Integration of skills is a difficult concept to fully understand, and more difficult still to explain.
Throughout our publications, you'll find references to experiential learning; a process that places experience as a the lens through which truth passes. However, even experience can be insufficient. We also need contextual relevance. This article is about a car wreck that left two in critical condition, but it's more than that. It's about why the approach we use is effective, and how it can be used to save lives. More importantly, we hope it'll be an actionable guide for you to gain skill and experience, teach others, or rise to the challenge if faced with an emergency.
Let's look at what happened and dissect it to better understand this.
On a normal afternoon like any other, we were in our home enjoying a quiet day. Suddenly, the walls shook. I got up quickly, looking out into the courtyard to see what I could see. It sounded like a car had hit the building we live in. After checking the courtyard to make sure it was safe, I ran outside. Across the street, I could see people starting to look on. Two cars were along the road with minor damage. It didn't look serious, but there was no way that sound was from a fender bender. 'Keep looking for that next thing...'
I saw a tree laying over a destroyed, white car. This looks more serious. Smoke billowing, I approached the drivers side door. A man is suspended there, heaving in pain. The smell of oil and the chemical cocktail that propels airbags lingers in the air. The driver is pinned and belted in.
Another guy arrives and helps pull the door open enough so we can gain access to the driver. I draw a rescue hook and slash the small portion of the belt that I can see. He comes free and we remove him. At first people try to help but dead weight isn't like other things. I grab him under the arms and around the sternum and lift. A man grabs his legs and we clear him from the vehicle. I ask "How are you holding up? Can you tell me your name?"
His face is swollen, blood swings from his lips under the effort of being carried. He manages some pained sounds, and sputters his name as we set him down. He can barely talk, and a crowd is beginning to gather. Nearby, a man is crying. Several women have come from the nearby apartments and are looking on. Not just rubbernecking, wanting to help, but not knowing what to do or even what can be done.
Pause. I know what to do, do I? I lay him on his side so he won't choke on the blood, and help him curl up into the recovery position.
"Default to your lowest level of training"
There's a common phrase among trainers that says under stress "you don't rise to the occasion, you default to your lowest level of training." That doesn't do reality justice, but at the same time, it is a sensible observation. What training allowed me to react differently than the onlookers? Right up front: I'm not a special guy. I've got enough knowledge and experience to know that when it comes to developing knowledge and experience, you might quit, but you'll never finish.
What I'd say is: I always took things seriously. Even with courses I wasn't interested in. 1st Aid/CPR is a block to check at my workplace. The class is typically pretty cut rate, and not interesting. It's barely professional... But I still take it seriously.
Even that isn't enough to really move a person to action. In order to act effectively, we need to recognize there's a problem and know we can provide a solution. You have to recognize what you're dealing with, what will reduce the complexity of the situation, and address the critical elements effectively. Some of the things that helped me include:
- Recognition of the threat (continuing to scan and make reasonable conclusions under pressure).
- Orienting to the scene; determining the safest approach and priority of treatment.
- Extricating the victim; this required an assessment of his condition, the proper tools, and a degree of physical fitness
- Once extracted, placing the victim in the recovery position.
- Communicating with the victim in a way that told me something about his condition.
- Communicating the relevant information to the EMS personnel - and knowing when to shut up and step back.
Training IS experience.
Medical isn't unfamiliar to me. I grew up in a place where accidents were a bi-monthly occurrence. At least one killed a fella. It was rural to the point that the sheriff went to voicemail and EMS was about 45 minutes out. Later on, I spent time in the military, and got some experience with emergency medicine there. I view it as an annual requirement to hit some sort of medical training or another, however, I try and make sure it's not the same thing over and over again. Wilderness medicine, bleeding control, response to active shooter, self-aid based medical... I want the training to challenge, not bore.
The reason I got him out of that vehicle is that's what I learned. Absent a neck wound, stabilizing the patient outside the vehicle allowed for the greatest opportunity to observe and address his injuries. There were fumes and smoke. It made the situation less complicated.
This is the core of ISG strategy of emergency management: Recognition of the type of situation, having the skills and equipment, and reducing the situation to it's simplest form.
That said, most of the skills that helped me were basic awareness. These are an element of most "good" training. Some of the classes that were extremely helpful in cultivating this skill were:
- ECQC- Shivworks
- Urban Escape and Evasion - OnPoint Tactical
- Response to Active Shooter training - (any venue that offers force on force would be fine)
- Various Medical Classes (TCCC/CLS, 1st Aid/CPR, etc)
It may seem odd to have martial classes listed as "contributing", but they preach awareness, and keep you alert to the possibility of further threats. One of the things you pick up from scenario based training is awareness. If we really get down to it, training is experience, which is why it's so important. It's also why it's so important to challenge yourself and ensure you've got good instructors.
The experience was validating in some very minor ways; the tools and approach used was effective. Specifically, the Benchmade Rescue Hook, which was instrumental in safely extracting the male victim. The ISG approach to understanding emergencies and organizing our skill and equipment around those emergencies proved to be extremely valuable. The principles of Everyday Carry allowed me to respond as fast as I could orient myself to the situation. That's huge, and something I hope people will take seriously; dress, carry, and train for these situations and you *will* be ready for them.
One of the failing points was communication. In the instance, I did a poor job of communicating with bystanders. It would have been beneficial to have people who wanted to help have some direction; helping keep onlookers at a distance, having someone stay with the victim (and ensure he kept warm), having someone verify that 9-1-1 had been called... these are all things that could have been done that I didn't do. Communication needs to be a part of our training. We can't do everything ourselves.
The untold story here is that I left my home and family to deal with an external threat to someone else. Their management of the emergency deserves recognition and required an approach that managed the initial uncertainty with the evolving requirements of the scene. While I was trying to find a way to extract the female from the vehicle, my wife was speaking with people, bringing me equipment, monitoring our family, and generally making it possible for me to focus. In the future, I'd like to integrate them more into my plans of reaction.
In every situation I've found myself in, there have been people milling around, looking on. They need direction, and our training needs to include directing them. Apart from allowing them to feel useful, it saves us time and energy. Train to ensure you're using your surroundings effectively.
We hope you find this addition to our editorials a useful guide to managing emergencies. If you find it interesting, please look over our others articles on the subject! They're "additive" which is to say they build on one another. Best of luck, and stay safe.