This has been very much on my mind when getting TC3 training

[Erick]

And that is the Civilian1stDefender/Prepper/Insurgent/Survivalist (or whatever moniker of the day applies) will NOT have access to fast MEDEVACs to a proper hospital.

Yet military style TC3 techniques which are the product&distillation in their nuances of  counting on speedy MEDEVAC and the ready availability of quality trauma care.
In other words they are designed with all that in mind which we wont have.

This is one reason why I was always skeptical when learning my TC3 because when you have combat wounds and you are not part of a large functioning military medical infrastructure getting people past the Golden Hour just doesnt cut it.

So how do we modify our medical TTPs?
As non MDs who here dares to think about modifying published TTPs and doctrine to reflect that our medical paradigm will be distinctly different?

For example maybe our triage needs to change because some guys who would easily make it in a military environment will very much not in a prepper environment no matter how good our TC3 is .......since we dont posses the medical logistics tail that modern TC3 presupposes.

Just an example....:Maybe we might need a TTP about patching a guy who we know will not make it ...but get him "good enough" limited mission capable to hold a choke point for us from the prone to delay OPFOR follow-on forces and to give us time to escape? This is just one example of something that current TC3 doctrine simply doesnt have.. but the brutal reality of a medical starved post SHTF sitation may dictate...

So in summary I propose that the Operational Concept for Medical Casualty Care in the military presupposes support that we will not posses and therefore the kit and TTPs derived from that Concept may not all apply to us.
It follows that we need to evolve a modified or even alternate Medical Operational Concept that is Prepper/Insurgent/Survilaist specific and will drive different TTPs to give us better service and survival than a concept that does not fit us properly.

Any thoughts..

BTW even the Army has been thinking about non medevac TC3 environment.. so perhaps in 10 yrs their TC3 might be a better fit to us..
www.wearethemighty.com/articles/the-army-is-preparing-its-medics-for-a-war-without-medevac-helos

[panzer0170]

There is a very logical line of thought here.

Traditional triage would suggest to deal with catastrophic bleeds first, but if there TRULY is just you and your friends, and no real medical support available... Yeah. It's shitty to think about, but the quicker you deal with your other casualties the more chance they have have of surviving too (dealing with something BEFORE it becomes a problem).

Standard triage is a solid protocol for regular soldiers, police and citizens in a normally functioning society. I think the problem with having TTPs for anything beyond that are that there are SO many variations on what you could do, all of which are not 'wrong' answers... I think the only real modification, as non-medical, I would be comfortable making would be simply 'leaving' someone, and moving on to a treatable patient, and really all you're doing there is moving the bar from 'dead' to 'won't last long enough to be of any use', and or 'ties up too many resources and we've still got problems/need to move'.

Definitely an interesting point, though.

[Ivarr Bergmann]

Great observation and its good to hear someone else say it out-loud about how things will not be like a modern battle field when the hammer drops. It seems to be a reoccurring theme among a lot of folks who think things will be functioning like a modern supportive infrastructure.. Seems no one wants to talk about how the need for larger loads will increase, along with improvisation of a great many things on a grand scale, as will tactics have to be modified when the hammer drops.. I can see non combatants having to go along with fighters with no other job then carrying supplies and tending to wounded and driving the "death wagons" reminiscent of ancient times. These non combatants will also needs supplies when they go along...Its going to be a mess.

I don't have much to add on the medical side of it. Being alone, if i get hit or even a bad infection its a certain death sentence. I focus more on prevention then anything else.

Bergmann

[Hawkeye]

This is one of the downfalls of the TC3 protocol for our use. It's fine for current, grid up situations. It's heavily focused on stabilizing the patient and then the ambulance/medevac taking them off to the trauma center. For us, and what we're talking about here, that wont be an option though. That's why I think Patriotic Sheepdog 's AC3 class is so valuable. In full disclosure, I havent taken it myself yet, but we have talked about it together for more than 2 years.

[protus]

I've taken his course...and others prior as its evolved.great info.
There's only so much you can do for a guy 4 miles from the retreat and opfor is closing.
There's only so much we and even trained guys can do with out a full trauma team/room.
Guy gets a chest wound..or gut shot..hell any center of mass gsws.
What do you do.
Slap on a chest seal....try and move..try and fight.
We can't leave jimmy here ted..his wife ...CONTACT REAR....
Now what.

That's where our heads need to be at in this game.
It's hard to think about what we'd have to do.
But no matter what. Folks need to train and get in a mindset to help and save..but be able to make that non emotional what's better for everyone else. Be that the stay behind get as in erics op. Or to least get the guy those few minutes to say good bye.

Sorry..it's blunt..but we won't Have the luxuries a big logistics train has..we need to adapt to that fact.
Ymmv.
Edit to add few things

[Patriotic Sheepdog]

Okay, I am late to the party here it seems....

Hawkeye hit it...I have developed an AC3 (Armed Citizen Casualty Care) class for just this purpose. I started working on it over three years ago and have taught it for the last two years to friends to refine it. A couple guys on here have attended and can comment to the course itself.

Erick wrote...."...Maybe we might need a TTP about patching a guy who we know will not make it ...but get him "good enough" limited mission capable to hold a choke point for us from the prone to delay OPFOR follow-on forces and to give us time to escape?" Or maybe we just patch him to get him back to base to say goodbye to his wife and kids....

Here is a description of my program:
Armed Citizen Casualty Care (AC3) Guidelines
Written by R.M.W.
(Patriotic Sheepdog)

There may be times where we will need to treat trauma patients when there is no functioning medical care system. This may include times following a NBC/EMP event, hostile takeover such as an invasion from a foreign country or a Pandemic where the medical system is completely overwhelmed and possibly the hospital may not be a safe place to seek out care. It will be imperative to be able to stabilize and possibly treat a patient to save a life.

Unfortunately, if we are living in a time where the medical system is not functioning, we may have very limited means of maintaining the medical care needed for a significant injury. We will not have the well equipped Emergency Department, a Fire/Rescue transport service, a hospital Operating Suite, a professionally staffed Intensive Care Unit or all the support personnel and supplies needed to care for a critical patient for weeks at a time. Your group may have a surgeon, which will be wonderful, but again, that surgeon won't have the anesthesiologist, nurses, blood supply, ventilators, laboratory to monitor simple blood tests such as electrolytes, radiology for X-rays and CT scans, medications, 24 hour support staff and the equipment needed for long term care.

This guideline is for those times. These guidelines should not to be used when there is a functioning EMS/medical system. These guidelines will try and guide you through treatment of a trauma situation to try and keep a patient from progressing to a critical state. Having members of your group trained in some basic medical care will be essential to the health and longevity of your group. Having medically trained personnel such as Doctors, Physician Assistants, Nurse Practitioners, RN's, LPN's, EMT's and Paramedics would be preferable.

Being an armed citizen just the word "armed", means that you most likely will be with, and may need to employ, a "weapon" of some sort. These guidelines will assist you no matter if you are using a club or a rifle to defend yourself. There may be times that you will be with others when an incursion occurs. These guidelines will hopefully assist you with group medical activities or if you are alone.

Many of these guidelines follow the Tactical Combat Casualty Care (TC3) used by the Armed Forces of the United States. The military though has the advantage of having unlimited resources that will not be available to the armed citizen when the medical system is no longer functioning. Therefor, these guidelines have been modified for the Armed Citizen during these times taking into account that the Armed Citizen will have limited medical supplies.

[whitebear620]

More info for this class Sheepdog?
Cost?
Link?

[judomayhem]

Outstanding. I am strongly considering an MOS reclass to 68W (medic), and would buy a manual should you create one.

[ncregularguy]

I have some thoughts on this. Some are based on prior experience of what worked and what failed. Lessons learned is more applicable category. Others are theoretical based on a potential WROL situation.

I'll organize them and get back when I have a bit more time.

Take care.

[ncregularguy]

So, TCCC guidelines were referenced. One needs to keep in mind that these guidelines are constantly changing. About every quarter, new guidance comes out and little things get tweaked here and there. Technology and knowledge (gained from experience, hopefully) advances. One also has to realize that there are different TCCC protocols depending on your scope of practice. It is entirely possible that a TCCC type event may go past the traditional phase 3 scope.

If you have not looked at the TCCC guidelines lately, they may be worth a new look and/or a refresher.

I do not know anything about Patriot Sheepdog's AC3 curriculum. He and I have messaged back and forth a few times and the topic has not come up there. I can only assume that given his knowledge and experience that he has put forth his best efforts. The concept is definitely a sound one.

When I mention a level of care (time of care really) going past phase 3 of TCCC, what I'm really getting into is what we term PFC (Prolonged Field Care).

What happens if the MEDEVAC can't get there? There are several other reasons why the treatment might not end with the more traditional phase 3.

However, the goal of TCCC treatment, and with all treatment IMO, is to stabilize the patient. Once the patient is stable, you have bought yourself some time to work on treating the causes/mechanisms of illness/injury instead of only the signs/symptoms.

Let's face it. We are not just going to ENDEX at phase 3 and stop. We are going to continue until we can't do anything else. At least I hope we would.

With that as our plan of action, we really don't have anything to lose in a grid down situation with no MEDEVAC ever coming. We as the people treating the patient are the last line, so to speak.

Is the patient going to die? Unequivocally, YES. We are all going to die, sooner or later. Jesus excluded, none gets to live forever, at least on this Earth.

So, what we are really trying to do in to prolong the life of the patient in a grid down situation. If that is hours or days, we still did something. It may be weeks and years. It may only be minutes. The point is not to just give up because we are not trained.

To do this, an effort must be made now.

I know most of you are not medics or really interested in medicine. It is an insurance policy you hope you never have to use. I understand that.

However, with that being said, many of you have invested the time/effort to get trained up to the TCCC level. Where I come from, that isa 40 hours course (one week, 5 days, 8 hours per day) that I do prior to each deployment along with all of my team mates.

I've seen a few TCCC courses advertised online and they only take a few days. This is not the complete TCCC curriculum with all of the scenarios utilized. It's a matter of putting in the time. Then it is a matter of refresher training to keep up perishable skills.

For those of you at this level that wish to go beyond this, I'm available for any questions. I have different curriculums/POIs that I have taught other groups in the topics of PFC. It really isn't rocket science. I'm happy to discuss it.

Let's go down a brief rabbit hole into PFC so you can see what I mean.

Let's look at a GSW in the chest. I'll try to use layman's terms and not specific medical terminology.

Hole in the chest. Sucking chest wound. most people know how to treat this. Occlusive dressing, front and rear (if there is an exit wound). That is the only mechanism of injury. Treat for shock.

Administer the Combat Pill Pack. (For those that don't know bout this, please ask and I'll go into it, but it is rather fundamental to TCCC training that most of you have had).

We treat the standard MARCH algorithm and go from there. Only there is no MEDEVAC.

Due to the injury our patient now has air inside his body in places where it should not be. We applied those occlusive dressings to prevent more air from entering the entry/exit wounds, but that caused an additional issue. He is probably going to end up with a Tension Pneumothorax (Sorry med term, but I don't know what the layman term is).

This is easy to mitigate (temporarily) with a needle decompression, however we still have a long term problem. We can give our patient needle decompressions until we run out of needles, but that is not going to fix anything.

what he is going to end up needing is a chest tube.

Oh no, you think, I can't do that, that is for the doctors.

Well, first off, you're going to need the equipment, which costs about $100 or so for the procedure and if you want an electrical suction, maybe another $200. OH, nd you need to learn how to do the procedure. It takes less than 5 minutes and will save their life.

So, how do we go about teaching this and practicing it? Well, that is another topic for another day. While it is nothing illegal, it is something I won't go into on an open forum, but for many of you 'in the know' I'm sure you can figure out where this may be headed.

IMO, they methodology works and is worth it, despite what PETA thinks. Just my opinion, but I can point you to some people that are alive because of it.

Anyway, I've typed enough to bore most of you, but for those that hung on to the end nd you have questions, feel free to ask either here or via PM.

I'm not saying that PFC is easy. I am saying that most of it is simple.

One more thing that I will throw in there is infection. All of what we'll be doing in PFC will open the patient up to infection. A knowledge of antibiotics is a good thing to have along with where to get them.

I highly recommend he Stanford Guide. amazon sells them used and cheap.

I also have a PDF file that covers the uses of many common antibiotics. I'll gladly get that to you if you want it as well, just ask.

That's it for now. I'll post some more up when I have some more time.

Take care,
K

[Patriotic Sheepdog]

K, great thoughts...

PFC is a whole new topic to most that take a FA class or to some degree, my basic AC3 class. It is another whole course. What do we do with that guy that is still living, but will likely die at some point? How much supplies do we have to last us all for the SHTF event, and how much do we use for this one event? That is a VERY hard question to answer and will be made at the time this situation arrives, but you need to think about it now. You may say "if he's going to die, well lets not use all or most of our supplies." But what if it is your son, your dad, your spouse? what will you be saying then? As I said, it is a very hard subject, but people will be dying.

[ncregularguy]

I've got a couple of medical blogs that I follow regarding this type of medical knowledge.

I don't know what the policy is here for posting references to outside material.

If that is OK, please let me know and I'll post up the links to some blogs that cover the information mentioned above.

Thanks.

Take care,
K

[judomayhem]

Oct 6, 2016 13:22:51 GMT -5 ncregularguy said:

I've got a couple of medical blogs that I follow regarding this type of medical knowledge.

I don't know what the policy is here for posting references to outside material.

If that is OK, please let me know and I'll post up the links to some blogs that cover the information mentioned above.

Thanks.

Take care,
K

Unless they are in competition with our host somehow , I don't think that will be an issue.

[panzer0170]

There is stuff advertised on the website that is directly in competition with UWGear.

This forum is more about spreading valid knowledge than about pushing a profit agenda.

Which in itself is a cracking marketing tactic It's part of the reason I have done some trading myself on here, because it's not a forum to promote dogma, but to promote argument, in its grownup form (discussion, challenge of viewpoints through logic, questioning that which is unproven etc..)

Go for it, anything that helps anyone is welcome here.

[ncregularguy]

That may be and I don't disagree with your thoughts, however I'd rather hear it from a moderator or Hawkeye himself.

I'm trying to do the right thing and ask permission fist.

Thanks.


I know Hawkeye has bigger issues to contend with right now along with others in Florida.

I just want to be sure and prevent what happened during a previous post I made a while back. I'm trying to learn here .

Take care,
K