Another good review from my friend and fellow instructor, Chris Upchurch. I will be taking this class May5-6, in Logan Ohio.
TMCO May 5-6, 2012
Saturday
Saturday dawned cool and wet. As I made the drive from my hotel to the range, it rained off and on, something that would continue throughout the day. We spent a lot of the class with everyone crowded under Don's portable awning, but you can't run an entire class from there, particularly a FoF focused class like this one. John did his best to time it so we did lecture when the rain was hardest and went out to shoot during the breaks, but it rained enough that everybody got a bit wet, despite their rain gear.
We started out with some lecture from John, laying down the background and context of the class. He talked about the development of emergency medicine, including it's battlefield roots from World War I to the present, and how the Battle of Mogadishu (a.k.a. Black Hawk Down) led to the concept of Tactical Combat Casualty Care (TCCC) which forms the basis for what we'd be learning in this class. They key is to integrate the tactical and medical interventions and perform the appropriate intervention at the appropriate time.
Most first aid classes teach that initial should be guided by the mnemonic 'A.B.C.' for Airway, Breathing, Circulation. In a world where choking, seizures, electrocution, and heart attacks are more common than penetrating trauma, this is perfectly appropriate. After a gunfight, however, it doesn't make sense to look for a piece of underchewed steak lodged in someone's throat before dealing with their spurting femoral artery. Instead, John teaches the acronym M.A.R.C.H. for Massive hemorrhage, Airway, Respiration, Circulation, and Head injury/Hypothermia. The majority of people who die from gunshot wounds expire from blood loss, so that needs to be our first priority.
With the groundwork laid, John split the students into two groups. Don and I took half the class and ran through basic force-on-force exercises while John covered the fundamentals of hemorrhage control. So while he went through tourniquets, wound packing, and pressure dressings, Don and I covered getting off the X and shooting on the move. Since there were an odd number of students in each group, I stepped in to provide a force-on-force partner for the odd man (or woman) out. As usual for this sort of thing, I acquired a fairly good case of Glock pox, but we got everyone up to speed on the FoF stuff.
After breaking for lunch, John resumed with some more advanced tourniquet topics. During the morning session he talked about the tourniquets he recommends (the C.A.T., SOFT-T, and Cav Arms Slick Tourniquet), now he talked about the two common ones he specifically doesn't recommend: the SWAT Tourniquet and the TK-4. Both of these are simply not very effective at constricting the limb enough to cut off blood flow to the wound. He also showed off a ratcheting tourniquet that basically works like a ratcheting tie-down strap you might use to hold a load on a truck. In fact, John said that a tie down strap from Home Depot cut to a reasonable length would work just as well as the $60 medical version.
We also discussed improvised tourniquets. When John asked the students what they'd use to improvise a tourniquet, the universal response was a belt. However, as he demonstrated a belt makes a lousy tourniquet, largely because they tend to be too stiff. Gunbelts, being even stiffer, tend to be even worse. His preferred material for an improvised tourniquet is some sort of large piece of cloth that you can roll or fold. For demonstration purposes he used a cravat (a large triangular piece of cloth) but just about anything you could tie securely around the limb would work: a t-shirt, a pant leg, etc. To tighten it down, John prefers a carabiner. He carries his keys on one for just this purpose (as do I, at least since the TMCO class last fall). The key is to get a real climbing carabiner, not one of those little keyring ones they sell next to the registers at Walmart. Those just aren't strong enough to tighten it down properly.
With the lecture done for the day, it was time to brave the rain and continue with the FoF drills. We went through the standard S.I. after action assessment routine and made sure everyone was up to speed on it. The after action assessment we teach in every class always includes checking yourself for injuries, but in this class it's time to actually do something about any injuries you find. We spent the rest of the afternoon running various FoF scenarios. One student would be designated as the 'bad guy' and try to mug the other student. They'd go at it with airsoft and after the initial exchange, John would call out an injured body part and they'd have to apply a tourniquet to it. We began with some simple one on one scenarios, and after everyone was pretty comfortable with that we tried two on one, one on two, and other variations. The scenarios that put the good guy with a unarmed companion inspired some good discussion of how to talk to your family about this stuff and what tactics are appropriate.
We kept this up until about 4 o'clock. By that time everyone was pretty worn down from the cold and wet, so John called it a day. We'd covered a lot very quickly thanks to the smaller class size.
After going back to the hotel and drying off and warming up, several of us got together for dinner at a local eatery. As usual with this sort of thing the conversation and the fellowship was great and a good time was had by all.
Sunday
Thankfully, Sunday dawned sunny and clear, and stayed that way. Not a cloud in the sky and not one drop of rain. It was still cool, but without the incessant rain that we had yesterday, the temperature was nice, rather than miserable.
We began the morning with a discussion of two things that are commonly taught in first aid classes that just aren't very applicable in a tactical setting: CPR and concern for spinal injuries. If someone's heart as stopped due to loss of blood, CPR is inappropriate. Pounding on their chest isn't going to fix the blood loss and in a tactical situation it may be actively harmful by tying you to one position and distracting you from possible threats. First aid courses often caution against moving anyone with 'trauma' for fear of exacerbating a spinal injury. If someone has just been in a car accident or fallen off a building this makes a certain amount of sense, since a spinal injury is a realistic possibility. If the trauma they're suffering is a gunshot wound to the leg, however, it's not going to magically cause a spinal injury. Again, mindlessly adhering to basic first aid in a tactical situation and not moving them may leave them (and you) in an exposed position when you could be behind cover.
Next up was a discussion of splinting injuries. John showed off the SAM splint and talked about improvised splinting options. After using a couple of dummies for the splinting demonstrations, we talked about how to pick up and move patients, using the dummies for the exercises. Moving an unconscious person is harder than it looks, especially by yourself. There's definitely a technique to it, and doing it correctly is makes it less difficult (though by no means easy).
Last up for this morning was airway management. John talked about various types of airway obstructions and how to deal with them using body positioning, positioning the jaw, and a nasopharyngeal airway. I was again struck by how simple using the NPA was. At this point, we broke for lunch.
After lunch, to refresh everyone's memory from yesterday, we played 'tourniquet twister'. John called out a body part and the students had to apply a tourniquet. We repeated this and passed around different tourniquets until everyone had a chance to try each of them.
Just because you get shot doesn't mean the fight is over, so we did some dry practice on how to keep the gun running after you've been injured. We worked on one-handed reloads, passing the gun from an injured hand to an uninjured one, and shooting while lying on the ground.
Moving on to the live fire portion of the class, we started out with some basic draw and shoot drills, then gradually incorporated after action drills and tourniquet application. Students first had to apply the tourniquet to themselves, then to a dummy representing a loved one who was injured during the fight. We spent the rest of the afternoon running through these drills in various permutations, giving everyone lots of repetitions.
With this, we wrapped things up. John handed out the certificates and everyone packed up to leave. I helped John get loaded up and got a lesson in how truly difficult it can be to manhandle an unconscious person when I helped get one of the dummies into his back seat (a process that wasn't helped by the compact car the dealership had loaned him while his SUV was in the shop).
Conclusion
As usual, a great class from John Meade. Don Robison did good work supporting him and I'm proud of whatever I could contribute as well. The knowledge and skills taught in this class are absolutely vital to anyone who carries a gun for self-defense (or spends a lot of time on shooting ranges). We've got a lot of TMCO classes coming up all around the country.
TMCO May 5-6, 2012
This week is spring break for the university where I teach, and what could be more enjoyable than hanging out at an S.I. class? I came down to Crestview, Florida for the Trauma Medicine for the CCW Operator taught by Dr. John Meade and Don Robison. John was kind enough to let me sit in on the class and 'assist'. In return, I got another chance to absorb this vital, life-saving information. I took the class last October in Blairsville, but this stuff is important enough that it definitely bears repeating.
Saturday
Saturday dawned cool and wet. As I made the drive from my hotel to the range, it rained off and on, something that would continue throughout the day. We spent a lot of the class with everyone crowded under Don's portable awning, but you can't run an entire class from there, particularly a FoF focused class like this one. John did his best to time it so we did lecture when the rain was hardest and went out to shoot during the breaks, but it rained enough that everybody got a bit wet, despite their rain gear.
We started out with some lecture from John, laying down the background and context of the class. He talked about the development of emergency medicine, including it's battlefield roots from World War I to the present, and how the Battle of Mogadishu (a.k.a. Black Hawk Down) led to the concept of Tactical Combat Casualty Care (TCCC) which forms the basis for what we'd be learning in this class. They key is to integrate the tactical and medical interventions and perform the appropriate intervention at the appropriate time.
Most first aid classes teach that initial should be guided by the mnemonic 'A.B.C.' for Airway, Breathing, Circulation. In a world where choking, seizures, electrocution, and heart attacks are more common than penetrating trauma, this is perfectly appropriate. After a gunfight, however, it doesn't make sense to look for a piece of underchewed steak lodged in someone's throat before dealing with their spurting femoral artery. Instead, John teaches the acronym M.A.R.C.H. for Massive hemorrhage, Airway, Respiration, Circulation, and Head injury/Hypothermia. The majority of people who die from gunshot wounds expire from blood loss, so that needs to be our first priority.
With the groundwork laid, John split the students into two groups. Don and I took half the class and ran through basic force-on-force exercises while John covered the fundamentals of hemorrhage control. So while he went through tourniquets, wound packing, and pressure dressings, Don and I covered getting off the X and shooting on the move. Since there were an odd number of students in each group, I stepped in to provide a force-on-force partner for the odd man (or woman) out. As usual for this sort of thing, I acquired a fairly good case of Glock pox, but we got everyone up to speed on the FoF stuff.
After breaking for lunch, John resumed with some more advanced tourniquet topics. During the morning session he talked about the tourniquets he recommends (the C.A.T., SOFT-T, and Cav Arms Slick Tourniquet), now he talked about the two common ones he specifically doesn't recommend: the SWAT Tourniquet and the TK-4. Both of these are simply not very effective at constricting the limb enough to cut off blood flow to the wound. He also showed off a ratcheting tourniquet that basically works like a ratcheting tie-down strap you might use to hold a load on a truck. In fact, John said that a tie down strap from Home Depot cut to a reasonable length would work just as well as the $60 medical version.
We also discussed improvised tourniquets. When John asked the students what they'd use to improvise a tourniquet, the universal response was a belt. However, as he demonstrated a belt makes a lousy tourniquet, largely because they tend to be too stiff. Gunbelts, being even stiffer, tend to be even worse. His preferred material for an improvised tourniquet is some sort of large piece of cloth that you can roll or fold. For demonstration purposes he used a cravat (a large triangular piece of cloth) but just about anything you could tie securely around the limb would work: a t-shirt, a pant leg, etc. To tighten it down, John prefers a carabiner. He carries his keys on one for just this purpose (as do I, at least since the TMCO class last fall). The key is to get a real climbing carabiner, not one of those little keyring ones they sell next to the registers at Walmart. Those just aren't strong enough to tighten it down properly.
With the lecture done for the day, it was time to brave the rain and continue with the FoF drills. We went through the standard S.I. after action assessment routine and made sure everyone was up to speed on it. The after action assessment we teach in every class always includes checking yourself for injuries, but in this class it's time to actually do something about any injuries you find. We spent the rest of the afternoon running various FoF scenarios. One student would be designated as the 'bad guy' and try to mug the other student. They'd go at it with airsoft and after the initial exchange, John would call out an injured body part and they'd have to apply a tourniquet to it. We began with some simple one on one scenarios, and after everyone was pretty comfortable with that we tried two on one, one on two, and other variations. The scenarios that put the good guy with a unarmed companion inspired some good discussion of how to talk to your family about this stuff and what tactics are appropriate.
We kept this up until about 4 o'clock. By that time everyone was pretty worn down from the cold and wet, so John called it a day. We'd covered a lot very quickly thanks to the smaller class size.
After going back to the hotel and drying off and warming up, several of us got together for dinner at a local eatery. As usual with this sort of thing the conversation and the fellowship was great and a good time was had by all.
Sunday
Thankfully, Sunday dawned sunny and clear, and stayed that way. Not a cloud in the sky and not one drop of rain. It was still cool, but without the incessant rain that we had yesterday, the temperature was nice, rather than miserable.
We began the morning with a discussion of two things that are commonly taught in first aid classes that just aren't very applicable in a tactical setting: CPR and concern for spinal injuries. If someone's heart as stopped due to loss of blood, CPR is inappropriate. Pounding on their chest isn't going to fix the blood loss and in a tactical situation it may be actively harmful by tying you to one position and distracting you from possible threats. First aid courses often caution against moving anyone with 'trauma' for fear of exacerbating a spinal injury. If someone has just been in a car accident or fallen off a building this makes a certain amount of sense, since a spinal injury is a realistic possibility. If the trauma they're suffering is a gunshot wound to the leg, however, it's not going to magically cause a spinal injury. Again, mindlessly adhering to basic first aid in a tactical situation and not moving them may leave them (and you) in an exposed position when you could be behind cover.
Next up was a discussion of splinting injuries. John showed off the SAM splint and talked about improvised splinting options. After using a couple of dummies for the splinting demonstrations, we talked about how to pick up and move patients, using the dummies for the exercises. Moving an unconscious person is harder than it looks, especially by yourself. There's definitely a technique to it, and doing it correctly is makes it less difficult (though by no means easy).
Last up for this morning was airway management. John talked about various types of airway obstructions and how to deal with them using body positioning, positioning the jaw, and a nasopharyngeal airway. I was again struck by how simple using the NPA was. At this point, we broke for lunch.
After lunch, to refresh everyone's memory from yesterday, we played 'tourniquet twister'. John called out a body part and the students had to apply a tourniquet. We repeated this and passed around different tourniquets until everyone had a chance to try each of them.
Just because you get shot doesn't mean the fight is over, so we did some dry practice on how to keep the gun running after you've been injured. We worked on one-handed reloads, passing the gun from an injured hand to an uninjured one, and shooting while lying on the ground.
Moving on to the live fire portion of the class, we started out with some basic draw and shoot drills, then gradually incorporated after action drills and tourniquet application. Students first had to apply the tourniquet to themselves, then to a dummy representing a loved one who was injured during the fight. We spent the rest of the afternoon running through these drills in various permutations, giving everyone lots of repetitions.
With this, we wrapped things up. John handed out the certificates and everyone packed up to leave. I helped John get loaded up and got a lesson in how truly difficult it can be to manhandle an unconscious person when I helped get one of the dummies into his back seat (a process that wasn't helped by the compact car the dealership had loaned him while his SUV was in the shop).
Conclusion
As usual, a great class from John Meade. Don Robison did good work supporting him and I'm proud of whatever I could contribute as well. The knowledge and skills taught in this class are absolutely vital to anyone who carries a gun for self-defense (or spends a lot of time on shooting ranges). We've got a lot of TMCO classes coming up all around the country.
