LETC [2014] 114

By John Krupa III

How many times have you been at the range and thought “What do we do if someone gets shot or injured during training?” You’d be surprised to learn that there are a lot of range facilities that do not have a posted Emergency Medical Action Plan (EMAP) in place to deal with serious on-site injuries! Sure, they may have a policy protocol established in their range operations manual, but who is responsible for executing it? Have they been trained appropriately on how to respond to medical emergencies and what resources are available on site to actually deal with serious injuries?

If you do ask that question at the range, most of the time the response will be to use the first-aid kit that is available on site and to call 911 for serious injuries. It’s obvious that there needs to be a much more detailed plan other than just slapping a band-aid on a wound and waiting for EMS to arrive.

It has been my experience when inquiring about EMAPs at range facilities that they are not all prepared to deal with serious medical emergencies and lack proper equipment and training to deal with trauma injuries.

So let’s explore some steps on how to establish a reliable EMAP and how it can be implemented so students, instructors and range staff alike will know these procedures and what actions to take at the onset of each training evolution.

Start out by acquiring medical supplies and build medical kits that can be easily identified and accessible on the range. I recommend building a First-Aid Kit, a Trauma Injury Kit and AED Kit.

The First-Aid Kit is typically built using a heavy duty plastic tool box or tackle box that is orange or yellow in color. Use an indelible black marker to write FIRST AID KIT on the front, back and sides of the box in large letters so it can be easily identified.

The First-Aid Kit will include all of the essential medical supplies that will be used for non-serious injuries and will be accessed regularly to treat small scrapes, cuts and other minor injuries. This kit should be monitored on a regular basis to ensure that used items are replenished.

TMS-R-AID

The Trauma Injury Kit is typically built using a heavy duty plastic tool box, tackle box or soft canvas bag that is RED in color. Use an indelible black marker to write TRAUMA KIT on the front, back and sides of the box or bag so it can be easily identified.

While this kit will rarely, if ever, be accessed (hopefully you won’t need to use this kit!) it should also be monitored regularly so items with expiration dates can be rotated out and replaced with fresh supplies.The Trauma Injury Kit will include all of the essential medical supplies that are needed to treat serious trauma injuries such as; hemorrhage control, deep lacerations, penetrating puncture wounds, gunshot wounds, sucking chest wounds and tension pneumothorax.

The Trauma Injury Kit should ONLY be accessed for serious injuries and by personnel that have been properly trained in TCCC (Tactical Combat Casualty Care) or training of equivalent level.

The AED Kit (Automated External Defibrillator) is something that every range facility needs to acquire and have available at all times. While AED units can be purchased new, with a little work searching on the Internet, you should be able to find a source that will donate a decommissioned unit for your facility.

The First-Aid Kit, Trauma Injury Kit and AED Kit should be kept on-site where the training is actually taking place and immediately accessible. These kits will be useless if they are kept in a range building down the road or in a vehicle parked 100 yards away!

The next step is to establish a communication protocol to contact 911 for EMS response. While hard line phones may be on-site, they might not be immediately accessible on the range. I recommend assigning at least (2) range staff members or students with reliable cell phone service to keep their phones with them on the range in the event a 911 call needs to be made. Another option is to have a police radio on the range for direct contact with dispatch. Assign (2) people to emergency call duties in case one of them is the person that is injured.

Create a laminated handout, outlining the EMAP, that can be kept on the range and accessible with the medical kits. The handout should contain the physical address of the range facility, GPS coordinates (for Life Flight dispatch) and the direct phone number to EMS dispatch. The direct number is important, as a 911 call on most cell phones may not always reach the dispatch center for the area you are training at. Having the direct number to dispatch available, the people assigned to emergency call duty can preprogram that number into their cell phones.

Include the name, address and phone number to ER of the closest Level 1 Trauma Center in the laminated handout in the event the decision is made to use one of the vehicles on site to grab and go vs. waiting for an ambulance. Sometimes it may be quicker to drive someone to the local hospital vs. waiting for EMS to respond. If you do decide to grab and go, make sure a phone call is made to the hospitals ER in transition from the range to the hospital to notify them of what you have and ETA to ER.

LETC [2014] 282

In summary, review the EMAP with everyone at the beginning of each training evolution during the range safety briefing. Show everyone in the class where the medical kits will be located on the range. Identify range staff that are TCCC qualified. Identify any students in the class that might have a medical skills background and recruit them to assist the range staff, should a medical emergency occur.

Assign at least (2) reliable people on the range to emergency phone call duties and verify the direct dispatch number, GPS coordinates and range address with them. Make\ sure they know where the laminated EMAP handout is located with this information.

Lastly, if a serious injury incident does occur, whether you decide to wait for EMS or grab and go to the hospital, be sure to secure the area where the incident occurred as responding LEO’s will be required to process that area as part of their investigation. It is also recommended that anyone that witnessed the incident remain on scene for LEO debrief.

If you follow these procedures and develop a sound EMAP, you’ll be ready to handle any emergency medical situation that occurs on your range.

As always, stay safe, remain vigilant and Fight to Win!

John Krupa III, of Spartan Tactical Training, is a police officer with the Orland Hills Police Dept. (IL.) and has over 24 years of experience in law enforcement. He has previously served as a patrol officer, FTO and firearms instructor with the Chicago Police Dept. He is a recipient of the Award of Valor, Silver Star for Bravery and Distinguished Service Award for his actions in the line of duty. He is a certified Master Firearms Instructor from PTI and graduate firearms instructor from the Secret Service Academy, FBI, DEA and FLETC. He holds the rating of Distinguished Weapons Expert with the Department of Homeland Security and has presented numerous courses at training conferences across the country including ASLET, IALEFI and ILEETA. John can be reached at – [email protected]

 

This article originally appeared at Action Target and is republished here with permission. 

 

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18 COMMENTS

  1. “The Trauma Injury Kit should ONLY be accessed for serious injuries and by personnel that have been properly trained in TCCC (Tactical Combat Casualty Care) or training of equivalent level.”

    How does one acquire such training?

    • EMTB/EMTP certification would go a long way.

      Or simply learning how to properly seal wounds with occlusive dressings, along with managing wounds in general (gauze, pressure dressings and tourniquets, when and how they should and should not be used)

    • You won’t find it at the American Red Cross. You’re best bet is to check out local firearms training schools and gun clubs. There are also regional wilderness medicine schools that may offer such training. Sig Sauer Academy has a couple of TCCC type courses available (Bullets and Bandages 1 & 2) as do other schools around the country. Google is your friend.

      You would do well to get fully up to speed (if you aren’t already) on basic first aid, CPR, AED, advanced first aid and advanced life support prior to signing up for a TCCC class.

      The last couple of years my club has brought in a fella named Chris Van Houten (NREMT-P) out of NYC and a few assistants. He’s a 20+ year vet of the business. Here’s a bit of his bio; “Taught by an experienced 20+ year NYC paramedic, students will leave knowing what does and doesn’t work in the real world. The course will be a mix of lecture and hands on practical skills culminating in an intense scenario where students will apply everything they’ve learned.
      Instructor Background: Christopher Van Houten is a nationally registered critical care paramedic with 20 years of New York City Emergency Medical Service (EMS) experience. Chris serves as northeast regional (Region 1) faculty for the Tactical Combat Casualty Care (TCCC) program and develops programs for numerous federal and local agencies.”

      I took his class last year and it was excellent. I try to keep up to speed and take a class like this every other year or so to stay sharp.

  2. Half of my range bag is stuffed with various bandages and first aid supplies. Seemed like a good idea.

  3. The nearest ER is more useful than the nearest Level 1 Trauma Center.

    All of the state of Arkansas does not have a Level 1 Trauma Center, I believe.

    Get the patient ASAP to the nearest definitive care, which if the patient isn’t sufferinng from a brain injury/punctured heart should be most any competent local ER. Even punctured lungs should be able to be addressed at any small rural ER.

    • If you can control the bleeding in 3 minutes from the event rather than packing the injured person in a car and letting them bleed on the floor for 30+ minutes, I don’t see how that theory makes sense.

    • FYI – there are 6 level one trauma centers for the state of Arkansas. Because of proximity, 4 of them are in either TN or MO. I know if I’m down in southeast AR, I’m heading to Memphis.
      Arkansas Children’s Hospital (ACH) Little Rock, AR
      Cox Health Springfield, MO
      Le Bonheur Children’s Hospital Memphis, TN
      Mercy Hospital – Springfield Adult Springfield, MO
      Regional One Health Memphis, TN
      University of Arkansas for Medical Sciences (UAMS) Little Rock, AR

  4. Good call on having an AED on site (for use in cardiac arrest in conjunction with CPR) and that it must absolutely be on-site, not 100 yards away.

    There is no perfect.

    While this article is written from the perspective of what a range should do, I’d endorse having your own medical kit with you. In your vehicle as a daily kit (I need to build one of those myself, now that I mention it….) and on your person when warranted (say a range kit, again, I personally need to walk the walk on that one….)
    Build a kit on what you’re competent with, and no further. If you can put on a band aid, have those. If you are competent with gauze, tourniquet use and such, have that. If you have EMTP cert and want to be prepared for the possibility of pneumothorax (collapsed/punctured lung), have yourself some chest darts.

    Just remember; once the most basic of life-saving goals is accomplished (stopping major hemorrhaging, for example) the best thing that can be done is to get them to definitive care (a local ER, for example). Time spent dicking around trying to do interventions you know nothing about (chest darts, for example) or trying to be a hero (I have SEEN CPR started on a patient who STILL HAD A PULSE, thanks for breaking her ribs, friend) is hurting, not helping.

  5. The laminated card that has emergency phone numbers also should have a “phone script” labeled “What to say to 911” :

    “There has been a TRAINING ACCIDENT at….”

    Saying anything to dispatch that contains the words or phrase “shooting” is guaranteed to triple the EMS response time – they will delay entering the scene until it’s cleared by law enforcement.

    All the best, James

  6. Yes and no. I’ve responded to a couple hundred shootings , yes back in the day we never staged for the police to clear and today we do mostly…..

    It’s up to me as a LT. Someone lying in the road, no active shooting /fighting we’re going in, a gun range we’re going in as it’s not the same as a shooting at a drug house where we’ll wait for it to be cleared.

  8. I wish more ranges in Canada took this into consideration on a more serious level. In the last five years, I’ve shot at perhaps a dozen ranges in three different Provinces, and not one had either a trauma kit or an AED.

    The majority of the ranges had pretty basic first aid kits. In only one instance was the range kit comparable to the one I keep in my truck, which is an abbreviated version of the one my wife and I have at home. The ranges I’ve shot at most frequently in the past few years only had tourniquets on site when I was shooting; I have two in my own kit; they have none.

    I’ve pretty much stopped openly inquiring about first aid equipment at ranges; I’ve yet to have a favourable reaction to the question, even from one range who had one of the better kits I’ve seen…sad that it was kept in a LOCKED building!

    I should point out that this is not something I’m overly sensitive to; I’m not an EMT or Paramedic…simply a retired guy, volunteer search & rescue tech with an advanced first aid certificate

    • Yea, I carry med kit in vehicle and keep trauma packs on my person, in my range box and in both my tac bags and all of our bugout bags. And no, I am not paranoid, I am prepared! 😉

  10. Looks like serious overkill to me. And I’m sure the antis could really make hay with this stuff… wonder how many ranges they could get shut down because they didn’t keep an EMT on staff… How much do you suppose all this stuff would add to the cost of your range time? If your range is so dangerous that being shot is any real threat, maybe you need to find a different one.

    Our range is available to any member, at any time. We are on our own, and there is no official RO for anything except organized events or things open to the public such as zero in days for hunting season.

    In more than 20 years, we’ve had no “training accident” more serious than a banged up thumb from a slide. Anyone who cares brings a first aid kit, and I carry a trauma bag all the time. I’m just not always there, of course. We don’t even have a telephone or running water at the range.

    Yes, we have a written “plan.” In reality, it boils down to this:

    Follow Cooper’s rules
    Keep your gun pointed down range
    Don’t shoot at anything but the targets
    Anyone who won’t do those things is asked to leave…

    Seems to be working for us.

  11. Basic Individual Aid Training. Trauma Pack on each person. Don’t shoot each other.

    As for privately owned, open to public ranges, they should have medical gear and at least one medical aid trained person on site during business hours. Its just common sense. With the large numbers of trained personnel that have cycled through and out of the US military during the last 14 years there ought to be lots of people with the requisite training.

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