Issue 38 Beyond Bullets Tom Marshall Join the Conversation Photos by Chad McBroom, Muzzle Flash Media, And Recoil Staff Two Experts Give Us Their Input on Best Practices for Concealed Carry Medicine When browsing “EDC” or “pocket dump” on our favorite forum or social media channel of choice, we see a lot of cool gear. Pistols, holsters, knives, watches, challenge coins, flashlights, and sunglasses all run aplenty on these look-at-me photo threads. Even combs, travel razors, beard oil, and “tactical wallets” all wind up getting meticulously laid out among the supposed daily carry of internet enthusiasts everywhere. But one item that continues to make fewer appearances than it should is a well-thought-out carry med kit. They’re typically not flashy, expensive, or an inherent source of bragging rights. Medical gear is, in our opinion, one of the things that separates those who are carrying to be prepared and those who are carrying to start conversation. But the particular sundries required to tend the wounded — and the knowledge required to use them properly — are an oft-misunderstood subculture even among armed professionals. On the battlefield, the days of taking a knee and yelling “medic!” are well past. Likewise for law enforcement, stringing up yellow tape while waiting for an ambulance is the procedure of a bygone era. The advent of domestic terrorism and the intense media publicity showered upon active shooters has, for better or worse, made casualty response a job that can now fall upon anybody regardless of what uniform they wear — if any. In order to better wrap our heads around the problem, we spoke to two instructors who have made great efforts to spread their wealth of knowledge about trauma medicine to uniformed personnel and citizens alike. Kerry Davis of Dark Angel Medical spent 16 years in the Air Force, including service as both an ER medic and flight medic. Additionally, he has 10-plus years in civilian emergency rooms, working as a paramedic while completing his studies to become an RN. Glen Stilson works for Independence Training, which offers both firearms and emergency medical training to the communities around Phoenix, Arizona. He began seeking further development of his own medical skills in 2006 after becoming a father. He has been teaching “Dirt Medicine” and TCCC-style classes since 2009. The staff at Independence Training includes both current and former paramedics and flight medics, as well as several former members of Army Special Operations units. With a wide variety of medical kits and components available, make sure to have quality kit and the skill to use it. RECOIL: Why should people who choose to carry concealed consider medical preparedness (training and gear) an important part of exercising their right to carry? What about people who don’t carry a weapon? Should they consider medical training and gear as well? Kerry Davis: Medical preparedness (training and gear) is absolutely an essential component of “EDC.” If you are exercising your right to carry a firearm for self-defense, then you should also be trained in, and carrying, medical gear for the same reason. Carrying a firearm without carrying medical gear should not even be an option, because the chances of using your medical gear far outweigh the chances of using your firearm. With hemorrhage being one of the leading causes of death in the U.S., being able to stop the bleed is one of the most important things we can learn. We always tell people in our classes that even if you don’t carry a weapon, you can carry a medical kit and still be a “force multiplier.” Also, you can’t carry a weapon everywhere, but I’ve yet to be anywhere I can’t carry a medical kit. And, statistically speaking, those places where I can’t carry a weapon are probably the places where I would need the medical kit should, God forbid, something tragic unfolds. There should always be room in your EDC for medical gear, even if it is something as small as a tourniquet and a pair of gloves. Obtaining solid medical training doesn’t take a lot of time and can make the difference, literally, between life and death. Glen Stilson: Everyone should be carrying medical equipment and have the skills necessary to use those tools. You are much more likely to need to help yourself or someone else in a medical emergency than you are to shoot a bad guy in the face, and if the average firearm owner spent as much time, money, and effort on their medical skills and tools as they do on their guns and shooting, we would be an amazingly prepared community! The best part of carrying medical gear everyday is that you can take it anywhere with you — into “gun free zones,” onto airplanes, into government buildings, etc. Plus, there are some everyday useful items in a good med kit, such as tape, light, and shears. What medical gear do you consider the absolute bare minimum requirements for daily carry? Why? KD: As stated above, the very bare minimum equipment I would carry would be a tourniquet and pair of nitrile gloves. If I could add to that, I would add a small pressure bandage and a hemostatic agent (QuikClot Combat Gauze or ChitoGauze) and a pair of compact chest seals. The difference in wounding patterns in civilian mass casualty/active shooter situations is different from military scenarios in that the wounding patterns in civilian settings are typically thoracic and cranial injuries. Those areas are typically protected with military personnel; thus, their injuries tend to be mainly dealing with the exposed extremities. However, our main emphasis remains on stopping the hemorrhage first and extremity injuries do still occur in the civilian populace, so our treatment algorithm remains unchanged. GS: I would say that there are five trauma kit essentials: tourniquet, bandage, gauze, tape, and occlusive seal. These items allow me to handle the most serious life-threatening wounds that may happen to me (yes, my kit is for me — if I can help other people then so be it), such as massive bleeding or a compromised chest cavity. They also allow me to handle less serious (and more common) injuries, such as a nasty cut, a broken bone, or a strain/sprain. If possible, I would add another five items: shears (5.5-inch are TSA approved), nitrile gloves, emergency blanket, hemostatic gauze, and a light source. These additional items help me handle the aforementioned wounds and reduce the risk of shock, which is a serious threat in any medical emergency. How do you carry/conceal all that gear on your person? Do any of the women in your life (wife/sister/daughter/mother) carry an EDC med kit? If so, how do they carry it? KD: Where to carry the gear is a very common question and one that we believe we have the answer to through offering several versions of low-profile/low-visibility trauma kits. Carrying “enough” medical gear is basically up to the end-user, and it depends on what their mission requirements are. We have an ankle kit, three very small pocket kits, a flat kit that will fit easily into purses, soft armor, cargo pants, and we have a small belt-mounted kit. For those who want additional, off-body carry, we offer a backpack with a pocket specifically made for a full-size D.A.R.K. (Direct Action Response Kit) insert and a tourniquet. My daughters carry Pocket D.A.R.K. Mini kits and Combat Application Tourniquets (CAT) in their purses and school backpacks. GS: I carry all of my medical gear in an ankle kit, every day of my life. I chose the AFAK from Ryker Nylon Gear due to its ability to carry all 10 of the items that I mentioned before in a comfortable way that is also fully concealed. The kit itself is also very adaptable to be used around a backpack shoulder strap, range bag handle, dog collar, seatbelt, tossed in a bag, etc. I fly everywhere with my kit and go into government buildings and other restricted areas without any issues at all. My wife and kids carry the same supplies but vacuum-sealed in a bag that is the same length as an M4 mag and the same width as two M4 mags put together. This allows the kit to be small enough to put in a purse or a backpack, which is how they mostly carry it. I find that a kit put together in that manner or setup in an AFAK from Ryker Nylon Gear are the two most common ways our students end up carrying a kit once they have trained with us. Just remember, skills trump tools and tools enhance skills. For those without current knowledge on how to treat traumatic injuries, what’s the best way to seek out a training class? Short of actual training, are there books or websites you can recommend as reliable sources of information as a primer? KD: Generally, using any search engine for the internet will bring up quite a few classes nowadays. This wasn’t true several years ago, but I will add a word of caution that there are a lot of “me too” type classes. Ensure that you vet the instructors and course of instruction for these classes. Just like with quality firearms training, quality medical training will not be cheap. Our classes are nationally recognized in that each student receives BCON (Bleeding Control) certification and EMTs or paramedics receive continuing education hours toward their refresher training. There are a lot of good books and videos out there that can be utilized as a primer or reference, like the LEFR-TECC (Law Enforcement and First Responder-Tactical Emergency Casualty Care) site, the Stop the Bleed (bleedingcontrol.org) site and several others. As far as the proper use of the components of the kits, one can always source videos from the actual manufacturers of the products on YouTube. As always, a video or a book are not a replacement for a class with “hands-on” training. A great starting point is to contact your local hospital or Red Cross or American Heart Association and see when and where the next AED/CPR/first-aid class will be held. Short of going to a local community college and enrolling in the EMT course, these are some of the easier things to seek out. GS: Anything beyond a basic first aid/CPR class is going to be helpful! There are a lot of great places to get training these days; just remember to always check the validity of what you are learning. For example, learning from someone who comes from a clinical background may not be as applicable to you if you spend most of your time away from clinical settings. Learning from a combat medic who left the military 10 years ago and hasn’t stayed current on new techniques and concepts will still be useful, but not as useful as learning from someone who is more current on their information and can apply it to your everyday life. Medical training is like firearms training — résumés and “been there done that” is nice; however, current and modern experience is much more helpful, as is actual teaching ability. There are lots of free classes out there, specifically the Stop The Bleed classes, which are often taught at no cost through hospitals and community colleges. There’s also lots of info available online via social media and YouTube, but again, be aware of who you are learning from and where they draw their experience or material from. Independence Training, whom I work for, has several medical instructors who come from different backgrounds, giving us a broad spectrum of information and experience to draw from; some of our team are still working in the medical field. We also have several consultants working in the medical and tactical fields and providing us constant feedback, as well. This helps us to make sure we are on the razor’s edge of the most valid, most current, and most effective techniques and equipment. Besides carrying a medical kit and obtaining the knowledge to use it properly, is there anything else you recommend to help people prepare for responding to a mass-casualty event, should they find themselves in that situation? KD: One of the best things to do, after obtaining the proper training and equipping yourself, is to practice and become, as we call it, “subconsciously skilled.” This is probably one of the most important aspects of being able to react in a positive manner during a mass casualty incident. The other important aspect is having the proper mindset. Practicing with one hand, or the non-dominant hand, in a sensory deprived environment always helps. Think of applying a tourniquet to your right leg with your left hand in the dark, with gloves on — and the gloves are slathered in hand lotion and on a timer. Performing these tasks over and over until you are doing them in your sleep is key to being able to perform them under duress. Learn how your body will react to duress and how your practice can help mitigate the negative effects of the body alarm response. LTC Dave Grossman’s books, On Killing and On Combat, are really good resources on how the body will respond, both physiologically and psychologically, to stress. Taking care of yourself after a critical incident is paramount, as well. Consult a counselor as soon as possible, hopefully less than 72 hours after an incident has occurred. Talking with someone will help in the healing process. Talk with pre-hospital health professionals about how you can properly interact with them should you be the first to render aid to a trauma victim and then transfer care to EMS. Most importantly, get solid medical training, carry top-notch kit, and be prepared to use it. In any traumatic event, the best thing to you can do is focus on the types of injuries you know you can help and not the ones you cannot. The goal is to render fast, effective aid to as many people as quickly as possible in order to increase overall survivability. Keep your eyes open and your head on a swivel in order to increase not only the survival rate of your casualties, but yourself also. Having solid situational awareness can be an invaluable tool in increasing your survival rate and, in this day and age of technology, it seems to be one in which many are lacking. In the end, our goal in teaching people how to help themselves and others is all about empowerment; being a “by-doer” and not a bystander. GS: Awareness is not a verb, so merely being aware of a problem isn’t enough. We like to teach our students the old Sesame Street game of “one of these things is not like the other; one of these things just doesn’t belong.” Look for people or things that don’t belong and then act accordingly. Leaving the area may be your best option; alerting authorities may be possible, or perhaps intervening in a physical and/or violent manner may be necessary. Start preparing and practicing now on what to do if you find yourself and those you care about in harm’s way: how will you communicate? How will you move? What tools do you and those who may be with you have available? What tools can you make/improvise? How can you expect your friends/family/kids/coworkers to react in an emergency? Talk with your local fire and police personnel about what you can expect from them when they come on scene. Write everything down once the violence has ended and you have rendered the best possible medical aid to yourself and everyone else — what you saw and heard, what you did, what aid you rendered and to whom. This kind of information can be very useful to professional responders once they are on scene. Overall, remember that when seconds count, help is just moments away — it’s up to you to save you, so prepare and train accordingly. Conclusion While this article is by no means a comprehensive primer on medical equipment or training, we hope that some of you will heed this as a call to seek professional education on the topic. If you’ve already taken that step, we hope this affirms your confidence in that decision. Even for those with prior professional experience or recent classroom training, do your best to keep current through whatever means are available to you. Near continuous feedback from both the battlefield and the urban jungle mean that best practices are constantly being revised or altered. While sinking hard-earned coin into a med kit may not be as flashy as cutting windows in your slide or getting a fluted titanium nitride barrel, it’s much more likely to save your life if you ever do need that sweet-ass blaster. 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