Session 2: Immediate Aftermath Assessment

When we're discussing the principles of self-defense medicine, one of the first things we've got to assess is the immediate aftermath assessment. And what that is a consist of four things. First, is the scene safe? Is scene safety. Our environment, is our environment safe for us to be there or not?

If you're not part of that environment then don't run in there trying to become part of the problem, be part of the solution. If you're already part of that environment, part of that violent altercation, Then the first thing you need to do is neutralize that threat before you render aid to anybody, including yourself, loved ones or your buddies. The second thing is assess yourself. See if you've got any injuries. Case studies have shown us and proven that majority of people when they get shot or they get stabbed or injured they don't know that they've actually been shot or stabbed until moments later until minutes go by, minutes later or after somebody tells them, hey, you've been shot or hey you've been stabbed or they notice all the bleeding or worst case scenario, they start going unconscious and they start going into shock.

If you haven't done so already then we'd call 911 and start getting help there. Okay? The average national response time to get a 911 or get EMS to your scene is about nine to twelve minutes, which isn't too bad. But taking consideration that this has been evoked violent altercation that response time might be a little bit more dragged out or take a little bit longer to get those professionals to you, especially the ambulance. They're gonna stage and may take a little bit longer to get to you after the police have come in there and secured the scene for you.

And forth, then we're gonna start assessing our loved ones and our family members or any other bystanders that may be injured. When we're talking about scene safety and assessing our environment, we're looking at a few things. One is the threat neutralized? Two, is there any potential areas or anything that the potential other threats could be hiding behind or could they come around a corner or whatnot? So we need to assess those as well as well as other bystanders.

Are they a threat? Do they see me myself as a threat? And then third, we need to put ourselves in a superior position. Whether that's be we leave, if that opportunity arises that we can leave that scene or get away from there two, if we can't then maybe put ourselves up against a backup, against a wall or even better a corner, if that presents itself or hey, maybe I can make it to a vehicle or the engine block of a vehicle. But those are the things we're talking about as far as scene safety and assessing our environment.

When talking about self-assessment, we're talking about how we can actually check ourselves for any physical harm or injuries that we've sustained during that violent altercation. Case studies have proven that sometimes or the majority of the times actually, people don't know that they've actually been shot or stabbed or punched until moments later or until someone points it out to him and says, hey you've been shot or you've been stabbed or worst case scenario is they go into shock and pass out and bleed out. So keep in mind that the first thing we're looking for is any moderate to severe bleeding. Okay? Now that can be a little subjective, but for example I would say that severe or moderate bleeding would be any bleeding that's saturating clothing.

Well, that's one thing, if we can visually see it, great, but if we can't then we actually have to come up with a technique. We have to use a technique that we can actually look and check our bodies with and without in places we can't really see. This technique is called the blood claw. Okay? Now the blood claw is very important because it allows us to actually check our body.

And cause we can't look at a hundred percent of our body, and even if we do, we may not visually see those things or notice those injuries, but we can definitely feel them. We can either, whether we the bullet holes or stab wounds but we can definitely look at our hands and visually see, hey, there's blood on my gloves and this blood on my hands, I need to investigate that further in that body position or in that part of the body. So the way we actually do the blood claw. So we're gonna start with our hands. We're gonna start at the top of our head.

We're gonna work all the way down, downward, down to our chest, our torso, down to our legs and then our arms. Now it's very important that we check these body parts in this order. It's an order of precedence because it's our head, our lungs, heart and then the major arteries that are large in our legs and then our arms. Okay? So how do we do that?

Well, let's start with our head. First thing we do is physically put our hands on top of our head and claw around to the back and then look, and this is a key thing. Anytime your hands come off your body, you need to visually look at both hands and see if you find any blood. Otherwise, what happens is you go all the way through, you check your whole body for any blood, you look at your hands and go, oh, wow! Wow!

I found blood. Well, where did, what part of the body did it come from? So every time your hands come off that body part, check and physically look at both hands and see if you find any blood. Now, considering our environment here we also need to keep reassessing our environment for any future potential hazards or threats or bad guys. So every time we check our hands for any blood we also need to check our environment.

So let's go ahead and go through the blood claw. First it's gonna be the head look for any blood, do a quick scan, and scan to see if you see any threats. Then I'm gonna check my neck, look for any blood, also take a quick check for any, scan of the environment. Then I'm gonna check the torso and you can, as you're checking yourself it's gonna be a little bit more difficult, but you can start at the top of the shoulder, claw your way down the front of your chest it may take, depending on your size, one or two claws, and then same thing on the other side. Check for bleeding, also check your environment.

Now then we need to check the front, we need to check the sides, we check as high up under that armpit right down to our hip, look for blood. Same thing on the left side, look for blood, scan our environment. Now we're gonna check our pelvic and our groin area all the way around through this full circumference, I'm gonna look for blood. There's no blood. Okay.

Check the environment again. I'm gonna check the rest of my leg, my foot. Look for any blood, do a quick check and scan then move on to the other leg, look for any blood, quick scan and the rest of the leg. Check for blood, do a quick scan. And then I can check my own arms and I'm clawing down them.

Look for blood, do a quick scan And claw again the other arm. Now because I physically haven't looked at my own body, I know where my own body parts are. I can also be scanning and looking for other potential threats or hazards while I'm still assessing my own body. For example, if I'm scanning, checking my arm, well, I can still keep a look out for any bad guys and still check for blood at the same time. situation dictates, so just another little trick of the trade there.

Now let's talk about calling 911. If you already haven't done so, now's a great time to, after we've assessed our scene, we've assessed our body and ourselves for any potential immediate life-threatening injuries and we've treated those injuries. Calling 911, well, first off, we've got to know where to scene the good guy, so, okay. We've got to know where to scene police, fire and EMS. So it's really important that we start paying attention to our surroundings, not just our environment, but hey, where we're at.

Start paying attention to the address of the building you're at or hey, if that's the grocery store you happen to be in, do you know that it's physical, the actual physical address? If you don't know the physical address well, then start paying attention to the major cross intersections using train features and train association maybe. That might be able to help. Now the national average response time is nine to twelve minutes, which is not too bad considering but add onto that though, it's been involved violent altercation or a violent attack. Now that EMS or that ambulance crew is going to stage two and three blocks away until the police come and they enter that scene and they render that scene safe and they determine that, hey, yes the bad guys are taken care of, whatever that may be, the good guys are okay, and now the ambulance can come in here and the fire department can come in there and render aid.

Also what you may be able to do too, is while you're assessing, while you're maintaining your scene and you're maintaining your situation awareness and scanning your environment, you might be able to delegate calling 911 to others to other bystanders or family members or some of your buddies and help them out. That way you can still keep an eye on the situation, an eye on the scene, while they're sitting there calling 911 giving the 911 operator the information of the location, what's going on and how many patients there are. Now, we're gonna talk about how we assess that patient or that loved one or buddy, or maybe even a bystandar. We're gonna use a similar technique. We're gonna use that blood claw but this time we can actually look at our patient and kind of see some things.

So the first thing we're gonna check is our overall general impression of the patient. We're gonna look at them and just overall, do they look sick or injured? Okay? If they're standing up there talking to us they maybe not look too sick or injured. If they're laying on the floor, grabbing their ankle then obviously something is wrong there.

We need to investigate that ankle and see what's going on. But don't forget the first thing we're gonna check and assess is any moderate to severe bleeding. Okay? Just like we've done before, the way we just do our blood claw. So what we're gonna do, so we're gonna have Rob come out, and Rob is gonna give us a hand here.

Rob is gonna be our patient for us. And now our overall gender impression, we look, do we see any, any moderate to severe bleeding? If we do anywhere in the body, we can identify we go ahead and treat that, But let's say we can't see it, so this is where that blood claw comes into play. So we're gonna come up here, now before we actually put our hands on another patient, I want you guys to remember in the medical field and even here for personal defence medicine it's a good idea to use personal protective equipment and to actually practice body substance isolation when it's available and when it's viable. Okay?

Not all the time are you gonna have your med kit or your IPAC on you that have access to those gloves, those nitrile gloves. If you do, now's a great time to put them on. If you don't, then you're gonna have do the best you can with what you got. But please, if you have access to them, please use PPE. So the first thing we're going to do here is we're going to assess the patient's head, claw up, claw the top, look for blood.

Now don't forget, because this has been an environment we had threats earlier, the threats may come up, so I'm checking for blood, do a quick assessment of my scene, go right back, check the back of the neck, and towards the front, look for blood, quick assessment, I'm gonna overlap my thumbs here, Start at the top of the shoulders and claw my way down to the hips and to the belt, look for blood, do a quick assessment. Same thing on this side. Come down to the waist, look for blood, quick assessment, Now I'm gonna check the front and now I need to check the sides. Don't forget those armpits, get to know your buddy. Claw down, check for blood, quick assessment, I've checked the front, I checked the sides.

Now I need to check the back. The way we're gonna do this is take this arm, place it above their head here. Rob is gonna be medic friendly, he's going to help me out. We're gonna grab his hip and a shoulder and simply roll them towards me. We're gonna lean them, kind of lean them up on our thighs a little bit.

I'm gonna check the back again, always from the top, down look for blood, quick assessment, look for blood, quick assessment of the scene. If I don't see anything. I'm gonna roll them back gently with a hip and a shoulder. Now I'm gonna go to the legs. I'm gonna go to the legs before I go to the arms because the legs actually have a larger arteries.

They can bleed out faster there. So I'm gonna work on this side first, the full circumference of the leg, and look for blood, check the scene, I'm gonna assess the scene, Go down the rest of the leg, Check for blood, assess the scene. Go back up to the next leg, look for blood, assess the scene, check that other leg, look for blood, assess the scene. Then I can go up to the arms and now I can assess the arms again, assess the arms, and look for blood. There's no blood, assess the scene.

Claw the arms, look for blood, assess the scene. That shouldn't take you even maybe 90 seconds or so to go through there and to check for any major bleeding. Cause that's what we're checking for first.