Recently I had the opportunity to attend a course organized by Suarez International called Gutter Medicine for Shooters. The instructor was Ian McDevitt, a former Army medic, tactical medical consultant to domestic and foreign military units and law enforcement agencies, and currently a practicing paramedic in the northeastern USA. One of Suarez International’s staff instructors hosted the course near Tampa, Florida. The course is not a substitute for official certification as an EMT or paramedic, nor are the skills and techniques intended to supplant professional medical care in a trauma center or hospital. Rather, it serves as a starting point for learning basic techniques for self rescue and rendering first aid to others relating to penetrating trauma injuries associated with use of force incidents, including gunshot wounds. In other words, these skills can be used by a person critically injured in a fight to make a successful transition from the gutter to the gurney.
Two of Ian’s points of emphasis were rapid identification of injury mechanism, and correct patient/victim primary assessment. He showed the class some graphic photographs of various injuries (many from the USA’s contemporary military engagements in southwest Asia) to prompt discussion of injury mechanisms and primary assessment. Later, Ian graciously critiqued this author’s interpretation of the primary assessment and offered the class suggestions for developing this perishable skill. We learned about the killer B’s (breathing and bleeding) and practiced techniques associated with controlling arterial bleeding and bypassing obstructed airways. Ian shared his thoughts on relevant medical gear, including blood clotting agents, tourniquets (still highly controversial), high-performance wound dressings, airway blockage and chest penetration solutions, and some commercially-available kits, and gave the class suggestions on where to obtain these items, how to use them and how to best organize them. Finally, Ian treated the topics of proper mental attitude relating to injuries, protecting oneself while rendering aid, interacting with medical responders, and retaining mobility and weapon options.
I wish to advocate the value of “soft� skills including (but not limited to) unknown contact management, recognition of pre-assault cues, visual discipline, learning to properly articulate one’s actions after a use of force incident, and in extremis medical self rescue, as de facto necessities in our uncertain world, whether or not one carries a gun for personal protection. One does not need a government-issued piece of plastic to need to know these things or to use such knowledge, and these skills are much more portable than handguns.
Gabe Suarez frequently mentions in his writings his concept of the “Complete Arsenal�, which encompasses learning firearms, edged weapons and empty-hands skills, and cultivating physical fitness and a fighting mindset. I believe that this “Complete Arsenal� is incomplete without the soft skills mentioned in the preceding paragraph; they may enable one to possibly avoid a fight, spot an unavoidable fight and get into action quickly, and optimize a fight’s medical and legal aftermath. Progressive-minded trainers and organizations such as Suarez International are doing CHLers a major service by giving such subject matter serious consideration, as evidenced in the recent Gutter Medicine course.