Basic trauma care is the oft-neglected leg of the Holey Trinity: Poke Holes; Prevent Holes; Plug Holes. Our introduction to trauma care was Doc Gunn’s one-day Boone County class described in an earlier AAR and S.W.A.T. article. Good basic trauma care training is something that has been difficult to find and schedule for the whole family.
Pat Rogers has stated, “We require BOK for all students in the shoot house class. In 2012, they will be required for all carbine classes as well.” It goes without saying that having a BOK means little without the skill sets to employ its contents.
Enter Bayan Dakuginow, 12-year municipal paramedic with medic contractor experience in Iraq and Afghanistan and owner of as well as lead instructor for Active Trauma Management, Inc. We first met The Mongrrrorian back in 2004 at an EAG COC class at Boone County. Of him, Pat says he “is a rock solid shooter and teaches a great trauma management course.”
After a brief discussion during the July EAG Carbine Operator Course 2, we engaged him to journey down to our Southern Indiana homestead to conduct his Trauma Care 1 class for Clan Paskey. Accompanying Bayan was his able assistant, Brad Trittipo, a fellow EAG student and Indiana police officer. As with most classes, the organizer’s seat was gratis and we paid the standard $89.00 per student. This is a bargain, as I hope to demonstrate.
Bayan offers Trauma Care 1 with the option of taking Trauma Care 2:
Trauma Care 1 and 2 - what to do in the event of violent trauma, active shooter, home invasion, or robbery. We cover some of the fundamental principles of security, moving to a patient, then treating the patient.
We opted for TC 1 only due to constraints of this year’s training budget. Our primary focus would be bleeding control and chest wounds along with a very basic overview of dealing with airway clearance resulting from an incident here at the farm.
Prior to class, I requested that, for the most part, Bayan instruct using the same materials we have in our medical kits: Olaes dressings, Israeli dressings, CAT tourniquets, TK-4 tourniquets, H and H Compressed Gauze, Asherman Seal and QuikClot Combat Gauze. We agreed that skill sets take second place to gear; however, it makes sense to train with the gear normally employed.
Bayan speaks in plain English. He uses the Socratic method for teaching, asking trainees questions to show they actually know more than they think and building confidence as he explains the course material. Unlike law school professors, he neither hides the ball nor leaves it in his office. His goal is to impart solid knowledge and skill sets for its use.
The context for the training was that security comes first. Whatever situation which occurred must be dealt with before treating the wounded. Everyone in the Clan understands this. Then treat the casualty and call EMS or get them to the hospital.
Bayan provided each of us with a copy of the Indiana Good Samaritan Statute. He gave no legal advice concerning it. He simply encouraged us to study it and consider its implications if we were ever faced with a real casualty. This led to a discussion of duty, if any, to provide care someone injured by one of us exercising lawful use of deadly physical force. Between the paramedic, the police officer and the lawyer present, we knew of none.
Next came a discussion of blood-borne pathogens, their sources and how minimize exposure: Wear gloves, wash hands and keep your fingers away from orifices or open skin.
Roughly two thirds of our time was spent on bleeding control. Bayan would introduce a portion of the topic with Power Point slides, demonstrate the pertinent skill set to the nine of us around the dining room table. After questions, we’d head to the living room to perform what we had just been taught. It was always taught in the context of buddy aid first so we could help each other followed by self aid, after we knew better how to perform the task.
Direct pressure methods were covered first, using each type of dressing and then field expedient devices. This approach showed that we understood how bleeding works and what was required to stop it. Then, always, assess. Determine what needs to be done next.
Pressure points were briefly discussed; however, the focus was direct pressure methods of bleeding control. If the dressing were to bleed through, options of using the first dressing for packing so as not to lose those valuable clotting factors that have soaked into it or packing with hemostatic gauze and covering with another dressing.
For arterial/massive bleeding from an extremity, going straight to the tourniquet was offered as a very good approach. Bayan prefers a ratchet device; however, he said our CATs were good to go. As for the TK-4, no justification of its uses in addition to use as a tourniquet would sway him that it was of any use. Again, we applied each to our training buddy to learn proper placement. Then we applied it to ourselves on each extremity. Bayan would check pulses so each person would experience just how tight and how much discomfort is required to stop the flow of blood.
A bit less than one-third of our training dealt with chest wounds and their immediate treatment. He had two good video clips so all hands had some idea what they would look like. Looking for exit wounds was stressed. Duct tape was used to secure an occlusive dressing (the covering from an Asherman seal) to a volunteer. My wife was astonished that it was stickier than medical tape (or the adhesive on the back of the Asherman itself.)
Again, the key was understanding what was the goal, in this case, preventing air from entering the chest cavity. As we had with things which could be used as field expedient tourniquets, Bayan went around the table asking each person to point to something in the room which could be used for an occlusive dressing. Thinking outside the box was encouraged.
Finally, Bayan spent about fifteen minutes on methods of clearing the airway. He demonstrated both the textbook and street methods of head tilt chin lift. He then bravely let each of us perform them on him. The theory of and insertion methods for nasopharyngeal airways (NPA) were covered as well as a very brief description of symptoms of tension pneumothorax. Use of a decompression needle for its treatment was described but outside the scope of training provided. We did not stick needles between beef ribs but instead used the meat to feed our instructors after a great class.
In all, we accomplished the goal of providing each family member with the same baseline knowledge. Perfect practice makes permanent is only useful when the skills are learned properly the first time. My wife said that she felt confident that she could now use the items from the medical kits found in our cars or around the house and out buildings. Priceless!
At the end of the class, Bayan asked each person to relate one solid skill they carried away. We first experienced this technique in John Chapman’s No Light/No Light Class last March. Pat did it as well after the July COC 2. This is a great way, in my view, for an instructor to discern if he is really getting across his material and a source for students to make notes to help remember what others did take away that, perhaps, they had missed.
Active Trauma Management, Inc. will travel 6-8 hour from Central Indiana to provide training to motivated (and sufficiently numerous) students. Its other course is
Range Safety Trauma Care 1 and 2 - we look at some of the day to day moderate to severe injuries you can run into whenever you have people mixed with firearms (or sharp things). We also look at assisting you with a range emergency plan and assembling a first aid bag.
You can get more information and contact Bayan through his web site:
http://activetraumamanagement.com/
For anyone Bayan’s AO, I highly recommend the training he offers.