We have repeatedly recommended the document “Law Enforcement Use of Tactical Emergency Casualty Care” by Lifehold Strategic as a vital reference on “tactical” medical intervention in the real world.
The work compiles every LEO use of TCCC/TECC interventions that could be found, since 2004, into an easy read, complete with infographics. It is well worth your time to download and check it out. In reading it, one of the things that jumps out at us as we read, and look at the numbers, is the incidences of “Drags and Carries”. This is a subject that is sometimes little touched on, and little prepared for by non-medics, but the numbers make a strong argument to change this. In LEO TECC/TCCC incidents since 2004, drags or carries have been employed 58 times. Compare this to 62 uses of hemostatic agents, 37 uses of chest seals, and only 1 use of a nasopharyngeal airway (NPA). The need is clearly there for guys and gals to be up to speed on their drags and carries. We’re going to talk about gear here, but the very first thing is to get the skills, and regularly work the skills. Not fit enough to move another human being? Work on changing that. Don’t know how to move another human being? Classes covering the ways and means are out there. Plus, the information is readily available, and a patient friend can probably help you out if no formal training opportunities are readily available (just, use caution and work carefully. If you get hurt, it’s your own fault).
Let’s ask this question: How many of us have chest seals and NPA’s in our kits, but no casualty drag equipment? We’re wagering it’s more than a few. There are plenty of commercially available drags out there. Many of them are somewhat bulky, requiring a dedicated pouch, but also offering quite a bit of length and various attachment and routing options. And no matter the size, most of the dedicated “tactical” casualty drag set-ups are expensive. Between size and expense, drags are often relegated to carry only by medical responders, packed in larger kits, and not often considered “individual equipment”. One proposed solution to this is to carry several feet of 1” “climbing” (or tubular flat) webbing in a cargo pocket, or small pouch. How much, exactly, varies depending on who is making the suggestion: Just enough to get under someones arms, all the way up to 20-feet (an approx. 7” roll). Whatever length you find works, both for carriability and being long enough to actually use, a strap of 1” webbing is not a bad idea. The only problem with it we’ve run into is that unless it’s carefully stored and carefully deployed, the two free ends can be hard to keep track of (and sometimes, hard to hang onto if one’s hands slip any). Here’s an alternative setup that we’ve been playing with for awhile:
w/ 6″ ruler, G17 mag, standard ID/CC size card, chapstick for size reference.
Climbing slings are a sewn loop of flat webbing, available in different lengths. And, in truth, the majority of climbing slings are far too short to be useful as a casualty drag. But, 6′ and 8′ loop-length slings can be found if someone looks. And most of them are cheap. The one pictured, a 72” Advanced Base Camp (ABC) sewn-sling, costs around $8 on Amazon where we got ours. To make the sling more versatile, we’ve paired them with a “quickdraw”, or two carabiners connected by a short dogbone of webbing sewn to hold the ‘biners at opposite ends. You can use two loose ‘biners, but we went with a quickdraw because it helps to retain the ‘biners in the wrapped up package, and adds some versatility in how they can be used. Quickdraws are available ready made, such as this $13 MadRock unit, or you can buy ‘draw connectors to use ‘biners you already have. Connecting two ‘biners yourself allows you to scale down a little more, like we did by using the smallest (3.7” long) ‘biners Mad Rock makes.
Although this set-up will lack some of the options of a longer strap of flat-webbing, or the purpose made casualty drags, it still offers a multitude of options for use. The greatest advantage here is the size of this setup once complete. Folded up, and secured with a rubber band or a silicone bracelet, this can be stuck in many pockets (to include jeans pockets), and certainly in a multitude of small pouches. Cost is also a significant advantage, coming in around $20 for the whole rig. You could also spend a little bit more, and get the 10′ loop-length North American Rescue Hasty Harness, which comes in at about $25, and gives you more length but will also fold up larger than the climbing sling.
To make this setup even more useful and easily carried, it can also be staged on the belt using a PHLster Flatpack to contain the sling and quickdraw. One end of the ‘draw can be attached to the sling, and the other to the ring on a riggers belt, while worn, to create a ready platform for rapid extraction.
How to best use it? The best option with any medical, or med-adjacent, skills is to get hands on training. If you can’t yet, look online for various references on casualty drags and carries, and work from there. Take some time and figure that out for yourself and your tribe, team, etc. There are multiple ways to route the sling, or attach it to equipment, and to use it to drag someone. Remember when we said that the first and best thing was to get and maintain skills at moving a casualty? Setting up and figuring out this Pocket Casualty Drag is a great opportunity to work on that.
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There are things we know.
We know that at 2:00 AM on June 12th 2016, an ISIL inspired killer walked into the Pulse nightclub in Orlando and started shooting. Before he was stopped, 49 people were fatally shot, and 53 wounded. The law enforcement response began just two minutes later, but no officers entered the club until ten minutes had passed. In the minutes following, officers carried 14 wounded out of the club before asking Orlando Fire paramedics to go inside with them. Orlando Fire commanders refused to make entry, and continued to refuse for nearly an hour despite the offer of ballistic vests from another agency. 88 people were left alone, injured and dying. A study published in the journal PreHospital Emergency Care, by E. Reed Smith et al, found that 16 victims would have survived if they had received care within ten minutes.
We know that after calling 911, the next thing we do is wait. “Emergency medical service units average 7 minutes from the time of a 911 call to arrival on scene. That median time increases to more than 14 minutes in rural settings, with nearly 1 of 10 encounters waiting almost a half hour for the arrival of EMS personnel. Longer EMS response times have been associated with worse outcomes in trauma patients.3 In some, albeit rare, emergent conditions (eg, cardiopulmonary arrest, severe bleeding, and airway occlusion), even modest delays can be life threatening” writes Howard K. Mell MD, MPH,CPE in a 2017 paper published in the Journal of the American Medical Association – Surgery. We know that even once official “help” arrives, they have no duty to actually do anything. We have known this for a long time.
We know that since the 1960’s CPR has been taught to everyone from school kids to lifeguards to dental hygienists. We know that when someone has a heart attack, immediate resuscitation performed by bystanders improves outcomes significantly, vice waiting for trained responders to arrive. This logic is increasingly being applied to managing severe bleeding too, with the Hartford Consensus and rise of Stop the Bleed programs.
We know the pithy sayings like “when seconds count, 911 response is only minutes away” are rooted in a cold reality. That, in this greatest of all possible worlds, when emergencies happen we are on our own. Maybe help comes, or we find our way to help, but in the critical seconds and minutes, outcomes depend entirely on the people who are there. There is no one coming to save you or anyone else. If you want to have survivors, you have to make survivors.
What not everyone knows, is how to do that. What is required, in those lifetime-long minutes or hours until help arrives or is reached? We propose that it is nothing superhuman. To be a survivor, to make survivors, you do not need to be a superman assuming some heroic stance in the face of great evil. You simply must, as Uncle Scar taught us, be prepared.
The level of preparedness and skill required depends on your purposes, your environment, and the threats you face. Solo hiking deep backcountry trails requires more preparedness, and a deeper skill, than walking to the corner and back. Field research in the Mongolian wastes requires more than research at your local library. Conducting special operations in hostile lands, more than shopping at “that” Wal-Mart or Murder Kroger. And so on… But, is there something more exceptional about those skills in harsher environments, than in your own? No. You can acquire, train, and perform the skills to survive austerity and hostility, whoever you are.
One doesn’t need to be an ascetic disciple of survival skills to use them. No one coming to save us for a life of disciplined doldrums would probably be a blessing. We survive to return to a life that we’ve built for our fulfillment. A life spent in monastic devotion to mastering some art of living when others die isn’t a life worth living at all. The best skills and tools at survival, and self protection, are those that work smoothly into the life you already lead, the one you are building, not as the purpose of that life. You can spend a weekend learning wilderness survival, practice the fundamentals in your backyard and every camping trip, and survive a disaster. You can give a few weekends a year to classes, and a handful of hours a week to dry fire, and shoot better than most other gun owners. You can take a Stop the Bleed class in a day, and practice applying a tourniquet now and then, and successfully save a life.
Conversely, this is not to say that weak effort will be rewarded, or that suffering a bit to get better at these skills isn’t required. You get out of a thing what you’ve put into it, and if what you’ve put in to your skillset is laziness, apathy, and too much time on the couch, when you are selected, your performance will suffer. If you want to be hard to kill, you have to make yourself hard to kill. It does not happen by osmosis, or through minimal effort. There is no one coming to save you, you have to do it, and to do it, you must put in the work.
“One way of looking at this might be that for 42 years, I’ve been making small, regular deposits in this bank of experience, education and training. And on January 15 the balance was sufficient so that I could make a very large withdrawal.” – Capt. Chesley “Sully” Sullenberger on landing Flight 1549 and all 155 souls aboard safely in the Hudson River.
That effort is doable. The results attainable. You can do it. As in an emergency, start where you are and do one thing that makes a difference, and then do another. Change the batteries in your smoke detector, learn to use a tourniquet, shoot a new drill at the range this weekend, dry fire, learn CPR, eat better, lift a weight now and then. One thing, then the next, this is doing the work. Nature produces many things which are hard to kill, but their very lives require the use and refinement of that ability day in and day out. You aren’t a great jungle cat or a hippopotamus: If you want to be dangerous, you have to earn it.
Dangerous? Aren’t we talking about survival skills, not just violence? Yes, dangerous. Do you want to face death and not be? The word dangerous descends from Middle English, where its meaning included difficult, arrogant, and fraught with danger. Being hard to kill means being capable where others aren’t, being difficult to subdue be it by attack or the depredations of environmental extremes, in short, being dangerous. The world is full of wonders, and if you cannot stand in the face of death and say “not today” you will miss out on many of them. To live the life you want, you must be dangerous when confronted with risk. This you must do for yourself. There is no one coming. Everything is up to you. If you can’t be safe, be dangerous.
Each and every one of you, if you venture into the wilds, drive the roads, pursue adventure or live a quiet life, volunteer in conflict zones or at the safest church in the best neighborhood. Each and every one of you who want to live a good, and long, life. Each and every one of you who are sincere about affecting your passions despite any threat, need to be dangerous. You need more skills, more depth, than a single article, class, or book can give you. It is a lifelong pursuit.
This is something you know, and knowing this, having taken that first step, having that sincerity about your passions, this is your mandate to become fucking dangerous.