Condition Red is focused on delivering high quality pre-hospital education specific to austere, remote and tactical environments. Designed ...
April 30, 2021
9 am – 5 pm (one day)
You may have been encouraged by your training mentors to be as well-rounded as possible as responsibly armed citizens. Get in shape, learn pistol, carbine, precision rifle, shotgun, combatives, blade, and medical etc.
Each one of these subjects is worth a deep dive, and I feel that of these, medical is probably the most difficult to do hands-on, unlike say, pistol, carbine, and combatives. That can make the learning more abstract if done in a classroom-only setting.
Also – this isn't the kind of training that I consider fun. A few days on the range? Fun. Grappling with buddies on a mat? Fun.
Medical? Bleah. Honestly, I was dreading this class.
But I strongly felt like I needed to attend. And with today's ammo prices, the round count was ...just right.
I'm a clueless civilian so keep in mind that is the perspective I'm writing from. I have attended multi-day TCCC (Tactical Combat Casualty Care) classroom sessions with local trainers and instructors like Will Willis. Many of the live fire instructors I have hosted and trained with have given medical briefs.
I also recently attended a one-day TECC (Tactical Emergency Casualty Care) class with Chris van Houten of Condition Red, which is how I learned about this cadaver lab.
I haven't yet attended a live tissue lab – so I'm unable to draw a comparison for you.
I'll try to hit on some of the highlights. For a one-day lab, we covered a lot of material.
So the setting for training was a bit unusual – an anatomy lab in the bowels of a university medical school in a large northeastern city. It's my understanding that Chris and this institution has been collaborating to train US military personnel in TCCC for some time now. I believe this was the first open enrollment opportunity.
The laboratory is connected to a “clean” classroom stocked with a mini-kitchen. Our lab tech Mike brought us bagels and coffee.
There were nine students including 3 LEO's, several volunteer EMS personnel as well as front line medical personnel.
Just a few feet away from the classroom was the donor.
He was a military-aged male between 20 and 30. He had recently passed away following treatment for a life-threatening disease. He donated his mortal remains for medical study and in exchange his body would receive a free cremation.
Shortly after the donor expired, his body was embalmed and as a result may have been a little bloated. Most body hair was shaved (people are basically unrecognizeable with shaved head and eyebrows). The body itself was intact with no visible trauma.
Half of the training day was dedicated to bleed control. You can bleed out in about three minutes. With the average EMS response time of nine minutes, that means you can bleed out 3x while waiting for help. Being able to stop the bleed is super important.
How can you make a cadaver “bleed?”
By circulating dyed fluid through the blood vessels with an embalming machine hooked up to the an artery in the neck.
When it comes to tourniquets, you can't have too many. This is an example of a wound (right femoral) that required TWO tourniquets to fix. Takeaway: Carry TWO tourniquets or have a plan to use something else (like direct pressure) to stop the bleed.
You can bleed out and die in minutes. You body contains 5-6 liters of blood. When you lose 1.5-2 liters, you lose consciousness. After losing 2.5 liters, you are beyond help.
How quidkly can you lose blood? Check out this femoral gusher that was made with just a scalpel. Pretty sobering. Time is of the essence to get this leak plugged.
I've made the video a .gif if you can't see the embed on mobile
A very significant learning point came when a student was attempting to tighten a tourniquet on an arm with a cut to the brachial artery. After a few turns of the windlass – the tourniquet broke – spectacularly. Chris deliberately snuck a counterfeit CAT tourniquet into the kit pile. The student applying the fake tourniquet was visibly stunned. Had that been a real patient, it could have been a bad day. I wish I caught it on video – it was gold.
Counterfeit CATs are sold on ebay and Amazon – the first hint they may be chinese knockoffs is the low price. They fail not only because of subpar materials but also insufficient stitching.
PLEASE CHECK YOUR GEAR.
BUY YOUR GEAR FROM REPUTABLE SOURCES.
One of the easiest ways to spot a counterfeit CAT tourniquet is to look at the plastic base plate. A genuine CAT of more recent vintage (Gen 7) will have raised lettering. For olders models, see below.
Packing a wound on a foam dummy just ain't the same as sticking your finger in a wet, slimy and cold body. It is a weird sensation. Call me crazy.
Wound packing is done primarily on the limbs. As the chest and abdominal cavities have empty space, there isn't much for gauze to press down on to stop bleeding.
If rolled up, gauze is easiest to apply from the center of the roll.
After packing the wound, apply pressure bandage. Interesting to note that even if they're called Israeli bandages here, medics in some foreign military organizations aren't allowed to call them that per Chris.
Techniques to stop bleeding include tourniquets, wound packing, and direct pressure.
Tourniquets are intended primarily for limbs. There is no place to apply them for junctional (where the torso joins the limb) bleeds.
For femoral junctional wounds, direct pressure is likely the only method that will stop bleeding. This can be done with a specialized tool (as Chris demonstrated in a previous TECC class - JET tourniquet, or an improvised one made from two CATS and water bottles).
Chris showed us a very interesting hack to very quickly apply pressure to these deep bleeds using a surgical clamp and gauze. It reminded me of the scene in Blackhawk Down when Cpl Jamie Smith was bleeding out and the medic couldn't clamp the artery.
Here's a way you can use a surgical clamp to stop a bleed without actually clamping a blood vessel. Clamp + gauze + direct pressure on the wound.
Tension pneumothorax is a life-threatening condition that can start as soon as 10 minutes following penetration of the chest wall (example: gunshot wound). Air from the outside gets trapped and starts compressing the lungs, major blood vessels, and eventually the heart.
To a certain extent, tension pneumothorax can be delayed by using chest seals (although I'm told the thinking on this might be subject to change based on new data).
Once underway, tension pneumothorax can be relieved by thoracostomy.
That can be accomplished with needle decompression, a finger through the chest wall, or with a chest tube.
Most of us are familiar with the concept of needle decompression. There are two places on each side of the chest you can safely do this with a needle, taking care not to puncture the heart if you are decompressing the patient's left side. The hardest part is finding the correct intercostal spaces and the correct lines.
The finger thoracostomy was … interesting. Best way I can describe it is to visualize a slab of ribs. You are using a scalpel to make an incision in the skin to access the meat between the ribs, which you initially bore through with a Kelly surgical tool. Then you use your index finger to widen the hole (you are ripping meat with your finger).
In the small amount of spare time at the end of the day the group had the opportunity to open up the thoracic cavity and examine the heart and lungs and nearby structures. These pics pretty much speak for themselves, so I will post them without comment.
An anatomy course is a rite of passage for medical students. No big deal for them. I guess some people can get accustomed to working with dead bodies but I'm going to go out on a limb here and say that most people aren't. In our (first-world) minds, death is something that happens to other people. Dead people are whisked away and we don't see what goes on behind the scenes in hospital morgues and funeral homes. Death is sanitized for us.
When working with a cadaver, we are reminded of the fragility and impermanence of life. On top of that, there is the yuck factor – touching and feeling blood, guts, and all the things that horrify the squeamish amongst us. This is not normal.
Then again, rolling up on a mass casualty scene, engaging with deadly force, or getting shot, stabbed, or blown up is not normal.
I think one of the most valuable things this type of hands-on training provides is a form of stress innoculation. People respond to stress in different ways.
Stress does funny things to your mind and you don't even realize it. At one point I was prepping the cadaver for emergency limb amputation (with a sawzall) which involved applying two tourniquets and wrapping duct tape around the limb. You'd think that applying the tourniquets would be easy – I've repped tourniquets on myself and others countless times in flat range training.
Yet, because a part of my brain was quietly freaking out, I screwed up the tourniquet application. I couldn't even explain what I was doing to the instructor … like I had a weird case of the verbal bahabbafabba's. I eventually worked through the problem (amputating the limb was the easy part) but made a mental note to jot this experience down for later reflection.
Stress makes you do funny things, and in fact in the real world, it's not uncommon for tourniquet placement to be imperfect according to Chris. It happens.
If you decide to attend this type of training – don't pass up the opportunity to practice something as seemingly mundane as applying a tourniquet to a bleeding cadaver limb. The stress is the missing ingredient when you're doing it on yourself or another uninjured person.
Here is a vid of my friend Kenny Stretz of Stretz Tactical. As an LEO in one of the country's largest cities, he has seen more than his fair share of death and bad things happening to good people. This is not the first time he's held a tourniquet either. Look at his facial expression in this very unique setting. I've removed the audio because Chris was trying to lighten the mood with some humor. Even so, Kenny's mood was pretty grim.
I believe Chris will be offering more open enrollment cadaver labs in the near future, pending availability of donors and lab time.
I would not hesitate to jump on these opportunities.
I will note that cadavers (and lab time) are very expensive – averaging several thousand dollars per cadaver. The tuition for this class was $600/student which for the number of attendees was a breakeven event for the instructor. I would expect future classes to cost more, reflecting underlying economics.
Is the tuition worth it?
Jump on it. As with many aspects of what we train for, there is no substitute for getting hands-on (and fingers in) with a human being.
While there are no pre-requisites to attending, I think you'll get more out of this class if you've had some type of Tactical Combat Casualty Care medical training. Chris offers a one-day TECC class which is a very helpful intro.
Photographs and video were permitted during this class. However, Chris requests some discretion as to where they are posted. Out of respect for the donor's family, it's a good idea to not include personally identifiable features in photos if you can help it. These include the face, the eyes, birthmarks, tattoos, distinct scars, and genitals. For next time, I would recommend that these features be draped prior to photographing. It's much easier to do that than trying to photoshop/edit out personally identifiable features after the fact.
I feel taking photos, video, and notes are very helpful but as your hands can get kind of messy throughout the day, you'll be changing your protective gear quite a bit. Gloves, gowns, face shields, and booties are provided and there is no limit. I would suggest you also bring a head covering with you when things get a little messy. Your pants from the knees down to the tops of your shoes are not protected so keep that in mind.
Bring a change of clothes just in case. Next time I think I'll wear scrubs and change into regular clothes afterwards. I had to burn my pants and shoes. But that's a post for another day.
Please note that this facility (Massachusetts, university campus) is off-limits for carry by statute even if you are a holder of a valid Massachusetts License to Carry. For out of state LEO's - this is a grey area so keep that in mind.