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TCCC Dark Angel Medical

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#1 Randy Long

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Posted 12 November 2013 - 06:45 PM

I was wondering if any one could recommend a TCCC course? Also if anyone could tell me how Dark Angel Medical training compared to the other TCCC training?

#2 Jersey0311

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Posted 13 November 2013 - 06:12 AM

What's your background? Different classes fit different folks.

I've taken the Dark Angel Medical course and know Kerry Davis. Good class, but as he'll tell you if/when you take it, it's a MEDICAL class with SOME shooting, NOT a shooting class with some medical.

I've also taken the "official" TCCC class through NAEMT and am now an instructor. I've also done the CLS/LTT thing in the military. The TCCC course is totally dependent on the facility, resources available, and the background of the instructor staff. The first TCCC class I attended as a civvy was geared more towards LE/Public Safety response to incidents like officers down on a stop, and Boston Marathon type things. The class I just wrapped up was strictly .mil and focused on scenarios more geared towards a war zone.

But from personal experience, an GSW or other injury sustained overseas is the same as the GSW/injury sustained back home. Only difference is who caused it. An IED blast in Afghan is the same as an IED blast in Boston.

If you take the NAEMT TCCC course, the curriculum is the same regardless of the student body. Whether it's a public safety class or for the .mil, it's the same slides. NAEMT mandates it. As such there's things that aren't applicable in a civilian setting, like the combat pill pack.

Also, the military isn't bound by specific protocols if you're a non-medical guy. Everyone can pack wounds, do a needle decompression, and insert an NPA. In the civilian setting, you may or may not be allowed to do any of those things depending on your level of training. I'm an EMT in NJ, and hemostatics are unauthorized. Needle decompression is an ALS procedure left to the paramedics. NPA is a BLS skill that I can do. So it all depends on your background and what laws you're governed by.

However, minus the needle decompression, TCCC is 99% BLS. IV/IO access and surgical airways are covered, but not taught in the program. Depending on the facility and instructors, you may get to do that, but it's not a guarantee.

On the topic of ALS procedures in TCCC, IE the needle decompression, surgical airways, IV/IO access, and drug administration, it's important to note than NONE of those things are performed while shit is still hitting the fan, or when you're still on the X. I wouldn't place such emphasis on learning those things because good medicine at a bad time is liable to get you or the patient killed. Half of TCCC is timing. Care Under Fire is NOT the place you want to attempt any invasive procedures. If the only thing you get out of TCCC is proper TQ application, wound packing, bandaging, and NPA insertion, that's just fine. That will keep 99% of viable patients alive until you can get them to a higher echelon of care.

The Dark Angel Medical "Bullets and Bandages" class is good as well, but is geared towards personnel with a non-medical background. I was still able to get stuff out of it however. Live fire movement to patients and getting them off the X and applying TQs while your team mates are laying down suppressive fire is a good learning experience similar to my experiences overseas. It's 2 days of classroom (good knowledge) and 1 day prac app on the range. It comes highly recommended. Having gone through both classes, I'd do the Dark Angel Medical class before the NAEMT TCCC. TCCC is good if you need a no-shit card that says you're certified in TCCC, but if you're only in it for the knowledge, it's better to go to a provider like Dark Angel because the quality control is better. The NAEMT course has too many variables associated with it when you realize you don't know the instructor's background, what facilities you're gonna get, etc.

Most NAEMT courses won't do any LTT because of the regulatory requirements associated with it. However, the Dark Angel course actually bought some cuts of meat to shoot up to show the class the wounding effects of various rounds, and we practiced our wound packing on them. The TCCC class I went do did none of that. They only talked about wound packing.

In short, I'd only attend the NAEMT TCCC class if you need an official recognized certification for a job. If you just want the knowledge and know how, take a class from a different provider, like Dark Angel, Lone Star Medics, etc. There's plenty of TCCC type classes out there, which are way better than the "official" class, because you'll most likely get to do some live fire and actual practice with things like wound packing. I've taken a number of "tactical" medical classes, and the NAEMT course would be the last on my list if I didn't need the damn card.

However, any medical training is better than nothing. In Afghanistan I went through more medical supplies than I did magazines, if you catch my drift.

I'll give you a quick down and dirty on some TCCC procedures. TQ application, GSW, Amputations, chest wound management, and NPA insertions.

TQ Application

1. Put TQ as high as possible on affected limb

2. Tighten TQ until there is no distal pulse and bleeding has stopped.

3. Write time of application on patient.

A GSW can be treated as follows:

1. Apply TQ as high as possible on the affected limb.

2. Pack the wound with gauze. Normal Kerlix (roller gauze), H&H gauze, and QC Combat Gauze work well. You DON'T need a gauze impregnated with a hemostatic for it to work. Normal gauze works just fine if you can't find or afford the fancy shit. Find the source of bleeding, PACK TO THE BONE, and keep packing. If necessary, use another piece of gauze. As a side note, QC Combat Gauze requires you to hold pressure on the wound for at least 3 minutes for the clotting to start. This is why you don't pack a wound on the X.

3. Wrap the wound in a pressure bandage, IE the Israeli or OLAES bandage. Wrap it TIGHT. This secures the gauze in the wound and provides additional pressure to stop bleeding.

Amputations can be treated as follows

1. See #1 above. TQ as high as possible on affected limb(s)

2. Apply pressure bandage to the "stump". The abdominal sized pressure bandages work well for this purpose as you can wrap the entire stump with the dressing in the center of the bandage and wrap the excess above the stump.

Chest wounds can be treated as follows. Remember to clean the area around the wounds as best as you can so the seal has a better chance of sticking and staying stuck.

1. Check for entry AND exit wounds. I can't stress this enough. People have died because the guys doing treatment missed the exit wound.

2. Apply a chest seal to both wounds.

3. If a tension pneumothorax begins to develop, perform a needle decompression (needle between the 2nd/3rd intercostal space, or 4th/5th if you do it axillary. If no chest needle available, you can "burp" the seal by pulling a little of it off the wound for a second or two.

If your patient is unconscious, insert a NPA to maintain their airway.

1. Lube the airway by using lubricant (if you have it), or stick it in the patient's mouth and use their saliva

2. Insert the NPA upside down and rotate it as you insert it into the nose.

3. If your patient begins to gag, the NPA is probably too big. Pull it out until the patient stops gagging, then insert a safety pin into the airway to act as a flange.

Any other airway compromise (facial injuries) will require a surgical airway. At that point there's nothing you can do without the proper equipment and training.

As an FYI, most TCCC kits I see come with 28 Fr sized NPAs. They range in size from 20 to 36. 28 fits most people. But, for informational purposes, you size an NPA by holding the flange end by the patient's nose, and the other end by the patient's ear. In EMS work, I automatically reach for a 28 Fr regardless, unless I have a rather large or small patient.

"The fate of the wounded lies in the hands of the ones who apply the first dressing." - Dr. Nicholas Senn - that's something to think about

Remember, air goes in and out, and blood goes round and round. Any deviation thereof is a bad thing.

Edited by Jersey0311, 13 November 2013 - 07:10 AM.

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#3 Randy Long

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Posted 13 November 2013 - 06:51 AM

Thanks Jersey0311 that is what I was the information I was looking for my background is light on the medical training as I was trained as a first responder some years ago.

#4 Jersey0311

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Posted 13 November 2013 - 10:44 AM

TCCC is essentially the first responder level when it comes to battlefield/tactical medicine. EVERYONE should have TCCC training from some source. If the cops at the Boston bombings would've had IFAKs and TCCC training, it would've helped tremendously.

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#5 bigpac931

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Posted 15 November 2013 - 04:13 PM

the NPA is pretty much useless as it does not secure the airway . it only keeps one nare open if the Pt's chin touches there chest the airway is pretty much closed for someone who is not controling their own breathing. This is why a [head tilt or a jaw thrust] is used to make sure air is going in and out
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#6 Condition Write

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Posted 22 November 2013 - 05:03 PM

I did Kerry's class while he was with Magpul (before he started Dark Angel). I'll echo everything Jersey said above. My one gripe - and this (1) is specific to me and (2) may have changed since Kerry struck out on his own - was that the shooting/range portion was geared toward LE who are operating with patrol rifles and backup, not civilians who are alone and working only with CCW weapons. So there were some assumptions about tactics and equipment that may not have been true for all students. But the actual medical curriculum? If I could afford the travel and vacation time, I'd re-take it every year to ensure I stayed current.

Edited by Condition Write, 22 November 2013 - 05:04 PM.

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#7 Randy Long

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Posted 22 November 2013 - 05:29 PM

I signed up for Dark Angels Medical class in march in my state thanks to Jersery0311 review.

#8 Jersey0311

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Posted 22 November 2013 - 05:38 PM

When you see Kerry, tell him Justin the Marine says hello.

Pocket Doc is good people. I still have all the class material and he was nice enough to send me a few CD's worth of extra knowledge. I've used his DARK kit in real life and true to his word, he replaced it, free of charge.

I cannot stress enough the importance of medical training. No matter who you get it from, just get it. Go back through it every year at least, even if you're a medical provider. It's a whole different sort of medicine.

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#9 toddxtyboy

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Posted 07 December 2013 - 10:17 PM

Is anyone allowed to take a TCCC course or do you need to be qualified i.e. EMT or first responder?

I'd be interested in taking one. I'm a new RN, and while RN's are not typically first responders, i love to learn skills.

#10 Psybain

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Posted 08 December 2013 - 12:45 AM

The one I attended was an open enrollment class with no medical exp needed. I was definitely the most inexperienced person there, and I had no real problems passing.

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#11 Jersey0311

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Posted 08 December 2013 - 05:34 PM

Is anyone allowed to take a TCCC course or do you need to be qualified i.e. EMT or first responder?

I'd be interested in taking one. I'm a new RN, and while RN's are not typically first responders, i love to learn skills.


It depends on the provider of the course. When I took Dark Angel Medicals class, there was an RN in the class. When I took the "official" TCCC class, there was a decent showing of first responders.

You should have no issue finding a class you can get into.

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#12 Psybain

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Posted 08 December 2013 - 09:04 PM

Todd, whay part of yhe county are you in?

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#13 Randy Long

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Posted 24 March 2014 - 12:40 PM

Well I posted my AAR/Review of training with Dark Angel on the Training section under Medical AAR/Reviews topic.


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