Thursday, April 25, 2013

Part 2: AAR – SUT/Patrolling/Logistics Course – April 19-22, 2013

In Part 2 I will discuss the TC3 aspect of the class. Part 1 of the AAR can be found here.

The most important lesson about treating combat injuries is this:

The best medicine on the battlefield is fire superiority!

You don't treat anyone until the fight is over. You stop the enemy from shooting at you either by killing them, or forcing them to flee. When it is safe, then you can attend to the injured. If you have to move an injured person, you move them while continuing to engage the enemy, and if the injured person is able to do so, they should be engaging the enemy while being moved as well.

Without going into all the specific details of TC3 (Tactical Combat Casualty Care), I'll discuss the hands on portions we covered. You can download a copy of the US Army TC3 Handbook for all the nitty-gritty details. However, don't rely on this alone...without the proper hands on instruction, you won't understand the context and could end up doing more harm than good. Get trained first!

First Mosby went through everyone's IFAK to make sure they had the proper gear. Not everyone did. He had the list of required items listed on his blog. Make sure you have what's listed when you attend his class.

He showed us the HALO Chest seal for sucking chest wounds and discussed its purpose and proper use. During this portion, he also discussed the proper use and application of the 14 gauge ARS for Needle Decompression when treating a life-threatening tension pneumothorax.

The first thing to do for an injured person is to stop life-threatening hemorrhaging if tactically feasible. This is accomplished, in most cases, with your handy-dandy CAT tourniquet. Make sure you have the real deal and not the cheap ineffective knock-offs. You keep tightening it until the blood flow stops. Leave it on.

The class was instructed on the proper usage and application of the CAT. We were timed on getting one on ourselves as well as getting one on our partner. Untreated arterial bleeding will kill you in less than 3 minutes and you will lose consciousness in 60-90 seconds, so arterial bleeding must be stopped ASAP!

The proper use and application of gauze to stop bleeding from a gun shot wound and promote clotting was discussed. Students were taught how to properly dress a wound using an Israeli Battle Dressing. The debate on using Celox or Quick Clot impregnated gauze basically came down to preference. Even regular gauze works just as well if properly packed into a wound. One concern with using Celox is that it contains Chitosan, a shrimp shell derivative that could be fatal to someone with a shellfish allergy.

The importance of ABC (Airway, Breathing, Circulation) was discussed.

An effective airway must always be maintained. If the patient is unconscious or risks going unconscious, a Nasopharyngeal airway (NPA) insertion will be necessary. If this is not an option, due to severe maxillofacial damage, move on to a surgical cric. (this is beyond the scope of this AAR but was discussed in great detail)

A couple students volunteered to allow a NPA to be inserted in their nose.

I won't go into the details of how this was achieved because I'm not qualified to teach this and I'm not a doctor, nor do I play one on TV. But suffice to say, it was not a difficult procedure to execute properly although it was humorous at times.

As you can see in the illustration above, the purpose of the tube is to provide and artificial airway in the event that the natural airway becomes blocked.

Afterwards Mosby discussed the proper way to start an IV in the event of, or to prevent  Hypovolemic shock and even allowed 2 students to actually attempt it on himself. What other instructor would ever do that?! The man is dedicated!

If you have an injured person that has a high probability of not surviving, even with medical treatment, don't treat them. Do what you can for pain but don't waste your finite resources on treating a dying man.
"It's called triage. It's is a mother fucker, and it sucks...but it's necessary."
- Mosby Maxim #35 -

Mosby recommended that we get the Special Operations Forces Medical Handbook along with a good human anatomy & physiology book.

In a SHTF scenario, you may have to rely on yourself for medical treatment. Get the books now and get familiarized with it. Practice conducting a surgical cric on a chicken neck. Practice suturing on a chicken breast. Shoot a roast and practice packing the hole with gauze and bandaging it.

Get medical training and Practice! Practice! Practice!

A good place to start would be to enroll in a CERT class near you.

The sooner you get trained, the sooner you'll be ready.


  1. Excellent AAR, and thanks for those PDF links.

  2. Do a wilderness first responder course too. Good info on moving patients in rough terrain and more that is applicable to TC3 training. Well worth the time and expense if you're into medical things.Here's a link to some info on the NOLS Wilderness Medicine Institute course and free Wilderness medicine test.

    CERT is ok but depends on what area you're in for it to be of real value though the information is good for a lot of scenarios. YOU have to learn about NIMS and ICS but it is good to know how the Fed's run their operations. CERT is a great networking resource too. The SAR section is of great value and the START triage protocols are great too.

    yes triage is a motherfucker, you cannot save them all.Sounds like an awesome class. Keep up the fire.


  3. Ok, Where do you EVAC your wounded TO? How do you get them out? What is your chain of care? Who dose surgery? Who dose recovery? What Pain/Shock drugs can you field? Do you have IN PLACE a network to do ANY of the things necessary to treat even minor trauma? If you don't have a solid YES to all of the above ,then your IFAK content is meaningless, you won't need to treat a sucking chest wound, cause if you get one you die. "Mosby" served in a military with unlimited on call MEDEVAC-- you don't. Small gurrilla units can treat minor wounds , but stuff that needs surgery is a death sentence. Having a fantasy underground "network" of secret hospitals is great and all, but it is more the stuff of movies than reality. When this CWII starts people WILL die. Most of them from stuff that is easy to fix in a major hospital. Too bad we don't have any.

    1. When you die we will rember this rant and split up your gear after you come down to room temp

    2. Good points and I didn't go into detail in this part of the AAR, but that is where your Auxiliary comes into play...having an established advanced medical care network in place. More in future postings.

  4. A few guys and I train together. We had a very morbid discussion the next echelon of care off of the battlefield. Between civilian EMT's and paramedics, along with an E.R. nurse, our limited supplies will be put to good use during a SHTF scenario. The next echelon is the motherfucker. A clean bed, dressings and antibiotics is obtainable in various ways. Beyond that it may mean dropping off a casualty at an ER, probably dooming them to incarceration or worse. Depending on where you are operating, that may not even be an option due to OPSEC. It's a big boy game.

  5. As an EMT I can say good training. We have a Dr in our tribe. Good to have indeed.