Owning a gun comes with a lot of responsibility. Shirking those responsibilities opens the door to having them taken away. Just like someone who proves to be irresponsible with their time and is consistently late for work might lose their job. If we as a gun community are not vigilant in our responsibility in keeping high standards with new gun owners, we allow ourselves to be placed in a situation where our disarmament seems justifiable.
One of the big responsibilities is being able to treat injuries that could be caused by our guns. You need to be equally as proficient with your first aid as you are with your draw. Knowing first aid is applicable in many foreseeable scenarios. Accidents or ND’s can happen. You could be shot by someone, or you may have to defend yourself then render first aid to your adversary. Whatever the situation is we need to prepare for it.
If we get to the very basics of emergency first aid, we keep air coming in and out and keep blood inside and circulating. I have been taught lots of acronyms for first aid throughout the years. Some are good, some dumb. Acronyms are good way to handle the first aid processes during a stressful situation. Kind of like a mental check list. These are a few of the ones that have stuck with me.
Just to be clear, I am not a doctor or first responder. I have received a bunch of training as a slow speed some drag type service member and that's where I’m pulling most of my info from. Also, this post has been checked over by all of my doc friends I could talk into get to looking it over.
A.B.C
DIFFICULTY: Easy
This is more of a basic life saving acronym than a trauma acronym. It works well if you have an unconscious person or someone having trouble breathing. It is good to know even if it is not specific for gun related injuries.
A. Airway. Verify nothing is blocking the throat and that air can get in. For example, if someone is choking. If you can physically remove whatever they are choking on then do it. If not, try the Heimlich maneuver.
B. Breathing. Watch for rise and fall of the chest. Feel for air leaving the mouth/nose. Listen for respiration. If they are not breathing, prepare to perform cardio pulmonary resuscitation (CPR). Perform a head tilt chin lift to get an unobstructed airway.
C. Circulation. Check for a pulse. You can find one in the neck, or the wrist. If there is no pulse, start chest compress ions. Do 2 breaths for every 30 compression if they are not breathing.
S.C.A.B
DIFFICULTY: Easy
SCAB is a down and dirty no frills life saver. It covers the minimum and doesn’t go into a lot of detail. If you have a hard time remembering things and want to keep it simple, this is a decent one to remember. SCAB or something similar is usually performed before the next acronym, H.N.S. Casper.
S: Scene safe. Make sure it is safe to render first aid. If you need to render self aid, get to somewhere you can do so safely. If you need to help someone else make sure it is safe to do so. If there is an active shooter, deal with that situation first so they wont be able to cause more damage. For example, barricade everyone in a room the shooter can’t access. Or if you are capable, disarm or incapacitate the shooter.
C: Circulation. Check to see where the blood is escaping and stop it. Use tourniquets or pack the wound with gauze and apply a pressure dressing (kind of like an ace bandage). Check for a pulse. If the heart isn’t pumping, get ready to start CPR.
A: Airway. Is there anything obstructing air from entering or leaving. If there is, remove it.
B: breathing. Look, listen, and feel for breaths. If the person isn’t breathing, do two breaths for every thirty chest compression during CPR. Perform a head tilt chin lift to have an unrestricted airway.
H.N.S. CASPER
DIFFICULTY: medium
H.N.S. CASPER is a decent head to toe check of the body. It hits all the major parts however it is quite a bit to remember. It is mostly used after initial first aid has been rendered.
H: Head. Check the head for obvious injury, bleeding, fluid from the ears, or busing around the eyes that look like a raccoon’s mask. These are more common from blunt trauma than bullet holes, but still good to know. If these signs are present, it is a possible skull fracture or internal damage. Do not put pressure on the head, for example, like with an ace bandage or pressure dressing. Tell the higher echelon of care if those signs are present.
N: Neck. Check for obvious deformities in the trachea (throat) area. Large veins that look like their bulging. These might be signs of a tension pneumothorax or built up pressure collapsing a lung or putting pressure on the heart. Look out for other cuts, burns, and bruises.
S: Short spine. Being careful, run your finders along the spine in the neck and feel if anything seems out of place. Immobilize the person if you find damage.
Note: I have also heard the “S” stand for shoulders. That wasn’t what I was taught so I don’t exactly know what to look for. Just a bit of FYI.
C: Chest. Check the ribs chest area or “the box” for equal rise and fall on both sides. If one side is not rising as much as the other it might be a sign of a tension pneumothorax. The side that isn’t rising would be the side to pay special attention to.
If you suspect a tension pneumothorax use a needle “D” technique to relieve the pressure. The simplest way I have been taught to do a needle D is to place the patients hand in their armpit on the affected side (think making fart noises with your armpit, same basic move) At the base of the hand in the armpit, insert the needle. Attempt to avoid hitting the bottom of the rib as that’s where a bunch of nerves run.
Another way is start at the middle of the clavicle (collar bone) and count down three ribs and insert the needle. Depending on how big the person is it might be hard to find there ribs. The needle D will probably be painful, but the release of built up pressure in the chest cavity will be a welcome relief for the patient.
Check for puncture wounds or entrance wounds on the front of the chest by spreading the skin looking for damage. If you find a sucking chest wound or a “hole in the box” use a vented chest seal to patch the hole. Check for an exit wound on the back of the chest during the second “S” or long spine stage.
A: Abdomen. This is the “guts”. It includes everything from the bottom of the ribs or the diaphragm, to the groin. Break the abdomen into four quadrants and check them systematically for obvious injury or pain. Check ant treat cuts, burns, and bruises. Pack wounds with gauze to control bleeding.
If some of the guts are popping out, wet a clean cloth with water and wrap them up. Secure the cloth as best as possible to the abdomen. Do not try to shove the guts back into the body.
S: Long spine. If major trauma is suspected to the spine, immobilize the patient and skip this step. It’s going to be a judgment call. Do your best. If you decide to check the spine, kneel next to the patient and roll them against your lap. This will give you ample control of them with minimal movement. Glide your fingers along the spine checking for deformities and damage. This is also when you would check the back of the chest for any exit wounds from the found entrance wound in the front of the chest. There may not be a direct line from entrance to exit. The bullet may still be in the body or it could have changes trajectory when it entered the body. If you find an exit wound, apply a vented chest seal.
P: Pelvis. With the patient on their back check the pelvis by very gently pressing on the hip bones. There should be no movement and no pain response. This step is sometimes skipped to avoid risk of pinching the large arteries and veins that run along the pelvis. If the pelvis is broken and you spread the pieces apart, when they come back together the veins and arteries could be caught between the pieces. Just be gentle and you will probably be fine.
E: Extremities. Arms, legs, hands, and feet. Check for cuts, burns, and bruises. Splint and immobilize broken bones. Massive bleeds should have already been tourniquet’d during “SCAB” or initial treatment. Pack wounds with gauze and keep pressure applied to control bleeding.
R: Repeat. Keep checking on the patient until you can get them to a higher echelon of care. Anytime the patient gets moved you need to reassess tourniquets and bandages.
M.A.R.C.H.
DIFFICULTY: medium
MARCH, MARCH-P OR P-MARCH-P are all the same basic thing, the first P is just for Provider to make sure the scene is safe to perform first aid. The last P is for pain management. I am not going to talk about pills and drugs. However, something I do keep in the back of my mind is that Aspirin thins blood so its probably not the best for flesh wounds or massive bleeding cases. The rest of the MARCH is the most current acronym I have been taught and is an all around good head to toe check. It tries to pull SCAB and HNS Casper together. If time permits I still might go through some HNS Casper after performing MARCH.
M: Massive bleeding. Deal with massive blood lost first. Priorities this over respiration. On extremities apply tourniquet high and tight. Tighten tourniquet until the bleeding stops. Do not remove tourniquets if bleeding starts again. Instead apply another tourniquet above the first one and tighten until the bleeding stops. Don’t worry about losing a limb or amputation. Modern medicine has been able to save tissue that has not had circulation for several hours. Use your tourniquets!
For massive bleeding in joints or places you cant apply a tourniquet, pack with gauze and apply a pressure dressing. H bandages or Israeli dressings are the pressure dressings I have used and they both work well.
A: Airway. Check and see if the patient is breathing. Look for rise and fall of the chest. Listen and feel for breath entering and leaving the mouth and nose. Check for obstructions on the airway. If they are not breathing prepare for CPR.
R: Respiration. Check the chest for “holes in the box”. Use a vented chest seal if any are found. Perform the needle D if the patient is showing signs of tension pneumothorax such as: deviation in the trachea, bulging veins in the neck, uneven rise and fall of the chest.
C: Circulation. Perform blood sweeps on the extremities to find bleeding not previously dealt with in “M” massive bleeding phase. Check for a pulse at the neck or the wrist. If there is no pulse prepare to perform CPR.
H: Head/ Hypothermia: Check the head for fractures and bleeding. Check the eyes and deal with any other cuts, burns, and bruises. Cover patient and keep them warm. If they have lost a lot of blood or have a weak pulse they will be having a hard time regulating the temperature of their body.
Before I get all the haters telling me CPR is not a part of MARCH or Tactical Combat Casualty care (TCCC) at all, I know. This is because once you start CPR you don’t stop until properly relieved or the patient starts breathing and pumping on their own. That is not conducive with a TCCC situation, but it may be in a more civilian situation so I found it reasonable to add it in.
Last thing I should touch on is the nose hose or Nasopharyngeal. It is a little trumpet looking tube you insert in the nose that goes to the back of the throat. It keeps an airway clear and is helpful especially in throat burn or allergic reactions where the airway might restrict from swelling. It’s also a fun drill to perform on your friends.
As insightful as this post is, it should not be considered training. Get some real training. There are plenty of people out there from tactical types to first responders who give exciting and useful classes. Use Google and find people in your area. It usually isn't the cheapest training around, but a lot of times you can find someone who will offer classes and give you a better rate if you go as a group. If you find someone you recommend, leave me a comment and I’ll add them to the list of training post so others can check them out. Click here to see the list.
I hope this has been helpful in exposing some people to the level of First aid you should be proficient in if you own a gun. Stay fresh with your skills. First aid is just as perishable as your shooting skills. Practice your tourniquet applications. Keep a kit in your car and in your bags. Have an individual first aid kit (IFAK) on your shooting belt. To paraphrase Mike from Garand Thumb, Looking cool is the most important thing. Do you know what makes you looks really cool? Knowing what you are doing makes you look really cool.
If you feel that it is important to own a gun, then be diligent in your training. Share what you know with everyone who will listen. Share the joy you find in shooting with people who have not had the opportunity. Hold every other gun owner accountable to the high standards and responsibilities that come with owning a gun. If you are not going to live up to the responsibilities and standards required to safely own and operate a gun, then don’t own any.