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rhino
September 3, 2006, 04:36 PM
Tactical Treatment of Gunshot Wounds with Doc Gunn
05 August, 2006
Copyright © 2006 rhino465@yahoo.com

On Saturday, 05 August, 2006, I completed a one day “Tactical Treatment of Gun Wounds” with Doc Gunn of DTI Roanoke dtirnk@yahoo.com. Assisting Doc were Frank S. and Angelo N. of DTI, and our affable host, Captain Ken Campbell of the Boone Co. Sheriff’s Department (Indiana). The focus of the class was on the necessity of accurate shot placement and the immediate treatment of life-threatening injuries resulting from gunshot wounds.

The class started with introductions and a brief overview of the course material. The prior medical knowledge of the students spanned a spectrum from a paramedic who works with a tactical entry team, to a veterinarian, to those with minimal or basic first aid skills. Doc provided all students with a manual summarizing the essential concepts and other important information, so I chose to listen carefully rather than take notes during the class. After listing the course objectives, the four Universal Safety Rules and range rules were reviewed. Another very important topic was having a pre-existing plan for emergencies. This was especially interesting to me, since one of the main reasons I was in the class was to help me develop emergency plans for two shooting clubs.

Most of the morning session was devoted to how to make our handgun bullets more effective than those of the assailant. The importance of situational awareness was stressed, and that it’s vital to eliminate all threats before shifting focus to treating injuries (your own or someone else’s). Defensive movement was also an essential part of the package, as avoiding being shot is the best way to minimize the effectiveness of an attacker’s bullets. Doc explained what to expect if you’re shot, or if your enemy is shot, which is generally not the same type of reactions you see in the movies.

The fact that all handgun rounds are “puny” regardless of caliber was stressed, and that the key to making them as effective as possible in stopping threats is accurate shot placement. On the surface, that was not news to me, but in the past I had underestimated the level of accuracy truly required for defensive shooting. Most handgun wounds are very survivable, and among those that are not, few will incapacitate a determined individual before they have time to do great harm to you. The mechanisms of why people are stopped by wounds were covered in detail, including the effects of bullets on living tissues. Finally Doc raised the point that the only target that is a “guaranteed” immediate fight stopper with a handgun round is a direct hit to the brain stem.

Following the lecture was a session of drills on the range which served two goals (at least). First, it demonstrated clearly how important accuracy really is. The second (unspoken) purpose was that it allowed Doc Gunn and his assistants to verify that we could handle our weapons safely, which was essential for the final exercise of the day.

After lunch, we went into the medical aspects of the class. First was a brief summary of what “tactical medicine” is, and that our class was a subset skills taken from that discipline that we could use to save lives as well as teach to others afterward. Doc explained that in tactical medicine, there are seven categories of life-threatening injuries. After eliminating all threats, the injured individual is then assessed based on those seven. We spent most of our time discussing diagnosis and remediation of airway obstructions, tension pneumothorax, and bleeding, with some time spent on “flail chest” and sucking chest wounds as well.

That brought us to the equipment portion of the class, which covered:

• Recommendations for a minimal kit;
• Insertion of a Naso-pharyngeal airway (correction courtesy of pacer) to maintain airways;
• Proper use of a needle catheter to reduce tension pneumothoraces;
• Application of occlusive dressing for sucking chest wounds; and
• Use of the incredibly versatile “Israeli Battle Dressing” (IBD) to apply pressure to wounds, immobilize limbs, etc.

For those who are unfamiliar with the IBD, it is a combination wound dressing, elastic bandage, and tourniquet. Because of its unique design features, it can be used in place of a variety of other items (separate dressings and bandages, etc.). In addition, it can be applied very quickly and efficiently, even with one hand when necessary. Increasing or decreasing the amount of compression is simple and does not require removal of the elastic bandage to do so. I admit that when I first learned about the IBD last year that I initially dismissed it as a “gimmick.” Now that I’ve seen it demonstrated and learned to use it with my own hands, I am a believer that it is an essential part of anyone’s personal or range first kit.

After a demonstration of the proper application of IBD and its many uses, the class worked in pairs, applying the IBD to each other in several different configurations. Using the IBD on arms, legs, and torsos was straightforward, but applying it to neck or head wounds required some simple but interesting configurations, as demonstrated by Doc Gunn. In addition, he showed us how to immobilize a limb (such as for an injured shoulder), as the IBD can also work in lieu of an Ace® bandage, with or without a penetrating injury.

The final exercise of the class brought all of the day’s concepts and ideas together into one scenario. Working again with partners, the students were faced with two threat targets down range. While issuing verbal challenges and then engaging the threats, a “tactical sock” was thrown at one of the two, which was the sign that they’d been “hit” by a bullet. Both students continued to move and engage the threats until the signal to stop. At that point, both reloaded and the injured party declared their status to their partner. While maintaining situational awareness, both went to the ground, where the injured partner kept their weapon trained forward from a prone position to cover the downrange direction and engage any threats. The other partner holstered their weapon (prior to getting on the ground) and while applying the IBD to the injury, also maintained vigilance over the uprange direction. At another signal, the wounded partner resumed engaging the threats downrange. During all of this, constant communication between the two was required, both to update status of threats as well as to assess the alertness and condition of the partner who was shot. After successfully applying the IBD, the uninjured partner helped their wounded comrade to their feet.

The exercise focused on:

• Situational awareness before, during, and after the fight;
• Defensive movement;
• Accurate shooting;
• Communication;
• The necessity of staying in the fight and eliminating threats before tending to injuries; and
• Application of the IBD under the stress of the scenario.


The class concluded with some final remarks and distribution of certificates of completion.

Overall, it was an excellent class and Doc Gunn is a great source of knowledge and experience. In addition to the simple yet effective new skills I have, which I can now teach to others, I also have a much better understanding of what my clubs need to incorporate into their respective emergency plans. Hopefully I’ll never have to use anything I learned in the class, but if the need arises, I am far better prepared than I was before, as will be two shooting clubs in central Indiana. I recommend both Doc Gunn dtirnk@yahoo.com and his class without reservation.

Odd Job
September 4, 2006, 11:53 AM
Great report!
Sounds like a good course, all the information is solid.

rhino
September 4, 2006, 12:11 PM
Thanks!

Coincidentally, I just finished my draft of a safety plan outline for two of my shooting clubs.

Pacer
September 4, 2006, 12:11 PM
One small correction (I believe).

Your comment re: "nasal cannula" to maintain airway patency, should read "nasal airway" or more accurately "Naso-pharyngeal airway", which is in fact a "cannula" or tube placed in the nose to lie behind the tongue.

That is what Farnum (DTI) demonstrated in his brief discussion during a "basic defensive handgun" course touting the tactical treatment of gunshot prepacked kit.

In strict medical circles, a "nasal cannula" is a device with two prongs used to administer oxygen,a nd will do nothing to preserve an open airway.

Pacer, DO
(ret emergency phyisician)

rhino
September 4, 2006, 12:35 PM
Thanks for the correction, Pacer! I appreciate the input. I'm pretty sure I used "nasal airway" in my note and outline, but I'll check to make sure.

It's just as easy to get it right as it is to ... not.

KSFreeman
September 4, 2006, 03:18 PM
Not one comment about me and my snazzy outfit and gear?:p

rhino
September 4, 2006, 09:19 PM
KSF ... I didn't want to make the other kids envious because they couldn't see for themselves. You do cut a dashing figure in your bandana, smartly tied about your neck. Again, only a man of your breeding and intellect could make a utilitarian piece of neck protection into a statement of fashion and nobility. :p