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Posted: 6/23/2015 2:07:17 PM EDT







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The "Stan FAK" I was wearing on my gunbelt at the time of the incident.  Israeli Bandage shown.




7 June 2015 Burro Canyon Gunshot Wound Incident After Action Report




*This after action report is for one primary purpose; for the betterment of the firearms training community and serve as a guide for best practices for other trainers, range officers, RSOs and anyone hosting a range to improve or maintain their emergency action plans and standards.  This is NOT an invitation to debate about holster styles, the four safety rules, unholstering/holstering techniques or denigrate the wounded (as my actions in this are only as a first responder.)




*On Sunday 7 June 2015 at approximately 2:30pm I had just given a brief on the Tueller Drill, my RSO Enrique added to the lesson when I heard the sound of a single gun shot and then the distinct sound of a man in pain from the adjacent range to our own.  I quickly walked over past the edge of the berm blocking my view and saw a man checking his abdominal area, I asked what happened and he responded that he had shot himself.  At that point I ran over to the patient and the following occurred.




*Patient was 30ish year old male.

*Had the patient lay down to better triage his wounds.

*Had the patient’s legs elevated by another member of party.

*The patient’s shirt was raised exposing the entry wound on the lower abdomen then lowered the patient’s pants completely exposing the exit wound on the bottom portion of his scrotum.  Patient’s scrotum was bloody but from my best observation there did not appear to be an arterial injury fortunately.

*Decided that an Israeli Bandage (from the FAK on my gunbelt) was the best course of action.  The wrapper of the bandage is designed to be tough for protection from the elements, I found with the blue nitrile gloves on it was difficult to tear open (they kept slipping)  so without hesitation I used a pair of shears to open it up.  There is second plastic wrapper on the inside and that needed to be cut open as well.

*Applied Israeli Bandage to the scrotum, weaving the loose ends of the straps through the built in pressure applicator to press down on the wound.

*The entry wound was much smaller and appeared less serious, for that one I used a simple adhesive bandage to keep dirt and sweat out.

*I heard someone mention the word "ambulance” and I highly suggested they simply drive him directly to the hospital because the range sits on top of a mountain range and is at least 30 minutes from town.  Someone from the patient’s party drove him to the hospital immediately thereafter.




Suggested Practices:

Briefing of the four firearms safety rules is of course a given, after that the first aid/gun shot wound treatment and medical evacuation plan should be thoroughly briefed as if an emergency incident had already happened to you.  




First Aid/Gun Shot Wound Kit:

1.Multi-purpose battle dressing/pressure bandage/Israeli Bandage for most wounds.

2.Hemostatic agent like Quikclot Combat Gauze or Z-fold for more severe hemorrhaging.

3.CAT or SOFTT Tourniquet for severe hemorrhaging to the extremities.

4.Chest seals for sucking chest wounds. Halo Chest Seals set the standard.

5.Shears: Not just for cutting clothing but tearing open foil and plastic can be challenging with gloves on.




Someone should be able to brief all of the above in detail.  That someone should be with the party from the beginning to the end.  I think it’s acceptable to have the GSW kit centralized but extra credit points for wearing it.




The Medical Evacuation (MEDEVAC) Plan




Reverse plan: from the hospital how did the patient get there? In which vehicle?  Who drove?  How did they know how to get there?




*Thus, there should be at least one designated ambulance.

*Driver designated, preferably someone who knows the area.

*Keys will be on the dashboard or in the ignition.

*Google or Yahoo map from point A (the range) to point B (the nearest hospital with a 24 hour emergency room).  Ensure it is not a convalescent home or veterinarian!

*Parked in a manner with an easy egress route.







*I got a lot of kudos for this but I return all the compliments to US Navy Field Medicine.




Respectfully Submitted,




Stan



Link Posted: 6/23/2015 2:12:05 PM EDT
[#1]
To reiterate:



*Type of holster, carry etc. irrelevant to me as I was a first responder not the patients trainer.

*Reason for private movement vs ambulance: Range is on top of a mountain 30 minutes from town.  Ambulance = 1 hour round trip.

*All trainers and RSOs should have a GSW kit either on them or centralized.

*MEDEVAC plan should be briefed in bleeding detail, the range/class/group "medic" needs to be there from start to finish, no exceptions.
Link Posted: 6/23/2015 2:21:41 PM EDT
[#2]

Discussion ForumsJump to Quoted PostQuote History
Quoted:


To reiterate:



*Type of holster, carry etc. irrelevant to me as I was a first responder not the patients trainer.

*Reason for private movement vs ambulance: Range is on top of a mountain 30 minutes from town.  Ambulance = 1 hour round trip.

*All trainers and RSOs should have a GSW kit either on them or centralized.

*MEDEVAC plan should be briefed in bleeding detail, the range/class/group "medic" needs to be there from start to finish, no exceptions.

View Quote
The range I go to is basically a guaranteed MedFlight ride after a GSW.

 



There also isn't good if any cell phone coverage there (in a valley) so just getting help is going to the ranger station or climbing up the hill (in car or on foot) to make a connection.




I carry an Israeli bandage as well as a basic med kit. (No quick clot though.)




==========




You didn't see a holster or hear about what he was doing to shoot himself?
Link Posted: 6/23/2015 2:33:50 PM EDT
[#3]
Good on you, but calling off EMS was probably dumb.  I worked that area for many years.  Now, if the patient made the call to go on his own, and you have witnesses, then ignore the rest.

AMR (do they still have the contract?) could have met him with LA Co. FD coming off the access road.

Mercy Air migt have flown there direct amd got him out sooner.

Where the heck did his friends take him?  There is a reason that we have trauma centers in SoCal.  Did he go to Huntington Memorial (20 minutrs from the freeway, without traffic), or some other little ER along the way that had one doc, three nurses, no on call surgeon?

Your "patient" bleeds out on the drive down.  His friends say "well the paramedic said to drive him..."  Any actual level of training is suddenly irrelevant when the police come to talk to you.  If you truly have no stamdardized medical training you may be off the hook, but if you do, then you may have to worry about patient abandonment issues.

Link Posted: 6/23/2015 2:44:13 PM EDT
[#4]
He got off light. Good job reacting, and addressing those wounds. Having a evac plan is now one of my musts.



Good write up.
Link Posted: 6/23/2015 3:17:03 PM EDT
[#5]
Your kit is kind-of light.  I suggest buying one of the more complete Larue or CavArms kits and supplementing it.  

One pair of gloves is not enough and there are good ones and bad ones.  You need the needle resistant 4 mil gloves, several pairs.  One set for you, one for the first one that rips, and one set for a helper.  

Celox bandages and applicators.  Think "blow out" kit.  

The Larue kit comes with a tourniquet that can be applied with one hand.  This could end up being very important.

I also added regular bandages, several kinds of tape, lip balm, sun screen, insect antihistamines, and a bunch of other items that slip my mind.  

I keep this kit in my truck and try to put it in any vehicle I am taking on a trip or to the range.  

Link Posted: 6/23/2015 3:29:10 PM EDT
[#6]


Discussion ForumsJump to Quoted PostQuote History
Quoted:



Your kit is kind-of light.  I suggest buying one of the more complete Larue or CavArms kits and supplementing it.  





One pair of gloves is not enough and there are good ones and bad ones.  You need the needle resistant 4 mil gloves, several pairs.  One set for you, one for the first one that rips, and one set for a helper.  





Celox bandages and applicators.  Think "blow out" kit.  





The Larue kit comes with a tourniquet that can be applied with one hand.  This could end up being very important.





I also added regular bandages, several kinds of tape, lip balm, sun screen, insect antihistamines, and a bunch of other items that slip my mind.  





I keep this kit in my truck and try to put it in any vehicle I am taking on a trip or to the range.  





View Quote
Thanks for the tip, On second thought after comparing  LaRue's and CavArms kits, my Stan FAK includes a USGI-issue PMI Halo Chest Seal for sucking chest wounds which IIRC LaRue's do not.  Mine has USGI issue Quikclot Combat Gauze vs Celox.  Both the CAT and the SOFTT are one hand usable.  Mine comes with the SOF issued SOFTT-W.  IIRC none of cav arms are military adopted.  So thus the Stan FAK is more a blow out kit, with less clutter than some others mentioned; so I'm not sure where you are coming from.



We're talking about two different things; a GSW kit which ideally should be on you at all times at the range and a general purpose first aid kit.





The misc stuff like lip balm, sun screen etc. do not belong in a GSW kit and can go in your general first aid kit.





I also have a general/community FAK bag centralized that duplicates and exceeds the same capabilities.

 





Also, you do realize that the great majority of trainers, groups, dudes "shoot'n shit"  on any given weekend at the range probably have some band aids and tape as their first aid kit (if anything at all)?  Most probably don't have a MEDEVAC plan.


 
Link Posted: 6/23/2015 3:41:00 PM EDT
[#7]



Discussion ForumsJump to Quoted PostQuote History
Quoted:




Good on you, but calling off EMS was probably dumb.  I worked that area for many years.  Now, if the patient made the call to go on his own, and you have witnesses, then ignore the rest.



Range management was in 100% agreement with my actions.
AMR (do they still have the contract?) could have met him with LA Co. FD coming off the access road. Yes, could have done this, should have been in their party's plan).
Mercy Air migt have flown there direct amd got him out sooner.  Range management says anywhere from 15-45 minutes and is a large logistical footprint.   Depends on where Air5 is that time.
Where the heck did his friends take him?  There is a reason that we have trauma centers in SoCal.  Did he go to Huntington Memorial (20 minutrs from the freeway, without traffic), or some other little ER along the way that had one doc, three nurses, no on call surgeon?  
Your "patient" bleeds out on the drive down.  His friends say "well the paramedic said to drive him..."  Any actual level of training is suddenly irrelevant when the police come to talk to you.  If you truly have no stamdardized medical training you may be off the hook, but if you do, then you may have to worry about patient abandonment issues.  OK, in the time we wait for an ambulance the patient can bleed out and die as well.  Also, to avoid legal entanglements I could have just as easily crossed my arms and said "too bad for him" and let his friends figure something out. He could have died and then rose from the grave. So I don't get the "what if ing". A lot of things could have happened but he lived and was released from the hospital the next day.
View Quote View All Quotes
View All Quotes
Discussion ForumsJump to Quoted PostQuote History
Quoted:




Good on you, but calling off EMS was probably dumb.  I worked that area for many years.  Now, if the patient made the call to go on his own, and you have witnesses, then ignore the rest.



Range management was in 100% agreement with my actions.
AMR (do they still have the contract?) could have met him with LA Co. FD coming off the access road. Yes, could have done this, should have been in their party's plan).
Mercy Air migt have flown there direct amd got him out sooner.  Range management says anywhere from 15-45 minutes and is a large logistical footprint.   Depends on where Air5 is that time.
Where the heck did his friends take him?  There is a reason that we have trauma centers in SoCal.  Did he go to Huntington Memorial (20 minutrs from the freeway, without traffic), or some other little ER along the way that had one doc, three nurses, no on call surgeon?  
Your "patient" bleeds out on the drive down.  His friends say "well the paramedic said to drive him..."  Any actual level of training is suddenly irrelevant when the police come to talk to you.  If you truly have no stamdardized medical training you may be off the hook, but if you do, then you may have to worry about patient abandonment issues.  OK, in the time we wait for an ambulance the patient can bleed out and die as well.  Also, to avoid legal entanglements I could have just as easily crossed my arms and said "too bad for him" and let his friends figure something out. He could have died and then rose from the grave. So I don't get the "what if ing". A lot of things could have happened but he lived and was released from the hospital the next day.





 
Link Posted: 7/1/2015 11:55:42 PM EDT
[#8]
As said before, you did abandon the patient.  You should have rode with him. Once you put hands on and start care you are committed to the patient until they die, you are too physically exhausted to continue (CPR), or someone with equal or higher training relieves you. Best option would have been to call EMS and meet them in route.  I would add some compressed gauze to your kit for areas that cannot be addressed with an Israeli.  Good on you for responding though.
Link Posted: 7/2/2015 6:12:49 PM EDT
[#9]
100% success in my opinion.
Link Posted: 7/6/2015 9:00:27 AM EDT
[#10]
Good for you in stepping up... my thoughts on calling EMS... why not? At least the wheels could be in motion... the car used to transport the patient could have got a flat tire, took a shit, or the driver could have had an accident/or got stuck (due to being excited, scared, or in too big a hurry). It's better to have things in motion than trying to get them in motion later. Again, good on you for stepping up... thanks for the AAR.

At my place... the grid coordinates are posted in the class, GSW kit is on hand, and two students are pre-identified to respond to the gate to flag/direct EMS in (if one of these students are the subject injured, the other grabs the first person they see)... all this is covered BEFORE and DURING class and is part of the emergency response plan. I send two students to the entrance just in case multiple EMS units respond.
Link Posted: 7/8/2015 12:38:52 PM EDT
[#11]
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