#126 Sam Boyer Groff - PrepMedic
Sam Boyer Groff - Swat Medic, Flight Paramedic, Educator & Content Creator
"The creator and owner of PrepMedic, Sam Boyer-Groff is a critical care flight paramedic and a member of a special operations response team in northern Colorado which attaches medics to two high call volume SWAT teams, SAR, and dive rescue. He has over a decade of EMS experience and spent several years as a sworn law enforcement officer, SWAT entry team member, and lead SWAT medic in central Iowa. Sam holds a BS in Emergency Management and teaches ACLS, PALS, AMLS, PHTLS, Stop the Bleed, and BLS.
Sam brings medical insight, preparedness, and the best-related gear reviews to the world through YouTube and social media. He uses his experience as a critical care flight paramedic, reserve deputy sheriff, and tactical medic to help first responders and civilians alike implement evidence-based medical care, select gear, and gain insight into EMS and law enforcement."
Tune in as Sam Boyer Groff joins Bobby Marshall in the studio to discuss tactical movements, saving lives, swat medics, flight paramedics, law enforcement, awareness, safety, how to identify common medical problems, and so much more.
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Sam Boyer Groff - PrepMedic
Our guest for this episode is Sam Boyer. He's part of a special operations response team working with multiple SWAT teams as a SWAT medic here in the state of Colorado. He's also a full-time Flight Paramedic. Sam has a multitude of experiences in saving lives, and he's harnessing it all through PrepMedic and, more importantly, his YouTube channel. This was an incredible episode. I learned so much. We went over how to place tourniquets, how to identify strokes, cardiac arrests, CPR, and so much more. I encourage you to read this episode in its entirety. It was a great conversation. Sam is an amazing human, an active first responder, and I enjoyed having him in this episode.
Let's dive right into it here. Ecstatic to have you in the studio. I've actually been reaching out to you for some time, but we haven't been able to connect the dots. You're a busy guy. The reason why I reached out to you is to talk about your background, but also how you're educating the general public in SWAT medicine, tactical medicine, critical care, and flight crew. I'm going to let you go through all that, but more importantly, I feel that personally, this is something that I need growth in. It's to take care of a situation. If I'm in the backcountry and I get a severe bleeding thing, maybe I'm with somebody that has cardiac failure. I know that concealed carry is a big thing right now and everybody's concealed carrying. They're like, "It'll be great if there's an active shooter situation."
In my opinion, and this is just my perspective, I think what you're teaching is way more important. You're going to find yourself in a situation where you might have some severe bleeding. It could be from a car accident or a number of things, especially if you're a backcountry hunter like I am. I think about it now a bit more like I'm running around in the woods with razor-sharp broadheads that can cut you in a heartbeat and then get into field dressing an animal. You're running around with super sharp knives or bone saws. We could go on and on, but I think that you're more likely to find yourself in a situation where somebody needs serious medical attention, and you don't know what to do.
It's such a big thing right now because everybody's starting to see cracks in the system where anybody working for the government or for a first responder agency has seen the failure points for years. Now, I feel it's starting to come to the forefront. As you're saying, you've identified a lot of dangers that a lot of people don't see in those backwoods. Even in your everyday life, you don't think about Evergreen being super off the map. We're in a populated area and stuff, but even here, I don't know how many ambulances Evergreen has, but it's not inconceivable that you're going to wait a long time for help to come.
We're incorporated. I know that there are full-time fire and ambulance that are on, but it's only at certain stations. You saw what we got going on with traffic right now. You're not going to get a fire truck or an ambulance past that construction. It is one lane. I think the national average for a police officer to show up is 4 to 5 minutes. Medical care is even longer, and I don't know what it is now, so I'm speaking off the cuff. You could save somebody's life from bleeding out, especially if it's a femoral or major artery. I don't know how fast you bleed out, but I would imagine it's a matter of minutes.
There are a lot of factors that go into it. Let's talk about cardiac arrest first. If somebody has a heart attack that causes them to go into a lethal arrhythmia, they have three minutes before you start to have irreversible brain damage and eventual physiologic death, where there's no coming back from that. Right there, you're behind the eight ball. I have never successfully resuscitated somebody that did not have bystander CPR done prior to our arrival. I've been a paramedic for many years, been an EMT for a couple of years before that, and ski patrol a little bit before that. I don't know how many cardiac arrests I've run, but the only ones that have ever walked out of the hospital, and there are still a small handful, had bystanders do CPR first for them.
That's not cool or sexy. That's not in the tourniquets and the bleeding control, but knowing CPR is absolutely huge. You have your massive bleeds. That's not a tactical scenario. That's not somebody shooting up the bank you're in, you get shot, and you have to apply a tourniquet. This is arms through plate glass windows. This is motorcycle wrecks, leg entrapped, partial amputation, hunting accidents, fall from a big height, or trapped under a piece of machinery. With that, your femoral artery, you have probably about 2 minutes before that person has lost enough blood to go into decompensated shock and they're going to be dead within 4. If you don't have somebody that can intervene, chances are, if you have a femoral artery laceration, they're going to be dead.
What's cool about both CPR and bleeding control is both have tools that can help you. You can get a face mask or a tourniquet packing glass, but similarly, both of them can be done with nothing at all. If you have a shirt on your back, pants on, or socks, you can pack a wound and stop bleeding. Same with CPRs. You don't need to give rescue breaths, you can just do compressions. Those two things right there can, will, and have saved lives. That's one of the things I'm so passionate about. You don't need to have your MD. You don't need to be a paramedic and EMT. You don't need any of that. You can learn these skills very quickly and make a huge difference in somebody's long-term outcome.
You don't need to have your MD or be a paramedic in EMT to learn BLS. You can learn these skills very quickly and make a huge difference in somebody's long-term outcome.
I commend you for doing that and putting that out there publicly because it's a quiet professionals' community a little bit. It's something that's what I was getting at. Your chances are much higher of going through a plate glass or getting in a car accident than getting in an active shooter situation. Not to mention the people that have successes in that situation with a firearm. You're much better off knowing some medical skills.
Personally, what opened my eyes was having kids. I was like, "I want to be able to protect them." Especially if we're remote. If we're 5 to 6 miles back in on a 4-wheel drive trail in dispersed camping, maybe we're hiked in even, sometimes me and my son hike in and pack in a couple of miles, you're not going to get medical attention very fast. This is something where I need to up my game. I'm going to say it publicly. I know some basic wilderness first aid and I carry some stuff with me like some gauze and stuff like that, but there's definitely a ton I could learn. This is why I'm excited to have you in. I'm probably going to keep you here for hours, if that's all right.
No worries. All the time in the world.
Let's dive into your background a little bit because you have a super interesting background. SWAT Medicine and Critical Care Flight Paramedic.
That's my job title right now, Critical Care Flight Paramedic.
In those situations, you're dealing with the worst of the worst situations. If they're sending in a helicopter, need some severe rescue and high-angle stuff, somebody's about to die, in my opinion. What got you into this career and your background? Just dive into it.
Back in high school, I was not super successful academically, as you can tell by my diction and my ability to pronounce words. I was struggling through school. Yet, in all of these classes, I was struggling, but when I went to take my scuba diving certification at age ten, I did phenomenal. My parents were like, "We thought you were dumb." They didn’t actually think that. That was like, "You have potential." The rest of my high school career was trying to find something that mixed. Real-world education, a skill that wasn't subspecialized to going to work at Google or a tech company that had applicability outside of that environment. Something that I could relate to my everyday world but still do something that was worthwhile, could make money, and give me independence.
I took this first aid class in this class called Rocks and Ropes, which was learning to climb and rig some ropes. It was a cool high school class. We went spelunking. It was cool and very impactful. I did this first aid class. I was like, "I like this. This makes a lot of sense. It makes a lot of sense why I'd want to know this stuff." From there, I was also on the ski team and was doing a lot of that. I was like, "These guys are skiing around in red coats. That's cool. I bet you they get free lift tickets and they know first aid. That's awesome."
I got hooked up with a volunteer ski patrol agency in the Midwest Madison, Wisconsin, at Tyrol Basin. It's a volunteer thing. It was not a career, but I went through that. They had an outdoor emergency care technician class, which is roughly equivalent to what was then EMT basic and has been transitioned to just EMT with a focus on outdoor care. You learn a lot of orthopedic injuries because that's what's happening at ski hills. Snowboarders are reaching out, breaking their wrists and clavicles.
A lot of splinting going on the ground.
A lot of splinting, and you're doing it with nothing. You carry a fanny pack up the lift and somebody goes down to get ready to call you go. You basically manage them with nothing, and then they bring it to bog into you. You're calling an ambulance or a helicopter, and it takes them twenty minutes to get to you. It's a cool environment to cut your teeth in the basics of medicine and get good at simple things. What was so cool about that was there were a couple of mentors. I didn't know it at the time. They were professional paramedics, firefighters, and police officers.
One by the name of Chance Kezmarsky. I don't know why he liked me because he's a pretty gruff individual. I was seventeen and a half years old and unbearable. Looking back at it, I was a pain. He turned me on to these internship programs in the area that would pay for your firefighter 1 and firefighter 2. They'd put you through the full fire academy, they'd get your EMT, and then they'd put you through paramedic school. You'd live at the station 24/7. You'd do a normal shift. They would give you time off to go to school and they'd pay for everything.
Were you still in high school during this program?
In OEC, I was in high school, graduated that, and then went right into this internship program in EMT Basic. Right when I got out of high school, I was like, "This is cool. This is a great mix of the blue-collar camaraderie and that environment with some of the white-collar respect. I liked that combination, plus everything I learned, I could take it home and I could use it. That was something that's a skill that no matter what happens in my life, I now have this skill and knowledge base. That interested me a lot.
I went into this internship program. Basically, you go in and you're competing with a bunch of other eighteen-year-olds that all want this free ride. There are seven smaller fire departments that surround Madison, Wisconsin would all send their representatives and they'd all recruit 2 or 3 people, so there are a couple hundred of us going for it.
It's a selection process.
It's a selection process, and it was my first real interview outside of Subway. You're sitting. There are probably fifteen fire chiefs in the semi-circle around you and you're in a chair. You don't even get a desk to hide behind. They go one down the line, they all ask questions, they go back, and you get interrogated. The fire department will roster who they want. I ended up being picked up by the Monona Fire Department, which is a small suburb of Madison. They had two ambulances, a couple full-time guys, a bunch of volunteers, and then interns.
Through that, I got all my stuff, went through the fire academy, went through my EMT, and then eventually got my paramedic through them. What I thought was firefighting was cool. It was fun. Somebody's going to take offense to this, but a lot of it was monkey work. It was very direction-oriented. "Get this hose. Do this. Put water on fire." There are a lot of nuances to that, but that job boils down to putting water on fire and then spending the next twelve hours of your life rolling a hose and laying it back in the truck. That wasn't my passion there.
Transversely, I love the paramedic side. Going through class was awesome. With EMT, you learn your basic life support. Back to learning splinting, you learn taking vital signs and doing CPR and emergency interventions. You learn some advanced things like putting certain kinds of breathing tubes down people's throats. They're called superglottics. It doesn't take a lot of skill, basically. Just jam it down their throat, but it is an advanced skill.
With EMT, you learn your basic life support. You learn splinting, taking vital signs, and doing CPR and all these emergency interventions.
In paramedic, you go into advanced life support. That's these advanced surgical procedures. You can do something called endotracheal intubation and rapid sequence intubation. It is essentially giving somebody the drug cocktail that they're giving in the operating room to paralyze, sedate, and put a breathing tube down directly into their trachea, as well as doing surgical cricothyrotomy.
We learned pericardial synthesis, which is a needle into the sacra on the heart to drain fluid off of it. You learned to interpret your 12-lead EKGs. You have a pharmacology of 100-plus meds. You're giving on standing order. You're doing it on your own. It deep dives into pre-hospital medicine. I feel like a lot of people don't know the distinction between an EMT and a paramedic, which is one of the tangential things that I try to teach on there. The number of times I've been called an ambulance driver is crazy.
I thought it was the same. I thought an EMT and a paramedic were in the same. If you can elaborate on that a little bit, too.
For EMT training, I did mine in 2 months-ish, it's 150 hours, and then you do 3 rides. I did one ride on an ambulance and I did 2 ER rotations where you go and see things, you take vital signs and stuff. You're like, "Here's your National Registry of EMT Certification." EMT is what you'll find in a lot of rural communities. A lot of volunteer squads are EMTs. There is still a knowledge base and academic demands for that. You have to re-cert every two years. You have to prove you're doing this continuing ed, but it's not that intensive for it. Paramedic school, depending on where you go, is between one and a half years to two years.
Do you have to have your EMT to enter paramedic schools?
You have to have your EMT. There are some levels in the middle. When I went through it, it was the EMT Basic, then you had your EMT IV, then there was EMT-I/99, and then your paramedic. National Registry was like, "This is way too confusing." They slashed that. Now, we have EMT. They removed the basic. You have AEMT, which is your Advanced EMT. That teaches IVs, some simple medications, some simple airways, and things like that. You then have your paramedic, and then you have your critical care paramedic after that. Paramedic school is 2 years, and that's 500 hours of classroom time.
Much more extensive.
Yeah, it's a lot.
Quadruple the time, right?
Yeah. It ended up being 50 credit hours. Going so, a lot of programs are now associate's degrees. When I went through, it was a certificate-based course, but I have basically the credit hours for an associate's there. Very similar to your RN. Through that, then you have another 500 hours of ride time or clinical time. I'm probably misquoting the hours. It's been a long time since I've been through. You spend a lot of time on ALS ambulances. You do a lot of hospital time, but instead of being in the ER, you go to. You do your intubations there following anesthesiologists.
We went up to OB and delivered babies. We went to the ICU and learned about drug interactions, drip calculations, and things like that. You still spend the majority of your time in the ER because that is where you're going to be working. After that, then you go to your ambulance ride times. You get basically farmed out to whatever ALS agency will take students and is okay putting up with you. You spend the rest of your time doing that.
That makes a lot more sense now. Thanks for explaining that. Sorry, I didn't mean to interrupt you, too, but I'm going to be diving all over the place in this conversation. Going back to that, you get your paramedic. How do you make that jump to SWAT medicine? I'm sure that that's a whole another, because, at some point, you're probably learning some tactical stuff like how to shoot. Maybe you need to be sworn in as a sheriff or a police officer, I would imagine, to be on one of those teams.
Fast forward a couple of years, through that in Madison, the next step after all of those certs was to get my associate's in fire science. I didn't like that. Whether I was too immature for it or whatever, I did not like, at that point, going to school for that. I wasn't interested in it. I could only learn about the fire tetrahedrons so many times before I wanted to move on. I escaped Madison, Wisconsin, and moved out to rural Iowa because a nineteen-year-old, the world's your oyster. You choose rural Iowa. I could have gone anywhere and I went to Ames.
Iowa's not that bad. There are worse spots, honestly.
It isn't. I bought my first house for $90,000. For that, Iowa will always have a place in my heart. I went out there. I was working for a hospital-based service in Ames. They served pretty much the entire story county area. With that, you had the sheriff's office and the police department. Both had their own SWAT teams. Now, it is rural Iowa. It's not like these guys are in LA County. They're hitting doors three times a day high tempo. These are street deputies that are high performers that are taken off the street for callouts and sent to that, and then they go back to their squad car and go run patrol more.
I don't want to give the wrong impression that this was everyday officer-involved shootings and crazy things like that. With those two SWAT teams, they had no medical coverage. They had nothing. They weren't even carrying IFAKs on half their kits. A couple of guys were dialed in and would have a tourniquet or something.
What's an IFAK? Is that tourniquet-based?
Individual First Aid Kit is what it stands for. It's like their blowout kit. The standard contents are going to be a tourniquet. Usually CAT tourniquet, a thing of hemostatic gauze, quick clot, some pressure bandage, and then depending on their training, a nasal pharyngeal airway or a needle decompression device. With that, they're doing these high-risk things and they had nothing.
I started to make friends with this deputy named Joel. He would come into the ER and he came in with this counterfeit CAT tourniquet. For those of you guys that don't know, counterfeit tourniquets are this huge deal. China is knocking them off to sell them on Amazon. They're these things that look like a Combat Application Tourniquet. If you apply them, they're going to break. Not all of them will break the first time, but they have a huge failure rate because it's cheap materials.
How is there no governing body on that?
You get 1 shut-down and 5 more pop up. They're being manufactured in China, so they have very sneaky ways of doing it, but they market themselves as the real thing. He came in with that and I was like, "That's no good." I went to the supply room. I'll deny it if their management ever comes back to me, but I stole a bunch of medical supplies. I was like, "You can't go out with this tourniquet. Here are some actual stuff for you to kit." I started teaching him that. Some other deputies came in and I would teach them for the greater good.
These guys are out there and a lot of times, they beat us there. It's almost like helping myself because if these deputies get in a bad situation and they've got a patient that's hurt, they're dispatched on medicals. I want them to be able to intervene because that's going to make a big difference for me down the road and that patient, not to mention the risk to themselves and the people they encounter on a daily basis. I started doing that and made a lot of connections there.
If deputies get into a bad situation and they've got a patient that's hurt and they're dispatched on medicals, they should be able to intervene because that's going to make a big difference down the road.
They were like, "There's this reserve program. We'd love to have you on. It's a program where you basically go through the police academy over the course of a year. On weekends and nights, a lot of online modules, and then you get tested out on different phases. You get sworn as a law enforcement officer in the state of Iowa." I was like, "Yeah, that sounds fun. It sounds cool. Give me a gun. Give me a vest. Tase me a couple of times. Let's go."
I started going through that. I got my law enforcement certification through them and was a reserve with them. Basically, I was helping advise the sheriff's office on medical supplies. With the goal in the back of my head, it's like, "I want to get on ERT, which is their SWAT team, Emergency Response Team. It just sounds less scary." I twiddled my thumbs for a while. I did my best to support them and then eventually got on their ERT. I tried out for them, and they brought me on as an entry team member. The fact I was a paramedic was great. They brought me on as an entry team member to go through the door with them, fully armed, a member of the team. With that, I basically defined my own role within that as a subspecialty of, "I'll be the team medic."
My employer at the time at the hospital was like, "We're not going to pay you for this because it's volunteer, but we'll put you under our medical direction. We'll give you supplies if you want supplies. You just go out and help them." I started doing that and that was basically my entry into tactical medicine. I knew nothing about tactical medicine at that point. I had taken one TacMed class that was a weekend long and I learned nothing in it.
Nothing that applied to real-world situations?
It did, but the problem with a lot of tactical classes out there is they're more designed to make you feel cool than actually teach you good information. That's not exclusive. You can find a lot of good classes, but a lot of these, especially civilian-based TacMed classes. They're either taking paramedics and they're trying to teach them like cool guy tactics for a SWAT team. You spend the time clearing rooms, which is fine, but I was getting that from the SWAT team and the basic SWAT school I went through. Also, you have the classes that are TacMed for cops that they're trying to teach them medical interventions. It's really basic. Finding something that is teaching paramedics how to elevate their medical skillset to the tactical environment and teach them advanced things, not just teaching tactics is rare and hard to find.
It's probably situational, too. There are so many different scenarios that you could find yourself in that, I would imagine.
It's tough because there's no standardization across the country about what a SWAT medic is. Some places, the SWAT medic is sworn like I was and they're carrying a gun. They're in the room with them. Some of them are paramedics being brought into that. Some of them are law enforcement officers being trained as EMTs or first aid, and then they're called the medic. You've got unarmed and unsworn tactical teams.
It goes by state or county jurisdiction, right?
It all depends. That makes it hard to have a curriculum. I digress. With that, getting on with them, I was able to standardize their IFAKs a little bit more like, "This is what everybody should be carrying." I got one of the deputies to be my second set of hands. I trained them up a little bit and stopped the bleed in what to do and how to help me best. I distributed some of my gear so I'm not carrying a huge backpack with all this medical crap. I was able to go back to my EMS agency and start training them a little bit. We got vests for a rescue task force on every ambulance. The paramedics at least had bulletproof vests that they could put on in the event of a school shooting or something. They weren't just staging outside.
That was a question that I have and I don't want to forget about it. We're going to dive off your background and circle back to that. Active shooters, especially in Colorado, become such a common thing in schools nowadays. Law enforcement agencies are training for that. You had some bad scenarios that happened in the past, like Sandy Hook or something like that where, who knows?
I hate talking about this because you got to walk on eggshells talking about it. I don't want to come off or sound the wrong way. I'm hoping that there's something on the paramedic side that they're doing as well because how many lives could be saved by stopping the bleeding? Is there some set plan working in the state of Colorado? Are there vests on ambulances and stuff like that where paramedics are expected to run into gunfire or towards the sound of gunfire to help?
This started to originate in Colorado with the Columbine shooting, which was the event that kicked everything off. Unfortunately, it showed evil people what you can do. Through that, what we learned is that in EMT school and paramedic school, you're taught "BSI! Scene Safe!" as the first part of your assessment. They say, "Get your gloves on and you have to make sure the scene's safe because a dead rescuer is not a rescuer at all and you're just a liability." For a long time, if there was any violence, you would sit three blocks down in your ambulance and you would wait for PD to go in and clear the scene and make it safe for you to go in.
What we saw in Columbine was that it was impossible to make that scene safe in any reasonable timeframe. It took hours. There are people that died in Columbine that would've been alive if they had gotten medical attention an hour earlier. There are literally people bleeding out on the floor in Columbine. We quickly realized, "We're in this new era. This is going to happen more. We can't just sit and wait." That's no longer acceptable. You still have services doing it that'll put their ambulances out and they'll wait. In my opinion and in a lot of expert opinions, that's no longer an acceptable response for EMS. We have to be able to adapt to our environment and we have to be able to make access to patients quickly.
Especially kids.
You can't sit outside. That's why the Uvalde thing is so disgusting. It's horrible because that flies in the face of everything that has been taught in the last few years. What we got from that is this concept of rescue task force, which still has a lot of issues with it. Essentially what that means is that law enforcement, EMS, and fire all converge on the shooting scene. Law enforcement is going to create contact teams. It's not SWAT. They're not special. They're patrol officers that get together in groups of 1, 2, 3, 4, and they start running through the school listening for gunshots. They're not clearing room to room. They're listening for gunshots. Their goal is to shoot the shooter or get the shooter to shoot themselves.
Go to the gunfire.
Go to the gunfire. Stop killing. That's the single most effective thing you can do. You can stop them from shooting anybody else. If they're engaged with you as a law enforcement officer, they're not killing more kids. The next part of that is you've got more people coming. You've got state patrol. You've got other jurisdictions. Everybody is dispatched to these shootings. As those law enforcement officers come in, we've got 4 or 5 contact teams engaging the suspect and trying to clear rooms and get people out. Now you have these other law enforcement officers that are standing around. They're going to create these security groups that will bring in the rescue task force. They'll pair up with firefighters, paramedics, or whoever is there for medical stuff. They're going to go into what we call the warm zone.
They're not diving in front of active gunfire. They're not going to be like the guys down the hall shooting at them and they're trying to treat a patient. That's an unacceptable risk in the eyes of many experts. They're going to throw on some vests. They're going to at least get into that school, and start dragging kids, whoever shot out and start doing treatments. If they can't get out, they're going to do casualty collection points within the building and treating people there. They don't have to be armed, but they have the bodyguards.
They can focus on their job.
Everybody can focus on their jobs. That's the rescue task force. Now, you take that one step further. One thing I tell people is SWAT isn't a mass casualty resource. SWAT, even where I'm working, we have two pretty high call volume SWAT teams and they're still not full-time teams. They take a while to deploy. There should never be a scenario in a shooting where you're waiting for SWAT to get there.
SWAT isn't a mass-casualty resource. They take a while to deploy. There should never be a scenario in a shooting where you're waiting for SWAT to get there.
The only time you might do that is if the shooter's barricaded in a room and there's nobody with him. Keep him in that room and wait for somebody with bigger guns and more armor to confront him because there's no reason. If there's anybody that's in danger, you're not waiting for SWAT. You do have tactical medics, which is what I do, where you're attached to that team and you have a little bit more capability of being in that hot zone where there's still bullets flying and rendering care in those situations. It’s this multi-layered response. We're training officers in bleeding control.
The body cam footage that was released made me upset. Me as a civilian who has no experience, and I don't know unless I was put in that position, but my natural reaction would be to go try to stop it.
That's a reasonable human being. You're trained, you're equipped, you've got rifles, you've got body armor. You're up against some crappy kid. You have all the tools. You have all the people. If he shoots three of you, that's not even 1% of the people on the scene.
In that scenario, it was some border patrol agent that went in and said, "Screw this. I'm not waiting. I'm going to go in. This is ridiculous." I don’t know for sure.
I know there was something like that. I heard mixed reports. I try not to get too far in the weeds of it. The big thing through that is that flew in the face of every piece of training that's been released since Columbine. That was a Columbine-style response. There was no reason for it.
On the contrary, my hat goes off to all first responders. You guys are put in some serious situations. Whether it's wildland firefighters, firefighters, paramedics, EMTs, or police officers, you guys deal with some shit and I understand that. I guess it's situational. Every situation's different. You turn around on the contrary and you look at how they handled this one in Nashville, Tennessee. That was crazy.
That's how that's supposed to be done. It's awesome that that's how that was responded to, but it should be nothing special. That's the standard you're trained to. Those officers did what they were paid to do. That doesn't take anything away from them. Looking at that and starting to contrast to this other event, you can see how it changes throughout the landscape. Anybody tuning in to this, that's not a first responder. It's easy to put, but you don't realize it when you're outside of it. You think of your own workplace and, I guarantee you can think of somebody that's incompetent and shouldn't have the job they do. They're not doing anything at the moment to get fired. There's that potential, but they hang on.
Just enough to get by.
You're like, "I hate that guy. They're doing a horrible job." Any form of first responders, it's the exact same. There are crappy firefighters. There are crappy EMS personnel. There are crappy flight medics. You have bad people. I'm not saying that they're absolutely corrupt or people are turning a blind eye, but it's like, they're not doing enough to get fired because if they got fired, it would be a wrongful termination suit, but they're not doing a good job. When shit hits the fan, then you have this push, "Everybody knew they were bad.” I guess keeping in mind first responders are people.
Not to mention it's a hard career to fill right now. How many people want to go do this? That's an issue in this country right now.
It is. What sucks and what I try to do in these conversations is bring in some nuance to it because there's the BLM or Black Lives Matter. All cops are bastards. You then have, on the other side, a thin blue line, "They can do no wrong. There's nothing we can do to improve law enforcement. Everything's fine." There are so many things. The truth is somewhere in the middle. You have bad cops. You have really freaking good cops. The solutions being thrown out, in my opinion, by the left are ineffective. They let us pat ourselves.
Defund the police? Come on.
You know what's going to make a police department better? It's cutting their training and their personnel, and making people more stressed and not making good applicants supply. Let's get that high school bully in that cop uniform because we have to fulfill our insurance requirements for the city.
To rely on non-profits to do some of that, too. There are a ton of non-profits that have popped up. There's an awesome one that's teaching street police officers and they'll basically give them jiujitsu skills up to a blue belt. It's Back the Blue, BJJ. That's such an awesome nonprofit. Any police officer, if you have a badge, you can come in and you can learn some basics up to a blue belt, which can be a couple of years of training, honestly. In certain situations, that could save your life or save somebody else's life.
That's the big thing. It's not just saving your life as the officer. It's making them rely less on the tools on their belt. Tasers are less lethal. They're not non-lethal because they can still kill you. Same with firearms and all of that, that's lethal threats. If you can control somebody with your hands, it's going to save their life. If you're good at that ground and pound and you can restrain somebody effectively on your own, you're going to save other people's lives. That nuance, it's like, you have to defund the police. These police agencies have numbers they have to fulfill for the city. They don't have a choice. They have to have this coverage in the city or you have a bunch of insurance issues. The actual street-level problems that we see aside of the criminals.
That's a problem with LA County. Look at how many corrupt cops are in that.
They got budget cuts and they were going to get rid of their Air Rescue 5, which are their special rescue deputies, which are flying around in the Jolly Green Giant doing hoist rescues and stuff. That was what was going to get cut because they need the patrol cops. They're not cutting patrol. They're going to cut these special teams that are very specialized in dealing with the specific threats of any agency.
It's one of those things where it's like, "I see what you're saying, but at the same time, the way you're going about it is wrong." You want to get cops better and you want to hold them accountable. I am so on board with that. You do that with community engagement, getting them out in community policing, embedding them within these neighborhoods, and more training. It all goes down to the more training somebody has, the less likely they are to be a shithead. Recognize, "What is a threat to me? What isn't? How do I de-escalate?"
You want to make cops better and hold them accountable. You do that with more training and community engagement. Get them out to the community, policing and stuff, and embed them within these neighborhoods.
That's a good point you brought up. There are good and bad people in everything whether it's the military, law enforcement, or Apple. You start going down corporations. It could even be school teachers. There are good and bad people and those people get figured out, but I would say it's not a 50-50 split. I say it's more like a 95% and then the 5% of them are bad.
I wouldn't even give it 5%. If there was 5% of cops that were truly bad, you have badly trained cops, you have cops that aren't good in certain situations. Truly corrupt evil cops, less than a percent. I have nothing. I've got nothing to back this up. I have my own experience in the guys I work with on the law enforcement agency side, but it's such a low number and you wouldn't know it if it was more than that.
I don't know any firsthand. I know a ton of first responders and I have a ton of family members that are in these fields too.
My brother-in-law said it best. I don't know if he's still my brother-in-law. He's my wife's sister's husband. He is from Mexico City and he grew up there, went to college there, and then came over here for a tech job.
That's a different deal.
He's so interesting to talk to about his experiences in Mexico because all of this kicked off. He's like, "I do see what they're saying, but in Mexico, you don't go to cops. Cops are not to be trusted because they are all corrupt. They're some evil people. They're owned by people.
I've experienced it firsthand.
He was like, "It's so different here because if I'm in trouble and I go to a cop, I know they're going to help me. You read about some stories where they don't, but that's the exception. In Mexico, it's the rule." He has a very interesting perspective on all of that because he's seen what a true corrupt police force is.
We're so fucking lucky. All the third world countries that I've been to with my prior career, the corruption that I've seen firsthand and the corruption that's happened to me in the middle of the night. Crazy shit.
We're very lucky in that aspect. I guess I'd just say that there is nuance to the conversation.
I couldn't agree more with you. I'm sorry, we totally diverted there, but it's all good stuff. You get into the Iowa SWAT team. You were sworn in at that point, so you get your tactical training in.
I went to basic SWAT school with them and everything through NTOA and started running calls.
What are some of the job demands for that? Maybe you're on an ambulance or something at that point and a SWAT call comes in? You're like, "I got to go to this call." How does that work?
Relatively low call volume. Most of what they do is training. With that, my EMS agency is still in Central Iowa. We ran three rigs, there were twenty of us, and I knew my boss well. I talked to him and I was like, "I'm doing this if this comes up." He's like, "If we have this coverage in the city and you need to go do that, you can go do that." It only happened a handful of times where I left work for a lot of other times where you're sleeping at 1:00 AM and they're like, "Drug task force has this warrant going on."
That's when all the bad shit happens.
It's always late at night or you've got a barricade. With that, it was being on call 24/7. If you can't respond in a situation, it's okay, but your phone's always on loud, and they'll call you and say, "You had to be within a certain amount of time of the station. You have all your shit in the back of your car." It only works in Central Iowa because I had my rifle, $20,000 worth of armor and medical equipment in the back of my car, and I lived there all of the time as my car's parked in the street in Des Moines, Iowa. They'd call you in at a moment's notice and SWAT can be cool and it can be freaking boring.
A lot of my work was pre-planning. They'd get a warrant and I would contact the EMS agency that was in that area we were doing and be like, "We're doing this thing. We're not going to tell you what we're doing, but if you can happen to have an ambulance sitting at this grocery store at this time and be on this radio channel, that would be freaking awesome. PS: Don't tell any of your friends."
I'd call whatever the local medical helicopter was and be like, "If we can get you on a ground standby for this spot callout, we're doing excellent." I would come up with, what threats are we facing? What's our evac plan? Who's going to drive what truck? What ambulance do we have? I'd have all of that pre-planned so that if an officer went down or the suspect got injured on that call out, we would know exactly what would happen, what hospital they would go to, and what their means of transportation was.
Some sort of medevac plan.
Even when you get to these prolonged callouts, the medic is generally responsible for hygiene. That's a big thing. It's not something I did so much. I would do it a little bit more now, but do we have porta-potties on this 24-hour, 48-hour barricade?
It's funny. Some of the SWAT guys that I know are still street patrol officers and then they get called up. They're like, "I always pack food because there are calls that I'll go on for 24 hours and then I have absolutely nothing."
I show up with a case of water and a bunch of R-Bars. I've used that way more than I've used a tourniquet.
You're probably a very loved man for that, too.
Exactly. Through that, you'd be in charge of all of that stuff going on. We had cards for every member on the SWAT team that I would keep in my vest that was everybody I had. Name, date of birth, blood type, medical history, allergies, and next of kin contact. What's their religion? Who do they want to notify, their wife or husband, if something goes wrong? I had those cards on me. A lot of what I did was backend. That being said, when stuff did hit the fan, I was in the stack with them going in the house, I had my own assignment and being a medic was the secondary job role. Shooter first, medic second. We all had our little subspecialties and that was mine.
Going into some of these situations, are you going into active shooter situations and stuff like that very often, or is there a lot of it?
No, not there. A lot of what we dealt with people, I give SWAT teams shit. I'm like, "You're busting drug dealers all the time." We did our fair share of stuff with the drug task force and everything, but the vast majority of what we did was to go after truly evil people, which truly evil people are rare. I'd be surprised if there's one in a million that are truly evil.
The one callout that was the last callout I did with them before I left. It viscerally sticks with me where these two guys were teenagers. They essentially were breaking into people's houses, stealing cars, and being general shitheads. One time, they broke into their grandmother's house, sprayed her in the face with a can of wasp spray, raped her multiple times, stole her car, and let her house on fire.
Their own grandmother.
Yeah, and beat her half to death. Lit her house on fire and stole her car. The family knew this. Three weeks later, they gave their grandmother a hug at their family reunion and wished her, "I'm so glad you're doing better." Things don't move fast. You can only detain somebody for 24 hours without bringing charges against them. You don't want to jump too fast because you don't want to tip them off that you're onto them. You have to collect evidence and you have to give your detectives time to get that. It was one of those things where everybody knew who did it, but we needed the evidence for it. We knew, but in the legal system's eyes, we didn't know.
It's got to be so frustrating.
They got all this evidence. They were like, "Fine. We don't even have an arrest warrant, but we have a search warrant for these pieces of evidence in their house.” That was such a cluster fuck of a warrant. All of these shitheads' houses, I swear to God, had 10, 20 people living with them. It's always that way. They all have warrants and they all have reasons to hate you as a cop.
You could be going into a serious situation at that point.
For them, I think we were looking for a bloody underwear. That's what the search warrant was for. I can't even remember. This was years ago. We're going in there trying to find this stuff, but you still have to detain everybody because everybody's a threat and you don't want people flushing evidence or doing things. That warrant viscerally sits with me on what was going on with them.
How could it not?
Those are the kind of people SWAT is designed to go after. These super high-risk people. These people that are sociopaths that have weapons and that have proven that they have no regard for life or personal safety.
SWAT is designed to go after super high-risk people—people that are sociopaths, that have weapons, that have proven that they have no regard for life or personal safety, or anything like that.
I commend anybody that's out there doing that, too. Does your care as a SWAT medic, I'm sure it extends to maybe there's a hostage situation or maybe it's an active shooter situation. Will your care extend to somebody that's involved with that, too? Is there a bunch of training for that end of it as well?
Our care is for whoever needs it. We have priorities of care. Our first priority is the SWAT team. Second priority is victims and innocent bystanders. Third priority is suspect. That's not to say we ignore the suspect, but if we have an innocent bystander that's bleeding out, a suspect that's bleeding out, our choice goes to the bystander. For that, even if the SWAT team shoots the dude that needed to be shot, I'm going to go treat him and do my absolute best to keep him or her alive. That's what's so cool about it. You are there as much for the people as you are for the SWAT team. Not quite as much, but you're there to render care and preserve life.
As far as training for different scenarios, a lot of it blends together because the training of a SWAT medic for that potential active shooter, which I've never been deployed as a member of a tactical team to an active shooter or anything that. Two shots fired, two somebody shot, but not in actual mass casualty event like that. I've never gone as member of a tactile team. A lot of that training's the same. It's like, "Stop bleeding. Do your basic triage. Get them to somewhere else that's not where you are.
You're currently still active in SWAT because you do mostly critical flight care now.
I met my wife out in Iowa. She had the bright idea to go to medical school out there. By the time she got done with that, it was too late. We had tied the knot there. I moved back out to Colorado, which is where she's from for her to do her residency down in Denver. I moved out here. I gave up that, got a job at a large EMS agency, and they have their own TEMS Team.
I was a ground paramedic with them in an urban environment and was on their TEMS Team. This TEMS Team is unsworn. We wear the body armor, have the helmet, look the part, but we are unsworn, so we don't carry guns, which means we have professional bodyguards everywhere we go. I have opinions. I will tell you that.
What is your opinion on that? I would feel safer if I had a firearm myself.
I would very much like one. I think the way we are deployed, it's very safe for us. I feel safer on that team than I do rolling around the streets in an ambulance because at least I know the threat there. I have people with guns that are looking out for me. The one bonus or the silver lining is that I have nothing to distract me from doing medical care. They can be in this crazy gunfight. I don't have to join in on that. I am here for that officer that got shot. Meanwhile, they can concentrate on doing that, knowing that their buddy is being cared for and I'm no hands lost to them. That's the bonus, but I would personally like to have a side-arm or something for self-defense, even if we're not in the stack having the ability to defend ourselves.
Is that a Colorado State Law that they don't swear in?
No, it's agency dependent. We are part of a much larger healthcare organization. The risk management department is barely okay with us being in body armor and going on these things. They'll never take that liability. You then look at South Metro Fire. They keep it quiet because they don't want any controversy coming out of it. If you get on their TEMS team, they will send you to Douglas County. They take you offline for six months and you go through the post-certification law enforcement academy. They come back as fully sworn law enforcement officers. They're brought on to their SWAT teams. They're rifled up in the stack like we were in Iowa. It depends.
It depends on counties.
If you're in the Denver Metro, they don't do anything. They give them some vests at the beginning of their shift, and they're like, "You're this rescue task force," but the Denver SWAT has no medics on them.
They're probably the highest tempo or the highest call volume right now.
They're the only full-time SWAT team in the state of Colorado. Maybe Springs might, but I don't think they do.
Why is that?
I don't know. It's anyone's guess. It's so area-dependent. For us, we do the SWAT thing with them, but then we're also deployable. We go with search and rescue in our area. We're their medical support pack-up hiking with them.
It happens a lot here.
We then go with dive rescue as well. We have this range of responsibilities. SWAT is just one thing we do.
How many certifications do you have?
Too many.
As a SWAT medic, your kit, are you carrying a huge backpack and all that stuff with you, or is it minimal so you could move?
It depends for us. We all have stuff on our plate carriers that the initial section of your March algorithm, which is your life threat. We can treat that off our vests. We also all have kit bags that we have on the back of our carriers. Generally speaking, we'll go in. We try to stay within 30 seconds of the team, last point of hard-cover.
Sometimes we'll go in the stack if it's a bigger building, but a lot of times we'll go hide in that tree out front or sit in the BearCat if it's a single residence or something like that. We'll then take that pack and we'll put that at the last point of hardcover as we go in just because it's big and bulky. We're trying not to do that advanced care in the house. I'd rather do that in the back of a BearCat or somewhere that we're safe instead of there are bullets flying and we're trying to start an IV. Contrary to what you see in movies, IVs don't save lives unless you have blood products, which we don't have on there.
This is something I want to dive into later, the Hollywood medic.
There's so much, but for that then we'll try to bring the person out to us or if we have a secure room within the building, we can have somebody go up, get our bag, come in, and we can do more prolonged care for them. We have that like, what's on our vest is the basics, then we have some more advanced stuff in the kit. In the BearCat or the ambulance that's supporting us, we have our full-blown ALS kit. We try to stage it so that we are able to do the care that makes sense for whatever phase of the incident we're in.
PrepMedic: What's on our vest are the basics. We have some more advanced stuff in the kit and in the BearCat or ambulance that's supporting us.
Diving into the Critical Care Flight Paramedic, what got you into that? How do you fall into that? Not only is it insane being a SWAT medic to me, as a normal civilian. I guess I can't understand or fathom. It's so cool what you do, so I'm not downplaying it by any means, but it's hard for me to understand. That's why I'm asking a million questions right now, probably stupid questions a million times. I was highly intrigued. As a kid, I was going to be a Flight for Life pilot or paramedic, and then Metallica came along, the Misfits, and some other stuff. I took a different path a little bit later in elementary.
One of those things was Flight for Life Colorado landed a helicopter at my elementary school and we got to walk around it and meet some of the paramedics. I thought it was super cool. I grew up in the era of, just to date me a little bit, this probably wasn't around when you were a kid, but Rescue 911 was the largest TV show that there was. I think it was a very cool guy type of career at that point, but I'm still super intrigued by that. I want to dive into that and what you're doing there and how you got started in that as well.
Flights, if you ask any new grad paramedic or new grad nurse, not exclusively, there are people that legitimately don't want to do it, but a large percentage will say, "I want to be a flight nurse" or "I want to be a flight paramedic," just because it's super cool.
Just spending the time in the helicopter. I've been lucky in some rock and roll situations, on some photo shoots dealing with some helicopters and movie sets, and being able to be in. Some of the military stuff that I've done, I'm still fascinated by them.
It's super cool. We all take pictures of ourselves. You think I'm too cool for this. No. We still all think it's cool. The second you think it's not cool what you do, it's time to retire. Through that, it's very sought after. To get on flights, you have to do and demonstrate a lot to get there. The first level of that is just making sure you have the basic certification.
For us, we require at least 5 years of experience in a busy 911 system for the paramedic, or at least 5 years of experience in the ICU as a nurse before you're even considered to be allowed to apply. You need to get your board certification in critical care. I have my FPC or Flight Paramedic Certification, which is a board cert for critical care and aviation medicine essentially. I get that you have to collect a bunch of other alphabet soup certifications here and there just to make sure you have them to just even be eligible to submit your application.
The reality is you need about ten years before they're even going to consider you. You need to demonstrate a lot of stuff. The thing about EMS is that it's a small community. If you apply somewhere, the first thing they do is call their connection at this whatever region, they're going to call their connection, and you're going to find out references. You have the legal reference, which you're not allowed to ask anything, and then you have the actual reference that happens. It's like, "Sam applied for this position. What was he like when he was your partner on the ambulance?" All it takes is somebody to be like, "I hated him," and you're done.
I knew I wanted to do that. I was in this training role at my EMS agency. I wasn't loving it. I was in middle management. There was not a whole lot to love about being middle management in a large system. It's freaking hard. I applied for Flights. I didn't get it the first time I applied. I applied for our base down south in Colorado. About a year later, another position opened up and I applied for a base close to where we were. I think through my application process. There are probably 50 to 100 other applicants, all phenomenal paramedics.
For one position?
We had two positions, but it's tough. You go through simulation training. We had two doctors watching us do it that were our medical directors. We had the chief flight nurse. We had all of these people watching you go through three sets of interviews you do, like your written test. They vet you up and down. I don't know what happened. I don't know who I was up against. I know there were some experienced people in there and I somehow got it. Flights breaking into it is the hardest part because everybody wants somebody with flight experience. Usually speaking, if you're against somebody with flight experience and you're new, you better have something special to break into the field. Magically, me and one of my friends got this position up here.
I'd be out right away. I'm glad I didn't pick it as a career because I'm too big for it. It's a compact area that you guys are working in.
We have a weight limit. With helmet, night vision goggles, full flight suit boots, and everything in your pockets, you have to be under 230. We weigh in every month, and if you're over 230 with all of that stuff on, they cut you from flight line right away, instantly. They give you six months to get your shit in order, but there's no mercy. It makes sense because if you're heavy, that limits the patients.
You have to pick and choose. Is there a weight limit on a patient that you can pick up, too?
We have weight limits every day, depending on temperature, aircraft capability, and crew because the pilot enters all of our weights in the computer in the morning.
Lots of sciences where you're going if you're flying in the 14,000-foot peaks.
How much fuel do you have? All of that. Generally speaking, because of our weight restrictions and the airframe we fly, we can usually pick up between 300 and 400-pound patients.
You can pick me up then. Thank goodness.
It's not comfortable.
Please don't pick me up.
It's like reverse engineering the Pillsbury cans of biscuits. You're trying to close the door. You're like, "Push this here, we're there," but they fit. When you get hired, you quickly realize, "I made it. I'm here. I'm a hotshot. I know everything." You start going through their six-month orientation process and you're like, "I know nothing. I've been doing this job for ten freaking years and I am a freaking idiot compared to these people." That was a huge wake-up call because now you're learning this whole other side to medicine.
When you get hired, you think, "I made it. I'm here. I'm a hotshot. I know everything." And then you go start going through the six-month orientation process, and you're like, "I know nothing."
That had to sharpen your skills drastically, especially on the SWAT side of stuff, too. How much more stuff do you know? If you're getting picked up in a helicopter, and correct me if I'm wrong, or MedEvac from rotary air winged, you're in bad shape. It's critical care.
Our capabilities expand on the helicopter compared to what a ground service can do. We have these cool interventions on the ground, but then you get more of it. 1) My base is a team of 14 of us. There are 7 nurses and 7 paramedics. We are a very small group. We train every month with our physician advisor. We have continued education all the time. We get things like we're doing chest tubes, finger thoracotomies, cutting somebody's chest open, sticking your finger, to expand their lung. We have blood products on board, so we're doing transfusions. We can run laboratory values in the aircraft. We can draw your blood and run arterial blood gases in the helicopter. We've got a ton more meds.
That information is being sent to the hospital wherever they're going, so they can get ahead of that as well?
No, we get it, so it's all us so that we can relate, and then we can treat most of the things we find. We also have IV pumps and ventilators. That's what critical care medicine is. It goes from being a low-level ER in an ambulance to being an ICU room. Going into more prolonged management and optimizing your patients. That can be everything from your scene call. The motorcyclist that goes off the ledge and you give them a blood transfusion and intubate them to the ICU patient with fifteen drips going. They're on a balloon pump or ECMO. They're intubated. They've got tough fence settings. Those are the two extremes we do. We both do the inner facility transport as well as the scene flights.
I didn't realize that much went into that happening while you're in flight.
I remember I was listening to one of your other episodes with a young lady.
Please tell me I got something wrong.
No, you didn't. It was interesting to hear because part of the channel that I run is teaching people about this because we are predominantly a silent professional community. You don't know what are the capabilities of that helicopter that's coming for me. You had your nephew bit by a rattlesnake, right?
I was living in California still, but I was here at work. I was born and raised right here and all my family was here. The industry that I'm in, you work some long hours and long days. I've seen some tragedy happening on the job site. That's another reason for me to upgrade my medical stuff. It's not the safest job out there. Everything's big and heavy. There's equipment moving around. People are working on little sleep sometimes, so long days. I had a small window of time and I wanted to get up here and go for a hike. Most of my family lives up here in the mountains, or Georgetown, or even further on the Western slope. They're spread all over. They were all eager to see me because I hadn't seen them in a while.
Growing up here, I specifically don't go to Morrison, the closest that you'll find me to go recreate. Morrison is at Red Rocks to catch a concert. It was right after the Broncos won Super Bowl 50, so it was the NFL kickoff. It had to be late summer. The reason why don't is, growing up here and with all the generations here, there are too many rattlesnakes. We don't want to deal with it. I've had family members that have been bitten more than once and it's a pretty common thing that happens here. You can probably attest to that.
Anyways, there wasn't a whole lot of time. We had a small window. I was like, "I just want to get out in nature," because I was living in California at the time and was working a lot, so I was like, "Why don't we meet somewhere?" Somebody suggested, "Let's go to Waterton Canyon.” We even brought up, "We probably have to deal with snakes." We knew Waterton Canyon Road is like a fire road that goes up there, but it's gated off. Only EMS can get up to it, whatever division of wildlife or whoever needs to go in and out of there.
It's a pretty good road. We had a lot of young cousins and kids with us, and we made it maybe 2 miles up and we were being conscious. We're like, "Don't go in the deep grass," because kids are curious. Normally, up here, we just free reign, like go figure it out. There are common things that you need to watch out for up here, but if there's a large apex predator in the area, you want to pay attention, but that's very seldom. It's just being aware of your surroundings.
We were trying to do that, and we got up to about a mile and a half up there or a mile and there was a public restroom. We went over to that because somebody had to use the restroom. Of course, there's 15 or 20 of us out there and half of them are kids. Not even in the deep grass, one of my nephews picked up a baby rattler or a small rattler. When he picked it up, it bit him around the thumb three times. Right away, he started crying and I saw something hanging off of his thumb. I was like, "This is not good. That's a rattlesnake."
My brother stomped on it because it was striking at the other kids that were around it. Instantly, I was like, "We are so far from the parking lot right now. I'm going to get him to the parking lot." I said, "Somebody dial 911. I'm going to run to the parking lot." I don't run very fast. I'm a big guy. I'm trying to get under a ten-minute mile right now, but I Carl Lewised it down there with him. He was in good spirits. He thought it was fun. He's just a little kid, so he didn't realize what was going on.
They forgot about that pain so quickly.
I didn't think about how much time that we had, so they called it in. Let's say I made it down there in 4 or 5 minutes. It's all downhill and I was hauling ass. I was sprinting as fast as a fat guy could sprint with this kid. By the time I got to the parking lot, probably 5 or 6 minutes, fire and rescue, I think it was West Metro there that pulled in. They were awesome. They were right off the truck, basically waiting for me in the parking lot by the time I got there. They were there pretty quick.
An ambulance showed up maybe a minute later. Right away, the firefighter that took and started administering care started Sharpieing him. By this time, my brother showed up with the snake. That's something I forgot to bring up in that episode. Basically, if you can get the dead snake or whatever so they can identify it, you're supposed to bring it with you.
You don't have a bunch of different species in Colorado.
This was a Pygmy rattler or something.
If you're in the wild and you get bit, they recommend not getting the snake because they don't want somebody to go up and get bit. If the snake is dead, if that happened, you killed it, fine. Why not? This isn't Australia where you're like, "Which one of the ten venomous snakes could this be?" It's a rattlesnake. Unless you're at some exotic reptile show and you get bit by some king cobra.
There were all these urban legends in myths that were totally debunked by going through this and learning about it. Anyways, we handed him off to the firefighters. My sister had called. By this time, she was in the parking lot, so she was the one that called 911. It was her son. We got down there and the firefighter said to me, "I'm going to call for air support. Are you okay with that?" I was like, "Do whatever. You're the professional. Yes. Do it." Probably within five minutes of being in that parking lot, they landed a helicopter and transferred him from the ambulance to the helicopter. My sister got to fly with them and they flew him to Children's.
The whole time, he seemed pretty all right. By the time I went down to go visit him at the hospital that same day, by the time we got down there and got everybody back to where they needed to go, his thumb was swollen up huge like a balloon and it started turning black. They Sharpied all over his arm. I'm sure you know all about this, but I don't know what I did wrong or right in that, so I'd love some critiquing. I've told the story multiple times on the show, so I'm sorry if you listened to it again.
The thing is, I try not to backseat quarterback. In a constructive manner, you didn't do anything wrong. That's the thing. Getting care quick. Kids are portable. I teach pediatric advanced life support. That's the thing I tell people, "Kids are portable. If you can get them somewhere where you don't have to have search and rescue for three hours hiking up to you, freaking awesome."
Running to the parking lot's great. The point I wanted to bring up in that story and what a lot of people don't know is the reason they call a helicopter for rattlesnake bites. We're auto-dispatched in Northern Colorado to any rattlesnake bite. Regardless of where it's at, who it is, age of the patient, we are auto-dispatched because we carry CroFab.
The reason they call a helicopter for rattlesnake bites is because they carry CroFab on the helicopter, where ground EMS crews don’t.
We carry the anti-venom on the helicopter, where an EMS crew doesn't. We can go assess, "Is it a dry bite? Is it a wet bite?" Rattlesnakes don't always release their venom when they bite somebody. A lot of times, they'll hold that back because it's hard for them to make it. It takes time. That's how they get prey, so they don't want to give out their store, they just want to get somebody to get away. They're a defensive creature. They're not stalking humans. When a two-year-old reaches down and picks them up, that's when they bite
That's what's going to happen. I think if he hadn't picked it up, nothing would've even happened. It was so small. It was like the size of this Arrowhead or the Spearpoint and it was not big.
With that, they're able to administer that CroFab in flight if they deem it necessary and maybe not seeing what it looked like. It sounds like it was a wet bite, but if they're not seeing systemic changes, they might choose to wait on the CroFab. That's the big reason. It's because you can intervene with that on a helicopter where a standard ground ambulance couldn't.
That makes a lot more sense. That was pretty frightening for me, but he came out of it. He still had to go through a bunch of physical therapy and stuff. It's a serious thing that happens. It's not like you're just better after they give you the anti-venom. It deadens the tissue. There are all kinds of stuff he had to do.
There's vascular injury. Even if you're not going to die from it, you can lose digits or you can have all sorts of other things. We only hear the statistics about people dying. In 2022, the one fatality was a two-year-old that got bit. Not many people die from it, but it's the old and infirm and it's the super young.
I don't remember exactly where I heard this, and maybe you can debunk this. There's a main artery that runs out of your left hand from your ring finger all the way to your heart. Is that true?
Every vein in your body runs to your heart. Every vein is a direct line to your heart. Arteries are always pumping away from the heart, so that's the big difference. An artery is something pumping away and it's a high-pressure system. A vein is pumping towards your heart and it's a low-pressure system. It's a lot more passive. Maybe there's a larger artery in your ring finger. I've never heard in terms of that.
Somebody had told me that that's why you wear your wedding ring on your left hand. I could be totally wrong on that.
I would imagine your right and that's what the feeling was back in the day, but as far as I know, I don't think there's anything worse getting bit on your thumb versus your ring finger or anything like that.
He got bit on his right hand because he is right-handed. They were saying that potentially the venom could've went to his heart faster if it was on the left side for some reason. I don't know.
Potentially. The thing is the venom going to your heart isn't like the TV shows where, once the venom reaches his heart, he will die instantly. What we want to do is keep the spread of venom. I guess really quick for anybody tuning in for basic snake first aid. Never buy a suction kit. They're crap. Don't carry one isn't. They don’t work.
The old thing they taught us as a kid was to lacerate it and suck the poison out.
No, don't do that.
We had some older family members that were ready to do it. I was like, "No."
Those suction cups don't work, those de-venomers. They're still selling it at like REI and it drives me freaking crazy, but there's no data behind them.
I didn't even know there was a de-venomer.
The other one was like, "Tourniquet the limb.” Don't tourniquet the limb. The best thing you can do is keep their heart rate down, so you can splint the limb. Just keep from exerting themselves as much as possible.
You're not pumping blood.
Try not to move that arm too much there. There's a debate. I wouldn't raise the arm, but I just keep it level with the heart there and then go to definitive care. You can mark it with the Sharpie to see the progression. Write the time. You can see the progression of the swelling. It's not the end of the world if you don’t do that.
That's how they give the anti-venom. They chase it back?
We don't. We have set doses for weights on the number of vials we give, but when we do sometimes ghetto medicine. That’s what I call it. A Children's Hospital ICU doc might have a much more nuanced way that they like to do it, if that is the case, though I'm not aware of it.
There's a total misconception on here that, before I forget about it, I want to debunk, too, because the doctor told me this specifically while I was sitting in the room. I said, "It's a baby rattler. They don't know how to control their venom." He was like, "Yeah, that's BS. The smaller the snake, the smaller the amount of venom. It depends on how much you get injected into you." I think that there's a misconception that a baby rattler can kill you because it doesn't know how to control its venom.
I heard that. I did a rattlesnake video and I said something like that in there and I got wrecked right away. I'm trying to remember exactly what they said, but essentially you're right. That's a myth. Baby rattler will give you less venom. I don't think there's a difference in dry bite versus wet bite between an adult and a baby. I don't know. Neither one's good but if you're small, it can kill you.
There's no difference in dry bite versus wet bite between an adult and a baby. Neither one's good. Both, if you're small, can kill you.
Especially for kids.
Kids are the big one.
They're the most common to get bit.
You and I could probably get bit right on the jugular. We would feel absolute shit for a couple of days, but we would probably be okay without intervention.
One of my family members, when my grandfather was a kid, and it was right in Morrison or someplace. This is in 1940. He was playing Cowboys and Indians. He was five years old and he was crawling on his hands and knees in deep grass and got bit in the face by a rattler and lived with no medical attention. This was before anti-venom. It was just like, "I hope you make it, kid."
Rattlesnakes kill very few people. A very low number of people die of rattlesnakes. Rattlesnakes bite people all the freaking time, but it's not like the Black Mamba that bites you and you're dead. You're probably going to be okay.
That's a whole different thing. Before we dive off that, I'll come back to this. The most common rattlesnake bites, are they on the leg?
You can have the legs. The demographic that gets bit the most is males. I think it's between the ages of 17 and 24.
They're not after the old dudes.
It's because you're stupid in that age range. You're hiking with some girls and you're like, "There's a Rattler. I saw Crocodile Dundee do this." You go up and they're the ones that are going to try to catch it. They're the ones that are going to try to show off, "Hold my beer, watch this." A lot of those bites are arms because they're reaching for it, they're trying to capture it and you don't realize how far they can strike. In my experience, that's the biggest.
Most of the time, if you're walking on the trail, they're going to warn you. They've got the rattle for a reason. They're going to warn you. As long as you can back off, that's awesome. Where you have some issues is climbing rocks, they're on the trail, you got headphones in, and you walk right past them, they hit you in the ankle, or something like that.
Straight up, if you're in a rattlesnake country and you know you are, and it's the middle of summer when they're out, don't be stupid. Don't wear shorts and Tevas or whatever else. I don't even know if Tevas are still a thing.
Be aware of what you do. I trail and run a lot. If I'm on the road, I'll listen to music all day long, but the second I'm on a trail, I take my headphones out because rattlesnakes, mountain lions, and even mountain bikes coming up behind you, you have to be aware of what's going on.
With the advancement of technology, people are missing nature for what it actually is. It's awesome to have that awesome photo or to put it on your Instagram, "Look at me at Hanging Lake." I urge people to do that for the connection process. There's nothing better than that. One of my favorite things to do is get up early in the morning, especially during the summer. I start rocking a lot to get in shape for elk hunting and go out.
I'm super fortunate. I have a 3D archery range that I'm a private member at American Bowman. I'll go up there a couple of times a week and that's 4 to 5 miles. Just that peace, there's no cell phone connection or anything, so I know my phone's not going to ring. I get so much out of that. I urge people to honestly connect with it when you are in it. Don't bring your JBL speaker and ruin it for everybody.
I hate those people. It drives me insane. If you're going to listen to music, you can get the ones in front of your ear that project it back so you still have some situational awareness and stuff. I'm with you. This is way on a tangent. I'm a relatively new father. I've found these last couple of years that running's my escape and meditation. I love going out to the trail and being by myself. Not with my wife and friends, I just like being by myself on the trail in the middle of nowhere with nothing. That's amazing. I'd highly recommend anybody that lives in Colorado to go experience some trails with nothing if you can.
Don't be scared of rattlesnakes. Just be aware of it. Don't wear headphones. If it were me, I'd be wearing pants or boots, and/or both if I know I'm going into some place that. Spider bites. Is that a big thing?
No. You got black widows and brown recluses are the two big ones.
You don’t want aftercare. It's not life-threatening when you get bit.
Brown recluse, not so much life-threatening. Black widows can be. I'm not entirely sure. I've never seen a black widow bite in Colorado. I've seen one brown recluse because it came in a transient's luggage and bit him on the foot when he was hopping trains to get over here. Old school transient stuff, but that's the only spider bite I've ever seen. Those will create a keloid scar. They get big and nasty looking, but it's not that immediate life threat.
It's like a couple of days.
It takes time. Usually, you don't even realize it happened. Your black widows can be life-threatening, but even so, I don't think they're hugely concentrated in Colorado. You see them a lot more in the Midwest in the musty basements.
A lot of people get bit in the hands reaching behind something. I'm conscious of that even in my garage over the winter. You get a little nest or whatever. Don't go reaching for your cornhole set that's behind the freezer.
It's not a huge thing, though. It's one of those things like rattlesnake bites and shark bites. It's overblown because you hear about it when it happens, but you don't realize that there are billions of people on this planet and that doesn't happen that often.
In your air wing, are you guys doing a lot of search and rescue, too? Are you guys doing a lot of rescue types?
We have a mission profile. We call it a search and assist. What that means is that the local search and rescue groups can call us and they can call us for a search and assist where we will go and we can search coordinates for them from the air. We can look out. Especially at night, we all fly with night vision goggles, so if somebody even has a cell phone light and you're in the ray wall wilderness, you can see that cell phone light from miles under night vision goggles.
PrepMedic: We have a mission profile called search-and-assist. What that means is that the local search and rescue groups can call us for a search-and-assist and we search coordinates for them from the air.
We'll do a lot of those for them. We also do lift ticket rides. We train all the SAR members, including their dogs where they get this lift ticket and we can land at their headquarters. Let's say you have a kid that wandered away from camp. We can pick up rescue techs, load them in our helicopter with their stokes basket and other equipment, and we will fly them to the scene to cut down that drive time for them.
We've had Alpine Search and Rescue on. With the influx of people that live in Colorado now, I-70's a parking lot. Most of these search and rescue situations end up in the mountains. Getting west on I-70 sometimes is they use helicopters a lot.
They love it because our search and rescue team is a volunteer team. A lot of them are exceptional people, but their daily job is they're accountants. One works for OtterBox. You've got a couple of true past bad-asses. We've got a PJ on the team and a Navy SEAL on the team, but they're just normal people. They do this to support their community and do something cool that got the ordinary.
It's super awesome.
It's amazing, but then they're like, "There's an opportunity for you to get in a helicopter."
They'd be calling a helicopter for everyone.
To the point where in our county, the team is led by full-time people that they work for emergency services or the sheriff's office, and they coordinate everything. It's to the point where they look at them and they're like, "No, we're not calling a helicopter. It's just somebody lost on this well-known trail, go find them. We're not calling a helicopter." I'm always like, "No. Call a helicopter. I want to fly into the mountains."
We'll do that. We had that one summer It was one of my all-time favorite scene calls we've done. There was a hunter way back in the wilderness. He did one of a drop camp outfitter where they horse-backed him and his two buddies. They set up a pretty decent camp for him in the middle of nowhere BLM land or something. They then left him. They're like, "You're going to be here for two weeks. Here are your provisions. Go bring forth an elk."
Honestly, when I was looking, I was like, "This seems cool. Nobody's bothering me. We can just do whatever we want." They were split up for the day and the one hunter was like, "I feel lightheaded. He started to have chest pain and it was radiating down his arm and up into his jaw. He was like, I feel like I've read these symptoms are bad. He had his rifle. He shot it three times, which is the international distress. It's three shots in rapid succession because chances are in any big game hunt, you're never going to hear that.
It’s 1 or 2 shots, maybe.
Three shots, rapid succession, is when somebody's in distress. I cannot advocate for these enough. He had a Garmin inReach on him
This was my next question for you.
I've seen so many lives saved by Garmin inReach. Maybe there's other stuff out there, but it is so cool because you get the location right away. They're in contact with local authorities right away. There is a third service, but it's quick to connect you to help.
So many lives have been saved by Garmin. It’s so cool because you get the location, and they're in contact with local authorities right away. It's quick to connect you with help.
That's what I was wondering because I had one as soon as we started going backcountry with the kids. Now, I take it everywhere with me. Even if we're just going on a day fishing trip, I know that we're not going to have cell service, I have it. It's nothing to carry. All I have to do is make sure it's charged and make sure that I have the service plan, which I just pay for. I up it to the unlimited. That's mainly for my own greed, so I can text whoever I want.
It's helped me text an outfitter like, "I got an elk down. It's hot as hell. Can you bring some horses, so we can get this thing out of here so it doesn't spoil? I've had a family emergency where I was at 14,000 feet and somebody texted me I had a family member pass. I was spiked out. I wasn't planning on coming out for three days, but I was able to pack up camp, get back, and support the family during that situation.
Mainly, I bought it for the SOS feature for my kids, but I've never had to use it. I was wondering how well does that work? I'm a big advocate for it. I'm also a big advocate for not relying on it because it is a battery life type thing. I have two external chargers that I'll carry the weight in my backpack just for that sheer fact, especially if the kids are with me. First and foremost, I always make sure that I have a battery backup.
As a disclaimer, I think that anybody that's entering the backcountry, whether you know the area or not, should have some basic navigation skills. There are a ton of schools here that can teach you that in an afternoon. How to shoot an azimuth, use a compass, and have a map. I always carry a map and a compass in my backpack of whatever area I'm in. There are a ton of great maps out there. You can pick up down the street here at Boone Mountain Sports. You don't have to go to REI. There are no excuses.
A lot of the trailheads that you go into in the open space, they have a little map that's for that area. Grab one of those and throw it in your pack. You never know. Especially if you're communicating with EMS, if you can give them better coordinates, geological features, or topo map and pinpoint where you're at, that cuts down on time.
It does. It's great, but it's a tool in the toolbox. With a Garmin inReach, you hit it and people think the military's right there. Everybody's right there to your rescue. Honestly, we get a search and rescue page. If you're in a relatively well-traveled path right outside the city limits of Fort Collins, it's still going to take search and rescue an hour plus to get to you. This is not things happen instantly. People are sprinting up the trail instantly. These are volunteers. They're coming from their work, they get their truck, they get to where the trailhead is and they have a meeting that they're going up. Maybe they'll get dispatched as a helicopter search and assist. You have to be able to take care of yourself for a period of time.
Be your own first responder. It's huge. That's one of my goals. I'd love to come learn from you. I don't know if you do any classes or anything like that.
For you, I will do a class.
I fucking need to do it. I've been preaching about it on the show and had the opportunity to do a wilderness first responder, but I don't have seven days to go spin. I'd love to learn the basics from somebody you. It would be amazing. I'm going to take you up on that. I'm sorry. Where were we going with the inReach?
This hunter back there is having a heart attack. This is something I should specify. A heart attack is not cardiac arrest. Heart attack is a blocked artery in your heart where it causes your heart to lose oxygen.
I want to dive into all that, if you’re cool.
We're fine. Cardiac arrest is when you actually die. You go into a lethal arrhythmia and your heart's no longer pumping blood. Two separate things. It's one of my pet peeves in the media when they had a heart attack. With that, this guy's having a heart attack, hits his Garmin inReach, shoots three times, and his hunter buddies come to him. Basically, he's so far back. It's going to be three hours by ground to get to him. We get dispatched to give SAR a lift ticket. We pick up one of our special operations medics on the TEMS team. We pick up a rescue tech. I boot a nurse off the helicopter because we need to go with whoever has more experience in the backcountry you get to ride.
We then fly up and we basically do all of this MacGyvering and we're at 12,000 feet land on the top of this mountain and we know this hunter's a mile below us. I love hiking. I love hiking on the job too. We get all our kit and everything. We go out and we hike down to this guy, run an EKG, and sure shit, he's having a massive heart attack, which this is something that is low survival. You have a high chance of going into cardiac arrest with this. That's with rapid transport to the hospital.
We're like, "This guy is 280 pounds. He's on the side of this cliff face. It's going to be three hours before SAR can get to the base of this trailhead, and then they have to hike seven miles up to this guy, put him in a stokes basket, get it down" or "we have to get him a mile up to the helicopter to get him off the top of the mountain." It's a huge problem-solving thing. I don't want anybody thinking this more, but I love this kind of thing. This is why I do this job.
We're there and we get down like, "Yeah, you're having a heart attack." We start some interventions, hang some heparin, aspirin, and nitro, all of that good stuff. It's sitting there. We're like, "Let's see if we can get up to the top of the mountain while our helicopter pilot calls and he's like, "We're getting weathered out. We've got weather moving in and I can't stay on top of this mountain. Are you good?" It flies away. Now, we're on the top of this mountain by ourselves. In the state of Colorado, the only hoist-capable aircraft we have, so sending somebody down on the line, picking somebody up is the National Guard.
Black Hawks.
They have a five-hour deployment time, so we call them. We had called them before just to get them spooling, but they're like, "ETA, three and a half hours, and that's being generous." We're like, "We're going to be here for a while." We're chilling with this dude. His friends are like, "Can we go pack up camp?" We're like, "No." We're coming up with the excuses. The real reason we want there is we want them to be able to do CPR when their friend dies. We're like, "No. Stay with this guy, please. Stay with us." There's three of us.
It's horrible, but it's a cool waiting game of managing this patient for hours, and then finally, we get search and rescue to us just as the Black Hawks calling and telling that they're 45 minutes out. We get them to the top, and we got to take a ride Black Hawk to the hospital, which I've never felt cooler. Landing in the parking lot of the hospital, having all the nurses come out and popping out the back of a Black Hawk with a dude having a massive STEMI. This is badass.
I'm sure he was appreciative. I'm sure he thought it was badass, too.
The crazy thing about him was that, we had been with him for almost three hours on the side of this mountain. That's not counting flight time back to the hospital. They get him over to cath lab. They move him to the cath lab table, cardiac arrest seconds after getting there. They defibrillated him and got him back. They did the stint and recovered. He was fine. It was literally seconds. If that had happened on the side of the mountain, he'd be dead. It's amazing how that worked out.
That's incredible.
Yeah.
That was partially because of a Garmin.
Yeah, that was it. When you do anything on the Garmin, even when you send a text message, it sends your coordinates with it. The in-between service, I cannot remember its name, basically put him in contact with ES, which is our Emergency Services. They were getting these live coordinate updates as they were going.
Anytime that you send a text, it sends coordinates with it. A family member or EMS can log in somewhere, and then you can set your Garmin up to every ten seconds it'll send a tracking point.
We were able to pinpoint. We knew right where he was. We were able to pull up Google Maps and our pilot was like, "Whether we can land here or here. This is the downhill hike. We know he's around here." The rescue tech, they have a lot more mountaineering experience than we do, so they're able to come in. It also helped that this special operations medic we were with, John, is a professional alpinist and he owned his own guided service and climbing service and stuff that are fucking badass.
Those are rope access and all that stuff. The training that they have is incredible.
John comes out and shoots with me. He has a background in film and the knowledge base he has, it's amazing. This is once again another tangent, but what's so cool is I'm pretty average within the flight industry. I'm not even the best paramedic at our base, and I will freely admit that, let alone the nation. I am amongst giants at work. We've got one of our pilots climbed Everest. I know some special forces dudes like Drew, he's a badass. I know these guys are badasses. Drew's just this happy smiley family man that you'd never fucking guess. I had to pry the story of Everest out of him to even hear about it.
My full-time partner, she's done the Leadville 100 a couple of times. We've got another ultra runner. We've got a semi-pro baseball player that's now semi-pro mountain biker. Freaking awesome people. Tangent aside, there's so many expertise there. Between John and this rescue tech, it made a huge difference in just locating us and getting down to him.
This isn't an advertisement for Garmin, either. I have no affiliation with them. I'd one if you're tuning to this, Garmin.
I wanted them to send me one of these watches and they're like crickets. I spent $1,200 on it. They won't give me crap.
No, they don't do much, but they have an outstanding product. It's super affordable. I can't urge you enough if you're to any sort of backcountry thing, even if it's only for 5 or 6 days a year. You're talking, there's about $300 or something.
They have a new one that's not even a screen. It just connects to your phone and it still is the SOS. I think it's less than $200.
The service is super cheap. The cheapest plan that they have is $10 a month to have service to this thing.
You can do it where you're not paying for it.
You can turn it all off when you want.
You're paying for it if you use it. If you're like, "It's winter, I'm not going anywhere." You can deactivate and not pay anything. I might be wrong about this, but I think it will always work in its emergency function. If you have no plan and you press the emergency button, I think it will always work.
Really?
I think so.
Between the app and my phone, I can still mark waypoints and everything because I do it elk hunting or scouting. I always have service on it when I go out, but I know that it does work. I've had it where it was deactivated service-wise and the map still works and it still is communicating with the satellite. I don't see why it wouldn't.
It's a great device. I'd recommend that. There are other ones too that will work as well. Garmin's just the one I know. I think there are other stuff out there.
There is other stuff out there. There's a spot device or something.
Spots are fine. We have one on the aircraft actually that if we're going to go hiking, we throw one on our vest so that we have it.
That's the texting feature. Garmin makes sat phones. They make Rinos like the walkie-talkie. I don't know what bandwidth it is or anything like that. I don't have any of that. The inReach is great for me because it's small, especially if you're a backpacker. It's the size of a coin. It's not very big. I guess since we dove into the wilderness and we're bringing up this now. What are some of the best practices for anybody that's in the backcountry for you guys to help find them besides an inReach? Some reflective material or some high-colored blanket. These are all things, but if we could go through the basics of something that makes your job easier.
Signaling devices are huge. Smoke is awesome for us, but it also depends on your environment because we'll go back Rawah Wilderness where you have nobody around from miles. It's easy to find a standalone light source or smoke. If you're lost near Evergreen, Colorado, where you've got campers and stuff, you can still be lost out here and not be that far. It's harder to pinpoint if this is some dude with a flashlight or this is a lost person. It depends on your environment.
The ability to make fire is big because smoke's great for us. It gives us wind direction. You can see it from miles away, at least during the day, and you're not relying on light. It's amazing. You can be dressed in full blaze orange and it's amazing what you can't see from a helicopter and how hidden people can be for that. High-vis clothing is excellent, but also it's not the be all end all.
If you have some flagging, you can put something bright orange. Buddy runs tough possum gear. He makes the survival scarf that's big in orange. You put it on top of a stick and you can wave it. We can see that movement a lot better. Signaling mirrors can be used. You get that flash of light in the aircraft, but it's only good if you have sunlight and it's not cloudy. If it's 1:00 in Colorado, good luck. It's cloudy and thunderstorm. You're not going to see anything. At night, any light source is huge. I was talking about MVGs, having a flashlight, this light on your phone works. We can see that. They're MVGs.
The flashlight on the phone or just the screen illuminated?
Screen illuminated might be a little bit harder, but you can see the flashlight. We've found people because they're holding up their light. Under MVGs, it amplifies any amount of light. If you have no ambient light, you can see it. Once again, that's so situational.
If you're going in the backcountry, I always plan, whether it's a day trip or not, that I'm going to spend the night. Flashlight, fire source, and med kit. I always carry an extra flashlight too, and I have spent a little bit of money on a flashlight for this very reason. If you get one of these SureFires, $100, you can get a crazy amount of lumens.
The other part of that is you're going to be found eventually. If you have any kind of communication, you're going to be found eventually. You can speed that up by letting your family know where you're going, your plan, and what time you'll check in with them. If they don't hear from you, they're not waiting two days to call search and rescue because that's where people turn up dead. Nobody knew they were going to this area. They're like, "I don't know. He was just going camping for a couple of days."
If you have any kind of communication, you're going to be found eventually. You can speed that up by letting your family know where you are—where you’re going, what your plan is, and what time you're going to check in with them.
The other thing is being prepared to spend that night. Some of that's what you're wearing. Most of our rescues are some idiots that decided to hike a mountain in blue jeans and some cotton shirt. It falls in the river and it's a nice 65 degrees during the day. Guess what? You're in the mountains, it's going to be 24 degrees that night and that's what kills you.
Weather can change this time of year, especially in the spring. It can go from being 70 to 24 in a hurry, especially if you're at elevation. Real fast.
I'm not a survival expert and I'm not going to pretend to be. I'm not search and rescue certified. We go with them. We hike. I've got some knowledge and we find them in the helicopter. The survival aspect isn't my main thing. I can tell you what we've found people with is bright color flagging, light sources of different kinds, fire, and then having a communication device. Just having those GPS coordinates, that's freaking easy. If you give me lat and longs, the pilot presses four buttons, puts them in his GPS, and the helicopter will fly us directly to where you are.
I think the new Apple phones and Apple watches have an SOS device on them, too but I don't know that it works without cell service. I would imagine.
I think it does. I think they're satellite-related because we got a hard fall alert and it's crazy. I had never experienced a dispatch based solely on a watch, but apparently, this watch sent, "This person took a hard fall. They were mountain biking." It sent us GPS and it spun up the cavalry. We had search and rescue going up. They called the helicopter. They called local fire. We did a grid search for this person that was never found. They were fine, I'm sure.
They got back on their bike and sped up.
I had an issue. I had an Apple watch that was a gift and a first generation, so I'm sure they might have fixed this. When I would go to work out in it or something, it would sometimes press the SOS and it would start dialing 911 and I was like, "Stop." I'm just doing pushups. I'm sure that technology has got to come along a little bit with it.
I actually thought about something just talking with Alpine Search and Rescue. That's what I love about this show. I've learned so much sitting at this table or the previous studio. Couple things. You can pick up some cards from them or you can print them out on their website. You throw it on the dash of your truck or vehicle, and it's basically an estimated time of where you're going. It's kind of a game plan. They're going to end up probably at the same parking lot that you're at. Having that bit of information will tell them a lot, or if law enforcement is like, "This truck's been parked here for five days," then people know.
They said the other biggest thing that they have issues with is lost kids and dressing kids in bright colors. The North Face camo rain jacket looks awesome on your kid, but be conscious. Dress them in some high-vis type stuff if you're going out in backcountry and stuff. That's one thing. I've applied those things. Those little practices, I think, help a lot or help them with their job a lot.
We had a rescue a while ago. It was a church group up in this wilderness area. This church group well-meaning, and they did this survival class. Their directions were like, "If you're lost at night, find a bush, hide under it." This poor kid leaves the group, goes down to wash up at the stream, and changes out of his blaze orange hoodie and gray pants. He washes himself up, changes into a camo hoodie and green pants, and can't find his way back up. He was fine. It was a happy ending. He got lost there and then followed their instructions.
We're low passing with the helicopter. We've got FLIRs out looking for heat signatures. We've got search and rescue and hasty teams walking up and down. The adults are all looking for him and stuff. This kid's doing exactly what he was told to do. He's hiding under a bush in camo clothing. It was another day before they found him.
Misinformation gets under my skin. I try not to speak on anything that I'm not educated in. That's why I have experts you in. Just educate yourself with somebody that has the knowledge. Don't tell somebody something if you don't genuinely know what to do. Don't lacerate a snake bite. Suck the venom out. Yes, that was standard practice back in 1962, but now that we've evolved, take the time.
That's one of the things I want to commend you on with your YouTube channel, PrepMedic. Definitely go check that out. There's so much valuable information on there. You're the only one that's doing it well. That's accredited. There are a ton of people out there that aren't accredited. I love the guys that have no tactical background or they weren't special operations. They have warrant SWAT or whatever, and they're giving all this tactical advice. Learn from the experts or take advice from the experts, and then figure out what works for you, too. If you got an entire group of kids in front of you and you're giving them information to hide if they get lost, that's the worst thing you can do.
It's so hard to vet people. Medicine is hard too. How I trained years ago when I went through paramedic school versus what our practice is now, I was trained blatantly wrong. We thought it was right at the time. To the best of our knowledge, it was right, but medicine changes from month to month and year to year. I need to go back through some of my older videos and make sure to call some information because things evolve and change. That PJ, the best of the best combat medic, they are the people to talk to about combat search and rescue. You have a PJ that was in twenty years ago, and you use that credential as, "This guy knows what they're talking about," mean well, but that doesn't mean that what they're saying is up to date.
It hasn't changed.
Things change. The recommendation on tourniquets changed. The recommendation on how we do bleeding control change. When I went through paramedic school, for example, we were teaching for bleeding control. They're like, "It was step-wise, so you have a major arterial laceration. You're going to take direct pressure. You're going to try that. If that doesn't work, then you're going to elevate the extremity. If that doesn't work, now you're going to put a pressure point on the brachial artery. If that doesn't work, now you're going to go to a tourniquet."
You could have gone to a tourniquet.
Now, you do have a potentially life-threatening bleed, put on a freaking tourniquet. Don't try anything else. Just put on a tourniquet. That drastic of a change. I still have people I'll publish something on tourniquets. They're like, "You didn't put that high in tight." I'm like, "The current recommendations are 2 to 3 inches above the wound."
This applies whether you're inner city or backcountry. There are seven things that I try to focus on. Part of the seven most common things were coming up with this show and seeing where our conversation would go, but more it's genuine greed. I came up with seven things that are the most common things that I would run across. When I started thinking about these, I was thinking about family members. I had a bow hunt with some of my uncles that are now in their 60s or getting close to their 60s. I have other family members that are in their 40s that go out with us in the backcountry and maybe they're not in the best shape. I'm not in the best shape I could be in. I'm trying.
As you get older, there's all kinds of stuff that can come up. I was thinking about my immediate family, kids, and everybody. Not so much self like what I am going to encounter, but what I might encounter with them in the activities that we do. Whether it's driving to the grocery store, going to the movie theater, going on a backpacking trip, going on a day hike, backcountry archery hunting, or hanging out at a family reunion, I tried to encompass all those. I think that this applies in the inner city.
Disclaimer here, for anybody that's tuning in, don't take my advice. Seek professional medical help if you're having a serious situation. Don't go back and drum up this show and be like, "What did he say there? I can treat this." No. You have to practice these things and this is one thing that I want to do. You can have all the tools. You can buy all the badass tourniquets, gauze, quick cloth, and all that stuff. If you don't know how to properly use it, it's just a pile of cloth or a strap with a plastic turn thing on it. You need to know how to use these things.
There's also a ton of people out there that put fear tactics into some of these things like tourniquets and stuff like, "If you put a tourniquet on, you're going to lose a limb." I've had family members say this. I want to go over some of those things with you. First and foremost, I think I picked this up from one of your videos that I watched a while ago. I truly wanted to educate myself better in this for multiple years and I still haven't done that well with it. I'm going to make time to do this. I publicly said it, now I have to do this. Call 911 right away if something's happening. That's the first thing. Get people that are better than you there to help.
Get them coming because they're not going to be there instantly. The faster you can get them spooled up, it takes time. It's a game of telephone. You call dispatch. Dispatch calls them. They have to get out of their recliners and get to their truck, then they have to get to you, then they have to find you. Start that early.
There's much more that goes on behind that. This is what I learned from your video. Whatever the situation is, they might send a paramedic over an EMT. They might send air support to get you out of a situation. Beyond that, it might be faster to get in your car and start driving to the hospital. But you should stay put because once you get in that ambulance if you're in cardiac arrest or having a heart attack, that might depend on what hospital they're taking you to.
I have a great family story about this. My aunt noticed that her husband was having a stroke. They were in Evergreen. She had that same thought. She's like, "By the time I call 911, get the ambulance here, we get him loaded up. I could have gotten him in this car, got him to the hospital, and been done with it." She didn't call 911. She put him in her car and drove to the hospital. The problem is not every hospital is a stroke facility. Also, unless you're talking about Anschutz, which is the big university hospital or Denver Health, these hospitals don't keep all of these specialists in their hospital at all times. They can't afford to. They're out on the golf course. They're at home with the family. They have to be called in.
A lot of hospitals don't keep all of these specialists in their hospital at all times because they can't afford to. So they're out on the golf course or at home with the family and have to be called in.
What happened was she got to the hospital. They were not a comprehensive stroke center. They couldn't treat him. They also didn't have their neuro dude in there, so they had to then call an ambulance to the hospital to load them in the ambulance and then drive them to a different hospital. If they had just called 911 right away, it would've taken longer than it took for her to drive there. However, they would've called a stroke alert ahead of time so that everybody would've been called into the hospital. They would've gone to the appropriate hospital.
They can call the doctors in, too. A lot of this shit happens at night, too.
We call trauma alerts, we get trauma surgeons in. We'll call cardiac alerts. We'll get our interventional cardiologists in. Stroke alerts, you'll get your neurologist in. These things preempt that. By the time you walk in the door, if we call a stroke alert, we don't go to an ER room. They've got a bed waiting in the hallway right outside of CT. We throw you to that bed and they CT your head within 30 seconds of arrival. The neurologist looks at it and goes, "This is an ischemic stroke." Gives you TPA, and then you can go about it. As opposed to, "We walked in the front door. They triage me. They go to the ER room. We're calling the neurologist in. We're getting the CT cleared because there's somebody else in it."
If anybody's ever walked into an ER room, good luck.
They try to prioritize these serious things, but it's not instantaneous, whereas you can set yourself up for success. That's my thing about ambulances. It's not just what they can do and it's not just the speed. They're not just ambulance drivers. They're doing other stuff. Sorry to derail you there, but call 911.
Thanks for sharing that because it's super important. Whether you're living in an inner city or whatever, I was trying to think of, "This could apply anywhere. These seven things." The first thing that I wanted to go over was arterial hemorrhage and bleeding control. What are the best practices? Obviously, a tourniquet. We were just talking about that a minute ago. There's this myth out there, I've heard it on both sides, and I'd love to hear it from you. If you tourniquet somebody and it's put on improperly or for too long, you have the chance of losing a limb. You do have the chance, but it's not as drastic as everybody thinks. There are some people out there that are saying, "If you apply a tourniquet, that person's going to lose their limb."
For best practices for bleeding control, we're talking about preventable causes of death, we're not necessarily talking about the most common causes of death. If you get shot in the head, that's going to kill you. Honestly, we're talking about things that you can intervene on the side of the road or the soldier can in the middle of Afghanistan or paramount. We're talking about preventable causes of death. One of those is arterial hemorrhage. Whether that's a gunshot wound or an accidental thing, you have an artery that's severed and let's say it's on the extremity.
Arms, legs, hands.
Bright red spurting blood or a lot of blood. Blood that's pooling under the person saturating a lot of clothes. If you feel like it is a life-threatening bleed, it is far better for you to intervene on it than to second guess yourself. A lot of times, we see tourniquets and things applied that aren't necessarily indicated, but it's way better to act and be wrong than not act and be wrong. If it's on an extremity, the best practice is to use a commercial tourniquet on that wound. Most common is going to be the CAT tourniquet.
If you feel like you have a life-threatening bleed, it is far better for you to intervene than to second-guess yourself.
Is this something that the general public can buy, too?
There are so many tangents. The DoD established the STOP THE BLEED campaign after Sandy Hook as an apolitical way to address lives lost in active shooting situations. Basically, they looked at it like, "What's killing people and what can we do?" Bleeding control was the big thing. I train civilians all the time to lay people to control bleeding. Anybody can do this. You're not going to go to jail. You're not going to get sued. You are protected under the Good Samaritan laws in almost every single state in the United States. If you go, you act, and you do a horrible job, you're still probably not going to be sued. I advise action.
With that, commercially available tourniquet, CAT tourniquet is the most common. There are a bunch of other ones that are CoTCCC recommended. That's the Committee for Tactical Combat Casualty Care. They look at what tourniquets work and what don't. That's your primary. If you don't have that, the current recommendation is not to try to do a makeshift tourniquet because that's what we've heard in the past.
Shoelaces or some bullshit like that.
Don't do shoelaces. It's too thin. You could try ripping up a shirt and putting a stick in there.
They want it to be a certain width.
You want it to be at least an inch wide because the wider it is, the lower the occlusion pressure is, which means the less pressure put on that, the less tissue damage you have, the less pain that patient's going to experience. If you don't have a commercially available tourniquet, the next step would be to do wound packing on that. That would be taking a tight-knit fabric, it can be your T-shirt, and finding where that artery is because that's what's spurting the blood.
Take that t-shirt, shove that in the wound as hard as you can up against that artery, and hold direct pressure for as long as you physically can. That's the next thing. Let's say that happens at a junctional site, so that's going to be your armpits, the base of your neck, or your groin. Those are called junctional sites and you have major arteries there. If you have a bleed there, it's straight to wound packing because the tourniquet can't get put on that high.
It can't wait. If you were to apply a tourniquet, what is the proper way?
To put on a tourniquet, essentially, the teaching used to be high and tight. It goes high on the arm as you can, tighten it down as tight as you can, and be done with it. Right now, the recommendation is, if I cut my arm and I've got this rolled up flannel, and you can see my cuts right here. Don't go high and tight, go 2 to 3 inches above that injury.
You're pointing at your forearm now.
Go 2 to 3 above that, and apply the tourniquet avoiding joints. If there's a joint in the way, just go a little bit above the joint. Don't put it over the elbow. It doesn't matter if it's the two bones in your arm or the one bone in your humerus. They used to think it mattered. It doesn't. The closer to the wound you can get with that tourniquet, the better. If you have somebody in the winter and they're bleeding like a stuck pig from the right arm, but you can't figure out exactly where it is right away, then that's where you'd go high and tight with the tourniquet.
If you have scissors, would you try to expose that and figure out where it's at?
If you can, you can put a tourniquet over clothes. What you and I are wearing right now, no issue whatsoever. You get the construction worker in the three layers of Carhartts and his coveralls, that might actually interfere with the tourniquet's ability to work. If you can expose it, do so. If you can't, just do your best over the clothes. It would be what's being taught right now with it.
If you have scissors, great. If you can, like they say in firefighting, try before you pry, don't cut the car up. If you can unzip their coat and take it off, unzip their coat and take it off. You don't have to cut it. It looks cooler if you cut it, but don't overcomplicate it. 2 to 3 inches above the wound. If you can't figure it out, just go high and tight in the arm, and then we can reassess that later.
About the myth of you putting a tourniquet on you losing the arm, that used to be the teaching. That's completely not based in fact because we didn't have vascular surgery back then. We didn't have the understanding about metabolic processes and aerobic respiration at the cellular level. Now, we know better. If you put a tourniquet on, we're never going to loosen it. Once you've applied that tourniquet, you keep that tourniquet on.
It's not in every fifteen minutes?
No.
I've heard that before. You're supposed to loosen it, and then re-tighten it.
All you're doing is you're putting them more into shock. You're busting clots that have already formed and you're hindering hemostasis. What happens is you have two kinds of cellular respiration. You have aerobic and anaerobic respiration. One is with oxygen and one is without oxygen. When you cut off oxygen to cells, they still try to respirate except they put out a lot of harmful byproducts.
Once you've applied that tourniquet, keep it on. If you loosen it and then re-tighten it or something, all you're doing is putting the patient more into shock. You're busting clots that have already formed, and you’re hindering hemostasis.
I'm way oversimplifying this, but they're putting out carbon dioxide, free radicals, and acids within your blood essentially. That's okay for a time. We get that when we run. We get lactic acid building up in your legs, you get muscle soreness, and it's okay. That's why you breathe faster to breathe off a lot of that CO2. When it's restricted in the arm for a long period of time, that metabolic waste builds up.
After a couple of hours, if I was to loosen that tourniquet without any other pharmacological intervention, all of that shit gets sent right to the heart and the heart puts you into cardiac arrest. It's not the end of the world. Keep it on. When they get to the hospital, you can have tourniquets on for four-plus hours and still have full limb recovery. There's going to be a process. You're going to be going through a lot of PT and there's going to be issues, but you're not getting that arm sawed up.
In a backcountry situation, if you know you're not going to get medical attention for four hours, would you recommend packing it over a tourniquet then?
That gets into tourniquet conversions, which I do have a video on. I guess that gets way more into the weeds of like, "We have a tourniquet on. We stopped the initial bleeding. Now, I'm going to pack that wound. Now, I'm going to loosen that tourniquet a little bit and see if we have hemostasis." It's complicated.
That's the next level.
Being four hours from rescue is rare. Maybe getting four hours from getting out of the backwoods is possible, but most of the time, somebody's going to be beside you that can do something. I think that's out of the scope of this because I think the initial intervention of the tourniquet's okay. If it's on over four hours, that's okay. We've had soldiers with them on way longer that have been completely fine. The key is don't take it off. Once it's on, you've made that decision. It is on.
Also, I think one of the biggest things that I've learned from this show is carrying a Sharpie in my med bag or backpack. One to mark a hunting tag or write a letter, but more importantly, if you get bit by a snake, you can mark the time of when it happened. Tourniquet, for sure. I think there's even a spot on the tourniquets where you can write in the date.
There is. You can write the date and time on the time strip of the tourniquet. These things are missed when you get to the ER. If somebody's being transported and they have a tourniquet in place, I'll write it on their forehead, "Tourniquet, 18:25." When they're cutting clothes off, they're not cutting through that tourniquet and now they've got a garden hose spraying in the face. Sharpie is a great idea. Essentially, you're not losing your arm because you put a tourniquet on. It's totally fine to have a tourniquet on for a long period of time before there's going to be an issue. It's also not like you might have some neurologic issues if it's on over that time, but you can still get good in recovering.
It's better than losing your life, though.
It really is.
You can go through post tourniquet. If it's bad enough that you actually need a tourniquet, then probably, there's a good chance you're going to lose your life from bleeding out.
Exactly. Don't be afraid of it. Don't be afraid of getting it wrong.
Get some training in it. If you own one, get some training in it.
STOP THE BLEED classes are most of the time free. Most fire departments and EMS agencies will offer a stop the bleed training.
Is that what you're doing now on dummies and stuff like that?
Bleed trainers or anything like that are super easy to find. There are a lot of civilian classes that cater to more CCW stuff where they'll teach you self-defense handguns, but then they'll also go through STOP THE BLEED through it. It's a common curriculum. You have to be a little careful of who your instructor is. You want somebody in the industry because pretty much anybody can become an instructor.
Those guys are found out pretty quickly and they get blasted. I'm not saying that you should look at YouTube comments, but if 90% of them are, "This guy's bullshit," stop listening to him. Unsubscribe.
In line with that, we're talking about junctional sites. These sites here goes straight to wound packing. Look at the wound, figure out where the most bleeding's coming from, and just pack the living crap out of it. It's painful. It doesn't look pretty. They will not like you in that moment, but just getting your t-shirt and shove it as chockful as you can.
Packing gauze is not that expensive. I think I spent $5 on this stuff that I buy. It's pretty high-end, it unspools, and it's not in the roll.
You can do two kinds of gauze. You can get the hemostatic impregnated gauze, which is a QuikClot gauze, Celox gauze, ChitoGauze.
They're more expensive.
It's $50 for a roll. It has a five-year shelf life on it, and then you can get your z-folded gauze, which is $2. Between those two, what we know is that the quick clock gauze stops bleeding a little bit faster. You don't have to hold pressure on it quite as long. With that, you save five minutes holding pressure, then you can wrap it with a compression bandage. With the other gauze that doesn't have hemostatic agent in it, you can hold it for at least fifteen minutes. What we know, though, is that survival rates downstream are identical between the two. Just because you're like, "I can't afford the best of the best." If you get that $2 thing of gauze or your t-shirt, it's not as good.
You can put together a med kit that's pretty good, cheaper than what you can go and buy a first aid kit for, honestly. That first aid kit is the band-aids, Neosporin, and shit in there that's for little abrasions or minor cuts.
It’s not life-saving. It's good to have because those inconveniences can ruin an elk hunt pretty quick, but they're not going to kill you. Now, things to avoid. The QuikClot powder. Don't buy powder. Powder is pretty much universally not done anymore where it was like pouring QuikClot into the wound. What we know is pressure is king, so applying that manual pressure is what's really stopping and keeping that pressure.
Also, I've been taught or told that if you have a huge laceration, maybe you fell onto a stick and it went through you and now you've extricated it from you. You could have a large pool of blood. You're supposed to try to get that excess blood out before you start putting in the gauze because it'll saturate the gauze.
This isn't the biggest thing ever, but if you have a pool of gauze, expose that a little bit. Do a finger sweep. If you have clots, try not to pull clots out of the wound because those are helping you. A big pool of blood, you can do a little finger sweep to try to get that out of the wound. In my experience, it's kind of a textbook thing. If you see a true arterial hemorrhage, it's like, holy crap. I know there's a video in Australia at one point where a guy is out of the bar and he gets stabbed in the neck. People were messaging me nonstop. They're like, "That guy's dead, right?" I'm like, "No, that's an arterial hemorrhage."
You're talking about every artery springing. That's an arterial hemorrhage.
That guy probably was going to be dead, but you could probably control that bleeding with good packing. That is mind-boggling because people don't understand what an arterial hemorrhage looks like until you see it.
That's something that's like the classic Hollywood military movie. There's always an arterial oil hemorrhage in one of those movies. I want to keep going on STOP THE BLEED, but going back to tourniquets, I had a couple of questions that came up. Is it one size fits all or is there a specific tourniquet for kids? Do they make a kid's tourniquet if you have little ones? What about infants?
Recommendations with kids is that, when you're a kid, your blood pressure is much lower, especially infants. Your blood pressure incrementally goes down with these kids. Generally speaking, children don't need tourniquets. Most kids, like 90% of grade school kids, are going to fit a CAT tourniquet. Those kids that can fit a tourniquet should have a tourniquet happening. If you have a kid that is too small for a CAT, which get very small. Right now, I believe the recommendation is you can just take a tight-pressure bandage. You can wrap that wound tight and it's going to do what you need it to do.
Almost like a rubber band?
Not necessarily a rubber band, but just like a tight ACE wrap. That kind of thing where you're wrapping it tight. If you cut off blood flow, that's fine, but they won't require the extreme measures that an adult would necessarily. If they fit the tourniquet, use the tourniquet.
Maybe six years old and up. I don't know if you could put an age limit on it. It's more size, right?
It's size based on the tourniquet. If you have kids and you have a tourniquet, put it on, and see, "Does it fit them? What's my plan B going to be for them?" That's going to work. Wound packing's going to be much more effective on children just because they don't have that required occlusion pressure to stop everything. A lot of people want to go to the RATS tourniquet, which I have feelings about, like we don't need to get it. There are tourniquets that market themselves for kids. I've never applied a tourniquet to a child. I've always been able to control bleeding with pressure wraps. There is stuff out there that will fit smaller arm sizes. With those kids, if it's too small down here, try going all the way up the arm because that's a little bit bigger. It really depends. Rates of arterial hemorrhage on these small kits are low, too.
We did extremity or limbs and then junctional sites. What about if it's in the chest cavity or an exposed head?
They need a trauma surgeon at that point. If you have a bullet wound to the head, obviously, don't pack anything into their skull because you don't want to push things into their brain. It sounds like I'm being dramatic, but you don't want to do that. With a head wound, people bleed like stuck pigs off their heads, even a small cut. It looks like they're very vascular.
That's why fighters bleed so much.
Not usually threatening, though. All you need to do because you've got a good bone backdrop there. If it's a laceration, it's bleeding a lot, just take a gloved hand or some gauze.
Cutman treatment. We've all seen it. If you're a UFC fan, you see it every fight.
You just put pressure on their head and it's going to stop. You don't need sutures. They'll need sutures eventually, but you don't need to consider that. All you have to do is put pressure, and it's going to stop. If it's a penetrating head injury, what I'd say is anything sticking out of somebody, don't remove it. RIP, Steve Irwin. They think that one of the reasons he died was because the stingray went in, punctured his heart, and when they pulled it out, left a little hole in his heart and he bled out.
That goes with arrows. Anything like following an arrow.
Don't pull it out. Keep it in because that might be occluding the artery. That might be giving you wound packing. You pull that out. I won't even pull it out as a flight paramedic. I'm going to stabilize that in place as much as possible and I'm going transport them, and then they're going to go to the OR table. They're not going to take it out in the er, they're going to put you under, and they're going to surgically remove that to make sure it's not doing any more damage.
With your head, there's only so much you can do. Honestly, if it's something where they have an impending airway issue, they're gurgle and blood, they're vomiting, putting them in the recovery position is great. Turning them on their side, you can put their arm under their head so their head's not going like that. People get scared of spinal injuries. They're like, "He fell." You have to prioritize your airway over the potential of a spinal injury. I don't want to excessively move that patient.
During medical emergencies, you have to prioritize the airway over the potential of a spinal injury.
Hold bleeding for that matter, too.
We have to prioritize that, so if you have to turn somebody on their side and you think they might have a spinal cord injury because they've got an airway compromise, turn them on their side. Let that fluid automatically drain out of their mouth. It gets their tongue out the back of their throat. Recovery position's big.
What about pass-through? Let's say it is a gunshot wound and it's in the lower extremities. Pretty good chance you have some pass-through. Are you still packing at that point? Are you packing from both ends?
People have a lot of questions about that. I can't say I've ever packed a wound channel that was seeing daylight on the other side where it's like I'm flossing them with the gauze.
Right, because the bullet goes in and it starts doing all kinds of crazy.
What I would say is you're not just packing down into the wounds. You're packing to where it's bleeding the most. If you've got a passthrough, it's not bleeding astronomically from every portion of that. It's going to be coming from 1 or 2 arteries.
You're going to be able to tell where it's coming from more than likely.
Hopefully. If you can pack to that point, and if you have to pack from both sides, do it. Basically, however, you accomplish that objective, do it. There's no magic sauce. I'd say a pass-through where you have a very known wound channel is rare.
The next one that I had on the list was CPR. That's super important to know. If you have little ones or around little ones, I encourage you to go do an infant CPR, too. You mentioned something at the beginning that without some outside intervention in a heart attack or cardiac arrest. That's the next thing on the list. Maybe we can just combine these two since they go hand-in-hand. What's the best way to go get CPR knowledge? Don't watch a YouTube video. I guess you could, but it's hands-on training.
CPR training is easy to get right now. You can get an AHA certification. Go in and get the old CPR card that we're used to seeing. Any healthcare provider will have that card, but what they're pushing now is this hands-only CPR, where fire departments will go out to a community event and they'll set up some mannequins. You can get certified in hands-only CPR, where they give you a five-minute spiel, show you the dummy, do a couple of rounds of CPR, and they're like, "Great job." You don't need a card. You're still covered under Good Samaritan.
That's as simple as it is. 1) Recognizing when somebody's in cardiac arrest. With adults, a very common cause is going to be your heart attack, where an artery is blocked in the heart. The heart doesn't like that ischemic insult. Their heart goes into a lethal arrhythmia. They fall down on the ground. Start to tap and shout. "Are you okay?"
What would be the first rule to identify what it is because we're talking about two different things?
They've taken out. For this hands-only CPR, you're not even checking for a pulse because that's hard to do. That's hard for healthcare providers to do, especially when somebody's shocky and down. When somebody goes down, tap and shout, pinch their traps, do something that's painful, not harmful. They don't respond to you. Are they breathing? Are they breathing effectively? You have somebody who gasp once in a 30-second period. That's an agonal respiration, not effective. If they're not breathing anymore, you call 911, get me an AED, and start CPR.
That's the first step.
You're not doing mouth-to-mouth. I don't do mouth-to-mouth. I'd do that on my child and that's about it. If I saw somebody go down in a grocery store, I'm going to start doing compressions. You're going to do compressions between 100 and 120 compressions a minute. If you're an optimist, it’s going to be the beat of Staying Alive. If you're a pessimist, it's going to be Another One Bites The Dust. You can do either song. Sing it in your head, not out loud. You're going to do compressions at least one-third the depth of the chest. You're going to do that for as long as you possibly can on a hard surface. Not in their bed. If you can't lay them down on a hard floor, and then get an AED. When that AED is attached, do what the AED tells you to do. It'll say, “Stop compressions. Analyze it.”
An AED is those things that are behind glass at the gym.
Automated External Defibrillator. Another misconception with CPR is CPR doesn't bring people back to life. CPR circulates a small percentage of blood through the heart into your body.
You're basically pumping the heart.
It's keeping the cells of your body alive. Your brain cells are starved of oxygen for any period of time. They're going to start dying. You can't get them back. Same with your heart. Your heart gives itself its own blood supply. Same with your kidneys. All of these organs need blood supply. What you're doing is you’re a delaying tactic until something can fix it. The things that are going to fix it, if it's an electrical arrhythmia, it's going to be that AED or defibrillation.
If your brain cells are starved of oxygen for any period of time, they're going to start dying, and you can't get them back.
If it's something else, that’s something that can happen in the cath lab for a heart attack. That's something that can happen in surgery, if it's trauma. All you're doing is delaying and you're keeping that alive until something else can be done. There are some rare cases, but you're not going to see somebody come back to life when you start CPR. They're going to stay dead and you need to do something else.
Recognizing it, tap, shout, “Are you okay?” You don't have to check for a pulse. Are they breathing effectively? Are they not breathing effectively? Start CPR. Let's say you were wrong. Let's say they weren't in cardiac arrest. They fainted. As they say in the South, “They done fell out.” They passed out. You start CPR and they're going to hate you. It's going to hurt. They're going to come back and be like, “My chest. Holy crap. You separated my ribs.” There are going to be no prolonged issues for them. There's no prolonged harm that occurs with CPR. Bleeding control is air on the side of caution because it's far better for you to intervene and turns out you were wrong, like some egg on your face. Arrive in the ambulance, and then when we're done, I'll talk some shit.
Heart attack comes before cardiac arrest.
Potentially. Heart attack is one potential cause of cardiac arrest. You have coronary arteries in your heart. Those are arteries that wrap around the heart. The heart’s a muscle. It needs O2. That's what gives the heart its own oxygen supply. The heart beats, sends the blood up the aorta, and then when the heart relaxes, some of that blood falls back down the aorta, goes into the coronary arteries, and peruses the heart. Those arteries are very small. You can have a clot in one of those arteries, and then there's no blood flow downstream.
You get what's called ischemia, which is lack of oxygen in the lower parts of the heart muscle. That is irritating to the heart. That part of the muscle can't beat well. You can go into V-Fib or V-Tach, which are two lethal arrhythmias where the heart's essentially sitting there and it's quivering, but it's not effectively beating. That's a heart attack. That heart attack can oftentimes lead to cardiac arrest, which cardiac arrest is that lethal arrhythmia where the heart's quivering or it has no movement or at rest. It's not beating at all. If you're doing CPR, it could be a heart attack. Not every heart attack is going to result in cardiac arrest. Not every cardiac arrest is a heart attack.
You could have a heart attack and still be conscious, right?
Yeah, it happens a lot.
Pain in the arm and shortness of breath. What are some ways to treat that? I carry baby aspirin in my med bag just for that very reason.
It's 324 milligrams. It's 481 milligrams tablets of baby aspirin.
You're supposed to chew it up, right?
That's called buccal absorption. With aspirin, it's not a blood thinner. It's an anti-platelet. It basically makes the platelets in your blood, which are part of the clotting response. You have this clot and it just makes them a little bit more slippery. You're trying not to grow that clot anymore or occlude more of the artery that's already there. You can do the four baby aspirin chewed up. You can get the PO absorption. When you swallow it, it's absorbed in your stomach and your intestine. That goes into circulation. You can get buccal absorption through the mucus membranes of your mouth, where it starts absorbing it right there and the action is a little bit faster, which is why we do baby aspirin instead of adult aspirin.
Disclaimer here. Don't give somebody aspirin if you're trying to stop the bleeding because it thins the blood.
In tactical medicine, we won't give anybody NSAIDs, so ibuprofen or aspirin as a pain reliever. In this case, if we're talking chest pain, they're complaining of chest pain radiating down their arm up into their jaw. They're nauseous, diaphoretic, sweating a lot, and pale. If I saw somebody like that, I don't need an EKG to tell you. They're having a freaking heart attack. That 324 of aspirin, sometimes people would be prescribed nitroglycerin, which is a vasodilator.
They prescribe it to high-risk heart attack people, I guess.
People with angina. They have this chest pain on movement and stuff. They have some atherosclerosis in their coronary arteries where if they'll move around, they'll get some chest pain. They take some nitro, it makes it better. If they're prescribed it for chest pain, you could assist them with their prescription. I'm not officially recommending this.
Just don't carry nitro.
No, don't give it out because there are so many other factors that go into that. If that person's taking erectile dysfunction meds and you give a spray of nitro, their blood pressure's going to burst. You have to be cautious, but if they have a prescription for it, you can help them administer it to themselves and go get it. Other than that, the biggest thing there is to limit exertion because the more they walk and move around, the more O2 demand they're going to have.
If you’re having a heart attack, limit exertion because the more you walk or move around, the higher the oxygen demand.
Don’t ask them to walk upstairs. Call that ambulance. Don't ask them to walk to the car.
Firefighters get trained to work out. Let them carry this person up the stairs. It's totally fine. Try to keep them calm. Call an ambulance because they can intervene en route if they go into cardiac arrest. They have defibrillators there. They can pre-notify the hospital and not every hospital can handle a heart attack. We call heart attacks STEMI. It's called an ST Elevation Myocardial Infarction, which is a sign that you see on an EKG to tell you that they're having a heart attack. You can tell what artery is blocked in the heart. They'll take one of those, and then they'll go to a facility that has a staffed cath lab. They know where that is. Don't take them to the wrong place because then you're going to get a nice helicopter ride from me going to a hospital that does have that capability.
While we're on this subject, and I don't have it on here. I feel it fits in, like strokes are around the same age range demographics. What should you do for immediate treatment for that? Obviously, dial 911.
The best thing you can do is recognize it and dial 911. We don't give aspirin in strokes because you have two kinds of strokes. You have an ischemic stroke, which is a clot, and yes, aspirin would probably benefit that group of people. You can also have a hemorrhagic stroke where something bursts in their head and you have this bleeding in the brain, in which case you're now giving them aspirin and you're making that bleeding worse.
I didn’t even think about that.
There's not much we can do pre-hospital for strokes.
It's mainly just identifying it and then seeking medical attention. Face paralysis. What are some of the other identifiers?
There are a bunch of acronyms. There's BFAS. Balance, you have somebody that has this sudden uncoordination. They're not able to stand. They're not able to balance on their own. You then have facial droops. They ask you to smile and one side of their face won't move with it. We have arm drift. Have them close their eyes, take their arms out in front of and count to ten. Sometimes, only one arm will come up. Sometimes one arm will come up, and then one arm will drift down. Sometimes they won't even be aware that one side of their body even exists.
Sound like a roadside.
It's very similar. S is speech slurring. You can't teach an old dog new tricks. Are they able to say things? A lot of times, you'll have this expressive aphasia where it's creepy because they will look at you and they will know what they're saying. You'll ask them a question and they'll be like, "Toaster oven house purple." You're like, "That doesn't make sense." In their mind, they're perceiving that they are communicating with you in English and they're saying random shit. You can have that. You can have speech slurring. You can have all of these other things.
Going through that quick stroke assessment to recognize a stroke. You can have mimics, but once again, all of these things, you can have Bell's Palsy is a common one where you'll have that facial droop. Rarely any other symptoms. Don't try to figure that out. Just call 911. Let somebody else figure that out. There are ways to recognize it, but that's nothing you have to worry about.
When these first responders show up, how important is it for you to do your job for them to be totally transparent if they've been using any sort of drugs, alcohol, or anything like that? People tend to like, it's the classic, "I had a couple of beers" or "No, I didn't do any drugs."
A couple of things that you have to understand is we are bound by privacy laws on there. You could have been completely toasted. You could have done a bunch of cocaine drunk, a bunch of alcohol, crashed your car, killed a family of five on the highway, and flat out admitted to me that you're fucked up. Unless that law enforcement officer heard me talking to you and overheard it, I can't then go to that law enforcement officer and say, "He's fucked up. You should book him for DUI." That's illegal. That is a HIPAA violation.
Your privacy extends to law enforcement. I will not disclose anything to them without a court-ordered subpoena of my medical report. With that, I'm not going to tell you that paramedics are never going to judge you. They shouldn't judge you, but we're all human. You tell them that, that's super important, and your privacy is still protected.
Your privacy extends to law enforcement.
How much does that help you do your job, whether you're administering medicine or treatment-wise?
It helps me differentiate, especially for strokes. Are you blitzed or are you having a medical emergency? I can't run your blood for blood alcohol. I'm not going to have you blow in a PBT or anything, so if you tell me that, "I've had five drinks." I might be a little bit slower to spool up that stroke team. It might save some resources there and vice versa. Just being honest. We're not here to judge you. Do your thing, but letting us know what's going on is important.
Moving on to the next one. Is there anything that we missed there?
No, I don't think so. That's a lot.
I think we went over bonus points. I've dealt with this personally. My youngest daughter had a severe anaphylactic allergic reaction. Now, I have to have an EpiPen with me wherever I go or I choose to have one with me. She also has asthma. On top of that, it's this compounding thing. Allergic reactions, especially if it's an obstructive airway, what's the best way to handle that situation?
Your hallmark is always going to be Epi, which, if you have reactions to anything, doctors are super quick to prescribe EpiPens. If you're prescribed an EpiPen, have that freaking EpiPen on you. Wherever you go, have it because there's an allergen.
You know what's great? Now, when you get an EpiPen, they actually give you a trainer with it. It's cool.
Have the EpiPen, know how to use it, and that is your hallmark of treatment. That is the only intervention that you're going to perform that's going to save lives. You could take 50 milligrams of Benadryl. That's not going to save your life. That's going to make the hives and itching a little bit better, but that's not going to increase survivability from an anaphylactic reaction. Getting that Epi on board is huge.
If you are stuck with an Epi, whether you're stuck with it or a family member, seek medical treatment because there are some after-effects that go along with that. Still call the ambulance and get the ambulance ride.
You can get rebound reactions when you have that Epi on board. You feel great things are better, and then in an hour, when that wears off, things get worse, and now you don't have an EpiPen. That's why you get two EpiPens so you can readminister for it. Still call 911. If you're older or if you have pre-known cardiac conditions, call an ambulance because that Epi is adrenaline. Epi is a naturally occurring hormone in the body and we know it as adrenaline, which speeds up your heart. It can give you tacky dysrhythmias, all kinds of things. Have an ambulance.
That takes care of that one. Also, I guess one of the things that I learned on here, which I thought was pretty cool that I never carried in my medical kit, is I carried a little tube of cake frosting, like a decorating frosting for people with low blood sugar diabetes. I've run across this twice being on a trail right here in open space where somebody's down on the trail get up to me and like, "What's going on?" They're either dehydrated or need a little bit of sugar. Is that something that you recommend?
You have to understand what you're dealing with for that. Hypoglycemia and diabetics, most of the time, they will know or their family will know what's going on. If that patient is totally unresponsive, don't put anything in their mouth because you're going to make them choke on it. Now, they've got an airway problem along with diabetes. If you have somebody that's they're hypoglycemic, they're confused. You find that alert bracelet and they're wandering around the path and they're confused. If you know they have diabetes, you can take some of that cake frosting or sugar or something and put it under their lip, between their gum and their lip or under their tongue. That goes back to that buccal absorption.
You just do a little bit at a time and it's going to take a while. It will take 20 minutes to an hour to get them back to a point, but that will start raising their blood sugar back to where it's supposed to be. That becomes an issue usually because if you take your insulin and you don't eat right afterwards, you misdose your insulin there. If you exerted yourself crazily and you haven't been eating enough as diabetic.
You don't even know that you have diabetes. It comes up.
It's possible. Generally speaking, though, when you're first diagnosed with diabetes, you're going to have crazy high blood sugars. That's how it's found. We oftentimes find it in kids where they're like, "They've been lethargic for the past two weeks." Check their blood sugar and it's 700. Usually, newly diagnosed diabetes will present with high because, in diabetes, you don't have the ability to make use of the sugar. You have the sugar in your bloodstream, but there's no way to get it into your cells. That's what insulin does. It unlocks the cells to bring the sugar into your cells to give them nutrients. If you're not taking insulin, your body's not creating insulin. You're going to have high blood sugar.
In diabetes, you don't have the ability to make use of the sugar. You have the sugar in your bloodstream, but there's no way to get it into your cells. What insulin does is unlock the cells to bring sugar into them to give them nutrients.
Is there something better to carry than cake frosting? It's basically sugar.
Honestly, do cake frosting because we have this glucose gel. It's nasty. It's so gross. It's this little thing and it's the same thing.
Is it the GU packets that they give the runners?
It's a GU packet, except worse. I think somebody was like, you know what, we don't want people eating this for fun, so we're going to make this lemon flavored. I swear I give that to people and they throw up all the time. I feel so bad. They're like, "I don't want more of this." It's like, "I'm sorry. Here's some more." A lot of times, diabetics will have glucagon, which is an intermuscular injection. I'm not saying do that for them, but family members are oftentimes trained in glucagon. It basically takes sugar stores from your liver and it's a little bit faster. It's an intermuscular injection that they might have on them. If somebody's there to that nose, they can use that. Look for the glucagon.
Dehydration. Pretty common.
Drink water and salt. It's super common. You can have a couple of different things. Salt keeps water in your bloodstream. It uses osmosis to attract stuff to you. With dehydration, drink water, drink some electrolytes. You can eat electrolytes too. If you got pretzels, you're getting electrolytes that way. I would say drink water if you're out for a day.
Those elements. Salt packets weigh nothing. I love them. They've sent me some free stuff. They're not a sponsor, but that stuff is incredible.
That's what I use for my runs and stuff. If you look at my hat afterward, it's filled with salt. With oral hydration, you don't need an IV. Oral hydration is very effective. Just take your time with it, drink slowly, drink enough water, and make sure you're hydrating. If your pee gets brown-looking, you need to drink a lot of freaking water.
Oral hydration is very effective. Just take your time with it and drink enough water slowly. Make sure you're hydrating.
It's okay to take bathroom breaks during a show as long as you're hydrated.
It is. We've never done that. What we're told on the SAR team is that we are supposed to carry a gallon of water per person per day, especially with any hiking, physical activity, and any hot weather, having a lot of water.
Backcountry, make sure that's the most important thing. Water source, filtration, clean water.
If you don't even want a filter, just get some iodine tablets. They weigh nothing. They are nothing. You don't even need the cancellation tablets. They just taste nasty, but if you have them, and then you can purify almost anything.
It's totally key. Especially if you're going out, make sure you go out with enough water and know where there's a water source at.
Just because water's running doesn't mean it's clean. There are arguments of these short-term rescues where you're severely dehydrated. Giardia is not going to kill you in a day. It's going to suck. If you can guarantee your rescue within a couple of days. I'm not recommending this, but I'm saying there is an argument to be made for drinking unfiltered water if that's all you have and you know it's going to be short-term. If you're talking about any long-term survival, that's a death sentence, don't freaking do it. You can do that, but just because the water's running over some moss doesn't mean that that water's clean. For all you know, there's a dead bear a mile upstream or some just kid pooped in the water and now you're getting that. Just because it's running doesn't mean it's clean.
The next thing on my list is splinting a large limb break. What's the most common practice for that?
Splinting is based on principle. You can splint joints or bones. When you're talking about a long bone, so radius ulna in your arm here, if I have a break anywhere on that, my goal with splinting is to stabilize the joint above that injury and the joint below that injury and that limits the movement of those bones. The reason we do that is we don't want those bones rubbing together. It prolongs healing. You can have vascular injuries. That way, it causes a lot of pain and you can have neuro deficits down the road. We want to stabilize that. It's going to help everything. With a long bone fracture joint above and below, try to keep those from moving and you're going to be golden.
For a joint issue, a dislocated wrist or something right on the joint, you stabilize the long bone above and below. If you have an elbow injury, I'm stabilizing my radius ulna and my humerus. That's my goal with that splinting. Understanding those two principles. What's cool about splinting is however you accomplish that, it's okay. Magazines curved around the arm are great.
Sticks, make sure you're padding it there. It's something you have to practice, and then you can get into doing slings and swaths for their arms and triangular bandages and stuff like that. I would say splinting is one of those things. Get somebody to go hands-on and train because it's not, it's great in the classroom. It's super easy, but when you're dealing with somebody in a lot of pain, figuring out how that works.
Knowing how to do it on a femoral bone is key because there are so many arteries in there.
The femur, we splint that differently. You can just splint it like that, but we do traction splints, which isn't something you're going to do as a layperson.
You're not going to have that on you. Not the typical person's going to carry that.
I took a NOLS class, and they taught us how to jury rig one and I wouldn't do it personally.
The last one I had on my list was snake bites. I think we covered that at the beginning. Go back and rewind if you're tuning in to this. One thing I didn't talk about that I just now thought of, what if you have a big hemorrhage and it's turning into a sack or something relieving that pressure?
Are you talking about compartment syndrome?
Yes.
You have some fibrous compartments in your arms. You can see it anywhere, but where you're going to see it a lot of times is your two bones, so the radius ulna and tib fib in your leg. Right in between those bones, you have this area. You can cause compartment syndrome, which you're going to see what crap
Can it happen in your chest, too?
You can get compartment syndrome in any body compartment, where it basically just have increased pressure.
It's basically internal bleeding and swelling.
It's multifactorial. The best thing you can do is recognize it. You can have the big symptoms. They call it the five P's, where it's pain out of proportion with the injury. They're like, "It is painful." You have palliation, so it looks pale. This is horrible. I don't even remember the rest. That pain out of proportion with the injury. There's nothing you're going to do with it except get them to a surgeon.
Swelling is multifactorial. The best thing you can do is recognize it.
You're like, "I thought my buddy was tougher than this. What's wrong with him?” Get him to the hospital because that might be compartment syndrome getting worse. It can happen with breaks, tourniquet applications, and relatively minor injuries. You can get in a lot of different situations burns. Ultimately, they're going to do sclerotomies in the ER. You're not going to be decompressing their skin or cutting or anything there. There's not much you are going to do in the field for it.
I want to bring this up. This isn't something that is very common. I had a close friend of mine's dad die from this. It was a culmination of things but an obstructed airway. Tracheotomy, is that something that's like, you need to know what you're doing? There's an old myth of you could take a ballpoint pen.
This is my current battle. I put out a video on surgical cricothyrotomy on my channel, not to tell people to do it, just for professionals to refresh them or have somebody understand what the procedure is. Everybody's like, "Cool, now I know how to do this on someone." I was like, "No. Stop." Obstructive airway or choking, know the Heimlich.
Choking. I didn't even think about that. That's probably the most.
That's what's going to cause it most of the time. An airway obstruction is going to be choking. The best thing you can do is do abdominal thrust, which used to be called the Heimlich. Now Dr. Heimlich's family wants royalties for it, so I'm not supposed to say Heimlich anymore.
Sue us. We got a lawyer next door.
With that, that's a fist above the belly button and doing a thrust in and up to the diaphragm causes increased thoracic pressure, which expels that object. The best thing you can do for those cases.
Children. Are you supposed to turn over on their back and then hit them?
Kids, you do five back blows, then you turn them over, do five compressions, and then turn over. Any BLS class or any CPR class you take should cover choking as well.
They should, yeah. If you can clear the airway too, it's important.
If you can see it and you can grab it, great. Never be like, "Maybe there's something in there and stick your finger in," because you might push that past and cause a lot of issues. Never a blind finger squeak, but if you see it, you can get it out. If they go down to the floor, they lose consciousness. Start CPR.
What do you think of these new pops up?
The D choker?
Yeah.
I need to get my hands on one.
They should be your next YouTube video.
I'm so afraid to do it, though. I saw them and my immediate thought was, "That's fucking dumb." Now, it's more and more. I'm like, "I don't know." I haven't seen enough literature on them to see, "Is this for real or a gimmick? I just don't know. Now, there is an argument to be said. Sometimes abdominal thrusts aren't going to work. I would always recommend going with the Heimlich first, but if you have one and they went unresponsive, you're going to do CPR until they're dead. May as well try it, I guess, would be my feeling. It's one more thing. You might be able to get that airway obstruction.
If you have one, I'll definitely try it.
I'm on the fence about it.
I think we've covered everything I want to cover in only three hours. What I'm building here at the mountainside is a bit of a community, so I'd love to have you back. I didn't expect to fit it all in here. We can dive off and talk about some normal stuff or not even medical stuff when you come back in this next time. I'm sure this is your identity now between YouTube and your profession. I'm sure at some points you're like, "I want to have a normal conversation." You can come in and do that. I'd love to have you up. We'll have a glass of whiskey or not, and just shoot the shit.
Thank you so much. I feel like we packed so much knowledge into this. I think what you're doing is so incredible. Definitely, go follow PrepMedic on YouTube. Your Instagram page is amazing. If you want to see some badass helicopter footage, there are some of your tactical medical stuff on there, too. The SWAT medic stuff. Really cool stuff you do. Awesome gear reviews on there. I need to do a deep dive on your YouTube channel and hammer up some of those numbers. You're welcome here anytime if there's anything that we can ever do for you.
I appreciate it.
I appreciate your time. I feel like this has been a super valuable episode, so thank you.
I'm glad to hear it.
Drop your Instagram handle.
It's @Prep_Medic. Somebody else got the other handle and they don't post anything and they won't respond to me. On YouTube, it's just PrepMedic. It should pop up pretty quick for you.
Definitely go give Sam and follow and support our first responders. Thank you to any first responders out there that are doing those jobs and you're welcome here anytime. Thanks.
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