PDN 2012 National Training Tour Update: Week 10

All right, Rob Pincus is here with the 10th update from the PDN training tour, 2012. It's been another great week. I've been just outside of Salt Lake City. In fact, I'm standing here right now about 15 miles from Park City that way. About 15 miles maybe a little bit less to Salt Lake City down that way.

And it's another great day in the mountain. We had a great three-day class here hosted by STD Chris Wilden. Chris is a great operator in his own world and he's also a great instructor and he hosted a class here this week for us a combination combat focus shooting and advanced pistol handling. One of our combat focus shooting instructors from 10 X defense out in California, drove over to help me out Jeff Barner. Now this is my next to last stop.

I'm gonna take the next week off from training. I've actually got a trade show in the martial arts industry to go to in Las Vegas with one of our PDN contributors Kelly Mirror with her Wrong Woman Program, as well as her Instructor Revolution Program. And then it's 4th of July weekend. I'm going to celebrate Independence Day with some family but the rest of our instructor team is still traveling around still gonna be running courses. My next stop is going to be out at the Firearms Academy, Seattle.

Now this update it's going to be a little bit longer than average because we're going to talk about emergency trauma emergency medical response out on the range. Now, as you may have seen on the internet over the last week we made a special video while I was out with Phil McFall in Leadville, Colorado. Now Phil McFall runs high caliber consulting. He's a firearms and martial arts instructor and he's also an emergency medical specialist. He teaches tactical medicine and that's what he does for a living.

Well, one of our other outside CFS instructors Mike Will was also out with us. Now he's based in Montrose, Colorado and he drove over to help out with the class. And it just so happens that Mike has a prosthetic foot. In fact, he's got a prosthetic leg from the knee down and he said would there be a way for us to do something with putting around through my extra foot, to teach some lessons about what to do on a range or how that might happen or some safety principles and things like that? Well, I think all the things about knowing offset and knowing, you know to make sure you don't cover your own foot with a muzzle are pretty obvious and pretty standard.

But what I do see a lot of people lacking in is an awareness about what they would do if they actually did have a student, if they had themselves they had a friend or anyone on the range with them put around through their foot. Let's take a look at that teaser. Stop! Stop! Stop!

Sit back, sit back, sit back. Phil, take control, relax relax, cease fire. Phil, you're the medic. Phil. Get your kit.

I got this on safe. That video really was the basis of getting people to think about what they would do if they had a worst case scenario. They had a person put around through their foot. Now, unfortunately, as you might guess, there were a lot of people who simply answered with smart-ass comments and snarky remarks, things like "I'd point and laugh. What I would do next is tell him not to shoot his foot next time." And some other things that just show that a lot of people are living in denial.

They aren't really accepting the fact that if you are involved with live fire firearms, for any reason I don't care if it's recreational shooting, hunting, If you're like the people out here that are just having a good time at the public range, if you're involved in training classes, if you're an armed professional, of course if you have to use a firearm to defend yourself during a violent encounter competition, any reason that you're using a firearm, if you don't accept the fact that somebody could put a bullet through their body and you might have an opportunity to step up and help them you might need to help them. You might find yourself needing help from someone else. Put the gun away. Don't even carry it. Don't go shoot it because you're not doing yourself the right amount of responsibility.

And you're certainly not being a responsible firearms owner. You need to acknowledge that regardless of everyone's best intentions, regardless of every manufacturer's best intentions to make high quality things that won't malfunction, regardless of everyone's safety rules and safety procedures at ranges like this one here, people can get hurt, accidents, negligence. These things will take place. And of course, ultimately, even if you do live in denial of that ever being the case, we acknowledged that bad guys have guns too. And one of them may fire a bullet through us or through someone else that we care about.

So we need to have a plan. And if we're out on the range with our firearms and our other shooting equipment, we should have some equipment that's actually going to help us to respond. You've got the body position, three points of contact. When I give you the Up command, go ahead and take the shot. Stand by.

Kneeling. Standing. Up. A box, use the A box. Kneeling.

Seated. Up. Kneeling. On your back. Stop!

Stop! Stop! Sit back, sit back. Stop! Stop!

Sit back, sit back, sit back. Phil, take control. Relax, relax. Cease fire. Phil, you're the medic.

Go, get your kit. Oh God! I got this on safe, relax. Dan, just get a phone, call nine one one. Tell him we're at the rage.

Go. Call them now. Phil, what do you need from me? What do you need from me? Give me some access up there so the ambulance can pull straight up.

All right, Dan, move that car. Move that car. Move the silver car. Got it. Relax, relax, relax.

Keep talking, keep talking, Mike. Will, Will you've been shot. Relax, relax, relax. Talk to me now in case you pass out, are you taking any medicine at all? Yeah.

What is it? Illerca. Anything else? No. All right.

Do you have any allergies to any medicine at all? No! Oh God. Relax, buddy, relax. Rob, I need you to hold this.

Got it. Hold off, Will. Keep talking, keep talking. Oh my God, is it bad? It's clean right through, okay?

Ambulance is on the way, okay? Okay. That's good. Hold my hand. Hold my hand.

Relax, relax, relax. You're all right. You're all right. Will, Will? What?

What's my name? Tell me where you can feel this. Yeah yeah. Okay. Oh God!

Not bad, dude. Not bad. Not bad. It's what we got Phil here for. Relax, relax.

It's what we got Phil here for. All right. All right, now let's take a look at what the suggestions are for what we're actually going to do if this happens. The stuff on the internet was great. I contacted a person in offense, network contributor, Dr.

Robert Smith of Direct Action Medical Network. Showed him the teaser video. I said, what would you do? He gave me his thoughts. Hopefully you have a medical kit out there on the range.

Now, personally, I say, every time you're on the range you need to have a compression bandage of some type. Some kind of a compression bandage. These Olaes bandages are great. They're convenient. They're easy to use out on the range and the range environment.

Of course, this one is still sealed. The other thing you're going to need to have is a tourniquet. Now both of these things are very inexpensive very easy to have and they should be kept separate from everything else in my opinion. The one thing you might want to add would be something like a hemostatic agent, a combat gauze, a C-lock, something like that. These two or three things in one pouch in one bag clearly identified for everybody involved in that day's competition recreational shooting or training environment, and make sure that it's out there on the range somewhere, not, Oh it's somewhere inside of my truck.

So one of the things we do is we simply designate one bag with nothing else in it. This holds the immediate action trauma response medical equipment. We mark it very clearly. And then we put it down on the range. Put this right on the edge of the firing line, put it right behind the firing line.

Let everybody know where it is because this will save you 30 to 45 seconds a minute two minutes of, Oh, it's somewhere in that bag. If you do happen to have a highly qualified medic right out there on the range with you, he's probably going to have much more equipment, in a larger bag. But we don't need to go rooting through that to find the things we need. Gauze or a compression bandage, some other type of rolled gauze, whether it's four by four sheets that we're holding in the place as you saw Phil use inside of that video or something like that bandage with a large pressure dressing. And then the wrap that goes around it and they're connected, especially that one which happens to have a pressure point that we can push right down the area that blood is coming out of, whatever it is, have that and have the tourniquet.

What happens when someone shoots themselves in the foot in the limb, when you're out on the range in the middle of any kind of shooting endeavor? First and foremost make sure the guns are safe. Make sure the guns get put away. Now, I don't think you should have a crazy, you know, unload and show clear, secure the guns in a pile type procedure. There's no reason to get into that.

When you've already got somebody down on the ground, somebody bleeding, somebody has been hurt. Do the things you would normally do. Call stop, call cease fire, index the drill, get everybody to put their guns on safe and let them hang. Get everybody to get their hand guns back into their holsters and a safety cocked condition. If you want to take the long guns off and have somebody ground them, that's great.

That's fine. But don't assign someone to make sure all the guns are unloaded and clear. There's bigger things, more important things to do. Get the gun safe. Of course, we have to treat the wound.

Let's get down there and find out what's going on. Let's get our medical equipment our emergency trauma response. Let's assign one person. Hopefully the person with the most advanced medical knowledge, they do that. Another person's going to have to get assigned to make contact with nine one one, with emergency services, get in contact with them let them know what's going on.

Make sure that nine one one, the emergency services know that this was an accident or that it was negligent. The point being accidental injury with a gunshot. We don't want them to think that this was violent. We don't want them to think that there are unsecured firearms or violent actors up here and have them stage a mile away waiting for law enforcement escort and then have law enforcement come up here. Guns drawn telling everybody to stand down.

You've got a person who's hurt. Make sure they know the person that was hurt was hurt through an accident. And that it was a gunshot wound. Next thing you want to do is make sure that there is a pathway to either get a vehicle in up to the person to transport them or hopefully to let the ambulance respond. Now, if you're out in the middle of nowhere and you think that the ambulance response is going to take too long maybe a volunteer system where they're gonna have to get 5 or 10 minutes to their medical facility to the medical equipment, 5 or 10 minutes to drive out to you, whatever it is, if you really believe that you're better off transporting the person yourself drive safely, put your seatbelt on, don't be talking on the phone, get the person into the vehicle, get into the car, get your seatbelt on.

Follow the rules of the road. Don't make a bad situation even worse by running a red light, causing an accident, going off into a ditch, thinking about applying pressure while you're trying to drive and skidding off and hitting a tree. Drive safely if you're doing the transport yourself. Let's go back to the specifics of the wound care. 50/50.

Do we take the shoe off or do we not take the shoe off? Most of the medical professionals that I talked to said if you can apply pressure, if the footwear is something like a sneaker, if the footwear is something relatively soft and crushable that you can apply pressure with your wrap, with your gauze especially direct pressure from either side, maybe even with your hand, once you're applying direct pressure, if that shoe is on, leave it on. Because the shoe may actually be helping to contain damage that was done to the foot. If the shot was near the edge of the foot, split it open. If the shot was near a toe, blew it off.

Let's keep everything as contained as we can. If on the other hand you can't get pressure because it's a big, heavy boot something like that, a big, heavy wide sole you can't get pressure to stop the bleeding. Then yes, you may have to take that shoe off. One thing that came up was whether or not to put the tourniquet on. Well, what you saw in our video was that we chose to stage the tourniquet.

So we're going to try for the four by fours with the gauze wrap or the compression bandage whatever we had field dressing. While that's applying direct pressure if that stops the bleeding - great. But just in case, we stage the tourniquet. If we start getting bleed through or we start getting that pulsing blood from an arterial wound especially higher up on the foot, near the ankle maybe a shot into the wrist, shot into the base of the hand. If we're getting that pulsing blood pushing through our dressing, let's go ahead and tighten that tourniquet down.

But at least we have staged the tourniquet. Once the initial pressure dressing has been placed there and that gives us a 30 second 45 second headstart once we realized we are losing blood through an artery and we need to clamp it down. You need to know how to apply this stuff. And that includes, then possibly the hemostatic agent. If you have someone in your group who has the hemostatic agent, you know how to use it, you want to go ahead and apply that apply it according to the directions, whether it's a gauze whether it's an injection, whether it's a powder make sure that you're following directions on that and make sure that you're not applying it for what essentially is a pass through without having broken any major vessels that you are going to simply be able to get pressure on there, stop the bleeding get the person to professional medical technicians.

Let them go ahead and take care of the next steps. What you do down there in those immediate first few moments may save a life. Maybe it'll just stabilize the person. Once you've done that and you've stopped the bleeding you've controlled the bleeding you've done what you can make sure you're also talking to that person. Maybe you've assigned someone.

You work on the wound. You talk to the person, keep them calm. Start looking out for signs of shock. Keep them as calm as possible. Try to keep them warm.

Talk to them, keep them talking, keep them conscious. Get them to start talking to you about who should be called, giving phone numbers, things like that. All the standard information that we want from that person. Sure, it may be written down on a waiver or a form somewhere else. But if you can grab a Sharpie out of your pocket and start writing it down on your arm or write it down on their shirt or write it down on a box of ammo, whatever you've got.

Now you have it right there. You can start being ready to prepare that call, prepare someone else with that information so they can make the phone call to the emergency contacts. When the emergency medical technicians get up here or when you drop that person off they're going to want to know exactly what happened, what type of firearm it was. If they're knowledgeable in terms of trauma response if they're a level one or two trauma center they may be able to do things differently or understand there may be a different type of wound for a high power rifle versus a hand gun bullet. a hollow metal versus full metal jacket.

Was it a pass through or has the bullet not come out? There's no hole in the bottom of the shoe or the shoe's off and the bullet must be somewhere in the foot because there's no exit wound. Be prepared to tell them that. Also, of course you're going to want to tell them what you've done. If you have one dressing on there that doesn't have much blood but you've changed dressing three or four or five or six times, they probably gonna want to know that.

Let them know that a lot more blood loss than they can see has happened. Obviously, if there's a tourniquet on there while they should be able to see it. If they can't see it for some reason because of clothing or other dressings, make sure they know that there is a tourniquet on the foot, something like that. At the end of the day, this is really about having a plan. It's about acknowledging that this could happen to you, could happen to one of your family members.

one of your friends, one of your classmates, one of your students. And you need to be prepared for it. Don't go around with the bravado idea that, Hey it will only happen if somebody is an idiot. Well, while there are idiots around then it could happen because someone is being idiotic. It could also simply be a misunderstanding, negligence, accident, tripping, act of God, malfunctioning equipment.

It could be anything that puts that bullet through the limb. Be prepared for it. Don't live in denial. Have a plan for what you would do next. What I'm going to do next is head to the hotel, take a shower, clean up after the day of training.

Again, as I said, I'm going to be not training for the next week but you will get a weekly update. I'll see you on the next one for the Personal Defense Network Training Tour, 2012