Tactical Medic First Responder Course – Jeff Hensly and Sonny Puzikas

Tac Medic

Tactical Medic First Responder Course – Cricothyrotomy

Tactical Medic First Responder Course

Over the past weekend i was lucky enough to attend a Tactical Medic First Responder Course here in Dallas.

This class was taught by Jeff Hensley and Sonny Puzikas

Tactical Medic (TacMedic) courses seem to be the new ‘trend’ if you will, and for good reason. This is stuff anyone and everyone should know how to do. This was a two day course that included Force on Force scenarios which puts it beyond the Trauma First Responder Course i took a few months back.

Medical courses is always something i have viewed as interesting material, trauma based even more so. As i talked about in a previous post about in a different First Responder course, the knowledge here is easy to learn, but hard to master. What makes it interesting, or more so depressing is how expensive medical items and classes can be. The reasoning behind this, and why you don’t see all that many of these courses is for the lack of a better term ‘liability’ and money. By making something ‘medical’ the prices skyrocket. Take a Israeli bandages as a example, its a usually absorbing cotton bandage that get wrapped in a elastic wrap to compress on the wound. Brilliant idea using cheap common materials, but because its medical (or military/tactical) it costs a lot more than it should. Even as i put my kit together i am still amazed on how a little metal tube with a plastic sleeve costs $10 dollars.

Everyone should know how to do this

“How many people here are worried about learning how to do treat a Tension Pneumothorax (think collapsed lung) something that has a 0% survivability rate if untreated and causes 22% of trauma deaths?” said Jeff Hensley. “What about a cricothyrotomy (emergency airway puncture [top picture])? Airway blocks are 6% of all trauma deaths.” (The following is paraphrased) “This is one of the easiest things I can teach you to save a (trauma) life. But because its a ‘medical procedure’ it should cost you years of training and thousands of dollars. I know because I’m still paying for mine.” said Jeff (paraphrased).

Learning how to treat a tension pneumothorax, which is very common after trauma to the chest/lung (gun shot, stab, whatever) and a how to do a cricothyrotomy for a blocked airway and even a IV showed he was right. By the end we could all find what we needed, perform the procedure all while blind folded. This was something that was brushed away during other Trauma First Responder courses as to risky, and i don’t think it could have been done any easier.

The first day we went over the standard ABCs, which you can read all about in my previous post here, and we then added a X to make it XABC. The X stood for many things, getting off the X, clearing the X, securing the X. It was the ‘tactical’ portion of the tactical medic course. Most of this up until the pneumothorax, cricothyrotomy and IV where more of a review for me. We wanted to get through the knowledge portion as soon as possible so we could start running drills and scenarios. Man where the scenarios something else. There were designed on a scale, started off easy, simple run from here to there and put a TQ (tourniquet) on that guy. Ok, that guy is unconscious go and do a assessment, then treat him. We also had to create our own TQs and treatments based around the materials at hand. All kinds of great drills. Then the fireworks, smoke bombs, flashbands and force on force started.

Willy - Our only friend

Willy – Our only friend

NOTE: Spoilers Ahead!
If you are planning on attending one of Jeff’s courses the surprises he has stored is one of the best parts about the whole event. If you don’t want some of them spoiled for you then skip ahead.

*BANG* “AHHHHhhhhh! I been shot!” a call cried out. “Your friend is hurt, go help him!” So armed with a medkit, and a airsoft pistol we started entering the maze. This is when you really started to learn. I was to help the number 3 victim and to do that i had to go past victim number 4. I start quickly clearing my way through, i find the first victim, tell him helps on the way and continue, i get to my victim and there is another ‘medic’ returning my way and we both stop at this victim.  “…This is victim number 2” a instructor said. “Oh shit” I said, I missed a area, and so did the medic in front of me for he had to come back. “Well…first big scenario and i have already screwed up badly” i though as i found my patient and i start going to work. He had cuts on his face, gunshot to the leg and was calling out for his wife. As i worked i  would talk and comfort the patient, i asked about his wife, what she looked like, tell me stories, because if he was talking he was breathing. If he was breathing he has circulation and is still alive. During this i got caught up on the Israeli bandage, it had a weird loop in it and was starting to tangle and my attention started focusing more on it and not my area (another lesson learned). “Reports of a shooter in the area!” a voice calls out. This call snapped me out of my daze and i finished the bandage and luckily i have already moved my patient to a more secured area and had good visibility. A head and a gun pops around the cover and quickly moves back, hes no friendly. I quickly engaged and dispatch him going low when he expected high. Soon the scenario was over.

We then all meet up for a debriefing. As the instructors/over seers went over what they saw i was brought up. They talked about how i was the only one who was really believably trying to comfort my patient. I kept him talking but quite, i asked about his wife and kids and how none of the other students was doing anything remotely like that. But he did notice me get caught up and fixated on the bandage and how i went to the wrong victim.

From there we went over many more situations: active shooters, IEDs, suicide bombers, working as a team (man i need to work on my vocal commands) and more. To end it we had a bit of a ‘final exam’, it was a two parter and we where split in to two groups. I was the third to go in group one and we where taken to a more remote part of the area. “First up come here” said a instructor as he moved him away from the group, they talked and the instructor then went into the ‘maze’. The student looked ready to ago, a scream was then heard and off he went. Some time later he walks out very visually shaken, it was all over his face. “What happened man?” we asked him. “..oh..your know soon enough..” he reply as he walked by.  “Next one up” the instructor calls. Once again they talk and the instructor leave. Another scream is heard and in he goes. Some time later, just like the other he comes out very visually shaken. So by now im getting pretty nervous. “Next!” he calls, and i walk up. “You married?” he asks, “Yes Sir”, “Whats her name?”, “Jennifer, Sir”, “any kids?” , “No Sir” , “ok wait here…your know when its your turn” and off he went, and i waited.

“Rooobbert!” a voice screams “i have been stabbed! help!”. “Shit” i though and in i went. Cleared a few corners and there they where, it was a hostage situation. Someone was playing my wife (kinda glad i didn’t actually bring her) and a guy behind her has a knife to her throat as she is ‘bleeding’ from the chest. I engaged and took him down with no major problems and i started working on ‘her’. Unlike all my other patients where i was very reassuring and talkative, it was as if that part of my brain went “Nope, we are not playing this game” and shut down. My stress went through the roof and i went to work treating the victim saying as little as possible. This of course made the instructor mad, “Shes your wife! Shes dieing! and you have nothing to say to her!” and as i silently worked he started listing off everything that has happened to ‘her’, the amount of blood she is losing, the damage that was caused, how i may never see her again, how could i have let this happen. Everything and anything he could do to max out the tension and stress, all i could think was how glad i was that i didn’t make her come to this with me. I left that scenario as shaken up as everyone else was. What really stuck with me, and stuck out to the instructors was how i was so good at keeping the patient calm and talking to them to then just see that part just shut down was very interesting. They did a great job of building up stress and tension. The second half of the final was a downed unconscious guy with a gun. I searched him of everything, two guns, two knifes plus extras. A ‘bomb’ was tossed and i had to use him as cover, then as i rolled him over he wakes up holding his own bomb, he was a suicide bomber. I take off running, and as i run i shoot him in the leg, apparently i was the only one to actually do this. Once cleared i then had to come back and start treating him as if he was a bomb blast victim, plus i had to treat the gun shot wound i caused. This of course was designed to take more equipment then we had in our kits to get us to start improvising. I went for a rope, my belt and the victims belt. Once that was over it was fun to watch others run though it and freeze when they realize they did not have enough equipment, or that he had a bomb on him.

That was just a small section of all the scenarios and drills we covered that weekend. Most of the trauma stuff i was familiar with, but it was very nice to see it presented from another perspective and here we actually performed IVs, cricothyrotomy, and tension pneumothorax. I’m still surprised how easy it was. The instructors where great. They all had great stories and great ways of building up stress and tension. It was well worth going, one of my favorite courses by far.


If you want to read more about the medical side of things you should read my First Responder post.

I enjoyed this course greatly for it gave me a chance to try out the things i learned in my Trauma First Responder course a few months back. Unlike then where we pretty much sat for a slide show, here we did as many drills and practicals as possible, so Power Point time was kept to a bare minimum. The scenarios where great and well thought out and allowed everyone to try out the skills they are learning. Jeff was very knowledgeable and was able to give lots of great examples and explanations.  This is one of my most favorite courses i have taken.


+ Lots of great life saving skills
+ Very little power point
+ Lots of drills and practice
+ Great scenarios


– Not enough time in a weekend

FINAL – Highly Recommended!

You should totally take this class if you can!

Robert Klenka
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