BAR NUNN — Whether it’s a misguided hunting arrow, getting mauled by a grizzly or a car crash on a mountain pass, the wide-open spaces of Wyoming can be dangerous — if not downright deadly — for those who aren’t prepared.
Getting as ready as anyone can be to face the unexpected of being in Wyoming’s backcountry is one of the missions of a group called Wyoming Patriots, which hosts classes in backcountry medicine.
Preparation is the mission behind everything the Wyoming Patriots do.
“We kind of have a goal to build a stronger, more prepared community that can help each other in disasters,” said Eric Paulson, president of the nonprofit organization, during a recent class in Bar Nunn. “Given Wyoming's current situation, the fact that we're very out in the middle of nowhere, we have all sorts of oil riggers, ranchers; you know, these are just skills that you don't want to learn them when you need them.”
The group gathered at the municipal building in Bar Nunn to learn from former Navy corpsman Keith Grimes, who called the training “wave top” or basic medical skills. It was based on curriculum from the national Stop the Bleed program sponsored by the American College of Surgeons to educate people on emergency techniques and tactics to get bleeding under control.
Grimes said he decided to become a Navy corpsman after driving home one night and witnessing a man drive off a road above the city while he was living in San Diego. Below the cliff were buildings and a parking lot.
When the car launched it turned over top down. The vehicle landed 60 feet below the road on a pile of hay.
“I have no idea what the hay was doing there, right next to a restaurant in the middle of a parking lot,” he said. “And I realized getting him to the EMTs that I knew how to fix and rebuild engines … (and) that I don’t know how to fix people.”
Four Priorities
Grimes and fellow instructor Dave Guidi, who has 20 years of EMT experience, took participants through the ABCs of the Stop the Bleed program that include:
• Alert 911.
• Find the bleeding.
• Compress wounds with pressure, packing or applying a tourniquet.
• Treating for hypothermia.
As a Navy corpsman retiree with combat experience with the Marines in Iraq as well as other assignments, Grimes brought intensity and enthusiasm to the session.
“Today I am trying to hit the wave-tops of information that any individual could learn and apply to any environment to manager their risk to address a situation to help people to manage wounds,” he said. “Life will kill you … what you do and how you make your decisions will help mitigate at what point on that timeline and how far you make it.”
Assess For Bleeding
Participants learned when coming upon or accident or dealing with a crisis in the back country, it’s important to get the professionals rolling by calling or having someone call 911. The next immediate step is to assess for bleeding.
Grimes asked the class how quickly a person can “bleed out.”
“Thirty seconds,” came the reply.
Grimes affirmed that arterial bleeding requires immediate action and talked about assessments of accident victims and how important it is to determine if there is bleeding, what kind it is, and for fast and appropriate actions to stop it.
Bright red blood comes from an artery and needs immediate compression to stop it, which potentially could require a tourniquet. Darker blood comes from veins and takes a back seat when addressing other bright red wounds.
When compressing wounds with gauze or other material, Grimes said it’s important to never to take it off — just apply more when bleeding continues.
Compressing the wounds can be done using hands or even knees to free a responder’s hands to do address other wounds. Compression needs to continue until help arrives.
Grimes showed a photo of a person who suffered traumatic injuries with severe wounds to both legs in several places and potential broken bones.
There were two tourniquets on each leg. He said the tourniquets were the right action, because the immediate issue was to stop the flow of bleeding, and if responders worried about splinting or dealing with the other wounds, the person could have bled to death.
People practiced appropriate application of tourniquets on each other, learning they need a belt or object at least an inch wide, meaning shoestrings, handkerchiefs and rope will not be effective and can cause harm.
The tourniquet needs to be as tight as possible to stop the bleeding. And once applied, the tourniquet should never come off.
Class participant Greg Flesvig, of Evansville, right, practices applying a tourniquet to Eric Paulson, president of the Wyoming Patriots. Paulson said the group, which sponsored the class, has a mission to help prepare people in the state for everyday emergencies. (Dale Killingbeck, Cowboy State Daily) 
Instructor Dave Guidi, and EMT for 20 years, showed participants his own first-aid kit and encouraged them to think about what they can realistically carry every day in order to be ready for an emergency. (Dale Killingbeck, Cowboy State Daily) 
The Wyoming Patriot’s Backcountry Medicine Class in Bar Nunn focused on the importance of stopping the bleeding during an emergency situation. (Dale Killingbeck, Cowboy State Daily) 
Backcountry Medicine instructor Keith Grimes said the class is meant to be a foundation and incentive for people to build on and pursue additional medical/first-aid instruction. (Dale Killingbeck, Cowboy State Daily) 
Examples of supplies for first-aid kits, as well as the ability to purchase some supplies, were made available at the Backcountry Medicine class. (Dale Killingbeck, Cowboy State Daily)
What If Someone’s Impaled?
As an EMT, Guidi said there have been situations where he didn’t have time to put on gloves before trying to stop the bleeding on the victim.
Worry about blood-borne pathogens should not prevent immediate efforts to stop the bleeding. He advised people not to have black gloves in their first-aid kits because they will not be able to see the blood on them as they assess victims.
Grimes talked about and displayed Israeli battle dressing compression bandages that are 6 inches wide and designed to allow progressive pressure to stop bleeding wounds.
“These are extremely popular in a variety of different environments,” he said, adding they’re good to have in an emergency kit.
Both instructors also covered impaling wounds and what to do, such as person falling and becoming impaled on a branch or someone accidentally shot with an arrow.
The answer? Don’t remove the arrow or branch. Cut off the excess part if possible and immobilize the branch or arrow so it cannot create more damage.
Other training during the three-and-a-half-hour session includes ways to deal with tension pneumothorax, a medical emergency condition where air builds up in space outside the lungs and can collapse the lung and heart.
There also was information on splinting broken bones and the need to treat patients suffering from blood loss for hyperthermia.
Training also covered chest bandages and the appropriate size of first-aid kits.
Guidi said his own kit is small and probably enough to help a single victim. He encouraged people to be realistic, improvise and do what they can if they encounter a situation that involves multiple victims.
One person in the class, Steve Rupp of Casper, said he had an EMT class several years and came as kind of a refresher for his skills.
“Life brings its challenge and injuries with it and it’s good to be able to patch at least some of those up,” he said. “I have kids and wife to look after as well. If they get injured it’s good to be able to do something and avoid a trip to the ER.”
The class is designed to be an introduction and encouragement for people to add to the information through further training, Grimes said.
Paulson said he hopes in the future to get the Stop the Bleed training into schools. He said the Wyoming Patriots are planning a series of instructional classes for the coming year. The next one in February will center on winter preparation and coping tips and skills at the Casper Unitarian Church.
Dale Killingbeck can be reached at dale@cowboystatedaily.com.
