The class was extremely interesting. It wasn't a general first aid course, and while there was some overlap with what I learned in the CERT first aid module, this class was focused on traumatic injury. While other students had CPR certification I was the only CERT member and clearly had the most first aid training going in.

I'll try to hit the high spots of the class and then talk about equipment.

Our lead instructor was an Army combat medic in Iraq, a civilian paramedic, and is now a police officer. Our training was based on his practical experiences as well as the evidence-based medicine learned by the Army and the hospital systems he worked in as a civilian. He covered far more than I can put into this post, with excellent slides and some good hands-on drills.

Most important is the combat mindset. I won't talk about it here other than to say that complacency kills.

Next most important are tactics -- knowing what interventions to use for a given situation.

After tactics come skills -- practicing those interventions so that you can perform them correctly under stress.

Last and least is gear. Gear, he said, is "the weak person's crutch." He believes in having the right gear but the best gear is worthless unless you train and practice with it. If you don't have it with you, it's worthless. Even fifty yards away in the parking lot is too far.

There are three kinds of casualties: People who will live if you do nothing, people who will die no matter what you do, and people who will live if you apply the correct interventions immediately. We focused on that last category.

Getting to definitive care as quickly as possible with a live patient is the goal. As firearms instructors we should know about the local hospitals, know where the nearest trauma center is, and liase appropriately with the local EMS, before holding a class. If the local EMS is professional and nearby, you're probably best off calling an ambulance. If the trauma center is ten minutes away but the volunteer FD ambulance is thirty minutes away, you're probably best off transporting the casualty yourself.

The three most common killers for casualties who could otherwise be saved are loss of blood, tension pneumothorax, and airway issues. We learned interventions designed to keep casualties alive long enough to get to definitive care.

For loss of blood, we learned about direct pressure, packing wounds (gauze is good, tampons work but are invasive and can cause us liability problems) pressure dressings, tourniquets, and hemostatic agents, with good drills on applying them.

For tension pneumothorax, we learned about occlusive dressings, both pre-made ones (and like MDinana says, avoid the Asherman), petrolatum gauze with tape, and "ghetto-fabulous" field-expedient dressings made out of a plastic bag and tape. We learned about needle decompression but were told very sternly that it is too invasive and out of our scope of practice. If we use needle decompression we'll face significant civil liability.

For airway issues, we learned how to use a nasopharyngeal airway (NPA) and an oropharyngeal airway.

We all had questions about gear. Since we were all firearms instructors, RSOs, or LEOs, we were focused on equipment we could carry with us to treat a single wound in the field. For that purpose he recommends the Army issue IFAK. The IFAK contains:

• CAT Tourniquet
• Compressed gauze
• Compression bandage
• Gloves
• Tape
• NPA

With an Army IFAK I can do almost everything he taught us to do, using the package for the compression bandage as an occlusive dressing. He says that the issue tape is crap and should be replaced with duct tape. His favorite compression bandage is the Israeli Battle Dressing. His favorite tourniquet is the CAT, with the SOFTT being a close second. His favorite hemostatic agent for deep wounds that can't be addressed with a tourniquet is CELOX-A, with QuickClot Combat Gauze highly recommended as well.

I have what North American Rescue calls a USCG IFAK coming. I consider the it to be pretty complete. I'll be adding the following to it:

• another pair of gloves
• duct tape
• shears
• Laerdal CPR face shield
• a travel package of aspirin
• a travel package of Benadryl
• CELOX-A

I'm considering this a supplement to my regular first aid kit and it's going to be on my person when I'm on the firing line. The aspirin and Benadryl will be reserved for cardiac issues and anaphylactic shock, respectively. Running back to the car when someone is bleeding is not an option.

It can't be said too often or too forcefully: If you want to be able to help people who are hurt at the range, get some training.