Saturday, July 7, 2012

Carry a Gun and a Bandaid

I get more inspiration and help from my Facebook (FB) friends than I do from any other source. They ask questions that not only keep me thinking and learning but also prompt me to explain some of the things I do and talk about.

I recently announced that I have been in school to become an Emergency Medical Technician (EMT). It has been something I have been interested in for a long time for many reasons. I did not go into those reasons until someone on my FB page posted this:

"What is the connection between, EMT, CCW and first aid kits? Really? Enlighten me please."

Carrying a gun and emergency medical training have two really big things in common: They are both centered around the idea of being ready for the worst case scenario and saving lives.

Now some may question how firing upon someone is "centered around saving lives" but the truth of the matter is that many violent criminals do not stop being violent until they are taken down with force. It very well may be that the only way to save your own, a loved one's or even a stranger's life is to use deadly force.

I have often said that one should put at least as much effort into learning how to save a life as they put into learning how to take one.

It's my own personal belief and philosophy and here is why:

1. You're far more likely to die of a medical complication than from a violent attack.
I'm not going to go hunting for statistics here but heart disease is still the #1 killer in America and many accidents such as drowning and falls come before shootings on the CDCs list of causes of death in America. So you got that pea-shooter strapped to your belt everywhere you go, ready to save yourself or your family in the event you get jumped by some criminal. But, at your annual Christmas get-together your father starts complaining of difficulty breathing and chest pain and suddenly slumps to the floor and stops breathing. Or, while on vacation your kid falls into a pool and upon dragging him out you realize he's not breathing. What are you going to do?

You've invested time and money and training in and with your firearm to keep your family safe from the unlikely. Yet many completely ignored preparing for the likely. The fact of the matter is, medical training is going to save more lives than firearms training in the civilian sector. And if your goal is to save lives, it makes sense to get some medical training.

2. If you get into a violent encounter to where your firearm is necessary, your medical skills and equipment could be just as instrumental in saving your life as your firearm.
Let's take any number of mass shootings as an example. You are in class or in the mall and someone starts shooting. Before you can even orient to the situation you are hit. You are able to return fire and stop the threat. But there are ten other wounded individuals around. You have no medical knowledge or training or tools available to stop your own bleeding. Medics are called but it takes fifteen minutes for them to arrive and then they are instructed to wait outside of the scene until it is secured by law enforcement. It's now been twenty minutes before medics are even allowed into the scene and once they get there they still have to triage. Another two minutes are spent triaging and by the time they get to you it has now been twenty-two minutes since you were injured.

What if you couldn't get your bleeding under control in that twenty-two minutes? What do you think your chances are of still being alive once medics got to you? On the other hand, what if you carried a pressure bandage or a tourniquet? What if you knew how to make one with tools on hand? What if your spouse was hit and has a sucking chest wound? Would you know how to treat it to keep him or her alive until medics arrive and can begin treatment?

Sure, your firearm can be instrumental in keeping you from getting wounded multiple times or more severely but sometimes you can't avoid being hurt by violence and having some skills or tools in your back pocket can be just as important as the gun and ammo in your front pocket.
Supplies for about 3 good-sized blow out bags

3. Accidents happen.
Firearms accidents happen. It is true. It is the elephant in the living room that no one likes to talk about. No one likes to admit that sometimes we gun owners make mistakes and we get hurt with our own guns. Worse, sometimes we do something stupid with them that results in injury. You don't have to look far for evidence, either. Just type, "man accidentally shoots himself" into your favorite search engine.

Of course many other accidents happen as well where some basic medical knowledge would come in handy but I'm not going to list all of those and just leave it at being a little gun-centric.

Having the knowledge, skills and tools to treat a gunshot wound when you own a gun is comparable to learning how to change a tire if you drive a car. It doesn't mean it's going to happen. It doesn't mean you want it to happen, but if it does happen you are ready for it.

This doesn't mean that everyone who carries a gun needs to be an EMT, but there are some basic training you can take and tools you can incorporate into your Every Day Carry.

I am a big believer that everyone should learn CPR, basic wound management and shock treatment. The information available for these skills is not hard to find nor is it expensive or difficult. Many firearms training facilities will have combat medicine classes available. Often times combat medicine is included in some firearms classes. If it hasn't been included in any of your training the list of written resources is vast.

Do a book search for "combat medicine," "tactical medicine," "gunshot wound care," etc and you will be overwhelmed with resources.

The term used in the gun community is "blow out bag." It's basically a first aid kit with equipment instrumental in treating more substantial traumas such as gunshot wounds.

There is no exact list of what going in a blow out bag. There are commercial blow out bags you can purchase or you can do what I've done and make your own and it can be as big or small as you want it to be. Furthermore, there are many everyday things you can use in lieu of actual medical supplies if you are caught without a blow out bag and the goodies therein.

There are many conflicting ideas of what makes a good blow out bag so I'll just throw out everything and the kitchen sink and you can decide what you would think would be useful for your own kit/bag. Everything I'm about to show you and talk about I took from my own bag that I carry with me everywhere I go, so it's not impossible to carry all of this stuff.

Nitrile (non-latex) gloves in a plastic bag
Gloves! ~ I carry a small sandwich bag filled with two or three pairs of nitrile (non-latex) exam gloves. Granted, if I were treating myself, my husband or my children I would probably not concern myself too much with isolating myself from their body fluids as I know their medical history but if I chose to treat someone else I am not going to take the chance of getting infected with something like Hepatitis or HIV. Besides, that little plastic bag can have a secondary purpose (more on that later).

81 mg chewable "baby" aspirin
Aspirin ~ I carry 81 mg chewable "baby" aspirin for two reasons: small aches and pains that do not involve bleeding and possible heart attacks. Because it is chewable it dissolves very quickly and therefore gets into the blood stream and starts working faster. For potential heart attacks, aspirin thins the blood and can keep clots from forming. Chewing 4 "baby" aspirin at the onset of chest pain upon suspecting a possible heart attack can be lifesaving. Always remember to tell responders about anything you took, including aspirin.

Obviously, you would not want to use this for anyone who has an aspirin allergy. Also, because aspirin is a blood thinner you would never want to give it to anyone experiencing blood loss no matter how much pain they are in. Just say "no" to giving aspirin to trauma victims.

Trauma (Mild to Moderate):
Artificial tears/sterile saline ~ One thing I use more often than anything else in my bag is my artificial tears/sterile saline. You can find boxes of individually packaged and wrapped containers or a multi-use bottle. I have the bottle for my house, the individual containers for my bag. Not only can you irrigate your eyes if need be but you can also do light irrigation of wounds and small burns.

Bandaids ~ I am a little bit of a bandaid freak. I carry many different sizes and types. Waterproof, large, small, finger, cartoon, if it's out there, I have it and I probably carry it with me, too. That and a little neosporin and I'm ready for any superficial scrap and mild cut life has to throw as me or my kids or anyone around me.

4x4 surgical sponges
Dressings and Bandages ~ When a bandaid isn't enough to stop bleeding or isn't big enough to cover the entirety of the wound it's time to step it up to dressings, gauze, tape and/or other bandages (Just so we get our terminology straight I'd like to point out that a dressing is what goes over the wound and a bandage is what holds the dressing in place). You can use any size of surgical sponges/gauze pads you want as a dressing and cut them to size but the preferred size seems to be 4x4 surgical sponges. They are big enough to be big but small enough to carry in mass quantities. They can be piled on top of each other, lined up, folded over, wrapped, whatever. You can also keep piling them on top of each other if bleeding doesn't stop.

Thin Cinch pressure bandage
If bleeding doesn't stop it's time to get a little more aggressive and the first step is pressure. Manual pressure is pressure you apply yourself or have someone apply with their hand or you can get or make your own pressure bandage. Any type of wrapping with some stretch to it can make a very decent pressure bandage. Ace bandages and self adhesive bandages commonly used in sports medicine are good options. But if you are pressed for space and time and/or treating yourself with one hand, you might want to go ahead and carry a pressure bandage that is already prefabricated such as an Israeli bandage or Thin Cinch. It has a sterile dressing already attached to some sort of elastic bandage.

Bandages can also be used to stabilize sprains and hold splints or injured joints in place. A good, all-purpose bandage is the triangular bandage. Not only can it be used as a bandage but as a sling and even a tourniquet.

Trauma (Moderate to Severe): 
CAT tourniquet
Tourniquet ~ If bleeding still hasn't stopped in a limb with the application of pressure then it's time to move up to a tourniquet. It is a myth that the application of a tourniquet automatically means the loss of the limb. The truth of the matter is that tourniquets save lives and limbs. The best thing to use as a tourniquet is an actual, no-foolin' tourniquet such as the Combat Action Tourniquet (CAT).

If a commercial tourniquet is not available, however, makeshift tourniquets can easily be fabricated provided you do it correctly. Always use something with a wide surface area such as a belt or a broadly folded cloth. The point is to tighten the tourniquet to the point it cuts off blood supply and applying that much pressure to something thin like a shoelace, wire or zip tie encompassing the limb will end up cutting the flesh and underlying tissue causing more trauma (which is bad).
Compressed, sterile gauze

Sterile Gauze ~ If the wound is on the body vs the limbs a tourniquet will not work. Use sterile gauze to pack wounds and soak up blood. The texture in gauze helps to promote clotting. You can buy it in sterile rolls that are not compressed but they take up more space. Compressed gauze is vacuum sealed and a lot can be found in a very small package. Gauze can also be used as a loose bandage on wounds where you do not want to apply pressure. Head and neck wounds are wounds that you want to wrap just tight enough for the dressing to stay in place. You don't want to put so much pressure on a neck wound that it cuts off blood supply to the brain. In head wounds, if there is bleeding there is a good chance of increased inter-cranial pressure (pressure building inside of the skull). A pressure bandage to the head can keep the blood building up inside the skull or shift bone fragments or fractures that results in putting undue pressure on the brain and causing brain damage. A non-pressure dressing and bandage can protect the wound and help stop the bleeding without increasing the pressure. 

QuikClot Combat Gauze
Antihemorrhagic agents ~ If bleeding on the body is arterial (bright red and spurting) and cannot be controlled with a tourniquet (because it cannot be applied) or dressings and pressure than it may be necessary to use an antihemorrhagic (hemostatic) agent such as QuikClot. There are other types of hemostatic agents out there and their use is controversial. They come in either sponges or gauze that is coated in chemicals that activate coagulation (clotting) and constrict blood vessels. They do a fine job of stopping major bleeding but they can induce allergic reactions in some people and can be difficult to remove when the time comes. They are reserved for moments when death from blood loss is imminent and the risk of allergic reaction or further trauma from the removal are secondary to loss of life. They are expensive and do not last long past their expiration date but are life-savers from massive uncontrollable blood loss.

Occlusive Dressings ~ Occlusive dressings are those that do not allow the passage of air or fluids through the dressing. There are four basic wounds where occlusive dressings are indicated: neck wounds, open chest wounds, an evisceration (a wound wherein the organs of the abdomen spill or are pressed out of the body) and burns.

Petrolatum Gauze
The neck has a lot of important stuff running through it. Large blood vessels that get nicked (the jugular, let's say) can suck in air like a vacuum hose. That air can travel to the heart or lungs and cause death. Yes, you have to stop the bleeding but in a way that air cannot enter the neck. Apply an occlusive dressing--plastic wrap, the baggie for your gloves (there's that secondary purpose), part of your gloves taped down, a pantie liner taped on all sides, anything that does not allow air to enter the wound.

Our lungs are kept inflated by negative pressure and are protected by our ribs. That being said, if a hole is created in the chest wall so that the negative pressure is compromised we may get what is called a pneumothorax (collapsed lung) and/or "sucking chest wound." In order to reestablish that negative pressure a three-sided occlusive dressing needs to be applied. The occlusive dressing keeps air from being sucked into the wound and collapsing the lung and the one way valve allows  the trapped air already built up in the cavity to escape. It will also allow for the escape of blood should it begin building in the area. You can use petrolatum gauze or that baggie for your gloves (baggies make great occlusive dressings). Apply it over the wound and apply tape on three of the four sides. Duct tape is a good tape to use in traumas.

Large occlusive dressing
An evisceration is a pretty nasty thing and not all that uncommon in knife attacks. The knife cuts the skin and the muscle and the guts that were held in by them spill or are pushed out. There are two very important things to remember when dealing with an evisceration: decreasing pressure on the abdomen (so you don't end up losing more guts) and protecting the organs that have spilled out. You protect those organs with an occlusive dressing--preferably a large occlusive dressing. The large pads you can buy for potty training pets work well. They are not sterile but they will keep your insides protected. If you do not have an occlusive dressing any dressing that is large enough will work but the organs that are normally nice and moist might start to get a little dry with the air flow of a non-occlusive dressing. Either way, it's very important to cover them up and keep them protected and provide a new barrier that they cannot escape from now that the skin is no longer doing that job. Never try to put the viscera back in the abdomen. Leave that for the surgeons. If at all possible have the victim lie down on his or her back with the feet flat on the floor and knees up. This will take pressure off of the abdomen and gravity can help keep stuff inside the body where it belongs. Apply the dressing and tape around all four corners too keep air and debris out and moisture and bodily fluids in.

In burns, occlusive dressings help keep the pain down and protect the burn from irritation. Plastic wrap is great for burns but depending on the size and severity whatever you have an hand will have to do.

Improvised tools ~  There are a number of things that can be used in a medical pinch. T-shirts torn into strips make great bandages. Feminine hygiene products such as pads are phenomenal at stopping blood and all of them are occlusive if applied correctly. Tampons can be used for gunshot wounds as they can be inserted into the wound tract or even unfolded and used as a dressing. Definitely throw a few of those into your blow out bag! Diapers are also fantastic improvised dressings. They have a large surface area and they can absorb a lot. They are semi-occlusive as well. Pads and diapers also have saturation points, keep them to show to responders so that they are made aware of how much blood the patient has lost.

Tension Pneumothorax Decompression Needle
Pneumothorax Decompression Needle ~  I'm only putting this in here because I carry one. According to some and depending on state law you need a prescription to even get one. A tension pneumothorax is a condition wherein a lung is compromised and air is now filling the chest cavity but there may or may not be external wound. These injuries are common in blast injuries. The air has nowhere to go as it cannot be exhaled and continues to build in the chest cavity until it puts pressure on the heart and the remaining (and presumably undamaged) lung. If the pressure is not relieved death will soon result. The signs of a tension pneumothorax can be hard to diagnose but major two are pain and difficulty breathing. Loss of lung sounds on the affected side and hyper-percussion are other signs but hard to diagnose without training and a stethoscope. A major but very late sign of a tension pneumothorax is tracheal deviation.

But herein lies the rub: Using a pneumothorax decompression needle is considered a surgical procedure and one can get in trouble for practicing medicine without a license. If things go wrong and you are sued (and even if they go right and you are sued) you will be hung out to dry. You must also know where to insert the needle so as not to puncture a blood vessel and cause more damage and bleeding and turn a pneumothorax into a hemopneumothorax. This needle is a tool I got and was almost afraid to put into my bag. I will do almost anything I can not to use it and will never use it on anyone but myself or an immediate family member.

Now, I'm no doctor. I'm not even an EMT yet (hopefully that will change in two weeks (wish me luck)). All the advise I've just given you on tools and wound management is as a lay person so take it at your own risk and do your own research. But I hope you can see how having a few of these tools and the knowledge and skills to use them could be instrumental in saving a life while waiting for medics to arrive or triage and transport.

Medical training and tools do go hand in hand with carrying and training with a firearm. If you haven't looked into medical training and tools for yourself, what are you waiting for?


  1. I puckered up when I saw your pneumothorax decompression needle and then breathed again when you said you'd only use it on yourself or a family member, because that's waaaaayyyyy out of scope of practice for an EMT and the Good Sam Law won't protect you if you used it.

    I've pared my kit down a lot. Pretty much I have maxi pads, tampons, Quick Clot, gloves and tape in my range bag. If I need more than that, I've got a stocked jump kit in my car. I figure that if I've got a way to control bleeding while I'm out at the range, I'm golden.

    1. You are very correct. A decompresion needle is serious business and very out of scope of practise. Here's the good thing about carrying it. Paramedics can do needle decompressions but many of them do not carry the decompression needles. I can wait rod them and hand them my

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