When survival is measured in seconds, will you know what to do? Just as we train for worst-case scenarios in shooting, we must also have the medical training for worst-case medical emergencies, as well. Emergency medical training should be a part of the basic skill set of every firearms owner. Quite frankly, it should be part of the basic skill set of everyone. The time to learn to use a trauma kit isn’t when someone is bleeding out.
I had the opportunity to attend the Dark Angel Medical Direct Action Response Training (D.A.R.T.), hosted by Scottsdale Gun Club in Scottsdale, Arizona. Geared towards those with little to no medical training or background, the two-day course is offered at locations around the country.
D.A.R.T. is designed to fill the niche between military self-aid/buddy care training and civilian EMS training. The course provides the student with critical, need-to-know information that can be utilized in a great number of situations. All participants receive BCON (Bleeding Control) certification from the American College of Surgeons. It also provides 16 hours of CEU’s, per CECBEMS, to NREMT EMT-Basics/Advanced and Paramedics.
The course consists of a total of 16 hours of classroom work that includes discussion, slide presentations, videos, question and answer sessions, and hands-on practical skills application. A training manual and all necessary training materials for the course are provided. An optional D.A.R.K. (Direct Action Response Kit) may also be provided to each student at a discount as part of the tuition. The D.A.R.K. is one of the most well thought out individual med kits available. It’s in keeping with the Dark Angel Medical philosophy of “Simplicity Under Stress.“
The course I attended was taught by Kerry “Pocket Doc” Davis, founder of Dark Angel Medical, and Ross Francis, his chief instructor. Both are outstanding instructors that brought with them a wealth of practical, real-world experience and passion for the material being presented.
Kerry Davis joined the US Air Force in 1991 and served until 2007 with jobs consisting of ER Medic, Flight Medic and Officer Training School Instructor. He attended US Army Airborne School at Ft. Benning, Georgia while stationed as a flight medic at Pope Field in Ft. Bragg, North Carolina. He subsequently worked as a civilian paramedic and completed his RN. He has worked as a critical care and emergency room RN since 2003. Kerry is an avid shooter, He has instructed with Magpul® Dynamics and is currently a part-time instructor with SIG SAUER® Academy, where he also teaches firearms classes.
Ross Francis is a US Navy combat veteran with had multiple deployments to both Iraq and Afghanistan as a Navy Corpsman and later as a contractor. He is a Nationally Registered EMT. Ross has flown with the Air Force Pararescue Jumpers (PJ) and was attached to Marine Force Recon Scout Sniper units as a Corpsman. He currently works in San Bernardino, California as a Paramedic.
The D.A.R.T. Course
The D.A.R.T course is quite intensive and covers the following:
- Need for training
- History of Emergency Care
- Ethics and Legality
- Physiological and Psychological reactions to environmental stress
- The importance of having the proper Combat Mindset
- Basic Anatomy and Physiology of life-sustaining system
- H,A,B,C,D,E’s — Hemorrhage, Airway, Breathing, Circulation, “Da Brain” (Neuro), Expose and Environment
- 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, EMS and other First Responders)
Although that’s a lot to cover in a two-day course, the material was presented with professionalism and enthusiasm, in an efficient, thorough manner conducive to learning. The instructors clearly not only know their stuff but how to present it in an engaging way that keeps the students focused.
The training was conducted much as one would build a building. The instructors first laid down the foundation then built the structure on top of the foundation. The slide presentations and videos, many of them quite graphic, and instructor demonstrations reinforced the instruction and drilled the points in, as did the intensive hands-on training which gave the students the opportunity to practice the skills they were taught. The students were free to ask any questions throughout the course.
We began our first day covering the need for training, history of emergency care, ethics and legality, and warrior mindset. The right mindset will get you through the toughest situations We covered combat psychology and the effects of stress and the body alarm response. We learned that the key to success is long term potentiation (“train how you bleed”) and the need to stay focused.
We next moved on to scene safety, situational awareness and the Cooper Color Code System. The common factors at can impact good situational awareness, such as protective gear, low light conditions and environmental factors were also discussed, as well as the importance of personal protective equipment (PPE). Personal safety trumps everything else. Options to preserve our safety while still providing patient care were discussed. It does no one any good for use to become another patient. Sometimes hard decisions have to be made.
We then moved on to basic anatomy and physiology. The H, A, B, C, D, E’s [Hemorrhage, Airway, Breathing, Circulation, “Da Brain” (Neuro), and Expose and Environment] were the areas of focus. We learned how to assess a patient and identify and treat the most life threatening injuries.
Early on in the course, the instructors began to explain the importance of tourniquets and the various types. Roughly 80% of combat deaths and 50% of civilian trauma deaths are attributable to hemorrhage. It’s the most preventable cause of death in compressible injuries. The proper use of tourniquets saves lives. We also learned wound packing, and the types and the use of hemostatic agents and pressure dressings.
Every student was provided with a Combat Application Tourniquet® (C-A-T®) at the beginning of the class. At random intervals throughout the course the instructors would call out “tourniquet” and a specific limb for us to apply it. It became a race to who of us could be the first to properly apply the tourniquet to our limb. We also took the tourniquet home with us overnight to practice further with it. Needless to say, all of us became quite proficient.
Airway & Breathing
After we dealt with treating massive blood loss, we moved onto the respiratory system. We learned to identify whether or not our patient had patent (an open and maintainable airway) We studied the anatomy of the respiratory system and common airway and breathing injuries that could arise as a result of trauma and how to treat them. As the brain has a constant need for oxygen, it’s vital that we get the patient breath and oxygenated blood circulating as quickly as possible.
The types and use of artificial airways, artificial respiration, barrier devices and occlusive dressings (and field expedients) were covered. C-spine precautions and c-spine control, the recovery position, and special considerations were also covered.
After any massive bleeding has been stopped and our patient’s breathing has been assessed, we need to make certain the blood is circulating throughout the body. We studied the anatomy of the circulatory system and learned how to the assess and interpret pulses from various points on the body, skin temperature, color and capillary refill. The importance of thoroughly reassessing the patient periodically or if the condition deteriorates was also stressed, including but not limited.
The body is a hydraulic machine. The blood is the body’s hydraulic fluid. As emergency caregivers, we must keep as much of the patient’s blood inside the body as possible and to ensure that it’s circulating properly.
“Da Brain,” Expose & Environment
We then covered anatomy and physiology of the neurological system. We learned how to assess the Level of Consciousness (LOC). The importance of constantly reassessing metal status was stressed. An altered level of consciousness can be an early indicator of “things going bad. Any deficit in blood, sugar and oxygen will present in the form of an altered LOC.
After that we covered the last step in the assessment process , which is to expose the patient to assess for any further injuries. You don’t want your patient to die due to a lack of attention to detail. After exposure and assessment it is important to think of environment. Cover the patient up and keep them warm.
Individual Medical Kit
The instructors then went over the Individual Medical Kit (IMK). Many of the students had purchased the Direct Action Response Kit (D.A.R.K.) from Dark Angel Medical and the instructors went over each of the components in the kit and why they were included. For example, you should always use nitrile since many people have a latex allergy and can go into anaphylactic shock as a result of contact with latex. Many of the components have “other capabilities” than their primary purpose. We were given gave examples of how they may be used. For those that didn’t purchase the kit, some time was also spent on putting together one’s own kit.
We then moved on to specific injuries and how to diagnose and treat them. There is no hard and fast rule in trauma. The situation and injury will dictate the treatment. Injuries were broken down into three minor injuries, emergent injuries, and environmental injuries.
Minor injuries covered included:
Emergent injuries are severe, sudden traumatic injuries. They can be immediately life threatening. They may combination injuries. Emergent injuries covered included:
- Gunshot Wounds
- Stabbing/Impaled Objects
- Blast Injuries
- Chest Trauma, including Flail Chest, Sucking Chest Wound & Tension Pneumothorax
- Facial Injuries Compromising Airway
- Hypovolemic Shock
- Anaphylactic Shock
The second day of the course started with a discussion of environmental injuries. Environmental injuries are often overlooked. They are easy to prevent, but can have serious, immediately life threatening consequences. They include toxins, heat and cold injuries. Environmental Injuries that were covered included:
- Poisonous Plants
- Carbon Monoxide
- Thermal Injuries, including Heat Exhaustion, Heat Stroke, Burns, Frostnip, Frostbite, Hypothermia.
The amount of detail and time spent in on type of injury each varied, with the greatest emphasis on traumatic injuries and those injuries that could be immediately life threatening. Pediatric and K9 injuries were also discussed. Rather than memorizing one action for each injury as taught in many first aid courses, we learned that common treatment modalities can address multiple injuries, a trauma treatment force multiplier, if you will. A few different techniques can be utilized in multiple combinations. Once again, this is where our understanding of anatomy and physiology came into play.
With specific injuries out of the way, the next thing we covered was victim movement, victim positioning, cover vs. concealment and additional considerations such as low light environments and NBC/HAZMAT Operations were covered, as well as guidelines triage. Incidents may have more than one victim.
Triage is based on a color code system: Green – Minimal (walking wounded); Red — Immediate; Yellow — Delayed; and Black or Blue — Expectant (nothing can be done to save). Triage prioritizes treatment. In a tactical, environment. Colored Chemlights are often used to tag victims. The most important thing to remember is “do the most good for those you can help“
Hands-on skill stations were then set up in the classroom. We practiced inserting the Nasopharyngeal Airway (NPA) after measuring its correct length (on an airway management trainer and not students) We practiced applying different types of tourniquets, packing wounds (on wound packing trainers), applying direct pressure and pressure bandages. We also practiced splinting and tying a sling and swathe. The instructors were always around to guide us and answer any question. After we had rotated through all the hands-on skill stations, we all felt quite confident in our abilities.
Finally, each of us was paired up with another student, where we practiced our assessment and treatment skills on each other. We each had the opportunity to play both emergency caregiver and victim. The victim or an instructor chose the injury. The instructors evaluated and critiqued our performance. It was an excellent learning process.
At the end of the course, each student who successfully completed the training was awarded a Dark Angel Medical Direct Action Response Training Certificate of Completion and a Dark Angel Medical challenge coin.
I have only praise for Dark Angel Medical Direct Action Response Training. It’s outstanding course. I highly recommend it. The training you will receive is invaluable.
The course is hosted at various locations around the country throughout the year. Cost is $420.00 and worth every single penny. You can add a D.A.R.K. Trauma Kit for only $150.00 additional. The kit is $204.99 if purchased separately. To register for a course or for information on hosting a course, contact Dark Angel Medical www.darkangelmedical.com.
I received this product as a courtesy from the manufacturer so I could test it and give my honest feedback. I am not bound by any written, verbal or implied contract to give this product a good review. All opinions are my own and are based off my personal experience with the product.
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