AAR: Tacmed, by Continuum of Force Concepts, @ Defensive Action Center, Spokane WA 2020-01-18


Network Support I
Tacmed 2020-01-18
Instructor: Continuum of Force Concepts taught by Harvey Ballman
Training site: Defensive Action Center, Spokane WA

Attendee background: I attended this with my son.
Me: very old medical training consisting of American red cross Advanced first aid about 30 years ago, American red cross 1st responder training about 15 years ago, both were semester long course at the local community college. That said, these are both old to the point where I consider myself untrained in current ways of doing things aside from what I have independently learned so I felt this would be a good class for me to “reset the clock from zero” as it were. No formal firearms training, no force on force training.
My son: no formal medical or firearms training. This was meant to be a pre-req for both of us to continue to formal firearms training.

Overall training experience: single day class. Course consisted of half day of classroom with second half of day focusing on application via force on force scenarios.
A great emphasis was placed on securing the scene first. Gain fire supercity first and foremost, Move patient if needed for security and if available, differences between cover and concealment. Self aid vs. Buddy aid, if the patient is capable, get them working on self aid as you secure the site. Treatment via M.A.R.C.H and evacuate pack and go via civilian transport vs professional responder transport and hybrid meet part way transport.
Class was taught with the standard M.A.R.C.H. format. MASSIVE HEMORRHAGE: via TQ, pressure and wound packing. Wound packing was covered via demonstration on meat and students all participated in a hands on round on meat as well. TQ’s used in glass where C.A.T. multiple applications where done over the course of the day some spontaneously triggered during other topics. TQ selection was covered via TCCC guidelines with specific mention of staying clear of TQ’s with no mechanical advantage such as RATS. AIRWAY was covered via noninvasive techniques as recovery position, head tilt-chin lift and jaw thrust and when to use which, RESPIRATORY was covered with occlusive dressing placement/burping, recovery position with a known chest wound, watching for tension pneumothorax. CIRCULATION watching/treating for shock and finally HEAD INJURY/HYPOTHERMIA covering keeping the patient warm even if the environment is warm patient will need help maintain body temp after blood loss.

Force of force: each student was given a different scenario and was not told much details prior to entering.
Student 1: had an assailant shoot their passenger while at a stop light, student had to return fire from within the vehicle/exit/secure/treat.

Student 2: had a simulated ND with leg injury with the partner they attended with treating. Fairly straightforward although there was a big size difference between the two so patient control was definitely an issue the student had to work through.

Student 3 (my son): had me and him in a tight alleyway, assailant approached and scuffled and shot me and the leg and turned and ran, my son drew and promptly had a weapon malfunction, he secured/watched while trying to clear a double feed, dragged me into a side room and treated

Student 4 (me): I was waiting in line at a atm, one person on the ATM, one person in line ahead of me person waiting became verbally aggressive and eventually physically assaulted the person on the ATM. During their scuffle I heard a shot, person who was at the ATM appears to be going down with a serious neck bleed, assailant turns towards me and clearly was the one with the gun (at first I wasn’t sure who shot who or if the person on the ATM tried to defend themselves and ND’d themselves. Once I saw the gun in the hands of the aggressor of the incident I drew and fired approx 4 rounds until I registered them going down. They fell in a seriously awkward spot I made a short attempt to secure their weapon but it wasn’t practical in a timely manner, they appeared to be incapacitated. I dragged the victim into the “store” and began to assess, very apparent severe neck bleed, bystander appeared with some gen medical supplies and I rolled the victim to their side with the bleed up and applied pressure and then a dressing with pressure, victim was responsive and giving good feedback on their breathing. I had the person who brought the supplies trade off and put pressure on the wound whole I spoke with 911/secured the building/checked if the assailant was still where I left him. I didn’t utilize the bystanders as well as I would have in a normal medical situation, beings I shot I want me to be the one to talk to 911 and didn’t want someone unarmed to to check the assailant. The one person I did use I could have used waaay earlier than I did and my main screw up, which IRL could have been seriously damning was after the initial stabilization of the victim I did not further asses aside from the verify airway recheck. I did not ID an exit wound or treat that, there may well have been an exit that needed bleeding control or even possibly a exit in the chest that needed a seal...so that was a pretty big failure on my part.

Student 5: this guy had his in total darkness with only his WML as a light source, his occurred indoors his partner left the room and screamed from an adjacent room. Student entered room and flashed/assessed with his WML, moved, re-flashed engaged the targets, one assailant went down on the spot and one fled and went down in a other hallway but was not incapacitated, student dragged his partner back to another room and secured, treated.

All scenarios had a component of calling 911 and giving information to the 911 operator.

Summary: I am very happy I attended this, it was a great reinforcement of a few things I knew and I definitely learned a few things I didn’t (Paws not Claws for patient assessment was totally new to me for instance) this was my first force on force training so it was very illuminating on the realities of on on the fly decision making and the OODA loop in action.

I'm sure I missed some points on what was covered in this class so please treat this as an overview and not an all-inclusive list of topics covered.
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