Emergency Medical Care

TCCC - Traumatic Combat Casualty Care
CLS - Combat Life Saver

Both of these classes are very similar in nature. The bulk of the material overlaps. TCCC has its origins in USSOCOM, whereas CLS originated with the US Army. Both courses focus on treatment of a troop wounded in combat.

The Minuteman would be well-advised to take as many classes like this as possible. Well no blog post could even begin to be all inclusive with regards to the material presented in either course, this post will attempt to hit the highlights.

The US military, in both of these courses, states that over 90% of preventable combat casualties occur from massive blood loss. A significant portion of the rest of preventable casualties happened from Airway obstruction. So, for the record, the minute man should carry an NPA - Nasopharyngeal Airway tube.  And know how to use it. 

IFAK
This is an individual first aid kit. The contents of your IFAK are be used on you. Here are suggestions on contents:
Blowout kit - minimum contents:
(Easily accessible by either hand)
1 EMT shears
1 tourniquet
Two rolls gauze.
Two chest seals.
1 NPA

IFAK.
 1 tourniquet
 1-2 hemostatic gauze
 1-2 Pressure Bandages
 2 rolled gauze
 2 triangle Bandages
 1 NPA
 2 Chest Seals
 1 EMT shears

Hyfin chest seals. 
AED bags 
NARP S-Rolled gauze. 
Naturally, the Minuteman would be well advised to seek out professional medical advice on specific contents for his own IFAK, as well as any other Medical supplies.

Catastrophic Blood Loss
As catastrophic blood loss accounts for over 90% of preventable combat casualties, it will be the one that is focused on in this blog post. There are three major ways to treat catastrophic blood loss hyphen tourniquet application, wound packing, and chest seals.

Tourniquet Application
The Minuteman is well advised to carry one or more CAT (combat application tourniquet) tourniquets on his loadout. There are two schools of thought within the medical community as to the location of where the tourniquet needs to be applied.

A tourniquet, once applied, should only be removed by qualified medical personnel. Typically, this means a doctor in a hospital. As a rule, most nurses, paramedics, and EMTs are not qualified to remove a tourniquet.

The more traditional method is to apply a tourniquet 2 to 3 inches above the wound, and not on a joint. The rationale here is that if professional medical help cannot be reached in time, and the limb lost, then lose as little of the limb as possible.

The more recent school of thought is to apply the tourniquet all of the way up the limb. "High and tight." This comes from the Practical experience that are military has had in the global war on terror. Many servicemen, when applying a tourniquet 3 inches above the wound, we're experiencing further damage to the wound, as there might have been shrapnel or bullet fragments still inside. The tourniquets were being applied over the foreign objects, compressing them into the flesh further.

Once the tourniquet has been applied to the point of bleeding stops, the patient is now on the clock. There is about an 8-hour window during which the patient must be taken to the hospital, or else the limb will be lost.

The Rifleman suggests the "high and tight" method.

In either event,  apply the tourniquet , and wind The Windlass until the bleeding stops. Sometimes this may take 3 full rotations, or more. Please be aware that a leg - particularly a thicker leg - may require two tourniquets to stop the bleeding. Be sure to note the time of the tourniquet application, as the 8-hour window has begun - a Sharpie marker can help note the time. Alternately, you can use the patient's blood to write the time on the forehead.

Chest Seal
A person shot in the chest, or thoracic region, needs a chest seal applied. If a lung has been penetrated, there is significant risk that are conceived into the chest cavity and compress the lung. This can result in collapsed lung, and difficulty breathing.

If there is an entry wound, there may be an exit wound. Make sure to examine for both. You will need to examine both the front and the back of the patient.

The wound furthest from Gravity (with respect to how the patient will be transported) should be sealed on three sides, with the side closest to gravity left open. This allows air to escape, but not get sucked back into the chest. All other holes in the thoracic region need to be sealed on four sides.

Wound Packing
Catastrophic bleeding from a wound in a junction area (not a limb or chest, but in between - see picture above), needs to be packed with sterile gauze. You may be surprised how much gauze will fit into such a wound. Once the wound is packed as tight as can be, bandage the top of it, and of course get the patient to a hospital as soon as possible.

Non arterial bleeding on a limb can also be treated via wound packing. Again, once the wound is packed, bandage the top as best you can.

Never pack a wound to the gut. Bandage the top as best you can, and get the patient to a hospital immediately.

Summary
You really need to take as many Medical classes as you can get your hands on. A good TCCC or CLS class is well worth the money.  Some even include an IFAK as part of the tuition cost.

And always remember this rule of thumb - any class worth taking once, is worth taking twice.