Tactical Treatment of Gunshot Wounds Course in Boone County, IN July 19, 2008

[rhino]

It was a pleasure getting to assist the class today (well, yesterday). I'm sorry I had to leave early, because the practical exercise at the end when you put it all together is one of the best parts of the class.

As usual, Doc Gunn did a great job with the able assistance of Glock21. I've been present for the class a few times now, and each time I learn something new.

If and when you guys need a refresher on the application of the IBD, your CD-ROM has demos, as does the web site of the distributor.

Last year was the first brief exposure to the intraosseus infusion device, and this year it was a more significant part of the class. Did any of you stay after the class was over to play with the thing any more? It's a really neat idea, not just for simplifying introduction of blood volume expanding fluids for those who lack the skills to do IV administrations, but it's also good for people whose condition or physiology makes a standard IV either difficult or impossible.

In the past, I've heard some minor critcisms of the shooting part of the class, but in each case it was from someone who missed the point (or at least that is my opinion). The brief drills do a great job of illustrating how vital accruracy is for brain stem shot, but they also help to reinforce how important it is to be able to deliver that one, nearly perfect shot on demand. In any kind of deadly force altercation, you may only get one shot to solve the problem, and you won't have time to "warm-up" with a few dozen rounds.

One of the students mentioned to me that when his small training group gets together, they only try "head shots" after they have "warmed-up" a little with other shooting drills. He told me he would start doing some precision shooting as their first shots from the holster.

[shooter521]

Originally Posted by rhino

Last year was the first brief exposure to the intraosseus infusion device, and this year it was a more significant part of the class. Did any of you stay after the class was over to play with the thing any more?

I think everybody got their rotation in during the bit of down-time we had in the afternoon. While it's a neat device and I understand the application for which it was designed, I would just as soon have not covered it at all because that application is so specialized. Like I said to Doc at the time - even if I had this cool gadget that let me start a line, I wouldn't have anything to hook up to it...

In the past, I've heard some minor critcisms of the shooting part of the class, but in each case it was from someone who missed the point

My only criticism is that we didn't do enough of it. The course overview called for 250 rounds, and I shot maybe half that. I would've liked to spend a bit more time on the "zipper drill" (which was new to me, and I like it). Running the final exercise twice also would've been great - once with the instructors coaching us through like they did, and once on our own with no (or at least minimal) guidance and a critique afterward (if you take a "test" with the professor whispering the answers in your ear, what are you really learning? ). And we certainly would've had time to do one or maybe both of those things, since we wrapped up more than half an hour early.

[Glock21]

First, thanks to everyone who came - great group! Every one a serious student!

Rhino - (thanks for the help!) - you make a perfect point with what Doc was trying to do with the brainstem shot. It is ALL about what you can do out of the holster cold. Any one claiming a need for warm up time is fooling themselves - it has to be right the first time! Too many of us go to classes with a subliminal (or right out front) desire to show off how well we can shoot, and to engage in some sort of unspoken competition with the others in the class. That should never be our goal! Our goal should be to learn, and the first step towards knowledge is repentance - we must repent of our old ways before we can move forward.

I think too many courses out there don't do enough to challenge the core beliefs and habits of the students. Of course, I'm not suggesting that some things aren't constants, nor am I saying that it's not ok to introduce different ideas which may only work for some students and not for others. I like the idea of throwing things out there that make the students think, and force them to choose something. Sometimes that's just how they perform a reload, and sometimes that's how they view the world, lol. A lack of "warm up" is a direct challenge to how the students view the world. Some will understand it as truth, other will not see it as such without explaination. And if we do our job, they all leave understanding that there is no warm up on the street, and that they understand exactly what their level of talent is should they have to make a brainstem shot on the way home after class.

And with that, you'll notice that Doc did it cold - correctly - first, as a demonstration. Very few instructors shoot in front of their students, and that is something that Farnam has beat into every one of us over the years. We all shoot in front of the students, and the lead instructor demonstrates every drill. Not because we're super shooters, many of us pitch shots on a regular basis. But students will forgive us for pitching shots, what they won't forgive is cowardice.

And perhaps an explaination of the minimal amount of shooting: Doc is a medical expert more than he is a shooting instructor, though he's great at both. Farnam is an expert a shooting instruction (and can give better than the basics of the medical side, as well.) So when they teach the TACMED together, you'll get more shooting with John there. When Doc teaches it alone, he sticks more to the knowledge he is a specialist at. That's just the nature of that beast.

All that being said, that is the first class I was ever at that we didn't run the drills at least twice at the end, and I really think that was due to Doc being worn out. The humidity and his allergies seemed to be getting the best of him, but I didn't ask him about it, it's just my guess. He seemed to be moving very slow after class.

Also with that, believe it or not, it was the cleanest set of first runs I'd ever seen any class do. Everybody got the point and the motions, so perhaps he didn't see the need for any more practice. Again, just a guess.

At any rate, it was a pleasure to meet everyone, and my applogies for not being a bit more animated yesterday. I was up at 5am to drive down and was working on a 5-hour-a-night average of sleep for the week. It sure was great to sleep in this morning!

Thanks again to all - I was an honor to be there!!!

[rhino]

Frank, do you think it makes sense to have a different description of the class when Doc G teaches it solo to reflect the lower round count? Of course, ammunition requirements are always the maxium you'd expect. I know in Louis A's classes we never shoot close to what is specified, but that's okay.

[Glock21]

Originally Posted by rhino

Frank, do you think it makes sense to have a different description of the class when Doc G teaches it solo to reflect the lower round count? Of course, ammunition requirements are always the maxium you'd expect. I know in Louis A's classes we never shoot close to what is specified, but that's okay.

I'm pretty sure this is the first time I've ever had this discussion, lol.

Maybe I just look at it different. If I'm going to a class I just bring "enough" ammo. And I don't count up what I shoot as opposed to what anyone said to bring. I really don't care about how much I shoot, I care about what I learn.

The number thrown out by any school is just a benchmark to make sure that everyone has enough. Weather, student number, student questions and performance, as well as how aggressive any given student shoots, all play a part in how many rounds are fired.

Also, just about every instructor I've spoken with is reducing the round counts of their classes due to ammunition costs.

As far as the Tacmed goes, it's not a shooting class. The drills demonstrated are intended to teach a concept, the operators may then practice them when they will. It's meant to give you ideas for your own training. Of course, as you may remember, we ran all the drills multiple times last year - my memory is slowly coming back of Saturday's class, and there were a couple of guys who were pressuring Doc on an afternoon break to get them out of there asap, as they had "long drives." Maybe that was part of it, as well.

And even if John was there, I doubt more than 175 would have been fired. He may have added one other drill, or ran the others a couple of more times, but that's about it. But here's what I don't understand - everyone there was a decent if not really good shooter. Sure, we could spend time shooting, but to what ends? Now if it were me, and this is just me, I would want to take advantage of the information available, and Doc showing and explaining was the best way to do that. Heck, if it were me, I'd want to spend more time using the needles and bandages, I can shoot anytime, but I can't practice medical procedures with a trauma surgeon standing there with me when I get home.

My goal was that everyone understood: clear the airway, stop the bleeding, needle the tension pneumothorax. And I believe that goal was realized!

And everyone please try to remember, I don't speak for Doc, and I know no more about his goals and motives than you do. If you have a questions or there is something you'd like to bring up with him, I suggest that he be contacted directly, as all I can do is speculate, and that will probably do more harm than good.

[shooter521]

Originally Posted by Glock21

there were a couple of guys who were pressuring Doc on an afternoon break to get them out of there asap, as they had "long drives." Maybe that was part of it, as well.

The course overview said it would run 9:00 to 5:00, and IMO they should've been prepared for that. I hate to think that the rest of us might have missed out on some additional instruction because a couple guys whined.

But here's what I don't understand - everyone there was a decent if not really good shooter. Sure, we could spend time shooting, but to what ends?

Well, like I said, the zipper drill was new to me, and I would've liked another run at it just to get the practice in with instructors critiquing. And running the final exercise again would've allowed us additional practice at the med skills, teamwork AND shooting.

My goal was that everyone understood: clear the airway, stop the bleeding, needle the tension pneumothorax. And I believe that goal was realized!

Speaking to those points - I would've liked some actual practice working with the nasopharyngeal airway (can that be accurately replicated on something other than a live victim?), as well as self-application of the IBD (DVDs are nice, but I'm a "learn by doing" kinda guy).

I'm just trying to offer some feedback and constructive criticism here; please take it as such. I will certainly Email Doc with my thoughts, as well.

[rhino]

Originally Posted by Glock21

I'm pretty sure this is the first time I've ever had this discussion, lol.

Maybe I just look at it different. If I'm going to a class I just bring "enough" ammo. And I don't count up what I shoot as opposed to what anyone said to bring. I really don't care about how much I shoot, I care about what I learn.

Agreed 100%. I'm to the point now when an instructor brags about how many rounds will be fired (or were fired) that I want to jab a shard of broken glass into my neck to make it stop. Of course, that will give me an opportunity to use an IBD on a neck wound . . . which I know how to do!

I suppose I asked my question because I know that many (perhaps too many) people judge classes by the number of rounds they fire.

[Barry in IN]

I guess I only have two complaints, and taking care of one might fix the other. They have already been mentioned.
I'd like less bone gun and more airway clearing.

I've always heard airway clearing was the #1 priority, and it's listed first in the handout. When he talked about the cannula as it was being passed around, I thought we were just getting a quick overview of everything and would come back to it sometime.
I didn't know that would be it for the cannula.
I honestly forgot about it with the other stuff we covered, so never thought to ask about it later.

But that bone gun kept showing up.
While the B.I.G. is a nifty tool, and I can sure see that it's lot quicker/easier than starting an IV even if you knew how...I agree with Shooter 521- Why would I use one if I didn't have a bag to connect?
I understand the "what if" scenario of having access to an abandoned hospital, but overall- me having access to a bag of IV fluids will be a rare occurance. Having access at the same time I need them will be even more rare.
But every time I turned around, there was that bone gun.

Since we finished early, I wish we had talked more about clearing airways. But I sure didn't think about it. And if Doc was feeling ill, I can see why he wouldn't.
That bone gun was snapping away though.

I gave no thought to the round count. While a key part, that wasn't what the course was about. I knew what the course called for, and followed my usual habit of bring 2X that amount.
Had I been asked beforehand, I might have guessed we would fire maybe 20 rounds, but I brought plenty. I don't mind hauling it in, I don't mind hauling it out, and I don't mind shooting it up.

The same goes for the amount of shooting. I think we got the drift. If there was some other twists to be added, then yes, it might help, but I think we understood the basics of what we were doing.
But I was partnered with Trunk Monkey, so I would be expected to call "no mas".

I was surprised at the number of people who stopped when "shot" with the socks. He led us to believe it would happen, and it did, but I was still surprised.
I guess we are conditioned to stop for safety reasons whenever someone gets our attention on the range.

People really didn't ask to be accomodated because they had to leave, did they? I consider myself to be quite a jerk, but would never do that.

Don't misinterpret my two complaints. I liked the class, and got a lot from it.
I know a LOT more than I did before.
There was a lot of information conveyed in the time spent. I would recommend it to others (and am doing that).

[rhino]

Originally Posted by Barry in IN

I guess I only have two complaints, and taking care of one might fix the other. They have already been mentioned.
I'd like less bone gun and more airway clearing.

I've always heard airway clearing was the #1 priority, and it's listed first in the handout. When he talked about the cannula as it was being passed around, I thought we were just getting a quick overview of everything and would come back to it sometime.
I didn't know that would be it for the cannula.
I honestly forgot about it with the other stuff we covered, so never thought to ask about it later.

I always have more and different questions each time I'm present for the class. Don't be shy! I don't think Doc would mind a "show me how to use that" question at that point in time, but I understand how your questions can get lost in your brain when you're trying to process all of the other information.

As far as the nasopharyngeal airway goes, it's about as simple as you can get. You just push it in their nose and leave it there until someone who knows more about you (or the person themself) takes it out. I think the key information with them was to know when to use it (i.e. any time the person can't stop you from inserting it, do it).

Doc has been more explicit about clearing airways in the past, though. He's discussed thing like using your fingers to reach inside the victim's mouth and "scoop" any foreign matter in there like teeth or bone fragments.

[Barry in IN]

Ya know, you're right. He did go over that with the cannula.
It was early in the class and short (if there isn't much to it, there isn't much to it).
But with this being new to me, I remember things according to how much they are stressed. The fact the nasopharyngenal airway came around once early on with only a quick mention now and then during the day; yet the bone gun came up early, often, and never for less than a few minutes...Well, it put them in the wrong perspective to each other for me.
Not that it made me think the airway was of little import, but maybe that it seemed to elevate the bone gun too much.

Tell a new shooter that trigger control is everything, then spend much of the day talking about a new sight that came out, and they will probably come home thinking about the sight.