1. WELCOME Subhead goes here. Remove “Welcome” and add text box for presentation slides. FIREARMS INSTRUCTOR RANGE MEDICAL PRACTICAL’S COURSE

2. Legal Issues Consent – Actual – Implied Liability 2

3. Good Samaritan Doctrine One who sees a person in imminent and serious peril through negligence of another cannot be charged with contributory negligence…negligence of volunteer must worsen position of person in distress before liability will be imposed Nolan JR, Nolan-Haley JM, Black’s Law Dictionary, 6 th Ed. 1990 However you are held to: “Gross Negligence” or “Willful/Wanton Misconduct” 3

4. 4 POTENTIAL ILLNESS and INJURIES Cardiac Arrest Anaphylaxis Heat/Cold illness Sprains/strains Contusions Fractures Envenomation Burns Gunshot wounds

5. 5 THIS WILL COVER THE FOLLOWING: Cardiac Arrest Anaphylaxis Gunshot Wounds

6. Heart Signs and Symptoms Chest pain Shortness of breath Weakness Nausea Confusion 6

7. Heart Disease: Do Not Downplay!! Contact EMS Allow individual to take their own medication (if applicable) Have AED nearby 7

8. Anaphylaxis Acute allergic reaction: sting, food, medication Weakness, nausea, difficulty breathing, loss of consciousness Untreated, may lead to death 8

9. Anaphylaxis: Treatment Epinephrine is life saving – Self-administration – You administer EMS Close observation - AED close by Must be transported, even if feeling better 9

10. Gunshot Wounds Injury patterns vary greatly: Firearm type Bullet velocity Fragmentation Permanent/temporary cavity Distance to muzzle Area(s) struck 10

11. Gunshot Wounds Bullet path cannot be determined based on examination of entrance and exit wounds The most common preventable cause of death in GSW is exsanguinating hemorrhage (massive blood loss) 11

12. REALITY: FEMORAL BLEED 12

13. GSW Principles of Treatment Stop bleeding Start breathing Protect wound Treat for shock NOTE: Disarm the casualty! 13

14. Stop Bleeding Tourniquets: your friend! – First line treatment in tactical scenario – Apply immediately if direct pressure fails – Commercial or improvised acceptable – Apply high on extremity over uniform 14

15. Stop Bleeding: Tourniquets 15 Combat Application Tourniquet ® (C.A.T.)® SOF® Tactical Wide Tourniquet

16. Stop Bleeding Where to apply Tourniquets? – As far above the wound as possible – As far up near the arm pit as possible – As close to the groin as possible – Also apply high on extremity over uniform 16

17. Stop Bleeding Hemostatic agents: QuickClot®, Celox®, HemeCon®, etc… – Continued bleeding following tourniquet application – Unable to apply tourniquet – Note: Does not produce any heat 17 Note: Can use plain gauze if Hemostatic Agents are not available

18. COMBAT GAUZE Needs to be pushed deeply into the wound as far as possible & in all directions It may take 2 packs to pack the wound Won’t go in any further, press remaining on top of the wound 18

19. TRAUMA DRESSING Then secure with a trauma dressing/pressure bandage 19

20. COMBAT GAUZE May take up to 3 minutes before the Combat Gauze to start to stop the bleeding Be sure to keep pressure on the wound 20

21. Start Breathing Ensure adequate breathing following any injury Breathing may be compromised following a wound to the chest, or due to shock from any wound and head injury 21

22. 22 HOME LAND SECURITY: SHOTGUN INJURY WINCHESTER SUPER-X SLUG

23. 23 HOME LAND SECURITY: SHOTGUN INJURY WINCHESTER SUPER-X SLUG

24. 24 HOME LAND SECURITY: SHOTGUN INJURY WINCHESTER SUPER-X SLUG

25. HOME LAND SECURITY AGENT The slug struck the agent on the top of his left foot and exited from the bottom of the foot. The exit wound was about twice as big as the entrance. Three agents responded immediately and treated him with quick clot, an Israeli bandage and a tourniquet. Had the bleeding stopped within probably 2 minutes of the GSW. 25

26. 26 RETIRED CHIEF OF POLICE – ST. CROIX, 7.62 x 39 ROUND

27. 27 RETIRED CHIEF OF POLICE – ST. CROIX, 7.62 x 39 ROUND

28. 28 RETIRED CHIEF OF POLICE, TOURNIQUET SAVED HIS LIFE

29. 29 KEL-TEK KSG SHOTGUN, HAND SLIPPED IN FRONT OF MUZZLE

30. Start Breathing Any compromise in breathing: chin lift/jaw thrust/NPA Roll casualty onto their side (Recovery Position) If no response, rescue breaths may be attempted* 30

31. Protect Wound Apply a clean or sterile dressing if available Apply splint or immobilize affected area Occlusive dressing is protection of choice for chest wounds 31

32. Treat for Shock Prevention is key Bleeding control and breathing assistance Elevate the feet Keep warm Reassurance 32

33. OTHER INFORMATION YOU NEED TO REMEMBER Remove the officer’s firearm immediately and secure it as soon as possible Don’t want officer/patient coming to, become startled and do something they’ll regret 33

34. WITH REGARDS TO MEDICAL HELICOPTERS Medical Helicopter protocol: “NO FIREARMS ARE PERMITTED ON THE HELICOPTER!” Remove the officer’s duty rig before he/she is placed on the helicopter 34

35. WITH REGARDS TO MEDICAL HELICOPTERS This also includes “Back- Up/Secondary” Firearms Too much can go wrong while helicopter’s in flight 35

36. Questions?? 36