In my overview of the 2015 Rangemaster Tactical Conference I said that I was focusing on “action based” blocks of instruction. Having taken time off to have yet another baby I wanted to use my time at the Tac Conference to gauge what I’m retaining, what I’m learning, what I’ve overlearned, what I need to work on and where I need to focus my training efforts going forward. It’s hard to do that without action-based assessments.

Karl Rehn and Caleb Causey’s Low Light Force-On-Force was not only an assessment of low light tactics but also incorporated medical scenarios. Being an EMT I was excited for the opportunity to practice and be assessed in some of the trauma skills I have been trained in but blessedly don’t have much opportunity to use.

I’d heard a lot about both Karl Rehn and Caleb Causey from other instructor friends but this was my first time meeting or training with either of them. Karl has extensive experience running force and force and Caleb is a veteran combat medic who now teaching civilians the principles of providing trauma care in hostile environments.

This would be a new experience for me. The few traumas due to violence I’ve responded to in my capacity as an EMT have all been secured prior to entry by law enforcement. The only potential criminals I’ve treated have been in handcuffs with a sheriff’s deputy standing over both of us. I’ve never had to provide both security and medical treatment or to pick priority between the two.

The class could only take 15 participants but we snuck a 16th under the door because he was a local officer who brought his own airsoft gear. The class opened with introductions and then Caleb asked how many of us carry medical gear with us everywhere we go. There were a few people who said they keep it in their car but as far as I could tell I was the only one who professed I carried it with me everywhere.

I don’t think Caleb believed me. He told me he wanted to see my bag and how I carried it and I welcomed him to do just that. In fact, I was hoping to get his take on my kit anyway to see if there was anything I needed to add or change. I can now proudly say that my med kit is Caleb Causey approved!

Karl ran the make up of the scenarios while Caleb ran the medical portions. All of the scenarios would be blind but with the same basic scene. The scene was set up as though there were a massive power outage. You were exiting your place of work into a parking garage that had automatic locks so you couldn’t retreat back into the building. Cell phones did not work and at the end of the parking garage was your car and the street. Karl would pull out a few people, take them aside and give them instructions, turn off the lights and the welcome the participants into the scene, usually in groups of threes. Injuries were indicated with strips and pieces of bright orange duck tape. Not all participants were armed and not every scenario was a fight or shooting scenario.

Those not involved as roll players were allowed to stand aside in a predetermined area in the room and watch but could not interfere in any way.

The first group of three walked into a pitch black room where four individuals were fighting. As soon as they came in, two of the individuals ran off and what was left was a man lying on the floor, unmoving, and a woman running around frantically screaming for help for her loved one.

Two of the participants had recently gone through a tactical combat medical class and while not entirely versed in the concept of triage, did quite well with their assessment and treatment of both the man on the floor and the woman who, it was later discovered, was shot in the chest.

The scenario brought up concepts like triage and focusing treatment on outcomes you can change and allocating resources and making advanced decisions about getting help vs staying and treating. When it came time to move the patients it became quite obvious to many that moving dead weight humans is a lot harder than most people anticipate and deciding to move someone vs calling in help may be an important advanced decision to make.

The next scenario had three individuals walking into an ambush. All three of them were shot–one in the upper thigh, one in the strong hand and one in the belly. Their med bag was stolen and they had to clear the area.

Had this scenario been real life it wouldn’t have boded well for any of them. None of them had medical training and clearing the room to find their med bag was difficult due to a lack of tactics and application of using lights and cover. When they did get their med bag they had to take the additional time to attempt to read the instructions on the back of packages on how to use the medical gear, all with injuries and while one of their participants bled to death. The scenario was ended early to walk through how it could have gone and to drive home the lessons of seeking training in medical skills and movement and off-hand shooting.

This scenario was designed to show the need for a security priority but also to use everyone for that means of security. We also talked about setting up a secured location where even the wounded can provide security and using cover and concealment.

When it came time for “my” scenario I was told that I’m walking to my car with my two friends. Neither of them have medical training and neither of them are armed but they both know that I’m armed. I sighed. I pretty much knew what was coming.

I was told my med kit was in the car and we were sent into the room.

Right away one of my companions blasts out ahead of us to “the car” while myself and my other companion are taking our time. Just about the time we come to our first corner, I hear her get into a tussle. She’s yelling, and there’s some popping from the airsoft guns and I push my companion behind me and into a nook behind cover, turn off my flashlight and draw my gun.

I hear, “Oh Shit,” ring out from the darkness.

It’s completely dark for a few moments. There’s no sound and no movement and I’m trying to take some time to think about what to do next. In many of the scenarios, once the initial violence was done the bad guys ran off. The bad guy could have run off or he or they (I didn’t know how many there were) could be waiting for me. My companion could be shot or hurt and needing help. Either way, help and rescue are forward and I have to move out of my relatively good position.

I step out from behind cover and turn on my light again and the moment I do the officer who brought his own air soft gear flies around the corner and shoots me in the leg while I shoot at him. I don’t know if I got any hits on him.

Caleb pauses the scenario and says, “Ok, well you weren’t supposed to be doing this so well so let’s just fast forward this and just say you are up here by the car,” he moves me into position, “and shot here” he puts a piece of tape on my left arm, “here” on my left upper thigh, ” and here” on my left upper chest. “You are having difficulty breathing and cannot stand. Go.”

I lay down on the floor, take a moment to collect myself and tell companion number 1 to go for help. He leaves to do that while I ask companion number 2 to bring me the med bag and I start walking her through treating me in order of importance. Apparently because I was helping too much Caleb then decided that I’d also been shot in my upper right arm and tells me that I now cannot speak for 20 seconds.

I’m lying on the floor, spread eagle, not able to talk or use any of my limbs and my companions are supposed to have no medical training. Goodbye, cruel world.

When Caleb told me I could talk again I had her put the med bag on my chest and show me everything in the bag one item at a time. When I identified what I wanted I talked her through applying it to include putting a tourniquet on my leg, a chest seal on my chest, searching my back for any exit wounds, putting a pressure bandage on my right upper arm and holding pressure on my left arm until help arrived.

At that point I was pretty thankful for the loads of “bystander” scenarios we did in EMT school where we had to direct clueless bystanders.

This scenario was supposed to illustrate the short-sightedness of people who say things like, “Well, my friend is armed,” or “My friend is a medic, if anything happens, we’ll just let you take care of it.” If your armed medic goes down, you might be up a creek without a paddle.

The scenario was also meant to illustrate to me the difficulty in “treating through a barrier” which is a medic having to direct someone else in providing care vs doing it themselves. In a high stress environment, trying to explain to a frightened individual what to do and get them to understand things they’ve never had to do before can be quite challenging. Placing a tourniquet or even identifying a tourniquet or defining what a windlass is can be maddeningly frustrating. It’s frustrating enough without real blood and pain and nerves. It can be fatal otherwise.

I hadn’t heard her but when my companion ran ahead of me and was accosted by the bad guy she had screamed out, “She has a gun!”

Going dark when I heard the commotion was exactly the thing to do but I exposed myself and gave away my position when I turned my flashlight back on and that directly led to me getting shot.

Flashing and moving or staying behind cover and flashing and moving to another piece of cover would have been far better for me. I need to work on my movement between cover and concealment and using my flashlight.

The next two scenarios were more along the lines of teaching wound priority and just because someone is making the most noise doesn’t mean they are the most wounded and not everyone who needs help is a good guy.

Each of the scenarios were built to illustrate a vital point and not a single one of us went away without having learned something very important from the experiences.

My biggest take-aways were security priority, maintaining that security throughout treatment and using that light to your advantage. Scene safety is drilled into anyone who attends EMT training but it means something entirely new when you are in a hostile environment that doesn’t include police officers standing by.

Another thing I found interesting was how fixated we all got during treatment to the point where guns were being completely forgotten. Some of the scenarios would end and people would be left looking around for the gun they were supposed to have during the scenario. I had lost mine because I’d been told I was shot in both arms and to drop it but others would put theirs down to treat, move and completely lose track of them. With security being a priority, keeping track of that firearm is pretty important.

I liked both Karl and Caleb. In addition to being knowledgeable they were both edifying and constructive in their criticisms. It can’t be easy teaching a class with participants from all ranges of skill but they pulled it off nicely, challenging those who needed to be challenge and instructing those who needed instruction and inspiring everyone.

I look forward to taking more training from both Karl and Caleb in the future!