Mission First Gear, New LBT Chest Rig and Some Pillow Talk – Gear Tasting 69

On this episode, Bryan showcases some new gear we received from Mission First Tactical, including their stocks, grips and magazines. He also highlights a new chest rig he picked up from LBT, which is an upgraded version of the popular 1961.

Finally, Bryan heats things up with a little pillow talk, including details on a new Sea to Summit inflatable pillow he picked up for the Mammoth Sniper Challenge.

In each episode of Gear Tasting, Imminent Threat Solutions Editor-in-Chief Bryan Black answers your gear-related questions and shares his insight into what we’re currently evaluating at ITS HQ.

For more on the gear we review, check out our GEARCOM category here on ITS.

To have your gear related question answered on an upcoming episode, tweet us using the poundtag #GearTasting on Twitter.

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Looking at Security through the Eyes of a Physical Security Analyst

While my background is mostly in computer security, I’ve always been interested in the intersection of physical security and the general concepts behind the field. Through this has come a number of physical security classes where I’ve honed skills like lock picking, bypassing, red teaming and social engineering.

Earlier this year, I had the opportunity to take the CORE Group’s “Covert Entry Concepts” class, taught by Rob Pingor and Deviant Ollam. The Covert Entry Concepts class was heavy with hands-on experience, identifying and subsequently defeating locks and methods of illegal restraint. So when invited to take the follow-up class, “Physical Security Analyst,” given at the CORE Group’s facilities in Ellicott City, Maryland, I jumped at the chance.

The “Physical Security Analyst” class is geared towards individuals who have an interest in performing analysis of physical security systems in residential, commercial or government facilities. It was less of a hands-on “here’s how to circumvent any number of locks” class, but rather a class that gives some valuable insight into what someone who might offer these services would do in performing said analysis. It also covered the underlying ideas of what it means to perform these services for paying clients.

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Upon arrival in Maryland, the class attendees met at one of two team houses procured for us. We then moved to the classroom in a nondescript office park nearby for pizza and a viewing of the movie, Street Thief. The film was created with the appearance of a documentary, though it was actually fictional. In the movie, the filmmakers follow the exploits of Kaspar Karr, a career burglar living and operating throughout the Chicagoland area.

Karr discusses and demonstrates a number of physical entry and escape techniques, as well as the meticulous planning, reconnaissance and social engineering necessary to successfully ply his trade. As this class was aimed at people attempting to defend against people like Karr, it proved valuable to see what we’d be defending against.

After the movie was over, everyone headed back to their assigned team house and rested up for the next morning, which was to be our first full day of class. Upon re-convening Saturday morning at 0900, we began the deep dive into the material the class would cover.

What Are You Protecting?

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One of the primary questions a physical security analyst has to determine is what they’re being asked to protect and its relationship between actual and perceived value. Keeping this in mind, there are different levels of security based on the actual value of what you’re defending.

Minimal

Minimal security includes the definition of borders or boundaries and hopes to deter opponents; preventing them from gaining access with simple locks and simple barriers.

Low

Low level security intends to impede and detect threats by means of employing reinforced doors, window bars, high security locks, simple security lighting and alarm systems.

Medium

Medium level security intends to impede, detect and assess external threats with advanced intrusion detection systems, establish a perimeter with penetration-resistant fences and can include unarmed security personnel.

High

High level security impedes, detects and defeats threats. It’s marked by the existence of formal response plans, close ties with Law Enforcement, high security lighting and physical access controls. These access controls include things like RFID badge readers, retina scanners, etc.

Maximum

Maximum level security’s goal is to impede, detect, assess and neutralize threats. It’s defined by everything in the previous levels of security, with the addition of sophisticated alarm systems and highly trained armed response units on site.

What Are You Defending Against?

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Another primary question in physical security analysis is who are you trying to guard against? There are various levels of threats, just like there are various levels of security.

Unskilled Threat

These are people with a small knowledge base, no support system, detailed planning or sophisticated equipment. An example of this would be people with no experience who attempt to commit a crime of perceived opportunity.

Street-Hardened or Semi-Skilled Threat

These people have a greater knowledge base and may be more aware of intrusion detection systems or the presence of guards. They may also have some limited technical or financial support.

Their conduct is distinguished by a higher level of detailed planning, some team coordination, use of specialized tools and attempts to cover their tracks. The fictional Mr. Karr from “Street Thief” is a solid example of the street-hardened or semi-skilled threat.

Professional and Skilled Adversaries

These threats have a great deal of training, engage in extensive pre-incident reconnaissance and make an effort to know everything they can about their target. They’ll also have extensive technical and financial support systems.

Their conduct includes thorough planning, attempts to defeat intrusion detection systems, capitalizing on vulnerabilities of the target security system and the practiced use of sophisticated tools and techniques. They may also have high-end access to “Tier 1” level tools and equipment. They’ll definitely use tightly coordinated group actions, with distributed skill-set specialties amongst the members of the group.

Hard Truths About Physical Security Analysis 

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In the class, we were warned the security analyst job isn’t an easy one and that very few people fully understand overall security, much less physical security. While physical security measures are always used to protect information, the reverse isn’t always true.

Upgrading physical security equipment costs time and money, which can be in short supply in a corporate or government environment. Security isn’t a profit center, it’s a cost center and is often looked at from a budgetary standpoint as unnecessary. That is at least, until the first time something goes wrong.

Once a breach happens, funds to address security concerns can suddenly appear. As a physical security analyst, it’s important not to take these things personally; your job is to assess and recommend courses of action. Once you’ve done this to the best of your ability, taking action to address these concerns is in the hands of those who control the purse strings.

You present a problem and suggest a solution. You’re often times working against a complacent institutional mindset that may want to save money by ignoring what you find or suggest. However, nothing loosens wallets like a critical incident.

Dilemma of Protection

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Implementing increased security procedures, architecture, or policies, often times has to be balanced against aesthetic concerns or convenience. The reality is that you can’t defend against every threat and in a corporation or other organization, people need to be able to perform their duties. So simply adding more layers of security that slow them down from completing their work, gets in the way of the overall goals of the company or organization.

Aesthetic concerns are a factor as well; a technology company is unlikely to want to have their workplace environment looking and feeling like a maximum security penitentiary. Despite the fact that such an environment might provide greater degrees of protection of their intellectual property.

Also, the aesthetic environment has a legitimate effect on the productivity of those working within it. Proper security intends to find a functional balance between protecting that which an entity deems worthy of protection, while still maintaining a productive environment for those who work there.

Physical Barriers

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Physical barriers are generally outer-layer security measures and include anything from perimeter fences or walls, to passive and active vehicular barriers, shrubbery and gates.

Fences

There are a wide variety of fences available, in various materials. The most common fences are chain-link, though “anti-climb” fences also exist. These make climbing more difficult by using a significantly tighter mesh than normal chain-link fences. There are also Anti-Terrorism/Force Protection fences, which are part of an overall ATFP federal security program. These are generally anti-climb fences with strengthened, reinforced cables run throughout the mesh of the fence.

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Some fences are angled inward at a certain height, in order to make climbing more difficult, while other fences may have “toppers” such as barbed or razor wire coils interlaced and mounted to the top of the fence. Some are hybrids of ATFP fences, anti-climb fences, angled fences and fences with “toppers.” However, at best, fences predominantly define boundaries and keep animals out. While they can buy some time for a reacting security force, they won’t stop a dedicated attacker.

A prime example of fairly effective fence deployment can be seen at the facilities in Guantanamo Bay, where tall fences with “toppers” are alternated with patrol pathways and deep trenches. Without going into too much detail, the series of physical barriers in place at Guantanamo Bay may not completely stop a professional group of attackers. However, they will definitely buy significant time for the highly trained, armed response units that make up the next layer of security at that camp to arrive on the scene and address whatever threat may be there.

For most commercial installations, the accepted standard for fences is:

  • At least 7 feet tall
  • Utilize 11 gauge wire
  • Constructed of 2” mesh
  • Uses a 12” topper (razor wire or barbed wire coils)

Signs

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Obviously, the primary function of signs is to convey information. In this context, signs can be used to good effect as a security measure, letting potential threats know they’re being watched, or indicating a facility’s security posture is an aggressive one.

At the same time, signs can also indicate to those threats that something of value resides inside. So the use of signs should be smart and shouldn’t inadvertently give potential threats too much information that can be used against the target.

Vehicle Barriers

A facility can employ the placement of either active or passive vehicle barriers in order to thwart vehicles from approaching too close to a target. Hydraulic bollards which can be raised or lowered can make it difficult, or even impossible for a vehicle to progress toward a target, as can static bollards, strategically placed.

Placement of both active and passive barriers needs to be fully thought out though. If a vehicle can simple go around these devices, they’ll fail to serve the purpose for which they’re designed.

Defensive Shrubbery

Some plants have natural characteristics that make movement through them difficult. Holly, roses, honey locust and raspberries all provide positive aesthetics, but will make egress through them painful, at best.

It’s also important to remember when using defensive shrubbery, that you’ll  still want visibility. The goal isn’t to build a wall of plants, shrubbery should be lower than eye level. Trees should also be trimmed to above eye level. In addition, when planning plant use, you should consider the differences in time of day.

Pedestrian Gates

Pedestrian gate mechanisms can manage flow of people coming in or out and can help control access to a facility. They are, in essence, the beginning of your screening process in a layered security approach.

Defensive Lighting

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Lighting used as a defensive technique should be continuous, fixed and stationary. In addition to ample coverage of open spaces between the outer perimeter and any buildings on the facility, entry lights should cover all entrances. Other aspects to consider are standby lights, portable lights and emergency lights. Depending on the situation, all of these can provide value.

There are a wide variety of light types, with different advantages and disadvantages. These include incandescent, fluorescent, mercury vapor, metal halide, high-pressure sodium and low-pressure sodium lights. All serve slightly different purposes across a spectrum of price points.

While in the past, fluorescent and high pressure sodium lights may have been the prime contenders, but these days they’re being replaced by light emitting diodes (LED), which are on average, roughly 25% brighter and use 85% less energy. They also have a significantly greater lifespan than other forms of lighting.

For placement, you’ll want to make sure you illuminate boundaries, avenues of approach, entryways and functional areas within the perimeter you’re trying to protect. Another aspect of lighting to consider is making sure you’re not impeding any camera system that may exist.

Rob told us that it’s a good idea, when evaluating lighting in a given area, to use a photographic light meter. Standing directly below a light, you can use the meter to take a reading. As you walk away from the light, the reading will lower. When the reading has reduced to 50% of the initial reading, you may want to look at placing another light there.

Drinking from the Firehose

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In the remaining hours of the first full day of class, we went over guards and guard houses. There are a variety of factors to consider here, including wall construction, door construction, types of doors, door materials, ANSI testing, levels of doors and door locks. This led us to a little bit of in-depth discussion of locks in general, though not to the degree they were covered during the “Covert Entry Concepts” class.

We also touched on hotel safes and learned some interesting workarounds for most of them. We then moved onto external intrusion detection systems, including fence sensors, attenuators, ground sensors, microwave sensors and the like. We briefly touched on Sensitive Compartmented Information Facilities (SCIFs), which have become their own vertical cottage security industry post 9/11.

Finally, we did some preliminary OSINT (open-source intel) recon on the location that would be our field exercise the next day. After this, the two team houses broke off for dinner and prep for the next morning.

Field Exercise

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I apologize in advance for being sparse with any identifying data on our contact or the location of the field exercise. As a matter of general principle and in consideration for both the facility and contact’s desire for privacy, I won’t mention the actual site we evaluated or mention our contact’s name. Furthermore, the photos for this article have been scrubbed of any identifying information and if for some reason, readers are able to recognize the location, please keep that information to yourself.

At around 0830, we all gathered at the facility we’d be evaluating that day and met with our contact. At this point, he briefed us on the changing demographics of the facility, surrounding neighborhood, history of the area, security policies and systems in place, recent security incidents and routine or nearly routine security incidents and most importantly, the concerns and security issues our contact felt needed to be addressed.

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The focus of the entire class was to provide a framework for people interested in performing physical security analysis in a professional capacity. In addition to providing technical information, one lesson in particular was a crucial one; as a security analyst, your primary focus should be on solving the problem the facility personnel who contacted you has described as his or her main problem.

While you may notice a wide variety of vulnerabilities and even provide methods to resolve or mitigate these, if you fail to listen to the people who brought you in when they describe what they’re looking to get from your services, you’ll be failing to deliver what they want.

For our group, the problems our contact wanted our specific input on were the flow of individuals through the building at particular times and the evacuation policy for people in a particular area of the building, upon arrival outside. That is to say, getting everyone out of the building wasn’t a problem, but how to manage that area’s population once they were evacuated, given a rather geographically constricted area outside this part of the facility.

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We took an extended tour of the outside of the facility and managed to find a number of concerns, including windows that had been left open and a door that had been left unlocked. However, we also found the surveillance camera system did a fairly good job of providing visibility of all areas surrounding the facility.

We then went through the inside of the facility and everyone took notes of what they found. Notes included doors that had enough gap to employ an under-door tool, security camera locations and the noticeable smell of natural gas in a kitchen area (a burner had been left on, but unlit).

We also found laptop storage cabinets that were unlocked, with keys readily accessible to anyone who happened to walk by them. However, our contact assured us that the theft of these items was a non-issue; the normal inhabitants of the building had yet to even attempt stealing any of the devices.

psa_attenuator

During our tour, we noticed a sensor in the open lobby area and we weren’t sure what it was for. It was about 40 feet up in the air and wasn’t near any entrances or exits. When we asked about it, we were told it was an earthquake sensor and that they inadvertently discovered an issue when flying a drone inside the building that broke the beam between the sensor and its partner at the other end of the area, triggering an attenuator.

We toured the main areas of the building and the controlled access areas, as well as the server room. The lock to the server room was found to be perfectly adequate, though access to the server equipment inside the room was insecure. (Cabinets weren’t locked or otherwise protected). However, this was a non-concern for our contact, as this particular facility didn’t retain any confidential data on the server equipment, nor was it a particularly attractive target for the normal inhabitants of the building.

When our tour and note-taking was complete, we met back at the classroom to cover the use and considerations of CCTV systems and microwave sensors. We also discussed the wisdom (or lack thereof) in using “fake” security cameras. They’re generally ok as an additional method in residential situations, but a bad idea in commercial environments. We also touched on access control systems, badging procedures and the problem of tailgating, as well as some aspects of active shooter precautions.

Tools of the Trade

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For the class, we were also provided with an overall equipment list that would be required for performing the duties of a physical security analyst. This list included things like basic lock bypass tools, picks and jigglers, a photographic light meter, good camera and a rangefinder.

Behavioral Profiling

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After this, the subject discussed turned to suspicious behaviors and how to profile them. Situational awareness, sensitivity to baseline behavior and anomalies from said baselines, critical thinking and rapid decision making are all key.

Knowing what’s normal for an environment is a prerequisite for being able to spot things outside that norm. The ability to recognize, as described by Gavin de Becker in his book Just 2 Seconds, the “moment of commitment” and the “moment of recognition” is also highly beneficial to predict a suspect’s future behavior.

When monitoring people in an environment, you can create “suspects” based on the behaviors they exhibit. Are they “inspectors” checking their environment for things no one else seems to be checking for? Are they “organizers” perpetually adjusting themselves or items in their control? Are they “sweaters” perspiring when no one else seems to be perspiring? Are they “fashionistas” dressed significantly better than those around them?

All of these things could be indicators that these people don’t belong and may have ulterior motives for being there. Giving suspects a distinct nickname based on that behavior makes it easier to keep track of them, particularly in environments where there may be multiple suspicious persons.

Wrapping Up

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Once we finished up drinking from the firehose, Mr. Pingor gave us some business tips for doing this sort of work. A key tip was ensuring to include significant time for writing an extensive report when devising an estimate for a client. Another was not underestimating the value of your time and not being afraid to throw out what you might think is a “high number” to a prospective client.

After all, you’re providing them with your expertise, which cost you a certain amount of time and money to obtain. In the end. the worst they can do is say “no.”

The Takeaway Treasure Trove

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At the beginning of the class, each student was given a binder containing examples of fairly comprehensive commercial and residential site surveys used by the CORE Group. While we didn’t explicitly cover the contents of the binder during the class, they were mostly self-explanatory, particularly when examined through the lens of having completed the class.

CORE Group offers a longer, more extensive version of this class through the SANS Institute, which goes into greater detail on each subject covered during this abbreviated version of the class. Still, provided you have some background knowledge on this subject already, this version of the class provides an exceptional value for the price. Not only for the wealth of knowledge imparted in such a short time, but also the binder full of CORE Group’s intellectual property (students were encouraged to use the material as we saw fit, but to not distribute it to the Internet as a whole).

Finally, what’s possibly the best value of all, is the networking you’ll get to do with the other like-minded individuals who take the class with you. While some of these faces were already familiar to me, I definitely got to spend more time with them individually, during which ideas got bounced and new connections got made.

Editor-in-Chief’s Note: Matthew Sharp is a Plank Owner and Life Member at ITS and goes by the username “viator.” He lives in The People’s Republic of Northern California and enjoys long range shooting, carrying heavy objects great distances and fuzzy little puppies.

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Headed to SHOT Show 2017? Come Bowl with ITS, PDW and Other Great Industry Companies!

SHOT Show, the annual industry event is almost here! Featuring upcoming products and the latest developments in Hunting and Outdoors, SHOT Show spans four days in fabulous Las Vegas.

While ITS and PDW are no strangers to throwing epic SHOT Show parties, we’re changing things up this year and leaving it all out on the lanes. The Inaugural ITS + PDW Bowling Battle Royale competition will include teams from ITS, PDW and other soon to be announced industry companies. Continue reading

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We’ve Gone Rogue: ITS Rebels & Troopers Morale Patch Collection, ITS Christmas Morale Patch and 30% Off All T-Shirts!

The holidays are here and we’re excited to be adding two new products into the ITS Store today! In addition to these great new products, we’re running a sale on all T-Shirts and you can save 30% on some of our best designs!

Our new ITS Rebels & Troopers Morale Patch Collection features characters from a galaxy far, far away and is extremely limited! Also new to the store is our ITS Christmas is Coming Morale Patch. While we released a few of these early in our latest Mystery Box, they’re now available for purchase individually! Continue reading

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Butt Tattoos – Ridiculous Dialogue Episode 67

Episode 67 – Butt Tattoos


On this episode, Bryan, Rob and Matt discuss avoiding Rogue One spoilers, Matt’s new dongle bag and his adventures in Butt Tattoos.

The guys also discussed stupid things they did as kids and trying to do math in a group.

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Ridiculous Dialogue was created to share the banter that takes place at Imminent Threat Solutions on a daily basis. It’s us; candid, unedited and talking about everything from what movies we’re watching to the general geekiness that keeps us laughing here at ITS HQ.

While we generally keep the vibe in our articles PG rated, be warned, it may not be safe to blast over your speakers at work. We hope you enjoy the insight into ITS and who we are behind the scenes as a company; pull up a chair and tune in to Radio ITS.

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GORUCK Shooter Giveaway and Flashlight Considerations – Gear Tasting 68

**Update: See Below for Winner Announcement**

On this episode of Gear Tasting, Bryan features some new gear from our friends at GORUCK, including their Shooter Ruck and its accessories. He also announces a special giveaway offer from GORUCK and details on how to win your own Shooter Ruck are listed below!

Bryan also delves into his recent experience at the Telluric Group Night Vision Operator Course, including why he recently upgraded his EDC flashlight. Finally, he answers some Questions Over Coffee involving swapping gear and vehicle food storage.

To enter the GORUCK GR1 Shooter Giveaway, follow the instructions listed below in the giveaway widget.

**Congratulations to Brian H. for being selected as the winner of the GORUCK GR1 Shooter Giveaway!**

a Rafflecopter giveaway
If the giveaway widget above doesn’t load, click here to enter.

Good luck! Contest Fine Print:

  • By entering to win the GORUCK GR1 Shooter Prize Pack, you understand that the options for configuring your GORUCK GR1 Shooter Ruck and Accessories will be limited to stock on hand from GORUCK. Additionally, by entering the giveaway, you agree to receive future emails from GORUCK and ITS. Neither company will ever sell your email address and you can unsubscribe from our correspondence at any time.
  • One winner will be selected at random and will receive the prize listed above.
  • Winner will be notified by email and once contacted, will have 24 hours to claim their prize. If we do not receive a response within 24 hours, we will select a new winner.
  • Contest ends at 11:59 PM CST on 12/22/16.
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SITREP 10: First Drone Delivery // Former SEAL Joins Presidential Cabinet // 75% of ISIS Fighters Killed

Today, Amazon has announced they’ve made their first successful delivery by drone. On December 7th, an Amazon customer in the U.K. ordered a Fire TV and a bag of popcorn, which arrived to his house via drone 13 minutes later.

Dubbed Prime Air, Amazon’s drone delivery service aims to have customer’s orders delivered within 30 minutes. Deliveries will be available seven days a week during daylight hours, as long as the weather permits. In addition, orders will need to be under 5 lbs. to qualify for Prime Air delivery.

Currently, the program is under a private trial with two customers, but Amazon plans to add dozens of customers in the upcoming months to collect more data and further the program.

Read more about Amazon’s groundbreaking drone delivery on BBC.

President Trump Selects Former SEAL as Interior Secretary 

Ryan Zinke

President-elect Trump announced that he’s selected Republican Rep. Ryan Zinke to serve as the secretary of the Department of the Interior. Zinke served for 22 years as a Navy SEAL before running for Congress in his home state of Montana. Currently, he sits on the House National Resources Committee and the Armed Services Committee.

An avid outdoorsmen, Congressman Zinke has defended public land access and a large goal of his campaign for the House was to achieve North American energy independence. Zinke is the 16th of 21 cabinet positions to be filled by President-elect Trump. Some of the other cabinet members will include retired Marine General James Mattis, former Texas Governor Rick Perry and retired Marine General John F. Kelly.

For more information on President Trump’s selection of Ryan Zinke, read more on The Washington Post.

New Discovery Shows Mars Could Have Supported Past Life

Boron on Mars

New observations by the Mars rover Curiosity show that parts of Mars may have been capable of supporting life for long stretches of time in the ancient past. Some of these stretches may have lasted for hundreds of millions of years at a time, according to NASA.

By drilling into rocks on Mars and studying the samples, scientists were able to determine there may have been a habitable lake and stream system once on the planet. Much of the research points to a long, interactive history with water on the planet, which could be good news for future manned missions aimed at inhabiting the planet.

Read more on the recent Mars discoveries on Space.com.

U.S. Officials Say 75% of ISIS Fighters Have Been Killed

Airstrike

Last week, a U.S. Official announced that the United States and its coalition partners have killed 50,000 militants since 2014, estimating the number of battle-ready ISIS fighters to now be between 12,000 and 15,000.

Brett McGurk, U.S. special envoy to the anti-ISIS coalition was quoted as saying, “The number of battle-ready fighters inside Iraq and Syria is now at its lowest point that it’s ever been.” The majority of these casualties are a result of the 17,000 air strikes conducted against ISIS targets by the coalition.

Meanwhile, the mission continues to take out ISIS leader Abu Bakr al-Baghdadi, who recently released an audio recording, but has not been seen in years. Commenting on this issue, McGurk said, “Issuing audiotapes deep in hiding is not really a sign of a confident leader, particularly in today’s media age. So eventually, we will find and eliminate him as well, but the leadership ranks continue to diminish.”

For more information on the fight against ISIS, read more on CNN.

Local Firefighter Saves Restaurant Patrons from Carbon Monoxide Poisoning

Firetruck

A North Carolina firefighter saved local restaurant patrons after noticing several people exhibiting symptoms of carbon monoxide poisoning. Lonnie Wimmer, was eating at the River Ridge Taphouse, when he noticed several people acting sick and nauseated.

Wasting no time, Wimmer called the local fire department and upon arrival, they found high levels of carbon monoxide. The source of which they believe was the natural gas heating system. Officials said more than 30 people showed symptoms of carbon monoxide poisoning.

Read more and see an interview with Lonnie Wimmer on Fox 8 News.

SITREPs are our timely updates on developing news and interests discovered on our journey through the Interwebs.

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Backcountry Emergencies: Why You Should Learn How To Identify Spinal Injuries

Imagine you and your teenage son are out for a day hike in the backcountry. He’s admiring the view from atop a cliff and slips on some loose gravel; falling over the edge and landing on a ledge about 20 feet down.

You can access him from a path that leads down to the ledge and when you get to him, he’s just starting to wake up, having knocked himself unconscious. You have basic first aid training and you remember that any fall from a distance greater than the “patient’s height” is super scary and you should make sure they don’t move in case they “broke their neck.” You know he lost consciousness, but he seems “with it” now.

Extracting an immobilized patient on a trail increases the time.

Checking your cell phone, you see you’ve got no signal. You estimate that you’re about 4 miles from your vehicle, parked at the trailhead.

The trailhead is about an hour’s drive from the closest town, which you recall had not much more than a gas station. What do you do?

Do you leave him, hike back to the vehicle and go get help?

You estimate you’re about 2 hours from the town and maybe an hour beyond that from being able to get some sort of medical help to the town. After that, it’ll be an hour drive back up the road to the trailhead.

Based on the mechanism of injury, EMS will likely want to backboard your son. This means you’ll also need more help to safely carry him out. You figure out you’ll need eight people to safely carry out an immobilized patient (you can do it with six, but you’re putting the rescuers at increased risk). Extracting an immobilized patient out on a trail increases the time. So, let’s demonstrate a timeline:

12:00 – Your son falls 20 feet over a cliff knocking himself unconscious.

12:05 – After getting to him, you find him now conscious. You decide to go get help and instruct him not to move, as you’re afraid he “broke his back.”

13:00 – You make it back to your car at the trailhead and begin driving into town.

14:00 – After reaching the town, you’re able to activate EMS (who also actives search and rescue).

15:00 – EMS arrives to the town.

15:30 – Search and Rescue arrives to the town.

16:30 – Everyone is present at the trailhead.

18:00 – All personnel arrive at the accident scene (it was a bit slower since extraction equipment was needed).

18:15 – Your son is assessed and found to be in mild sub-acute hypothermia from laying on the ground not moving for the past 6 hours. He’s strapped to a backboard which is then loaded into a transport basket.

20:00 – All personnel make it back to the trailhead.

22:00 – The group arrives at the hospital.

23:00 – Your son is finally able to get in for an X-ray.

23:30 – The X-ray imagery is assessed. Coupled with doctor’s physical examination, your son’s spine is “cleared.” However, it’s discovered that he has significant tissue break down on his shoulder blades and hips from laying on a hard surface for nearly 12 hours and not moving. If only there was a better way…

Sure, there’s a bit of fluff in that scenario, but it’s honestly not that far from what actually happens most times.

Background

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One of the “sacred cows” in EMS is the idea that during any kind of significant trauma everyone, “buys a backboard” (this is currently changing, albeit slowly). Meaning if you’re involved in a “high velocity impact” (e.g. a car accident, fall from height, gunshot to your torso) and you engage EMS, you’re more than likely going to be strapped to a backboard, as well as having a cervical collar applied.

You’re going to be transported on that hard plastic board and dropped off at a hospital. Here, you may spend anywhere from an hour to several hours, completely immobilized. You generally won’t be released from the board until you’ve undergone a strict examination and most likely had some sort of imagery done.

We generally think of that as an acceptable practice given the type of injury that can occur from “spine” damage.

The risk is that a full transection of your spinal cord (that doesn’t outright kill you) can lead to complete tetraplegia (or quadriplegia, if you prefer). Pretty scary, right? Okay, so what’s the actual incidence of this happening? Before we discuss the answer to that question, let’s talk about some anatomy.

What is “C-Spine” Anyway?

To understand C-Spine (and injuries to the spine) we need to understand the anatomy of the spine as a whole.

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Regions of the spinal column.

Specifically we need to differentiate two main components of the spine; the column and cord.

The spinal column itself is a strong bony structure that provides stability and support of our trunk (it’s one of the reasons we’re able to walk upright).

It also protects the spinal cord, which is the main communication line in the body, sending and receiving messages from all parts of your body. It also has redundancy built in.

The cord is contained inside that hollow spot in the middle of the spinal column. It’s surrounded by a cushioning layer of cerebrospinal fluid, all of which is contained by dense fibrous layers of tissue called the meninges. The meninges are further separated from the spinal column by fat.

The heavier and thicker aspects of the spinal column are generally less flexible (your lumbar and coccyx, or lower back and tailbone) while the lighter and thinner structures are more mobile (such as your cervical spine, or your neck).

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Dermatomes represent nerve pathways we can use to test sensory inputs on the body.

Between the two, it’s generally easier to injure the cord in the lighter and thinner sections and more probable to injury the column in the lower sections.

To injure the cord and have motor or sensory problems, you have to have significant enough trauma to bypass all of the other protective structures, all with enough remaining energy to disrupt the cord. If you’re having trouble tracking, it basically boils down to significant enough trauma.

Why Should We Bother To Clear a Spine?

Okay, so let’s get back to the incidence of actual injury. The National Spinal Cord Injury Statistical Center (NSCISC) has been tracking spine injuries from at least 1973. They estimate the annual incidence of spinal cord injury in the U.S. is 40 cases per million individuals, which is roughly 12,500 total (assuming a population of 313 million).

…hundreds of thousands of people are needlessly put on a backboard.

That number does not include those that died at the scene. That is four thousandth’s of a percent, or 0.0039%. Only 14% of those cases resulted in the worst case, complete tetraplegia; with another 20% in complete paraplegia.

We’re going to spit ball a little bit of math here, as statistically the error makes little difference. In 2015, of the recorded spinal cord injuries, 33% of those were from auto accidents, 22% were from falls and 15% were from gunshot wounds.

“But Tom,” you say, “better to be safe than sorry, right?” I’m going to argue that context is everything. If you had a major car accident 5 minutes from a trauma center, then sure, hop on that backboard. Roughly 4,125 spinal cord injuries came from auto accidents. 1,403 of those resulted in a complete transection (either tetraplegia or paraplegia). That means that hundreds of thousands of people are needlessly put on a backboard.

Now let’s assume that 100% of all falls humans took in the backcountry from going over a cliff resulted in cord damage (even though that’s absurd). That’s 2,750 total injuries. We could clean up the math a bit and correct for numbers of people falling in the backcountry opposed to urban environments, but we’ll leave it as is for now.

The point of all of that gross math is that damaging your spinal cord is a very rare event, especially in the context of delayed access to medical care.

Apply all of that math to the scenario we started this post with. If we can walk your son out and drive him to the hospital, we should do so, rather than increase the overall risk of the event (risk to rescuers, potential of increasing complications to our patient, etc).

How to “Clear” a Spine

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Mechanically, clearing a spine is very simple. Once the following conditions are met, you can have reasonable assurance there’s no cord damage.

  • Your patient must be able to discriminate between dull and sharp sensations at all four extremities.
  • The patient must be able to move all four extremities, mechanically demonstrating push and pull against resistance.
  • Your patient must not have any point tenderness to their spinal column.

To make these tests successful, you must have a patient that can appropriately respond to questions. Not intoxicated, completely “freaked out” or distracted by an injury, etc. They have to be able to respond to questions, follow directions and be able to tell you if something hurts.

You can do the following steps in any order. If you discover anything along the way, keep going with the rest of the test and keep good notes.

  • Palpate (examine by touch) along the entire length of the spine.
  • Check push and pull function on both of their hands and both of their feet.
  • Check for sharp and dull discrimination on both hands and feet.

Palpating the Spine

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Using your index fingers (or thumbs), press firmly on each and every vertebrae.

If the patient reports “point tenderness” (which is akin to having a burning match head pressed on that spot during the palpation) you can assume there’s damage to the column. We’re not talking about an ache or soreness, this is legit acute pain at a specific spot.

Motor Check

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Feet are easy. Have the patient “step on the gas” while you provide resistance. Do both sides at the same time. Does it feel equal and strong? Good. If not, make note of that.

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Now have the patient try to touch their big toe to their knee on the same leg while you provide resistance. Does it feel equal and strong? Good. If not, make note of that.

Hands are a little trickier, but still easy. Have the patient bend their arms to 90 degrees with upper arms tight at their sides. Then have them fold their wrists toward their midline.

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You’re going to apply resistance to the backs of their hands and have them try and push you away.

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Then hook your hands over theirs and have them pull toward themselves against resistance. If the patient has new weakness on any limb you can assume that there is cord damage.

Sensory Check

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Find something sharp that’s not a knife, as stabbing your patient isn’t an appropriate way to check. A pine needle works great, as does the corner of a stiff page. Something like a ball point pen isn’t sharp enough.

Find something dull and soft. Things like the the back of a pine needle or book binding work great.

Have the patient close their eyes. Ask them to tell you what they feel and where they feel it. Then poke them gently with the sharp object on the left and right of their forehead. Repeat the same with the dull object by gently brushing it across their forehead (left and right side). For this, you’re getting a baseline.

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Next, with their eyes still closed, check sharp and dull on the back of their hands. I’d recommend testing in a couple places (thumb side and pinky side).

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Repeat on the little toe side of their feet. If you can’t access the feet for some reason, you can go to the outside of their leg.

They should respond appropriately for each test. If they have any new inability to discriminate dull/sharp (or feel anything), you can assume there’s cord damage and you should note down where and what failed.

How Does This Help Us?

Now it’s judgement time with you and your patient. If you come up with no findings, congratulations! Your patient is clear. They may be sore, but their spinal column and cord should be fine. They may want to get checked out, but they definitely don’t need a backboard and C-Collar.

If they have column damage but no cord damage, I’d be comfortable walking them out; assuming they’re otherwise physically capable and willing to of do so. Obviously go slow and provide support, as you want to prevent further falls.

Every situation is different and you should have as many tools in your toolbox as you can.

If they have cord damage, which will almost always be associated with column damage, I’d recommend getting them comfortable and protecting them from the environment. They’ll likely need to be carried out to minimize any further damage.

However, remember those notes you were taking? What happens when the body is injured? It swells. What does swelling eventually do? Goes away. Peak swelling occurs within 24 hours. There’s a potential your patient has some deficit right now, due to swelling.

Chances are, if you check back in a while and repeat the test, they may be able to pass. Keep in mind this won’t happen in all cases and you should not delay evacuation and access to treatment just to perform another check. Every situation is different and you should have as many tools in your toolbox as you can.

What Now?

Like many other topics, medicine is a skill set. Sure there’s a decent amount of schooling to become a provider (a lot of it being exposure to actual patients), but most of the base concepts are simple. Spine clearing is a very useful skill, especially if you spend time in areas with reduced access to medicine and engage in risky activities.

Practice this exam and become comfortable with the mechanics of it. Teach your significant others, kids and anyone you may go on adventures with. It’s an easy diagnostic you can use to rule out a serious injury and in the process, save a significant amount of time and resources.

Editor-in-Chief’s Note: Tom Rader is a former Navy Corpsman that spent some time bumbling around the deserts of Iraq with a Marine Recon unit, kicking in tent flaps and harassing sheep. Prior to that he was a paramedic somewhere in DFW, also doing some Executive Protection work between shifts. Now that those exciting days are behind him, he has embraced his inner “Warrior Hippie” and assaults 14er in his sandals and beard, or engages in rucking adventure challenges while consuming craft beer. To fund these adventures, he writes medical software and builds websites and mobile apps. He hopes that his posts will help you find solid gear that will survive whatever you can throw at it–he is known (in certain circles) for his curse…ahem, ability…to find the breaking point of anything.

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Christmas is Coming: New ITS Watch Cap and Special Edition Mystery Box in the ITS Store!

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