Review By Chris Upchurch, Suarez International Staff Instructor
With a life and death technical subject like this, it’s important that the authors have the knowledge and experience to credibly write on the subject. In this case, the authors have this in spades. Dr. John Meade is an emergency room physician, SWAT medic, and medical director for several EMS agencies. Sua Sponte is the nom de gurre of an active duty Special Operations medic with extensive experience overseas. Both have been there and done that.
The book begins by laying out the context of these skills for private individuals. It introduces the M.A.R.C.H. acronym. M.A.R.C.H. stands for Massive hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head Injury. This defines both the major problems we need to address when treating penetrating trauma, and the order in which we address them. The rest of the book is structured to address each of these in turn.
Before diving into the medical elements, the second chapter covers the tactical elements that distinguish tactical medicine from other types of trauma. Most other causes of trauma, a car accident for example, the cause of the trauma is generally over and done with before any opportunity for treatment arises. In a tactical situation, however, the incident may still be going on. If someone is out there shooting at you, finishing the fight is often a higher priority than immediately treating injuries. Even if you think you’ve finished off the adversary, or he’s moved away from your immediate area, you need to be ready incase a new threat emerges while you’re treating injuries. Despite the fact that both authors come a team tactics background (SWAT and Special Operations respectively) the tactical portions of the book are written with the individual operator in mind. The book describes the Suarez International after action assessment process, one-handed gun manipulation, and discusses tactical considerations like light discipline, cover and concealment, and moving injured individuals.
Chapter three is in many ways the heart of the book. It’s the longest and most detailed chapter, with good reason. Massive hemorrhage represents the biggest threat and most likely cause of death from a gunshot wound. After a quick overview of the circulatory system’s response to major leaks, the chapter goes through the major methods of dealing with serious bleeding: direct pressure, hemostatic agents, and tourniquets. In most circumstances, direct pressure is the standard treatment for major bleeding, but in a tactical situation it has the drawback of tying up the responder’s hands applying pressure. With penetrating trauma the effectiveness of direct pressure can be increased by packing the wound, exerting pressure deep inside rather than just at the surface. The book covers both of these in detail. Hemostatic agents are chemicals that promote clotting, stopping bleeding. They are not a magic bullet, however, and are best used in conjunction with direct pressure.
The remainder of chapter three is largely dedicated to tourniquets. Because they don’t tie up the responder’s hands after application the way direct pressure does, a tourniquet provides more mobility and a greater ability to respond to threats. This makes them our default choice for heavily bleeding wounds to the extremities in a tactical situation. The book first deals with the myth that applying a tourniquet means certain amputation and should be applied only as a last resort. Despite what I learned in Boy Scouts, this is absolutely untrue and the reluctance to apply such an effective means of controlling massive bleeding has led to many deaths. The authors recommend three types of pre-made tourniquet: the Combat Applications Tourniquet (C-A-T), the Special Operations Forces Tactical Tourniquet (SOFT-T), and the Cav Arms Slick Tourniquet. They describe all three in detail and give application instructions for each. The book also describes how to apply an improvised tourniquet using a bandana, carabiner, and key ring. Quick discussions of abdominal and head wounds round out the chapter.
Chapter four covers airway management (the A in MARCH). After an introductory discussion of the anatomy and physiology, the chapter covers the recovery position, which can be used to keep people from drowning in their own blood or vomit. Next up is the head tilt-chin lift, used to keep someone from choking on their own tongue. Much like direct pressure, the head tilt-chin lift works well, but the fact that it ties up the rescuers hands is a disadvantage in the tactical context. A better solution is the nasopharyngeal airway: a tube that you can insert though the nose to establish a clear passage to the back of the throat.
Next up in chapter five are sucking chest wounds. After the usual discussion of the anatomy involved the book describes the pneumothorax. Essentially this is air inside your chest cavity, but outside the lungs, which keeps the lungs from properly expanding and filling with air. The chapter focuses mostly on recognizing the condition, and preventing it from occurring by covering chest wounds with occlusive bandages (basically anything airtight).
By now, we’re up to C for Circulation in our MARCH acronym. Chapter six is dedicated to shock. Shock is one of those words with a lot of varied definitions. In this case we’re not talking about emotional shock, or electrical shock, we’re talking about hemorrhagic shock: the body’s reaction to severe blood loss. The chapter describes the symptoms of hemorrhagic shock and how to treat it, starting with keeping as much blood as possible inside the body.
Chapter seven steps away from the MARCH acronym (Head injury having been covered in chapter 4 and Hypothermia in chapter 6) to cover musculoskeletal injuries: sprains, strains, fractures, and dislocations. The chapter describes each of these, then spends quite a bit of time talking about splinting to stabilize these injuries for later treatment.
The final chapter covers trauma kits and equipment. There is a strong emphasis on not including too much stuff. Much like with firearms, a bare bones kit that you have with you when you need it is better than the kit with everything that’s sitting at home when the bullets fly and the blood flows.
Beating the Reaper is an excellent book. It’s well organized, well written, and has just the right level of detail for the layman. Almost anyone who picks up this book will learn a great deal of lifesaving information. I would highly recommend it for anyone who carries a firearm for self defense.
As good as the book is standing alone, it makes an even better supplement to Suarez International’s Trauma Care for the CCW Operator (TMCO) classes. The TMCO class is kind of like drinking from a fire hose, there’s a lot of information there. Reading the book beforehand means that this won’t be the very first time you’re hearing most of this stuff, and will allow you to hone in on aspects you don’t understand or need more clarification on. If you’ve already taken the class, the book will do wonders in helping you review and recall the class material months or years down the line.
Buy Beating the Reaper!!! Vol 1: Trauma Medicine for the CCW Operator at onesourcetactical.com.