FREE Emergency Trauma Response Training Course

[Paladin]

I stumbled on this FREE online course when picking up some medical gear. Emergency Trauma Response Training Course

This is a FREE online course with critical lift saving information. I've taken it. It's taught by a Corpsman/EMT who has been there and done that. I highly recommend. Even if you've seen this kind of information before its a great refresher. It's about 4 hours worth of training and they provide you a very nice eCertificate at the end.

[Jose_in_Dallas]

Thanks for sharing. I'll have to give it a look later.

[AF-Odin]

Will definitely take a look later. Too many of us spend all of our time training in the shooting aspects and not enough in what comes next.

[Rafe]

Wow. Thank you! Great find! It's difficult to beat free, especially when it looks like it's the real deal introduction. There's also what looks to be a follow-course for the grand total of $2: https://www.mountainmanmedical.com/prod ... ng-course/

Preparing For and Responding to Medical Emergencies On The Gun Range

Mountain Man Medical is proud to present “Range Medicine” a video-based training course for firearm instructors, range safety officers, range medics, and anyone who wants to be better prepared for medical emergencies on the range.

I think I know what I'll be doing with some of the time off I'm taking around Thanksgiving.

[Mike S]

Thanks for sharing this link. I will watch the entire course with an open mind & give my take on it once I'm done, but I will say that I'm concerned about his promotion of the SWAT-T as a tourniquet from another YouTube video I've seen of his

((While you 'may' be able to get total occlusion of an arterial bleed with the SWAT-T, it's not nearly as reliable as the CAT, SOFT-T, or any other commercial TQ that's been approved by the C-TCCC ((the C-TCCC hasn't approved it for military use, and neither does the civilian equivalent CoTECC)). I would honestly say that using the old school improvised 'sticks & rags' TQs that was taught in military basic training pre-2001 is much more effective than the SWAT-T.

The SWAT-T 'is' good for an improvised wrap to secure a pressure dressing, but I wouldn't rely on it to occlude arterial bleeding.

Since I haven't watched this course yet, I have no idea if he mentions the SWAT-T in the course, so it may or may not even be of relevance to this thread)).

[Paladin]

Thanks for sharing this link. I will watch the entire course with an open mind & give my take on it once I'm done, but I will say that I'm concerned about his promotion of the SWAT-T as a tourniquet from another YouTube video I've seen of his

((While you 'may' be able to get total occlusion of an arterial bleed with the SWAT-T, it's not nearly as reliable as the CAT, SOFT-T, or any other commercial TQ that's been approved by the C-TCCC ((the C-TCCC hasn't approved it for military use, and neither does the civilian equivalent CoTECC)). I would honestly say that using the old school improvised 'sticks & rags' TQs that was taught in military basic training pre-2001 is much more effective than the SWAT-T.

The SWAT-T 'is' good for an improvised wrap to secure a pressure dressing, but I wouldn't rely on it to occlude arterial bleeding.

Since I haven't watched this course yet, I have no idea if he mentions the SWAT-T in the course, so it may or may not even be of relevance to this thread)).

He recommends using an approved TQ, with SWAT-T as more of an improvised wrap or backup TQ

[mrbc]

Yes, thanks for posting. I will be partaking in this during free time.

[Tex1961]

Thanks for sharing. I’ve bookmarked the site.

[Tex1961]

I just got back from two days in Florence for the School Safety Instructor course. I did the Hunter safety course 2 weeks ago 8 hours, and still have to sit through 6 hours online to finish. Now this... Whew.. My brain is getting fried from classes. But not complaining..

[Mike S]

So here's my review of this online course.

Overall, it's a really good overview of the M.AR.C.H. algorithm, and the majority of what is presented is spot on. There's at least one thing he got wrong, and a couple things that I feel are important enough to clarify or expound on that could lead to a really bad outcome if there is a delay in casualty evacuation time since the course didn't cover them in detail.

Using the chapters of his presentation, here's my AAR comments:
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Course Overview & Intro to MARCH: Great pacing & delivery, not just in these sections but throughout.


Massive Hemorrhage: This was a good overview. Tourniquites were discussed, but steps for application were deferred to later in the course. Deferring tq steps to a later block facilitated not losing the flow, but could have also been covered here. No worries.


Airway: A factually incorrect statement is made regarding nasopharyngeal airways (NPAs). NPAs can and should be used on conscious casualties; yes, it is uncomfortable, but if properly sized it won't trigger the gag reflex (and if it does, back the NPA out slightly). Once the NPA is in place, & after the eyes stop the momentary watering because a rubber tube was slid up the nose, NPAs aren't pleasant but also aren't super uncomfortable. But, if the casualty is in & out of consciousness or has an altered mental state they should be monitored so they don't pull it out, as is mentioned in the course..

A couple additional areas that I'd recommend including in this section are:

1. How to properly size the NPA to the casualty;
- if the NPA reaches from the edge of the earlobe to the same-side nostril, it's probably the correct length for that casualty. If too long, will activate the gag reflex in a conscious casualty.

2. Indications that a casualty may need an NPA;
- if the casualty is unconscious, or conscious but altered mental state where they can't follow simple commands (UNLESS any of the injuries in 3. below are present)
-an injury to the jaw that limits their ability to open their mouth / breath normally thru their mouths (UNLESS any of the injuries in 3. below are present)
- may need a bag valve mask (BVM) or O2 later on when EMTs arrive (UNLESS any of the injuries in 3. below are present)

3. And absolutely should include the contraindications for when an NPA should NOT BE used.
- If conscious without a compromised airway, won't likely need an NPA
- If casualty has facial trauma other than the lower jaw (especially trauma involving the soft palate at the roof of the mouth (because the NPA will transit over the soft palate on its way to the back of the epiglotis)
- If casualty has a suspected fracture around the base of the cranium (anywhere 360* around the base of the head...) ((Indications of possible skull fracture: obvious deformity of the head; unequal or huge pupils, or pupils that don't respond to light stimuli properly; clear or pink-tinged fluid from the ears or nose)). ((It's unlikely, but there is a risk of the NPA routing air into the cranial vault if there's a fracture at the front of the base of the skull)).

4. How to insert the NPA
Its not quite as intuitive as you might initially think; it doesn't go 'Up the nose' but more 'towards the back of the throat via the nose' . After lubing the NPA with a non-petroleum lubricant (oftentimes water based lube is included with NPAs packaging , but if no lube available can also use the casualties saliva or blood as a lube), you'll use a fingertip to push up gently on the tip of the casualty`s nose (giving them a "pig-nose" to open up the nasal passages), then insert the NPA perpendicular to the face / straight down towards the back of the throat (ie, Don't try to slide it 'Up the casualties nose, as it'll bottom out in the wrong space...). Generally, the right-side nostril is usually recommend as the right nostril is usually a little bigger in most people, but you can use the left side if necessary. The bevel of the NPA should be facing the septum when inserted, & slide it in until it's bottomed out. If the casualty gags, slide it out slightly until the reflex stops.


Respirations: Since around 2018'ish data has shown the use of non-vented chest seals has limited efficacy & may be more harmful than beneficial if there's a punctured lung. Whereas the CoTECC updated guidelines (focused on civilian application of MARCH) has totally deleted the use of non-vented chest seals in the 2020 updated guidelines for 'Civilian Active Bystanders', the TCCC guidelines (military application of MARCH) states to use vented chest seals, but still describes the use of non-vented / occlusive dressings if vented seals are not available, with the reminder that non-vented chest seals can create a tension pneumothorax if not monitored closely (Caveat: the current TECC guidelines for First Responders & EMTs still have vented & non-vented seals; reference to non-vented seals were only deleted for the Active Bystander guidelines for non-first responders), ((Personally, if I was out of vented chest seals and in a remote area, I would still use any occlusive dressing to seal up a sucking chest wound, BUT with either a vented, or non-vented chest seal, the casualty MUST be observed to ensure the seal doesn't need to be 'burped' ((less likely with a vented chest seal, however even with a vented chest seal if the wound clots up AND there's a punctured lung the air isn't able to escape the chest and can lead to a tension pneumothorax)). Since non-vented chest seals don't allow blood & air to escape the chest wall, this constant observation is even more critical.

Indications of a tension pneumothorax forming: Difficulty breathing / feelings of tightness in chest; shortness of breath; anxiety, agitation, or panic attack ((because they're unable to breath & get enough O2 as the lung is deflating because of the air bubble building up inside their chest wall)); neck veins bulging; increased heart rate or signs of shock. Lips & nail beds may start turning blue. Unequal rise & fall of the chest (side with collapsed lung may not be rising when the casualty inhales.
If you see the casualty`s trachea deviating to one side (away from injured side) it's gotten really bad, to the point the air inside the chest wall is likely pushing against the heart, preventing the heart from pumping; this will result in cardiac arrest and death.. This is why it's important to include the significance of constant monitoring, especially when using a non-vented chest seal.

"Burping" the chest seal basically means pulling back the adhesive to allow trapped air to escape. If the hole has coagulated blood closing it up, you may need to clear the clot so the trapped air can escape. After feeling the trapped air escape, reapply the chest seal. ((Commercial chest seals are super sticky & as long as you wipe most of the blood off, it will likely re-stick to the skin. If using tape for an improvised seal, you may need to use fresh tape. If you've had to burp once, you'll likely need to burp it again so make sure someone continually monitors the casualty.

Lastly, when communicating with First Responders ensure they understand there's a hole in the casualties chest & describe any of the signs above so they can prioritize evacuation.


Circulation: the Circulation phase is where a trained medical provider might start an IV Lock if casualty is not in shock yet but may needed to administer meds or fluids later, or if the casualty is already in hypovolemic shock, to administer whole blood products (if in their protocol); Hextend; or lactated ringers bolus until a peripheral pulse is regained.

As this presentation is geared towards a non-medical audience, it's prudent to have omitted fluid resuscitation methods; TXA; & the indicators/use of pelvic binders. However, this is the portion of MARCH where the signs/symptoms of shock is usually taught, as it will dictate if fluid resuscitation should be started ((he does cover the indications of hypovolemic shock quite thoroughly in the next section on Hypothermia)).

He does cover the "Reassessment of Previously Applied Extremity & Junctional TQs/Wound Packing" step of Circulation quite well. The only thing really concerning in this section is the mention of using duct tape to seal off the chest seal if any air flow is detected bypassing the chest seal, AND the test question of "Indications that a Chest Seal has Failed or is Improperly Applied are:" with the wording of one of the 'correct' answers of "Feeling Air Escape Through/Around the Chest Seal", as this could infer a need to seal it up when air is 'escaping' from the chest wall; you actually want the air to escape rather than build up & potentially cause a pneumothorax / tension pneumothorax as described in the Respiration phase of care above. ((And to be nit-picky, 'reassessment of all interventions' isn't a part of Circulation; this section only covers reassessment of previously applied tq's that were done in the Care Under Fire / Direct Threat phase, not reassessment of the airway / respirations. A full reassessment w/ blood sweeps head to toe comes in Reassessment, after the Hypothermia / Head section)).


Hypothermia/ Head Injuries: The portion about blood loss & compensated/decompensated shock is spot on, but in TCCC / TECC this portion on 'shock' is taught in the Circulation block. The intertwined nature of hypothermia & coagulation is the key issue or teaching point that is stressed in TCCC/TECC, and he covers that quite well in addition to how to prevent hypothermia in a casualty.

The portion where he discussed newer studies regarding the Trendelenburg position having limited efficacy for treating hypovolemic shock was new to me, so I learned something new there; the TCCC / TECC guidelines are all 'evidence-based' practices, so it wouldn't surprise me if their 'shock position' guidelines are modified in the next couple of years if there's limited utility in it, unless the mild benefits still outweigh any potential contraindications.

Reassessment: Spot on, with the exception of 'not recommending the repacking of a wound'. He also mentions this in another YouTube video. You can absolutely just apply direct pressure onto the wound and wait for EMTs, but the actual TCCC/TECC standard states you 'should consider removing & repacking the wound if more gauze is available'. The point here is that it's the direct pressure of the packing material against the artery inside the wound that's 'stopping the bleed' and allowing it to form the clot; hemostatic gauze merely promotes the clot to form quicker than normal. If the wound still has massive bleeding around the gauze & pressure dressing, then nothing is pressing against the severed vessel; either the initial packing wasn't firm enough directly against the vessel, OR if the initial pack-job was good and the casualty was moved, or even shifted their own body position, the elasticity of the tissue around the cavitation may have shifted & allowed the clot to be blown. So, while he's correct inasmuch as 'additional direct pressure' may stop the bleeding, if that doesn't stop the massive re-bleed then pulling the original packing out & starting over, even with direct finger pressure against the vessel if you can visualize it, might save the casualty's life (especially if the casualty has already dumped a lot of blood outside the body). Thus, his presentation of 'I wouldn't recommend it' coupled with the test question / answer indicating 'it shouldn't be done' are counter to the TCCC/TECC guidelines that it 'should be considered '.

Other Types of Injuries: All very good & practical info here.

Practical Exercises & Improvised Solutions: All good info, but again I would recommend including a mention of 'monitor for indications of a tension pneumothorax' and potential need of 'burping the chest seal' in the section on improvised chest seals
---------------------------------------------------------------------

So, all in all I absolutely love that he went to the time & expense to create a free web-based education course (although in marketing terms I believe this is what's called a "funnel" to build up an email list, but I ain't mad at him for being a smart business man), and the videos were professionally filmed & put together. And to be fair, he does advocate for in-person training for the hands on skills where some of the comments above would likely be addressed. My concern would be that the majority of people completing this course realistically will never attend an in person class, thus it's a missed opportunity to provide a little more depth. I wouldn't recommend against this online course; just go into it with the understanding that it's a general overview and at least a couple things aren't quite exactly correct,.

[Paladin]

Thanks for the detailed review Mike! No doubt that a hands on course is an important component of training. I'd strongly recommend at least a hands on stop the bleed course to follow up on this online training.

This is what a lot of people don't know:

even with direct finger pressure against the vessel if you can visualize it, might save the casualty's life (especially if the casualty has already dumped a lot of blood outside the body)

Even in the ER, with all the resources the ER has, they often use direct finger pressure against a vessel to temporarily stop bleeding.

[AF-Odin]

Great analysis. Would just like to be able to find a Stop The Bleed Course a little closer. When I search, I can find a lot of DFW and San Antonio, but nothing on the I-35 section between Austin and Waco.