The Scary Reality of Casualty Evacuation to a higher level of care:
You see it on Medical Survival and S.H.T.F. blogs often; Preppers with little to no medical knowledge or experience asking how to cut holes in peoples necks to breathe for them, push antibiotics and intravenous fluids they don't know about, and throw in a chest tube by cutting a hole in their thoracic cavity. What if a wrong intervention is performed, or the right one but the wrong time and now the patient is worse? Would you want someone who has never done that before to do it to you? In a life or death situation during a collapse, you may say yes as a last ditch effort. I'm not writing about not learning medical interventions as I love teaching medicine, and am one of the instructors for CAG. I'm going to explain why we should first consider alternate routes to give our patients the best chance that you could give them. Those routes are having a dedicated medical professional in the group as well as having a plan to get them to the nearest medical professional, whether that is a hospital, medical tent, volunteer center or a friendly Doc you've networked with down the road.
Acquiring a Dedicated Medical Professional:
I will start off this section by saying that I don't think medical people are capable of something you are not... as long as you have the training. That being said, finding a like minded medical provider could be difficult to get started, but infinitely worth the rewards. While having a full-blown Doctor or Special Forces Medic would be optimal, don't discount a Nurse, Paramedic, or even specialties like Dental Tech. A Medical Professional is not measured solely by their title but in my opinion by their passion and willingness to learn in order to remain competent. Having a Doc will be able to help you in a situation where medical care is not available, but if they like to teach and you are eager to learn, they will more importantly cross-train the group so you can all be "mini-medics", much akin to the Tactical Combat Casualty Care (TCCC) program where Medics train ALL their non-medical platoon mates on what to do if they are not around or get hurt.
An added bonus, is if the region you are in is unstable for long enough, the medical professional in your group could provide services to other locals for bartering, depending on their skill level. If it is a natural disaster, you could assist them in volunteering to help the affected area while learning along the way. Simply put, a dedicated Doc can provide more in-depth medical care by not just knowing "How To", but know "Why." You can be taught to treat a thousand wounds, but if you come across a wound you've never encountered, you won't be able to manage it unless you know how and why the anatomy, injury and intervention work. That is critical thinking.
"We simply can't find a Medical Provider"
Finding a "prepper" minded medical professional before-hand is an ongoing process... So why not become one? I recommend to everyone, preparedness minded or not, (especially if they have children) to take a First Aid/CPR class. Inexpensive, Quick, Simple and a good way to get your foot in the door. Not only will this let you know if medicine could be your forte or your kryptonite, but you can benefit more than just your group through what you have learned. CPR/First Aid looks good on a resume before an emergency and could come up in day to day life. From that entry level you could go on to CNA, EMT, or even volunteer with your local firefighters to work first hand with paramedics and those who handle wounded individuals often. From First Responders you can see how calm you should act in a medical situation and grow from that, while helping the community and making friends you could possibly turn into fellow Emergency Action Group members down the road.
I've treated the casualty to the best of my abilities...but 911 is simply not coming:
This is one of the most commonly neglected areas of most preppers medical plans. I see that they want to learn interventions far above their skill set because a Doctor is never coming... Wait, Come again? Where did all these Doctors go, did they get raptured away and disappear out of thin air?
My point is: There will always be medical pro's. Just because finances, governments, resources, electricity and all else collapses, they won't disappear. There have been Doctors who operated without electricity since the olden days, that knowledge won't simply dissipate. Even in Katrina there were volunteer tents and triage centers when the Hospitals were overloaded or non-operational. It would have to be a very specific situation for there to be 0% chance for your patient to see the next echelon of care. The truth can be much more difficult, but the chaos of it can be managed by training: Medical Evacuation.
Set a P.A.C.E. Plan (Primary, Alternate,Contingency, Emergency), Which is a fancy acronym meaning, "If Plan A Fails, Go to Plan B. If B Fails, Go to C, etc." You'll need to designate vehicles such as trucks, quads or even that tractor-trailer, to having to walk with a litter or SKEDCO dragging them behind you. Make sure to also ration and set aside fuel only to be used for hospital trips.
Know where the nearest hospitals are, their type, your route to get there and every different way route with maps. The distance to your regions medical facilities matter so you can plan how long it takes with different methods to get there, xx minutes by car, xx minutes by ATV, and xx minutes by foot, for example. After that has been loosely calculated, you can road trip there with your group for a get together.If you were to have a member of your group get severely injured, how many of your group will escort him? How many will stay back to manage the property? How do you communicate if the towers are down? Which vehicle stays, which goes? When do you expect them back if you don't have communications/radio? This possible logistics nightmare are all to be planned and walked through in a rehearsal. This is also where you make strip maps. You may know where the nearest hospital is and scoff at this paragraph but I ask you to ponder if you are the one that is injured and someone else is unfamiliar, a major road is closed or blocked by traffic, weather or debris, or you show up and the hospital is over run with a mass casualty. you may have a problem. Finally, knowing whether a hospital is a level 1 or 3, A Pediatric hospital or a volunteer clinic set up after a catastrophe can make sure your time is best utilized making sure your patient has the best chance you can get. This is a good habit to establish even if you have yet to join an Emergency Action Group, or moved to a new place.
Additionally, How do you prove you can receive medical care, or can pay for it? You'll want to bring what you'll need to receive medical care, and more. If you can prove you have medical insurance and cash, that may work. If the grid and financial low is far beyond that leisure, make sure to bring what you will need to barter for this medical care. Gold, Food, or others measures. This can be set aside with the emergency fuel explicitly to be used only for the Casualties evacuation.
In summary, You can see how a casualty can be a culmination of all a preppers skills and resources. You'll need to put your first aid skills to the test, stay calm to recognize if he needs more medical attention or not when you fall back on prior training during a moment of stress. You will execute a plan and three more back up plans with maps to get him or her on their way to someone who knows more medicine and account for setbacks. You may need to barter for care while you are there and use your communication set up to communicate back to your main location if you will have an extended stay. Keep learning austere/survival medicine, but also continue to account for ways you can provide them quality treatment if needed. I hope you gathered multiple thinking points to discuss with your Emergency Action Group. Most of these can be planned and talked over for the low cost of printed paper.
I 100% believe in what Austere Medicine is capable of. A handful of years ago I was a young medic in charge of the medical care for dozens of men for the first time on a remote outpost that was over 100 miles away from the nearest medical center. If the weather was too poor for a Blackhawk helicopter to get off the ground, or they were busy evacuating trauma casualties in another region to divert assets, I was all that there was. I learned that while controlling hemorrhage is the cool meat and potatoes of trauma, I needed to learn all aspects of medicine and dive into books to truly take care of my peers. I've managed broken bones, heart attacks and other medical emergencies at a time where if I made the wrong call and underestimated it, my patient would die, but if I called a MEDEVAC for someone who did not need it, I would be taking up the resources from the battlefield that really needed it. I've taught these lessons to U.S. Regular Army and Special Operations soldiers, to NATO soldiers and local Afghan Military and Police forces. I impart these lessons I learned to you as well, in hopes you can better the medical readiness of your EAG.
[caption id="attachment_200" align="alignright" width="300"] TCCC with CAG[/caption]
Naturally before we begin it needs to be said: CALL 911. However since we are a page dedicated to prepping and crisis management, it stands to reason that in this venue there is no 911 or 911 isn't coming. Either way YOU need to act....
Why start with trauma?
Trauma is universal to every major catastrophe that's hit the US since 1776. Of course we support learning how to shoot and the myriad of other skills required to stay ready, but trauma is statistically proven to be the most likely event you will encounter. Medical skills aren't sexy and tend to be put on the back burner in favor of more glamorous venues. A $2000 assault rifle ISNT going to stop bleeding or manage an airway is it?
We get it, medical supplies are expensive and there is an army of "practitioners" who want to keep control over medicine, but that isn't going to cut it for a prepper.
What medical program should look into?
There are dozens of good programs out there and they all will be great additions to your tool box, but for a prepper nothing can hold a candle to Tactical Combat Casualty Care or TCCC. TCCC was intended to teach a NON TRAINED service members in the military basic life saving skills so you can rest assured your "allowed" to know this. It's also what all of the elite fighting forces use on their teams, this goes for Green Berets, SEALS, PJs, Rangers and so on. Its also designed for an austere venue where evacuation will be delayed or wont be coming at all, again another check in the prepper block.
TCCC is backed with mountains of good data managed by Doctors and senior battlefield medics from across the DoD arsenal, this is a solid program for everyone to know.
If we ignore the word combat and instead use the word austere, all of a sudden this program makes even more sense. Can you give blood? Can you manage a delicate airway? Can you offer definitive surgical repair? Can you manage a collapsed lung? If the answer is no, then your entire trauma strategy needs to change to reflect this reality. It doesn't matter if it's an enemy force denying you evac or an economic collapse, you're on your own...
Where to begin?
Start with the assessment. Look at it like the toolbox, and all of the treatments are the tools. Lets focus todays article on the toolbox.
[caption id="attachment_340" align="alignleft" width="246"] TCCC trauma assessment[/caption]
The TCCC trauma assessment is placed in order of statistic injury patterns that are ranked from the most lethal (short and long-term) to the least lethal. All the "science" you need to know is built into the sequence. When in doubt or you get overwhelmed or lost, just start the assessment sequence over and you'll do fine...
Its easy, just remember MARCHE and treat as you go!
[caption id="attachment_344" align="alignright" width="253"] Bleeding was controlled with a ratchet strap![/caption]
M-Massive Bleeding. Here you are looking for pooling blood or fast bleeding you can see. We don't care if its bright red or not, those days are gone. You can die from losing venous blood also...If its NOT bleeding, skip it we will come back to it later. Ugly wounds are distracting but if they aren't losing blood (for now at least) they aren't a priority during your initial survey.
We need to save as many blood cells and clotting factors as possible and most arteries bleed fast enough to kill you in minutes. This is where TCCC tends to deviate from traditional EMS medicine. EMS hinges on the nearby hospital to manage the internal medicine issues that come with bleeding out like losing the ability to clot and acidosis. Saving as much "clean" blood as possible early on the event will give your patient the best chance at long-term survival when evac may not be coming... Use tourniquets and pack wounds, this is for time so hurry up!
[caption id="attachment_347" align="alignright" width="268"] Simple NPA[/caption]
A-Airway. Concept: Is the air hole open? It doesn't do us any good to make a patient respire if there is no hole to pass air. While we prefer to teach a modified jaw thrust, we don't have a problem with the head tilt/chin lift technique from your CPR training days. In effect, we are temporarily opening their mouth and we asses "how open" it is by LISTENING for them to breathe. Remember, an airway blockage may not visible from a visual inspection, you still have to look listen and feel for air passage. During this initial survey, consider temporary adjuncts like a nasal trumpet (NPA) or a J-tube (OPA), we like using positional airways, aka the "drunk don't puke roll to the side" technique...
[caption id="attachment_349" align="alignright" width="300"] NAR Chest seals[/caption]
R-Respirations. This gets confusing with new providers. When we say respirations we intend to examine the mechanical structures that are required to breathe. Namely the chest. For TCCC purposes the chest is front to BACK, Adams apple to navel. Here you will apply seals as needed and check for any broken ribs that could haunt you down the road. IF a patient has a collapsed lung, you wont really notice any one thing jump out at you, things like deviated tracheas and one sided rise and fall of the chest are late and grave signs, don't wait for those... It will be a combined series of symptoms that we use to direct treatment in the field, but that's another lesson in itself.
[caption id="attachment_351" align="alignright" width="300"] NAR saline lock[/caption]
C-Circulation. Here we will check pulses and other signs of perfusion/circulation, also we will wrap up any other "meat" wounds we skipped over during our initial blood sweep. IF you have the skills and feel the patient could benefit, now's the time to gain IV access, but that's a clinical decision based on your over all patient presentation and skill. Clean up all the boo boos we skipped and anything else we missed.
H-Hypothermia/Head injury. Not much you can do for a head injury other that take note of their level of consciousness. This early on information and the progression of symptoms form this baseline will be invaluable to any Docs that see them later.
[caption id="attachment_354" align="alignright" width="150"] Inexpensive options are out there[/caption]
Always treat for hypothermia. In trauma we aren't as concerned about heart attacks rather its effect on clotting. If you have a patient with internal injuries we want clots, and cold patients don't clot! Even in the summer put a blanket on them. Dead people are cold to the touch, even in summer... Don't look at it like it's a weather issue, look at it like their internal over has been turned off...
E-Evacuation. This is obviously your biggest issue as a prepper, or a commando. If we had this we wouldn't be having this discussion! In all seriousness evacuation may be only be delayed. Don't look at SHTF as the only event you need to worry about. Ice storms and tornadoes could delay your 911 evacuation and TCCC will carry the day until they get here.
Most of the lives saved during the global war on terror are from non trained medical providers using simple adjuncts early on in the patients injury/evac cycle. What I mean is that untrained providers are proving this system works....Numbers don't lie.
CAG also offers a no non sense trauma pack, inventoried by Special Forces medics, with high quality name brand tools to ensure that you have everything you need to your TCCC venue. Clearly labeling in modular cells its designed for the TCCC MARCHE complete with emergency blanket. In addition to the Tier 1 Med Pack we offer the TCCC training to go along with it!
Naturally we recommend taking a class on the subject. Please don't read something online and think you've check the block for medical training. Online programs are great for refresher and developing new strategy, but they simply don't replace the value of hands on skill training with experienced educators. We can recommend a few good online references if you're just interested in getting to know TCCC.
As always thank you and follow us on Facebook@ Crisis Application Group!