Tuesday, August 28, 2012

Logistics Primer...

AmMerc has a great piece on logistics HERE

".....are there any suspicious areas of inactivity?  People don't like to fight where they live if they can avoid it.  If the only difference between area A and area B is the level of conflict, it bears looking into.  This is where the military intelligence guys can come in handy, finding out what the scuttlebutt is on why neighborhood A is quiet."

As Napoleon Bonaparte famously implied; logistics is the lifeblood of warfare.

Sunday, August 26, 2012

TC3 Continued...

Medical continued……

Tactical field care 

Ok…..so, Joe’s bleeding leg has been brought under control via tourniquet and the enemy seems to have broken contact. A secure perimeter is established as everyone cross levels remaining ammunition. The QRF is still a ways off as you turn your attention back to Joe. 
   You see that Joe is struggling to breath…..that’s when you notice the blood pooling under him. You check the tourniquet on his leg, thinking that it must not be tight enough. You suspect he may have another wound and begin to check him when you see it; a bullet wound just below his right pec. You open up his shirt and can see the blood running out of the wound….you apply direct pressure with your hands and call for assistance. You calm yourself and recognize that this is a classic “sucking chest” wound and will need some kind of occlusive dressing to prohibit any air flow. Steve shows up with an aid bag and pulls out a chest seal dressing and slaps it on over the bloody wound. You roll Joe to his side to check his back and find an exit wound directly posterior to the entry. That’s a good sign you think to yourself as it appears to be an “icepick” wound as opposed to the bullet tumbling and taking the scenic route through Joe’s torso. There is more blood coming from the exit wound so you open a combat gauze and begin to pack some in the wound as you unroll it….you then apply an occlusive dressing.  Your mind races as you go through the treatment protocols in your head…..MARCH…(a variation of the old ABCDE)

Massive hemorrhage
Head & Hypothermia

Massive hemorrhage: OK, tourniquet on the leg has controlled that wound and the two occlusive dressings and gauze have controlled the chest bleed. Joe is having a difficult time breathing…..you ask him a question but he mutters incoherently. Okay, he was able to speak so his airway is intact…..but he is really struggling to take breaths. As you look at him you notice the vein in his neck standing out….then it dawns on you – his lung is collapsing due to the atmospheric pressure inside his chest cavity from the wound. You grab a 14 gauge needle, place your finger on his the middle of his clavicle (wounded side) and draw a line straight down through his nipple. On this line you find the second or third rib from the top, aim the needle just over the top edge of the rib and press in till you hear air escaping from the cath. After a moment, Joe seems to start breathing easier. You debate giving Joe morphine, but decide against it as you recall it is bad to give morphine to a patient in respiratory distress. 
You decide to check Joe for any other wounds you may have missed. Once you are satisfied, you pull out his poncho liner and wrap him in it. Joe becomes more lucid and notes his intense discomfort. You give him some water, oral antibiotics and Tylenol/acetaminophen since it will not disrupt his blood clotting ability. Steve takes a set of vitals from Joe and writes them down. Steve asks you to start a saline lock on Joe, but delay any IV therapy for the time being. You finish taping down the lock and wrap a blizzard blanket around Joe as you hear the faint sound of the approaching QRF….

OK….lets break this down.
First off; this is the portion of TCCC where most of your medical work happens. In the first stage – Care Under Fire – you limit yourself to stopping severe bleeds, since the primary concern at that point is stopping the threat. The reason we address severe bleeds is that a human can bleed to death in a matter of minutes from an artery.

Side note:
I would also note that the cross-leveling of ammunition occurs once everyone has roger’d up an ACE/LACE report:

Ammunition left
Casualties if any
Equipment status
(some units report liquids status – as in water)

Reason for this practice is that the guys on the skirmish line or making the most contact are going to have a lot less ammo remaining than the guy that was pulling rear security – fairly academic.  Cross-level to make the entire unit equally effective for follow on actions. 

Joe discovers a chest wound that he did not initially see…..hey it happens. One thing to note is that it can be tricky getting the occlusive dressings to maintain a seal on wet, bloody skin. If you are able to blot it dry real quick, you will get more mileage out the dressing. Once he has the dressings in place he recognizes that Joe is suffering from a tension pneumothorax and treats it with a needle decompression. Notice that Joe is careful to insert OVER the rib as there is a vascular bundle that runs on the bottom of the ribs.
I have seen several variations of the MARCH acronym – MARCH-E, ABCDE, SCAB, etc – point is, control the severe bleeds first, then airway, breathing, etc.
So, the couple of questions I can hear folks asking is: 1) Wouldn’t he be in shock? 2) Why not give him Morphine? 3) Why not start him on IV fluids?

1) He was indeed showing some outward signs of early shock. Joe covering him was an important first step. Any serious injury of this nature can quickly lead a patient into a hypothermic condition.
2) Morphine is contraindicated when a patient is in respiratory distress as it further depresses respiratory function. Ketomine or Acetometaphine may be better options.
3) This can be a tough one….adding saline or Ringer’s in the field to boost blood volume will raise blood pressure, but….it also can have a negative effect on clotting factors. I have seen this issue go back and forth over the years. I like the approach of getting a lock in place so you have easy access if the decision is made to introduce fluids. The most recent TC3 protocol is to administer a drug called TXA (tranexamic acid ) with the fluid if there has been substantial blood loss. This will aid in clotting as it inhibits the body from breaking down clots.

One last thing I would point out again is the importance of getting the patient warm. Even in a blazing hot desert, blood loss will lead to hypothermia and death. The Blizzard blanket is a very useful item that I would encourage everyone to have in their kit.

…….More to follow……

Wednesday, August 22, 2012

Item for your Bug-Out Bag...

Stumbled across this the other day........"The PowerPot"...

This clever item gives double-duty as a camp/field cook pot and as a power generator for small items such as cellphones, radios and GPS devices. Just add water or ice/snow and apply heat via camp stove or fire and it produces 5v DC using thermoelectric power principals. This may have earned a spot in my kit....

Website is HERE

Sunday, August 19, 2012

Russian Bear...

Interesting article here

One has to wonder why the mainstream press has not really picked up on this......kinda merits a mention I would think.
Coupled with the fact that Putin recently stated that they have stood up nuclear missiles in Cuba this May, (HERE) .....again the press is silent. Didn't we almost go to war over just this scenario once upon a time?

Curious indeed...

Friday, August 10, 2012

Warnings from the past

"I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them."
-- Thomas Jefferson

....if only....

Monday, August 6, 2012

More On Teamwork - The Medical Part

Teamwork for tactical units – part 2


As we are focusing on being a Gunfighter and not just a "trigger-puller", we must include medical skills in the definition. The military and specifically SOCOM, began to realize this reality after the TF Ranger operation in Mogadishu.  This is what led to the TCCC/TC3 concept (Tactical Combat Casualty Care). This follows the logic of “every fighter a medic” insofar as lifesaving and stabilization skills are concerned.  This was a huge step forward from the former CLS (Combat Lifesaver) protocols as this addressed the most common lethal injuries on the battlefield and provided for a committee that would regularly evaluate and implement the latest innovations and lessons learned.

To this day I still see organizations that go in harm’s way and only require CPR and sometimes basic first aid (Red Cross style)…..this is shameful to put it politely, especially considering that we have over a decade of combat operations experience to draw from. The importance of a robust and standardized lifesaving skillset among a tactical team cannot be overstated.

Even though I have had formal training as a Medic, the most useful skills I know, based on what I have actually employed in the real world, are found in the TC3 program.  TC3 breaks down into three basic sections.

- Care under fire
- Tactical field care
- Tactical evacuation care

Instead of simply regurgitating the TC3 manual (which you can find online), I want to frame each section in a scenario based narrative.

Care under Fire…

You are part of a small unit on a security patrol in a lightly treed, mountainous area.  Your team mate “Joe”, who is in front of you, turns to say something but instead of his voice you hear gunshots and Joe collapses. You dive towards a pile of nearby rocks as you fire several rounds into the grove of trees about 200 yards ahead where the shots seem to be coming from. From your covered position you do a quick 360 scan. You identify where all your teammates have taken cover and notice that most are directing fire into the same grove of trees, with a couple guys scanning the flanks and rear. As you line your sights up to acquire a target you notice Joe lying still on the ground at your 10 o’clock. You fire a few rounds as you yell at Joe to move to cover.  Joe is moving very slightly and is clearly disoriented. You notice his leg is at a “wrong” angle and his uniform is growing dark with blood. You identify a large rock about 15 yards away at your 2 o’clock. You fire a few more rounds, perform a retention reload and dash to the new piece of cover. This puts you directly across from Joe and gives you a larger field of fire.  You yell at Joe again but he is clearly unable to effectively move himself to cover. You yell at him to put a tourniquet on his injured leg. He slowly begins to fumble around his belt apparently searching for his tourniquet. At this point you decide that the team is effectively suppressing the enemy, as the rate of incoming fire has dropped substantially, and decide to bound to Joe’s position and drag him to a nearby ditch. As you reach him you grab Joe’s armor strap and drag him the eight or so feet to the safety of the ditch. You see that Joe’s shin has been destroyed by a bullet and he is bleeding bright red blood. You can’t find Joe’s tourniquet so you grab your spare and apply it high above the knee. Joe yells out in pain as you turn the windlass and secure the tourniquet in place. You reassure Joe as you move into a firing position and reengage the enemy. The patrol leader indicates that the QRF has been called and is inbound. At this point the enemy seems to have broken contact....

Okay. So what do we get from this scenario?
Care under fire is just that…..the minimum intervention that is necessary to keep someone alive while you eliminate the threat. Ideally, the injured party will be able to achieve a sufficient level of self-aid; for example – applying a tourniquet and moving to cover. This was not the case in our scenario, so our character had to make a quick judgment call. Another lesson we can glean from our story….Joe either did not have, or possibly lost his tourniquet. It is important for everyone to have a tourniquet readily available (easily accessible) and, ideally, everyone in the team wears their tourniquet(s) and their blow-out/IFAK kits in the same spot so you don’t have to search for it. I’ll tell you what….your buddy screaming and bleeding all over you coupled with incoming fire is not the time to be digging through a bag trying to find something that you desperately need. This is something that needs to be trained on regularly and this portion of TC3 can be easily inserted into your normal training activities.

…..Next time we will continue with Tactical field care and discuss Bail-Out Bags/Go-Bags/Bug-Out Bags and IFAKs.

Saturday, August 4, 2012

Full Spectrum Failure...

"A key and understudied aspect of full spectrum operations is how to conduct these operations within American borders.  If we face a period of persistent global conflict as outlined in successive National Security Strategy documents, then Army officers are professionally obligated to consider the conduct of operations on U.S. soil."

From the Small Wars Journal....HERE

Take some time and read the whole thing. They are making a case for even more federal control as well as expanded US military intervention in homeland affairs. The authors globo-leftist bias is not subtle in the least...but it does make for an interesting read and frankly it should scare the crap out of you.

Friday, August 3, 2012

Danger Ahead...

"After a shooting spree, they always want to take the guns away from the people who didn't do it. I sure as hell wouldn't want to live in a society where the only people allowed guns are the police and the military. "
-- William S. Burroughs

...Worthy of a re post considering recent events...

                                                          ...and the potential outcome...

Wednesday, August 1, 2012

Upcoming Courses

Calendar page has been updated with the projected classes for this Fall and Winter.......more to follow.