The TK-4 is one of the most simple and effective tourniquets ever to hit the battle field. Here a student practices applying one to the brachial artery. Photos Abner Miranda
Needle decompression is practiced on a slab of ribs. The validity of training lay persons to administer this treatment is often argued. However, without administering such a simple and effective technique, you could lose a patient. In the tactical medicine environment, time is not on your side, only immediate action has any bearing.
Inserting the Nasal Pharyngeal Airway (NPA) is one of the many skills that's covered in IAM. The NPA is primarily used when your patient is unresponsive or when they're slipping in and out of consciousness. It's very effective.
My buddy and civilian contractor, Edgar, practices binding an arterial bleed with an H-Bandage while keeping the limb elevated.
Practicing the binding of a severed limb may seem far-fetched, but it can be a stark reality in an IED attack.
Emergency medicine isn't for the weak of stomach. Disembowelment can be caused by a number of traumatic injuries and knowing how to stabilize the wound until help arrives, is critical to the patient’s survival.
Author practices binding an arm wound after clearing the immediate area of threats. Securing the scene first is crucial.
FEATURED IN TRAINING
Some folks cower in the face of danger while others are just wired to be fighters. During a conflict, most fall back to their level of mastered training, and everything else comes from critical thinking skills. Immediate Action Medical (IAM) at Tactical Response in Camden, Tenn., was conceived for those that choose to go into harm’s way armed with the greatest weapon of all—the prepared mind.
Tactical Response is owned and operated by ex-cop and contractor, James Yeager, who seeks to find creative ways to bring solid training to LEOs. Yeager has a core of excellent instructors that work for him like lead IAM instructor, Doc K. As an active duty, Special Forces, medical sergeant (18D), Doc K has a wealth of knowledge to impart on the subject of tactical medicine. He describes himself as a “forever student”—stopping often during lecture to welcome input and listening thoroughly to all sides of a discussion. He’s a true example of wisdom being applied—not knowledge being recited.
IAM falls in line with tactical weapons training, and should be treated as a piece of the pie. IAM gives you the basics of traumatic wound management within the confines of what can be done in the field. Doc K stressed the point that sometimes the best tactical medicine is fire superiority: You can’t get to work on the injured until all threats are stopped. Sorting things out takes time—something you have little of when blood is flowing.
Several acronyms are covered in IAM. The first is FAST (Fight, Assess, Scan, Take Cover). The “T” in fast also applies to things like Top off your gun, Talk or call for help and Treat injuries.
Right after attending IAM, I attended Fighting Rifle 1 where the steps of FAST were again covered. FAST truly applies to both facets of the mindset that are necessary in a tactical medical response. A gun fight usually only lasts for a few seconds, however, medical care can last for hours, if not days, depending on the veracity of the given disaster.
Once the shooters are down, you must transition to the five B’s.
- Bad Guys: You should have already taken care of them.
- External Bleeding: Apply pressure. You can’t treat internal bleeding so move on.
- Breathing: If the victim is making noise, they’re breathing. Move on.
- Brain: You must sweep for spinal cord and brain injuries by looking for depressed or bulging discs along the spinal cord. The spinal cord is the consistency of an overripe banana—it’ll bend a lot. However, if it’s pinched, it’ll separate easily so move the patient carefully.
- Total Body Sweep: When you’re doing the body sweep, you must surrender all modesty to the necessity of the moment—check everything! Put a hand on groins, between buttocks and under breasts. Bullets make small holes that may not bleed much because of their small circumference and high velocity.
Motionless Operators Ventilate Easily—got it? Since our bodies are essentially pneumatic and hydraulic systems, getting ventilated is the last thing you want—so move!
The Ventilated Operator’s Kit (VOK) addresses the most common battlefield injuries: tension pneumothorax, loss of blood and constricted airway. In supplement to IAM, Tactical Response offers a week long High-Risk Civilian Contractor Medical Package which is a live-fire class that will prepare you for dealing with traumatic injuries while bullets are flying.
The VOK is austere and yet comprehensive in its ability to address battlefield injuries. Some of the contents include: a TK-4 Tourniquet because arterial bleeding can kill in 1.5 to 3 minutes, an H-Bandage for applying wound compression, 100" roll of duct tape which is far better than any medical tape, a Nasal Pharyngeal Airway (NPA) used to preserve the airway in case your patient is slipping in and out of consciousness and a 14 Ga. needle, which is the most controversial item in the kit.
People get seriously riled up when they hear about “laypersons” drilling someone with a needle to relieve the pressure of tension pneumothorax. My sentiment on the matter is simple: If it comes to having to drill someone or watch them die— I’ll use the needle. Tension pneumothorax happens when the chest wall is punctured and air gets trapped between the chest wall and the lungs. With each breath, more air is trapped thus pressing on the lungs until they collapse. Doc K covered drilling extensively. We then took turns on a rack of ribs finding our landmarks through the heavy packaging then inserting the needle. That was by far the most useful example that I could’ve been shown.
I have nothing but high praise for IAM. Doc K took what should’ve been the PowerPoint presentation from hell and turned it into a two-day interactive series of exercises that kept us mentally engaged and physically involved. I came out of the course with a renewed sense of stability in what I already knew and a bag full of new tricks. The neat thing about this course is that you quickly learn that you can address a lot of injuries on the battlefield with a shredded shirt and duct tape.
One of the most important things to remember in emergency medicine is that sterility is highly overrated and that almost anything can be used to treat the wounded. Doc K told us that if it comes down to it, you can bind a wound with duct tape after shoving a handful of leaves into it to create pressure. It’s unorthodox, but it works.
My gratitude to James Yeager and Doc K for allowing me to come out to Immediate Action Medical. I hope that you will do the same. Remember: It’s your sole responsibility to go home alive at the end of your shift.
Until next time, practice hard.