Contact!

by Max Velocity

  Assessment: Once the H-ABC’s are taken care of, consider pain medication if you have it. Be aware that pain medication such as morphine can suppress respiration and therefore may be dangerous depending on the type of injury. You also don’t need to give pain medication to an unconscious or altered mental status casualty. If time and circumstances permit you will then go into a full head to toe assessment of the casualty, looking for further injury and treating as you come across them. This is where you would take a more considered look at the casualty, make sure you have found all the injuries, and treat other injuries such as breaks, non-life threatening bleeds and lacerations and burns.

  Use splinting to reduce pain from injuries such as breaks, burns and other suitable wounds. Burns are treated with dry dressings, not wet. The reason for this is hypothermia: burns reduce the skins ability to regulate body heat and treating a wounded and shocked casualty with wet dressings can bring on hypothermia. Be aware that circumferential burns i.e. all the way around the limb can act as a tourniquet on the limb. Burns to the chest can interfere with breathing and an escharotomy is a procedure to cut around the skin on the chest to reduce the constriction of full thickness burns.

  Once you have treated the H-ABCs you should cover the casualty with a thermal blanket to retain body heat and reduce the risk of hypothermia. You will continue to monitor the casualty and perform interventions as necessary both prior to and during the evacuation.

  Casualty Movement

  Casualty movement is one of the greatest challenges in the treatment and evacuation of wounded personnel. Manual drags and carries work over short distances but cannot be sustained. Suitable litters, such as the TALON II and the SKED, should be carried on vehicles for use on both vehicle and foot extractions from contact. The greatest aid to casualty movement and extraction will be the vehicles themselves.

  A vehicle, particularly if up-armored, can be used to cover, conceal, extract and evacuate a casualty. Space will be tight inside vehicles, but it is possible to treat a casualty while evacuating them and thus lessening the time to definitive care at a treatment facility. For significant trauma that may be beyond the scope of the CLS, rapid evacuation with the best possible CLS/combat medic care on route will be the greatest lifesaver.

  The classic Fireman’s carry has largely gone out of favor, mainly due to the weight of casualties today: not only the body weight due to increasing obesity and also the weight disparities between soldiers, such as a small female and a large male, but also because these differences are increased when the weight of body armor and equipment is added to that of the individual. The most effective short distance movement is the drag.

  The Hawes carry has replaced the Fireman’s carry: the casualty is behind the rescuer, laying down the back of the rescuer with arms around the neck/shoulders. This carry is easiest with some level of consciousness from the casualty. The rescuer holds the arms around their chest and leans forward to take the casualties weight on their back. The casualty’s feet will drag or scoot along the ground. The Hawes carry allows the rescuer one hand to operate a firearm as they are moving. If you have the fitness and a decent weight relative to the casualty, you can still do the Fireman’s carry, which allows you to run.

  Blog Post

  SHTF Combat Casualty - Considerations & Realities:

  On my CRCD class, I don't have time to do a full class on TC3 (Tactical Combat Casualty Care). However, what I do is give a few pointers as to how causalities will fit into the game in a real SHTF contact situation. I'm going to try and replicate some of those pointers here:

  When I train people in patrol break contact drills, I explain that it is like practicing a fire emergency drill. The fire alarm goes off, we all head downstairs and rally in the parking lot. Simple. But in the reality of a fire, we may not all get out, it may be a smoke and flame filled confusion, and we may take casualties. It's the same for break contact drills.

  So, we practice our choreographed drills and at the level of the CRCD class I don't even throw in casualties. The worst case reality of a break contact drill, facing a well sited enemy ambush, is that you may get out crawling down a creek bed dragging your wounded buddy. Or you may not get out at all. But that is worst case.

  Break contact drills are 'Oh Sh*t' emergency drills and there are worst case scenarios. The other side of that is that with a well-executed drill, even though you are doing the drill to ultimately get away, you may react and hit the enemy in such an effective way that you leave them reeling, wondering what happened as you "faded away into the woods."

  In the immortal words of Captain Jack Sparrow of 'Pirates of the Caribbean' fame: "We will fight them, to run away."

  The main point that I want to bring out today is firstly the effect of casualties on your drill, and secondly the effect that SHTF will have on your TC3 procedures.

  Firstly, the hardest thing you will do is going to probably be evacuating a casualty under enemy fire. Moving a casualty is very hard. Initially, you will be dragging the casualty by his gear every bound back that you make. You will move, dragging the casualty, covered by the other buddy pair. Then, you will stop, take a fire position, and fire to cover the withdrawal of the other buddy pair. As you get further away from the contact, creating a breathing space, you can consider reorganizing slightly so that, depending on the size of your team, there is an element moving the casualty and an element fire and moving back to cover that. For a four man team with one casualty, that will mean one person moving the casualty, whether by dragging or the Hawes carry, and the other two bounding back to cover that move.

  Once you rally up out of contact, you can reorganize, again your numbers will determine exactly how you do that (are you a team or a squad?), to create a litter carry party and a security party to cover the move out.

  Secondly, let's look at the reality of TC3 in an SHTF situation:

  There are three phases to TC3:

  1) Care under fire

  2) Tactical Field Care

  3) Evacuation

  In the Care under Fire phase, the primary thing you must concentrate on is fighting the battle. If you are breaking contact that means do that. Don't do anything that will cause more casualties, such as running out in the open to get that downed point man, unless you have first suppressed the enemy.

  The only intervention you, or the casualty, can do in the Care under Fire phase is to apply a hasty tourniquet 'high and tight' on a wounded limb to stop imminent death from extremity bleeding. As a team you will be going through your individual RTR drills, reacting to the contact, and then flowing into the break contact drill as appropriate. If you have a man down, you will simply have to grab him and drag him back on each bound you make back as part of your fire and movement.

  Even in the care under fire phase, don't try and put a tourniquet on in an exposed position. Drag the guy into a semblance of cover, be practiced so you can whip it on and tighten it down quick either in the groin or armpit area, and then get on with firing and moving. If you kneel in the open to apply a tourniquet, you will be shot down.

  If you are in some other contact situation where you are not actually moving and breaking contact, and you are engaged in a firefight with a casualty exposed in the open, then don't risk all to go to them. Concentrate on suppressing the enemy and winning the firefight. There are pretty much four things you can shout to them under TC3:

  1) Can you return fire?

  2) Can you apply self-aid? (i.e. hasty tourniquet high and tight)

  3) Can you crawl to me?

  4) Lay still! (so as not to draw more fire - don't tell them to "play dead", it's not good psychologically!)

  But, dependent on the situation you find yourself in SHTF, there are some other considerations. You probably don't have back-up and there is no 'dust-off' medevac on the way. If the guy is obviously dead, grey matter on the ground or whatever, then look to the greater good of the team and fight out of there. SHTF will make you face some hard decisions. You may not be
able to bring them all home. The other side of that is that wounds can be horrific and look a lot worse than they are. So long as the guy is breathing, even better screaming, then do your best to get him out of there, even though you may be repulsed and unsure how you could ever take care of such a nasty wound.

  The next phase to look at is the Tactical Field Care phase. This is where training can diverge from the SHTF reality. In training, once you have suppressed the enemy and got the casualty to cover, then you can go into Tactical Field Care, which means taking care of H-ABC (now MARCH, same thing) and then the full assessment before packaging up the casualty (thermal blanket to prevent hypothermia, even in hot weather) and monitoring them for evacuation. This is where a whole bunch of interventions are possible. However, in SHTF I can't tell you who your enemy will be. Worst case, they are an aggressive force that will follow you up, potentially even an 'enemies foreign or domestic' hunter-killer force. If so, you will not be able to hang around in the rally point for longer than it takes to do a personnel check, tactical reloads, and maybe a quick intervention on the casualty. Other than that, if you hang around and they follow up into your hasty ambush established as part of the rally, you will be back in contact and will have to roll back into the break contact drills again, back to another rally point. Don't hang about after breaking contact.

  In that sort of situation, you will have to do what you can for the casualty as you move back, creating further distance as you E&E away from the contact point. But here we hit another dilemma. You need to have equipment with you, and personnel, to carry the casualty. If you are using a litter, one casualty will take a squad to move - four on the litter at any one time, struggling, and the others pulling security as you move. You could use other methods, such as the ruck-style carry straps allowing one person to carry the casualty, but all this is going to be really hard work and make you slow.

  Enter: more hard decisions: how badly wounded is the casualty? Do you have definitive care to get him back to? How hard are you being pursued? Can you take care of the pursuit with a hasty ambush, or are you in serious trouble? Can you move fast enough to get away while moving the casualty? Will the casualty survive the evacuation (which as non-medically trained personnel you may not even know)? If you leave the casualty, what will the enemy do to him? Maiming, torture, cannibals, interrogation? Is leaving the casualty a security risk to your teams operations and ultimate survival? Do you have a contingency plan for team members falling into enemy hands - can you move your FOB location faster than you expect him to break to interrogation?

  No, I'm not advocating that you shoot your guy and leave him, or that he shoot himself. But this may be a time for a little volunteer heroics from the casualty, which always carries a risk of capture. It all just depends on the situation, and no doubt an SHTF or civil war/resistance type situation is going to throw up some really hard choices. Some of this ties in with comments that I have made before about dumping gear to get away, running off naked through the woods after having dumped all your gear to escape. The key here is to carry a load that you can move with, and shuffle-run out with if necessary, so you never have to dump all your weapons, ammo and gear even if you dump your patrol pack. If you are being closely pursued, whether you have a casualty or not, then you may face a choice of dumping everything and running, or you may turn and fight, hasty ambush, get close to the enemy negating indirect fire weapons, and maybe survive in the chaos, in the gaps. That is your choice and largely depends on what you are about i.e. what you see as your mission.

  There is a time to live, a time to fight, and a time to die. All that really matters is how much it's going to hurt, right? If you are going to go out like a fighting bear, go out like a grizzly.

  This leads us on to the last part, which is evacuation. The whole point, in a nutshell, of the TC3 protocols is basically to stabilize the casualty and keep them alive so that they can be evacuated back to definitive care, in military terms at the CASH (Combat Hospital). But in SHTF you will only have whatever medical care you have. Whether that is a medically trained person, or yourself having read up and taken some courses.

  The interventions that you do under TC3 protocols rely on further definitive interventions back at the hospital to take care of the problem. You have to take that tourniquet off some time right? Are you going to clamp that artery? Do you have the equipment? You have to get a chest tube in to take care of the sucking chest wound and tension pneumothorax (collapsed lung), right? Can you get over your own feelings of revulsion at the gore and blood in order to be effective in helping your buddy or family member?

  So ultimately, keeping the guy alive until you can get him out will then rely on being able to keep him further alive by definitive interventions. You may be back to an 1860's level of medicine, giving him a bottle of whisky to drink while you do what you can. So, you need to be able to clean, debride and suture wounds. You need to consider antibiotics, because back in the day infection was the major killer of those who initially survived their wounds. Think about use of betadine/sugar poultices and similar, as used by vets on horses.

  So, ultimately what is my point? Like all military style doctrine, it has to be assessed and looked at from the perspective of an SHTF situation. TC3 is no different. It is really useful to train as a combat lifesaver or combat medic and to learn to do TC3. But make sure you have assessed the use of it in a non-military SHTF environment and consider the potential absence of definitive care as well as the need for people in your group to step into those gaps with useful skills.

  CHAPTER SEVEN

  POST EVENT VEHICLE MOVEMENT

  “Tactics are like opinions, everyone has one.”

  Introduction

  Mobile vehicle and dismounted tactics is what many soldiers and security operators do/did in Iraq and Afghanistan; either escorting convoys, doing administrative moves, or carrying the personnel that they are tasked to protect. Surviving and reacting to roadside and site ambush and attack were what it was all about.

  In the early days, 2004, many operators had soft skinned vehicles. Rounds go through those like a knife through butter. The only protection is limited to the engine block and the metal part of the wheels. Thus, if forced to take cover behind a vehicle, take cover by the wheel wells. It was possible to add steel plate to vehicles to add protection, similar to ‘hobo’ Humvee's used by US military at the time. Remove the interior door panels and add steel plate, sloping up above the window base to provide cover for shoulders. Armored vehicles became the norm later, and really in an environment such as Iraq armored vehicles are required. They would be ideal post-event, but who has one?

  There is a difference between a tactical mobile force that you may decide to organize post-event, perhaps utilized by a retreat to conduct operations such as mobile perimeter defense or foraging parties, versus a family traveling from A to B, perhaps from home to a BOL, or because they have to move again due to a necessity to relocate, for whatever reason. For the tactical force, TTPs will be covered in more detail later.

  By way of introduction, such a force could consist of multiple vehicles manned by trained operators. To create ‘technical’ gun trucks you can use a pick-up truck. Put in a pintle mount in the truck bed for the weapon of choice, preferably a SAW or 240B/M60 type automatic machine gun type weapons. Then build up the sides of the truck bed to the preferred height with steel plate, to protect the gunner while standing at the pintle mount. Remember to armor the cab and to test the steel plate to stop NATO 7.62 (.308). You could also mount a steel plate to the front bumper to provide protection to the engine block / radiator from the front and perhaps therefore an increased ramming ability - which could also be used to ‘ram raid’ stores and other locations if foraging for food in a TEOTWAWKI situation, or to push aside a road block or vehicles used as a road block. If you wanted to get really serious, you could take out the windshield and replace it with two steel plates, fitted so as to leave a narrow gap for vision and to allow the passenger to s
hoot forwards.

  For a family travelling in a post event situation, there are multiple risk factors. For now, the assumption will be travelling in vehicles, for which you have sufficient additional fuel stored and you are able to carry your required people and stores in the vehicle for movement to your destination. If you don't for any reason have vehicles, such as running out of fuel, EMP or whatever, then you should consider acquiring additional vehicles and/or fuel before you consider taking off on your feet.

  If you do have to walk, then consider creating some sort of cart system, maybe using strollers if you have kids, both for child and equipment movement. You could also consider moving using bicycles with trailers and even horses. However, even in an EMP situation some vehicles will still work, even if yours don't, so if you have to bug out you should put serious consideration to obtaining vehicles and fuel so that you can drive rather than take on alternate means of travel. When on the roads, some hazards that you should consider:

  - Jammed roadways

  - Law enforcement/military traffic control points (TCPs)

  - Illegal traffic control points (ITCPs)

  - Manned roadblocks

  - Unmanned roadblocks

  - Ambush – static

  - Ambush – mobile

  - Urban areas

  - Mob

  - Trick or con

  General Movement Considerations

  The type of environment envisioned is a post-collapse situation where there has been a breakdown in law and order. This section is therefore not primarily concerned with the sort of ‘bug-out’ movement that families may conduct in response to a localized natural disaster, where you have to get in your car with some basic equipment and move out of the impacted area. Rather, this is directed at those who find they have to move locations after a significant societal collapse has happened.