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View Full Version : Just finished a Army CLS class, Heres the opening video. What would you do?



Stormfeather
06-07-2016, 03:45 AM
So, we went thru a CLS (Combat Lifesaver Class) which is your normal deployment first aid class. The difference with ours, is we get an upgraded version done by former SF medics versus the run of the mill one done by Active Army. They opened up the class showing this video, and asked, what went right, what went wrong?

Take a look, and give me your diagnosis.

WARNING, this aint pretty in no way/shape/form.


https://www.funker530.com/graphic-video-afghan-soldier-steps-on-ied/

Brownwater Riverrat 13
06-09-2016, 05:39 PM
31 views, no replies.......OK, here we go. So they are checking for wires, looks like they just got to that area and are doing a sweep. Comment "Looks like they were pre-staging" the ANA guy walks up says a few words and no one stops him as he walks through. They were obviously getting ready to move forward once they were SURE it was clear, not just there, but out in the distance as well. I'll just call this the unknown factor at this point and straight to the shit. All I kept thinking was AIRWAY!. The guy's helmet cam prevented most of my initial assessment of his head injuries so my head is ducking around my laptop trying to get a better view. Tourniquet, everything gets a "T" nowadays, they hit they limbs immediately. Initial assessment was L leg and arm, Head injury was jaw, teeth blown out, needed to do a sweep, took like what seemed an eternity till I heard the words. I was wondering why they didn't tube him to prevent aspirating on any frags or blood. He was all set to do a "trache", changed his mind when the other medic got there. They did a secondary(clothes off) once they got him somewhat tuned up, bandaged up left arm (almost looked as though the "T" wasn't needed) I wasn't there, can't say for sure. You might as well skip the dirt thing, we ain't in Kansas any more Toto. Shit dude all I can tell you I was white knuckling it like there was no tomorrow trying to get my hands in there. Fuckin shit sucks! All I can say is when shit like this goes down it's a flailex, you pray you did all the right things. Even though you did you'll always second guess yourself, the day you stop is the day you fuck it up.

Now having said that and watching this twice (thanks for the memories Stormy!) I know I missed shit, I watched it without stopping it because that's how it happened, then made my critique as best I could from the chaos. Now you (Stormy) being the "graduate" can fire away.

Did you go to Ft. Carson or Polk?

helomech
06-09-2016, 05:54 PM
Seriously if this happens to me, please just put me out. I truly don't want to come back from that.

Stormfeather
06-09-2016, 06:30 PM
OK, so here was my assessment...

Primary- tourny the arm and leg. (Stop the bleeding)
Clear the mouth (Start the breathing)
Now heres where it gets hinky...

1- Chest is showing Torsion Pneumothorax on right side, coloration and difficulty breathing tells me collapsed lung. So yes, get ready to hit below the 2nd rib down from the clavicle with the angiocath.. then the dude sits up and can breathe fine... So, do you hit him with the needle or let him sit up and breathe? Does it do more harm or good to hit him with the angiocath? Had to make a call, and I was right, let him sit up and breathe on his own versus adding another hole in the guy.
2- Now.. as BWRR said, I would have also gave him a nasal pharyngeal him since he had all the broken teeth and facial damage, which they didnt do. Not my call, but an additional step to ensure airway was open.
3- Treat for shock, send out the 9-line, and wait for the bird.

I was down at Bragg.

Now, the interesting part, this guy survived, with only the loss of his foot. So Helomech, while it looks harsh, its survivable.

helomech
06-09-2016, 06:31 PM
OK, so here was my assessment...

Primary- tourny the arm and leg. (Stop the bleeding)
Clear the mouth (Start the breathing)
Now heres where it gets hinky...

1- Chest is showing Torsion Pneumothorax on right side, coloration and difficulty breathing tells me collapsed lung. So yes, get ready to hit below the 2nd rib down from the clavicle with the angiocath.. then the dude sits up and can breathe fine... So, do you hit him with the needle or let him sit up and breathe? Does it do more harm or good to hit him with the angiocath? Had to make a call, and I was right, let him sit up and breathe on his own versus adding another hole in the guy.
2- Now.. as BWRR said, I would have also gave him a nasal pharyngeal him since he had all the broken teeth and facial damage, which they didnt do. Not my call, but an additional step to ensure airway was open.
3- Treat for shock, send out the 9-line, and wait for the bird.

Now, the interesting part, this guy survived, with only the loss of his foot. So Helomech, while it looks harsh, its survivable.

Wow, only his one foot? Amazing.

Fatty
06-09-2016, 09:19 PM
My initial knee jerk when I started watching was to check for pulse, then the classic start the breathing, stop the bleeding, check for wounds, treat for shock. He obviously started breathing again after a moment. Tourniquets would've been a given. Any discoloration would've been a red flag for internal bleeding. Thats my extent of interpretation and abilities. Collapsed lungs etc are beyond my abilities. However I am confident I could perform a field expedient tracheotomy.

ElevenBravo
06-10-2016, 12:36 AM
Overall, Im impressed. Field emergency room shit sucks ass. They did what they could with what they had. Most impressive was from boom to dust off in less than 10 minutes, maybe 20 to the MASH (Im old skool) so the golden hour was still salvaged.

That poor fucker, man he took a hell of a hit!

My CLS was not by SF. But I was on the rescue squad 6 years, ran hundreds of calls, some looked almost like that but were MVA.


EB

Vodin
06-10-2016, 12:45 AM
I passed over everyone's reply to mention these 2 things. 1st thing I would say is in no way am I saying those providing aid where wrong or could have done it better.

The 2 issues I saw
1 the lead aid provider had one of his hands with no glove. I have always been taught protect yourself first. (Minor yes but I believe it is a valid position with an unknown victim.)
2 he did not elevate the neck to provide a better clear of the airway. (He was breathing yest but there had to be bodily fluids draining into his esophagus..
My final analysis of the situation is a simple one no mater what improper, incorrect or devastating impact it had on the victim. The victim was transferred alive to a better trained group of individuals.
This only comes from one with minor instruction from CERT training.

Vodin
06-10-2016, 12:55 AM
May I use this link on another site? I will respect your wishes Stormfeather.

ElevenBravo
06-10-2016, 02:29 AM
Id have to watch again, but IIRC they never actually got the IV started.. which is not great... The moment they could have stuck him would have been the best chance to get a vein, *before* he goes hypo and/or shock and the veins are impossible to find (for field medics anyway...).

Airway... It may have not been perfect, but it was working... From what I see, short of an EOA I dont see anything working, and he was too conscious to be a candidate.. he would have fought it.

TK on the leg was a good call, Im thinking the TK going on the arm was for the intended IV.

I cant believe that dude was sitting up at one point! Jesus!

EB

- - - Updated - - -

Actually... my bad, he needed an intubation to keep the airway clear.... EOA would not have done it unless they got a blind intubation by a stroke of luck.

Sniper-T
06-10-2016, 12:33 PM
wow. just wow.

Done right?

Primary:
ABC

1. Airway? He wasn't breathing the greatest but he was breathing - move on.
2. Bleeding - stop the bleeding (tourneys on arm/leg (bandage arm)) (still breathing? move on)
3. Circulation - IV to replace missing blood. Still breathing? major bleeding still stopped? - move on.

Secondary:
1. check and stop additional bleeding - a bunch of small bleeders can be as life threatening as one big one.
2. immobilize - get onto stretcher to facilitate evacuation, and to prevent additional damage.


Done wrong?

- He clearly breathed easier while in a more vertical position, they could have propped the stretcher up to elevate the head to make it easier.
- Granted the head was a mess, but they should have bandaged/wrapped the wounds at the very least to keep the dust/dirt out. I know they had to allow the blood to flow out, or it would have backed up inside and drowned him, but they should have been able to staunch it somewhat.
- good eye on the right side lung issues Stormy - they should have elevated the left side of the stretcher to ensure that the good lung was higher than the bad.
- I don't know if it would be considered 'wrong' per se, but given the damage to his face, they should have intubated him. Had he stopped breathing, as it was (at any time prior to reaching a hospital operating room) they would have been in a mad panic to do it while his brain quickly died. Why not a 'wrong'? they may not have had the equipment or expertise to do so. Personally, I would have been more inclined to do a tracheotomy, or at the very least placed a scalpel (wrapped) and a tube on his chest, ready to go. (for either option)

That is all for now...

Brownwater Riverrat 13
06-10-2016, 04:03 PM
Well all I can tell ya is when I watched it the first time it was interrupted by MIL.... was using the speakers then tried to finish watching it. Then said screw it and sat down and went full screen with the head phones and the volume turned all the way up. I could hear almost everything but I could get a better effect and it was a one shot deal. All I can say is......I guess maybe I assessed myself at the same time. It was a bit of a rush for the 'ol SAR dude.. Personally I think they did a hellofa job patchin his ass up and getting his ass out!

Stormfeather
06-13-2016, 05:36 AM
My initial knee jerk when I started watching was to check for pulse, then the classic start the breathing, stop the bleeding, check for wounds, treat for shock. He obviously started breathing again after a moment. Tourniquets would've been a given. Any discoloration would've been a red flag for internal bleeding. Thats my extent of interpretation and abilities. Collapsed lungs etc are beyond my abilities. However I am confident I could perform a field expedient tracheotomy.

By knowing what to look for, you can bypass the field expedient trach sometimes. But the smart money is to put a nasal pharyngeal in, it doesnt hurt the situation any, and can only help either way. Collapsed lungs are easy to deal with, thats where you use the 2nd rib down from the clavicle and punch him with a hypo/angiocath. Allows the lung to fill back up with air, which air in the body = 99% good stuff.

- - - Updated - - -


May I use this link on another site? I will respect your wishes Stormfeather.

Of course you can, its open source material. I would like to see other peoples opinions, so when ya post it, can ya link it back to us here?

realist
06-13-2016, 02:55 PM
Stormfeather thanks for the post. Yesterday my daughter started an intensive EMT course I sent the link to her and told her to pass it around to see what their assessments of it would be so I might be a little. There is an active shooter segment of the course and I asked her to get the input of her instructors. She said she wasn't sure if he knew about it, I told her I wanted my money back if he didn't.

This situation would be nice to have suction to get some of the crap and blood out of the airway. Many times the decision to sit up will be left to the patient and it is usually correct. The problem with the Sked is you really can't prop them up because if has not sturcture. These guys did a hell of a job, calm and efficient.

Vodin
06-13-2016, 03:21 PM
So far awkward silence. Guess you need to have been in that type of situation to comprehend it. Will keep you posted Stormfeather.

Brownwater Riverrat 13
06-14-2016, 03:14 PM
Go back to me being the "First Responder" on the thread. "31 views, no replies" some people just go blank. That's why I went "full effect" took a little trip so to speak. Full effect was just what "I" needed for a little kick in the pants and gee, what are the odds a couple of days later, a huge mass casualty of over 100 dropped on your doorstep all GSWs. Sucking chest wounds arterial s from hell, gut shots, bleeders, SHOCK, SHOCK, SHOCK...that's what ya get in a gun fight. Granted it wasn't really but just an example, take you and your band of merry men and women get into a "skirmish", think about all the holes you're going to have to assess and fix in the aftermath. GREAT TRAINING let's keep it up!

OK, back on track before I derail but that is what this is all about is it not? As I said earlier, I'm going to base this all off of a one time running off my little "trip". All I could think of was airway. Stormy said "nasal" from my perspective I couldn't tell I could hear him breathing, from what I saw, I couldn't the condition of his mouth other than his teeth were blown out,. What's gone down the pipe? The nasal is only good for so far down,"I" just couldn't tell. So they might the right call obviously. My "old" training was "if they were breathing, fine, if there was rasping, then we got a problem, if there is none(breathing), then we check it for an obstruction and we got clear it and get some air in there." A lot of that training came and comes from "in your face" experience. Every casualty is different and yet the same.............they suck. OK, got a little trng. I need to conduct myself, out!

helomech
06-14-2016, 05:48 PM
I had nothing to say about this, because I was never taught that level of first aid. If he had to rely on me, he probably would not have done so well.

bacpacker
06-14-2016, 06:12 PM
I'm with Helo. Other than pressure or a TQ on the bleeds, I wouldn't know where to start.

I have been following this thread trying to pick up any little nugget I can. But since I had zero to add I've just been reading posts. But without support, both material and transport, and somewhere with doctors I don't see how anyone would make it very long in a similar situation.

Sniper-T
06-14-2016, 10:57 PM
Don't condemn the masses too quickly BWRR...

I was one of the 31... actually I was at least eight or ten of the 31. I clicked on the thread several times at work over a couple days, but could not watch a video there (firewall). I tried from home as well, but my internet sucks at best, and the video failed to play multiple times. After your post I went into work early and watched it on my laptop, when no one else was there. It took a while, but once I could actually watch it, I was all over it like a band-aid on a spurting artery!

Brownwater Riverrat 13
06-14-2016, 11:28 PM
There there Little Bear. It's all square. No condemnation here, only our government "condemns" things. Like it means something to them anyway, like it's going to make it all better.

No hey not everyone here has had training or experience. Mine is/was limited to what was provided, then the real world hit............totally different scenarios almost everyone, others were textbook EMT. Nothing can prepare you for what will happen then again it may never happen all. Some guys in the military spent their whole careers waiting for that one rescue, that one save. To most it never comes, to some there are too many, and to others they take it in and pass it on and become our mentors. People we want to emulate.......sometimes wish they didn't. I had a few that got out because of it.

Now me..............I can see it's time to ramp up on my training and refresh my skills, any volunteers. One of my "young sailors" finished up CLS down at FT. Swamp, Polk. I am supposed to get a digital copy of said training materials............standing by for that one.

What about you Stormy, you get a digital copy? Maybe we could disseminate this when one of us gets it?

Domeguy
06-15-2016, 03:12 AM
I could only watch about the first half due to bad internet, but I'm like Helo at first...it's game over, if it was me, please but a bullet in my head. I'm amazed to learn he only lost a foot. But I would be interested to know what kind of surgerys he had, and how his facial reconstruction went. As to what was done right or wrong, this is way beyond my pay grade. But if I had to do something, it would have been pressure points to control the bleeding until tourniquets could be administered, then pray for the best.

Stormfeather
06-15-2016, 04:28 AM
There there Little Bear. It's all square. No condemnation here, only our government "condemns" things. Like it means something to them anyway, like it's going to make it all better.

No hey not everyone here has had training or experience. Mine is/was limited to what was provided, then the real world hit............totally different scenarios almost everyone, others were textbook EMT. Nothing can prepare you for what will happen then again it may never happen all. Some guys in the military spent their whole careers waiting for that one rescue, that one save. To most it never comes, to some there are too many, and to others they take it in and pass it on and become our mentors. People we want to emulate.......sometimes wish they didn't. I had a few that got out because of it.

Now me..............I can see it's time to ramp up on my training and refresh my skills, any volunteers. One of my "young sailors" finished up CLS down at FT. Swamp, Polk. I am supposed to get a digital copy of said training materials............standing by for that one.

What about you Stormy, you get a digital copy? Maybe we could disseminate this when one of us gets it?

Didnt get a digital copy, got a hard copy, but I sure can run it thru the scanner and digitize it for ya if you want it! Matter of fact, once I do that, I will put it out to anyone who wants a copy.

Stormfeather
06-15-2016, 05:01 AM
OK folks, I know BWRR is chomping at the bit to start doing saline nerve blocks on someone, and if someone doesnt hurry up and volunteer, I daresay I fear for the feline population who will most assuredly be his first victims!

I jest obviously, because he know someone in his house aint going to let that happen!

But seriously, theres three pieces of medical kit you will never find me without.

1- Tourniquet... Stop the Bleeding.
2- Nasal Pharyngeal ... Start the Breathing.
3- QuikClot gauze.... Stop the Bleeding Faster.

Serious injuries means that the body is going to go into shock. So we stop the immediate bleeding with tourniquets, then we assess. Because as the body goes into shock in stages, things like breathing coming into play where the person may be breathing ok, but as the body goes into shock, the throat swells up and constricts. With a Nasal Pharyngeal you insert it into the nasal passage and call it good. This ensures that the body will be able to get air no matter how much into shock it goes. Then we assess again. Now its time to stop the bleeding that the tourniquet is controlling, that is where the combat gauze comes into place. We used to use the powder, and celox and so forth, but with the gauze you simply clean out the wound as much as possible, and you start stuffing it in. If it keeps bleeding, you stuff in more and more until the chitosan starts to take effect and coagulate the blood. This is what you are looking for. The trick is to clean out as much blood as possible from the wound until theres very little left. The least amount of blood means the less gauze you should have to use. Once that gauze is in place, and you are sure its working, then loosen the tourniquets and assess once more. If the gauze is working, now you concentrate on treating for shock. (Which is going to happen at this point pretty quickly) Elevate the legs, loosen clothing, and keep them calm and cool. From here its move them to transport and get them to a higher level of aid than you can provide.

Now, I know some of you are thinking "nasal pharyngeal"... whats that? Its a simple plastic tube with a flared end and the other end is beveled. Obviously the beveled end goes in the nose and down the throat all the way til the flared end is pushed against the nostril. You can buy them on Amazon pretty cheaply, and if you are budget minded, heck, you can use it on yourself as practice, run it thru the dishwasher and seal it up and use it again in an emergency!

https://www.amazon.com/Nasopharyngeal-Airway-Fr-9-3mm-Surgilube/dp/B003950R2E/ref=sr_1_17?ie=UTF8&qid=1465966195&sr=8-17-spons&keywords=nasal+pharyngeal&psc=1&smid=A2P5I4NW0QQAX1

Now, if you are feeling a bit unsure about using one, I promise you, its not something for the squeamish, but with a little practice, you can even do it on yourself. Just remember to take a deep breath in/out and swallow ALOT when inserting/removing it. Heres a couple of quick videos of how easy it is. Just remember, USE LOTS OF LUBE & Bevel faces the septum!

https://www.youtube.com/watch?v=fR5jsmGg6e8

https://www.youtube.com/watch?v=xIwLmq_3iws

https://www.youtube.com/watch?v=C8uuxSKtjY8

https://www.youtube.com/watch?v=hZ5jVPCoMGA


One of my personal Favorite NPA videos! Wait til 7:15!

https://www.youtube.com/watch?v=po8MOJzxQeQ

Stormfeather
06-15-2016, 06:06 AM
And for those looking for some high speed training when it comes to medical care, I cannot stress Combined Application Group. After that, I would have to say Tactical Element. Two really good groups providing high speed low drag training.

https://www.youtube.com/watch?v=gRmpnnmmZmo

www.cagmain.com

http://www.tacticalelement.com/

Brownwater Riverrat 13
06-15-2016, 02:08 PM
OUTFUKINSTANDIN Stormy! At's what I'm talkin about great breakdown. As for stickin cats well I got deer, cow, the neighbor kid's kinda funny lookin I call him Quasi Moto on accounta the hump. He's easy prey on that lawnmower. You named off "part" of my IFAK........got tape and scissors. I try not to overkill or you'd be callin me Quasi Moto. Oh, and a band-aid, Sponge Bob, one each.

By the way it's bad enough I got LadyHK chasing me around with an epi pen. Now you know.............OK one more fuckin dog fart and one of these pooches it going to be the training dummy! I'm outta here!

Stormfeather
06-17-2016, 03:07 AM
OUTFUKINSTANDIN Stormy! At's what I'm talkin about great breakdown. As for stickin cats well I got deer, cow, the neighbor kid's kinda funny lookin I call him Quasi Moto on accounta the hump. He's easy prey on that lawnmower. You named off "part" of my IFAK........got tape and scissors. I try not to overkill or you'd be callin me Quasi Moto. Oh, and a band-aid, Sponge Bob, one each.

By the way it's bad enough I got LadyHK chasing me around with an epi pen. Now you know.............OK one more fuckin dog fart and one of these pooches it going to be the training dummy! I'm outta here!

I would expect nothing less!

Sniper-T
06-20-2016, 11:09 PM
.........OK one more fuckin dog fart and one of these pooches it going to be the training dummy...!

It's not the dogs... the cats are like ventriloquists! Always blame the cats!

:)

LH will understand!

Brownwater Riverrat 13
06-23-2016, 06:19 PM
And that's why I call the cat "Snake ass" cause that's just what she smells like sometimes. You should remember the smell if you ever handled the critters. First thing they like to do is shit on ya.

Vodin
06-23-2016, 11:37 PM
Brownwater Riverrat, my dogs go crazy after that stench!

Brownwater Riverrat 13
06-25-2016, 02:34 PM
Brownwater Riverrat, my dogs go crazy after that stench!
You're killing me Smalls.....

Twitchy
07-01-2016, 04:09 AM
31 views, no replies.......OK, here we go. So they are checking for wires, looks like they just got to that area and are doing a sweep. Comment "Looks like they were pre-staging" the ANA guy walks up says a few words and no one stops him as he walks through. They were obviously getting ready to move forward once they were SURE it was clear, not just there, but out in the distance as well. I'll just call this the unknown factor at this point and straight to the shit. All I kept thinking was AIRWAY!. The guy's helmet cam prevented most of my initial assessment of his head injuries so my head is ducking around my laptop trying to get a better view. Tourniquet, everything gets a "T" nowadays, they hit they limbs immediately. Initial assessment was L leg and arm, Head injury was jaw, teeth blown out, needed to do a sweep, took like what seemed an eternity till I heard the words. I was wondering why they didn't tube him to prevent aspirating on any frags or blood. He was all set to do a "trache", changed his mind when the other medic got there. They did a secondary(clothes off) once they got him somewhat tuned up, bandaged up left arm (almost looked as though the "T" wasn't needed) I wasn't there, can't say for sure. You might as well skip the dirt thing, we ain't in Kansas any more Toto. Shit dude all I can tell you I was white knuckling it like there was no tomorrow trying to get my hands in there. Fuckin shit sucks! All I can say is when shit like this goes down it's a flailex, you pray you did all the right things. Even though you did you'll always second guess yourself, the day you stop is the day you fuck it up.

Now having said that and watching this twice (thanks for the memories Stormy!) I know I missed shit, I watched it without stopping it because that's how it happened, then made my critique as best I could from the chaos. Now you (Stormy) being the "graduate" can fire away.

Did you go to Ft. Carson or Polk?

He was still to with it to do any invasive airway management without a crap load of ketamine. They are truly limited in the field with what they can do. Hell, I don't even know if they have suction in those kits that's worth anything...