Dark Angel Medical - Training Review
On December 12th and 13th, 2015, I was able to take part in the Dark Angel Medical Tactical Aid course in Norcross, Georgia. This course was taught by Ross Francis from San Bernardino, California. Ross is a Navy combat veteran who had multiple deployments to both Iraq and Afghanistan as a Navy Corpsman and later as a contractor. He is also a registered EMT both federally and in the state of California. To preface this review- I must say that the real world trauma experience that Ross brings to the class is absolutely awesome and a large contribution to the course. He has flown with the Air Force Pararescue Jumpers, been the Corpsman attached to Marine Corps scout sniper units, and provided medical aid in the civilian world as an EMT. To say the least, his experience and resume left no doubt that he knew the content that he would be teaching for the duration of the weekend. The Tactical Aid course is 16 hours and focuses primarily on the treatment of life threatening, traumatic injuries. Per their website, the course content includes:
- Physiological and Psychological reactions to environmental stress
- The importance of having the proper Combat Mindset
- Basic Anatomy and Physiology of life-sustaining systems
- H, A, B, C’s—Hemorrhage, Airway, Breathing and Circulation
- Breakdown and usage of Individual Med Kit components
- Proper stowage and employment of the IMK
- Hands-on application of the IMK
- Basic and Advanced Airway management -treating and monitoring tension pneumothorax, sucking chest wound and flail chest
- Airway adjunct device placement-Nasopharyngeal Airway
- Basic First Aid and Advanced wound care
- Application of Bandages and Hemostatic Agents
- Application of tourniquets
- Recognition and Treatment of various injuries (Gunshot, Laceration, Burn, Airway, Head, Orthopedic, Environmental)
- Recognition and treatment of hypovolemic (hemorrhagic) shock
- Moving and positioning victims with various injuries
- Response to active shooter situation
- Proper use of cover and cover vs. concealment
- Casualty recovery in an Active Shooter situation
- Mass casualty triage procedure
- Emergency Medical Dialect/Lingo (911 protocol, cooperation with LE, Fire and EMS and First Responders)
Day 1 - Discussion, Lecture, Demonstration
From the very beginning of the course, it was clear that the content was going to be presented quickly, efficiently, and thoroughly. We were going to be pushing through the content at a very brisk pace in an effort to get as much of it presented as possible. For those that are completely unfamiliar with anatomy and physiology, this could potentially have the "drinking from a fire hose" effect as the course escalates rapidly right out of the gate. For me, this was a wonderful way to both keep my attention focused and my mind engaged. Though day 1 has a true "classroom" style of presentation- the content is such that it demands your attention. With images, videos, and demonstrations you can't help but want to flip ahead in your book to see what kind of crazy traumatic wound was waiting on-deck.
We began the day covering the Good Samaritan laws for the state of Georgia as well the mindset that would be needed to treat traumatic injuries. Ross re-iterated time and time again how mindset would get you through the toughest situations in medical treatment of a casualty. We covered combat psychology and physiology and talked at length about the effects of stress and body alarm on the human body. Similar to the stress-inoculation that shooters are exposed to in order to learn how to fight under stress, we learned how to try to remain focused as our body pumped adrenaline into our bloodstream.
Next we moved in to Scene Safety and Situational Awareness. We discussed some of the common factors than can effect good situational awareness such as protective gear that inhibits our senses (gloves impact our ability to feel, hearing protection inhibits our ability to hear, etc.), lack of light in dark environments, and environmental factors such as extreme temperatures and other considerations. During this portion, we discussed options to preserve our safety while still helping those wounded by potentially calling out to them with instructions and ways to help them obtain cover prior to us treating them. After all, it does no good for us to become another patient instead of a care-giver if we arrive on a scene that is not yet safe to provide aid.
From here we moved into the basic anatomy and physiology of the human body and began addressing the most life threatening trauma injuries in both combat and civilian applications. We learned how to assess the patient's Level of Consciousness as well as identify and treat immediate problems that would cause the patient's situation to deteriorate. With approximately 80% of combat deaths being attributed to hemorrhaging, it was appropriate that we spent quite a good bit of time figuring out how to treat injuries that cause a massive amount of blood loss.
Application of Tourniquets
From very early in the class, Ross began explaining and re-iterating the importance of the use of tourniquets and how the "stigma" of their use is finally starting to fade in the medical industry. He uses data collected from years of war in the middle-east to emphasize how the proper use of tourniquets saves lives and is no longer the old dogma choice of "life vs. limb" in medical treatment. This would be re-emphasized throughout the course, and the application of tourniquets would be a skill that every participant in the class would master by the end of the 16 hour course. If I learned nothing else in this training, I can say that I feel very comfortable applying a tourniquet to a bleeding extremity on myself or someone else.
Respiratory Issues and Treatment
After treating massive blood loss, we moved in to the respiratory systems and learned to identify whether or not our patient had an open and maintainable airway. We studied the anatomy of the respiratory system as a pre-cursor into some of the common issues that would arise due to injury. Understanding the way the body should work is crucial in diagnosing why it might not work after traumatic injury. As our understanding about airways grew, it acted as a perfect segway into the next step of our patient assessment: breathing. As the brain has a constant need for oxygen, it is important to understand if a patient is breathing. If not, it is absolutely vital that we get oxygen circulating through their blood as quickly as possible.
Circulation of Blood
After our patient is breathing, we need to make sure that the oxygen can reach the brain. This is accomplished through the circulatory system. During this phase we studied ways to check our patient's circulation through assessing pulse from various points on the body and understanding the signals that the body is giving us with that pulse. The blood acts as the human body's "hydraulic fluid" and is essential to sustaining life. Therefore, it was drilled into our brains that we must keep as much of the patient's blood inside the body as humanly possible and to ensure that it is circulating properly.
Identification and Utilization of our Kit
Many of the participants in the course purchased a D.A.R.K. (Direct Action Response Kit) from Dark Angel Medical and we spent some time identifying all of the components of this kit. For those participants who didn't invest in the kit, we spent some time identifying the essential components that they should include in their own personal kits that they would assemble. Small details were not overlooked in this process, and it included content that I hadn't previously thought about... For instance, when preparing your personal kit you should use nitrile material gloves instead of latex as some patients might have an allergy to latex. We spent a sufficient amount of time identifying and understanding the multiple components of our kits and understanding exactly what each piece was intended to do. We also learned of "other capabilities" that our components might have in the event that we need a different use than they were originally intended for. For example, our Israeli bandages could easily be utilized for a make-shift splint to treat a simple fracture. This portion of the course opened my eyes to the diverse and expanded use of the kit and confirmed my satisfaction of having purchased it.
This course does a fantastic job at teaching you some common treatment "paths" that you can take to address multiple wounds. For instance, the treatment of an abrasion caused by road rash might be treated very similarly to a glancing wound from a shotgun using bird shot. This allows us to multiply our capabilities instead of adding them... What do I mean by that? Similar to the way that I teach unarmed self-protection and firearm manipulation skills, I want to be able to provide a few different techniques that can be strung together in countless combinations. That way the student isn't memorizing one reaction per one action, but rather multiplying their abilities because they might be able to string together two or three simple techniques in order to solve some complex issues. This was the nature of much of our Tactical Aid training. Many injuries were covered, with varying amounts of detail and effort spent on each. They included:
As you can see, the extent of the content covered is more than your money's worth...
Day 2 - Hands On Work
Our second day of the course had the same pace as the first. As expected, we spent time making sure that our ability to properly (and quickly) apply a tourniquet was second nature as Ross would tell us spur the moment to "apply TQ to right leg" and would count down from ten to make sure that we could perform this action in less than 10 seconds. Later, we moved into occlusive devices to help us fight the sucking chest wound that we covered at length the previous day. We also worked on inserting the Nasopharyngeal Airway after measuring it for proper length and diameter. Ross drilled us repeatedly on not only how to apply the needed procedures but also when to apply them. Again, there were common patterns and themes that would help us use one solution to multiple problems. This systematic approach to treatment is best summed up by the course's tagline of "Simplicity Under Stress". Day two would simulate stressful situations and cover more complex problems such as:
- Victim Movement
- Scene Safety
- Utilization of Cover vs. Concealment
- Triage and care of multiple victims
- Creating splints and swoths
- Continued application of tourniquets (see a pattern here?)
- Compound Fractures
- Identification and prevention of Tension Pneumothorax
- Multiple injuries in one or more patients
In order to deal with these more severe wounds, we learned (and thoroughly practiced) how to pack wounds with dressings (while maintaining direct pressure) and apply bandages. We learned to make splints and how to apply them. We covered how to move a victim both alone and with another person there to help. We learned when/how to apply occlusive dressings to prevent a sucking chest wound from developing into a tension pneumothorax. We learned to double up our efforts as we would simultaneously assess the patient's Level of Consciousness while applying a tourniquet if needed. In short- day 2 was the hands on application of the content covered in day one.
The Good, The Bad, The Ugly
As I do with all of my training reports, I like to provide the biggest positive and negative aspects of the course from my personal opinion. I generally refer to this as "The Good, The Bad, and The Ugly" and make an honest assessment of what my take-away was from the training.
The content in this course, coupled with the real-world experience that Ross was able to provide, was exceptional. The photographs and videos in the course gave a new understanding to the anatomy of the human body and how to hopefully preserve life long enough for Emergency Services to arrive. Similar to the skills that I attempt to hone and fine-tune during firearms training, trauma care is a skill that I hope I never have the opportunity to use on myself or anyone around me. However, given the skill sets that I've acquired from this course, I feel confident that I am better prepared to preserve life than I was before enrolling in this class. If nothing else, this course did show me how little I previously knew about treating traumatic injuries, and sparked my interest to continue my training with further instruction. This course was excellent- and the instructor was awesome.
Regarding the presentation in this course, I wish that it was spread out over three days instead of two (or at least there were an option for a three day version). The volume of content is very high for a two day setting, and a third day might allow for more role-playing and hands on interaction to really fine-tune the skills that were covered. Also, I think it would be beneficial for the instructor to bring an additional kit and have everyone watch as he cuts it open and goes through each piece of it as it appears in the kit. For instance, we covered several variations of tourniquets, bandages, and occlusive dressings- but we didn't rip open our kits to see exactly which one was present in our kit. I'm sure I could figure it out without too much difficulty- but I'd hate to do that for the first time under stress. The other alternative is to break the vacuum seals on the kit which would make it difficult to pack back into such a compact carrying case. (By the way, the carrying case is a fantastic way to carry so much gear in such a small space. THUMBS UP on that!)
Due to the nature of the content in this course, I don't know that I would recommend it for someone with no real-world concept of violence, trauma, or severe injury. For instance, if an up-close image of a self-inflicted shotgun blast to the face is enough to make you vomit, then this probably isn't the medical aid course that you should start with. It is gruesome. It is ugly. It is difficult to look at and inevitably excruciatingly painful for the injured person(s) involved. However, it is a reality of life and I would rather face the real-world than act as a sheep hoping that I'm never subjected to the work of the wolf.
Would I Recommend This Course?
Yes. HELL YES. ABSOLUTELY YES! In fact, I already have recommended this to several people. I carry a concealed firearm every day, and I train to use that firearm in defense of myself and others. Adding a supplemental skill such as traumatic injury care seems to go hand-in-hand with a skill and tool designed to inflict trauma. Make no mistake- the people that were in this course with me were not the kind to go out and look for trouble. However they were the kind that acknowledges that trouble just might find us when we are least prepared. The motto of Dark Angel Medical is "Vita Vel Nex" which translates to "Life or Death." Their classes resonate perfectly with this motto as you are inevitably dealing with life threatening injuries.