MOTW #13:TACMED talk
Hey amigos. Welcome back to mind, the warrior dock with you here as always after a couple of weeks on the road just got back from Charlotte North Carolina last week was that the special operations medicine scientific assembly. So for those that, you don't know the special operations medical association been around for quite some time. We used to just call it the Soma conference. Now, they wanted to be a little bit fancier. I guess so it's called a scientific assembly. What it is big medical expo all kinds of people in the tactical medical community are there. Everybody from representatives of all the special operations forces, both US and international law enforcement fire EMS first responders high goal rescue multiple vendors, some old some new we're gonna talk a little bit about that. It's something that's. Been going on for a while. Now, something that I actually as eighteen delta avoided for a lot of years because it got to be a little bit crazy then at one point started going back again because what what a lot of people don't know. There's actually two conferences going on at the same time. There's the the one that you see, and then there's kind of a behind closed doors one that goes on as well. And that's where a lot of the big decisions get made, it's worthwhile. If you haven't gone in the past suggest it the big, Mike. My big thing about Soma. And now Somalia has always been is it's gotten so big that Khanna the bar the the bar you have to get over to get into get up the stage. Get on stage at one point had been significantly lowered yet a lot of speakers getting up and this. I'm gonna say between two thousand nine timeframe and two thousand twelve kind of in there. I saw a lot of speakers no special operations time. Really, no operational time getting up there being passed off as as such it matter experts. I didn't see that this year. I think things have gotten a lot better. They're still at the still what I call some tactical tourists in the crowd. And if you're in the community, you'll recognize him, but I think for the most part the people that so Somare doing an excellent job of of trying to keep the organization on course. And Paul Allen is good friend of mine. Physician assistant emergency medicine physician trained, physician assistant who was going through his fellowship when I was going through residency. And and also we're in Jason together. Great guy. He's a civilian vice president now, and he and I had a long talk about the direction of where the organization's going. There is a lot of great, man. Medical innovation coming out of it. Cut a cut in through the background noise. Getting right to the heart of what people need on the ground, which I think is really important at the end of the day. That's what's important that getting really important continuing medical education down to the medic level and strides are being made in that as well. 'cause it's it's really gotten to the point that it's almost cost prohibitive for medics to go at this point on top of the fact, thirty busy. They already have a ton of other requirements. They already have to be as proficient in everything as as all the other operators. Are you know, now add this this requirement, plus the monetary apartment going TDY everything else. So but things are being done for that. The good news is from what I understand going forward. It's going to be more expensive for guys like me to go to the conference and less expensive for eighteen Delta's and for ranger medics. And I think that's the way it totally should be. I think those of us at the top of the the medical food chain, and I use that term very loosely. Because we're at the top probably financially, not necessarily knowledge wise. I think we should be subsidizing subsidizing the the people that really need to go. But it was a great week. Really busy long days is always whenever I'm on the road. I'm just exhausted all the time. And how do I take care of that you guys who you've been podcast fans for awhile? You know, the way that I dress that fatigue is with strikeforce energy products. So always got him with me when I'm on the go for my Senator and afternoon coffee. I'll do an afternoon strikeforce energy pack it in my bottle of water, and it really keeps me going. And obviously I was to get up and speak gave a lecture that I'm gonna talk about a little bit more in depth. I don't want to be up there jittery. I don't wanna be shaken stuttering. I don't wanna look like Joe Biden when I'm up there behind the microphone, I wanna look focused. I wanna look sharp. So I drink some strike strikeforce centers you products. How can you get these same products? You may ask where you're gonna go to strikeforce end. Edgy dot com. You're gonna shop through there find what you want, and it's all great stuff developed in conjunction with a former navy seal who wanted something that gave him the advantage of an energy drink without all the bad side effects. You're gonna fill up your shopping cart and at checkout because you're loyal mind. The warrior listener, you're gonna type the promo code M O T W, Mike Oscar Tango, whiskey, you're gonna let them know that you're a loyal mind of the warrior listener. And you're gonna get a little cheddar off on the side. You get a little discount as you check out. So make sure your veil yourself without. I know a lot of you have I get notifications roll up at the end of every month. And I appreciate you guys going on there and using your promo code so enough about strikeforce energy for now. We'll talk a little bit more about the the special operations medicine scientific assembly. So we started off for me with the council on tactical emergency combat Kansas tactical. Emergency Cassidy care run by Dr Reed Smith who does an amazing job. He's out on the east coast. He was instrumental in standing up really the the early prototypes. Of of what we know to now be the rescue task force. He's he's one of the forefathers of the rescue task force. Great meeting covered. A lot of a lot of really good ground. This is of course, have to meetings a year, and I was at the other one in DC six months ago for those of you that weren't able to attend. I hope you caught the livestream as much as possible mytalk was on the livestream. But I'm going to kind of recap it briefly today because you know, we we are all about talking about tactical medicine on this episode, but submit shake things that came out of that a lot of the old issues are still being dealt with. You know, I it's it's difficult to manage kind of a national director national policy. It's the the council on tactical. Combat Cassidy care, right? Part of DOD in my opinion than their job is a lot easier than T E C, C Jarvis. Because I if you're running stuff for DOD, you put it down and your word is law and everybody up laments at and that's that's pretty easy. Yeah. There's there's sub commands along the way, but for the most part that I'll get absorbed. And if you look at the way t- triple C is performed at the Fort Hood mystic site, where I used to be the medical director or the four brag mystic site or the version of the mystic site that they have at fort Sam, it's it's largely the same those slides of the same policy for T E C C is a little bit different. Because not only you talking about all the way down to every single municipality. I'm talking, you know, every individual chief of police are individuals sheriff every individual fire chief and EMS medical director and senior paramedic. So it's all manner. Differently. And for that reason, I think t see as a much more difficult job, which they managed very well. But it's hard because you wanna put out guidelines. You wanna put out best practice formats, but you have to be really careful about endorsing anything specific or saying, you know, hey, this is this is a hundred percent the way this goes and. The like t t triple see DOD can do that. Right because everybody who's teaching t triple C on down the line in DOD. They're all using the same slides. They're all answering back to AM tea and how they do that. Whether they're doing it in uniform or doing it on the civilian side. Like, I did with my courts for for sheepdog for a long time. But when it comes to e c determining best practices, but a lot of people have teach in different things. Lot of people out. There have different monetary steaks and things and you have to really careful when you're an organization like that if you endorse one thing one way of doing things, you might be endorsing one way of doing things at one one organization does things at another organization does not and that's a little bit a little bit trickier in that side of the house. I think a lot of people don't don't appreciate that that that it's a little more difficult that and I'm seeing more and more. That the lessons that don't necessarily transfer from military to civilian I think a lot of them do hundred percent. I think a lot of them do. But but not a hundred percent. You can't say that. It's not cookie cutter. You can't take teach t try c as is as it's using a military environment and translated directly for a number of reasons, and I'm gonna talk about those. So let's let's talk about the reasons. First of all, the operational varmint is different undeniable, the operational environment is different. We're not talking about overseas. Moross tier environments. We're talking about urban environments were talking about closer action with civilian bystanders because each and every time that you're gonna have to apply principles in the civilian environment for T E C C by definition, you're talking about a high number of friendly civilians being in proximity. To that event. Whatever it might be. That's not necessarily the case, you know, unless you're talking about an ID going off at the bog or market overseas. The that's not necessarily the case if it's an isolated hit whatever it is if it's an ambush convoy ambush, stat, certainly not the case. So that's the dynamic of that is different in the environment. The medevac environment is different. You know, we have all the interlocking rings of medevac that we have overseas when we're fighting a dynamic battlefield. Of course. That's different. If you're thinking about your traditional like if we were to go into North Korea as we may end up eventually doing, I don't know that's different in the United States. You know, you it's it's similar to the rings system. Right. When you talk about different different trauma centers, different EMS systems. But if the, but it's not a a hundred percent cookie cutter exactly the same. So it's different. When you're talking about the military. You're talking about organic assets. Right. You're talking about each. Usual soldier being trained in t try see you're talking about integrated platoon medics, that's not a format that translates directly into the civilian world. We're talking about different law enforcement organizations, different levels of training, different levels of sustainment. A paramedic. Also doesn't operate at the same level necessarily a sixty whiskey certainly not at the same level as an eighteen delta. So you have differences there wounding patterns are going to be different. We're talking overseas. We're talking a lot more blast injuries. Allot more. Burns were talking high-velocity the lion share of the injuries being high-velocity. We're talking about body armor, and there was a slight came up one of the one of the classes actually in a couple of the classes one of which being having to do with triage about the difference in wounding patterns, certainly in military talking about t try see where ninety percent of the time turn kits of the answer. Right. Because we're talking about extremity injuries. We're not talking about. Series in the box because of body armor. We're not talking about as many head injuries because of helmets. Not the case when we're talking about civilian MCI's mass casualty incidents, so there were seeing a lot more toast, torso. Lot more abdominal a lot more head, but they're lower velocity. Because typically in those via remote blog. No this. I gave a breakdown just recently of we're talking about shootings overall, and especially mass shootings. The number is are overwhelmingly handguns, you know, for as much as people want to ban scary, black assault rifles. They're actually not guilty know blacks rifles kinda like Agent Orange. They get blamed for a lot of shit that they didn't do and we certainly seen that. So the wounding patterns are different interagency interaction is just so much different. I talked about that a little bit already. But imagine if every operation in the military. Imagine. If the salt force was army, the Cavic and medivac flights were run specific specifically by the air force. And all the medical assets were navy imagine what a disaster that would be right. Imagine how difficult it would be to manage to love these civilian agencies are dealing with to some extent because they're talking about completely separate organizations when it comes to law enforcement fire EMS and lifelike, you know, at aero medivac assets. They're all different agencies, and a recurring theme that came up again. And again, and again, both in my lecture and in really kinda permeated. I think the whole T C session was it has to be all about inter agency cooperation, it has to be about interagency rehearsal planning in collaboration all of these things. It's just an absolute must in order to get the most bang for your buck and to really be affect. When the rubber meets the road had some interesting reviews of some some after action stuff from the mercy hospital shooting also from the Austin, bombings lessons learned from all those that were pretty interesting, and I I hope you guys get a chance to to livestream some of that stuff as it's on. If if you didn't I highly advise, you if you're on Facebook, go to the council on T E C C's page like the page and scroll down and all of those are still available my lectures on there as well. And you can you can watch all those great lessons learned from a real thought leaders in the field guys like read Smith guys like Josh Bob co guys like Jason picket who are out there. Putting in the work every day, and and really doing what's right to to save lives in really inspiring just to be in a room with all those thoughtless. Offers and can't say enough about it. No thing I wanna say about the conference while I'm thinking about it is huge shoutout to all you guys who took the time to come over to me either at t c or at the purses medical booth on the show floor there and drop in and tell me you were fans of the podcast. And of course, there were so many of you. That even if I could have all the names, and I'm sorry. I can't it. We could do a whole show just me run it down. But really appreciate you guys. You guys are the co creators of this podcast and a huge part of what I'm doing here in. I can't tell you how much it meant to me for you guys to come up and tell me about what you were doing about changes your implementing in your own life in your department, and you know, and sitting down one on one with medical directors and senior paramedics and talking to them about their planning their training plans about doing things like entering these tackle medic competitions and things like that just really met the world me really reminded me, why do this podcast, and and why it's just so rewarding for me. So I'm talk a little bit about mytalk. So this is I I gave a talk at the American college emergency physicians last year that was kind of an abbreviated version of the same talk. It was called a the myth of the warm zone. And you guys have heard me talk about the warm zone before kind of my. Opinions on it that I think the whole world is a hot zone everything outside of my front door is a hot zone people. Call me paranoid for that. But change the title for for this talk because I want to cut a set the proper tone, basically, the the this go around the title was how warm is your warm zone. So recognizing the fact that a lot of people out there using the RTF system, and they're using a system where they got a break things down into a hot zone warms owner cold zone. And I just want to remind everybody that, you know, the warm tone is still a dangerous place to be, and that's basically the whole theme of this talk. This isn't about there's there's two groups of people out there. I'm gonna say that, you know, there's there's people that are very much supportive of of the traditional rescue task force template and planning, and there are some people that are very anti rescue tests worsen. And I said this mytalk, and I'm gonna say it again, I think the institution of the rescue task force was a. Monumental step in the right direction, and in that it recognized a legitimate need. You know, I'm you guys know I've talked about this before when it comes to medical products comes to tackle products. What thing that drives me? Absolutely crazy is when people try to solve problems that don't exist to justify whatever it is trying to sell a device or product or trying to get their name on something whatever it might be an end hotter percent. The the RTF is not in that category. We're talking about the RTF. We're talking about a real legitimate need. That was out there vacuum that needed to be filled and people stepped up, and they came up with the concept of the rescue task force, and we can debate all day long. Whether or not, you you or I agree with everything as it's outlined in the way, the RT of works, and you know, what in the future. I think I'm actually gonna have a panel discussion where we do that. And I'll probably just going to sit back and moderate it. I have my own opinions on it. Sure. But it's it's not about attacking the forms that people are using to address this problem. It's about trying to improve what's out there. So and something I'm gonna talk about a little bit more. I'm gonna talk about turn kits and kind of the same philosophy comes up when we're talking about turn it gets. And and stay with me on this. You'll see exactly what I mean. Basically what I went through in the talk. And I hope you guys go and watch the video on their on their website is, and you know, I, of course, I had to give a disclosure statement. I'll give it to you guys for those that don't know 'cause it's your first time listening. I am the medical director for purses medical. I did have a size as I said that this is this is not about being anti risky task force. This is about coming up with ways whether using a rescue taskforce format or another format about recognizing the threat that's out there. And really the underlying theme of my entire lecture is asymmetrical threats in this environment. Because. The moment you start to think of me as being symmetrical threats. That's when you're in trouble. And what I mean by symmetrical threats is this isn't a bad guy behind a line of demarcation. You know boxed in with engineer Tate. This is bad. Guys are everywhere. This is bad guys could be working in cooperation bad guys could be leveraging technology, and you don't know there's been multiple paradigm shifts throughout history, and when it comes to regular warfare or whether we're talking about mass casualty incidents and response to same look at the French and Indian war how we fought before. And after Vietnam how we fought before. And after global war on terror, another great example, we basically came out of fighting a Cold War and that a lot of low intensity conflict stuff into global war on terror, which was totally different both tactically and medically. We've seen multiple paradigm shifts when it comes to these mass casualty and since when it comes to mass shooters, whether we're talking about the university, Texas tower shooter Columbine, huge sentinel event, really changed the way we do things shocking that some agencies as recently as a couple years ago still work caught up on those lessons. Learnt, and I'm talking specifically about Broward County, you know, that, you know, the after action review from that, you know, coming out that basically at least on the part of a few individuals, you know, the that first officer who could have gone in. And the dispatcher that Columbine lessons learned were completely ignored. And that shocked me, you know, Boston marathon, really big paradigm shift, and I think people don't look at that for the paradigm shift that are truly is. And let me explain that. This is a prime example of what a couple individuals can do self taught leveraging. Operations between the two of them only to right and leveraging some technology in the form of their ideas. That's a monumental step forward for the bad guys. And that's not the last organ see something like that. And so we need to keep in mind. One of the achilles heels of the way that we do business in the United States. It's it's a good thing. And it's also a bad thing because we live in a golden age of technology. Right. So somebody in San Diego, California working as a medical director for sure sponsor, whatever might be comes up with a great way to address a problem. And they wore game it they go into the evidence and past incidences, and they they they do some data mining see how look for some commonality look for what would work they come up with. They pressure test it in training, and they think it's gonna work. So they put it out. There we usually that that's in the form of a white paper or journal article might even be a mass, Email, whatever might be. But eventually this fines this way through gems through. Other publications is finds its way all of the country. And that's great. The reason being is the lessons that are played for in sweat and blood by one individual one organization don't have to be paid for again, and they can be shared a large scale. Right. The problem is is that everybody that we're up against has access to the same information. So what I'm telling you is. Whenever you're coming up with your tactics techniques and procedures, and you're reading them from some type of open source, and you're gonna take these back to your department and say, hey, we're going to implement these. I want you to think as you're reading that think of at as your war gaming that that the same day, you were reading that information online somebody in your district was reading that same information, but for a completely different purpose. Somebody in your district was reading that information online from the point of view of how am I gonna exploit that? How am I going to utilize that information to take advantages of weaknesses and they're doing that? We know that we we know that we there was of course, no debrief and no kind of a cold trail when it comes to Las Vegas. But there there's some indications there that that he knew at least a little bit about how people are gonna react to that. Same with Arna brothers. That tactic technique tactics. Techniques and procedures were highly manipulated by the DC sniper duel highly manipulated to the point that they were bathing police leaving notes form things of that nature. So this is something to think about this. The things the way your agency operates is not a secret and that Infos out there. So keep that in mind, you know, if you're utilizing warzone, if you're utilizing loiter loitering areas for ambulances, whatever, it might be people are going to know that people are gonna know what trauma center. Those patients are going to ultimately go to and if they're planning a secondary or tertiary attack. They're going to use that information. What are things I really caution people against when I gave my talk is regardless of how much work it. You know, if you're whether you're on a swat team, you know, a whatever you call it a swat team S RT a crisis reaction team. Rescue task force whatever it might be. It's incumbent upon you as the person making those plans that you don't let your superiors think of you think of your organization your team as some type of security blanket that you know, it's it's not some type of break in case of emergency. And it's just magically going to solve these problems. We've seen this time. And again in the early days, the global war on terror things that were thought of as a given things that were thought of as a security blanket failed the moment that they were pressure tested. Whether that was a meta VAT plan whether that was emergency resupply plan. Right. You think about the unit's going into Iraq that completely outpaced their supply chains because it was something that had been the term is the military's was finger drilled, right? It's just you'd always just kind of set it in training and rehearsals, you'd never really rehearsed it you hadn't rehearsed your backup plans you had. Your contingencies. And they were security blanket. They were just gonna be there when you need them, and those plans failed those plans did not make it past the first bullet fired in anger and can't let that happen on your level. You need to be pressure testing, everything you do pressure test your communication plan pressure tissue backup communication plan, your emergency response plan. We don't what if what if you have an active shooter incident in a hurricane. What if what if there are? No, aero medevac. What if you can't drive into the into the what literally you need to go Kobayashi Meru on everything? Pat practice for every single contingency. What if the medic is the only person that gets shot things of that nature only through this pressure? Chest only through this pressure testing. Are you really going to expose the weaknesses? You have to push your leadership. To give you the leeway to do that training. I know you already have a limited training budget. But it needs to be expanded to practice all of those things and you need to walk away from training. If you walk away for training and everything went great. You didn't train enough? You know, if I'm leaving jujitsu, and I walked out of there. And I choked everybody out I was practicing with the wrong crowd. You know, you need to walk home every night. I go home from jujitsu every night going, man. These are the ways I got my asses handed me my ass, plural. As if I had more than one. These are the ways that I got my ass handed to me, and these are the things I need to work on. And that's how you should be leaving your training events is wild. That did not go like I thought it was going to go. We've got some work to do, you know, and they say don't practice until you get something right practice until you can't get something wrong. And I really want you to take that to heart when you're doing and do full mission profile rehearsals, right with everything, you know. There is no nothing is notional. Nothing is engineer taped on the ground. You know, everything is real. And that's the way you gotta do it man every single time. And the reason you have to do that again is we're talking about multiple cases of domestic terrorism that involved at least two people, and some cases probably more and in this day and age, you don't even really need to people all you really need is one person with a little bit of time, ingenuity the motivation and cell phone. That's all you need. And then we're talking ID's were talking remote devices that can simulate gunfire give the impression of multiple shooters and multiple locations. You can manipulate the entire nine one one system from that phone as of insight unfold, give me making bogus calls to nine one one misdirecting first responders and other directions. We saw a lot of misdirection in Las Vegas, and it wasn't because of anything like that. It was because of well-meaning individuals not understanding what they were seeing. In real time and calling in and those calls still have to be run down. And somebody doing that on purpose is really has the capabilities of paralyzing an entire first response network. So that's something to think about I'm not gonna go into it in depth here. You wouldn't be able to appreciate it on the podcast because it requires some visuals, but I gave an entire scenario basically, kind of a doomsday scenario where one person could paralyse an entire grid with some misdirection with some Squibb's with some homemade explosive devices and with a cellphone one firearm, and it is possible, man. And I I'm not trying to scare you. But I am trying to scare you. So just something to think about that's why you have to think of threats being a symmetric you have to think of everyone is being threat. And you guys know what I preach is. I think everybody going forward needs to be armed because I think everybody's an operator. I. One of my biggest fears is medics get a scored it into an area. And then for whatever reason their security gets pulled because of a secondary threat because of tertiary threat, and that's and that ends up being a diversion, and I'm terrified of a scenario like that. And that's why I think everybody needs to be armed from the get-go. I also think the big thing that we need to be doing more than anything else is we need to be concentrating on getting more people out of that hot and warm zone as opposed to leveraging more and more more resources into that hot warm zone. You know, I think we've got a little bit backwards, and I reread it preparation for this talk. And during the week at SOPs again, I went back and reread the after action review in Las Vegas, and if you look at how long it took to state, we're talking about almost an hour from the time, it took to stage resources and to have control the scene to the point that the RTF, I think it was fifty seven minutes. It's could even move in. That's fifty seven minutes, you can be moving people out, you know, rather than winning to leverage resources in. And again, that's I don't say that to be anti-risk tests worse by any means. I think the RTF has a very important role. But I think we need to be really really really concentrating on pulling people out and getting people to the resources that's always gonna be easier. Man. It's always gonna be easier to get people to resources. You know, what's the reason? Doctors don't make house calls anymore. Right. It's just it's really complex to go around town and take the resources you're back in the day when Dr just carry a little black bag with some pills in it, not we live anymore. We're talking about a lottery sources, and I always see these plans for people to carry all of these resources. And I I really think we need to be bringing Cassidy's to resources, and I think there's a lot of ways to do that. I think we can improve our triage we can improve the interface that we're doing with the first people that are going to be on scene with guns. And we need to improve what we're telling civilians today. What we're telling bystanders to we need to take a page out of Israel's handbook when it comes to this in people not being afraid to to provide bystander care, teaching people not only stop the bleed, but teach people do proper casualty carries, and I've seen footage from a few of these MCI's over the past years where they're making things a lot harder on themselves simply because they don't know how to do a cast to carry. And I think that's something we need to be integrating into Trey no trained to do CPR. Hey, that's great stop the plead. Also, great bliss train them. How to do a chair carry let's train amounted to a drag Kerry, so they could get people rapidly off the x and to the proper care. Also, you see me post online about this before this another thing that I talked about not only is the everybody's a shooter mentality is a complete mindset. Right. If if you're a paramedic. You need to think of yourself, in my opinion, you need to think of yourself as shooter. I and as you're moving into that area, you need to think of everyone you encounter as a shooter. I until you they've proven otherwise. And if you were department that's putting a big red vest on you. They're putting a big target on you because that's that is a sniper's dream to have people come in with big red vest because he knows that's an unarmed person. Right. And this is something that I said, my talk if I see one guy come in red vest surrounded by what appears to be two or two to four other people providing security headshots for the security and the kneecap for the guy in the red vest, and the nice wait for more people to come in and get him avoid the red vest, folks. You know, we don't medics don't wear big red crosses on their helmets anymore for a reason. And this is a dynamic battlefield when we're talking about these MCI's. So we need to approach it in a true, tactical fashion. Red vest. Not the way to go. So some of the points, and I'm just gonna go through these really quickly time is going to be a factor for us. It always is going to be when we're talking about responding to these MCI's, especially the medical aspect of it people are dying until we can get their own say their life. So for that reason we have to change victim mentality with chain bystander mentality. We have to get people trained and stop the bleed get people trained basic first aid law enforcement officers need to be trained at any higher level than that. And we need to be getting people out of the area. Everybody's a shooter until proven otherwise. And if you're going into a warm zone, if you're going into a hops hot zone, man. I I hope you're armed, you know, that's that's my opinion on it is I think agencies are doing people a huge disservice. Putting him in body armor and not giving them away to defend themselves sending him sending him into a situation like this. Because I think what we're going to see in the future. Is the type of event where everything is just a fainting maneuver, and it's all about drawing first responders in for a secondary and tertiary tack. And I think we need to be thinking about that. Now before it happens the way to stop bad guy with a gun is a good guy with gun. You know, we know this time, and again, it's been proven you gotta worry about the secondary threats on target and the biggest way to eliminate that. That is to move people off of target. It's quickly as possible. Because then if there is somebody hunkered down if there is somebody like we saw in San Bernardino, right? They predicted an advance where where first responders we're going to be and and they had hasty ID's put out to address that. And. That that can be a huge issue. So always remember man the warm zone is it's a designation. It's either a designation on a map or it was the hot zone. And now we've kinda claimed it, but that doesn't necessarily mean that that they didn't let us claim it and one of the things I said, my talk I said, if if you're moving and you're getting no resistance. It's there's a really good chance you're moving into an ambush, right? Nobody ever had to move under fire into an ambush. So the sometimes the path least resistance is right where the bag I want you to go something to think about for that reason. Whether we're talking about your designated a warm zone, or whatever you're calling it. When you're on the X when you're where bad things happen. You need to be doing nothing more than treating immediate life threats keeping that personal life for the next five minutes to get them somewhere else. If you're opening up aid bag set up the entire gypsy camp. You know, if you pull out things like a stethoscope? Or blood pressure cuff? You're wrong. You are one hundred percent wrong. Okay. Things that should never be going on the extra things like oxygen tanks monitors defibrillators. None of that should be going forward. The X is for immediate life threats, and then moving people, so we're talking turn it gets attorney kit, Jesse Neal decompression go. I mean, literally, that's we're talking about. And we can we can break that down in depth. You know, when we're talking I think it is the the calendar fire phase and the tactical field care face. But, you know, win isn't area truly secure. And that's what you have to ask yourself final take point, man. Just remember that bad. Guys, watched the news too, bad guys can avail themselves of any of the open source that you have availed yourself of. So you need to keep that in mind because it's things are going to go bad, if they're using your own planning against you in that fashion. So. No thing that came out this week was the Sarmento get a lot of texts here. I'm trying to think came out this week is the council on tactical combat as care released. Their new lists of turn it get recommendations. T t try c does not approve turn. It gets making air quotes. Right. They they recommend. Just because something made the list doesn't mean it's the best thing since sliced bread. Although a lot of these obscene on your great turn. It gets just because something didn't make the list. Does it mean? It's absolute garbage. There's reasons things that don't make the list there was a little bit. I saw some really stupid winding online that somebody said owes it all third party verification, which is crap. No third party verification pretty much everything in medicine is done. So if it weren't for third party verification every doctor would have had to have seen polio in order to to to not give the polio vaccine every doctor would have to have seen literally everything out there in order for us to establish medical protocols, and that's not the way things work. So I'm just going to go through this list or talk about what's on it. And that I'm a little bit about what's not just very briefly. All right. So going down the list here. So the cat the gen seven cats you remember they hadn't approved anything since gen four or five. On the cat. Both gen seven, Jen. Six cap made the cut that's not surprising. That was that was expected. The so those are considered to be recommended under a t try c the RMT. So the ratcheting medical turn kit was approved. Again, not not surprising. A lot of people were already using it the Sam XT. So that's the the Turkey made by Sam medical that. You guys are probably seen demonstrated. A number of my courses, I've worked in the past before person I had a relationship with the with the folks over at Sam that's a good turn. It get. I think it could be set to where you had to get a little bit tighter before the promise came out. But you know, I I liked the way work says a little bit easiest people like it. It's got a nice beefy. Buckle to would seem people seem to really like. So sam. Is a great tournament. The softy wide made the cut not surprising, of course, the tactical mechanical current turn get the TM TNT. I've never used that not familiar with it. I'm gonna a planet on looking at tickets at it this week some of these turn it gets that I've never had my hands on. I'm actually gonna order this week. So I can play with because they kind of think that's something I should be doing working in this in this arena. The t x to get which I was not even familiar with also made the cut says, it's a ratcheting one hand turning it and the T X three turn it, which is also a likewise a ratcheting turning it. So I'm gonna check that out soon. Pneumatic turn it gets that made it. The EMT which is the emergency military turn kit. It's as pneumatic single-handed application fix up. Lord, Chevy's not recommended for J fat, but considered for medics of accusation platforms role one two and three teams primarily fraternity replacement conversion or prolonged application, so the caveat to that basically means they don't recommend this as an as an every soldier or every operator carry turning it when it comes to the EMT, and I'm gonna get familiar with that I have a pretty good idea. I think of why because a little bit of complication especially in something that if you if if it's damaged in any way, is is not gonna be up to snuff is a reason not to push it down to receiver the tactical dramatic turn it a same deal not recommended for J fach recommended a revision turn kit or two next role use target. So both of those were approved in like. I'll check in both of those out. What else do I got here that looks like that looks like everything so couple of Turner kits that are cut a widely in use that were not on this list. And so we're gonna have to talk about that. Right. So one is the swat tea, which a lot of you have asked me about I gotta get approached about the swab t a lot when I teach courses, and I'm not a swat t fan. I think the advantage of the swat t lies in the fact that it can be kinda easily rolled up and put an purser pocket. What I don't like about. It is. I think when you throw it all the way out, and then kind of wrap it I think it's kind of everywhere reminded me doing my hand wraps before. I do am going to kick boxing. So it's kind of everywhere. I don't like that. I think it's difficult to get tight my -pinion now granted because of its with you don't have to get it as tight. So I think that's certainly an advantage. I disagree with the people that say can also be used. His pressure bandage because no really can't. Because it it. A it doesn't have anything cut absorbent to go over the wound. So really, you're just kinda pressuring over the wound. So I, you know, I I don't really agree with that. You know, maybe if he had a maxi pad or a handful GAAS maybe in that case. But also because you have to throw it out like that it makes applying it in that fashion a little bit harder again full disclosure because I always give guys full disclosure on the medical director for purchase medical. We make these Rayleigh bandage. These Rayleigh bandage is also approved to and I don't remember by whom. So I I know on on our instructions for use it's approved, but it can also be used as Ternate bright. And it's not it's a bandage. It's not a turning it. But it can be used as attorney kit. If you use the closure bar, basically as a winless. So that can be used in the same way that a swat is used basically both. Quays? And if it were up to me, I would carry something that's better bandage, and as good attorney kit, in my opinion, especially since you can use the closure bar and use it as a winless, and you may not necessarily even need it. If you Rach that thing down if you pull that thing tied enough through the tension bar a lot of times, you can get just as tight with without needing do that. So that's my opinion. But again full disclosure I worked for that company. And I'm not gonna not gonna be dishonest about that. Another Turner get the did not make the cut and law to talk about this online. Man. I it's something that people pretty emotional about is the rats Turner, get and the rats target. I've seen over the last couple years. Things got crazy online about the rats Chernick it. I mean, I'm talking this is probably more divisive than president. Donald Trump is just been amazing. And I was actually off social media for a good portion of it. So I'm thankfully history on a lot of it. But if you guys look at the active shooter video that I did was sheepdog you see that I demonstrate their ass turning it in that. And and let's talk about why. So I was a person that when I was first introduced the rats. I was not a not a fan at all of the rats and after sitting down and talking to some people that were carrying it asking them why they were carrying it have them demonstrate it for me talk to me about their reasoning. I understood cut where they were coming from. I still prefer a winless turn kit. I still preferred my cat to the rats. But I understood that and I knew that a lot of people were carrying it. And I saw in the sheepdog courses a lot of people were showing up carrying it. So recognizing that I recognize that I have a responsibility that if people are carrying something that I have a responsibility to make sure that they're using it properly. You know, I really I'm not always going to be able to change everybody's mind. And and get everybody to carry exactly the equipment that I want them to carry. So, you know, a good second to that is is making sure that they're going to use it properly. Let's talk about some let's talk about the rats a little bit. So it's is at the. Is it the Jesus Christ attorney kits? No. Is it the Satan of kits? No. So it's it's not the best thing since lice. Brad. It's not the reinvention of the wheel. But it also isn't just completely useless. I mean, it's not it's not without merit. But it has a very steep learning curve. So the rats is difficult to use properly. And it's really the a pit ame- of everything that I kinda talked about before leading up to this in the podcast talking about you have to practice and you have to pressure test. So for the people that are carrying were carrying the rats practices, even more important and being for millions it, and you know, practically again, and again and again and again because there's not as much Morgan for air there. When rats is applied and pride properly in someone that practice, it's gonna be a functional turn kit. And there was a time when everybody thought. It was just it was new hotness. And they're really excited about it. And then this big again this big schism happened in and now. Wow, just the anger that I see people getting ramped up over the rats is just amazing. And it's. I don't know what to say about it. I really don't think an inanimate object. She get that much of an emotional response out of people unless we're talking about putting tampons and bullet holes that that should get an emotional response because it's the stupidest fucking idea ever. But you know, people are very emotional over this. And they're they're very split on the issue. But it it did not get CO t try c recommendation, and I think a lot of people I don't know of anybody that really expected that it was going to cause the again the learning curve that's required to apply. A prior properly is pretty high. So, you know, expecting the average soldier to be able to do that under duress. I think might be a little bit outta bounce in its, and I know I've spoken to the to the guy that invented the rats, and he's again a lot of people are personally attacking online. And I don't think there's there's. Any need for that? It's the whole thing is just I'm not even gonna get into the weeds of of a fairly. This would completely off the track at one point of of the medical aspect of it. And I'm not even gonna get down the rabbit hole that and you guys know, of course, that I'm also also friends with with Andy Fisher, and I've worked with them. And Andy his is basically come out in with his position on the rats, which is very similar to what I just described. Right. It's not it can be an effective turning it. It's not God's gift attorney kits. And certainly Andy is is a thought leader in the industry, and he somebody that I looked to for his opinion being very valued on things like this. And like, I say his opinion, in my opinion, very very similar. You know, it's I think if somebody has a rat's in their kit right now, they don't have to they don't have to burn it. But they better be practicing with it. And you know, if you you set a rats on the table, and you said, a gen seven cat on the table ought to pick up, the gen seven cat, and that's, you know, that's that's my personal opinion. But a again, I'm not by any means saying that if if you have rats in your kit, you need, you need to burn them, and I don't have an emotional attachment to it like some people apparently do, but so the rats in the swat tea, of course, you say to turn it gets that the didn't make the cut for t- Tricy. I don't know when they're going to do this again. So them a long time to come around and do t- try see approval again, I can tell you that the let me look this up with this acronym stands for because I always get it wrong. Look this up. STMS? So the American society for testing and materials, I believe is what it's called the American study for testing materials. Basically think of is kind of a department of weights and measures they're kind of gold standard. If you have a climbing rope. They are probably the people that determined. You know, what how much weight can fall on that rope without the ropes snapping. If you have a a tire on tires on your car, probably had something to do with them ratchet straps, certainly things like seatbelts are all reviewed by TM AS TM is in the process of developing their their standards for fraternity. It's as as we speak. You know, they they have a certain set of standards and those are being improved. I shouldn't say they're developing new answer they're improving him as they go, which I think is a great thing because you're working in the working as a practitioner and working in the industry. You know, I'm always surprised about the answers that we have to. Two why things work and how much of X something should have. And the answers that we don't have. And I think we need to be improving that all the time and ESPN is working towards doing that. And one of the interesting things that came out of this week. Also for those of you that are using the the hat med trainer. Be advised that the hat. Mid trainer is not a calibrate. Oh bull device. Okay. It's not. It's it's fine. If you're just practicing repetition on it do not take it to the Bank. If you know in using scenario, number four, whatever it is you can't achieve he mistakes each and every time that doesn't necessarily mean you're applying that turn it getting correctly. It's a good device for training, repetition and training. How to do a task properly under stress it's not a it's not a calibrated device for evaluation of devices. So if you're doing something like taking turn it on that. And that was another Turner get didn't make the cut. I'm sorry. Forgot the. The big zip ties. And you guys are listening to this in. You're saying it out loud that doesn't help me. I can't hear you. So I got a Google it. The zip tie Turney kit. Is called the. Stat tournament is static. It was another turning get the denomination cut. And again, not surprising. I think it's a little on the thin side. I think it's problematic because it's difficult to get off a lot of people have. Ideally, the stature gets one of those kits that on the surface looked great because it looks like something variously going like a stop the bleed kit. I think they all have the little clock on him and stuff like that. Which is a great feature. Not surprised that it didn't get approval by t try see though, I don't think anybody expected to. It's basically a big zip ties when is gets too narrow. I think it's really difficult for somebody without the hand strength to apply it to the proper tightness. So I'm not surprised that didn't get approved. So where was I before I got a little bit sidetracked here. So so again, don't use the hat mid trainer as a gauge, you know, if you're if you're lining up a bunch of turn it gets and decided what turn it works. And what it does not work. Don't use that mid trainer to do it. Yeah. That's basically what they said and anybody's ever used one. We'll know exactly why. So the should be some products coming out at some point that will help you. If you're in a position that you're you want to do head to head of valuations truly of charter get affected nece, not you know, how how how fast they go on obviously determine on each other automatic Langer. Whatever it is. But as far as really determining what's going to work what's going to work the best. There are going to be devices coming out in the future that do that. And they're not out there now, but but they will be. What else from Samsa this week? Oh, talked about triage. And I'm gonna do an entire episode probably on triage coming up in the future. Got some of my own ideas on it. But I do agree that it's a little bit broken. So ramp triage was the big thing that came up this week, and I'm gonna tell you flat out. I gotta say my own opinion on it is I'm not a fan of ramp triage. And the reason I'm not a fan of ramp triage is if you look at the algorithm, and if you Google rap triage, you can look at the within that I'm talking about. But according to that algorithm. If I have a person who has to gunshot wounds in the chest as long as they're talking to me and have a radio pulse. They're lower trash category. And I disagree with that. Because I've seen those exact cases I've had guys run off target shot in the chest telling me there shot in the chest, bilateral intact radio pulses, one of which was dead. If you hours later one of. Which had his chest cracked open a few hours later and ultimately survived after multiple surgeries. But those are not people shot in the box people shot anywhere in the chest or abdomen. They are not let low triage individuals and in all go farther than that. So anybody shot outside of an extremity if you're shot in the in the face, neck, head junction areas to include XL a in groin area and inguinal Aries. Those are all high triage patients. Okay. Those are patients that have to go to a surgical suite if your shot zone to the neck, you know, the saying in medicine zone to to the right or to the I'm sorry zone to to the OR. So they have to go for as a minimum for exploration. So the idea that you're basically saying because somebody talks and because they have a radio pulse that their lower triage category. I don't buy that. So I think there's some I think ramp triage is very well intentioned. And I think it recognized some real problems in salt and start which I think are very much overly complex salt and start likewise have a lot of problems. There's a lot of stuff that gets through the cracks. I think we need to be pushing the skill of triage farther down. I think you know, I teach triage when I teach t try c and I teach a level that I think most people don't I think it's important for their basic things that are always gonna be a high triage category and somebody shot in the chest is one of those right because that's somebody who can suddenly de compensate that somebody who absolutely has to go to the OR, right? They need to get off the exit. It'd be enables they'd beat a trauma center. And I think a mistake that a lot of people make when it comes to triage again, I'm gonna probably a whole episode on this. But to sum it up. I think a big mistake that people make in triage is they misconstrue that when you are triaging, you're actually triaging for two purposes people that I'm gonna treat I and people that I'm going to evacuate. I saw a guy who shot in the chest who is otherwise stable and has no side. Attention Numa thorax and might need nothing. More than me throwing chess seal on I'm not gonna spend a lot of time doing anything on. I might need more time on somebody with three or four extremity wounds that I'm putting turn it gets on or let's let's say, they even high velocity. So let's say two of those are legit open. Fractures there. Spurting blood, right. I'm gonna have to do some legit treatment on that person right now before I can move them. And they're going to take a lot more my time than the first guy the guy who shot the chest. But really they're relatively stable. Once I get the turn it gets on. Once I get those open, fractures, splintered, they can actually go and sit in the ER probably get hooked up. Getting maybe a couple units of blood before Ortho comes Ortho vascular come down and pick him up. Where's that guy shot in the chest is probably gonna? Go right now. And I think this is especially true, even more true. If we're talking about those as low velocity injuries that those were just through through extremity wounds, and you know, granted if somebody has a pulse, Lois extremity, then we're getting into them being higher triage category. But still the guy shot in the chest. He's at least got go. Get a value in get a C T. I we might determine that that bullet didn't hit anything major. He's okay. But we don't know that in the field. Right. You do not know that in the field. We don't have a cat scanner in the field. Right. And for those of you who are going to take an ultrasound in the field, and I'm gonna and I've learned how to do an e fast that I'm gonna check for authorities. Okay. Knock yourself out that still doesn't tell you didn't hit any create vessels. That tells you don't have a new method axe. Right. This second doesn't tell you what you did damage wise in the way of major airway in the way of your bronchial tree in the way of vessels. So it's. And taken ultrasound onto the Xs a is a whole nother freaking conversation that we can have later. Bottom line up front. I'm not in favor of it. So triage again. So we're going to have a whole episode on in the future. But I do think it's kudos to the guys who came up with ramp because they are looking to solve a problem that really exists. I don't agree one hundred percent with their philosophy and their proton how they got there. But I'm not gonna I'm not gonna bag on them for trying because they are trying and they did some real research. They did they looked at some legit evidence based stuff. So again hats off to him for that. You know, I'm not gonna some sit appear in piss all over somebody else's efforts. Just because I don't agree with the the final solution that they came up with you know, in fact, I appreciate the growl or they did so much that I'm gonna review it in-depth. And I'm gonna see if I can come up with something better. And hopefully, I can if not hey, guess what I'm gonna do. I'm gonna reach out to people like Josh Bob co Andy Fisher and read Smith and say, hey, man, I need some help on this because I'm not the smartest guy in the room. But it is a problem that needs to be answered. And I think anybody's out there realized that you know, I'm a fan of dime. Triage, delayed immediate minimal expectant. I think I think it is the simplest even though it requires some clinical accurate, it will again, we'll talk about a little bit more about that a future episode, but we're at an hour, man. So I'm gonna wrap up here again for those that you came up and said hi at psalms. I really appreciate it for those that I missed makes you catch me and Raleigh next year. I probably going to be going to these in perpetuity every year, both because of my relationship with as person medical director, and my my ongoing relationship with the committee on on T C, which offered to be a part of that. And nothing that I say on this program is endorsed by anybody at T E C. This is all just Mike's opinion. Although I can think of a couple of people that would endorse it, but I'm not going to drag them into. Thanks for listening. Everybody, man. It's it's good to be back. I'm gonna try to get a couple of these in the can before I gotta travel again. Because I do I'm supposed to be shooting. An upcoming pilot other things coming up don't forget, we're all gonna do on June sixth. You got to two things you're going to have to do that day. You can have to do my my cross fit workout of the day that is posted on my social media. And I'll talk a little bit more about that at upcoming episode. So you guys know exactly what's on it. And that's day that my documentaries gonna drop on on Amazon prime in. That's either going to be called battlefield Normandy or Normandy, forty four. I'm not really sure which to tell you the truth by did that with James Holland last month over in southern England and France, so. Makes you over strikeforce energy dot com. Use the promo code Emo, T W at checkout. Make sure you listen to us next time should be coming out again next Monday gonna leave you with a quote by the late great General Douglas, MacArthur, general MacArthur's said age wrinkles the body quitting wrinkles. The sole. Very true words everybody in do not forget them until next time live life like a warrior.