Dark Angel Medical - Direct Action Response Training - Day 1 AAR

Go here http://darkangelmedical.com/training/ and sign up for a class.  I'll wait...  With that out of the way.  Holy s**t! We're only halfway through the class and I haven't done more than apply a tourniquet to my arms and legs but I'm spent.  The day started at 8:30am at a picturesque lakeside venue.

Fair Weather Farms in Monroe, GA

The class consisted of 15 men including myself and four women.  We were a mix of law enforcement, business owners, professionals both blue and white collar, a stay-at-home mom, and one full-time UGA student.  We spent a few minutes introducing ourselves.  I'd say about half were "gun guys", but a common theme among the students was to simply be able to provide help if the need should arise.  A few students had first hand experience with emergency situations that led them to specifically seek emergency medical training.  After signing the ubiquitous waiver, we then settled in for a steady stream of information.  Our instructor is Ross Francis.  He is a full-time instructor with Dark Angel Medical, served as a Navy Corpsman, and is also a paramedic. 

Our Instructor Ross Francis

I was allowed to take pictures of Ross and gear, but photos or video of the students or procedures is prohibited due to Opsec/Persec concerns.  He keeps the class moving along at a brisk, professional pace, but will quickly address any questions or concerns we have before moving to the next topic.  There are a LOT of topics.  The student manual is 148 pages of slides from the PowerPoint that Ross used for class.  He also utilized videos, some funny, some graphic, and some tragic, to underscore key points.

Student Materials

While 8+ hours of PowerPoint could easily be used in place of waterboarding,  Ross often inserts his own mix of "Fozzy Bear" humor, obscure movie references, and stories from personal experience to break up the slides.  For the first three hours, Ross covered mindset, situational awareness, and the bodys response to stress.  While this isn't a firearms class, a lot of the points he made can be applied to self defense and firearms.  We then learned about critical anatomy and assessing the victims injuries and mental state.  After a 10 minute break, he moved onto to equipment.  Ross covered medical kit components, explaining the function and differences of each type.

Medkits and Components

Until today I didn't really know the difference between a dressing and a bandage.  He explained gloves, pressure bandages, hemostatic agents, tourniquets, and the emergency blanket.  You wouldn't think a mylar blanket would be considered very important compared to TQ's and QuikClot, but we learned that blood loss, equates to loss of body heat, which slows down bloods ability to clot.  More on clotting agents later.  Since day one is all classroom, we did not practice applying any of these devices, just when, where, how, and why we use them.  We go hands-on tomorrow.  One exception is the tourniquet.  Each of us was provided with a bright orange CAT-T.  We were shown how to stage the tourniquet for one-handed deployment on our arms and legs.  Periodically throughout the class, Ross would randomly yell out left/right arm/leg.  We then had 30 seconds to get our tourniquets on.  We didn't just loosely strap them on either.  We had to get them tight enough to no have a radial pulse.  If you do it right, it hurts...a lot.

Tourniquet Right Arm

Tourniquet Left Leg

Contrary to what some people think, a tourniquet will NOT automatically result in the loss of a limb, proven by the fact that I was able to drive back to the hotel and type this up.  Properly applied, a patient is in no additional danger of losing a limb for hours after a tourniquet is used.  Obviously there are situations where you cannot apply a tourniquet such as the neck or abdomen.  We also spent a lot of time on hemostatic agents, mainly QuikClot and Celox, and why gauze is better than granules.  Ross cleared up some misconceptions about them, but also cautioned us about older "Zeolite" based agents.  These heat up in contact with tissue sometimes resulting in 3rd degree burns at the wound site.  Also, other than their intended use, tampons are only good for minor nosebleeds.  Not gunshot wounds!  Around noon we broke for lunch, but not before watching combat gauze being packed into an arterial bleed in a pig.

One catchy mantra is, "stop the bleeding, start the breathing".  After lunch, we dove into the second part of that statement.  We covered airway, breathing, applying occlusive devices for chest wounds, why we should keep duct tape and safety pins in our medkit, and nasal airway tubes.  Around 3:00pm the room became even more serious when we moved onto specific injuries and treatment.  While I'm not particularly squeamish, some of the material is hard to watch.  One particularly unsettling video showed a loss of consciousness within 15 seconds of a hit to the femoral artery.  We got our tourniquets on a lot faster after that.  Photos of real wounds are displayed in full detail.  Gunshots, stab wounds, lacerations, amputations, facial injuries, compound fractures, and evisceration are fair game.  I'm glad I wear a silicone wedding ring after seeing examples of "degloving".  Unlike the gory photos we were shown in high school drivers-ed, the purpose is not to gross-out or shock us.  Most of us instinctively avoid or turn away at the sight of such things, but without seeing them, and having them explained and put into context, how would we be able to assess and treat them?  The last thing we went over was shock.  The big takeaway was to stop bleeding before the victim loses more than 750ml of blood, where survival rate is 94%.  Past 750-1500ml, it drops to 14%.  As with many things, speed is life.

Many of the lessons we learned are intertwined with each other.  Stress effects heart rate and breathing.  So does blood loss which reduces oxygen/glucose in the body, which in turn causes shock, which again effects heart rate and breathing, and so on.  Much of what we were taught is related, and Ross is always circling back to previous concepts as new ones are introduced.  He also constantly drills us to hammer home important points.  I'll probably never forget that an occlusive dressing is used on penetrating wounds between the collar bone and belly button, all the way around the torso,

At the close of day one, students who purchased them received their Gen3 medkit.  I don't operate operationally so I chose high-vis orange.  We we encouraged to take our ornage tourniquets home to practice with.  Apparently we'll be using them a lot more tomorrow so we better get good with them.

Dark Angel Gen3 D.A.R.K

Back at the hotel, I pulled the "trauma kits" from my car and took a close look armed with a ton of new info.  About a year ago, I purchased a $25 Elite First Aid, Inc. Tactical Trauma Kit and a $25 Adventure Medical Kits Trauma Pak with QuikClot.  When I signed up for this class a few months ago after listening to a podcast featuring Dark Angel founder Kerry Davis, I also purchased a Dark Angel Pocket D.A.R.K insert.  I also keep two CAT-Ts in the car.

Elite First Aid, Inc. Tactical Trauma Kit

Elite First Aid, Inc. Tactical Trauma Kit - Components

This is NOT a trauma kit.  The scissors might work once and the pouch and gauze pads seem okay, but nothing in it will stop a major bleed.  There's a "tourniquet" consisting of a 1" wide 18" long latex strip.  It could be useful in other ways, but it's all but useless as a tourniquet, and it's narrow width could cause nerve damage if employed as such.

Adventure Medical Kits Trauma Pak with QuikClot

Adventure Medical Kits Trauma Pak - Back

The Adventure Medical Trauma Pak seemed better since they make great first-aid kits and it contains QuikClot.  Again only the pads, gloves, bandages, and duct tape roll are worth keeping, but the QuikClot sponge is in the trash.  Here's why.

It's not 12' of gauze, it's a sponge.  Sponges are fine for non-life threatening wounds, but cannot really be packed into a wound site with an uncontrolled bleed.   It's also Zeolite based, which heats up in contact with tissue.  The label even says "product will feel warm in use".  It's gone.

Dark Angel Pocket D.A.R.K.

I did have enough sense to purchase the Pocket D.A.R.K.  I bought it specifically for the QuikClot Combat Gauze (Kaolin based, no heat generated) and SWAT tourniquet which is better suited for children, adults with small limbs, and even pets.  I shudder to think what would have happened if I tried to use any of this stuff prior to receiving training though.  My vehicle kit now consists of the Gen3 DARK and the red molle pouch with the boo-boo kit and Pocket DARK inside .  The Gen3 will come with me anytime I leave the car where its size isn't an issue, work, training, the range, etc.  I'll be purchasing additional Gen3's for my wife's minivan, the house and garage.  The Gen3 is a bit large for EDC, but a DARK Mini will remedy that.  I'll also be supplementing my kits with Chito-Gauze and Red Cross CPR face shields.  Of course, we still have to actually practice using it.

I started the day thinking I'd just learn how to use a medkit and sip from a fountain of knowledge.  Instead it was a fire hose.  Learning how to use the tourniquet in this class is like learning how to load a gun in a firearms class.  It's a single technique, and a tiny fraction of the skills and information you need to learn and practice.  We haven't even gotten to hands-on application, but already I feel a million times more prepared for an emergency.  While I may have fallen victim to the Dunning-Kruger effect, most of the concepts are kept very simple.  Keep blood in.  Keep them breathing.  One of Dark Angel's principles is after all: "simplicity under stress."  

-Carry On