Mental Preparation and Training: Self Analysis of your Medical Preparations

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    • #91846
      Joe (G.W.N.S.)
      Moderator

        My recent Thread Treating Animal Bites (K9) got me thinking about how people get their medical training and what practice and follow up training they conduct.

        Much like everything else we discuss here, reality can exceed expectations.

        Dealing with a broken bone, a laceration, or even a gunshot wound can be pretty straight forward as far as initial stabilization is concerned.

        Where things get interesting is when the individual has multiple serious injuries or; even worse, your dealing with a mass casualty situation with multiple victims with multiple injuries.

        For example when I first saw the previously mentioned German Shepherd, my first thought was “oh crap he’s messed up!”

        I then took a deep breath and started going through my trained procedures.

        Remember too, this isn’t my first time dealing with this. I have experienced mass casualty situations with multiple trauma injuries and victims that are truly horrific.

        The more training you have the better, but the more realistic your training is what makes the real difference.

        Just like when Max talks about “crawl, walk, run” this applies even if your training is coming from multiple different sources you need to plan for this progression.

        Don’t stop until you can run (some pun intended) a mass casualty drill.

        You could easily be the only one prepared in public.

        So is your training sufficient?

        Is your gear ready to go or do you have to try and find it?

        How often do you participate in follow up training?

        Are you ready to run such a situation?

        Don’t be overwhelmed so you are ready to act, it might just save your family.

      • #91847
        Joe (G.W.N.S.)
        Moderator

          I know we have some professionals here that can add to this better than I can.

        • #91848
          wheelsee
          Participant

            Join your local volunteer fire dept/EMS. Some will pay for your EMT training or at least offer at a greatly reduced price. Another way is doing a community fire or police academy (designed for the civilian), don’t forget common sense (see recent news re: tragic consequences of stupidity on the instructor part).

            Volunteer for the American Red Cross – you’ll get good training and work at disasters- both man-made and natural. Various religious groups do the same, I.e. Southern Baptist Men’s group.

            Volunteer for ANY MCI (mass casualty incident) where you’ll be exposed to the sounds and sights, depending upon the acting. Still realize that death, burnt flesh, and open bowels have an odor all their own.

            I don’t focus on the screamers – they obviously have an Airway, are Breathing, and have Circulation (ABCs). I worry about the quiet ones who, without intervention, greet death without notice. But you’ll learn who is salvageable and who is expectant (death)……learn now, it’s a real bitch mentally to learn while it’s happening (and you’re own psyche takes a hit too)..,,.

            As I’m doing this on my phone, Joe may be able to resurrect the thread previous as my comments seem to be a deja vue…….

          • #91849
            Andrew
            Participant

              Mass Casualty Incident with hazardous materials around is another huge ball of wax.

              Also, mass casualty doesn’t have to involve dozens of injured. If it is more than you can respond to, which could be as few as two or three, you have a mass casualty incident.

              Basic first aid classes are a pretty good investment of time and money. But, look around and you can probably find a EMR, Emergency Medical Responder class that will take you a step further.

              You can probably find some reputable/reliable info on the internet regarding these things, but even with classroom training, there are some things you just aren’t ready for when they happen, but the training should get you started.

            • #91850
              HiDesertRat
              Participant

                Mental preparation? You do the best you can with the available resources. You triage the casualties. That will be a tough task for many folks, especially if you know the victim. Much will depend upon the available resources and what their disposition will be after initial treatment, and even if that is possible. You preserve who you can, stabilize them, and hope that there is a secondary facility available and the means to transport. Some of the obvious mortally injured should receive whatever comfort you or someone you designate can provide. As far as mass casualties, well, do your best, attempt to provide some human component to your dealings with folks, but expect a lot of negative consequences and feelings of inadequacy on your part for not doing enough even though you gave it your all. And pray some. It can really shut down your feelings, an inward effort for protection of self, and worse, when it spills into your personal life. Eventually you will have to share the burden you carry in order to lessen it. And that act will not be a sign of weakness but of recovering your humanity.

              • #91851
                Joe (G.W.N.S.)
                Moderator

                  Good thoughts and thanks for your comments Wheelsee, Andrew, and HiDesertRat.

                  Over the years I’ve had the opportunity to provide initial first aid for several of my children when they were kids, mostly non life threatening, but few were pretty bloody.

                  I was able to keep my head and had everything readily available (can’t stress having a comprehensive kit available enough). I did have a good case of the shakes once turned over to the ER workers afterward.

                  Since retiring I’ve had one Man die while providing first aid (a car wreck that I saw happen) shortly after Paramedics arrived. He was conscious when I got to him, his family thanked me for my efforts, but it still “sucked big time.” While I don’t dwell on it too much, when it comes up I tend to second guess myself.

                  There was something different about the military ones, still sucked, but it felt different. Sorry, but I can’t really articulate it properly.

                  My main point in this Thread is to get people thinking and considering some increased training at whatever level they are at.

                • #91852
                  wheelsee
                  Participant

                    I can’t emphasize the mental aspect of dealing with critical situations, death, and your own mental health.

                    I spent 10 years on a civilian air-medical rotor-wing program. One particular time period was especially tough for me – for 10 straight weeks, every single patient I flew ended up dying, my nickname became “101st” (look it up for why). I was investigated by the hospital and the state board. The end result?? I was cleared of ANY wrong-doing…….just the nature of the beast when dealing with super-critical patients. There was a learning curve for the hospital that wanted to charge me with improper transfers…..really?? As my Medical Director testified, “they were already dead, they just didn’t know it yet. Their ONLY hope/chance was to be flown to a trauma center.” Sometimes life sucks, and sometimes it sucks the life out of you.

                    And, yes, 36 years of doing this has left me an alcoholic, gone through burn-out several times, and come damn close to a divorce. Luckily I married a woman who works in critical care also (ICU RN), so we are each other’s support group. But I have MANY colleagues who are on their 3rd, 4th, and 5th marriage………

                  • #91853
                    wheelsee
                    Participant

                      BTW, my profession lends itself to being called cold-hearted SOBs……au contraire. We go into a professional mode that allows us to handle the situation rationally and logically. Emotions will cost you the life of your patient…… And there will be time for emotions later, believe me.

                    • #91854
                      wheelsee
                      Participant

                        Mass Casualty Incident with hazardous materials around is another huge ball of wax.

                        What do firefighters call police officers at a HazMat scene???? Canaries

                        “Headquarters, this is Engine 2. We have 4 police officers down at the scene. We are establishing a ¼ mile buffer. Requesting wind speed and direction.”

                      • #91855
                        Joe (G.W.N.S.)
                        Moderator

                          We go into a professional mode that allows us to handle the situation rationally and logically.

                          There are many terms for this; depending on profession, that deep breath I mentioned previously is my “switch” which allows me to change modes. Depending on which mode selected the hard part can be going back to normal afterward.

                          I can’t emphasize the mental aspect of dealing with critical situations, death, and your own mental health.

                          Agreed, this is what in my opinion is the difference between PTSD and not. Finding a release that works for you.

                        • #91856
                          Andrew
                          Participant

                            I had a 19 year old from a car wreck that was turned over to us from the Mexican hospital. I had to call for an advanced life support unit to come down and intercept us. He still didn’t make it. Had both a pneumo & a hemo thorax. That one didn’t bother me too much, except for the kid’s parents, because I know we did everything we could. Like wheelsee said he was dead and didn’t know it.

                            Also had a two month old who was septic. Kid was born with the two sides of his brain not grown together and already had a drain in his brain because he also had hydroencephaly. all I could do was give him O2 so he could breath better. He made it to the hospital okay, but that little baby still bothers me.

                            Weird the way it works.

                          • #91857
                            Joe (G.W.N.S.)
                            Moderator

                              Slight thread drift, but the unquantifiable part of trauma care.

                              The people that survive what should not be survivable!

                              Since it is part of Thread here consider the story of MSG Roy Benavidez:

                              On his first tour he stepped on a landmine during a patrol and was evacuated to the United States, where doctors at Fort Sam Houston concluded he would never walk again and began preparing his medical discharge papers.

                              It is important to remember that below occurred on MSG Roy Benavidez’s second tour.

                              See more in the Thread Never Give Up!

                              Of course there are countless others.

                            • #91858
                              gramma
                              Participant

                                It’s not just trauma care, guys. I won’t dismiss that though; my step-D is a trauma flight nurse. I know it’s intense.

                                When it became clear that my hubby had untreatable and terminal cancer & COPD and was cahexic to boot (and only a former SF surgeon would be upfront with me about expectations) – it was my step-D that taught me in 24 hrs what I needed to know to care for him. I did hire night nurses, that would insist I go sleep at 10 pm.

                                It was a grueling 3 months. And mentally stressful in the extreme. And yet, the ending – which occurred while I was searching information on death rattle – was as straightforward and uncompromising a situation as could be for me. It was release for both of us. It took an immense amount of control on my part to endure the people who kept asking if I was OK, and waiting on protocols to be completed for me not to insist that everyone leave. Now. I was able to realize that other people had their way of dealing with death, in the midst of my needing to be alone to pursue my own way.

                                No meltdowns or throwing people down the steps (tempting as it was for one particular over-caring soul) who kept expecting some kind of emotional reaction from me, that I was simply too busy to experience at that moment. I guarded my solitude & the experience of that moment, while I was holding him, like Fort Knox; I needed it to find the inner strength I knew I had. It’s not how a lot of people roll, I know that. It’s what works for me.

                                When I think about SHTF med care, I plan more for the common ailments and having the supplies to deal with insomnia, flu, constipation/diarrhea, chronic conditions, and plans for quarantine. Yes, I have some trauma supplies – and probably not enough. One thing I discovered about end of life care, is you need a LOT of supplies and you generate a lot of trash in the process. A way to deal with that trash is essential.

                                I firmly believe that dying is a natural part of life and that maybe helps me deal with this. I did start being exposed to it, as a child, so maybe that has something to do with my belief. I don’t treat it as if it’s the worst thing that could happen to someone. We can’t possibly know that.

                                Later on, one deals with the loss. The empty space someone else used to occupy. The things they used to do that worked in conjunction with your things… to keep the shared enterprise going.

                                The medical people did everything they possibly could. The only thing I wished they would’ve done – sooner – is admit there wasn’t anything that would help him get better. I was pretty angry over the things that were dangled as false hope and frustrated because according to the docs, he should be trying to do things that he clearly was NOT ABLE to do. I would’ve much preferred dealing with the terms of reality and adjusting to it, as required under the circumstances.

                                I found his mom, after she’d suffered a massive stroke just a few years before. And reacted much the same way – doing what needs doing right NOW – and after it’s in someone else’s hands, waiting for my solitude to process it all. It’s a strange characteristic, I’ll admit. Especially for someone without the real training.

                                All the mental traps – are what I call poking yourself in the eye with a sharp stick. You really don’t need to do that and it serves no purpose. It’s OK to be sad and have regrets when a patient or someone you care about passes. It doesn’t need all that other crap glommed on top of it.

                                So, dealing with a triage situation… horrific wounds… and people making that transition from this life to the next… is probably something I COULD do if needed. But it’s not something I would choose to do occupationally. I think I would suffer from the cumulative effects after awhile.

                              • #91859
                                gramma
                                Participant

                                  OK – just watched what you posted Joe.

                                  There is a difference between “will to live” and the “will to FIGHT to live”. This guy obviously knew that. I know that too – from an early experience – that can keep till another time.

                                • #91860
                                  Joe (G.W.N.S.)
                                  Moderator

                                    There is a difference between “will to live” and the “will to FIGHT to live”.

                                    Truth :good:

                                    It’s not just trauma care, guys.

                                    No doubt.

                                    When I think about SHTF med care, I plan more for the common ailments and having the supplies to deal with insomnia, flu, constipation/diarrhea, chronic conditions, and plans for quarantine.

                                    I have obviously dealt with more of this than trauma, it’s part of life.

                                    I plan for all of it, it’s who I am.

                                    Dealing with the standard illnesses of life is usually an endurance event with more time to think it through.

                                    On the other hand I view trauma as a sprint with little time to to consider options until person is stabilized.

                                    For me neither is a priority over the other, but I plan for the day when the only supplies I have will be foraged, grown, or blended.

                                    To round out this discussion consider this Thread Field Hygiene and Sanitation: The Most Dangerous Threat!

                                    Taken for granted in good times, it isn’t for just in the field!

                                    So you are preparing to defend your family and community from all threats?

                                    You have beans, bullets, and bandaids.

                                    You’ve taken the various MVT courses Max offers.

                                    Feeling pretty good about yourself?

                                    Have you mastered Field Hygiene and Sanitation?

                                    If not you are at serious risk!

                                    Disease and Non-Battle Injury (DNBI) can be defined as a military person who is lost to an organization by reason of disease or injury, and who is not a battle casualty. Historically this has accounted accounted for 80 percent of all casualties!

                                    Excluded from these figures are vast numbers of service members with decreased combat effectiveness due to DNBI not serious enough for hospital admission.

                                    Consider the following:

                                    With Merrill’s Marauders disease was an important detractor to this famous unit. The medical threat faced by the Marauders in the jungles of Burma was great. Everyone was sick, but some had to stay and fight. Evacuation was limited to those with high fever and severe illness. One entire platoon cut the seats from their pants because severe diarrhea had to be relieved during gunfights.

                                    Think about that!

                                    One entire platoon cut the seats from their pants because severe diarrhea had to be relieved during gunfights.

                                    Great fun!

                                    Everything is related and builds on the other.

                                  • #91861
                                    wheelsee
                                    Participant

                                      One entire platoon cut the seats from their pants because severe diarrhea had to be relieved during gunfights.

                                      Great fun!

                                      Everything is related and builds on the other.

                                      [/quote]

                                      A fellow firefighter on the snorkel (like a utility truck) developed diarrhea while fighting a large structure fire, while up in the bucket. He requested a 5-gallon bucket sent up to him. Over 8 hours later, when the snorkel bucket was lowered, there was also a rather full bucket of……

                                      Afterwards, while others “eewww” and “gross”, we laugh about it……why?? cause we’d each be damned if we ever let a brother down.

                                      Heck, one of my medical directors was seeing patients while dragging an IV pole around, IV fluids and antibiotics……..with a ruptured appendix, until his shift was over. Then he went to the OR (operating room). Think of the example……..

                                    • #115974
                                      Joe (G.W.N.S.)
                                      Moderator

                                        Overlooked bump!

                                      • #116004
                                        Roadkill
                                        Participant

                                          One thing kind of weird that I’ld like to share. I was 29 years FF/Medic. Many times people fight to stay alive with whatever symptoms are on them, then when we show up it’s like a switch flips and they mentally switch to a thought like, oh good someone is here to take care of me now so I can quit fighting. I can’t tell you how many times we’ve arrived on scene and then witnessed the person look at us and their eyes roll back in their heads and code out as soon as we make contact. Just human nature?

                                        • #116022
                                          wheelsee
                                          Participant

                                            One thing kind of weird that I’ld like to share. I was 29 years FF/Medic. Many times people fight to stay alive with whatever symptoms are on them, then when we show up it’s like a switch flips and they mentally switch to a thought like, oh good someone is here to take care of me now so I can quit fighting. I can’t tell you how many times we’ve arrived on scene and then witnessed the person look at us and their eyes roll back in their heads and code out as soon as we make contact. Just human nature?

                                            I don’t the response times v call times for what you’ve listed.

                                            However, our 911 system has gotten so good (compared to the 80s when you called the operator or a party-line to the fire department) that shortens our response times so I’m wondering if what you’re seeing is just the normal timing. I’ve worked trauma (on-scene) where if the response had been 5 minutes later, the scene would be a death investigation.

                                            The 2 that stick in my mind was 1) a car that rolled into a ditch at high-speed, one block from a city fire station, with the wreck being in front of a 24-hr gas station. So the response time was literally a “couple of minutes.” We were launched by the requesting fire medic on scene, again within just a couple of minutes (we used to monitor the 911 calls to get a jump on times). The passenger was extricated and taken by ground. The driver was pinned – He was talking to us when we first got there but coded as we were extricating; we intubated him on his side and our only IV access was his Right upper arm, blind stick (helps to know anatomy). It was 15 minutes by ground to the trauma center, only 4 minutes by air. We (air) actually got to the trauma center just as EMS was pulling in with theirs.

                                            2) 3-year-old riding in the front seat with a lap belt. Father hit a pole literally in front of the fire station. the kid submarined, resulting in a hangman’s fracture. The medics immediately secured an airway (intubated) and called us. Again, total time from time of original EMS call till when we had the kid in the trauma ED was < 15 minutes. If this had happened anywhere else, the kid would have never survived the initial injury (though he was a quadriplegic).

                                            My record flight time (and the record for the agency) was 7 minutes (total – from initial EMS call till when I had the pt in the trauma center) (I’m not a believer of coincidences)…… a lot of death can happen in that 7 minutes…..

                                            • This reply was modified 10 months, 2 weeks ago by wheelsee.
                                          • #149740
                                            Joe (G.W.N.S.)
                                            Moderator

                                              Bump

                                            • #149741
                                              BrothersKeeper
                                              Participant

                                                https://www.tacmedgroup.com/

                                                Thanks for bumping this. I have to increase my training and preps in this area. About a year and a half ago I sat next to the owner of the company in the link and promised myself I would go train there. Amazing dude and pretty intense training. I would love to take a couple of years off and learn how to be a paramedic, but stuff like this will have to do for now. Hopefully soon I can will get to this.

                                                Land Nav - 08/15
                                                Combat Team Tactics -
                                                Combat Patrol - 10/15
                                                Combat Leadership - 09/17
                                                Alumni Weekend - 07/18

                                              • #149770
                                                Civilianresponder
                                                Participant

                                                  doesn’t look like they have any future courses scheduled. Thats a bummer because it looks like they have some cool offerings. Odin medical, Lonestar medics, and Darkangel medical have some good classes.

                                                • #149773
                                                  DuaneH
                                                  Participant

                                                    https://ruffnermountain.org/whatsgoingon/alabama-wilderness-medical-association-presents-advanced-wilderness-life-support-training-dk54d

                                                    I was planning on taking this class but it was cancelled due to covid. I need the CEUs and I would rather be sitting outside than in a classroom. They MAY not accept lay people into the class, but you can check.

                                                    I read through the entire thread. I completed the Army Medic course in 1991, became a Registered Nurse in 1994, NP in 2018. When I went on Active Duty in 2013 at a Warrior Transition BN and got to be around soldiers with PTSD I realized that I had a touch of it as well. Not necessarily from combat, but from being a nurse for 19 years.

                                                    • This reply was modified 1 week, 2 days ago by DuaneH.
                                                  • #149795
                                                    wheelsee
                                                    Participant

                                                      Lone Star Medics – I just did their Medicine-X class (get off the X). Good information. Caleb Causey (owner) was a Combat Medic. Has a good teaching ability – finer points that I had never heard before.

                                                      https://www.lonestarmedics.com

                                                    • #149797
                                                      wheelsee
                                                      Participant

                                                        When I went on Active Duty in 2013 at a Warrior Transition BN and got to be around soldiers with PTSD I realized that I had a touch of it as well. Not necessarily from combat, but from being a nurse for 19 years.

                                                        I think many of us from the 80-90s have it (PTSD) a bit. CISD (Critical Incident Stress Debriefing) didn’t even come to Shreveport until the early mid-90s. Many of us just followed what the old guys (Firefighters) did, which in my case was alcohol (I was an alcoholic by age 18, I started FF/EMS age 17). No one taught us how to handle death (my 1st 2 calls as a senior in HS were dead people, including one with rigor mortis, a neighbor)

                                                        The NREMT (National Registry of EMTs) did a study (late 80s, early 90s??). Findings (as relayed to me by Shreveport Fire Chaplain Durell Tuberville) were that if a Medic was married within 2 years of becoming a medic OR becoming a medic within 2 years of being married, the divorce rate was 95% for men and 100% for women. He did a similar study in Shreveport FD and found 100% across the board.

                                                        We know so much more today. Spiritual health is paramount.

                                                        • This reply was modified 1 week, 2 days ago by wheelsee.
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