Class Review: Active Response Training Tactical First Aid & System Collapse Medicine

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Originally posted here: https://williambrownhandgunnery.blogspot.com/2020/02/class-review-active-response-training.html

Company: Active Response Training
Instructor: Greg Ellifritz
Location: Richwood Gun & Game Club (Richwood, OH)
Student Count: +/- 20
Cost: $150
Date/Time: 26 Jan, 2020 (9:00am - 6:00pm)

Note: I am using Pat Tarrant's AAR format for this review. It is available at primaryandsecondary.com.

Equipment Details: All equipment was provided by the instructor. We had the opportunity to try multiple commercial pressure dressings, multiple commercial tourniquets (TQ), improvised TQ's, wound packing blocks, and suturing equipment.

Personal Experience: I am former Marine Corps infantry and received first aid & trauma training of varying quality during my time in service. I have attended many firearms classes, some of which had basic "Stop the Bleed" briefs. This was my second time attending this class. After attending in 2018, I was impressed enough that I sent my wife in 2019.

Preparation Drills: N/A

Class Demographics: Due to class pace & size there wasn't much time for socializing or introductions. I attended with a friend from my church who works in the medical field.

TD1 (Morning): The event host, Michael Craig of Personal Defense Systems, opened the class. He welcomed the students and emphasized the importance of the info that Greg was going to relay. From there, Greg took the reins. After giving his bio, he explained that the class could go 1 or 2 directions. This class covers 3 topics in-depth: trauma care, survival medical care, and legal methods of stockpiling medical drugs (LMSMD or "doomsday prepping", as Greg jokingly put it). In an 8-hour format, he usually has time to go over 1 or 2 of these topics in-depth and breeze over 1 or 2. The last time I attended this class we focused heavily on trauma care and LMSMD. During this class, we focused very heavily on trauma care and briefly covered LMSMD.

The trauma portion of the class was based on Tactical Combat Casualty Care (TC3) guidelines. TC3 is basically first aid under battlefield conditions. It differs from standard first aid in several ways, the main 2 ways being injury mechanisms and the conditions under which care is provided. In standard first aid classes, we are taught to use the ABC (airway, breathing, circulation) acronym when assessing a patient. These address common causes of preventable deaths in civilian medical emergencies. However, under battlefield conditions (or a mass shooting, perhaps), the most common preventable causes of death are much different. These are addressed using the acronym MARCH (massive bleeding, airway, respiration, circulation, head injury/hypothermia). Greg covered M, A, R, and C in-depth, beginning with massive bleeding. He demonstrated several methods of applying direct pressure to wounds and had us partner up and practice on each other. Next, he covered pressure dressings. Several types were on-hand to pass around while Greg discussed how to apply each one along with the pros and cons of each. The Israeli Bandage seems to be the bar against which other pressure dressings are compared these days, and we had the opportunity to practice applying them. I was particularly impressed with the H Bandage and how easy it was to apply. Greg also talked about improvised pressure dressings since improvisation is a key component of TC3.

Along with pressure dressings, Greg talked about wound packing and when it is appropriate. Several Phokus Wound Cubes and gauze rolls were available for practical application.

Next, Greg talked about tourniquets (TQ's). We learned when and where it is appropriate to apply TQ's and Greg dispelled several TQ myths. As with pressure dressings, Greg had plenty of TQ's for us to try out, including several recent TCCC approved models. He recommends North American Rescue's Combat Application Tourniquet (CAT) and Tactical Medical Solutions' SOF Tactical Tourniquet (SOFT-T). My TQ of choice is the CAT, but I was excited to try some of the recently approved TQ's Greg had on-hand. The SAM-XT is similar to the CAT but has teeth that lock in to ensure that the user has proper tension on the TQ before engaging the windlass. During my brief use of the SAM-XT, though, the teeth seemed to do the opposite. Multiple times they locked in too early, requiring more turns on the windlass. The TMT was also similar to the CAT. It was very wide at 2.5" and had a quick-release mechanism for scenarios where the TQ would have to be wrapped around a limb instead of slid over it. Greg had some concern that the TMT's quick-release mechanism could easily be engaged inadvertently. The TX2, TX3, and RMT all use ratcheting mechanisms instead of windlasses to exert force. I was impressed with these TQ's, but self-application is not as intuitive as with the CAT, SOFT-T, or TMT. Once this design issue is ironed out, I am convinced that ratcheting TQ's will become the new standard. Greg closed out the TQ discussion by covering improvised TQ's. More often than not, improvised TQ's aren't very effective, but there are still correct and incorrect ways to build them. Greg talked about what to look for in your materials and had us cobble together TQ's using a USGI triangle bandage and makeshift windlass. Greg specifically did not recommend elastic TQ's, such as the RATS, that failed the recent TCCC TQ trials. He also warned us about counterfeit and airsoft TQ's. Generally, if you're paying less than $30 for a commercial TQ there's a good possibility that you're getting a cheaply made counterfeit. I have some personal experience with this, as my friend mistakenly purchased some Amazon med kits that contained counterfeit CAT's. In the following video, I compare one of his counterfeit CAT's to a legitimate NAR CAT.

The last bleeding control tool that Greg covered was clotting agents. He recommended hemostatic gauze over Quik Clot powder due to powder's tendency to wind up where it doesn't belong. Hemostatic gauze is infused with a clotting agent and is packed into the wound so that it makes contact with the source of bleeding. Greg recommended Quik Clot's Combat Gauze, Celox Trauma Gauze, and Hemcon Chitogauze. During our lunch break, Greg was available for questions, and we all had opportunities for further practical application with the wound blocks, TQ's, and pressure bandages.

TD1 (Afternoon): With massive bleeding out of the way, Greg got right into the A (quick, what was the A in MARCH w/o looking?) after lunch. He covered the chin lift/jaw thrust and recovery position, and talked about nasopharyngeal airways (NPA's) and when it is appropriate to use them. They are a valuable tool, but could seriously injure if applied to a patient with a basal skull fracture. Greg discussed the signs of a basal skull fracture that you should look for before applying an NPA and showed a slide depicting what they would look like on a patient.

During the respiration portion of MARCH, Greg spoke about sucking chest wounds, tension pneumothorax, and tension hemothorax. He talked about chest seals and had some samples on-hand for us to check out. He also spoke about needle decompressions enough that I'm confident it's not something I'll be doing. I'm a firm believer in the words of Inspector Harry Callahan: "A man's got to know his limitations."

One topic I don't remember Greg covering back in 2018 was opiate overdoses. He told us how to recognize an opiate OD, places that OD's are likely to take place, and discussed Narcan. I recently added some Narcan to my med kit, so I had a couple of questions about storage and expiration dates that Greg cleared up.

During circulation, Greg covered wound disinfecting and closure. He is generally a proponent of flushing wounds with clean water as opposed to using alcohol or hydrogen peroxide, since these slow the healing process. He prefers to close more serious lacerations (those requiring more than a Band-Aid) with glue & steri strips or with a surgical stapler. We had the opportunity to practice closing wounds on chicken legs using suture kits and surgical staplers. Greg demonstrated suturing for the class and was available to help when we practiced on our chicken legs. After suturing the wound and then using the surgical stapler, we understood why Greg recommended the stapler - it is much easier!

Before the class closed, Greg briefly covered medical drugs that we may want to have on-hand and may not be available in the aftermath of a natural disaster or other societal collapse. He talked about legal ways to acquire medical drugs and their lifespan. He covered this information in-depth when I attended in 2018. How far into it he goes depends on which way the students prefer him to take the class. Greg also provides a CD-R full of valuable medical information to everybody who attends this class. It includes all material covered in the curriculum, including the medical drug info that he breezed through this time.

Class Debrief: There wasn't much of a formal debrief or hot-wash after this class as there are in most shooting classes. Instead, Greg would quiz us and/or review material before moving on to different portions of the class. He was also available during lunch and after class for questions, gave us his contact info in case we thought of questions later, and provided all students with a CD-R that covered his whole curriculum and then some.

Greg knows this material inside & out and it shows. Attending this class is like listening to a Ph.D. teach his/her discipline. I really couldn't ask for anything else that would fit into a 1-day format. He uses real world events to drive home the reality that any of us could wind up in a situation where we have to apply these lifesaving skills. There are quite a few gory photos throughout the class, but Greg gives plenty of warning so that nobody is startled. He also makes sure to reference the photos in the most respectful manner possible and for educational purposes only.

After Class: I had a 3-hour drive to get home, so after talking to Greg briefly I hit the road. The next day I reviewed my notes and began exploring the CD-R that Greg provided. The CD-R is invaluable. A friend that I attended with in 2018 actually used it to create a short "stop the bleed" style class for our church security team. I highly recommend this class to anyone seeking to improve their understanding of traumatic medical care.