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Battlefield Trauma Care – Nashville March 11

Tactical medicine has become a buzzword in the law enforcement community in the past few years… but like many new concepts, it means different things to different people. Depending on who you take the class from and where, the curriculum can vary enormously, and the quality of the instruction can be anything from cutting edge to dull and disinterested.

Tactical Anatomy SystemsTM is offering our basic (4-hr) Battlefield Trauma Care class in conjunction with our Advanced Instructor class in Nashville on March 11. This class was developed over several years taking into account my training and experience as a certified Emergency Physician, EMS Medical Director, and after taking the tactical medicine classes offered by colleagues around the country. I am not too pround to say that as a physician I have learned a huge amount of field medicine from guys with basic medic training who have had to use their training under enemy fire.

The terms "tactical medicine" and "tactical emergency medical services" bug me… I don’t think they really tell the listener/reader what the course or discipline is about. I like "battlefield trauma care" (BTC)  or "combat trauma care" because they speak to the crux of what most of us in the TEMS field are trying to do: train non-medical personnel how to do the necessary things to survive combat trauma during the firefight and immediately thereafter.

So what does Tactical Anatomy ‘s  BTC training consist of? To be honest, it depends on how much time you allot for training, and what the level of skill and training the class has going in. My most basic BTC class is a 4-hour block that covers the basic principles of field treatment of gunshot wounds, edged weapons wounds, and blast trauma, with hands-on practical exercises in using the basic survival tools that every soldier or cop should have on hand in a violent confrontation. If we have a more advanced group with more time, we’ll go into more advanced scenario-based training incorporating simulated wounds and simulated-fire and live-fire environments. 

The next scheduled Battlefield Trauma Care class (4-hr block) on our books will be held in Nashville on March 11, 2009. Tuition is $145 and includes a basic trauma kit for each trainee. Register by clicking the caddy button below and following the instructions (credit card), or if you wish to pay by check or department purchase order, contact me through the "Contact" button on this website and I’ll email you the info you need to sign up.  

{simplecaddy code=BTCNashville}


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A Brush With Death


My commute to work is 48 miles each way. My usual route is on a 2-lane state highway and a couple of 2-lane county roads. Traffic is light and the rural scenery is beautiful.
Two days ago Wisconsin was hit by a snowstorm, and two days prior to that we had freezing rain. The result was atrocious driving conditions, so I decided to skip my usual route and take the alternative, which follows three different 4-lane highways.
Big mistake. The 4-lane roads were no better plowed/salted than my usual 2-lane roads are, and traffic was heavy. Clots of slow-traveling vehicles (30 mph) created as much hazard as the idiots doing 75 mph. I had my cruise control set at 50, which in my vehicle was a safe speed for the conditions.
I had just passed a clot of 3 or 4 vehicles and moved back into the right lane when I came to a highway overpass. As I came over the crest, I was horrified to see a spun-out vehicle stalled in my lane facing oncoming traffic. The steep grade of the overpass had prevented seeing him in time, and I realized I was going to hit him head-on at 50 mph. I pulled the steering wheel to the left and simultaneously hit the brakes, hard, hoping to avoid the inevitable collision. The antilock brake system chattered like an Uzi on full auto, but the Blizzak Snow & Ice tires gripped the road as advertised, and my car pulled into the left lane. I may have brushed the stalled vehicle with my rear bumper, but I didn’t feel an impact. However, the violence of my maneuver put me into a clockwise spin.
A spin at 50 mph on icy roads is no treat. I slid into the concrete median divider butt-first, striking a glancing blow with my right rear quarter, and that impact spun me back across the highway counter-clockwise. I hit the steel guard rail hard (again with my right rear quarter panel). I struggled to get the car pointing the right direction, knowing that if I came to a stop facing any other direction I would almost certainly be hit by one of the following vehicles. I was still doing 30 mph when I got the car under control. I looked into my rearview mirror and was horrified to see three or four vehicles spinning down the overpass toward me, all out of control.
As I hadn’t hit another vehicle, and in my estimation stopping there would almost certainly result in being hit by another out-of-control vehicle, I continued on. I tried to report the accident on my cell phone, but the county dispatch officer asked me to call back later as they were swamped with emergency calls at that time. I did so, and learned that 14 vehicles had crashed as a result of that single spun-out vehicle on the overpass. I was unhurt, but several people had to be transported to the regional trauma center.
The lessons that can be drawn from this incident are potentially life-saving. If you live in the South, you may want to skip this blog. But if you live in country where it snows/freezes, you may want to pay attention.
As and ER doc I have more than passing familiarity with motor vehicle collisions (MVC) and the damage they can do to people. MVCs, which are nearly always accidental or negligent in character, killed 43,667 Americans in 2005 (most recent year full data are available). By contrast, firearms deaths accounted for 30,694 deaths, and the majority of these were suicides and homicides. In the same year approximately 100 law enforcement officers died from gunshot wounds, yet nearly four times as many died in MVCs.
Not surprisingly, winter driving conditions dramatically escalate the number of MVCs. But there are things you can do to reduce the likelihood of being in a crash, and if you do have a wreck, reduce the chance of injury. I’ve been following these steps for years and it’s kept me out of an accident for more than a decade. Two days ago, I believe they likely saved my life.
First: don’t drive a vehicle that is unsafe. Pickup trucks are notoriously unsafe vehicles (as it happens, the stalled vehicle I narrowly avoided hitting was a pickup), and your chance of being killed in a pickup crash are nearly twice as high as if you’re driving a sedan or station wagon. Why is that? Because trucks have a higher center of gravity, and they most of their weight in the front. As a result they are prone to rollover and spinning out of control. Moreover, the legally mandated crash protection standards in passenger cars don’t apply to pickups or SUVs. Fullsize SUVs are, by the way, just as bad as pickup trucks, because they’re built on truck chassis and have the same high center of gravity and poor front-to-back weight distribution. Four-wheel drive and all-wheel drive does NOT make trucks any safer. In fact, they make them less safe because the IBTW (Idiot Behind The Wheel) falsely assumes his/her 4WD will allow faster speeds on slippery roads.
Second: the term “All-Season Radial Tires” is bovine excrement. ASR’s are fine in spring, summer, and fall, but they suck in snow and on ice. Numerous studies have shown that a good Snow-and-Ice (SI) tire will keep you on the road when everybody else is in the ditch or behind a tow truck. SI tires have a more aggressive tread that sheds snow, while ASRs’ treads pack with snow and become effectively “bald”. Moreover, SI tires are made of a softer, stickier rubber compound. This reduces their wear life if driven on warm pavement, but it allows them to stick to icy surfaces. Bridgestone’s Blizzak tires have been my standard winter footwear on all my vehicles for 10 years. In that time none of my vehicles have been in a winter MVC, until this week.
Third: learn to drive in unstable conditions. Various auto clubs provide winter driving courses. Another good option is to take a race driving class, such as the excellent Bob Bondurant courses offered around the country. You’ll learn an awful lot about handling a car in a skid from Bondurant’s instructors.
In my MVC two days ago, I was saved from death or serious injury by these three things. I was driving my Chrysler 300M, which is equipped with Blizzaks, a sport suspension/steering package that makes it far more responsive than most cars and a very good ABS system, and I’ve taken Bondurant’s course. If any of the three had been absent, I’d have hit that pickup and if I hadn’t been killed, my legs would probably be shattered and I would have sustained significant chest, abdomen, or pelvic trauma.
But if I’d been driving my Blizzak-equipped Subaru (which my daughter was using that day), I not only would have avoided the collision, but I would probably have maintained stability and wouldn’t have even hit the guardrail.
As it happens, I’ve been looking into replacing my Chrysler with a Subaru Forester recently. Once I get the bodywork done on the 300, I’m selling it. And next week I’m picking up my new Forester.

Anybody want to buy a Chrysler 300M Special Sport?

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December Ramblings

I apologize for the gap in blog entries since my Thanksgiving post.

So, anyway… Lisa (my webmaster) scrunched my TAS Skull Guy with my favorite Overloaded-AR pic and hung some Christmas lights on it, and I think it looks pretty damn festive! (Nothing like a skeletal zombie with a Santa cap and locked-and-loaded AR to remind you of the Yuletide spirit, right?). Then she hung some falling snowflakes for me. Not too shabby! Only problem is, since we activated my website snowflakes, we’ve had 18 freakin’ inches of snow in East Central Wisconsin!  (Coincidence? …. or psychic phenomenon?)

Yeah, right. This is Wisconsin. It snows here. A LOT. Let’s move on.

Training issues are paramount right now. We are reading a LOT of stuff from people in the Sandbox and in Intel that suggest that there will be terrorist activity inside the CONUS sooner rather than later. Our recent presidential election  has encouraged the Hadjis to believe that our response to terrorism will be muted, if not null and void. Who knows? I will state at the outset that I have zero confidence in Barry Obama’s ability to lead American warriors. Zero.

Anyway, my greatest concern, as always, is training our Good Guys where to place their bullets so they can terminate the fight as early as possible. This is not an academic exercise. I repeat: THIS IS NOT AN ACADEMIC EXERCISE. 

I have been a hunter my entire life. At no time in my hunting career did any of my mentors tell me that it was OK just to wound or cripple an animal. Why not? Because they knew that a crippled or wounded animal would live on and it would be harder to harvest. And while I have limited personal experience in hunting dangerous game (i.e., animals that fight back more often than not unless incapacitated early in the fight), the imperative is clearly to put your quarry down before he puts you down.  Well, guess what. If we train LE/Military personnel to just shoot a Hadji anywhere, as we are apparently doing, we are going to have the same damn problem.

What we have to do is train our people to shoot the "good stuff". It’s not an academic exercise. It’s survival training.

If your survival depends on you killing a moose for your winter’s meat, learning to kill moose is survival training. I learned almost 30 years ago where the vital anatomy is in a bull moose, and that a bull moose will provide more than enough meat for a young family for a year. Such food surplus may make the difference between survival an annihilation. If your survival depends upon you killing the predator before he kills and eats you and your family, that’s an imperative of a higher order.

If your survival depends on dropping Hadjis to the turf, it’s survival training of a different sort, but it’s still survival training.  Either way, you need to learn how to place your shots where they need to go. This is what Tactical Anatomy is all about.

Two weeks ago a gang of lowlife Hadji scum terrorized Bombay, India (sorry, for you politically correct types, that would be Mumbai), wounding and killing hundreds of people. No disrespect intended, but the cops who responded to the call were woefully inadequately equpped to deal with the problem. They lacked the training, the weapons, the ammo, the comms, the… you name it. 

Could that happen here in America? You bet it could. Do we have the means to defeat such attacks? Perhaps. Fewer than 40% of American police patrol cars have rifles in them. From what I am aware, fewer than 10% of American patrol cops have training in fighting with their patrol rifles. And NO ONE is training American cops in any kind of two-man team fighting, the kind of fighting the Bombay cops desperately needed. There are people ready to start that training, and moreover, there are trainers ready to conduct that training.

Learn what you need to learn.

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Thanksgiving 2008

This morning I walked downtown to Kristina’s Cafe for a late breakfast. Late, for me, because I had spent a couple of hours learning the nuances of processing book and target orders through the PayPal feature on the new website. At about 0900 I decided that I’d better get out of the house or my computer screen was going to get a non-standard response of 230 gr JHP through it.

The air was crisp, as it should be in Wisconsin in late November, and I couldn’t help noticing the twinges of pain in my knees as I walked to Kristina’s. My waitress, Tammy, brought me my coffee and a copy of the Milwaukee Journal-Sentinel, which isn’t a bad newspaper for a communist party publication. By the time I’d read the first section I was thoroughly bummed and decided to just concentrate on my steak & eggs and my new copy of American Handgunner.

I left Kristina’s and went to the bank to make my deposits, then walked down to the post office to pick up the handful of mail orders were waiting there, then walked home. I have to admit that at this point I was pretty cranky.  And I’ve got good reason to be cranky.

In the past month, the American people have elected the most avowedly Socialist president in our history. The media is feverishly echoing the Obama Machine’s planted stories about him being the Second Coming of Lincoln (sorry… I’ve read the history of Lincoln’s presidency, and his roughshod abuse of the Constitution, and I’m not all that impressed). Yet I read on Obama’s website that the first thing he wants to do when he sits in the Oval Office is sign a bill that will overthrow any and all state and federal laws limiting abortion. I read that he wants to make the Assault Weapons Ban more Draconian than the Clinton version, and he wants to make it permanent. I read that he wants to create a compulsory national youth workforce that would be funded on a level equal to the level we fund our military (can you say "Hitler Youth and Brownshirts rolled into one", boys and girls? I knew you could).  And I see a Democrat-controlled congress that has no clue how to deal with our nation’s current fiscal crisis throwing taxpayer money that hasn’t even been collected yet around like blood in a slaughterhouse. Our nation’s economic lifeblood.

Over and above all this are burdens I must bear that I will not share on a public forum, but which have been and continue to be very hard. I am NOT whining. But these burdens are real and sometimes crushing, and it takes no small amount of  discipline at times to keep moving forward. Those of you who know me personally know whereof I speak.

Anyway, about halfway home, walking up the gentle hill to my house, something made me take notice. I won’t speculate, but it wasn’t just idle thought. I suddenly became aware that I was walking home. It’s only about 5 blocks from the post office to my house, but 2 years ago there was no way I could cover that ground on my own two legs. Some folks may take being able to walk 5 blocks for granted, but not me!

All my life I’ve been an active guy. I am not an athlete, but that doesn’t mean I haven’t tried to be one. And I’ve succeeded to a modest degree in a few sports: football, rugby and freestyle skiing as a young man, then basketball for many years in my middle years. But 5 years ago I blew out what little remained of one of my ACL’s, and the downward spiral started. It took 4 years to finally get all the surgeries done… the last one was January of 2007, a right total knee. In the intervening time I’ve begun to walk again, something I used to take for granted.

So this morning when I trudged up the hill to come home, it struck me that today, the day before Thanksgiving 2008, I have a lot more to be thankful for than I have to be fearful of.

I have a good job (I like being an ER doc) in a good hospital. I have a good family: a smart and loving wife of 30-odd years who sees the details I tend to gloss over; two loving and loyal daughters and a stalwart son, three good sisters and a brother and all those good nieces and nephews. A brother-in-law who is dearer to me than any man on the planet, smarter than me by a damn sight, and my best advisor. I live in a lovely small town miles from any Interstate, and a good long way from any big city. I have a good local gun club where I have good friends who share my love of shooting and hunting. I have a wonderful local police department that does a damn good job of making our town a safe place to go for late-night dog-walks. I belong to a church that provides the spiritual support I need on a level that most people who don’t do what I do and teach what I teach wouldn’t be able to comprehend, and my pastor, Father Bob, thinks what I do and teach is rock solid. I have forged a network of people who support me and care about me and what I do. I have forged a snail-mail relationship with my two United States Senators (one good, one not-so-good) and my Representative, and despite the fact that the guy I didn’t want to get into the Oval Office did in fact succeed, I thank God that I live in a nation where that Office is still only accessible by the Will of the People.  And I have my eccentric Tactical Anatomy training business that seems to be beginning to appeal to people.

So, tonight, the eve of Thanksgiving, this most uniquely American of holidays, I find myself  profoundly grateful for the good things that have been granted to me.

Happy Thanksgiving to you all, and may God Bless America.

Especially now.