AAR M.A.R.C.H / TCCC Training - 12 Feb 2023
AAR Originally posted at Thehebrewhammer.net
Any time there’s a good medical class offered, I try to clear off my schedule so I can take it. I know shooting is more fun, but the reality is that I’m a lot less likely to shoot someone, and a lot more likely to need to treat an injury.
I’ve taken CPR and Stop the Bleed classes, but I’ve never done a TCCC-oriented course. When I saw that Green Ops was offering one, I made sure to sign up. What did I think? Read on.
Disclaimers of Sources of Bias: I am one of the admins on the Green Ops Facebook alumni group, which is more of a job than a perk, but I suppose has some influence on my perspective.
Class Title: “M.A.R.C.H/Tactical Combat Casualty Care Training”
Class Description: From the website: “Demonstrate comprehension of M.A.R.C.H. principles (Massive hemorrhage, Airway, Respirations, Circulation, Head injury/Hypothermia) and competency at life-saving skills. This course is taught with the latest standards of care recommendations by the Joint Trauma System (JTS), American College of Surgeons, and the Committee of Tactical Combat Casualty Care (CoTCCC). This only an 8-hour course and is not eligible for a TCCC certification.”
Cost: $240. I don’t remember if I got a discount on this one since it had a guest instructor. Money well spent either way.
Round Count: Zero (0).
Instructors: David Lang. David is a former Army combat medic with extensive experience in helicopter medevac. He currently work the State Department doing training things. It is perhaps impossible to overstate David’s apparent expertise at his craft; every time you asked a question in this class, you got a fantastic answer that made that could he go as deep as you wanted. The personal anecdotes were also insightful and provided context to some of the things he taught us.
Almost as important, I found David to be a fun guy to learn from who treated the subject matter seriously, but with a (dark) sense of humor. He was both realistic and inspiring, which is a tough combo to nail down sometimes.
There were other Green Ops instructors (Josh Shaw, David Wampler, Luke Brooks) in the audience, but they were there as students and tourniquet dummies (more on that later).
Location/Date: Sunday, February 12th, 2023, from 8AM to about 4PM. The class was held in the clubhouse at Fairfax Rod and Gun Club. Despite being a competition shooter in the general area, this was my first time at FXRGC. I was quite impressed with the clubhouse – it was a very comfortable facility with a lot of room, and they even had a dining area where someone was cooking lunch if you ordered (which I didn’t) and sold snacks.
Weather: It was a rainy, cold day, so we didn’t go outside for any exercises.
Equipment Details: I didn’t bring anything with me, except lunch.
Preparation Drills: Went in blind. I don’t practice with a TQ, albeit I probably should.
Author’s Previous Experience: Civilian with no military or LEO background. I’ve taken Stop the Bleed and CPR classes before, so the subject matter was not totally new to me.
Class Demographics: There were 18 people in the class. There were a fair number of vets, first responders, and other people who nominally had some sort of previous training. I would say everyone was very motivated, which was great to see.
TD1 (morning): David started the morning off by introducing himself and giving his (impeccable) credentials, and then had the class introduce themselves.
Good shooting classes have a safety and medical brief. Good medical classes seem to have disclaimers. David made it crystal clear to use that you can get sued for treating people. Some people will see you as a paycheck if they suffer any injuries in the course of you saving their life, and you can even go to jail if you perform a procedure you’re not licensed to do. He had sobering anecdotes for both of these situations. Much like it is with defense-of-others situations, interjecting yourself into care-of-others situations may not be a good idea.
Another up-front disclaimer was that we were going to see some blood and graphic pictures. Trauma is not pretty! In fact, trauma is often extremely ugly. We saw pictures from the Boston marathon bombing and other events that had blown off limbs, eviscerations, and so on. While I was able to power through, I appreciated that David made it clear that people should take breaks if needed. I wouldn’t call the class a safe space or anything, but I was impressed with the way he tried to make the class accessible even to queasier people.
The structure of the class was essentially driven by a (very good) slide deck, with a ten minute break once an hour. People felt free to ask questions during the lecture portions, and frequently did so. I thought this structure did a perfectly good job in assisting the learning process while not distracting from practical skills. The order of the material covered in the class followed the MARCH acronym, namely:
Massive Bleeding (#1 cause of death)
Airway (#2 cause of death)
Respiration
Circulation
Hypothermia
A tricky thing about writing this AAR is that, on one hand, I have copious notes I took from the lecture portion, but, on the other hand, I’d feel weird just writing them all down here. That is to say, even if you don’t see something written down in this AAR, it doesn’t mean we didn’t cover it. The best I can do is really give you a taste of the class.
The course started with a discussion of bleeding, and we all know bleeding = tourniquets. Besides thorough discussion of application (including the difference between hasty and deliberate), the comparison of tourniquet types was absolutely excellent. David covered CAT, SOF-T (regular), and SOF-T (wide). Most classes seem to stop at the CAT, which is unfortunate.
One recurring theme in the class was getting quality reps in. David had a bunch of trainer tourniquets, and we spent some time practicing on our buddies sitting next to us. I really found the opportunity to try different tourniquets to be excellent, and it did validate my decision to go with a SOF-T Wide for personal use. I think some people were a bit timid at first about really tightening down their tourniquets; this was generally over by the end of class, and people (mostly David Wampler) were in some real pain given how hard they were ratcheted down.
We also practiced putting people in the recovery position, which is essential for airway issues (vomiting, tongue while unconcious, etc). My son has (mild) epilepsy that is controlled by medication, but the one time that I was around for an absence seizure, I put him in a recovery position. Well, I found out I could have done a better job of that, and David showed us how. It was really rather eye-opening for me… I would not have thought of doing it the way he showed, but it worked exceedingly well.
A few other topics covered in the morning:
Finding wounds via raking technique.
Chest seals – packaged or improvised.
Abrasions, amputations, avulsions, and eviscerations.
Space blanket use to prevent hypothermia.
We broke for lunch around 11AM, and took about forty minutes for it. As noted in the brief, FXRGC has lunch offerings, which most of the class took advantage of. I could have done without the evisceration picture up on the projector, but I suppose toughening up never hurt anyone.
TD1 (afternoon): After lunch, we had a really good discussion about personal IFAK composition. I didn’t have any major revelations, but it was nice to see I mostly made the right choices. I will definitely be adding space blankets, though!
We then had a wound packing demo and some practice. David is a big fan of ACE wraps for keeping gauze tight rather than pressure dressings or IBDs. I personally thought I did better with pressure dressings than the ACE bandage simply because it was a little easier to handle, but it wasn’t night and day.
Following this were some general practical exercises as teams. David would call out the wound, and then we’d have to do something about it. Good times. There was a TQ competition in the class, where I got myself knocked out in the first round. Winners got a free TQ. Oh well. Just to spice it up, the final round was managing TWO patients, which was rather exciting for everyone involved. I can see how you’d have to act fast to avoid someone bleeding out in such a scenario.
Class Debrief: Wrap up discussion, with final questions and future class ideas. A lot of the final discussion focused on treating minors, who apparently present shock symptoms a little differently than adults.
There was an extra 45 minutes or so after the debrief where you could just practice wound packing and tourniquet usage to your heart’s content. I found this pretty valuable, and enjoyed trying to really master some of these tools. Some of these training aids(such as the Phokus Wound Club and so on) are not cheap, so being able to get use out of them was a real treat.
Conclusions: I really cannot recommend this class or David Lang highly enough. I learned a ton, and the practice I got with tourniquets, wound packing, and other techniques was really valuable. David is a gifted teacher, with just the right mix of knowledge, experience, humor, and pragmatism to communicate this material in a truly engaging way. If you get a chance to take this class, or, indeed, any class with David, you should jump at the opportunity.