Private Bloggins

CTOMS UNFILTERED

July 2, 2012
by craig.keller
1 Comment

To Train or Not to Train – There Really is No Question

You have probably heard the saying “Guns don’t kill people, people kill people.”

Well, I have my own saying, “Bandages and tourniquets don’t save people, people save people.”  and the only way they can do that safely and effectively is if they have the appropriate training.

The point that I am trying to make is that medical equipment sitting in a locker or a car or in a med bag or pouch does nothing on its own.  Throwing money at equipment, or packing extra in your kit in an attempt to compensate for a lack of confidence in abilities, in the hopes it will solve a problem is not the most effective solution.

Your most powerful tool is your brain, and your hands, and setting them up for success will pay untold dividends. Training the mind and the hands how to perform a critical medical intervention begins way before, during and after a deadly force encounter.

Setting yourself up for success begins with a solid mindset. This mindset does not come by accident, it does not come from reading, surfing the web or purchasing medical equipment. Reading about swimming and then buying a swimsuit and goggles does not make you a swimmer nor can it prepare you for the first time you have to jump in the water, swim across the pool and rescue a friend, pulling them back to shore.  I saw it once on YouTube doesn’t really cut it!

Training is more important than equipment. 

The only way to know how you may react to a life threatening event is to receive contextual and experiential training.

Every situation is different but you can be prepared for those situations if you choose to be. Get some training; continue training, push yourself beyond your failure point every time you train, and you will know beyond a doubt that you can make a difference.

June 21, 2012
by Chris
0 comments

Canada Day’s Coming…

As Canada Day fast approaches, I am reminded of many things. Canada Day is one of my favorite holidays because I am continually overwhelmed by the sense of patriotism displayed all across this great country. No matter where you are, there are celebration events and an amazing party atmosphere.

I have had the opportunity to celebrate Canada Day in a number of different places from Shediac, New Brunswick to Ottawa, Ontario to Parksville, BC and one thing I have noticed is that no matter where you are, the celebrations are similar and they are all amazing to witness.

One other thing that comes to mind almost always around this time of year is our deployed troops. I have found myself on deployment more than once for Canada Day and, believe it or not, have some good memories of these times. Although I was away from my home and my family, the Forces did a good job of trying to make it a special occasion and for a few brief moments I got to celebrate the great nation that I and my fellow troops were representing.

On Canada Day this year I will take some time to reflect and my thoughts will no doubt turn to those who are away from home giving us the opportunity to celebrate our great nation in whatever manner we please. If you are home this year and find yourself with a few moments to reflect, thank those that have given us the opportunity to enjoy our great nation.

To those of you deployed this Canada Day thank you for your service and sacrifices.

June 18, 2012
by Chris
3 Comments

Black Latex Fetishes

I need to address black medical gloves. And I hate to say this at the risk of offending, but I equate seeing a medic with black gloves in their kit to seeing a figure eight device on a climber’s harness, i.e. “you must not have gotten the memo!”. It leaves me wanting to say “try keep up!”, but that sounds condescending and I’m too nice of a guy.

Now I can appreciate the need to look tacticool, especially when treating casualties. And blue and purple (gloves) just don’t go well with camouflage. But there is function in color when it comes to medical gloves, and regardless of how cool it might look, black puts the medic at a disadvantage. They say MultiCam and Coyote Brown are the new Black, and the great part is that Tan is now a medical glove color option. And why is that important?

Consider these factors as important when choosing medical gloves:

  • Durability – most gloves are thin and are recommended to be changed every 20 minutes. I’d be very surprised if a pair made it that long in a tactical environment. All too often they rip, hence why I recommend wear two pair.
  • Color – to contrast the color of blood against them to assess for bleeding.
  • Cuff length – to protect your watch and uniform from getting munged up.
  • Licensing – Not as big a deal in the US. In Canada gloves are considered a Class 2 Medical Device and require a Health Canada Device License.

Picture searching for bleeding, conducting a ‘wet check’ as some would say, especially in low light or through NOD’s. Then take a look at the picture below and tell me what color gloves you think is going to work best? On the left is a tan glove. On the right a black one.  Both have the same amount of moulage blood on them.  Which do you prefer?

Blood contrast daylight.

 

Blood contrast in low light.

CTOMS™ is switching to new thicker, longer tan colored gloves.  We recommended you consider the same.

 

June 4, 2012
by craig.keller
0 comments

Tactical Rescue

During World War I, a soldier discovered his friend, wounded, had fallen between the trenches out in “no man’s land.” Ignoring his officer’s orders, he dashed from the safety of the trench to try to rescue his friend. He returned mortally wounded with his friend on his shoulder, now dead.

The officer was angry. “I told you not to go. Now I have lost both of you. It wasn’t worth it!”

The dying soldier replied, “But it was Sir, because when I got to him, he said, ‘Jim, I knew you’d come!’

Out there is the devil’s no man’s land, our friends are harbouring a secret, often unrealized hope, that we will come with some rescue from an ever-increasing hopelessness.

There are no seasons to the search – it goes on around the clock throughout the calendar. No one is excused from the task. All are commanded to go. I don’t know what reasons you might conjure up for not going or for the possibility of failure. All I know is that your friends are “out there” wounded, dying, waiting. Will you hear them say, “I knew you’d come”?

Derived from a story by Douglas F. Parsons

 

One of the most problematic aspects of combat casualty care is moving the casualty, especially considering the larger tactical situation. While issues like hemorrhage control, which treats the leading cause of preventable combat death, are being addressed with new technologies and emphasis in tactical first aid training, casualty movement usually does not get nearly the attention or the innovation that it deserves considering its importance. Casualty’s injuries and the treatment provided will vary from casualty to casualty, but their requirement to be moved will always remain a constant. Not every casualty will require hemorrhage control but every casualty at some point will need to be moved.  If firepower is preventative medicine, then casualty movement is essentially definitive care. Every movement of the casualty, from point of injury (POI) should be made in an effort to get them one step closer to definitive care while not further endangering you, the casualty, team members or the mission in the process.

Not every casualty will require others to move them. Though, it should go without saying, casualties that can ambulate themselves should remain in the fight, provide self-rescue and self-aid.  Casualties that are deceased should be low priority for movement and no attempt to move them until absolutely safe to do so. Those that cannot move on their own will at some point require to be moved. Deciding when and how it is appropriate is the key decision.

It must be both a tactical and a medical decision on when it is appropriate to move a casualty. Tactical considerations must be made regarding balancing resource distribution to the appropriate task at that given time (e.g. casualty rescue vs. assault/security) and risk management (e.g. is it worth risking resources to rescue a casualty if the attempt may lead to further casualties). Medical considerations must be made regarding the urgency of rescue and/or evacuation (will the casualty die if we do not rescue them right away?). Both the tactical and the medical considerations then need to be balanced to decide the appropriate action for the greater good of the mission, the team and the casualty. These decisions will need to be made by commanders or leaders on the ground with input from any medical authorities available, which doesn’t necessarily have to be a medic, but the decision will need to be made quickly. The ability to determine injury severity from a distance is difficult and ‘medicine across a barrier’ is a unique skill set that should be practiced by the medic. Optics can aid in distant assessments to determine if the casualty is salvageable.

It makes sense that those whose job it is to treat casualties be the subject matter experts in casualty movement, however no medic will be able to perform this task on their own, and sometimes shouldn’t perform it at all. It is not an appropriate use of resources to utilize a medic in a dangerous rescue. This once again creates a tactical problem as well as a medical problem. Not only has the commander lost the casualty from the mission, but now resources other than the medic must be dedicated to managing this casualty. The medic will usually not be able to move a casualty by themselves. This means it is essential that all team members be proficient in casualty movement techniques and commanders must be cognizant of the realistic logistics and effort involved in this task.

From a resource management perspective, casualty movement is logistically intense. Practicing and streamlining casualty movement techniques is essential to maximize efficiency of resources and energy. It is important to be able to move a casualty as fast and as safe as possible, with the least amount of resources, in the shortest amount of time, to the most appropriate location.

There are three phases in which a casualty will require to be moved. Each is unique and generally correlates with its respective phase of Tactical Combat Casualty Care, though there are slight differences. The three phases of casualty movement are:

  1. Tactical Rescue Phase
  2. Tactical Casualty Movement Phase
  3. Tactical Evacuation Phase

Each phase presents its own unique problems that must be overcome for effective casualty movement.

Stay tuned to the continuation of Tactical Rescue…

 

ctoms.ca

May 16, 2012
by Chris
0 comments

Crye Precision and CTOMS™ Official Announcement

It is with great pleasure that I announce this news: Crye Precision has officially designated CTOMS™ as its official associate and distributor in Canada!

To view Crye’s associates’ page, please visit: http://www.cryeprecision.com/international.aspx

We’ve have had an overwhelming interest and demand for Crye Precision products over the last year and we expect that to continue. You can view a list of Crye products that we currently carry on our website here: Tactical Clothing & PPE

For a complete list of Crye products, please visit Crye Precision’s website: http://www.cryeprecision.com/

We appreciate your patience as we back fill orders that were placed a while ago. Crye has grown at a furious pace and is catching up by opening new production facilities at their current location. This will allow for faster turn around times on all orders and diminish the waiting times on back orders.

If you see a product on Crye’s website that we do not currently carry or for any questions with regards to Crye and/or CTOMS™ products, do not hesitate to call our sales team and we will assist you in getting the products that you require in order to complete and expand your current gear.

 

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May 4, 2012
by craig.keller
0 comments

XCollar Education

If you are looking for new technology, in my humble opinion, this is just that. You don’t have to take my word for it though; take a look through xcollar.com and see for yourself . You will increase your awareness and knowledge with links to articles, case studies and information that you can pass on to others.

You make a difference. Your voice counts. You are the evolution of tactical medicine.

ctoms.ca

 

 

April 30, 2012
by Chris
0 comments

Save Your SlimLine™!

We’ve had a couple of people call us regarding a problem with the beaded pull and the quick release buckle on their SlimLine™ breaking.

I want to take a moment to explain why this could be happening. First, the Gen. I buckles, like most equipment, can break when used incorrectly. A newer and more resilient buckle is going to be replacing the old buckle very soon. However, the product still needs to be used properly in order to benefit from it, added resilience or not. Improper use can cause buckles to break. CTOMS™ has developed a new hang tag with directions for proper use of the beaded pull tab and the buckle in an effort to prevent this from happening to your SlimLine™.

 

Pulling the beaded pull tab straight out (horizontally) will activate the buckle and ensure the pouch disengages from the mounting panel. Pulling the beaded handle straight up (vertically) will only engage the top of the buckle, jeopardizing the integrity of the buckle which, in turn, may cause it to break.

You gear is important. Take good care of it. Call us with any questions you may have.

 

April 17, 2012
by Chris
7 Comments

How It All Began

Not many people know the history of CTOMS and why we got started.  10 years ago today, very early in the Afghanistan campaign, I had the unfortunate experience of being 150m away from a 500lbs bomb that was accidentally dropped on my platoon.  It killed 4 of my friends and wounded 8 others.  The post blast situation left me feeling quite ill prepared even with formal EMT training, even let down by the Canadian Forces for not providing adequate and appropriate training and equipment to deal with those types of situations.  Upon return to Canada I took it upon myself, with the help of countless others, to ensure that no one was as unprepared as we were.  We initiated the TCCC program within the Canadian Forces, running a pilot course in summer of 2003.  That program still runs today and is an essential component of pre-deployment training, preparing soldiers for the realities of managing casualties in combat.

One of the critical developers of the original TCCC program was Craig, my business partner.  He had been working as a TEMS Paramedic with the City of Edmonton at the time and we had randomly ran into each other when I recruited his help in the course development.  We became good friends and incorporated CTOMS together with the intention of running training courses for law enforcement in TCCC.

I retired from the CF in Fall of 2006 and shortly after we were approached by the CF to run a pilot program for Medical Technicians in Tactical Medicine.  The idea was a more advanced level course than the current TCCC course.  That pilot was so successful it turned into mandatory pre-deployment training for all Med-Tech’s on their way to Afghanistan.  And the rest they say is history.

That is an over simplification of the history of why CTOMS came to be.  But the important message that I’d like to convey is that Rick, Nathan, Ainsworth and Mark didn’t die in vain, nor did the injured receive life changing injuries in vain.  There were so many lessons learned and new training and equipment implemented because of that first event, that there are countless people alive today because of their sacrifices.  It is a true shame that it had to take the deaths of soldiers and a ground up initiative in order to affect change in the system, but that is the reality of a politically driven, and budget restrained bureaucracy like the Canadian Forces.  In their defense, when the true requirement was revealed, the right people in power positions did step up and change the system.  The novel training that occurred has been validated countless times quantified in lives saved.

So today, on the 10th anniversary of the Tarnac Farm Friendly Fire Incident, I remember my friends that we lost that night, and I thank them for their sacrifice.  I don’t think there is a better way to put it than my old Pararescue motto – they gave all so “That Others May Live”.

April 16, 2012
by Chris
0 comments

The Importance of Knowledge

Knowledge: “Acts, information, and skills acquired through experience or education; the theoretical or practical understanding of a subject.” (Oxford Dictionary)

As I think about the Friendly Fire incident at Tarnak Farms in Afghanistan 10 years ago, the question that keeps coming back to me is the following: If I had more training and knowledge of treating combat injuries, would my reactions have been different?

During our pre-deployment training, we focused mainly on our fighting skills and very little on our medical skills. My goal was to be able to survive in an infantry platoon without endangering my fellow soldiers or myself. I was very fortunate to be with a group of guys who “showed me the ropes” and guided me through the tough learning curve. I was mentally ready to deploy as a medic with an infantry unit, but what would I do when faced with trauma? We were 3 medics in this company and we discussed all sorts of situations and how we would deal with them, but our knowledge was not sufficiently developed for the mission. We could have gained this knowledge through proper training, but it wasn’t available at that time. Our training was based on a civilian model of casualty treatment.

The Canadian Forces has since then applied the Tactical Combat Casualty Care principles based on the US model, and developed it into a Canadian model. This training is given to all members who are deploying into a combat environment. Medics receive an additional two-week intensive course that prepares them for the work that they will have to do during their mission. This course gives them the practical and theoretical knowledge to treat and to maintain life in an intense tactical environment.

When I think back on the Friendly Fire incident, I know that we did as well as we could have with the knowledge that we had at the time. However, medics these days are much better prepared as their knowledge base has increased and so has their training. Knowledge is power!

April 11, 2012
by craig.keller
0 comments

Knowledge is Power

Quote attributed to “Sir Francis Bacon”

Take a moment to empower yourself by looking at the following website that is committed to providing evidence-based research in the discipline of tactical medicine. Throughout its pages, you will increase your awareness and knowledge with links to articles, case studies and information that you can pass on to others.

You make a difference. Your voice counts. You are the evolution of tactical medicine.

www.valorproject.org