Monday, April 27, 2015

Chest Decompression Needles; Vital Kit or Tactical Talisman? - By Jonathan Willis


            As will be the case in this often trend driven industry, yet another tactical talisman has entered the must have lists of many a preparedness minded individual. You’ve all seen them, or bought them, yet very few have any legitimate training or authority to even posses them. We are talking about the chest decompression needle. It must finally be said, please STOP; you know not what you do.

            I have been an instructor in most disciplines of Fire, EMS, and Technical Rescue operations for several years now, operating on the streets for 17 years. Like most in my service, I have responded to thousands of calls that include pretty much any insult to the human form an individual could imagine. But guess what, I’ve seen more double rainbows in my life than I’ve even heard of pre-hospital tension pneumothorax decompressions.

You might be interested to know that ER physicians have an approximately 68% success rate of successfully detecting tension pneumothorax within the controlled environment of an emergency room. Yet thousands of people believe they can pull it off with no training in the uncontrolled environment of a trauma scene. There are also a great number of false positives that end up “darted” that complicate patient condition greatly. This procedure is an extraordinarily rare need and NOT a “ground ball” to perform.

            I am very happy that there has been an increased focus on civilian trauma management education. Please stop calling it “tactical” or “extreme” to sound cool; it’s just trauma management. I instruct civilians. I instruct my family and friends. So I obviously believe it is vitally important that you are able to stop bleeding and live, whether it’s a gunshot wound or a workshop injury. I encourage everyone to attend a class and learn real world LSIs (Life Saving Interventions). Afterward, buy some appropriate kit and strategically locate it. You are good to go. A well intended tip; Like the shooting world, there are many instructors on this topic who’s credentials are suspect to say the least. Vet your instructors!

            Some folks have taken the next step and decided to attend an Emergency Medical Technician course. This is a great effort, easily completed in a few weeks, but be careful, far too often I see these folks carrying more advanced care crap in their kits than many of my physician friends. The quickest way to not be an EMT anymore is to carry advanced kit, made much worse if you dare attempt to use it. If you are an EMT, you are required to stay within your scope of practice BY LAW, and decompressing a pnuemo isn’t in your lane.

            Hypothermia management aside, there is no trauma intervention easier to master than modern bleeding control. This mastery however only comes from continual training, as these skills are perishable even for the professionals. The equipment used is top notch, represents a statistically relevant injury occurrence, and are actually LEGAL for civilians to obtain and posses without a prescription.

            I understand people’s attraction to do-dads, especially items of a tactical nature. I understand that there is a certain implied CDI factor to visually conveying an “I got this” attitude by wearing a full blow out kit on your belt. But when you take up a 3 ¼ inch, 10 or 14 gauge needle and attempt to place it perfectly within the plural space without any confirmation methods or true understanding of the indications or contra-indications, you have ventured out of your league. The patient outcome implications can be severe, and you will be challenged. Your good intentions, and one-day class on the matter cannot help you.

            Now I understand this will have the potential to offend a great many well-intended people, but know your efforts to learn are a tremendous positive step. Some of my most enjoyable teaching experiences come from working with civilians that truly wish to expand their skillset in appropriate trauma management techniques. I’m just sharing that there are FAR more important techniques and concepts upon which you should be focusing your time, effort, and money.

            I discussed this matter recently with a physician friend of mine. Not some technically a doctor type, but a down and dirty, aggressive young doc that is a driving force in trauma management and EMS operations in a significant metropolitan. For the ninjas among us, also a Brazilian jujitsu loving SWAT team member, with extensive military deployment experience in our recent conflicts. He echoed my sentiment saying frankly, “Too many folks just want to do the sexy advanced stuff. They need to be concentrating on BLEEDING CONTROL, AIRWAY MANAGEMENT, HYPOTHERMIA, and EXFIL.” Hypothermia and exfil are so ridiculously easy, but blankets and truck beds just aren’t that interesting. If I invented the Tacti-Quilt and patented Tac-Exfil Truckbeds I may be a millionaire sooner than I thought. But I digress. My friend added some other expressions against the absurd trend of civilians carrying pnuemo kits, but I’ll keep this family friendly. Sincere thanks for keeping it real Doc.
            In closing, there are many myths that have in recent years been debunked through real science and research. Back-boarding, Big bore IVs, TQ disasters, just to name a few. Add to that list, the misguided expectation that you aren’t on the cool kid list without a chest decompression needle. Stick to the list above from the good doc, with quality up to date training, and you are good to go!

Author: Jonathon Willis, Staff Member of Handgun Combatives
           
*For your questions on civilian trauma management, or to set up a real world trauma class visit: www.handguncombatives.com

           
           


Tuesday, April 21, 2015

Targets are Important! Combative pistolcraft requires specific bullet impact under stress




 

I have been carrying a handgun every day for 39 years, since I left the basic police academy and been a student of armed conflict, especially pistol fighting,  ever since. I have made it a point to talk with as many gunfight “prevailers” as possible along the way and I refuse to use the word “survive” as this is not what is required during a fight. Survive means “to remain in existence”… it is what one does if they have no say in what is occurring, much like the passengers on the Titanic. When engaged in armed conflict, the goal is to win… to be victorious…nothing else is acceptable. To survive means you are hoping luck is on your side and while I have heard it said it is better to be lucky than good, I prefer to make my own luck by being as skilled as possible. You see, the harder I’ve worked, the luckier I’ve become…at least as combative skills are concerned.

Training is just a step in the process of skill. First, one must understand they are at risk and decide on a course of action to thwart danger. In the case of criminal attack, this course of action will involve training in combative skills (“verbal judo”, open hand, impact weapons, chemical sprays, firearms etc.) as just buying a gun is not enough, though many believe it is. I continually hear from people who own and like guns but doubt the need for training. Some refer to The American Rifleman column The Armed Citizen that highlights average citizens repelling criminal attack across the U.S. Seldom are these citizens’ trained combative shooters, leading many to believe training is not necessary. Please understand this column highlights successes, not failures which there are many! Do you really think a column entitled “Folks who got lucky with their gun” would be a better banner for the magazine?!  Yes, the first rule of gunfighting is to have a gun, but the person skilled with the gun is MUCH more likely to prevail. We have known since the days of the Spartans that the single biggest factor in overcoming fear in conflict is confidence in personal skill(s)!

While the handgun is not the best weapon for personal security, it is the one you will likely have on/with you when you need a gun! Thus, the focus of my training company is “the combative application of the pistol” meaning I want to make students ready and willing to fight with the handgun. I really don’t care if I help them with their next match, what I want is prepare them for the most serious few seconds of their life. The person who says the stress of competition is the same as combat has never been shot at. I have competed and I have had someone try to take my life, trust me the two are nothing alike. Competition is fine and should be pursued, but there is no expectation of injury or death…no one is shooting back at you.

The primary goal of training is to hit your opponent well enough to stop their immediate action…death is irrelevant! If you hit them in the head and knock them out, great!! The problem with handguns, of any caliber, is they are underpowered weapons and require hits to vital areas of the body to get true incapacitation. You have to hit an important part of the body…period! While any hit on the body might convince your attacker to stop, you can’t count on this…as noted trainer John Farnam has said, “Whatever your opponent was doing before you shot them is probably the same thing they will be doing after you shoot them.”  I have seen many different caliber bullets removed from bodies at autopsy and I no longer concern myself with the 9mm vs. .45 arguments. I have seen with my own eyes that current generation hollow point ammo works well and bridges the gap between calibers. While I favor the all-copper Corbon DPX, you can also pick an HST, SXT, Ranger-T or Gold Dot and use the caliber you can control well in rapid fire and hit what you are shooting at multiple times while moving! That is where stopping power comes from in a fight…

Targets are important in this training process though many do not understand this. Some instructors are more concerned with using a target they designed than having one that trains their students to hit vital areas. It is well recognized through the research of SLA Marshal and Lt. Col. Dave Grossman that a combative target must look like a human being. People must look across their sights and see a person if you want them to shoot humans. Bulls-eye targets are fine for marksmanship, but if you want to prepare students to take a life they must train on “people”. A combination of paper, 3D, steel and covered targets works best. It’s certainly acceptable to shoot shapes (circles, triangles, dots, etc.) and objects while working essential shooting skills, but to prepare for conflict the student must shoot human-like targets to be truly prepared.

 I have designed a number of targets that emphasize shot placement to vital areas and they have been successful, based on the reports I have received from my students who have prevailed in gunfights. Keep in mind that I trained cops for thirty years and have had many, many involved in gunfights. I have never lost one and all stopped their assailants with accurate outbound fire. I combine these paper targets with steel plates to stop the student from trying to “score” their targets between shots, an act that takes their eyes off the sights, moves their head and shifts the eyes to the target. While I understand shooters will want to focus on what is attacking them, especially at close range, I know sighted fire is the best way to stop a threat quickly and if I can keep the shooter on the sights until the target falls in front of them then I have given them a precious skill. Falling 3D targets and knock over steel plates are invaluable for this.

The final target in the process is interaction with moving humans that show impact via Simunitions, paintball or Airsoft and people who are struck do react somewhat even if it is not the same way as they would if incapacitated. It is important to be a good training partner in this type of training. Pretending you are bot hit due to embarrassment does not accomplish this! When training to save your own life, choose your targets wisely…they may mean the difference between success and failure…and in combat failure is not an option as death is the result…

Monday, April 6, 2015

Stupid Controversies: Idiots at their best


Preparation is an important part of being ready to fight, and training is part and parcel of preparation. Information is critical for preparation, and arguing over stupid stuff doesn’t help! What stuff, you ask? Those subjects that pop up every so often that serve no purpose other than to confuse people and the internet only magnifies this problem. Most are silly, but “experts” argue them continually, even if they inhibit individual preparation and training. For many, the need to be right overrides everything, and these people will argue forever, regardless of whether anything is being accomplished.
What I’m going to do here is take a look at several of these controversies in hopes that we can begin to understand that such bickering solves nothing and often times results in nothing more than a Schwantz measuring contest. In doing so, those who are looking for help and a true path to preparation can move forward. Critical thought (mostly missing in such arguments!) will get most people past these silly debates, but some will still want to argue in an effort to raise their profile and “be THE MAN! “

Handgun Stopping Power
 I
 wrote my master’s thesis on the topic of handgun stopping power, and it proved to be a mistake. I thought I could collect shooting data from across the country and then come to a definitive conclusion. After all, part of a thesis is to defend a research conclusion. But how do you do that when nothing seems to come together? The agencies I contacted were good at supplying data, and I continued to collect shooting data until I retired and my contacts retired. I still get an occasional shooting report, but I never really learn anything new these days. 

There are two types of incapacitation: physical and psychological. Psychological incapacitation is impossible to measure, as some people will stop with a round through the finger. Others will fight through multiple 5.56 rounds to the chest. Physical incapacitation is usually explained as violating vital organs, which can certainly kill, but they don’t necessarily stop instantly. So where does this leave us? In the laboratory we look at wound patterns in ballistic gelatin—an apples to apples comparison of potential wounding effectiveness. But gelatin isn't human tissue. Humans aren't a consistent, homogeneous substance. Let’s disregard this and look at wound volume for each caliber. You’ll see that wound volume of the best .45 is 15–20% larger than the best 9 mm. Thus, it’s safe to say that a bigger bullet is a better bullet.

for the bad news…there is always bad news… that 15–20% is not enough to make up for poor shot placement, so we still have to hit something important for our handgun round to be effective. We must also take into account the probability of a missed shot. The best hollow point round available will be useless if it impacts the wall next to our attacker. Hits are critical. If a miss happens, we must be able to get back on target quickly for a fast follow-up shot.

The truth: We should select the largest caliber handgun that we can control under-rapid fire, given the level of training and practice time we have available under the weather conditions and environment we’re likely to face. Once you’ve determined this, practice until you’re confident in your skill as this is the single most important factor in overcoming fear in conflict.

Isosceles vs. Weaver

What we are arguing here? The Weaver stance, as currently taught by the folks at Gunsite where it was founded, is squarer to the target than before. Most realize that, in a fight, you’ll face your attacker, so the strongly bladed position is gone. Because we all know recoil is best controlled by leaning the upper body into the gun, all that’s being argued is whether the support arm should be bent. Doing so pulls the shooting arm back into the body like a rifle stock while applying leverage to the front strap of the pistol, thus camming the muzzle down. The Isosceles, on the other hand, pushes the gun forward with both arms somewhat straight like stabbing with a spear pushing the shooting hand into the support hand and…yes... applying pressure to the front strap of the pistol and camming the muzzle down.  Both control the recoil and are good enough for fighting distances, so who cares? Many people, actually, but is it important? Some argue that, in actual combat, shooters will naturally straighten their arms, but I’ve seen plenty of dash-cam gunfights in which officers have a bent support arm. So what’s the big deal? 

The truth: You’ll do in a fight what you've trained yourself to do, provided you've had more than just minimal training. Past studies have shown that minimally trained police officers (40 hours in the basic academy and one to three qualifications a year with no practice in between) will square to the target, thrust their pistol forward and smash the trigger with their index finger. What about practiced shooters? I’ve trained thousands of basic police recruits and some shoot better with the Weaver, others the Isosceles. I let them discover what works best for them. The only thing I insist is that they lock their shooting arm. Why? It’s consistent with what they’ll do when shooting with one hand, which happens more often than many realize and certainly lets the air out of the argument regarding the support arm. We must prepare officers to fight, not just shoot, because they probably won’t have the optimal shooting platform. Isosceles vs. Weaver? They are closer than you think…

Digital Dexterity and loss there of …

 It’s a proven fact that the fingers don’t possess the same level of dexterity in combat as they do when not stressed, but how “dumb” do they become? This seems to depend on what a given instructor wants his doctrine to include. I attended a school where the instructor told us we needed to grasp the slide on our pistols and manually cycle it to reload, as we wouldn’t have the digital dexterity to use the slide stop lever in a fight. I can understand the argument. However, during a carbine course I attended, this same instructor told the class to reload their AR-15 by inserting the magazine, rolling the thumb up and hitting the bolt-release lever. I saw this as a discrepancy and, when I asked, I was told that, “The size of the slide release on a pistol varies, but the bolt release on an AR will always be the same.”

I then inquired about the dexterity needed to press a trigger, hit the magazine release button and insert a magazine into a pistol. I was told, “Proper training will prepare you to accomplish these tasks without conscious thought.” Does this make sense to you? You can hit a magazine release button without conscious thought, but not a slide release lever?  I showed the instructor the slide release on my pistol was substantial. (The size of the lever is certainly a factor. For example, the stock slide lock lever on a Glock would be hard to manipulate.) He responded, “You can’t be assured that you will be using your gun. You might have to pick up a gun in the middle of a fight.” But isn’t it far more likely that I’ll start and finish my fight with the gun I have on me or in my hand? “You never know,” he said, which is true, but is it likely? Should we spend our valuable training time on possible or likely?  I have been studying armed conflict, primarily pistol fights, for over three decades and I can count on one hand the times a combatant in a domestic gunfight performed a “battlefield pick-up” and all involved the person starting the fight with a five shot snubby and no reload.  Thus, I believe it is FAR MORE likely you will start and finish your fight with the gun you “brought to the party”. Train accordingly…

Loss of Digital Dexterity does not mean the fingers do no work, it merely means they are less skilled if they attempt to perform a skill that is not anchored in one’s skill sets. If the task can be performed without conscious thought…what is known as “unconscious competence”… then the fingers will do what is asked of them.

Efficiency Defined

During a recent conversation with a well-known instructor, I was told “Just because something is faster doesn’t mean it’s more efficient.”  Huh? Efficiency seems to be one of the new buzzwords in firearms training, but the meaning seems to change from school to school and instructor to instructor. The Dictionary defines efficiency as “the least amount of time, effort and energy expended to accomplish the desired goal”. To me, this means if something is faster and still accomplishes the task, then it’s more efficient. 

On this occasion, I was taking a pistol class and was clearing malfunctions by turning the pistol sideways into my left hand (inverting the ejection port down so gravity would help clear the chamber). This allows me to grasp the slide with the heel of my hand, thumb, index , middle and ring fingers, which I believe are stronger than the middle, ring and pinky fingers used when grasping the slide over hand. The instructor stopped me, told me I was doing it wrong and that I should reach up and over the slide and “power stroke” it to the rear, hitting myself in the chest to ensure complete slide motion. Think about that…do you really need to separate your hands so far to move the slide less than one half inch?  The time needed to reacquire the two hand shooting grip when doing this is a lot. How about just pulling back on the slide until it stops…wouldn't that constitute full slide retraction?  I have no heartburn with this technique, if you like it. But I don’t find it to be efficient, I find it to be slow and overly complicated…though it might look cool to the uninformed.  

I believe my method is stronger, and it works with pistols of any size. When using small guns, if you work the slide in the hand-over method, your hand covers the ejection port, creating a stoppage or you’ll have a minimal ring/pinky finger grip on the slide. Thus, turning the gun inboard works with guns of all sizes, making it more consistent and efficient…certainly faster!

In Sum

There are but a few of the many controversies debated in the gun forums, there are many, many more...most just as dumb. 


Remember: It’s more important for a shooter to complete a given task with ease than it is for them to get all wrapped up in how it’s accomplished. Not all shooters have the same level of strength and skill, and we need to take that into account. Doctrine, not dogma, should be the rule of thumb in the combative application of firearms. Train someone to prevail by giving them multiple technique options and finding what works best for their physiology instead of trying to prove who can make the best argument in the internet.