Down on the Line

[Cat J Godden]

It wasn’t the sound of the rifle that made my heart jump, it
was the series of profanity after that made my adrenalin instantly spike.  As I turned to investigate (as any curious
human would) I saw my now patient laying on the line.  It was obvious right away that this was going to be bad, very bad.  I grabbed my medic kit and swore as I ran to my patient, who was already near complete unresponsiveness and massively hemorrhaging from the femoral artery. 

I had dealt with issues such as this before, learned to take
the emotion out of the treatment and let my training take over.  But you can’t help the flow of fear when you
watch that much blood run out of a patient.  Your fine motor skills dwindle, you start to sweat (even if its 30 degrees outside) and you have the sudden urge to pee.  But your mind takes over and begins the game of chess- trying to outsmart the kinematics of trauma.

So I pulled out my tourniquet and applied it as high up on
the leg as I could, I cranked it down as hard as I could-mostly out of habit but some of it was extra emotion and determination not to lose my patient.  With my knee enbedded deep in the injury to stop the blleding; I reached for my hemostatic gauze, my hands slipped on it with the combination of blood and cheap plastic, I ended up splitting it open with my teeth and both hands (which as a medic, I have to highly advise against this method).  I proceeded to apply the methods that I have taught for so long, pack to the bone.  I think after that first roll of
gauze, I finally took my first breath and the tunnel vision finally cleared.  Clotting factors take approximately 3 minutes to set in a trauma such as this and I jammed my knee in the injury to hold pressure while it set.  With my hands free, I finally looked up. 

Guns had been holstered, the world had stopped revolving and my team was around me.  As fast as I
could process the information in my head, my team was tossing assessments and information my way.  A team of alpha male operators, used to hammering in and taking charge; had fallen in line beside a lowly female medic and were following the training I had pounded into them.  Cohesively as a team; airway was managed, respirations supported, back up support called and en route, and vitals handled. 

Further assessment showed a single gunshot wound to the
femoral artery and focus turned to managing our interventions.  IV and fluids were in and thermal blanket
applied.  When my backup arrived I found
myself sputtering off a MIST report that my team had put together based off their assessments and interventions. 

A survival, a success…. This time.  I was a proud momma duck of all my little ducklings.  It didn’t matter how much training, education, powerpoints, or pictures I shoved down their throats, they had passed the final test.  A true bloody
life-threatening wound, and they had passed with flying colors.  We always train to prevent injury.  The true question is, do you train for the time that prevention fails?

 

October 31, 2011       
Cat J Godden NREMT-I, Tac EMT-I, EMS-I

[Cat J Godden]

Kim,

I was really hoping to put a class on for the WTA :) I am glad that ya'll are taking this angle of training. 

 

I have found a lot of help in the book:

"Tactical Emergency Care- Military and Operational Out of Hospital Medicine" by Robert A. De Lorenzo and Robert S. Porter.  The book is published by Brady

If you are looking for videos, the Quickclot Website and the Celox website has short videos on hemostatic agent useage and application.  I am not sure what you are planning on implicating in your class or what interventions you are going to teach, so it is hard to recommend... I have a lot of literature on hemostatic agents, tourniquets and airway adjuncts.  Depending on what you are looking to do. 

 

If you need help with the class, feel free to email me (text is better). My information is below.

Thanks.  Stay safe

 

“The fate of the wounded rest in the hands of the one who applies the first dressing”

Col. Nicholas Senn 1844-1908

 

Cat J Godden NREMT-I, Tac EMT-I

CEO, Emergency Medical Solutions

www.emergencymedicalsolutions.us

[e-mail]

979-270-1552

[Kim Heath]

Great post Cat, and awesome that you had it handled!  I've been through a couple self/buddy aid classes that addressed some things you mentioned in your post.  I'm in the process of scheduling a class for the WTA on that topic and was wondering if you could recommend any books or videos for our members that are interested?