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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.

FYI.
http://www.remotemedical.com They have 'Israeli Emergency Bandages', 'Celox Coagulant', 'Asherman Chest Seals', etc.
I've added some of that stuff to my firstaid kit. Bandaids and aspirin aren't enough when you are talking about guns, chainsaws, power tools, etc.
I would like to get some training, but not too much. I don't like yuckey stuff.
Regards, OE

I too, keep a 1st aid kit in my truck, wife's car, & my range bucket. All 3 are for major needs. Gunshot on the range, major wreck in the vehicle, Major cut w/ mower blade, machete....

Speaking of "yuckey stuff", at one point I thought Ian was going to demonstrate some injections on me, because my forearm veins are rather prominent. He was straying a little from the killer B's at that point, but it was interesting information and discussion.

FYI, Ian recommended keeping the serious trauma kit intact and seperate from the regular first aid kit, so as to discourage people from helping themselves to items that must be present when a life depends upon those items.

He was impressed that some people had already started EDCing some basic trauma kit. An EveryDay Carry trauma kit will likely be a stripped-down version of a fully stocked trauma kit you would keep in a motor vehicle or at home, sized to fit on your person in regular clothes, likely focused upon controlling major arterial bleeding.

yerasimos wrote: FYI, Ian recommended keeping the serious trauma kit intact and seperate from the regular first aid kit, so as to discourage people from helping themselves to items that must be present when a life depends upon those items.

In the class I was in, I remember him saying to keep the boo-boo kit seperate from the trauma kit.

What did he recommend for an edc trauma kit?

What were his thoughts on the clotting agents vs good old steralized gauze packing & pressure bandage?

fm2 wrote: What did he recommend for an edc trauma kit?

Looking at my notes, most of his recommendations for the trauma kit seemed geared toward a quasi-paramedic role, which is not surprising, given his background. He generally prefers to have individual nylon bags for keeping together trauma gear, which may not fit easily with everyday dress or a belt laden with other things, and seemed better suited for placement in a motor vehicle or at home. That said, I was surprised that he seemed to really like the little pack I have been toting around for the past few months in my pants pocket, though he would prefer the version with the QuickClot.

fm2 wrote:What were his thoughts on the clotting agents vs good old steralized gauze packing & pressure bandage?

It is not a question of either/or, or one versus the other. Each has its place in the toolbox, after using direct bodyweight pressure or tourniquets for initial/temporary stoppage of arterial bleeding. The gauze packing is really helpful for the deeper, irregular, less superficial wounds. The clotting agents cannot work by themselves to control bleeding; something else (direct pressure or tourniquet) has to get the bleeding under control or else the clotting agents will get pushed out of the wound via fluid pressure and rendered ineffective. The pressure bandage serves the role of applying some residual backstop pressure (though not as much compared to a tourniquet or direct pressure) and providing basic wound protection prior to seeking professional medical services or EMS arrival.