Let’s Talk Med Training!
At some point, whether through life experience, following social media, or just realizing its time to protect yourself or loved ones, you’ve decided that it’s time to get some medical training. On behalf of all of us, a sincere thank you. Knowing there are people who can step in and help save a life makes us all sleep better.
Now it’s time to figure out what kind of medical training best suites your needs and skillset. If you’re starting from scratch, no worries. We’ve all been there. When I started the SF Medic course my skillset was limited to putting on band-aids and giving hugs. We all have to start somewhere.
The following are my recommendations for what kind of medical courses you should be looking for based on your previous knowledge and skillset. Not everyone will fall perfectly into these categories, so figure out which works best for you. I also need you all to be honest with yourselves. If you have no foundation of knowledge, you don’t need to take a high-speed TCCC course from former SOF medics as your first class right out of the gate. Crawl, walk, run also applies to medicine.
Understand too that a lot of places will call classes by different names. We can’t keep track of them all, so we certainly don’t expect you to! Look for the classes that fit your level of interest and what you want to learn and a level you’re prepared to learn.
Category 1: No medical knowledge. (The vast majority of civilians/some military)
Limited to putting on band-aids and Neosporin after a scraped knee, this is the vast majority of people. That’s totally fine. For most of us, that’s as much as we ever needed. But now you’ve chosen to push past this comfort zone and build on it.
Recommendations for Category 1:
BLS/CPR, BLS/First-Aid etc.
Stop the Bleed/Bleeding Control (BCON) Courses
Med 101
These will all give you the basic fundamentals of stopping immediate and life-threatening emergencies that can happen to you or your family. Basics should include understanding why you use a Tourniquet vs. Pressure Dressing vs. Simple Dressing and how to do all 3. When and how to open an airway. Why and how to seal chest wounds, burns, splinting, choking, seizures, neck injuries and learning the recovery position. CPR is a plus.
I had to take a First-Aid course through the Red Cross as part of a civilian job requirement and was surprised at how accurate and good of a course it was.
Category 2: I know the basics, but want to build.
People who fit into this category know the basics or have had previous exposure to BLS/CPR/First Aid type classes, or participate in activities where you are more likely to encounter more serious injury (extreme sports, shooting, working for the postal service…jk.)
Recommendations for Cat 2:
This is where you may want to start getting into the TECC, TCCC type courses. The focus is on taking care of the threat first, and performing life-saving interventions rapidly in a more stressful environment for you and those around you. You will build on your First-Aid/BLS training and learn more advanced techniques to further your ability to not only immediately save a life, but provide some level of continual care until paramedics or a higher medical authority arrive.
Category 3: I missed my calling as a Pioneer.
The camper, adventurer, hunter or outdoors person.
Recommendation for Cat 3:
Austere Medicine Courses
Most Austere Medicine or Wilderness Medicine courses will cover topics that you can expect to encounter far from conventional EMS services. It will allow you to determine whether you can drive on, or sustain yourself or others until you can reach a higher level of care. Courses often offer topics on fracture splinting, realignment and dislocations, recognizing and treating frostbite, heatstroke, bites, stings, and respiratory and cardiac emergencies.
There are many sub-categories of medical training classes, such as Home Defense, Advanced Tactical Practitioner, ALS, TCCC-Advanced etc. For now, let’s stick with the basics for what we have listed.
As with any skill, you cannot just learn something once and expect to retain the info. Taking a medical class does not make you an expert. PRACTICING WHAT YOU’VE LEARNED makes you proficient. Please please please don’t be someone who takes a class, buys a medical kit to throw in their home or car and then never thinks about it again.
It is a list of companies that offer various levels of medical training organized conveniently by state!
We are here to help, so please don’t hesitate to contact us with any questions or input!
I know the picture is hard to look at, and the story behind it is heartbreaking. Sometimes it takes a dramatic picture like that to shake us out of our comfort zone and encourage us to learn something new. While we do follow the SMARCH algorithm for immediate care, there is a lot that goes on in these types of injuries that by recognizing the MOI and knowing what needs to come next in the order of follow on care, we can employ our skillset to help get ahead of these injuries.
First, let’s define what a crush injury is:
A crush injury occurs when part of the body is compressed, usually between two heavy objects. Common injures that occur from these types of wounds range from minor bruising and swelling to more serious injuries such as fractured limbs, heavy internal bleeds, rhabdomyolysis and crush syndrome.
There are two types of crush injuries that we can talk about. The first is the immediate injury. Someone was run over by a car (like in this instance), or injured in a building collapse but was pulled free quickly. The other kind is the prolonged field care crush injury, where they are trapped for hours on end before being rescued. In this post, we will focus on the immediate injury. Crush injuries of a prolonged nature are a future blog article.
This girl fell onto the road, and was ran over by a large vehicle. You are the first on scene as a paramedic, first responder or bystander who has equipment. What is the proper order of treatment, and how do we set this patient up the best we can to maximize their survivability chances? While there are many many many different ways a patient with a crush injury can present based off of their unique injury pattern, we will seek to outline some common injuries and what you can do.
We still follow SMARCH, because we always work to prevent what will kill our patient the fastest. Since we have talked about this subject quite a bit, we will breeze through it. Please check out some of the proper steps in previous posts if you want a complete breakdown.
Security—Active roadway, block traffic or immediately move patient out of a busy road if you are concerned that traffic will hit you/the patient.
Massive Hemorrhage—Stop all arterial or heavy venous bleeding immediately.
Airway—Clear the airway of dirt, debris. Ensure patient has proper access to O2 through nose or mouth. If trained and capable, provide cricothyroidotomy if indicated and necessary.
Respirations—Penetrating injuries get stabilized with chest seals or occlusive dressings. Have them on O2 whenever possible. Look for flail chest (2 or more adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently.)
Circulation – Bandage all remaining bleeds. Place Pelvic binder if SBP <100mmHg or HR > 100bpm, they have pelvic pain, or their GSC score is ≤ 13.
-Insert 18ga IV, keep TKO.
Hypothermia/Head Injury. Keep patient warm. Note GCS score. Keep patient calm and report cognitive changes throughout treatment to get a better idea of deterioration of condition.
If you suspect or see trauma to the head/spine/neck area…and you have help nearby or a C-collar, use it!
Now that we have rapidly gone over SMARCH-you have to think about what is best for this patient. Do you wait to further stabilize in the field/road/etc. or try and transport immediately?
In these instances, the answer is almost always Transport!
Recognizing the MOI in this injury is important. Often a crush injury will result in potentially severe internal bleeding and fluid loss, heavy bruising, and damage to internal organs. In almost every instance, they will require surgical intervention. Documenting and calling ahead with the correct wound pattern recognition will allow surgical teams to begin to understand what they will need prior to patient arrival.
Additional considerations for Crush Injury:
Severe bone/tissue damage. Stabilize in position of function and prevent further damage when possible.
Pain management: If patient is conscious, pain management will be key. For military medics and hopefully many civilian medics by now, this means Ketamine. If not, you will have to use your best judgement on opioids so as not to reduce their respiratory drive.
Fluid Resuscitation. Check Vitals repeatedly. Heavy initial external or internal bleeding may cause patient to begin to deteriorate into shock. Stick with Normal Saline, and only resuscitate to bare minimum for perfusion so as not to blow out any blood clots.
One of the huge keys in dealing with crush injury is to not try and treat everything at once. Stabilize the patient, and immediately begin necessary calls and arrangements to get someone to the proper level of care. Knowing it is a significant crush wound pattern or injury can help the dispatcher or EMS get them to the correct hospital with the correct resources.
Things that a surgical team will have to worry about 15 minutes to 4hrs post injury will include compartment syndrome and renal complications from the significant soft tissue injury, so getting them to a higher level of care quickly is essential.
We are consistently attempting to add pieces to your quiver of knowledge. We aren’t trying to introduce giant pieces of new information above and beyond what you’ve been taught from some of the other scenarios, but hopefully it gets you thinking about some additional steps you can take in the event of a non-gunshot, MVA, or similar wound we have described previously.
Build a foundation, then continue to add pieces to that foundation!
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