Wednesday, May 2, 2018

First Aid - Intro and Overview

Hour 3

First aid is just that: you're the first person to find or get to someone who's injured or ill.

It's the first thing I'd teach, because the person you're most likely to treat, for your entire life, is yourself. The military cleverly calls this "self aid".

And if everyone knows what to do, anyone can render first aid to others properly as well.
That would comprise "buddy aid".
As the manual states, "know what to do, know what not to do, and know when to seek (higher) medical assistance".

I'd even go as far as making the new guys the medics. You get a 100% training rate for basic medically qualified personnel, it gives you a chance to see and evaluate how trainable they are, and in any group, anyone too selfish to look out for others is probably not someone you want working their way up the totem pole to more important positions. They also have the backstop of knowing that everyone with more training/seniority can assist them adequately, so no one gets left with no help. (And Murphy being a capricious bastard, if you have only one designated medic, guess who will be the first casualty when it matters most?)

Nobody wants to be Private Wade in Saving Private Ryan, listening to a bunch of your knucklehead buddies say "Tell us how to fix you!", and having to teach first aid while you're bleeding out. Solution: everyone starts with medical training, and the basic entry position on the team is medic.

"Warrior Skills", from the Level 1 Soldier's Manual of Common Tasks,  cover everything with seventeen specific tasks (+13 preventative measures all slammed together under one topic). It gets abbreviated even more, down to
Start the Breathing
Stop The Bleeding
Protect The Wound
Treat For Shock.
Which still covers the ground, but pretty thin.

I've already recommended (oh, a few dozen times) that anybody worried about tough times, even if we're just talking about a local or regional disaster, should get first aid certification up to the level of basic EMT. And you should. FTR, that will be exactly 5x the amount of time I'd devote to covering it in a two-week initial training period, and the 20 hours I'd spend are about 3-4X what the .mil spends teaching it to new recruits. (I'd like a little more meat on the bones, is why. Especially because I don't expect you'll be using this with a school-trained medical specialist or hospital corpsman or three handy, nor have ready access to medevac after a quick nine-line casualty report, with first-world care just one Blackhawk ride away. So I want team members to all be trained for the longer haul, to a higher basic standard, and able to dig in on extended field care, quite possibly in an actual or functional third world situation.)

Break out the field manual on First Aid, and read the first section.
It's a very brief thirteen pages.
They manage to cover the anatomy and physiology for basic first aid in four of them.

After that, we'll cover the next module.


Anonymous said...

I think you should include the excellent piece on bandaging you published here some months ago. I printed them out and they are part of our curriculum.

Stu Clark said...

Taking EMR now and EMT-B in the fall.

Just because...

Anonymous said...

Mentioning wilderness first aid and wilderness first responded (2 days or 8 days training, respectively). Good classes by either SOLO or NOLS, my preference is for the SOLO versions. Learning the mindset of taking care of your own is a jump for a lot of folks to make. You'll find your 'game face' in these classes.

Aesop said...

1) When I get to bandaging, I will. ;)

2) By no strange coincidence, Big Green makes the NREMT standard their go-to basic medic's course. Then they add TCCC, etc., and then voila!, you're a 68W.
IMHO, for a small group without an entire Army infrastructure to rely on, everyone needs to be at least a 68W/HM equivalent.

3) Wilderness first aid is great, and largely what I'm aiming at. So too is the military training pipeline for all recruits. You're talking about dealing with trauma and illness in diverse places, where 9-1-1 may well be the guy with the aid bag, for some days, or forever.

Anywhere with 200 miles of the Gulf, and especially in NOLA after Katrina was wilderness for some good amount of time. So was L.A. for two weeks after the Northridge Quake.
BTDT, got the T-shirt.

I'd start everyone with a two-day class, and then pile on additional modules and field training over the next year.

(E.g., you're doing two weeks' group/unit training in summer?
Every day, every squad will have a designated casualty. Sniper. Snake bite. Heat stroke. Broken ankle. Whatever.
Some days it will be the biggest guy. Some days it will be the senior medic. Or one of the guys in charge. Then it's a leadership problem as well as a medical emergency. The other medics, and their squad-mates, are going to have various scenarios thrown at them at random times, and have to react to them. You could do them in 20 minutes, or make them last all day.
I'd make them PITA-evil, so they'll learn, but anyone can do the same thing on a family camping or fishing trip, or just driving in a car.
"The car blows a tire, daddy is unconscious, and mom has a broken leg. The cell phone doesn't work. It's 3AM, and there's no traffic around. Now what would you do, kids?"
If your kids or friends can't get into that instead of watching movies on DVDs in the car from time to time, probably better to just feed them to pigs now.

And if I'd known then what I know now, I'd have been throwing problems like that at my guys every day we were in the field.

Every platoon should have a training NCO whose job in the field is to be the Angel Of Death.

"It's 0800.
Second Squad, your Squad leader, Sgt. Tiny, all 300 pounds of him, just stepped on a land mine and blew off both his feet. Cpl. Smuckatelli is now leading the squad all day, and the medic and the rest of you will be graded on how well you take care of him all day until Taps is sounded. You will assist the medic, treat the casualty's injuries, monitor his condition, carry him to all evolutions, feed and hydrate him, and deal with when he has to poo and pee. Because of the tactical situation, no medevac will be possible until 2200. If he dies, you fail, and you will receive two additional casualties tomorrow, and dig a tank trap with e-tools in the morning.
He's down.
Go to it."

The Gray Man said...

My "next level" FAK. It's not paramedic level but it's head and shoulders above the crap you'll find for sale as a kit around town. Assembled myself, pics included, would love to know what you think. I'm off of the trauma/surgical floor and into the ER now, but you've been in one longer than me.

Aesop said...

Personal preference, but I'd leave out the suture material, and the IV gear.
With IVs, if I needed it, I'd need a lot more, and if I didn't, it's just dead weight.
With sutures, you need one of everything in 20 different types, sterile prep gear, etc., and then potentially Abx, which just turns into a clown car of problems.

If 9-1-1 is possible, let them do stitches.
If it's not, I want a full clinic with all the trimmings (even if it's the home version), not one lone 3-0 silk spool.

Both of them also run you afoul of certain douchebadges who deem themselves medical authorities on what you're allowed to have, solely by virtue of the intense medical knowledge conferred by their gun, handcuffs, and six hours of first aid training at the police academy 27 years ago. Ask me how I know.

But that's me.

Other than those quibbles, it's a solid kit for 98% of everything you'll ever see in your life, for >95% f the population.

The Gray Man said...

I had the same thoughts as you, like "well damn, if I'm running IV fluids for a volume expander, then they need a hospital", which brought me back to the original purpose (I should have included before). It's best described by what I saw Sam Culper write on a rough diagram, basically periodic and intermittent suspension of services and systems. I'm out in BFE a lot more often than I used to be, and I live here now. I'm hoping this bag might keep our heads above water during one of those possible upcoming suspensions of services. In a full fledged failure of civility, I expect it to be used up at the start.

The Gray Man said...

With that said... You mention a "full Clinic, home version". Interesting. Have you made a post on that?