On Sunday November 12, 2017, I took a one day Trauma 101 Medical Class with Atomic Legion. This was the first time I’ve dipped my big toe into the waters of traumatic wound care, and I went in with a healthy dose of trepidation not knowing exactly what to expect. The course description provides a rather lengthy list of skills that will be covered including Crisis Mindset and Leadership mentalities. Justin Hurzeler, the instructor is an EMT-P field paramedic, officer, and trainer for a municipal EMS system in central Texas. He is a NAEMT-certified instructor in the fields of Tactical Combat Casualty Care and Pre-hospital Trauma Life Support, among other subjects, and has taught over 1000 hours of medical curricula to emergency service professionals and civilians alike.
I signed up for this class with the intent of getting a handle on how to deal with the most time sensitive of traumatic care. My family and I like to travel well off the beaten path as overland enthusiasts. It’s not uncommon for us to set up camp thirty or more miles from the nearest paved road. While my wife and I have spent many hours learning how to defend ourselves, neither of us had previously put time into learning valuable life saving skills. My goal with this class was to start myself on the path to correcting that.
As the class started we did student introductions. The majority of the students are outdoor adventure types, and similarly recognize the value in being your own first responder. One of the students explained that every couple of years he takes another class like this as a refresher.
Justin then got into the class. He started with Scene Safety, explaining that going into an unsafe scene and becoming an additional trauma victim not only doesn’t help anyone, it actively harms the other victims by taking resources away from them to also deal with your injuries. Next Justin provided us details on how to contact Emergency Services. Details were provided on how best to talk to 911, what kinds of information they need, and how best to render aid while communicating with the dispatcher. The discussion then shifted toward Legality and consent. The Texas Good Samaritan Act was mentioned. One of our students was a Criminal Defense Attorney which offered an interesting additional perspective.
Then the real fun started. Justin explained that there are several acronyms used to help with rendering trauma aid. MARCH is one of them, but in this class we focused on the much simpler CAB which hits the big three immediate care items. Circulation, Airway, and Breathing (In order of importance.) We were shown how to take a pulse from each extremity, in addition to checking pulse at the carotid artery. Knowing how to check a patient’s pulse on their leg for instance becomes important once you apply a tourniquet to their leg. To avoid causing compartment syndrome it’s important to ensure that all blood flow into the limb is stopped, otherwise that blood will pool in the limb causing significant complications. Life threatening Hemorrhage must be addressed immediately. We discussed the various commercial Tourniquets available today, their advantages and disadvantages. The SWAT-T, and CAT were the clear favorites, as they are effective and combat proven life savers. I also found the CAT to be the easiest to apply to my arm one handed. We discussed checking for a pulse after applying a tourniquet, and if blood is still flowing you apply a second, or a third, or maybe even a fourth. Justin explained that while working if he puts a Tourniquet on a thigh, he almost always puts a second one on right away as legs regularly require more than one.
While still on the topic of Circulation we talked about packing wounds in distal areas. We practiced this using a pork shoulder with the bone in, and an IV to simulate a blood vessel. This was a technique I had never performed, and found it a lot more challenging than I expected it to be. I might have to practice this more on my own the next time we have a roast prior to cooking it.
We moved on to airway management. Justin explained how snoring respiration is an indication of a partially obstructed airway. We talked about how to tilt the head back, and move the jaw forward to help relieve this, but how that also ties your hands up. He then demonstrated how to install a Nasopharyngeal Airway (NPA, or Nose Hose) by putting one in his own nose. We talked about how unconscious patients benefit from being put in “The Recovery Position” as this helps fluids to leave the mouth rather than become airway obstructions.
Finally we talked about breathing. Specifically sucking chest wounds and what we as non-paramedics can do to help. We talked about commercial chest seals, like the HyFin, or Halo but also talked about how to improvise a chest seal. Justin didn’t want to discuss using chest darts, but mentioned that if breathing becomes labored you can and should “burp” the chest seal by lifting a corner. This should release some of the pressure building up in the chest outside the lungs.
We covered so much in the 8 hour class that I couldn’t hope to capture it all. It feels like I didn’t hardly scratch the surface of immediate life saving medical skills, however Justin assures me that a large percentage of things that will lead to end of life, before higher level care can arrive were covered in great detail. I guess that’s the real lesson. What I learned in this class is enough to hopefully sustain someone’s life until a higher level medical professional can take over for me.
I’d highly recommend this class to anyone who does anything rugged outside. Whether that’s offroading in the hill country of Texas, Hiking in the mountains of Colorado, or shooting on the range on the weekends. Medical skills are useful in so many unexpected situations. One of my friends was the first to arrive at an accident on the highway. The driver had sustained a piercing wound through his upper arm and my friend was able to apply a Tourniquet to the arm preventing the driver from bleeding to death. The Paramedics said he saved the man’s life. We should all aspire to be able to save someone’s life. Who knows, it might be your own.