Those with quick friends and the dead. An introduction to medical training.

As things around us heat up we should all be gaining, maintaining and improving our medical skills. There are lots of great options for this training, but the basics for trauma treatment in the field are pretty well developed. Exsanguinating bleeding, airway, breathing, circulation, XABC is a good way to remember it. For seriously wounded patients treat those, in that order and get them to definitive care as soon as possible. Your options for treatment will depend on your training, equipment on scene, and possibly local medical rules. One thing that is often not discussed is the last part, get them to definitive care as soon as possible, which we should all keep in mind and fold into training and planning. 

In a functional society when someone is hurt you call for EMS and try to help stabilize them until EMS arrives and takes over. When you look around does this look like a society that is becoming more or less functional? While you should always try to get your patient to EMS or EMS to them sometimes that is not possible. What do you do when you have a friend that is stabbed but 911 says response is not going to get there anytime soon? Or someone shoots up the concert you are at? 

You do what you have to. (https://www.foxnews.com/us/hero-marine-stole-truck-drove-vegas-shooting-victims-to-hospital)

First is always remove the patient from the threat, or end the threat. Once that is done treat those four main life threats (XABC).  Exsanguinating bleeding is the biggest threat, and treated first. If it looks like a lot of blood is coming out of somewhere and making a pool assume it is exsanguinating. If you have to ask, assume it is exsanguinating. On the torso this probably will take packing the wound which is a skill that takes some training. For most people, lots and lots of pressure with a bandage is the best you can do. Hemostatic gauze is a good investment for any trauma kit and has a proven track record in the military. Not a silver bullet, but it will make the most of you pressure dressing.

Exsanguinating bleeding on an arm or leg typically requires a tourniquet. There are lots of great products, but Combat Application Tourniquet’s (C-A-T) are cheap and effective. One note, just because you are applying a tourniquet doesn’t mean you can’t also apply direct pressure while you do it. Simply lay the wounded extremity out on the ground and put your knee directly over the wound and apply a little body weight to it while you are getting the tourniquet applied and tightened. For a large leg you may need a second tourniquet, always apply the second closer to the heart than the first and always apply them on the long bones and not on a joint. 

Airway is the next most critical, if you don’t have an airway you don’t have a patient. Without special equipment and training the main thing you can do if a patient is unconscious or otherwise unable to protect their airway is reposition them. Most of the time the main thing blocking the airway is just the patient’s own tongue. Every patient will be different but often simply lifting the chin and tilting the head back slightly is enough to help. A good CPR class will typically give you experience with training dummies on how to do this for little to nothing.

Breathing is the point of getting that airway open. The main breathing problem we are concerned with in a post insecurity round of treatment is sucking chest wounds. When the chest wall has a hole and is open to the outside atmosphere air works it’s way into what should be a vacuum. Initially this makes it harder to breath, but can eventually effect the heart. To treat this first cover the wound to the chest with a gloved hand, and then tape something that would block air over the wound. There are expensive chest seals that are great, but even a plastic bag works in a pinch. 

Circulation gets that oxygen to the tissues you are trying to save. The mindset for this stage is every red blood cell counts, and any that are lost you are not getting back during this round of emergency treatment. Try to find all bleeding that you may have ignored because it was not exsanguinating and get some pressure and a bandage on it. The other thing that goes with circulation is maintaining body heat. Patients that have lost significant blood or have other major trauma may have difficulty maintaining normal body temp. The various processes that the body depends on really only work well in a narrow band of temperature so you need to protect the patient from the weather and put something insulative around them. Space blankets work well, and if evacuating in a vehicle turn up the heat all the way. 

The last, and sometimes hardest part of the puzzle is getting them to definitive care. If you have a really hurt patient from trauma assume they need a trauma center. Not every hospital is one, but it is pretty easy to find out which are in your local area are. These places have surgical teams that can find and fix problems very quickly, and ICUs for recovery. If you’re in a strange place and don’t know which facilities are trauma centers or can’t get you patient to one a regular emergency department is better than nothing, but they will only be able to further stabilize and then transport to a trauma center. If at all possible just go to a trauma center. 

Medical training is not as sexy as shooting fast or running around with nods on, but if you ever get in serious spot of trouble you may need it or need someone with it. This is just the highest level overview, and there are hundreds of classes you can take to expand your skill set. Get out there with you guys and learn these before you need them. The life that effort could save could be your own.

-DeltaSchmitt

Editors note: Good medical supplies can be purchased readily on ebay and a few other select sites. We have no affiliation with any of the following but they are good places to get Medical supplies: https://www.chinookmed.com/ https://www.rescue-essentials.com/index

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