SOFREP:  What kind of combat trauma did you face in the war zones, and what were the challenges you saw in effectively delivering combat medical aid?

Max Dodge:  Everything from simple car accidents to complex blast injuries. The biggest obstacle to excellent care was my own lack of knowledge and training. Even though I was hungry for more knowledge, finding a reliable source of information and being able to effectively train was difficult.  As I progressed from a line medic to a flight paramedic I took on the responsibility to teach what I wish I had learned sooner.

Dominic Thompson:  Numerous blast injuries from Improvised Explosive Devices (IEDs), pediatric extremity [arm and leg] amputations, burns from pediatrics to adults, gunshot wounds, and skull fractures.  The challenges that I saw while deployed for delivering effective combat medical aid were not a lack of supplies or support, it was the ability to get to my patient in a timely manner so that I could do everything in my skill set and attempt to save their life to get them to a higher echelon of care.

Andy Fisher:  It depends on the unit and the mission.  As a member of the 75th Ranger Regiment, I saw a wide variety of penetrating and blast wounds.  Shrapnel from grenades and similar devices was not uncommon.  There was a mix of extremity and thoracic wounds.  The issues I noticed involved delivering medical care at the point of injury (POI), and delivering adequate care in MASCALs [mass casualty events].  You were limited to what you could carry on your back.  We did not have the luxury of a hard structure where you could store equipment, maintain a large staff, and shield yourself from the environment.  I have an aid bag on my back and people to help, but we also have to maintain security, engage the enemy, and complete the mission.  Casualty care is just a small part of the overall mission.

H.R. Montgomery:  Over the years, I have seen everything from jump injuries to gunshot wounds to massive burns.  They all fell into one of three categories: those who would die no matter what we did, those who would live no matter what we did, and those who were dependent on us doing the right thing at the right time that meant the difference between life and death.  Combat medics, EMTs, and now the civilians we are trying to reach must understand their part in dealing with casualties who depend on them to take the critical action at the right time.

SOFREP:  How can civilians best prepare to save themselves and others if faced with a mass shooting or terror attack?

Dodge:  I think that preparedness has been given a bad name.  Building and maintaining the tools and the mindset to be prepared when disaster strikes has been the top recommendation, whether it was from official sources like FEMA, or from the “old guys” who have been there and done that.

Thompson:  This answer is actually very simple – training.  If an individual trains on a piece of equipment initially and continues to train on it, he or she will become proficient in its use.  As a 68W instructor, we would have hundreds of students every class that had zero pre-hospital trauma training and the majority of them were straight out of high school.  We would explain and teach them why placing a tourniquet in this manner is so important and why it will save a casualty’s life.  After providing them a demonstration and them placing it on themselves and their partners, they knew where and how to place a tourniquet to effectively stop life-threatening hemorrhaging.

Eric Soderlund:  While some types of attacks are unavoidable, the idea is not to get injured in the first place.  Not becoming a casualty and being able to help others when the threat is eliminated or suppressed will lead to more lives saved.  We saw this in Boston and Las Vegas, as uninjured bystanders helped others.  Obtaining active killer training along with medical training is a good first step.

The Texas State University has the Advanced Law Enforcement Rapid Response Training (ALERRT) program which puts on training for law enforcement.  This program goes back to 2002 and is a nationally-recognized standard for active shooter response. 

One of the classes offered is the Civilian Response to Active Shooter Events (CRASE) course, which is designed and built on the Avoid, Deny, Defend (ADD) strategy.  This is a “train the trainer course” and it equips local law enforcement to host active shooter training for schools, businesses, and community members.  This gives direction on what civilians should do if confronted with an active shooter event.

I would encourage everyone to look for an agency who has been through this training and take a CRASE class.  At the very least, look at the Department of Homeland Security (DHS) Active Shooter Preparedness Program webpage for information on how to deal with active shooter events. 

Fisher:  Simple first aid education and training used to be common.  However, I feel with larger urban centers, better technology, and access to emergency departments, there is now a sense of security, so many do not concern themselves with learning the basics of trauma care.  Getting the right training through NAEMT [the National Association of Emergency Medical Technicians] or bleedingcontrol.org is the best way to ensure that you can respond appropriately.  Furthermore, communities should engage their local elected officials about placing Public Access Bleeding Control Kits near every AED.

Montgomery:  Often it is the feeling of helplessness that people in desperate situations have the most problem dealing with during and after the situation.  Hopefully, we are arming them with a skill that can both save a life and provide them purpose when confronted with these problems.  People knowing what to do will both raise awareness and skill at fixing the problem.

SOFREP:   The next article in this series will continue our interview, in which we ask the NGCM team about transitioning to civilian life and more.

Featured image courtesy of Next Generation Combat Medic.