Lee’s note: Here’s a real world lesson and some practical advice from Michael Sheesley – a practicing lawyer, firearms trainer and lethal force expert living on St. Thomas, USVI.
EMERGENCY FIRST AID CONSIDERATIONS
Story and Photos by Michael Sheesley, Esq.
I just recently had occasion to render first aid to an individual. I came on the scene in my car around 10:30 am. As I drove up I saw a man lying in the road with 5-10 people standing around. I stopped my vehicle just off the road so that traffic was partially blocked, got out and quickly surveyed the scene. The man was lying in the road with a fair amount of blood coming from the right side of his face and head, individuals were around but not rendering any aid.
I walked the 5 paces back to my car and retrieved a set of nitrile gloves from the three pairs that I keep in my glove box. I returned to the man who was moving on the ground and groaning. The man was wearing a backpack which was partially trapped underneath him and wrapped awkwardly around his arms and had a bicycle lying nearby. I asked everyone to move back as I put on my gloves and knelt next to the man. I requested that someone call 911. I asked the man a series of questions, including whether he would consent to allow me to help him. His eyes were unfocused; he was not coherent and was coughing and vomiting.
I asked for a knife and a bystander handed me a very small swiss army knife with a blade about 1 1/4 inches long. I cut the backpack off the injured man and attempted to lay him on his side so that he could cough up blood and vomit without the fluids going back into his airway. He kept trying to roll onto his back and became slightly combative. I was able to keep him on his side and keep his airway clear until the ambulances arrived. I supported his head throughout this ordeal. One man who seemed to know him indicated that he may have had a seizure which would explain his incoherence and general combativeness.
Some lessons learned from this experience:
1. Basic first aid training is a good thing, go get some. You do not have to go to medical school or EMT training. Red Cross basic first aid and CPR classes are readily available and inexpensive. The training is good with blended online video and testing and an in person practical part to complete your certification. This training is under $100.00 and available practically anywhere.
2. At a minimum keep very basic first aid supplies with you. I usually carry a pretty basic first aid kit which includes a tourniquet, an Israeli Battle Dressing, a CPR mask, quick clot, bandages, tape and other supplies.
I did not have my kit with me that morning. I had just returned from international travel the day before and had not put the kit back in my vehicle (it was removed because I drive a soft top Jeep and had taken out any extras while I was not with my vehicle to deter break ins). I did however have spare gloves in the glove box. I would have been hesitant to render aid without gloves due to the significant bleeding.
3. Keep cleanup supplies with you. The ambulance arrived and I helped the EMT load the injured man onto the stretcher, strap him in and control him while he was loaded on the ambulance. The man became more combative as he was strapped in and was being loaded. I ended up with a fair amount of blood on my arms. The EMTs gave me 4 alcohol prep pads when I requested something to clean myself with and then left to take the man to the hospital. I gave one of the prep pads to the bystander to clean his knife. Luckily I was close to a drug store and purchased some alcohol wipes, these will now remain in my car. Hand sanitizer with some spare rags would work as well. The EMTs were worried about the injured man, not my personal cleanup.
4. Keep a knife or trauma shears with you. Because I didn’t have my first aid kit with me I didn’t have my trauma shears. Because of my travel the day before my knife, which I always carry (read my article Why a Knife?), was not where it usually is and I did not clip it to my pocket that morning. Thankfully there was a helpful bystander with a knife readily available. The knife allowed me to remove the man’s backpack and better render first aid.
5. Crowd control is important. There were 5-10 people when I arrived, more came and observed while I was helping. When I made the decision to render aid I requested in a commanding voice that everyone stand back. There was one man who I quickly made a connection with, helped me get a knife and helped control the people and keep the crowd back. By being decisive and taking action and control of the scene the bystanders gave me room. When the EMTs arrived there was room around the injured man to allow them to get in, help me and render aid.
6. Awareness of the crowd is important. I was carrying my concealed firearm, as I do 99% of the time. My Glock 23 was sitting in a Crossbreed IWB holster on my strong side hip with 2 spare magazines on my weak side. I was dressed in a pair of shorts and a t-shirt. As I knelt next to the injured man and was rendering aid and controlling his combativeness I can imagine that my gun “printed” through my t-shirt at a minimum and my shirt in all likelihood rode up so that my gun was exposed a few times. My gloved hands and arms were covered in blood and I was pretty occupied on keeping the injured man from flailing around and hurting himself and/or me. I was not concentrated on keeping my personal firearm covered. I did position myself so that I was away from most of the crowd and my back was towards the other lane of traffic. I was also aware that there was a crowd around me and would have stopped rendering aid in an instant should one or two of the crowd decide they wanted to take the opportunity to attempt to relieve me of my firearm. The crowd around me was a cross section of the community from homeless people to cruise ship tourists.
7. Don’t expect the person you are trying to help to be appreciative or cooperative. The man had some fairly serious head trauma. He could have also been mentally ill, intoxicated, just suffered a seizure or any number of other things. I was able to physically control him to keep him from hurting me, himself or others. This is something to think about before you attempt to render aid.
8. Blood and guts are, well blood and guts. The injured man had a good portion of his right ear torn and injured along with a large flap of skin hanging loose around his right eye and what appeared to be a good sized hole in his right cheek. He was vomiting blood, bile and whatever else happened to be in his stomach. That stuff doesn’t bother me but if it would bother you, actually administering first aid may not be your thing. However, crowd control, calling 911 and helping to direct traffic is a great help to those administering aid. All those things do not take gloves, first aid supplies or first aid training.
9. If you are in your vehicle turn off and secure your car prior to rendering aid. When I returned to my vehicle I realized that I had left it running and the door was unlocked. In my haste I didn’t turn off the vehicle and lock the doors. This would have taken approximately 5 seconds. While nothing happened I risked having my car taken or anything in it removed.
10. Use everything you can as a learning experience. Soon after this incident I called my good friend and mentor Peter Burlingame and ran through what happened, what I thought I did right and what I thought could have went better. This allowed us to get thoughts and events on paper while they were fresh in my mind. I didn’t do everything perfectly. I immediately reviewed the situation with someone I trusted, learned from it and will be better prepared and equipped next time.
11. Be prepared, training can mean everything. I have first aid training. I carry a knife. I carry a first aid kit. I didn’t have my first aid kit or my knife with me that morning, probably the only day in 2013 that I didn’t have those things with me. But I did have my training, it was impossible to leave that at home.
I didn’t save this man’s life. I marginally helped the EMTs and assisted in getting this man to the hospital quicker and prevented him from injuring himself further. The lessons, especially about firearm retention and awareness of the crowd when rendering first aid were instructive. I preach preparedness but I happened not to have my tools with me that day. Tools can be left at home, training cannot.
Michael Sheesley is a practicing attorney, a firearms instructor and a partner in Virgin Arms, a FFL holder serving the law enforcement and civilian community in the U.S. Virgin Islands. Mr. Sheesley regularly deals with criminal matters involving the use of lethal force and is a consultant to expert witnesses. Mr. Sheesley is a member of the International Association of Law Enforcement Firearms Instructors and the International Law Enforcement Educators and Trainers Association. He can be contacted at: firstname.lastname@example.org