Atomic Legion – Trauma 101

On Sunday November 12, 2017, I took a one day Trauma 101 Medical Class with Atomic Legion. This was the first time I’ve dipped my big toe into the waters of traumatic wound care, and I went in with a healthy dose of trepidation not knowing exactly what to expect. The course description provides a rather lengthy list of skills that will be covered including Crisis Mindset and Leadership mentalities. Justin Hurzeler, the instructor is an EMT-P field paramedic, officer, and trainer for a municipal EMS system in central Texas. He is a NAEMT-certified instructor in the fields of Tactical Combat Casualty Care and Pre-hospital Trauma Life Support, among other subjects, and has taught over 1000 hours of medical curricula to emergency service professionals and civilians alike.

I signed up for this class with the intent of getting a handle on how to deal with the most time sensitive of traumatic care. My family and I like to travel well off the beaten path as overland enthusiasts. It’s not uncommon for us to set up camp thirty or more miles from the nearest paved road. While my wife and I have spent many hours learning how to defend ourselves, neither of us had previously put time into learning valuable life saving skills. My goal with this class was to start myself on the path to correcting that.

As the class started we did student introductions. The majority of the students are outdoor adventure types, and similarly recognize the value in being your own first responder. One of the students explained that every couple of years he takes another class like this as a refresher.

Justin then got into the class. He started with Scene Safety, explaining that going into an unsafe scene and becoming an additional trauma victim not only doesn’t help anyone, it actively harms the other victims by taking resources away from them to also deal with your injuries. Next Justin provided us details on how to contact Emergency Services. Details were provided on how best to talk to 911, what kinds of information they need, and how best to render aid while communicating with the dispatcher. The discussion then shifted toward Legality and consent. The Texas Good Samaritan Act was mentioned. One of our students was a Criminal Defense Attorney which offered an interesting additional perspective.

Then the real fun started. Justin explained that there are several acronyms used to help with rendering trauma aid. MARCH is one of them, but in this class we focused on the much simpler CAB which hits the big three immediate care items. Circulation, Airway, and Breathing (In order of importance.) We were shown how to take a pulse from each extremity, in addition to checking pulse at the carotid artery. Knowing how to check a patient’s pulse on their leg for instance becomes important once you apply a tourniquet to their leg. To avoid causing compartment syndrome it’s important to ensure that all blood flow into the limb is stopped, otherwise that blood will pool in the limb causing significant complications. Life threatening Hemorrhage must be addressed immediately. We discussed the various commercial Tourniquets available today, their advantages and disadvantages. The SWAT-T, and CAT were the clear favorites, as they are effective and combat proven life savers. I also found the CAT to be the easiest to apply to my arm one handed. We discussed checking for a pulse after applying a tourniquet, and if blood is still flowing you apply a second, or a third, or maybe even a fourth. Justin explained that while working if he puts a Tourniquet on a thigh, he almost always puts a second one on right away as legs regularly require more than one.

While still on the topic of Circulation we talked about packing wounds in distal areas. We practiced this using a pork shoulder with the bone in, and an IV to simulate a blood vessel. This was a technique I had never performed, and found it a lot more challenging than I expected it to be. I might have to practice this more on my own the next time we have a roast prior to cooking it.

We moved on to airway management. Justin explained how snoring respiration is an indication of a partially obstructed airway. We talked about how to tilt the head back, and move the jaw forward to help relieve this, but how that also ties your hands up. He then demonstrated how to install a Nasopharyngeal Airway (NPA, or Nose Hose) by putting one in his own nose. We talked about how unconscious patients benefit from being put in “The Recovery Position” as this helps fluids to leave the mouth rather than become airway obstructions.

Finally we talked about breathing. Specifically sucking chest wounds and what we as non-paramedics can do to help. We talked about commercial chest seals, like the HyFin, or Halo but also talked about how to improvise a chest seal. Justin didn’t want to discuss using chest darts, but mentioned that if breathing becomes labored you can and should “burp” the chest seal by lifting a corner. This should release some of the pressure building up in the chest outside the lungs.

We covered so much in the 8 hour class that I couldn’t hope to capture it all. It feels like I didn’t hardly scratch the surface of immediate life saving medical skills, however Justin assures me that a large percentage of things that will lead to end of life, before higher level care can arrive were covered in great detail. I guess that’s the real lesson. What I learned in this class is enough to hopefully sustain someone’s life until a higher level medical professional can take over for me.

I’d highly recommend this class to anyone who does anything rugged outside. Whether that’s offroading in the hill country of Texas, Hiking in the mountains of Colorado, or shooting on the range on the weekends. Medical skills are useful in so many unexpected situations. One of my friends was the first to arrive at an accident on the highway. The driver had sustained a piercing wound through his upper arm and my friend was able to apply a Tourniquet to the arm preventing the driver from bleeding to death. The Paramedics said he saved the man’s life. We should all aspire to be able to save someone’s life. Who knows, it might be your own.

Atomic Legion – Pistol 101: Beyond Fundamentals

On Sunday October 15, 2017, I took a one day pistol class with Atomic Legion called Pistol 101: Beyond Fundamentals. Atomic Legion in Austin, Texas, offers several training opportunities, and Pistol 101: Beyond Fundamentals is scheduled regularly. The course description is as follows:

Focuses on refining basic fundamentals of marksmanship and introduces the student to basic movement while shooting. Enabling objectives to include draw stroke training, comprehension of the shooting cycle, reloading and malfunction clearance exercises, and demonstrated control over one’s shot tempo. The student must score 80% or better on final test to pass.

The instructor Alex Acosta is described as:

A civilian marksman living in Austin, Texas. He considers himself a perpetual student of both skill and tactics as it relates to being a responsible armed person. Much of his time is spent understanding and breaking down the mindset, mechanics, and concepts necessary for the production of performance with a firearm. His education is ongoing, having received over 300 hours of instruction from some of the nation’s elite training schools. He continues to seek out methodology on topics related to the entangled use of force, management of one’s environment, modes of de-escalation, diminished light, and advanced tool use. Alex also focuses time on emergency medicine and maintains an NAEMT – TCCC-AC (Tactical Combat Casualty Care All Combatants) certification which focuses on basic life-saving care components.

I signed up for this class with the intent of diagnosing and fixing one specific problem. If I got more out of it, that’s great, but I went in looking for only one area of improvement. The class was one five-hour day. Round count for the day was about 300 rounds. Required equipment for the class was a fighting pistol, at least three magazines, a sturdy belt, a magazine carrier, and a holster. This is pretty standard fare for a one-day 101 level class.

The day started out at the range with Alex giving a safety briefing. We established who was responsible for calling for emergency services in the event of an injury, who was responsible for the trauma kit and its application (primary and secondary), and where the keys for his truck were, which was empty with the tailgate down, in the event we needed to transport someone up to the road. We then discussed the four firearm safety rules, in addition to a small number of range rules.

Alex approaches teaching by asking the students a large number of questions like, “So what does that mean when he says don’t allow the muzzle to cross the 180 degree mark?” During drills he pays attention to what is happening down range, and he will ask you “What did you see?” or “What did you feel?” He stated early on that while the fundamentals are important individual application and understanding of them is different. He stated that his goal was to help us understand what the expected result should be and help us come up with our own systems to achieve the desired result.

We then got situated with some paper targets and did a few reps of drawing from the holster and presenting the pistol to the target. This was followed by a few reps dry firing after presenting the pistol to the target. Then it was on to live fire. We started out simply with slow fire on a large eight-inch target. Alex spent a lot of time diagnosing individual students’ grips and helping diagnose where they were having problems. A lot of focus was placed on physical indexes. For example, I index the tips of my support hand fingers into the knuckles on my dominant hand prior to closing my hands around the grip of my pistol. This physical index works for me as a guide to ensure that my grip is created the same each time I draw and present the pistol. After a few magazines, we moved on to two-inch dot targets. It was during this string of fire that Alex was able to diagnose the problem I set out to fix as my only goal for the entire class. He observed that I was flexing my dominant hand thumb at about the same moment I decided to press the trigger. This has the effect of driving the muzzle down, and explains why I could shoot small groups but always one to two inches below the target. Just calling this to my attention helped me correct it. We did a few more static drills and then started to incorporate movement with our shooting. At first it was as simple as taking steps toward the target stand, and then he would call out A or B, which designated which 2” target we were supposed to aim at and shoot. This rounded out the morning.

The afternoon started with reloading drills. Alex provided his method for reloading a semi-automatic pistol, which includes indexing your pointer finger on the top round of the magazine you’re going to insert, while simultaneously pulling the elbow of your dominant hand against your side just above your belt. Locking this elbow in makes it easier to reload when you’re moving as your hand and the mag well move around far less.
An added bonus is this rotates the magazine well toward the hand that’s holding the new magazine. Finally it puts the pistol into your field of view, while allowing you to also keep your eyes down range. To see the stability benefit of this technique you only need to try to do a reload while walking across your garage. We then moved on to some malfunction clearing drills, which brought up a brief discussion about Hick’s law, which we tabled for later.

Finally we moved on to moving while shooting: Engage a target, then running laterally across the range to address a second target, then back to the start where you would re-address your first target. We worked on transitioning between several targets where Alex talked about “dancing” as he likes to transition between targets through his hips. Then the day finished with a final exam which was a simple pass/fail with “80” as the cut off. The final exam was shot on a USPSA cardboard target. The scoring areas were rather generous. (I thought so anyway.) I won’t give away the specifics, but I will say that the final test incorporated most of what we had practiced earlier in the day, with a time component as an added stressor.

All in all I was very pleased with Pistol 101: Beyond the Fundamentals from Atomic Legion. Alex is a good instructor. He does a very good job of distilling his knowledge into small enough bites for you to pick up a little bit at a time, and add or improve your own skills. He asks a lot of questions, which can be intimidating if you’re an introvert like me, but he does it in a non-threatening way.

If you’re in the Austin area, I’d recommend this class for anyone who carries a pistol. Even if you’ve done a lot of training before with other instructors, Alex’s approach is still likely to help you improve in at least one area.