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I had the opportunity to go to a Medical class with TDI in West Union Ohio this weekend. It facilitated by Dr. Greg Kennebeck an Active Duty Air Force ER Physician At Wright Patterson AFB and Greg Cootee Orthopeadic PA also active dutry AF @ Wright Patterson. This was a two day general medical class. It was a good mix of lecture and hands on training on the techniques lectured on.

Day 1 Topics Covered

- Airway Management (nasal cath and ET Tube). We had a chance to practice on a mannequin placing an ET tube through intubation. It would click signifying breaking a tooth. This is definately a technigue for those with specific knowledge. Although they had a neat tool that had a fiber optic camera on the end attached to a little screen. It was much easiser to guide when you could see where it was going. The nasal trumpet is the way to go for a layman needing to get an airway inserted.

- Wound management. We learned technigues for managing wounds. From using Israeli or Ooales bandages and direct pressure to TQ application and finally hemostatics. Learned that the granulars are falling out of favor as some are migrating in the bloodstream and causing clots elsewhere. The sponges or rolls are preferable as the particles do not migrate. We got to practice packing a deep wound with the combat guaze on a vennison hindquarter that the DNR dropped off. You really have to feel with your fingers and find the bleeder and make sure you properly pack the wound. We also got some practice on suturing technique on some pigs feet. I had some suturing experience from my ER days years ago. Amazing how much dexterity you lose in 20 years......and pig skin is tough!!

- Splinting and Extrication. We learned various techniques for splinting fractures with SAM splints, magazines, carpet rolls, ladder splints, and paracord. We also learned how to make an improvised C-Collar out of a SAM Splint and stabilize a c-spine injury. We also learned how to use a Sked litter and make improvised litters out of limbs and a wool army blanket, clothing, and a poncho. Amazing that these hold. We also learned single man carry and rwo man carry techniques.

- Travel medicine and threats. A great lecture on things to consider when traveling in remote areas and 3rd world countries and what to look out for. Also learned about meds to take with you and methods of water filtration.

- Final Exercise: We had a final exercise on Day 2. We had a 150lb dummy that had fallen out of the tree stand. we had to assess and adress the injuries to the patient. We had to stop an immediate blled form a compound fracture to the L humerous. We applied doirect pressure, then a CAT followed up by an israeli bandage. We then cut the clothing off and noticed a sucking chest wound. We had to apply and Asherman Chest Seal. He also had a simple L Femur Fracture. We reduced and rotated until we could feel pedal pulses. We sthn utilized out ladder splints and wrapped the legs together. We then healized he was having a temnsion pneumo we had to vent on the L. We applied our fabricated SAM C-Collar. We rolled the patient and slid him onto the Sked. We wrapped him in a couple of blankets to help ward off shock. We drug him approximately 50 yards out of the woods to the edge of the field and reasessed the patient. We awaited the air evac ambulance. Upon hearing the in bound chopper we set up a signal panel. After the chopper succesfully landed, the flight nurse came out and took report on our patient. They decided to start an IV and paralyze and intubate. We then loaded the patient on the Life Flight and they were on the way to the local trauma center.

Things I learned:

- Medical Traning is IMPORTANT.
- Medical Practice is even More so.
- RELAX - our scenario caused a large adrenaline dump
- Communicate Loudly so your team hears it
- Physical Fitness should be your number 1 priority. I've been working on it but running to a patient with all your gear, stabilizing and transporting him out of the woods is hard work. No wonder so many deer hunters die dragging them out of the woods. It's hard work.
- The instructors were tremendous and very approachable and knowledgable.
- This was more of a general class and did not have a firearms component. that is something they want to add in an advanced module in the future.

I thought it was a very well put together class and I learned some new things and refreshed some skills that I had let lapse. I woul like to see it expanded with a little more time spent on some areas and some extra field exercises as my only improvement suggestion.
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