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Pain at Arm’s Length

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Recognize and Treat Common Melee Injuries

This article is meant to be a general overview, and not a detailed guide, on wound treatment. Seek professional first-aid training before attempting any of the techniques discussed in this story.

We’re gun people. That much we can agree on. So when it comes to wounds from an up-close-and-personal physical encounter, it’s easy to adopt a myopic attitude and laser-focus our medical training on penetrating gunshot wounds. In our last issue we examined the treatment of those wounds to the chest and abdomen. And learning how to properly apply a tourniquet to the arms and legs is increasingly easy thanks to the Department of Homeland Security’s “Stop the Bleed” educational campaign.

However, unlike soldiers in a war zone who anticipate being hit with high-velocity projectiles like rifle bullets or IEDs, as civilians we’re much more likely to encounter a low-velocity weapon. This might include a sharp-edged weapon like a knife, blunt objects like a baseball bat, and, of course, fists and feet. Anyone who’s fought for their life can tell you it’s easy to inadvertently injure yourself as well, whether it’s abrasions from dynamic movement or broken glass that gets into your eyes.

In short, the point of this article is to go beyond the bullets and learn how to deal with everything else that comes from a fight. So forget about the movies. Ditch all those nightmare-fantasies where you get hit and fall to your knees in slow motion, Platoon-style, while “Adagio for Strings” plays in the background. When it happens, it’s going to happen fast. And it’s going to be messy afterward.

Treating a 'head wound'hand x ray

To teach us how to clean things up, we wanted someone who’s seen the aftermath of close combat in both military and civilian environments. We spoke with Marc Fridley, director of knowledge management at Tactical Medical Solutions. Marc is a former Special Forces medical sergeant who served with the 20th Special Forces Group as well as civilian law enforcement agencies including tactical teams and federal task forces. In Iraq he patched up good guys as well as bad guys. Here at home, he teaches big-city law enforcement agencies and military clients how to perform lifesaving field treatment techniques. Based on his broad experience, here are five of the most common injuries suffered during a struggle and how to treat them:

CAUTION! In almost every case, except where massive blood loss or some kind of arterial bleed needs to be addressed, your first step should be to call 911. Only attempt field treatment if tactically feasible.

Lacerations to the Head
Background: When one human attacks another, the first target is almost always the head. And since the head and scalp are packed with blood vessels, a deluge of blood can flow from what seems like the smallest of cuts.

Treatment: Use a pressure dressing or hemostatic gauze. Although if you’re pushing correctly, almost any improvised material, such as a torn T-shirt, will do. Apply firm pressure to the wound and keep it there. If you take the pressure off, for example, to use a weapon to defend yourself or to crawl to safety, the wound may start re-bleeding and you’ll feel like the little Dutch boy with his finger in the dam. This is why ambidextrous firearms training matters!

Note: If the eye is injured, and in particular if a foreign object such as broken glass is stuck inside of it, don’t try to treat it yourself. Instead, tape something over the eye to protect it such as a Styrofoam coffee cup while you get to a hospital.

Blunt Impact Trauma to the Head
Background: This is a deceptively simple injury. Besides the obvious wound caused by a moving object like a baseball bat connecting with the head, there is another less talked about, but just as dangerous, injury. This is when the head impacts a stationary object, for example, when a limp body hits the ground. The brain takes the hit not only from the initial impact that caused the fall, but also from getting slammed into the opposite side of your skull. At that point, it’s acting more like a rotten apple being bruised and crushed between two fingers instead of the center of your logic and motor skills. This is called a coup-contrecoup injury and is a type of traumatic brain injury (TBI).

USS Theodore Roosevelt anesthetist keeps Sailor in the game

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