Emergency Medical Planning

[Sam]

Darn.......I'm pretty handy with a GPS, but a compete and total screw-up when it comes to programming my cell phone....

I sure hope the Fire Chief has 9-1-1 on his speed dial.

[kimel]

Some of the ranges I shoot at do not have cell coverage so 911 requires someone jumping in a car and driving a bit to get into coverage. This is getting better as they build out in the area.

I would want a legal opinion before I signed up to a match to provide EMS coverage. If you receive anything for the service (match entry, free lunch, whatever) then a whole other set of rules come into play because you might be considered to be "in service" and the good sam laws stop working in your favor (in some states). I would also want the okay from my EMS chief first. Ligitation being what it is these days... :(

That being said; I doubt I could stand by and watch someone suffer when I had the training and skills to help. I guess at that point one just has to pray that the good sam laws hold and the ambulance chasers get lost.

I have often wondered what would happen if a shooter showed up at an ER with a shrapnel wound. My guess is that it would get written up as "gun shot" with the ensuing manditory paperwork and legal notification.

[kevin c]

I have often wondered what would happen if a shooter showed up at an ER with a shrapnel wound. My guess is that it would get written up as "gun shot" with the ensuing mandatory paperwork and legal notification.

That's what happened with that riccochet I described. A report was taken by the local PD, but they were quite reasonable and nothing came of it of the whole affair but a voluntary review by the club BOD to understand how it happened and what to do to prevent such a freak occurence from happening again.

[Sharyn]

Seeing as I do this stuff as a profession my plan is to simply point and laugh since it will definitely happen on my day off

Ha! I was thinking the same thing...

I have often wondered what would happen if a shooter showed up at an ER with a shrapnel wound. My guess is that it would get written up as "gun shot" with the ensuing mandatory paperwork and legal notification.

Here's my story. Yes, I was diagnosed with a GSW, but no law enforcement involvement or paperwork ensued.

Anyone with good ol' military training knows you can treat just about anything with the supplies provided by the patients themselves.

[XRe]

SteveJ and bigbrowndog can tell you a little story about the time that Steve caught big frag from a ricochet resulting from a shoot through onto the base of a popper - Trapr calls it in to 911 as a GSW, and then his cell phone connection drops before he can tell them it was an accident, etc...

Once the excitement died down, the authorities apparently determined that they thought it would have been appropriate to report it as something other than a GSW (due to the "special" treatment a GSW call gets) - the guys might could fill us in on the particulars that went down at the hospital, etc...

Steve still has the shrapnel with him....

[AlamoShooter]

SteveJ and bigbrowndog can tell you a little story about the time that Steve caught big frag from a ricochet resulting from a shoot through onto the base of a popper - Trapr calls it in to 911 as a GSW, and then his cell phone connection drops before he can tell them it was an accident, etc...

Once the excitement died down, the authorities apparently determined that they thought it would have been appropriate to report it as something other than a GSW (due to the "special" treatment a GSW call gets) - the guys might could fill us in on the particulars that went down at the hospital, etc...

Steve still has the shrapnel with him....

Humm old thread, I was with him drove him to the EMS pick up. 'My statement was that "He was cut by a piece of metal". When the guys write-ting the reports herd it stated that way, the paper work seamed to end for them.

@ the Hospital= Several xrays long wait, the guys don't want to cut the piece out. long wait, long wait finaly,= he drives home with a bandaid.

Its like this, if something cuts you when your playing the game. Thats all it is "A Cut" could be a piece of stone or a piece of wood or something off a passing car tire. The good thing is that if its a piece of jacket = it most likely sterile

[SLM]

I just shoot with a doctor. No worries!

[AlamoShooter]

I just shoot with a doctor. No worries!

so do I ...He 's the one that needs the most care.

[Michael Carlin]

Having a First Aid kit....good.

Having 911 on speed dial...good.

Much more than that is a waste. The Army had a requirement when I was in that all live fire ranges be supported by a medic. I can't tell you the number of wasted hours spent sitting in a cracker box waiting for someone to get shot...

I having been serving in the Army for about 25 years on active duty, in the last several years at the installation I am stationed at we had at least three gun shot wounds. One was fatal.

I was named to the investigating team for one of these. I can tell you that the Sergeant First Class Medic that treated the Airman who was shot in the lower abdomen/pelvis with an M16A2 at near contact range SAVED his life with an Israeli bandage. The air ambulance had him on the operating table in the hospital in just about an hour. He had many units of blood in flight. Had she failed to slow the bleed out down he would have died.

He was lucky.

There are several steps to risk assessment, we identify them, determine their frequency, and their consequence. Though a shooting on a live fire range is rare it has occurred at least a dozen times that I can recall offhand in my 25 years. Shootings can be fatal, that is a "catastrophic loss".

While I think that a medic can certainly engage in training on the range, the role they play in mitigating the risk of fatality is undeniable and justifies the Army policy. But as a Sergeant Major I suppose I am predisposed to believe in the programs we have in place.

I can tell you that prior to the publication of FM 100-14 I saw some real bonehead risk decisions made in a training environment.

Thanks for your service.

[John Dunn]

the role they play in mitigating the risk of fatality is undeniable and justifies the Army policy.

If you have an epidemiological study that shows this is true, I'd like to see it.

[Rob Boudrie]

I am aware of a couple of cases where there were deaths at a shooting range - in both cases, it was a heart attack, not a ballistically induced subcutaneous aperture, that caused the demise.

Although it makes sense to prepare for every emergency, the unique issues specific to firing ranges should not blind organizers to the other sorts of medical emergencies that present an unavoidable risk. If you're into covering the contingencies with every imaginable tool, an AED would be useful.

I don't have double blind peer reviewed statistical studies to prove it, however, my guess is that you are more likely to have a life threating medical incident at a USPSA match due to non-firearms related causes that from shootings.

[smokshwn]

I don't have double blind peer reviewed statistical studies to prove it, however, my guess is that you are more likely to have a life threating medical incident at a USPSA match due to non-firearms related causes that from shootings.

Rob,

You hit it on the head.

[Michael Carlin]

the role they play in mitigating the risk of fatality is undeniable and justifies the Army policy.

If you have an epidemiological study that shows this is true, I'd like to see it.

No, John I do not have an epidemiological study, there may be one. And, by the way, most Soldiers could learn a great deal about safe weapons handling on a move and shoot range.

An torso hit in one case was fatal, in another that I am with which I am pretty familiar (as a voting member of the CRC investigating team) the consensus was that the Medic's actions immediately following the gunshot were critical to the Airman's survival. (A member of the REDHORSE shot as I described above.)

That is one case I KNOW about, so in my opinion the policy is about right.

[John Dunn]

So you have one instance in a 25 year career where a life was saved by a SFC.

In my 6 years in the ARNG, our medical platoon responded to zero GSWs on a live fire range. I can't remember, but figure 15 medics in our HHQ company. Thats 90 man years of nothing happening.

If you figure out how many GSWs there are Army wide on live fire ranges, then subtract the quickly fatal head/torso shots where no treatment can help, subtract the extremity shots where basic first aid (pressure, tourniquet, etc.) would suffice, you'll have a number of GSW where immediate medical care might make a difference.

Now look at the opportunity cost of having medics on the range. While those medics are covering the range, typically solo, they can read FMs and do other hip pocket training, but nothing useful. Let me repeat that...nothing useful. For our section, the 91B skills started deteriorating as soon as you graduated AIT.

When looking at relatively rare events, you can't just say, "One life was saved, so it justifies the whole program." If so we could argue that if a medic is good, having a doctor stand by would be better. A helicopter on site is going to evac soldiers way quicker than an ambulance, so lets have a crapload of pilots and helicopters covering ranges. It might save a life...so its worth it, right? Wrong. It would be a waste of resources to have docs and Blackhawks on every livefire range.

So where do you draw the line? Maybe in the regular Army the medics have enough time to train and stay at the top of their game, so why not have them cover ranges. In the National Guard, when you have limited training time, requiring a medic at every range and PT test ensures the medics will be marginally more skilled than private snuffy. I'd rather have the 91B practicing IV starts, airway management, etc.

When it comes to USPSA matches, I think a bunch of hand wringing about medical emergencies is even less justified.

[uscbigdawg]

As an active duty Army Flight Medic, I'll tell you that the most wasted time for a medic is working ranges. Thank goodness for MP3 players and portable DVD players and caffeine pills.

Rich

[smokshwn]

When it comes to USPSA matches, I think a bunch of hand wringing about medical emergencies is even less justified.

With all due respect I don't think I have ever heard a more inane statement. We are not discussing asset allocation based on number the of occurences in a large military organization. We are discussing managing the risk to an organization sponsoring recreational activities of civilian members in a public setting.

As an organization USPSA would be very smart to develop a comprehensive medical plan and guideline for its members/clubs to follow. Ignoring the potential for medical emergencies (illness, environmental, or trauma) at a large gathering of people could potentially be very costly from a liability standpoint.

The solution is as simple as guidelines being developed for Match/Club directors to follow which could be be graduated according to attendance #'s for example. That is not to say we need a Flight Team standing by at every local match, however having a response plan in place should an adverse event takes place, shows a good faith effort on the organizations part to mitigate the obvious potential risks.

[uscbigdawg]

As I recall there was an ambulance on the range during the first SV Open. Probably not overall a bad idea for MD's to have a plan in place.

Rich

[John Dunn]

What happens if snuffy RO/RM deviates from the approved plan? Does the organization then assume extra liability because they didn't do things by the book? Say the plan calls for a cell phone to be kept handy, but the battery dies, so a GSW victim dies because of delayed evac. Who is responsible now? USPSA?

Say the guidelines call for an ambulance to be standing by, but none is available due to other events/emergencies. Do you cancel the match?

Say a competitor catches a ricochet off some steel and sustains a laceration, he wants to bandage it and continue but your plan calls for eval at an ER. Is he DQ'ed until he gets a doctor's note?

You may think it is inane, but devoting time and resources to fix something that isn't broken is stupid, in this case it may well increase liability exposure. If you can show me how a plan is going to make any difference to what a squad of high speed IPSC types would do naturally in an emergency, I'll reconsider. It seems like every squad I've ever shot with contained doctors, nurses, EMTs, paramedics, firemen, police, search and rescue gurus, current and former military, etc.

If one is so scared of liability, I'd suggest not running around with loaded guns, or having competitors and spectators sign a waiver.

[kimel]

Regrettably, in these times when litigation is taking the place of common sense there are times when NOT having a codified plan is actually organizationally more sane than having a plan.

It sucks, but it is true.

Have a good first aid kit and someone that knows how to use it along with multiple cell phones (which is going to happen anyway) and a set of good directions to the range that are written down and you are good to go. A lot of our ranges are in places not exactly well known by ambulance services. Wouldn't hurt to stop by and make sure they know how to find you.

[smokshwn]

John,

It is infinitely better as an organization to say "Snuffy screwed up" than it is to simply shrug your shoulders and say "we ignored the possibility". If the cell phone is there and service/battery/incorrect usage it is again much better to show that efforts were in place to assist during a forseeable adverse event.

Many municipalities/counties/ etc. already require medical coverage for mass gatherings of a certain size. It would be a simple matter of graduating the needs within the guidelines to conincide with those numbers. For instance in my locale you must have 2 responders for the first 300-2000 people expected at an event. It continues to add resources as attendance grows. If the match were smaller than that then there would be no call for it in the guideline.

As to a competitor being forced into treatment, it just can't happen. In order to perform medical care a practitioner must have informed consent to provide treatment. So the plan could not dictate treatment.

My argument is that as an organization a guideline for Match Directors/Clubs/RO's etc could be developed with very little effort and show that the organization is not deliberately indifferent to risks that are obvious given the activity we are engaged in.

Edited October 22, 2007 by smokshwn

[John Dunn]

So, the emergency medical plan could be a waiver to cover our butts, and a statement that matches should comply with local laws, first aid kit, and a cell phone. I feel safer already.

No one said a competitor should or could be forced into treatment, I proposed a hypothetical where the medical plan might call on officials to decide who can continue with the match without further evaluation. They might say that bleeding on the props presents a biohazard, so go to the ER or take a hike. Nothing in that situation forces treatment, it presents the shooter with a choice. Also, you don't always need informed consent to provide medical care, else I'd be in trouble for nailing that femur on Friday under implied consent.

You think a policy might make us safer, groovy, your heart is in the right place, can't really argue with that. Just don't make it onerous and we'll all be happy, remember unintended consequences and common sense.

[Ron Ankeny]

What happens if snuffy RO/RM deviates from the approved plan? Does the organization then assume extra liability because they didn't do things by the book?

Yup. But you already knew the answer.

Regrettably, in these times when litigation is taking the place of common sense there are times when NOT having a codified plan is actually organizationally more sane than having a plan.

Yeppers, if we place emphasis on "there are times"...

The best plan is probably a butt load of liability insurance.

[Bret Heidkamp]

As an organization USPSA would be very smart to develop a comprehensive medical plan and guideline for its members/clubs to follow. Ignoring the potential for medical emergencies (illness, environmental, or trauma) at a large gathering of people could potentially be very costly from a liability standpoint.

The solution is as simple as guidelines being developed for Match/Club directors to follow which could be be graduated according to attendance #'s for example. That is not to say we need a Flight Team standing by at every local match, however having a response plan in place should an adverse event takes place, shows a good faith effort on the organizations part to mitigate the obvious potential risks.

Necessitating a plan be in place, with review, and specifying qualifications or numbers for attending personnel is a great way to get our matches closed. How would you like to go to a club match and find out there wasn't an EMT, Delta Medic, ER Doc, or such at the match so it was canceled for the day? What about an area match that can't start on time because the EMT isn't there yet? That's what I see with this thinking.

That being said, I do believe an emergency kit is an good idea, that can be as simple as some cravats, gauze rolls, and a CPR mask (pretty much what I have in my vehicles) - or a full-on Delta loadout. I don't see requiring another piece of paper to be a good idea; it is a knee-jerk feel-good reaction just like reactionary gun control laws. Demanding a plan be in place leads to: Who writes this plan? Uncle Frank, the insurance carrier, or some new Nationally recognized body? Who reviews and approves this plan? How much will they charge every range in America for it? What is their political orientation? Anti-gun? Pro-gun? For how long? When will that political wind change? You can easily imagine the slippery slope this represents. What would the plan look like in New York or California? I can tell you: it will look like a box of ammo for anti-gun zealots to use on us.

With all due respect, the "comprehensive medical plan" is a very bad idea for these reasons.

I am not advocating the stick the head in the sand approach, either. We already have a "good Samaritan" law which prevents suits against people attempting to render assistance to others that are hurt. That, along with a basic med kit is all we should be talking about, in my opinion. Remember, many med kits come with the idiot's guide to bandaging and a CPR flip chart for those not in the know. Please keep in mind the whole concept of emergency aid is to stabilize (ABC's, splints, etc.) and get them shipped off to be someone else's problem (meaning an ER doc at the local hospital).

This may sound short, but ranges absolutely are not field hospitals. My background: several seasons as a ski patroller with our team treating on average 20 people / day for everything from head vs. tree, skier vs. skier, falls out of chairlifts, to simple torn ACLs or altitude sickness. I have treated plenty of injuries, including puncture wounds (no GSW's). I have decent training in outdoor emergency care, and practical field experience, lots of it. Perfect for what we're discussing here. My opinion is stabilize as best you can and make them someone else's problem - a rifle range is not a trauma center. We are not equipped and we will never have the ability to treat a GSW to the point of sending someone home.

Lastly, I believe the track record for IPSC is much better than any other shooting sport. That likely has a lot to do with our "cold range" and muzzle direction rules which are strictly enforced. I've seen plenty of sweeping in trap, skeet, sporting clays, and that's with a shotgun that will permanently remove a body part! I can't count the number of times I've said "watch your muzzle" to others at non-IPSC events.

Please don't shoot me in the back for this the next time you see me, it's my opinion on the matter.

Edited October 25, 2007 by Bret Heidkamp

[Michael Carlin]

So you have one instance in a 25 year career where a life was saved by a SFC.

In my 6 years in the ARNG, our medical platoon responded to zero GSWs on a live fire range. I can't remember, but figure 15 medics in our HHQ company. Thats 90 man years of nothing happening.

If you figure out how many GSWs there are Army wide on live fire ranges, then subtract the quickly fatal head/torso shots where no treatment can help, subtract the extremity shots where basic first aid (pressure, tourniquet, etc.) would suffice, you'll have a number of GSW where immediate medical care might make a difference.

Now look at the opportunity cost of having medics on the range. While those medics are covering the range, typically solo, they can read FMs and do other hip pocket training, but nothing useful. Let me repeat that...nothing useful. For our section, the 91B skills started deteriorating as soon as you graduated AIT.

When looking at relatively rare events, you can't just say, "One life was saved, so it justifies the whole program." If so we could argue that if a medic is good, having a doctor stand by would be better. A helicopter on site is going to evac soldiers way quicker than an ambulance, so lets have a crapload of pilots and helicopters covering ranges. It might save a life...so its worth it, right? Wrong. It would be a waste of resources to have docs and Blackhawks on every livefire range.

So where do you draw the line? Maybe in the regular Army the medics have enough time to train and stay at the top of their game, so why not have them cover ranges. In the National Guard, when you have limited training time, requiring a medic at every range and PT test ensures the medics will be marginally more skilled than private snuffy. I'd rather have the 91B practicing IV starts, airway management, etc.

When it comes to USPSA matches, I think a bunch of hand wringing about medical emergencies is even less justified.

John,

Clearly I am not going to convince you of anything. Were you the one with the transected femoral artery what would your call be then?

Michael Carlin

[John Dunn]

Michael,

Show me some evidence it might do some good other than one anecdotal experience. If I told you to wrap your children in bubble wrap before sending them to school, and then cited one case of a bubble wrapped child being saved from a pit bull attack when the dog's teeth couldn't penetrate the wrap, would that sound like a good idea? Even if it only saved one child wouldn't it be worth it? According to your logic it is...we should take extraordinary measures to guard against real but rare events. Let me know when you start bubble wrapping your kids.

I'll gladly run the risk of shooting on any live fire range without immediate medical back up.

Edited October 26, 2007 by John Dunn