is somewhat of a misnomer. High-risk lifesaver may be more appropriate. According to leading EMS physicians, this type of training ought to be incorporated in every law enforcement officer’s career within his first few years on the job. The focus of the curriculum is being able to save yourself or another person in a worst-case scenario when medical care is delayed or unavailable.
About one-third of casualties require an Advanced Life Support (ALS) level of care, while the remaining two-thirds are at the Basic Life Support (BLS) level. The trained operator can now better triage and treat the BLS patient, freeing up EMS medics to treat the more serious victims.
A morbidity and mortality study done in Los Angeles County during the mid-1990s made the point that the immediate control of bleeding and transportation were the critical elements for patient survival. This study concluded that with gunshot wounds, those victims who waited for paramedics to began treatment on scene had half the success ratio of putting the victims in the nearest car and control bleeding en route to the hospital.
While the team medic will have a large medical/rescue kit, and EMS has more advanced equipment, each person needs to have a small medical kit on his person at all times. The kit should be carried on the same location for each member of a unit with the rationale that the rescuer can quickly locate and use the victim’s first-aid resources. The content of this kit varies with the season, terrain and mission.
Some of the essential items for the personal kit include assorted bandages; heavy-duty, 6 mil gloves; scissors, knife or scalpel blade; head light or light stick; silver marking pen (works on both light- and dark-skinned people); Tylenol or similar pain meds, but not aspirin, which might increase bleeding; Sam splint or Ace wrap; silk medical tape; 1-inch by 25-feet of webbing; compass and map; 3M 1040 surgical drape (wrap); 2-inch safety pins; super glue; and sugar packets.
Various clotting agents and their application were discussed during the course. However, proper training is required to apply a clotting agent as the wound must be manipulated into a volcano shape to allow a liberal dose of the agent to get inside the wound. This is not a substitute for bandages or dressings.
Two Outstanding Items
During the course of the equipment lecture, two pieces of new equipment were introduced that bordered on phenomenal; the Israeli Bandage and Combat Applied Tourniquet. Both items are so exceptional to deserve stand-alone mention.
Available in 4-inch or 6-inch wide, the Israeli Bandage combines the attributes of an Ace bandage with a field dressing. The elastic bands holds the dressing portion more securely than its counterparts. It has slotted, plastic ears adjacent to dressing. When the bandage’s tail is passed through the ears and reversed, direct pressure is applied to the wound site, and the dressing area is basically secured. Additional wraps are made to completely secure the bandage.
The end of the tail has a built-in plastic clip that eliminates the need for tying or metal clips. In the classroom, the average time to apply the bandage was less than 30 seconds. The elastic tail allows it more stability when applied to the head. Additional field dressing can be slid under the elastic as needed. As a last resort, the end clip can be slid under the final two wraps and twisted as a tourniquet.
The Combat Applied Tourniquet (CAT) is an all-inclusive tourniquet. This eliminates the need to access the component parts for a tourniquet under stress. The device is a nylon web strap with Velcro and a buckle. Attached is a windlass device with ears and Velcro to lock it in place.
To apply, place the CAT above the wound site by wrapping the webbing around the limb, through the buckle and securing back to itself with the Velcro backing. Twist the plastic arm of the windlass until bleeding stops. Securing an end of the plastic arm under the attached clip and pull the small Velcro strap over to secure. When in doubt, apply a tourniquet, as it can be removed later.
For training to be valid, it must be realistic both in content and application. For example, at the basic level, the student bandages a partner sitting in a chair in the classroom. Performing this same task on a some wearing body armor and lying prone is an added, but lifelike complication.
During this course, each drill added an additional skill level or complexity to a basic task. Drills began in the class room with light gear, then ultimately progressed to moulaged patients with all participants in full gear and live fire. By the end of training, students performed two-man extraction drills engaging multiple targets, moving a live casualty to cover, reloading, bandaging and guns back up on target in 30 to 45 seconds. This provides students with confidence to act when the actual need arises.
The first step in treatment is an accurate assessment of injuries. During their drills, students became proficient in conducting head-to-toe surveys in the prone or kneeling position while manipulating a variety of ballistic and cargo vests. A first priority is identifying yourself as a friend while approaching the patient. The victim may be incoherent and could easily mistake the rescuer as a threat. Positive, reassuring words to the patient were also underscored as an aid.
For a quick estimation, you can use the following guide: If the pulse is felt in the wrist, then the blood loss is less than 750 ml (1 quart), and the prognosis is good. If the pulse is only felt in the leg/femoral, then the blood loss is about 1500 ml (2 quarts), and the prognosis is not good. If the pulse is only felt in the carotid/neck, then blood loss is about 2,000 ml (more than 2.6 quarts), and the prognosis is bad.
One and two-man buddy-carry drills were a major training topic. The focus of these was a short carry with the ability to maintain access to your weapon. Two main methods were taught. The first technique was the back carry where a semiconscious patient was carried piggyback.
The second approach, although deceivingly simple, proved more strenuous. The one-man drag employed a hand-to-hand grasp of the supine casualty. The keys to success were a good climber’s grip and the casualty pumping his legs to aid locomotion. The climber’s grip avoids a broken or nonexistent carry strap on the casualty’s vest.
Additional, procedures for moving a casualty over a longer distance were more complex. These included the Pack Strap Carry (one-man carry) and the Recon Carry (three-man carry).
Several common, yet subliminal, factors with these drills were:
During the self-treatment drills, the Israeli Bandage proved its worth. These are a progressive series of drills where the student first learns to apply the bandage to an extremity in the classroom. This is repeated until an acceptable level of proficiency is attained. Then the drill is brought to the range with additional tasks added. Students are ultimately able to shoot their weapons dry, reload, treat themselves with a bandage or tourniquet, and come back on target under time-induced stress.
The purpose of the team drills is to use teamwork to extract a casualty under fire. Based on the data showing that cervical injuries occur in less than 1% of casualties, a quick extraction was paramount over immobilization. If the casualty is from a fall off a roofline or motor vehicle crash, then consider a C-spine injury as possible. These are immediate action drills with one operator moving the casualty while the other covers.
Communication and coordination are key factors. Verbal commands must be short, loud and unambiguous, such as “clear,” “moving” or “on me.” Ten to 15 short commands cover most situations. The teams that perform best were those that communicated.
Vehicle Rescue Drills
Based on real-life experiences, extracting the patient with a vehicle involves unique techniques. The size of the vehicle became a factor; the bigger the better to get both the casualty and rescuer in through the rear door. An SUV is an asset because either the rear door or hatchback can be used. Regardless of what vehicle is used, the driver must stop so the rear wheel protects the casualty from incoming fire.
Being a live-fire drill, safety and muzzle control are paramount. The front seat passenger keeps his weapon extended throughout the drill. The rear seat rescuer must keep his weapon, usually a pistol, pointed down range while sliding backwards across the seat to avoid sweeping people in the front seat. Only after exiting the vehicle can the pistol be holstered and the casualty access.
By far the most authentic and graphic, these drills are considered the graduation, pass/fail exercise. Students are rotated in team positions and must complete tasks as both a coverman and rescuer/medical care provider. Fake blood and prosthetic injuries made for earthy, challenging drills. When faced with multiple injuries, a student quickly accessed his teammate’s kit for additional bandages and passing score.
As in most courses, there is a central theme with a basic take-home message. With this course, there was a five-part mantra, 1) stop the bleeding, 2) control the airway, 3) extract to a higher level of medical care, 4) wear your body armor, helmet and eye protection and 5) control your fear with tactical breathing and realistic training. One additional tip is to train in full gear. Not only is the weight increased, but bulk is added, drastically affecting how the drill is performed.
Sergeant Ron Yanor is a senior shift supervisor and FTO with the Sangamon County, IL Sheriff’s Department and former SWAT officer. He may be reached at email@example.com.
Published in Tactical Response, Sep/Oct 2006
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