AAR

TD1
On October 21/22 2017 I attended the “Combatant Casualty Care – C2” put on by Talon Defense and Ditch Medicine. *I was not a paying student. I had won the slot as part of a giveaway. I was only required to pay my range and bunk fees.

COURSE DESCRIPTION
“An emerging view of a well-rounded armed individual is that he possesses the ability to press home the fight and render aggressive patient care, not only to himself, but also to those who have fallen around him. From the initial contact to a position of cover, those skill sets will be taught which will enable the individual to fight and assist the traumatized while injured. Integration of physically demanding patient intervention and live fire techniques developed by Talon Defense and recognized under the moniker of “Injured Shooter” are designed to mold the disciplines of pre-hospital trauma care and weapons manipulation into a seamless response. The medical component of this course builds upon recognized doctrines of “Care Under Fire” and “Tactical Field Care.” No prior medical training is required for this course. The firearms component requires the student to have mastered at least an intermediate level of pistol proficiency. Potential students are advised that this course is mentally and physically demanding.”

The class was held at Double Tap Training Grounds in Calera, Alabama. The facility will get a separate review.

Chase Jenkins from Talon Defense has 25 years prior Law Enforcement under his belt with much of that time having been involved in training. His teaching style was relaxed and straight forward. He used crude humor and analogies to get his points across, which made the class more enjoyable.

Hugh Coffee from Ditch Medicine got his start as a Corpsman on Noah’s Ark. Well, not quite that far back, but Hugh has been a Paramedic long enough that his license number is only three digits. He has considerable experience teaching extended field care and austere medicine. He is soft spoken and gives lectures like a Preacher delivering a sermon.

After Chase and Hugh offered a little bit about themselves each student provided a little bit about their background. Our class was small, only 5 students. Two students had virtually no medical training aside from CPR. Three of us had significant EMS backgrounds. My background includes 12 years prior LE, current Paramedic, with Basic Tactical Operational Medical Support, TCCC and TECC under my belt.

After introductions, Chase delved into the safety brief. This included his take on the Four Safety Rules, Square Range vs Reality, training scars/bad habits, red guns and Force on Force.

Our first real taste of Hugh began with a barefoot lecture in the field next to building. Hugh discussed tourniquets (TQ) at length. Indications, application process, places to check for pulses and techniques for pressure points to slow blood loss while applying TQ. Here is where the first gold nugget was found. Hugh showed the technique of kneeling in the groin to apply pressure to the femoral artery. A student, with experience teaching TCCC, offered some refinements on the technique to make getting the TQ on easier. Hugh smiled, undid his pants and laid on his back. He had each of us press down on the center of his abdomen, just below his belly button, and feel the pulsing of his abdominal aorta. Hugh had a student kneel into this spot. Hugh offered that this was a quick and uncomplicated way to stop/slow blood loss from a femoral artery injury. He added that it provided more control over that casualty and put you in a better position to apply a TQ and further assess a casualty’s lower half. Using a Nalgene bottle and pair of CAT’s was shown/discussed for dealing with a high femoral bleed.

After our initial intro to TQ’s it was time for the range. Chase emphasized good habits and making every interaction with the pistol a “good rep.” We went briefly over drawing and properly presenting the pistol. We then put rounds on steel working back to about 35 yards. Once Chase was satisfied we could hit steel unimpeded, out came the tennis balls.
We started off with the tennis ball in our weak hand. Chase went over drawing, shooting and reloading with our weak hand impaired. Assuming we still had the hand/arm we used the tennis ball fist to apply the sideways support pressure we would normally get from our support hand.

Next was tennis ball in our strong hand. Chase went over drawing with the weak hand. He recalled a student that had been involved in a shooting where things started off with a disabling injury to his strong arm preventing him from drawing his service weapon. Chase told us that the place to figure out how to draw with your weak hand wasn’t in the field while severely injured. Everything we had done strong handed we now completed weak handed.

We took a half an hour mini lunch and got ready for the next block of instruction.

Hugh was up again for more medical. Bandages were the topic. We went over the various cinch tight, H, Olaes and Israeli. We each got reps in on each dressing. Hugh did not really go into dressing wounds other than extremities.

Hugh brought out a roast that he had shot prior to the class as a teaching aid for wound packing. Hugh demonstrated and we all had an opportunity to practice the skill. The unpredictability of the wound track was eye opening.

The discussion of blood loss included 5 x 1 liter bottles to demonstrate what it look like spilled on the ground. The clinical signs for each 500cc of blood loss were discussed. Hugh focused on mental status and capillary refill as the two most important vital signs.

We quickly went over extrication devices. Emphasis was placed on doing only one task at a time; moving the casualty or shooting, not trying to move the casualty in an inefficient manner while providing ineffective fire.

The time came for the first taste of suffering. Sprints, TQ’s, bandages and quality time with Rescue Randy.

Back to the range with Chase for more tennis ball action. We worked all of the previous SHO/WHO drills from flat on our backs, seated, kneeling and up to standing.

That finished up TD1.



TD2
TD2 saw us starting back in the classroom for another sermon from Hugh on the MARCH algorithm.

Hugh hit the importance of dealing with massive hemorrhage. The video of a pig with a femoral artery surgically transected for demonstration was played. This tied directly into the next topic of vasoconstriction. Hugh discussed the body’s mechanisms to compensate for blood loss. Afterwards the pig video was played again but now watched with opened eyes. The changes in the pig’s arterial spray and pulse rate were now plainly observable.

Airway was next with a demonstration on the mechanics of ventilation. Tension pneumothorax was explained and the need to prevent it emphasized. Hugh discussed commercially available and field expedient chest seals.

Respirations and airway adjuncts were skipped.

Circulation was addressed without discussing IV/IO access. Hugh discussed pelvic fractures and the additional injury to surrounding tissue/blood loss they could lead to. Pelvic binding was suggested long with binding of ankles to prevent an unstable pelvis from creating additional blood loss. It was pointed out that the addition of a pelvic binder over an existing Nalgene/CAT junctional TQ made it more stable and secure.

Hypothermia was addressed, and its importance driven home with a discussion on the triad of death. The significance of warming measures for casualty survivability was made very clear.

We were rushed back to the range for the last learning blocks before testing. We began with shooting from our backs but facing away from the targets. We worked getting pistols drawn and bodies oriented towards the threat. SHO/WHO malfunction drills were worked through each of the positions. Laying on back, prone, seated, kneeling and standing each had their own nuances. This included racking the slide of the pistol on the deck or environment as the situation/location dictated.

Finally we worked movement with a drawn pistol. Chase taught Temple Index and Holster Index. The key takeaways were that Temple vs Holster were situation and location dependent. Regardless of whichever method was chosen the pistol was indexed before the body moved and once movement was complete the pistol doesn’t get released from index until the body is facing the threat. Throwing in shooting close with others the teaching point that sticks out the most is “muzzle past meat.”

At this point we took a quick break to rehydrate and remove anything that we weren’t willing to have ruined.

The real testing began with Uncle Hugh’s Smoke House. One by one we were PT’d until we were sucking wind, had a wet pillow case put over our head and made to spin like a top until we were about to fall. With the entry fee paid we were pulled into the sim house which was full of smoke, blaring music and raging fire alarm. We had to low crawl to find our casualty, Rescue Randy, and perform a rapid sweep for the “arterial bleed” that kept hitting us in the face. You see Uncle Hugh was going Gremlin and making life difficult. Once the bleeder was located you had to get the TQ on. Total time allowed inside was two minutes.

We were given fifteen minutes to get geared up and have mags loaded for the final evolution. Chase explained the barricade numbers and target colors. Hugh handed out individual med kits and a team medic bag. Chase handed out duct tape and tennis balls. All of us had simulated injuries. You could have an arm taped up like a chicken wing, tennis ball taped in a fist, pinky finger taped down, tape over one eye or combination thereof. We sprinted to a SUV with Chase behind the wheel with instructions that they needed three of us in the back seat and two in the hatch. Oops, hatch doesn’t open. Two of us roll over the seat and land in a pile. Hillbilly tilt o whirl commences. Hugh is back in Gremlin mode and being generous with the blood spray. The guy next to me in the hatch now has a left femoral wound. Buddy system to get his TQ into play and applied. All the while it’s raining blood. Once we were properly shaken we pulled up to the field behind the building. Conveniently a large mud puddle had emerged, and Rescue Randy was in the middle of it. Gremlin Hugh was telling us Randy had a high femoral bleed and that we were not in a safe spot. We needed to fabricate a makeshift litter and stop Randy from bleeding out. Once Randy was properly TQ’d up and as secure on the litter as could be we needed to get to main range. Over the berm and under a log we went. Randy needed reassessed and additional treatment. Once on the main range weapons were made hot and the next phase began. Chase shouted commands to three of us and Hugh took the other two. Commands for barricade number and target color were given. Movements were expected to be safe and targets neutralized with 3-4 hits. Flash bangs and smoke grenades were in use as we were pushed faster. At some point Chase chose one of us to become a casualty and need evacuation. The rest of the students were given instructions by Hugh to address additional injuries. A Sked was used to extricate the casualty to the tower and up the narrow stairs. Once up top it was back down to the bottom and out to the parking lot.

We hydrated, reloaded, were given fresh med kits and were taped up in a different configuration from the first scenario. The exercise was completed again being pushed a little harder, faster and a more complicated path with the Sked utilized.

Afterwards were geared down, cleaned ourselves up just a little bit and met in the classroom for a breakdown of how we did. Chase and Hugh handed out certificates. Class pictures were taken outside.

I very much enjoyed the class. All of my previous training with regards to weak hand shooting pretty much relied upon magic for the gun to appear in my hand. I took away quite a bit to work on. I hope to take Chase’s full injured shooter pistol/carbine class in the future. Hugh had a wonderful way about him and I learned a few gold nuggets to keep with me. I think a more advanced class with Hugh to take advantage of my broader knowledge base would be beneficial.

Sounds like some good training.