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Old June 30, 2012, 06:38 PM   #1
Rob Pincus
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Shooter puts a Round Through His Foot... What do you do NEXT?

Last Week, I uploaded a video showing a simulation of a student shooting their foot during a class... and it generated a lot of conversation on the inter-web. In this week's PDN Tour Update, you'll see the WHOLE Simulation and hear the suggestions we have for what you should do if this ever happens when you're on the range:

"Student Shoots Foot" Teaser

PDN Tour Update #10: Emergency Response to Gun Shot Wound


-RJP
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Old June 30, 2012, 07:37 PM   #2
mete
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Simulation ? Recently a hunter in Africa shot himself in the foot -- with a .500 NE !! Don't rest you gun on your foot.
In another forum, doctors said one of the biggest problems in being shot is shock -that must be looked for and treated.
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Old June 30, 2012, 07:49 PM   #3
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Traditionally trap shooters rest the barrel of their gun on their toe. There are even special things to buy to put on your laces to hold the barrel.

I cringe everytime I see it!
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Old June 30, 2012, 08:01 PM   #4
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Hmmm. Judging by some of those videos, the first thing anyone does is start talking, and talking, and talking, and talking, while the vic bleeds to death.

Good show.

How about: shut up, put a tourniquet on the leg, and call 911.

Jim
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Old June 30, 2012, 09:44 PM   #5
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I'm an old trauma nurse. 20+ yrs experience, who knows how many gsw's I've seen. The guy on the video was (if you'll forgive the pun) right on target. The people he talked to knew what they were doing.

Some points to make clear. A tourniquet is for one thing, to save a life that would bleed away without it. It is a dangerous tool and and should be used knowing that cutting off the circulation could cause loss of limb. Is it a choice between losing the limb and death should be your question. Thats a very tough call for a panicing amatuer. Getting professional help ASAP should be your highest priority.

Check how much blood he is actually losing! I can't emphasize this enough. As someone who has had to draw blood out of foot veins at 3AM these are TINY blood vessels (there were only three or four of us who would even try to put a needle in these things). Just in case you were curious long time drug users quite often ruined every other vein and this was a last ditch thing. He might very well have only hit small vessels and just be oozing blood. On the other hand if you hit them right hands and feet bleed profusely. Don't fly off the handle until you know!
+1 on the video, good advice, would love to see it involved in firearms training programs.
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Old June 30, 2012, 10:05 PM   #6
Rob Pincus
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James K, did you actually watch the second video??? In the simulation, the medic barely says anything... other than occasionally encouraging the patient, he asks for help holding a dressing in place and then he reminds us to clear a path for the ambulance. Not much talking.


***

Thanks for your thoughts, Scrub... that is why we just "staged" the tourniquet in the vid!
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Old June 30, 2012, 10:21 PM   #7
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Rob,

Great stuff, as always.

One thing I'd like to share is something that we do. Everyone who comes onto our range, whether instructor, RSO, student, etc. is required to wear a neck lanyard. At the start of class, the student fills out a small sheet of paper with their name, emergency contact, and any medical issues. That paper goes into a plastic sleeve on the lanyard.

There is a second, laminated card that is on the lanyard. One side has the 4 basic rules of firearms safety. The flip side of the card has instructions for a medical emergency, such as call 911, provide whatever care you can, etc. and most importantly, the street address of the range. I can promise you that halfway through a class, no one will remember the address of the range. It may be a student calling 911 in the event of an emergency, and knowing where you are is crucial when seconds count.

I hope that others will copy this idea.

Jim
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Old June 30, 2012, 10:23 PM   #8
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I've given first aid twice in serious car accidents. One when a car got broadsided on Easter Sunday about 6 cars up ahead of me. Anther time when a car left the road and night and stuck a tree (both guys in the car injured.) And once in a karate tournament gave first aid to one competitor who got knocked out (thanking my stars it was not ME that got it!) So with the learning curve my first aid kit in the car got bigger and bigger!

I also taught Texas P&W hunter safety courses. They would send me a list of investigated accidents related to hunting every year. Quite a few would rest their guns muzzle on their foot and play with the triggers (with obvious results.) .22s were not so bad but a few fired shotguns through their feet.

And my learning curve went up some more and the first aid kit got even bigger.

What to do if a AD/ND on the range and someone ventilated?

Well I figured out to keep quick clot bandages in my car's first aid kit. Got both civilian QC bandages and Israeli BDs with quick clot in them. Add regular bandages, tourniquets, some disinfectant, and of course cell phone. Did this so when I went to training classes I aways had the means to give first aid to gunshot victims while getting the ERT to come.

So far never had to us them, and that's ok with me.

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Old July 2, 2012, 06:39 PM   #9
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Thanks Rob, the use of the tourniquet was set up perfectly, I was really trying to get people to focus on it.
Feet are funny things,everybody seems to want to stick sharp objects into them or crush them. Farms seem particularly hostile to them. I've seen injuries to them that included large holes and nearly no blood loss or nerve damage. Sometimes small holes had the opposite happen.

Back in the day( we won't discuss how long ago) tourniqueting was SOP, every old timer immediately defaulted to doing it. We lost limbs we shouldn't have in the most horrifying and painful manner. Blood loss leading to gangrene leading to amputation. The reason I mentioned it is this.

Effective training sticks in your head, even if it's wrong. As nurses we constantly had to abandon what we were taught and learn better methods. We didn't do it easily or half the time willingly and we were Pro's. Think about all the changes in how we have done CPR over the years. When we are in a critical situation the old ways give us comfort in the middle of chaos. CPR recertification was periodically required just because of this.

If you have the opportunity attend a red cross CPR/first aid class, even if you have before. Here is the link http://www.redcross.org/portal/site/...0089f0870aRCRD

As I was looking this up I found out they now have an iphone/android app! I'm downloading it now, I'll report in on it's effectiveness. Maybe this old dog has one new trick left
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Old July 2, 2012, 07:11 PM   #10
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Get the App. It's mostly simple but when you are rattled simpler is better. Some good skull sweat went into this app. It simple enough even a grade school kid can use it, If I had kids that age I'd be putting it on their phones ASAP. It leads you step by step through the right actions, even has little video's and is set up so you can call 911 off of the instruction screens. Some good work there.
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Old July 2, 2012, 08:48 PM   #11
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I did not get to watch the video due to slow connection, and an old computer. I can say on the ranges I have been around no one has shot themselves with a fire arm. Now I have had to use needle nosed pliers to get fingers, and thumbs off of target boards when the person was in a hurry, and click, crunch, owwwww.
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Old July 2, 2012, 11:18 PM   #12
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Old July 2, 2012, 11:57 PM   #13
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Call 911. Direct pressure, elevate the wound, check for shock. Wait for the medics.
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Old July 3, 2012, 12:52 AM   #14
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I suppose getting the weapon pointed in a safe direction then making it safe might be a good first step.

Assuming the shooter is wearing boots,it might matter how much blood is coming out of the boot.

Assuming bones are broken,ripping a boot off may start bleed that was not happening yet.The boot and sock might be as good as anything for stabilizing till the pros arrive if there is not serious bleeding.

Each situation will be different.

Its better to not shoot the foot.

Last edited by HiBC; July 3, 2012 at 01:13 AM.
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Old July 3, 2012, 04:08 AM   #15
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Get him to the hospital - and step on it!
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Old July 3, 2012, 07:36 AM   #16
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A few MAJOR points for EMS response.
Always wear gloves. Mr Pincus touched the wound area not wearing gloves. Possibly exposing himself to blood borne contamination and possibly putting contamination on the wound from his hands.
Tourniquet - Mr Pincus mentioned using it for bleed through of the bandages. This is wrong. You place more bandage over the wound and continue to apply direct pressure with bleed through. He did get it semi-right when he talked about artery spray.
The only time to use a tourniquet is when direct pressure fails and the tourniquet is a last resort. One guy mentioned the old days and tourniquet misuse. That must have been a real long time ago because I have been trained in first-aid since 1975.

Buzzcock made the best general response for rendering immediate aid.

The high points - informing EMS that this is accidental. His comments about LEO's response were right on.
I like the quick response bag ideal, but such a thing needs to be in a sealed bag due to weather. It could also have a pen or marker and sheets of paper in it.As well as a couple pf pairs of surgical or Nirile gloves.

Most importantly. If you have not had at least an 8 hour class on first aid get one. And take a refresher every few years or expand your skills as you go.
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Old July 3, 2012, 08:05 AM   #17
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+1 to the post just above this one about taking first aid class. I took an EMT class in college. I changed my career path but the information I learned in the class is great. I could not put a price on it.

Take CPR to assuming it is not part of your first aid class. They are usually combined into two.
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Old July 3, 2012, 08:21 AM   #18
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It took fourteen posts before someone said to make the gun safe.
You don't need two, or more, people hurt.
Make the gun safe then tend to the victum.
These days, with cell phones everywhere, holler at someone to call 911.
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Old July 3, 2012, 09:02 AM   #19
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Never treated a gunshot wound. Have treated several wounds caused by explosions and shrapnel.

The most effective method of stopping/controlling bleeding i have found is rolls of Kerelex (5"wide). Place one on the wound, in the case of a full penetration one on each hole. Take a third and wrap it as tight as possible around the limb and the Kerelex.

A less expensive, but equally effective, alternative is Kotex (unscented) pads and an ace bandage.

The pads are sanitary though not sterile they are highly absorbent and cause clouting. The ace bandage will apply effective pressure.

Off subject but in the same vein. Burns are a serious threat to us as many engage in camping and other outdoor activities. One of the best methods for treating a major burn is to apply foamy unscented shaving creme. The foam seals the burn cools the area and protect it from infection.

When the burn victim arrives at the hospital they simply wash it off.
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Old July 3, 2012, 09:07 AM   #20
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Another question to go along with Rob's, (no hijack intended, it's in the same spirit of the original post):

How many folks actually keep an IFAK/BOK with their range gear, just in case someone has a blow out? If you do, are you trained to use everything in the kit?

I know I've been overly lax about carrying a kit with me, and need to do a better job of it.


Quote:
These days, with cell phones everywhere, holler at someone to call 911.
That brings up another good point. When I did my Red Cross first aid training, the instructor made an excellent point about that:

People generally don't want to get involved unless they are "put on the spot," so to speak. If you need to get someone else to call 911 for you, don't just yell "someone call 911," because there's a good chance no one will call, because everyone is thinking someone else will do it. Tell one person, specifically, to call, and make sure they are able to pass along the pertinent info. Make eye contact, and be sure they know you are talking to them specifically.


Jason
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Old July 3, 2012, 09:48 AM   #21
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Quote:
People generally don't want to get involved unless they are "put on the spot," so to speak. If you need to get someone else to call 911 for you, don't just yell "someone call 911," because there's a good chance no one will call, because everyone is thinking someone else will do it. Tell one person, specifically, to call, and make sure they are able to pass along the pertinent info. Make eye contact, and be sure they know you are talking to them specifically.
Very true. When I took my first CPR/First Aid course, it was back before cell phones were commonplace, and the assumption was that if you were out in public, the call to 911 was likely going to be placed using a pay phone or a nearby business phone. We were instructed to tell someone to go call 911 **and then to come right back to the scene**. The rationale was that if they didn't come back, you could pretty much assume that they had just bolted, and that the 911 call probably wasn't made.
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Old July 3, 2012, 10:20 AM   #22
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A friend of mine shot his foot, not sure how it all happened, however, it did and he has phantom pains, and other issues. Being the man I am I would stop shooting and help a fellow shooter out.
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Old July 3, 2012, 02:51 PM   #23
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Old July 3, 2012, 09:03 PM   #24
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take his gun away, the laugh, then get him/her medical assistance. Not realy folks. Getting the person help i dont think would be a problem every cell phone in the class is bound to come out as soon as it happens jamming up 911 lines in the process. To stop the bleeding would have to be the first thing i believe. Knew a guy who shot himself throught the foot because he didnt want to go to school that day once. I still laugh about that one though.
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Old July 6, 2012, 11:17 AM   #25
Vermonter
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Unbelievalbe It could happen to you

Professionals at every level of every sport make mistakes and injure themselves all the time. This could happen to anyone.

Made me think about the location of the first aid kit in the truck. Sure the truck is only a short walk from the firing line but still it would burn 45 seconds at least. I did notice that Rob touched the wound without gloves as well. In the end I think this and videos like it are a great reminder. I just walked outside dug through the tool box and put my first aid kit back on top where it should be. If nothing else take that away from it.

I would like to raise another point regarding communication. The great state of VT is known for its hit or miss cell phone coverage. Where it is wall to wall one second may be non existant the next. I think the reality is that we need to be equipped to deal with an emergency and transport if needed at least to a point where Cell service is achievable.

Regards, Vermonter

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