I got caught up in a discussion the other day about something that I in hindsight find it strange that we are not addressing specifically in theoretical base as well as in drills.
"How to administer first aid without tactically compromising yourself?"
Peoples' first inclination may be:"Why should I bother? He attacked me! I gave all warnings and if he can't deal with what's coming, he shouldn't have attacked."
Well, people get hurt in fights you weren't involved in too. And hopefully, the chance is greater that you will observe a fight than participate in it. And there may not be a discernable "good guy" and "bad guy". And even the "good guy" would be in a less than resourceful state when he comes to. Indignation and adrenalin don't go well together.
Not to mention that if you administer first aid to a person that has been struck down by another person, then the guy standing may interpret your actions as hostile or at least blaming or accusing. Or even deciding that you *are* the problem. At least he knows in the back of his mind that there is a problem somewhere and his focus is on you. A very realistic drill, IMO.
Many people here are from public services like the Police Department. Administering first aid is part of the line of duty. The rest of us have the option of not getting involved if we get bad vibes, but what if it is, say, a friend of a friend that is laying there? Will you bet that he will be able to tell friend from foe? Like for instance if you hit someone with your car, you will have minimal criteria to judge what kind of person he is. And even if you have a basic idea from watching the fight, first aid takes you intimately close to strangers in a less-than-resourceful state. And people around are excited...
I don't think the quality of service rendered necessarily will have to come at the expense of the tactical concerns. At least not for the purely life saving first aid. But you need to know where and how to check for pulse and how to clear airways and should not have to spend a lot of time doing this and you can interpret your readings and yet keep focus around you. And communicating intent to everyone.
It would be useful even if you are the one who did the damage. Saves people a lot of pain in legal proceedings when probable intent is advocated/evaluated, how the jury will judge your character, wether you will lay and sweat the whole night through wondering if the cops are at the door next day as opposed to knowing that he did not lay and suffocate.
Ever since TB introduced the confrontational drill with NVP, self defense has been redefined to include identification of the determistic nature of human behaviour/response pattern and avoid or handle situtations in which the probability of someone else hurting you are heightened. This is such a scenario. And the humantiary nature of the situation may cause you to inadvertently disregard its tactical nature.
Or a more politcally incorrect concern: that you can know when you are really in trouble, when it's time to panick.
Like people learning to handle firearms usually learn how to treat gunshot wounds. Everyone is learning first aid these days, and if there is a tactical sound way of doing this, then I don't see why one should do it any differently.
Chances are great that a laying and kicking panicky person with an arterial bleeding from the neck will respond aggressively to well willing efforts.
Very intersting and important thread.
It illumintes our THREE FIGHTS principle:
FIght 1: You vs You (courage, fear management, self-coaching)
Fight 2: You vs the Opponent (skills, conditioning, Tactics, etc.)
Fight 3: You vs the Law. (Moral, ethical & legal considerations)
You can ace fight 1 & 2 and really blow fight 3. There are many
countries that require one to administer some sort of treatment and
there are likely sublte variations of this we should all at least get
Its a really edgy debate of course, aside from realistic concerns like:
bloodborne pathogens, skill fear (EMS trained vs not), fear of making
things worse through incorrect diagnosis...if you were involved in the
conflict there's clearly going to be emotional factors pulling at you.
If you have an opinion on this keep it succinct and professional. If
you have a tactical/medical and legal insight, do share.
I'll try to assist where I can...I am an LEO who has worked with HRT for over ten years and in my capacity have seen some serious stuff, including gun shot injuries where the shooting officer had gone into shock while the attacker was still conscious, talking and ending up survin the ordeal. Additionally, I have trained with medics and paramedics to be prepared for the worst case scenario on hte job.
Firstly...if you do not possess any First Aid skills relevant to the problem, you can not be held liable for not offering assistance other then phoning emergency services.
However, the other side of the coin, here in Canada anyways, says that if you have the training and failed to do something were someone had lost their life or is disabled because of inaction...you may be held liable. I know that this seems harsh, but it actually comes down to your ability to articulate what had happened, what you observed, the perceived threat to both yourself and the injured party, as well as your ability at the time to do something positive for that party.
As for being a third party assisting with first aid, my only suggestion is "choice speech". Creating replications or scenarios of certain situations may assist in developing rapport with those requiring the treatment as well as those who administered the injury and remains at the scene.
Keep in mind that depending on the severity of the injuries, this indiviual may be in shock and not cognitive of their or your actions. I was once kicked in the head while assisting a person who had gone into insulin shock. You need to distinguish the difference between intentional action and not while assisting.
Hope that this helps abit.
In addition to Sean's post.. I would like to add the following excerpt from an advanced first aid course I took here in Canada 6 months ago.
A first aider who assists someone in need of emergency care will not be held liable for negligence.
There is no need to hesitate or to be concerned about legal liability provided that:
1)First aid is not forced on a conscious person refusing help;
2)A common sense approach is adopted in giving first aid;
3)You use caution in giving first aid so that you do not aggravate or increase injury;
4)You give the help you would hope to receive if you were in similar circumstances
Robb Finlayson, PDR TEAM
I am a Professional Fire Fighter (17 years) and teach First Aid professionally as well.
As with many laws and legal issues, make sure you check your country, state, province etc. Many laws are the same, but some are different.
In Washington (and most Western states) you will not be held criminally liable for administering prudent first aid. You can however be held civilly liable. What is prudent first aid? Prudent first aid is the same or similar aid any one with the same or similar training would have provided under the same or similar circumstances (written by lawyers, can you tell). If you go beyond the scope of first aid or do something really stupid you can be held criminally liable (and Im sure a civil suit would follow).
Now for the reality check, I respond to an average of three medical calls every shift. In 17 years I have given one deposition. In other words, there are not a lot of criminal charges or civil law suits pre-hospital.
As Robb pointed out, I recommend everyone use the TEAM approach: Treat Everyone As Me. Treat everyone the way that you would want to be treated, treat everyone the way you would want a spouse or your child to be treated. If you do that, most of the time you are going to be o.k. legally, morally, and ethically.
Keep in mind that everything in first aid has a priority. The first priority on the list is your safety. If you cannot provide first aid safely, then maybe the only thing you can do is call 911. As Sean pointed out, you should be prepared to articulate why you couldnt safely provide aid.
Finally, if you have not had a first aid/CPR class recently, get out and attend one. I believe we all have a moral and ethical obligation to help even if there isnt a legal obligation. At a quality first aid course you will learn the legal requirements in your area, how to administer aid safely, how to protect against blood borne pathogens, etc. As Coach Blauer said at the BMF seminar The more you know . . .the more you know. Everyone should have first aid knowledge in his or her tool kit.
With Safety In Mind,
Rob Gebhart, PDR Team
I'm flashing back almost 20 years to a Wilderness Survival/Search & Rescue Course I did in Alberta in 85.
The thing I remember to this day was the Sartec instructor emphatically teaching us that rule number one was not to proceed if you felt doing so put you at risk of serious harm. All you'd probably end up doing was adding one more casualty to be humped out.
Sean wrote, "Creating replications or scenarios of certain situations may assist in developing rapport with those requiring the treatment as well as those who administered the injury and remains at the scene."
Sounds like the best advice! Let the scenario dictate appropriate tactics.
You guys are pros at this, you've used this training in real life
emergencies, how about some brainstorming and then a small session
at our combatives camp this summer? Just some basics, SOPs etc.?
If Doc L is available the three of you could put on an important
While the thread has evolved into something very pertinent, I would
like to also point out the SPEAR applications here for the proverbial
startle/flinch when your opponent awakens from unconsciousness or
an EMT administers FA and the patient reacts reflexively lashing out at
Dr, Levasseur, a trauma surgeon & PDR coach has had to use the actual
SPEAR tactic in the hospital to engage violent patients render them
immobile to administer treatment.
This is great content here. I'd like to throw in my two cents worth as well from two different angles.
For over twenty years my parents have owned daycare centers and have provided before and after school care for the local school district where we live. She makes all of her staff attend basic first aid and CPR sessions on a regular basis. The administrators at the school have the option of attending more advanced sessions. Since this is a family business and I have, in the past, assisted at the school, I have been received certification in both CPR and First Aid since I was 15yrs old. What I found important here was that not only did my parents stress the importance of this skill to her staff, and myself and siblings, she also made sure that it was outlined in all of her paperwork that parents received that the staff had this training and that if there were any questions or concerns with what might be conducted should an emergency arise, the parents could always contact her.
Certification of instructors might be an important dimension for people to add to their school programs, including the description.
On the professional level I have attended two First Responder courses in the last 3 years. One Wilderness related and the other Tactical (meaning combat situations. complete with scenarios, simunitions and other factors). First and foremost, the instruction was amazing. Second, they stressed exactly what everyone here has as well -- safety and common sense -- in the process of administering any aid.
This could be an incredibly vital addition of any scenario training in many different venues - not only LEO/Mil. Clear a path to assist a friend/colleague/ or family memeber; keep people away as you administer aid (verbal defuse); and on. We can all see the evolutions and possibilities. I would truly enjoy a session on this at the combatives camp in August.
At the Florida High Liability Trainers Conference last year, some paramedics put on an excellent presntation on self aid. It inspired me to get one together for our yearly survial class.
Went over really well.
Could you send me a copy for some more ideas?
Better late than never but here it goes. I was an EMT in Milwaukee WI before I was a cop and I met my wife running search and rescue dogs on a voluntary team.
First off the best option for people really interested in gaining knowledge is formal training. Wisconsin first responder class is a cheap and minimal time/cost commitment training which will help tremendously. EMT used to be this way but every year they complicate each class. Basic EMTs are now responsible for a level of trauma and ACLS meds that used to be out of their class. First responders are now held to the standard of old EMTs (my opinion). I always felt this standard was not to much and not to little for every citizen of average intelligence to master.
Secondly some treatment training for bone breaks, minor cuts, and similar minor injuries is a nice thing to have but usually not a real big deal.
Biggest deal is ABCs and before ABCs is one simple question. The question is "is the scene safe" if the answer is no - don't enter. If you are a cop you must first make the scene safe before you enter. The level of "safe" you make the scene before you enter may be, under fire with fellow swat cops delivering directed cover fire as you get to and remove a victim from a scene, or without swat cover it may be stay behind hard cover and verbally reassure the downed victim.
If you are already in the scene and it is not safe get out of there. This goes for getting your self out of there if you are the victim or getting your comrade out of there. If the scene is not safe to the victim because the victim attacked you and you are justifiably ending the violent encounter you are obviously preoccupied - but then after you end it and the scene is safe (unless he has pissed off budies posing a threat) there is probably a moral obligation to do something if the other guy is really injured.
the "is the scene safe" question should give people a road map of priorities. It has me - as an EMT, a cop, and a citizen. It helped me win fights 1, modified fight 2 (with the patient not the bad guy), and fight 3 (legally explaining what i/we do). Again from a concious thought standpoint this should come first as we only ad to problems by also getting injured and going down.
next would be the ABCs. They are Airway, Breathing, and Circulation. They work in that order. No other order is acceptable (thats my opinion, its what i was taught, what worked, and what i still beleive). I once I was with a new EMT who was starting to get stressed by a choking patient who was having repeated seizures. I put my hand on hers and reminded her that we must attempt to maintain an airway before helping him breath. That is all we did until a 3 man paramedic team came and took over from our 2 man EMT team. Despite the fact the man was turning purple our single minded actions kept him kicking long enough for paramedics to work their magic with meds and advanced airways - we were later commended for our patient care. In other words the worse the patient the less work you must do - kinda (its at least a good mind set shift to de-stress the situation).
To be continued on a second thread
Breathing is second and third is circulation. Circulation includes do they have a pulse and is there any significant bleed. Now if you do not have an air way, are not breathing, or have no pulse you won't know the difference. so the first thing you must be personally concerned with (aside from absenting your self from a scene which is not safe) is maintaining pressure on an arterial bleed. Finer details of this treatment include elevating the wound above the height of the heart if possible (basic Hydraulics). Treating yourself for shock (defined as inadequate perfusion - perfusion defined as oxygenated blood reaching the bodies cells) by way of elevating feet to increase blood pressure and usually a blanket to keep warm. A theory i heard which i believe to a certain point (a judgement call based on your training and experience in the field) is to not treat someone for shock who has a serious bleed. reason is by increasing the blood pressure they (or yourself) will bleed out quicker. But that is also covered by only doing ABCs first. Shock is not in the ABCs so you would never treat for shock unless ABCs were first dealt with to reasonable completion.
After ABCs (this assesment could take 3 seconds to complete) then you would go into secondary problems. Most concerning are some oddities. An example which comes immediately to mind is femur breaks with no immediatte professional care and other oddities. Another one is never pull out a foreign body (like a knife) foreign bodies need to be kept in place to control bleeding. Like a cork in a bottle. But Coach Blauer already teaches this. Knowing to look for a deviated trachea, subcontanious emphasema (like bubble wrap under the skin at a gun shot or stab wound), or asymetrical paradoxical chest movement are all fancy medical ways of describing things anyone can look for and only help you in identifying collapsing/collapsed lungs which you may want to suspect during gunshots or stabbings.
alright enough babling. Here are some points. Just like Coach Blauer simplifies and shifts the way to look at scary things for empowerment simplify what you need to know medically. scene safety and the ABCs are the only immediately critical things. If you do not have a pulse you won't need to worry about it anyway - if you are concious you can skip right to severe cuts. Secondary rules like keeping foreign bodies in are simple, empowering when you realize knife in is less desirable than knife that nevver touched you but more desirable than stabbing with knife now pulled out. all of these simple medical rules are easy to acquire from basic and simple first responder classes - which if you "don't let the math beat you" is no problem for most people.
last few things - legal disclamer I stopped renewing my EMT license about 1 to 3 years (don't remember) into my cop career so get training with licensed instructor in your area and check out the laws in your area. Empowerment of this material is that its been 3-5 years since i was a licensed EMT. Practicing in training, and performing it in life has ingrained it in me. Even after this lull of actively using it, its with me and it can be accesible to anyone. Coach Blauer is great at demistifying things and addressing it to the "warrior athlete" instead of the Chia master of spirit and blah, blah, blah. Demystify medical material in your own mind as well. Examply: I said shock was a matter of basic hydraulics. It is hydraulics and i just demystified it for myself. Its not as complicated as blood and guts, and cells, and blah, blah, blah. Hope ya got the point.
Hope it helps - i had fun walking down medical memory lane from some of my days gone by.
This thread was helpful, and thank you to those who responded.
I have held a course for local paramedics and just to practice normal procedures with a tactical element in it was highly appreciated. Most "presumed compliance" elements were easily transferable.
Took some elements from that course and made a standard "check vitals on seemingly incapacitated subjects without exposing yourself needlessly" which is worthwhile for everybody (not just paramedics) to be taught in our normal classes. Very simple stuff like talking while approaching a nonresponsive person lying on his side from his backside, and partially support yourself on his tricep before touching so you can jerk back if he should spin around. That sort of stuff and with people familiarizing themselves how to check for vitals without putting their ear to his mouth or chest :)
Even though this objectively isn't the greatest of threats, people with this knowledge has, IMO, a better chance of actually deciding to help people. And, as I said, if there is a safe way to this, why should anyone learn to do it differently?
Anybody with a chance of hitting someone with a car should learn this.