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From Practical to Tactical Hemorrhage Control with Toren Bell

From Practical to Tactical Hemorrhage Control with Toren Bell

Posted by Steve Cassidy and Toren Bell on Aug 24, 2024

Hey, everybody. Welcome to the latest edition of EOD, IMPROVISED. Super excited to have Toren Bell on here. So the problem is everybody spent a lot of money on weapons, a lot of money on glass, probably don't own armor, and probably don't own that great armor, and you don't know how to put on a tourniquet properly, and probably need some help, even with just some basic first aid. So what we're What we're going to do today is we're going to go from practical to tactical as it relates to medicine. So we're going to kick it off here with Toren Bell.

This is EOD Gear Improvised. Eod Gear, improvised. Eod Gear, improvised. Can we get to blow stuff up yet? Standby. Everyone in EOD has a laser-calibrated eyeball and plenty of attitude to go with it.

Seriously, can we blow stuff up now?

Fire in a hole. EOD Gear. Com. Initial success or total failure. Eod Gear, improvised with your host, former Navy EOD tech and owner of EOD Gear, Steve Cassidy.

All right, all right, all right. Here we go. All right, Toran, thanks for being here.

Glad to be with you here, Steve.

So we go back, I don't know, 10 years.

About that.

Yeah. So I remember we were working a security contract together, and I think we ultimately met at the Waffle House at about 3:30 in the morning. And it was funny because I was sitting there and I was like, Man, this guy's weird. And I'm like, Oh, he's just that smart. And so it was funny. It's like, there's that... If you ever meet somebody who's IQ is just off the chart, and it takes a second and you go, Oh, that's why he's that way. But, so I wanted to have Torn on here because he's got a super impressive background. So you were at Bragg, and then you've been doing spine and cranial surgery, and then your insecurity training investigations. And so you have all this stuff that's been going on. And so I really wanted to have you on to discuss The problem of people not really understanding how to best manage trauma to the body, whether it's a cut, like I did this past weekend when I almost took my pinkie tip off of the cigar cutter and looked like a crime scene. Unfortunately, and guys, if you don't ever have anybody to call, Toren is a great guy to call because he walked me all through it because it was a mess.

But then just going from severe cuts all the way up to gunshot wounds, packing wounds, tourniquets, and all that stuff. So what we want to do here is go through from tactical or tactical to practical with a splash of tactical and get you through. So you have something to go with and how to design whatever it is you're going to carry with you. So again, Toren, thanks for being on here. So you and I are both airborne. Army airborne. And Navy airborne, and airborne and-Army airborne.and Navy Airborne Navy. So a lot of common ground. And so I just wanted to thank you for having on. So you were originally born in what, Utah?

I was born in Arizona. Arizona. I grew up in Idaho.

Idaho. Okay.

From there, I grew up in a small town and thinking, there's got to be more out there than this small town. Not that it's a bad town. Joined the military, ended up going to Fort Bragg. Loved my time there. I learned a lot of things. One of the biggest things I learned from Bragg is about myself, what I can do, my mindset, how to control my mind more than my body. That's one of the biggest things with medical. Something happens, you've got to be able to calm yourself down and perform the functions that you need to perform and not go three sheets of the wind and say, Oh, what do I do now?

Right. How many years were you at Bragg?

I wasn't at Bragg about eight years.

Okay. Or Camp Liberty for you new folks. Oh, the look on your face.

We're not going to go there. Okay. You talk to anybody. It's the nostalgic people there. It's always going to be Fort Bragg. Yes, it is.

Now you're in, you move to Nashville, and you stay at a holiday in Express, and you go, I'm going to do spine and brain surgery. How did you end up?

I love medicine. When I was in the military, I was a combat arms medic. I did a little bit of everything there. I got hurt, so I was forced out. It It's like, What do I do now? I go, Let's just stick with the medicine route. Became a surgical tech back then, about 94. I took that up to a surgical first assistant, which I actually helped the doctor. I assist the doctor in the surgery. I can cut, sew, tie, dissect. I act as a second surgeon for him. Second set of eyes on the battlefield, so to say, because things don't always go as planned in medicine either.

So you're 30 years in?

Yes. Yeah.

That's clearly your experience exceeds most people's. And not just the clean and simple like, Hey, yeah, it's surgery, but The practical side, because of your background at Bragg and then coming into surgery, being able to understand exactly how the body works, where you have to be. Because you've told me a few stories where you've had problems with people on the table, and then it becomes, it's not surgery, it's saving.

It becomes a logarithm that you have to think out. I've got this issue, okay? All of a sudden, pressure starts dropping. Well, why? You notice breathing rate starts increasing. Why is that? It could be because of bleeding somewhere. Then you have to use a logarithm to say, I need to look for this or I need to look for that. When you find the problem, it's either a big problem or a small fix, just like anything else in life. What initially turns out to be what you think is a big issue, sometimes could be a real small and easy to fix, and other times it's a life-altering problem that you have to take care of.

Or it could be something you think is small, and then it just escalates.

It turns out to be big. You have to be able to calm yourself. One of the techniques I always use is I take a deep breath, exhale for 3 seconds, not thinking about anything, and then you go to work. It doesn't do any good to have a scrambled you find while trying to handle complicated issues?

So day to day, I know most of us, you and I, both carry pretty much everywhere. And so, yeah, we're in Franklin, Tennessee, but we do venture outside of Franklin, Tennessee once in a while. And so we do carry. And I think part of your security background and go into places that may be a little sketchy. I think any major city qualifies now. But being ready, taking that mindset from where you were at in the army to bringing it to surgery, to now you're out on the street. And I know you've had security contracts, and we've worked in some fun places together. Yeah, we have. And so I think it's really understanding that situation as well. So Tell us a little bit about mindset, and then your caring, but what do you have with you? Because I remember you were telling me this story about the guy who went down in the parking lot, and I think it was a stop the bleed situation, but you were like, you weren't going to touch him.

Something I always told my, and this is important with anything medical, I've told all my guards, Do not touch somebody if you don't have the proper PPE. That's a personal protection equipment. There's so much stuff out there that we can catch. It turns out It could turn out to be a life-threatening deal for you or a life-altering. So he was bleeding. He had been stabbed. I looked at the situation. I didn't have any gloves on me. And I looked at his friend and I said, Is this your amigo? He said, See, see. I said, Put that shirt on that wound and hold it.

Made him take his shirt off.

He looked at me and the guy goes, You're not going to help me? I said, I've got other things to do. If you don't want to die, have him hold this shirt. He later came back a few months later and said, Remember me? He says, You left me in the parking lot. I said, No, you were fine. But the thing is, whatever we do, you always have to triage whatever you do, whether it be medicine, your personal life. Some things we may think is a dire necessity that we do, and it really isn't. Look at things that happen in our lives and say, Can I put this off just a a little bit? Is this as dire as it needs to be, or does something else require my full attention? Which at the time, we had other instances going on. So you prioritize in your life as well as in medicine, your job, having that well-balanced life, career, family type of events.

I want to go back to that event and look at the pathology. This is This is about taking ownership. So here I am. Okay, so the guy comes back. You directed his friend, take his shirt off, put the shirt on there to stop the bleeding. And then the guy comes back and says, You left me. I'm like, I'd have been like, No, dude, you were a dumb ass and got stabbed. You were in the wrong place saying the wrong things to the wrong person, and you got stabbed. And then your friend, I guess, didn't even know what to do. So you didn't know what to do. Your friend didn't know what to do. And you did, told him what to do. And he still wants to come back and still not take ownership of it. I think that's a big eye opener in the way I see this is you have to take ownership of the situation.

Well, everything you do in life, you can't blame other people for choices you make.

Yeah. Except for the people driving slow in the fast lane. That really… I do blame them. Because I'm in that lane. I'm in there. I'll step away from that.

That's another topic, another day.

Yeah, that's another day. We all know that. Anyway, but yeah, I think it's taking ownership, and I think that's what's so great about what we're doing here with this podcast, but as well as the training platform that we've deployed through the EOD Gear tactical mastery is to help people be ready in a situation wherever they find themselves to be able to take ownership of that, and in some cases, extreme ownership and be responsible and then go, what does that look like? And that's why I see, we sell a ton of gear. We have people come in all the time and people buy really nice stuff. But don't know how to put on a bandaid, let alone a tourniquet. I think that's where you have to take an assessment of where you're at and what you have. Are you relying too heavily on gear? Because Because I'm a big fan of brains over brand any day because the brand doesn't matter. The gear doesn't matter. It's the gear between your ears.

Exactly. Do you know how to use it? A lot of people have gear between their ears But it's just a had record for most of the people.

Yeah. So I know we're getting ready to do. We're going to shoot some video about first aid. Then again, going from practical to tactical. So that's going to be on the Training and taking people through the process of, Hey, here's a situation. Oh, this is in your vehicle, this is in your car. What do you do for a living? Do you have a spouse? Do you have kids? Do you have elderly parents? It's all different. Having the right gear available, but also having the mindset to take the accountability and take action and fix the problem. You have the rest of your life to fix your problem.One.

Way or another.

Or somebody else's.

Or as we say in the OR, all bleeding stops eventually.

Yeah. Yeah. Note to self. Going along, let's talk about what's the basic kit? We have a kit here. Of course, when I'm at the cigar store and laid my finger open, they actually had a good kit. I just went grab a paper towel and sat there and smoked a cigar for an hour and a half before coming over here to grab my kit. But I'll give props to the cigar store, Franklin Cigar. Good job, guys. They were pretty quick to pull that out. It looks like they had a good bit. I'd stop in and take a look at it. What's the basics? I guess it's like, if I'm a listener here, how do I self-assess and go, What do I need?

Well, your basic first First aid kits could be anywhere from a booboo kit. I cut my finger, paper cut. Do I have some Neosporin? Do I have a bandaid? Did I get a sliver? You have tweezers to pull a sliver out. Put a bandaid on, nails for, and keep it clean. First aid kit is exactly what it says, providing the first aid before you need medical attention. Now, on those booboo's, you don't really need anything else. You put a bandaid on, you'll be fine. But you get up more serious things. You run your arm through a plate glass window. You get this massive hemorrhage on your arm now.

Or stick your finger in a cigar.

Or stick your finger in a cigar. Direct pressure, put a tourniquet on, call EMS. Can't Can you do that? Can you calm yourself enough to say, This is what I need to do? Once you've figured that out, you put it on, wait for EMS, they take you to the hospital, and the professionals will take you from there. But it's providing that initial care for EMS to get to you. All bleeding, like I said, early, stops eventually. It only takes 3-5 minutes for you to bleed out depending on what you've lacerated. It's not a whole lot of blood. It's not a whole lot of time.

Yeah, then you start making bad decisions as that continues to decrease.

Yeah, the more blood loss, The more you go in shock, you lose those fine motor skills. You're unable to put the tourniquets on. You're unable to hold pressure. You're host at that point.

In building out this kit, the easy button for the entry level is Amazon or Walmart. You go in there, pick up a kit. Just start with that. Do you have that? How many of those do you have? I mean, they're not expensive.

You can pick those up a dime a dozen around here now.

Right. I think just having that because you don't want to have to go find a bandaid because that always sucks. Bleed all over the house. It also depends on what tools do you work with. I reached into a bag one time in a trade show, and we have ceramic blades which are extremely sharp, and I cut longitudinally through my fingernail. It just went through it.

I think I helped you with that one, too.

I want They're always my first call, and I always do get pictures, folks. I'm a klutz a lot of times. But do you work in a place that has sharp things, or are you carrying? And do you carry Professionally, or do you just everyday carry? Or does your family member carry? How many tourniquets do you have if there was a AD, ND, however you want to call it, or if there was a legit shooting, or if you live Where people are prone to drive-bys. I mean, you just never know anymore because there's a lot of angry people out there. So how do you go from assessing where I'm at as a person? Who am I around? What people What role do I roll with? What parts of the country do I go to? What's the best way to start winding up? What I need to really start thinking about as far as what gear to have? And Having the gear, but also understanding how to use it.

So one of the first things you want to do is, what do I want the kit for? Is this bandages for my home? Is this something to keep in my car? What if I come up on a car wreck and someone's hurt really bad? Do I have the stuff I need for that?

Yeah. Then you go from paper cut to crush and burn.

Crush, burn, airway problems. Are you a law enforcement or military to where you need tourniquets, stop the bleed, packing gause rolls, things like that. Are you on a backpacking trip? Do you have splints in your first aid kit? Do you have Bug bites stuff, snake bite kits. Everything we do, there's not just one size fits all because every scenario puts you a little bit different to what you're going to need.

One scenario comes to mind is I've heard about the surgeon who was out clearing land. Can you talk about that one?

This was a surgeon I used to work with many years ago, and he has He was clearing land and ended up getting cut to his femoral artery.Terrible situation.Chainsaw?

Chainsaw. He was an orthopedic doctor. He's put hundreds, thousands of tourniquets on. He knew the anatomy of the leg. He knew what was down there. When they found him, then unfortunately, they found him expired because the bleeding got to him. But he is probably losing so much blood so fast that he start becoming unaware. You start blacking out a little bit. Your reasoning goes, your fine motor skills go. Can you twist the cravat to tighten the tourniquet? Can you pull the Velcro off even? Putting a tourniquet on yourself in a massive situation.

Was that the one they found him with his belt?

He was trying to put a tourniquet on his leg.

It was a tourniquet, okay.

I'm not sure. I don't remember for his tourniquet or his belt. But either way, he was trying to fix the problem. Just never got around to it, which is sad to say, but it goes to show how a real experienced person under a real traumatic injury, the body does a lot of stuff to shut down, to try to fix problems. And shock is a killer for most people.

Yeah. So self-aid, when you're the one who's experienced the trauma, the self-aid is going to be the most difficult. It's difficult depending on if it's buddy aid, if it's a buddy or complete stranger, you get to choose how involved you are.

Seconds count when it happens to yourself, because the more the second stick on, the harder it's going to be to get the job done.

Yeah. When we go From basic, and we're going to start rolling up and go, Okay, I'm a guy. Every day carry. What all should I now be thinking about to have with me since I am carrying? What What part? Obviously, tourniquet, but one is none, two is one. Is that the way we're going for it?

I always go by that principle. You never know what's going to happen. You may drop it, you may fumbly it. It's hard to tell what's going to happen, but if you have two, you'll always be good. Hopefully.

If you need more than In my kit that I usually carry with me, I'll have at least three tourniquets in mind.

I'll have two. If I'm at the range, I'll have two in the bag and one outside because you want to be able to get to it quickly. I have some quick clot, some hemostatic agent to help stop the bleeding. Curlix rolls to pack a wound. I'll have a chest seal in case you get a new more thorax.

Rumor has it you just got some decompression needles from EOD Gear.

Eod Gear. A wonderful store that they have.

We've done some cool kits for some really cool agencies.

If you're looking for anything for body armor, medical gear, tactical stuff, That's it.

Tactical stuff. You haven't been here, guys. You need to stop it.

It's a playground for adults. It is. I'm going to say adults because I know a lot of females love this stuff.

Yeah, they love coming in here, too. Then Clint will laser engrave anything you have on you, even if not you. So tourniquets, hemostatic gauze, wound pack, chest seals, needle deep. But the whole thing is you have to know how to use the gear.

And you do.

And you have to know how to use it under stress.

I used to help Steve out hit the store here quite often. I had a guy, gentleman, come in and wanted some bulletproof vest. I said, Have you thought about an IFAC, individual first aid kit. He says, No, not really. Said, If you're going to carry a gun and you think you might get shot, you might want to have a way to bug a bull hole, right? He goes, Oh, yeah. So he ended up buying a kit. I looked at him, I said, Do you know how to use it? He says, No. I was like, Well, why have it? Why own something if you don't know how to use it? So we took it apart. I helped stage the tourniquet for him. I said, You want to know where everything is in this kit? Because when something happens, it may be low light, no light, might be foggy, hazy, smoke.

I don't know how many times. I think it was like every day on deployments, you go through your kit. You know where everything's at.

And you go by Phil. You set it up the same way Do the same thing every time. So that it's muscle memory. When you need that tourniquet, you grab it and put it on and you practice. I told him, I said, you might want to get a practice tourniquet and just practice putting it on. Practice at the dark, practice at night, practice at the kitchen table while watching TV. Because if you can't put it on calmly and smoothly when you're resting, you're not going to put it on calmly and smoothly when you've been shot.

Under the rise, yeah. Or chainsaw it or anything else.

Do you know how to use this? Do you know how to pack a wound? Do you know how to put a pressure dressing on? When do you use a pressure dressing versus a tourniquet.

And that's one of the things- And tourniquet placement.

Yes, very important.

It's above the knee and above the elbow.

It's not supposed to be on any prominent joints. I heard a stat the other day that approximately 3,000 soldiers from Vietnam could have been saved if they had to carry tourniquets in Vietnam.

Is that so That's almost what, 6, 7%?

That's a fair amount of people. It's a lot. I know today, all the soldiers carry IFACs with them. Yeah.

Most of LA does as well. Well, they have it. If you guys have it in your trunk, better get it out of your trunk.

My son, who now works for Steve here, he rides-He's been here a month.

Probably seems like an eternity.

He writes It was cross country motor cycles. On his first ride, I said, You need a kit. I set him up a kit, and he put it in a saddle bag on his bike. I said, Why? He said, If you get in When you're in an accident, you're going to be anywhere from 15, 20, 50 feet away from your bike. Where's your tourniquet at? Good point. In my saddle bag, I said, You need to have one on you. At the time, we were I was on an ankle IFAK, and I got them an ankle IFAK with a tourniquet on it. I said, This way here, you will always have a tourniquet on you while riding. So even if you're 100 feet away from the bike, you've got a hemostatic agent, you've got quick clot to put on there, you have a Kurlex to pack it, and you have a tourniquet.

So I picked up my Harley in Pensacola, back in '99, the one I rode when I was stationed at Sigonella, Sicily. When Mobile Unit 8 was there, that's how long ago that was. So I ended up laying my motorcycle down on Highway 98 outside of Sandestin. And called one of my friends. He's like, Oh, my God. Is the bike okay? Yeah, the bike's fine. A little scuffing. So it's all about priorities. So I guess it depends on the motorcycle.

A little bit of bond to and pain, she'll be fine.

Oh, no, it was fine. It was still running. I was not. I broke my wrist, lost a lot of skin, and that was not a fun day.

But yeah, and that's one of the things that- You were right.

I was probably because the bike kept sliding. Skin traction helped me slow down on the road. We had some safe separation.

Then that's what you have to think One of the things I teach is how to use the medical equipment, how to put the tourniquets on, how to properly stage them. The last thing you want to be doing is fumbling with package, packaging.

We have those stop the bleed kits, but the packaging is actually hard to open up. I recommend when you get the stop the bleed kits because they come in that back, you see a pack. If you don't have a knife on you, it's going to It's going to take some time. Yeah, I would bust that open and put it in a zippered pouch.

That's what I always tell people is EOD gear has some great zipper pouches.

Thanks for the shame. You don't have to have a shameful plug every… No, you're good, man.

I appreciate it. They have You need rip-aways that you can put in your car and put in the back of your headrest or something. When you need it, you just rip it off there and it's already stayed.

You might as well tell them about the panels we cut, the MOLLE panels we've been cutting for 10 years. I'm just kidding.

This is a great place. You can always look, come here and say, I could use that for this. Or if you're looking for something, tell them what you need, and they can make it happen.

We're pretty good at that. I've really enjoyed going through your training. Then you came to a networking event this past week that I belong to just for the local area. Toren was able to speak to 75 people, and he had people coming up afterwards. We had a nurse come up, and she had to redo her search for first aid, CPR. I don't know what it is, you guys. What all do you teach on the medical side?

On the medical side, I'm an instructor for American Heart, Red Cross, Ashy, and Avert. I teach basic life support for healthcare workers, HeartSaver, CPR, AED, First aid courses, active shooter courses.

You do the armed guard.

The Tennessee armed unarmed guard license.

Concealed carry? I don't know if that's still a thing in this state.

Well, we've got the constitutional carry, and I do teach courses, and we go heavily over.

For all those not living in Tennessee, we are constitutional carry.

However, I would suggest anybody out there Having gone to some formal schooling or class in case something did happen, say, Hey, I've been trained. Here's my certificate of training saying, I've gone over laws, skills. I've demonstrated that I know how to shoot. Otherwise, you're just opening yourself up for what could be a hefty lawsuit. But with the first aid stuff, not only can I get first aid kits for you and trauma and the IFACs.

But show you actually how to put it together and use it.

That's the big part. It's no sense in heaven if you don't know how to use it.

Amen to that. Yeah, again, we put brains over brand. All day long. I mean, you got to know. If you have the gear, you need to know how to use it, because if you don't, then it's a waste of money. We don't want that. No. So you're part of the Instructor Cadre for EOD Gear's tactical mastery. We'll be doing the online training there. But if people just want to reach you and go, Hey, I want to learn more, or I just want some practical advice, Or I want to go through, I want to get certified. I want to have some additional training. I want hemcon, hemorrhage control training. So to go from something from BLS, first aid. Again, we're going from that practical to tactical and splash the tactical. To get somebody up to speed, how can people reach you?

You can do one of two different ways. You can sign up on EOD Gear on their training website, on Training page because a lot of the courses are there.

Yeah, we have the courses list on there. I forgot about that.

I teach there. You can email me at pangiertgc@gmail.com, which is P-A-N-G-I-E-R-T-C @gmail. Com. That's probably the best way to get a hold of me. pangiertc@gmail.com 

It's Papa Alpha, November, Gulf, India, Echo, Romeo, Tango, Charlie @gmail. Com.

You do that pretty good.

Like you've done it before. Right. Like I said, I think it's funny for all you. Torn was really surprised that it was Airborne Navy and knew what T&E was. Because I used to have to carry that 60, which was... Yeah, I'm that old. We're that old. We're carrying a 60.

That pig is something else. Yeah, it is.

But that's just a great way. So if you want to get up to speed, and if you're in the middle of Tennessee area and you want to start getting some training lined up, definitely reach out to Toren.

Or your business. Yeah. One of the things I do with my active shooter is I will attend your business location, and we go through your place of employment and say, All right, this is what you have. This is what will work. This was what won't work. So let you know at your place, rather than coming to my school or EOD gear here for your training, you guys actually see what you have at your place of employment.

You'll also do that for your BLS, First Day at Heart, American Heart. All that mess.

We can do this at your location and get you trained up and up to speed so that you can take care of medical emergencies at your location.

Fantastic. Well, good deal. Well, Toren, again, thank you so much. Last bit. Anything else? Just come out and see, I guess.

Give me a call if I can do anything to help you out. Thanks. Shout out to you, Steve, with EOD Gear once again, and thanks for having me.

You got it, brother.