The pictures are from a smoke alarm call at 02:00 recently. Light smoke in a house no obvious fire found, no fire damage was found during the investigation. House was about 4,000 square feet, two story. Attic space on both ends of the house. One attic access had a one foot step down I sent one Firefighter to inspect it after I had to make sure I didn't miss anything. He stepped in before he realized there was step down and I didn't tell him about it. He stumbled and went through the drywall that was the ceiling below. Luckily the open garage door caught him. Tell your people about hazards no matter what. Light bulb moment.

Not everything is lights and sirens.


Captain Swen

      A 23 year old, 230 pound, muscular, African-American active duty (AD) Soldier in the U.S. Army sustained a high-velocity gunshot wound to his left shoulder in Paktika, Afghanistan.  The projectile penetrated anteriorly, immediately inferior to the distal 1/3d of the left clavicle and exited inferior to the left scapula.  He was treated by a first responder AD 68W Combat Medic with two packs of QuickClot Combat Gauze (Z-Medica, Wallingford, Connecticut, USA).  The gauze was packed into the wound under direct pressure and an 18g IV was placed in his contralateral upper extremity.  An infusion of 0.9% normal saline (NS) was initiated at a slow rate. He arrived at the 9 man surgical element, we bypassed EMT and just brought him straight into the OR.

                 After preoxygenation with 100% oxygen, a Sellick’s maneuver was applied to the patient’s cricoid cartilage and induction of general anesthesia was achieved with Etomidate (Amidate, Pfizer, Inc., New York, USA) followed immediately with succinylcholine (Anectine, Quelicin, suxamethonium, Pfizer Inc., New York, USA).  Direct larnygoscopy was performed, a Grade I view was obtained, and an 8.0mm endotracheal (ET) tube was inserted between the true vocal cords to a depth of 22cm at the teeth.  The ET cuff was inflated with 5mL of air and breath sounds were equal bilaterally with a positive end tidal CO2 waveform on the monitor (Propaq, ZOLL Medical, Chelmsford, Massachusetts, USA).
 
                After verification of ET tube placement, a massive amount of blood was noted on the floor.  Upon inspection, the patient had a rapid, active, arterial flow of pulsatile blood emanating from his wound.  An entire roll of gauze (Kerlix, Covidien,-Medtronic, Minnesota, USA) was placed into the wound and direct pressure was applied.  The patient was placed on the ventilator.

                The patient was found to have a partially severed left subclavian artery. 

                Succinylcholine is a widely used medication as part of the RSI technique in combat casualties.  Application of Combat Gauze to penetrating injuries has become routine for U.S. military forces.  The fasciculations caused by succinylcholine can be of sufficient intensity to dislodge the Combat Gauze and result in a rapid loss of hemostasis.   Alternatively, an actively moving patient can dislodge the clot formed by combat gauze.

                  I recommend a reinforcing combat gauze prior to patient movement, using a defasciculating dose of paralytic prior to using succinylcholine, or avoiding succinylcholine altogether if the patient has had a hemostatic dressing applied. The patient also received 4u PRBCs and 4 FFP, we didn't have TXA during surgery.

 


-George Johnson
CRNA

EXAMPLE PHOTO

My ATRIC class ended at 17:00 on Oct 01.  At 02:30 on Oct 02 I was on the ambulance when a we received a call for a shooting at an apartment complex.  Initially advised to stage for law enforcement, within minutes we were requested to "make scene."  Once onscene, I never thought twice about the perimeter officers and door guys with guns drawn. I wasn't concerned that the first time I heard the shooter had not been located was while I was caring for the victim.  I was not worried, because of the training I've received by the ALERRT staff during the course of Active Shooter II and ATRIC.  I trusted that my officers would watch over us as we provided indirect threat care. SWAT Officers Ellingston & Beller had placed an Israeli bandage over the abdominal entrance wound (intestine protruding), and no exit wound found, so we quickly moved him onto a backboard and into the ambulance.  The victim ultimately succumbed to his injuries At a local hospital, but because of the immediate care he received (made possible by the direct training provided ALERRT, and teamwork practiced in live scenarios), he was able to name his shooter(s). 

Katie Contreras
Lieutenant/Paramedic

Case Study 1 presented by Katie M Contreras
Lieutenant/Paramedic
Feel free to comment and share these as they are posted each week. Pictures of the SWAG will be posted after they have received it. We have already been told that the NAR 4 Aid Bag will be put to work saving lives immediately.

"Experience is not the best teacher; evaluated experience is." Howard G. Hendricks
To that end, WE NEED YOUR HELP!

Send us your patient case studies, your down-range stories, your 911 call, your memorable training, learning, "oh wow"-light bulb moments!
Send us an email @ [email protected] or FB message or carrier pigeon with a video of you telling about it or a small narrative explaining what happened (videos, pics, links, etc....).

We will sort through them and pick some of the best to showcase on the FB page and website.

BUT WAIT..... THERE'S MORE!

To thank you for your time and wisdom we will send you (no catch, totally free of charge, you don't even pay shipping) some pretty decent swag (see pics!).
You can't train too hard for a job that can kill you (and you never know, the life you save, may be your own!).

August 7, 2017 will be the first Post going up from your experiences you all share. The 1st GIVE AWAY is a NAR 4 AID BAG! We will post pictures of the each person with their free SWAG!

1TCCC Bag
1 Knights Armament Rail Cover Set For AR
5 100 OZ. Camelbak Reservoirs For Your Back Packs / Aid Bags / Hiking Pack or whatever you want to put them in
20 Glow In The Dark MED Patches
10 Patch Hats
1 Tactical Waist Pack
1 Individual First Aid Kit (IFAK) Drop Leg / Belt / Molle (for bags or body armor mounting)
3 Seat Belt Cutters
1 Willie X PT-1 Eye Wear / Sun Glasses / Ballistic Eye Protection
1 Retractable Leash
1NAR IPRO / Ballistic Eye Wear
1 Camelbak OD Green
2 Medium Multicam Combat Shirts (Sexy Shirt For All You Tacticool Folks)
1 Digital Soft Shell Jacket
1 Digital Combat Shirt (Sexy Shirt)
1 Gerber Multi Tool
2 Nomex Gloves

Afghanistan war map February 2017
red : government
white : taliban

When you're passionate about your craft, and when your craft is saving lives, you want to bring that work to as many people as possible.  To that end, we have decided to branch out geographically and within the next year are planning to open a fourth training facility in the Colorado Springs to Denver corridor.  As always, our training operations can always be brought to your location; however, since not everyone has a facility to utilize all of our offerings, we have our own dedicated to providing our full training array.
This expansion will allow us to bring these life saving trainings to more people without adding additional travel expenses for our clients.
We are huge fans of the Colorado / Wyoming area and are beyond excited to be planning and implementing this expansion.  We're hopeful all of our clients (past, present and future) along with friends and family (framily) will share our enthusiasm! 

Version 5 of the TCCC Handbook. For those who don't know say hello to MARCH/PAWS and Prolonged Field Care. Let everyone know where to get the handbook.

Best job I ever had! Dynamic hoist in the Korengal Valley for a MEDEVAC. Remember Everything above in V5 of the TCCC Handbook has come from lessons learned in combat. Some good and some bad things were done by all in order for us to make the turn around the corner with these improvements. Keep leaning forward in the foxhole and striving for perfection. However, remember when you train, push hard and train till failure. Never stop when you have gotten it right because you are not pushing hard enough and nothing goes as planned when it hits the fan. Remember to learn from the mistakes, regroup and do it again.

Matthew Kinney

William H. McRaven, Chancellor of The University of Texas System and former commander of the U.S. Special Operations Command as the TexMed 2017 keynote speaker. McRaven’s address titled “Physicians in the Age of Terrorism – Stories of the Battlefield” reflects on policies resulting from terrorist events and the ramifications of a weak national security system.  What is and why TCCC was and is. The history from the conception of TCCC to now.

The Prolonged Field Care(PFC) Working Group has been working hand in hand with the US Army Institute Of Surgical Research(USAISR) and the Joint Trauma System (JTS) writing and editing new guidelines for medics and providers who may have to take care of casualties for longer than normal planning guidelines in resource constrained environments.  This could be a few hours or many days.

Before moving in to Prolonged Field Care  you should first master the basics and Tactical Combat Casualty Care (TCCC) Below are the tools and downloads from prolongedfieldcare.org for those of you who have the need to or are working in that environment. 

PFC Casualty Card v19

Medical Planning Tool

10 Essential Capabilities Grid

PFC Priorities RAVINE Mnemonic
12 Pharm Principles for SOF Medics Handout
MSMAID Acronym with Minimum, Better, Best Packing List
SORT Prolonged Field Care Nursing Checklist

44 Patient Mass Casualty Triage Tracker
Create a Care Plan Slide Show

Awake Cricothyroidotomy Checklist
Post Cric Checklist
Zoll/Impact 731 ventilator Cheat Sheet
Old Eagle Impact 752 Ventilator Cheat Sheet (Rule of 5s)
Scott Weingart’s Dominating the Ventilator Handout
Everything You Need to Know About Foley Catheters
Open Globe Eye Injury Guidelines
PFC Specific Hospital MPT Rotation AAR and Recommendations
TBI MACE Exam Card
Emergency Whole Blood Protocol
Skills Non-medical Team Members Should Know For PFC
Preparing for Operations in a Resource-Depleted and/or Extended Evacuation Environment -Gabe Corey
Click to Download PFC Scenario Used at SOMSA 2014
Patient Scenario
One way to run a Prolonged Field Care Scenario with references included
Malaria Treatment Protocol ver 1 4

Good knowledge to have and test your junior medics on. Every medic should know where the landmarks for Anterior Axillary Line needle thoracostomy and Mid Axillary Line Tubal/Finger Thoracostomy. You should be able to walk up to junior medics and "pop quiz" them by having them draw the safety triangle on their buddy with a marker and choose their site. (Some even use their povidone-iodine swabs to mark landmarks before the procedure.)
People accidentally tube livers, diaphragms and all. Know your landmarks!!!

If you're placing a needle, finger or tube through the chest wall, it should be lateral and in the 4th/5th ICS.

We will be giving a Level II Pistol and Bleeding Control Course to Selected LE this weekend. Dont forget to check our schedule class dates for up coming fun. Our next Pistol with TCCC-AC on day two is in late August. We look forward to seeing you all there.

This is one of the charities we have backed and participate in yearly. We will be competing again in September at the Great American Shoot to help raise money for these great men and their families. All the money donated between now and May 31 will go to the MSG Gordon MOH Memorial Fund.

Wonderful day to celebrate the 10 Year Anniversary of @thecomfortcrew for Military Kids & putting 100 comfort kits together for military kids here at Fort Hood!

November there will be a fund raising event held by The Comfort Crew. Please enjoy the video!!! That being said it is often times the kids are left home while their parents deploy. There are different types of kits available for the kids. Those kits consist of ones for deployment, reintegration after deployment, and how to deal or cope when your parent comes back injured or even the loss of a parent. We here at 911 Tactical Medicine hope to see you at the event!

EVENT DETAILS

Sunday, November 12th
Spanish Oaks Golf Club
13001 Spanish Oaks Club Dr. Austin, TX
6:00pm ‘till Midnight
Pre-Tourney Party, Auction & Concert
Monday, November 13th
Falconhead Golf Club
15201 Falconhead Blvd, Austin, TX
9:00AM Tee Off
Golf Tournament

Kick off Party

The 10 Year Anniversary Boots and Birdies Charity Classic Party will start at 6:00pm on November 12th, 2017 at Spanish Oaks Golf Club. Come join us for a tasty BBQ dinner and drinks, fun games, silent auction, military family fashion show, and concert by country music singer/songwriter Matt Stillwell.


Golfers who register for the tournament will recieve two tickets to the party. Individual party tickets will be available for purchase starting July 1, 2017.

Golf Tournament

This year's golf tournament is back at Falconhead Golf Course on Monday, November 13, 2017. Participants will tee off at 9am and play a scramble format. Expect great food, tee prizes, and awards as we celebrate our 10 year anniversary!

Registration begins on July 1, 2017.

Sponsorship Opportunities

Presenting Sponsor: $10,000

• Featured on all signage, printed materials, social media and Tee Prizes
• 4 player golf team ($2000 value)
• Additional 4 player Veteran Golf Team Sponsor Recognition ($2000 value)
• 20 VIP party tickets
• 2 tables with reserved seating for 16
• Special Event Hole Sponsorship
• Recognition during on-air media promotions
• 4 Complimentary hotel rooms
• Complimentary use of ride share to and from party event

Gold Sponsor: $7,500

• 4 player golf team ($2000 value)
• Additional 4 player Veteran Golf Team Sponsor Recognition ($2000 value)
• 12 VIP party tickets
• 1 table reserved seating for 8
• Sponsor logo featured on welcome banner, printed materials and social media
• Special Event Hole Sponsorship

Silver Sponsor: $5,000

• 4 player golf team ($2000 value)
• 8 VIP pre-tournament party tickets
• 1 table reserved seating for 8
• Sponsor logo featured on tournament welcome banner and social media

If you are interested in sponsoring this great event or have questions, please email [email protected]. 

November there will be a fund raising event held by The Comfort Crew. That being said it is often times the kids are left home while their parents deploy. There are different types of kits available for the kids. This week we dropped off 55 kits in the Ft Hood area to schools. Those kits consist of ones for deployment, reintegration after deployment, and how to deal or cope when your parent comes back injured or even the loss of a parent.

We will be there at the fund raising event in November and will be auctioning off a special event to help raise money to keep the kits coming for the kids. Stay tuned for more information and how you can help. We will be sharing pictures of the next days golf tourniquet and some of the events at the fund raiser. They say that Matthew Kinney and his daughter will be part of a fashion show.

The things that matter most to those who have been working in the medical field for a long time is not the money. The things that matter the most are those small things when you have touched a patient and there is the unbelievable outcome when there is little chance of survival where the patient lives to tell about it and thank you. The things that matter are those who you have trained get to come back to you and tell you about how things are going in training while going after a higher level of medical knowledge and how much you have helped them. The things that matter are when you leave students with that same knowledge after your courses comes back to tell you about a patient that should have never made it back to the hospital alive but did. An amazed Doctor who asks the Paramedics "How did you know to do that and where did you learn it?" Those are some of the real things in life for medical professionals that matter.

We here at 911 Tactical Medicine have been blessed in all accounts when it comes to the things that matter. This week it was a prior student calling to thank us on how smooth schooling was going and how much things made sense to them. Two weeks ago it was a call from another group of students who had saved a patient who was in no shape to have lived yet the correct procedures where done that saved the life. They where not 911 EMS protocol driven "Cook Book Medicine" but patient outcome driven. A month and a half ago a former student (Doctor) called from overseas thankful for the training and wanting to be able to get more, not just for him but all of his men there stuck in an austere environment.

When in class listen to the experience. Its not the book by itself but what is being said that correlates to the writing that has the experience and knowledge to back it up. What is being taught should be put in a perspective that is easy to understand where it is complex in writing broken down "Barney Style" as we like to say. At the end of the day medicine is medicine. No matter how you sling it. The only thing that changes is how you apply it in the given environment you are in at the time. The outcome becomes the things that matter.

#thingsthatmatter #911tacmed #trainasyoufight #EMS #Fire #Rescue #SWAT #EMT #Paramedic #criticalcare #Stopthebleeding #Weaponstraining #medicaltraining #musclememory #thelasteasydaywasyesterday #trainhardordiefast #whenihaveyourwounded #tosavealife #soothersmaylive

We have a 1,300-acre outdoor event, adventure, and education center lying just outside of Burnet, Texas. The Ranch is less than an hour from Austin. Below you will find a variety of unique training opportunities  to enhance, or add to, the tactical skills relevant to your professional environment.

Rifle and Pistol shooting range,  360 range
Long Range and High Angle Range
​Multiple Outpost or Structures for scenarios
Helo Shooting Range (1 Mile Straight Range and Hover Range)
Scuba & 100 foot-deep, clear water quarry
Obstacle course
50 Point Land Navigation Course
75' Rappelling Tower
Helo Pads (Fast Rope and Hoist Areas as well)
Off-Road 4x4 Course over mud, rock, flat, and steep hills

​

#TCCC #Tacticalmedicine #Tacmed #Jan2017

We want to hear what your favorite piece of medical equipment you use or have used and why.

Ok folks feel free if you need further info or if you want the pics your group. There have been a lot of fake CAT TQs showing up. This is a real problem because they have been failing. That is right, and some have paid with their live becuase someone took a short cut and didnt check what they were buying. Make sure the vender is an authorized one that sells your TQ of choice. I am going to tell you a word of advice. It is better to have a TQ you can put on with one hand and know 100% it is going to do the job in 15-30 sec. That being said I will only speak up for a few TQs that do the job as in tended. You have the SOFT-T and SOFT-T Wide (not a one handed appication TQ), CAT (Is a one handed applicaion TQ), and the new Tactical Medical Tourniquet (Is a one handed application TQ).

The suspect arrived with a checked gun, claimed his bag, took the gun from bag, went into the bathroom to load it and then came out and started shooting.

​1. This was in a bagage claim area that had lots of people.

​2. Five killed and eight injured

​3 This guy had plenty of time, even to reload.

​Given the number of people in a bagage terminal if they were to rush and over take (fight) the guy and not flee the numbers would be lower. The death number in this case may have also been lower if the correct treatment to the wounded had been given sooner.

​This is why it is critical for not just Law Enforcement and EMS to know this stuff. The average civilian can do miricals given a little knowedge. A simple Bleeding Control course or a PHTLS for First Responders will work wonders here. Basic first aid is what we are talking about that is current and up to date. You dont need a first aid kit, there are plenty of things around you to make TQs with and pressure dressings with.

​The same story keeps playing out over and over in just about every shooting or attack that happens.

​On another note I posted this last week about some Law Enforcement Officers and one was shot. There was no treatment being done what so ever, no aid kits. Medical aid happend when EMS arrived. This guys in the video was lucky EMS was near by. Putting someone is a car does not stop them from bleeding out or other bad things that happen. Covering your partner and returning fire would be a good thing as well. There is a reason there are thress phases of TCCC and TECC. Below is the footage of the body cam of the Officer who was shot.

We are starting a new BLOG spot for everyone to share their responce. It will be growning in time and with different categories. Please if you have something you want us to talk about please let us know or if it is just a simple question you wish converse on email. We have also created a Youtube channel that will be growning in the future as well you can check out.

​If anyone has comments before we grow the BLOG in to other categories please feel free to post below and introduce yourself then post away!