The movie The Perfect Storm, starring Mark Wahlberg and George Clooney, pits a motley crew of a fishing vessel against the impossible decision of losing their livelihoods vs their lives by trying to outrace a monster storm in the fishing grounds off the coast of Massachusetts. No doubt the real crew of the Andrea Gail had their “come to Jesus” moment on the deck of that boat before plunging full speed into that storm front, and the allegory provided by the experiences of those men is not lost on many facets of being prepared for an ever increasingly chaotic world.

Today’s topic of Emergency Care in High Risk Situations is one based on your own personal  Perfect Storm…..the one that comes upon you like the rogue wave in the movie, and pits your ability to process information about what has happened, or is happening still, against your skills and knowledge in order to provide lifesaving interventions, quite possibly while the event is still occurring.

Effective emergency care goes beyond what that Dark Angel IFAK (Individual First Aid Kit) gives you the impression you should competently be able to do folks…..Given the increasing numbers of Concealed Carry holders, and the very real possibility of high threat incidents, like the active shooter, violent civil unrest, and/or mass casualty terrorist attacks, settling for the notion that putting on a TQ and at least carrying Combat Gauze so that the trained guy coming in can fix you (or others for that matter) is simply misguided in this day and age. If you follow folks like E. Reed Smith or Greg Ellifritz, like we at CDT do, the point cannot be hammered home enough: Just as you geek out on gear, guns, and firearms training, so must you on the skills and knowledge necessary to not only fix the damage those implements can do, but those injuries combined with critical medical issues such as blunt force trauma. You must recognize that those kits are not designed for the statistical, multi-system trauma injuries suffered by the average American you might encounter in a defensive shooting or other high risk event.  Simply put, you must have more tools in the tool box.

The bottom line is that there are too many readily available resources and training out there to become more competent in giving you, and your fellow man, a fighting chance to live when professionally trained personnel are en route, and even possibly delayed due to the nature of the incident. The current training path being introduced into the EMS circles where I dwell suggests that our ability to intervene medically while the incident is still occurring, or directly following, is paramount to the survival of injured people. The training path for the civilian should be no different, and there is simply no excuse anymore for not having the skills.

Basic trauma care……recognition of the signs and symptoms of tension pneumothorax…..correction of heavy external bleeding…..compromised airway interventions…..add these in with the stabilization and evacuation of injured people to areas of relative safety should become part of the curriculum you pursue when you think about training. CPR, and I mean high quality CPR, should be one of the top skills you possess. Use of an AED (Automatic External Defibrillator)…..Proper expedient exam skills…..and placing yourself in realistic scenarios where you are made to decide whether extraction and retreat are the best option, or whether you need to begin patching holes in either yourself or someone else, even while it may be unknown if the threat is gone. Take 5 minutes and read the link HERE. It tells the story of 17 year old boy who, when faced with a life threatening situation he knew very little about, saved the life of a 56 year old man from the skills he learned in the Boy Scouts! Thank God that he was there, but don’t rely on the possibility that a bystander will be nearby with the requisite skills…..

From an EMS standpoint, statistically, only 10% of potentially fatal wounds result in death when medical care is initiated immediately. 42% die immediately after injury in most battlefield scenarios, from injuries incompatible with life. But the rates drop dramatically as the ratio of time of injury/time of care gets closer, with the fatality rate dropping to below 30% when we can medically intervene from anywhere in between 5 mins to 2 hours!

In other words: The sooner we render LIFESAVING aid, the better overall survivability outcome we can produce, and it all starts with retooling your training and equipment.


Now for the sobering thought: The kits, that 90% of civilians that carry a weapon for self defense have, have equipment in them that are not designed for the average American! Let’s look at CAT tourniquets….the wiz-bang that everybody shoves in their pocket “because the military uses them”.


Take a look at the pic below:


Now this is just a representation of a potential victim of violence you might encounter out in public, and maybe similar to someone you know, but the point to consider is this: Could you get a CAT TQ around the leg of this guy if he had an arterial “spurter” high up on his thigh? Is one TQ going to be enough? Are there other TQ products on the market that may do better job than this? Bodies come in all shapes and sizes, and you need to be able to recognize the limitations of your equipment.

I know what some may say: “I’ll just use my belt or a piece of cord…something to make an improvised TQ”. Good plan, but unfortunately Improvised TQ’s fail 40% of the time when used by TRAINED MEDICAL PERSONNEL. Today’s IFAK’s and med kits that are prevalent are designed primarily for the military….18-30 year old males that are in phenomenal shape and within the 80th Percentile of BMI. Unless you do your homework, chances are the TQ you carry is not a good choice for a wide variety of body types in a lot of cases.

Here’s the sobering news: The number crunchers also tell us that the wide majority of civilian deaths from potentially highly lethal wounds occur from trauma to the head, chest and upper back, and not from arm or leg injuries; over ¾ of them. 70% of trauma in this context is not even from penetrating objects, but from blunt force! Only 21% is extremity trauma resulting in the use of a TQ, so we see that while control of extremity hemorrhage is important and most certainly life threatening, it is simply too myopic a skill set given the low actual mortality. Why, then, are we so focused on that strip of nylon and Velcro?


So, given those numbers, what can we expect to have to do with those more prevalent injuries? Can you recognize and immediately treat the signs and symptoms of a tension pneumothorax? While this is a developing injury, it is no less lethal. It compresses the heart, if there is blood in the cavity (hemopneumothorax), and in general keeps the vital organs that are working to keep you alive catastrophically hypo-oxygenated.

Most of your commercially available kits have the option of carrying a large bore needled catheter for use in decompressing the chest in the event of what is known as a Tension Pneumothorax, also described as a critical buildup of air inside the space your lung normally occupies after an injury to the chest.


Modern medical guidelines now suggest that if there is a clinical presentation of shortness of breath following a traumatic injury to the chest in these cases, that it is completely within reason, and the scope of your training, to simply go ahead and use the catheter.  Doing so can immediately improve the overall vital sign response and survivability. Learning placement and landmarks on the body will help guide you to success, but what plan do you have in place when it’s dark, or the situation is still chaotic?

Another piece of equipment found in many kits is the Occlusive Chest Dressing or Chest Seal.


These are designed to treat an open wound to the chest that does not allow the lung to properly expand and inflate, otherwise known as the Sucking Chest Wound, or Open Pneumothorax. There are many different brands on the market, but which one do you use? Do you know how to properly apply it under less than perfect conditions, such as a wet chest or the simple presence of copious amounts of blood? Done properly, this is another rapid application skill that can without a doubt save a life.

And we’re just touching on the most prevalent……in today’s world, where multi-system trauma has become commonplace, we need to get “off the X” in essence and realize that our ability to intervene quickly with the rapid application of life saving measures is the not the goal, but the STANDARD you need to strive for.  We need to be treating folks, sometimes under less than optimal conditions, so that when they are transferred to a higher level of care, their chance of survival is increased exponentially.

Multi-system trauma is an increasing reality in these chaotic events. We will be showcasing some of the medical issues associated with the High Risk Scenarios in more structured fashion in future articles, but the light bulb should have come on by the time you’ve gotten here. Just as in shooting, unarmed combatives, edged weapons, etc., the day and age are here when just having the basics is gone. Your survival, and the survival of your fellow citizens, should they need you in the Perfect Storm, just might come down to taking your medical training just as serious, if not more serious, as the days spent at the range. The rogue wave knows no mercy…..