The Armed Tactical Medical Professional

[Rick Murray] Well, I've got right about seven o'clock, so we can go ahead and get started. Welcome everybody. This is the eighth tactical section webinar. Welcome for everybody who's attending. We're excited to offer a CME for this presentation. If you would, check in the chat box, and there is a CME required form to give out. It's a disclosure that would list any interest conflicts and any possible corporate sponsors, which there are no corporate sponsors. Some housekeeping activities. If you would, if you are not speaking, if you would keep your mic on mute. That way we can keep the background noise to a minimum. If you have a question, you can either raise your hand through the Zoom options at the bottom, or you can, when it's time for question/answers, you can unmute your mic and ask questions that way. You can also type in comments or questions in the chat function. We'll monitor those and pass those on to the presenter. So, also, if you do want to claim CME hours, make sure that you let Deanna know, that way we can make sure. We'll need your ACEP number, that way we can make sure that you can get the proper, the credit for this presentation. With that, I think that's all I have. So Dr. Springer, I'll give it to you, unless anyone else has any comments before we start.

[Brian Springer] Okay. I guess I'm gonna take it. Good evening, everybody. My name is Brian Springer. I think, probably most of you out in the audience, at some point or another, if I haven't met you, I at least have met you virtually on one of these webinars in the past, or in some other tactical medical environment. We're gonna talk tonight about the armed tactical medical professional. Just in terms of my background, I'm at Wright State University in Dayton, Ohio. I'm the Vice Chair, and I also direct our division for tactical emergency medicine. I've been pretty active now in TEMs, going back over 16 years. And I think that this topic, here, is something that you're all going to enjoy. This is... There we go. The learning objectives that we're going to cover. And we'll talk about some of the basic legal concepts applicable to firearms in a law enforcement context, or tactical medical provider context. Talk about how you need to think about things like financial and insurance concerns. We'll talk about the actual firearms use, some general advice in terms of what to be looking for as far as for weapons and training. Talk about some of the more common platforms that are used out there, and some of the different accessories are available. I'll tell you, honestly, I suspect that the crowd that's listening in today, probably already has an interest in this and probably has a lot of knowledge about this topic, and probably has their own opinions too. I'm hoping that, since this will be a recorded webinar available on the website, that in the future, residents or emergency physicians who have an interest in tactical medicine and want to learn a little bit more about this field, including this aspect, will take a look at this webinar to go ahead and get some hints and tips. I do not have any conflicts of interest. I've no corporate sponsorship. Unfortunately, I will say that this is one field where I would just love to get corporate sponsorship, given the cost of ammunition these days. So, if anybody out there from Glock or Smith and Wesson, or anything like that, if you want a corporate sponsor, I'll be your shill. In terms of my own background on all this, too, I've been involved in the firearms, and shooting sports and hunting, going back many, many years, starting even back, really, before the Marine Corps. And then, beyond. And, as I became more involved in tactical medicine, I really developed an interest in the actual tactical use of firearms. And I've trained with a lot of the big names that are out there. And I really try and stay on top of things as far as for my own skills in training. I certainly want to make sure that I know the things that I don't know. And so, I'm continually pushing myself. And I did find, just to show you all, a picture here that going back, this is 30 plus years ago, back when I even had some hair, but even back then, the two most important things in my life were guns and coffee. So, armed versus unarmed tactical medics. Actually, that is not what this talk is going to be about. We're not going to discuss whether or not tactical medics should be armed or not. I mean, there are clear advantages to tactical medics being armed, the ability for them to protect themselves and to protect others. There are disadvantages as well. When you are focused on treating a casualty, your weapon is gonna be in very close proximity to them. And you, as an armed tactical medic, anywhere you are, there is a firearm because you are the one going and carrying that firearm. So, , and I will also say that, in terms of an actual situation where, at least in terms of for civilian tactical medical providers, where they would be in a situation where they need to go ahead and use their firearm, I think you really need to be looking at better planning and tactics to go ahead and even prevent something like that happening. Now, that said, if it happens, it happens. And so, again, I'm a believer in medics being armed, but again, there's compelling arguments on both sides. If you go back, and if you think, I mean, traditionally combat medics been very lightly armed handguns or carving. I, basically, defensive weapons, and clearly mark themselves as medics. And so, therefore, according to the Geneva Convention, they really, they should not be deliberately targeted. Now, we know that it's very hard in the contemporary battlefield setting to be able to go ahead and delineate out who's your medics and who's not. And so, still most medics now will be going and carrying long guns out there. But, that said, even in the SWAT environment, the fact is that many of our tactical medics, because of their personal protective gear and stuff, it's difficult to tell them apart from law enforcement, and even if it says "medic" on their vest, it really is gonna be difficult to say who is who. And so, I think we have a trend now moving towards the armed tactical medical professional, and I suspect that, as law enforcement medicine expands its reach, we're going to see more individuals who are sworn, who are serving as tactical medical providers. So, basically, this train has already left the station. So, what I want to do is discuss options for the armed tactical medical professional and some training considerations. So, the role of the handgun, you can look at it from the standpoint of it's for being able to protect casualties. It's being able to protect innocent citizens. It's being able to protect your fellow tactical medical professionals and law enforcement officers. And, of course, also to be able to go ahead and protect yourself. So, really, all of these definitions here, as far as for role of the handgun from the concept and a standpoint of a tactical medical provider, it is a defensive role for the weapon. And I would say that even in the unlikely circumstance where a civilian tactical medical provider, as opposed to a sworn officer, is going and actually employing the weapon in a more offensive manner. Let's say going and pursuing an active shooter who's still a threat. Even this, really, is you're using this weapon in the role of defense of innocent citizens and others. So, I think we can really pretty safely say that from the tactical medical side of things, this is, it is a defensive weapon. By the way, regarding this picture, which I downloaded off of the Internet, boy, I got a couple of questions about it. I mean, first off, why, I understand why the armed medic there is trying to keep a low profile, but using your buddy for cover. Yeah, that's kind of poor form. And, also, if the situation is that bad, this is going on, maybe they should get off the X before they actually go ahead and intubate that individual they appear to be doing in the picture. So, once again, talking about the role of the handgun. Are pistols optimal weapons? And the answer is no. I mean, there's certainly other more effective weapons that are out there, but are they optimal for our purpose as tactical medical professionals? I didn't think there the answer is yes. So, a number of different advantages to handgun, size, availability, and then its effectiveness in the stated role, right? So the first rule of a gun fight is have a gun. So, a defensive weapon, having a handgun, that's something that can always be on the provider. It's something that they can keep out of the way, holstered, while they're actually going and caring for casualties. It can be deployed rapidly and it's effective in stopping the attack. And I think the defensive handgun meets these parameters, especially given in the most likely roles of the civilian tactical medical provider and the typical field of operations in which most tactical medical providers and tactical medical professionals function. Now, might there be a situation in which a long gun, a rifle, a shotgun might be a better defensive weapon for the tactical medical professional, even working in a civilian environment? The answer is, yes, it certainly is a possibility, but this certainly does create an other level of complexity, not only in mastery of the weapon, but in the ability to go ahead and administer care while also going and handling that weapon. So, let's talk about some of the legal considerations. So, these are all questions that you have to ask and you have to know the answers for before you get out there and start deploying in the tense environment. And I will, also, say things that you even have to know and be able to answer before you even get out there and start training with the team, if that training is going to involve the use of firearms. Now, are you a sworn officer? Or, is the tactical medical provider, who you're working with, a sworn officer? If so, are the duties of tactical medical provider within the scope of your supporting agency? In other words, you may be sworn of an agency, but now are they also allowing you to go out there and actually function as a tactical medical provider? What if you are providing tactical medical support for other agencies? Are they okay with that? Are they okay with you displaying their badge? I'm sworn through one agency, but I cover a whole host of different agencies as a tactical medic. And I had to make sure that that was all good, as far as with my actual department. Who's paying for this time? Is anybody going and actually paying for this time? Who's gonna cover you? I mean, not only talking about the legal aspects in terms of if you end up involved in an actual shooting, but what if you end up getting injured? What if you're disabled temporarily or even permanently? This is really, really important stuff to figure out in advance. Just because, again, just because you're sworn, doesn't always mean that you are 100% good to go in terms of being armed in every single environment. I will tell you myself, personally, even though I've been working now with FBI SWAT, basically since the very beginning of my tactical medical career and have been armed with them both, going way back as a civilian and then even once I became sworn law enforcement. When I worked with them to support the Republican National Convention, speaking with Dr. Fabbri, their chief medical officer. And even though I was sworn, he said, "Yeah, but you're still not an agent. And so, if you're gonna be working with our team on that, we don't want you to be armed." Strange things, even though I've been armed with them in the past and have been since. Also, taking a look there at that x-ray. So that's the 5.556 round that's still inside of my leg, from a training accident where I was basically hit by friendly fire, actually a ricochet. And so, you can imagine, as I was trying to explain to the Bureau of Workman's Compensation here in Ohio, that I'm an emergency physician, employed full-time, by Wright State University, who was on the range training with FBI SWAT while getting paid by the Kettering Health Network Police Department. So that totally made them cross-eyed, but we were finally able to go ahead and actually sort all of this out. But a big part of that was because the fact that, all in advance, it was talked about that, "Okay, this is the agency that's paying me while I'm doing these duties." What if you're not sworn? State laws that are out there? What do they say regarding you being an armed tactical medical provider? Again, the same questions as above, really, that you have to ask if you're involved in a shooting or you're injured, who's covering you? Who's going to be providing you legal counsel? Now, ideally, many of these new laws that allow tactical medical providers to be armed when working with a team should put that tactical medical provider in the context of if they're involved in a shooting, that they're basically a government employee and, therefore, they should have qualified immunity, and provided they did not act criminally in the shooting, they should be protected from civil suit. Now, does that actually work for these new armed civilian tactical medical providers? Well, guess what? We don't really know yet. We don't have those answers because we have not yet been facing those cases. So it is critically important that you know the law, that you make sure that you are operating under the law, and that financial and legal protections are going to be provided to you should you be involved in a shooting. Now, some of you have heard me say this before. This is Springer's Tactical Medical Professional Rule #1. Which is you do not, "Under any circumstances, want case law to be named after you." So, where to look, in terms of for background and for education. There's a lot of good stuff that's out there. There is also a lot of crap. And so, you have to be able to sort through it. There's some great classic books which are out there, which can provide a good historic context, explain basics of handgun safety, their operation, and their use. And, all of it comes down to, if you're going to achieve a high degree of proficiency, you gotta start by mastering those basics. So, go and start looking to the basics. Magazines. There are some good articles out there in firearms magazines. There are some really good writers who are out there who publish in said magazines, but this is also definitely a case of buyer beware. So, these magazines, yeah, they make money off of subscriptions, but also, really, the main way that they're going and making money is through advertising. And so you have to realize that many of the articles that you see in these gun magazines, whether you pick them up at the grocery store at the magazine shelf, or even start looking at these articles online, many of these articles are basically plugs for the industry. Now, you can still pick up a lot and you can learn a lot of information, but you have to really look at this with a very skeptical eye. The Internet, so much to say about the Internet. It's obviously an incredible, incredible resource, and it is a source of some fantastic information. And it's not only a great place for beginners to get started, but even for professionals to go ahead and to look for new and different ideas and concepts, and keep themselves educated. Some of the top names in terms of for pistol craft and competitive shooting and self-defense, post articles, they put up blogs, but you have to realize that as bad as some of the stuff that you might see in the magazines are, the Internet with the armies of fan boys and fan girls out there has the potential to be a thousand times worse. You have to look cautiously, and I really suggest that you start with some of the really top names in the industries. I mean, look for our articles by guys like Massad Ayoob, who's been writing about combat pistol craft, not only practical use, but also about the legal aspects, and was really one of the first authors to really delve deeply into the legal aspects of being involved in a shooting. Anything that you see that's written by this guy, you should be reading. Dave Spalding, really a master of pistol craft. Greg Ellifritz who's really coming into his own now, as an author, has a great blog called Active Response Training. Definitely take a look at it. And each weekend, he puts up his weekend knowledge dump, where he has links to all different sites that are out there as well. So it's a great way also to go and to expand your horizons and see some other informative online sites. I'll also put a plug in here, too, for the Warrior Poet Society. That's an excellent resource. I'd say maybe, this is personal opinion, a little bit commercialized, as far as they sell a lot of stuff on there, but they drop some serious knowledge bombs about self-defense, about effective weapon craft, and, most importantly, about cultivating a proper mindset. So, give them a look as well. Now, remembering in terms of with the Internet here, that if you are not careful that, yeah, this is probably the guy who you're going to be going and getting your information from. A lot of these so-called experts. So I'm going to say to you that if you are looking for information online, and if you are new to this, or new to really scouring the Internet, to say, "Hmm, what interesting things can I actually learn about offensive pistol craft?" Avoid anything that's on Reddit. In fact, you should just avoid Reddit altogether. Avoid the brand-specific forums. So anything that's gotta name to it, Glock Talk, XD Talk, insert-your-brand-there talk, you should probably avoid because most of the people on there are fanboys or pseudo experts, and you're going to get a lot of misinformation. If you maybe have a specific mechanical problem and you want to go and pick some people's brains, okay. But it is not a great resource in terms of really learning about good defensive pistol craft. Caution, in terms of with anything where you are reading an article, which is, allegedly, a former operator, or a SEAL, or a former Delta Operator, where they're talking about being on the x, and how fill-in-the-blank is the only piece of equipment that worked well, or so and so is the best man stopper that's out there. And, basically, everything else is for milk to sisses. Now, most likely, the individual who is going and plugging themselves as that is full of you know what. Now, there are exceptions to that, and there is the real deal that's out there. But, once again, buyer beware. Now, also, you have to look at this carefully because, even if the credentials of some of these individuals are legitimate, former SEAL, former high-level SWAT operator, their particular mission, the equipment that they have access to, the training that they have access to, this is going to be different than yours. And it may, very well, have limited relevance to your needs as a tactical medical provider, or even just as an armed civilian out there, as far as for self-protection. So, extreme caution when looking on the Internet. So, where to look. So, if you have taken a basic CCW class, great start. You need training beyond that. If you have even done really well in your basic military qualifications, fantastic, excellent start, but you need better training. If you have graduated from the police academy and you aced, you were their top shot there, as far as for their shooter, fantastic. But, once again, you need additional training. The standards for all of these here are based on everybody passing. That is what the goals of these training paradigms are. It is critically important that you are cognizant of the Dunning-Kruger effect, right? Shooters who achieved the skill levels above have achieved a minimum standard, and they will grossly overestimate their skills if this is all they know. Typical practice that people go and do out there, even going after finishing any of these courses here, are not generally measuring against any standard. We go out there, many times, we recreationally shoot, but how much were we actually going and pushing ourselves in terms of actually to challenge our skillset? Taking the next steps, getting real good quality training is going to bruise your ego. It's gonna hurt. You have to overcome this fear of failure and get out there, and go beyond this, and start taking much more intensive training to effectively run the defensive pistol. So I'm gonna paraphrase Craig Douglas, a great instructor. He's the owner of ShivWorks. And, basically, what he said is that, "They say that experience is a great teacher, and actually, no, experience is a terrible teacher. That's a terrible, terrible way to go ahead and learn. What you want is quality training to high standards. That's what's going to actually help you succeed in real world situations." So, who do you actually, who should you ask about this if you don't know where to look? And again, some resources that are there, in terms of books and magazines and online, avoid Internet experts for the most part, avoid the gun store commandos, ask your fellow SWAT team members, if you're out there as a tactical medical professional, ask them where have they trained, what training have they done beyond just the police academy to really go ahead and hone and their skills. And higher-level operators and the majority of SWAT teams will be going and seeking training on their own. Look to nationally-known high quality training. Look at places like Gun Site. Look at places like Thunder Ranch. Although, I actually heard Thunder Ranch is being sold. Look to Bill Rogers Academy. Look to places here in Ohio. We have Tactical Defense Institute. There's some really, really great places out there. Now, training with your team is a huge, huge plus. And that's what attracts many of us, initially, to tactical medicine. But, you have to have the fundamentals down, particularly when it comes to how to effectively and safely use a firearm. If you inadvertently muzzle the entire team while you're there on the firing line, they're not going to be happy with you at all. So now, let's figure out selection, in terms of what to actually pick out. Now, when I look at this picture and think, "Okay, what should I pick out," I think of Arnold Schwartzenegger in the Terminator when he says, "All!" But since you actually can't carry all, we need to be a little bit more selective. Now, some questions that we have to ask, are you being issued this weapon, or is it going to be an individual purchase? Does the team, if you're going to be doing an individual purchase, give you several options in terms of what to actually go ahead and carry. Look to what it is that your team carries. Look at what you obviously can most effectively carry and use as well as maintain. Now, I strongly suggest that if it's practical, the tactical medical professional should run, if not the same, at least a similar platform, as the operators on their team. Now, this might not work if it's a multi-agency team where they're, potentially, multiple different firearms manufacturer and models and calibers, but there's distinct advantages to carrying the same handgun that your team members have. These include the fact that you'll have familiarity with the weapon, should a situation arise, where you need to handle the operator's weapon. Now, that's whether to fire it, or if you're treating them as a casualty, to be able to go ahead and to render it safe. The above applies if the operator, for any reason, needs to go ahead and handle your weapon, whether it's actually use it, or just go ahead and take it off of you, should something happen. I may need to go ahead and render it safe. Having the same caliber and compatible magazines allows for ammunition to be shared in the event of some sort of an extended operation, and is also during training. Again, we talk about how we like to do this because it's also something that's fun, and we get a chance to get out there on the range and shoot with our team. And if they're providing the ammo, hey, it's nice if we have a weapon that's in the caliber, that they can provide for us. Also, similar maintenance procedures and maintenance supplies that will allow the tactical medical professional to keep the weapon well-maintained and keep it duty-ready. Now, also, we still have to think about cost. This is the Nighthawk Sand Hawk, which I have a picture of, that'll set you back $5,399. And, no, that's not Nighthawk's most expensive pistol. And no, I do not own any Nighthawk pistols. Now, a little bit of personal opinion here. I think that most tactical medical professionals will be best-served by a midsize to full-size duty weapon. And one of the popular calibers that is used by law enforcement, so nine millimeter, a 40 Smith and Wesson caliber, or 45 ACP. The polymer-framed striker-fired action pistols are the weapons that are now most often carried by law enforcement agencies across the country. And you really cannot go wrong with any of the service handguns that are manufactured by Glock, by Smith and Wesson, by SIG Sauer, and several other companies that are out there. Advantages include ease of use. Now, effective use, in terms of actually defensively using the handgun, is a little bit more are complicated than this. But the fact is, in terms of the mangle of arms for these weapons is, it's pretty much point and shoot. They're very, very safe weapons. Most of the modern striker-fired action pistols have multiple safety mechanisms that are built-in to prevent unintentional discharge should the weapon be dropped, or should it be otherwise mishandled. The safety mechanisms are, these are predominantly internal, which enhances ease of use, but does create the need for a greater margin of caution when handling these. These weapons can also be purchased with an actual external safety on them as well. They're very easy to disassemble and very easy to maintain. There are some out there who are argue that the field stripping process for Glock is fundamentally flawed because you need to depress the trigger before you actually take down the slide. But, if you do proper gun handling and safety then, and ensure, absolutely ensure and ensure again, that the weapon is empty, that really should not be a problem. Plus, these weapons have a very high degree of reliability in adverse conditions and with very rudimentary maintenance. Now, depending on your own size, your own strength, the size of your hands, et cetera, there's different models by the same manufacturer, and even in the same caliber, that are going to fit your hand differently, and that you may find easier or harder to shoot. And so, ask members of your team to go ahead and be able to fire their weapons. See if they personally own other weapons that they'll allow you to shoot. Again, once you are in there with the team asking questions like that, they'll be happy to help you out. And they'll like the fact that you have an interest in this. Some of these manufacturers, the pistols have adjustable grip sizes, which is a plus. You can expect to spend somewhere around 400 to $500 on these weapons. And everything's getting a little more expensive now. So, probably more along the lines of closer to 500, is gonna be your starting point. Many dealers, who are out there, are going to offer discounted pricing if you are law enforcement, or if you are EMS, or if you are military. Now, some other platforms, and I'll just touch on these very, very briefly, the double action/single action. For any of you military types, who towed around the Beretta M9 for a long period of time, still good platform. You have to be able to manage that change in the trigger pull, from your first shot to your subsequent shots. Also, you have to be able to learn how to manipulate the safety mechanisms and the decocking mechanisms on these weapons. Double action only pistols, very effective. You just have to be able to go ahead and manage that trigger pull. The 1911 platform that's been with us for a long time. For those of you who have had the opportunity to shoot it, you realize it's just a wonderful weapon in terms of how well it points, how easy it is to shoot, how easy it is to have a really fantastic trigger on there that just makes it, you have to work at it to actually go ahead and miss with that pistol. However, the actual running of that gun in terms of managing the external safeties on there is more challenging. The maintenance demands, in order to keep them up and running, much more challenging, finding the right magazines that feed right, especially if you're using modern ammunition, can be very, very challenging as well. So 1911s are very much professional guns, and take a lot of work to keep them up and running well. Revolvers, they actually still have a role out there. You have to learn how to go ahead and manage that trigger pull, but they can still be very effective weapons. Obviously, it's a very different manual of arms in terms of keeping them running, keeping them reloaded. And if the gun does happen to malfunction on you, actually, which which can happen with revolvers, getting it up and running is very different in proposition than getting a semi-automatic pistol up and running. So, once again, takes a lot of practice to run 'em well. What caliber to use? Honestly, the best caliber is the one that you can wield most effectively, right? Only hits count. You are responsible for every round that you go and you fire out there in the field. And, if you're flinching because of heavy recoil, and you miss on your first shot, or you start missing on your follow-up shots, you've not only, one, failed to stop the threat, but you've now sent a round or rounds sailing in the direction of a school bus full of preschoolers, or a car full of nuns. And that's obviously less than optimal. Now, as noted previously, the majority of law enforcement agencies now are moving to nine millimeter. You still may see 45 ACP out there, and still may see 40 Smith and Wesson. Tactical advantages over the last several decades have given us bullets that perform very, very effectively regarding penetration and expansion, improvement in propellance allows us to go ahead and launch these projectiles very, very quickly and get good muscle velocities from service-size weapons. And with these advances, now, many, many agencies are moving towards nine millimeter with the advantage of overall lower cost for the ammunition, lower rate, lower recoil, higher magazine capacity. And, they just beat up on the guns list, than something like 40 Smith and Wesson. If your agency uses an exotic caliber, like .357 SIG or .45 GAP, that's fine. But, otherwise, I would say avoid those calibers because they can be difficult to find. And they're very, very expensive, as far as for the ammunition. Recoil in most service-size pistols is generally not an issue. .40 Smith and Wesson can be pretty darn snappy in any of the major service calibers. If you are carrying a small-framed weapon, can be pretty snappy to fire as well. This, in terms of concerns over what caliber to carry, and is bigger always better, this is information from Greg Ellifritz, who I mentioned earlier, and what he did was take a look at 1,700 military, civilian, and law enforcement shootings. He had a strong interest. He read all the old stuff out there, and the old studies about stopping power and said, "A lot of this stuff doesn't seem to jive, or there's a lot of personal opinion, or they're talking about gelatin and not real people, or shooting pigs and not real people." So he looked at 1,700 military, civilian, and law enforcement shootings, people shooting people, and actually found that one shot stopping power of different rounds are very similar. Now, there were a couple of outliers in there, and even then, notes that the caveats, if you look at calibers like, .25 ACP, 32, and again, these very small calibers. And then, on the other end of things, like .44 Magnum, where the actual N, in terms of the number of actual shootings with those rounds, was very, very low. So, the numbers, here, are probably inaccurate due to the underrepresentation of those calibers in this study. Also, the majority of nine millimeter shootings were using full metal jacketed bullets, can pull a lot of those from military shootings, which likely negatively affects the outcomes from that caliber. Now, this is really interesting here, too. If we actually take a look at the average number of rounds until incapacitation. In general, looking at the major service calibers, they're really, really close. About two to two-and-a-half rounds until incapacitation. Now, some food for thought, as far as with these service calibers. So, if you actually look at .38 Special, which still considered a service caliber, .38 special revolvers, they're, in general, going to have the slowest rate of fire compared to a semi-auto pistol. And so, you're going to have a lower number of rounds fired overall. So, that's probably why you actually have a lower number in terms of average rounds until incapacitation. 9mm, most people can shoot nine millimeter pretty fast. So, it's probably the number of hits gets overrepresented because people can just shoot the gun faster. You see .40 and .45 kind of split the difference. So, if we try and factor, in here, rate of fire and how that affects things, the actual stopping power of the service rounds are likely even more similar than what we go and see represented in these charts. So, basically get what it is that your agency is carrying, and that you can shoot well. Some essential accessories. You need a good cleaning kit. You can purchase this specific tool, the platform that you're carrying, specific to your caliber, or you can purchase a universal kit that can be used to clean almost any firearm. I have of all sorts of stuff piled up down there. And, in terms of my shop. Some really cool universal cleaners from the company Otis, which I would recommend as well. Again, just 'cause I happen to like them. Extra magazines are a must as well. You should separate out your training magazines from your duty magazines, and you must, must run rounds through any magazine that you are going to be carrying for duty. You do not, even though it's nice to take that brand spanking new magazine out of the plastic, load it up and load it in your firearm, you still need to make sure that that magazine works because problems can occur. Manufactured defects can occur, and you don't wanna find that out when you're actually involved in a shooting. High-visibility sights, also a must. They have to be high-quality. They have to be rugged. Those basic stock plastic sights that come on Glock handguns, they're really nice in that they're high visibility and easy to pick up, but they're plastic. They are not suitable for actual duty carry. You drop those on concrete, and that plastic's gonna get scraped off, or you're in a scuffle, and that top slide of that gun slides against concrete, those slides are literally going to be filed right off of the gun. Tritium night sights, a nice option, but not 100 percent essential as part of a high visibility sighting system. Most cases, if it's too dark to see your sights, it's probably really too dark to see the target as well. And so, you need to be able to go ahead and train yourself where you're able to run a gun along with a light. Some other essential accessories. having a good quality retention holster, an absolute must. You have to take time and practice a lot in order to go ahead and master that retention system. Just because you are reliably fast using that holster when you're on a static range, does not mean that you're going to be able to deploy it reliably under intensive stress. You need to work with the gun and the holster, or better still, with a blue gun or some other type of training gun. Again, very, very cautiously here, making sure that the system actually works when you're wearing gloves. When you are in a compromised position, like you're down on the ground. When somebody is trying to, again, get your buddies to help you practice this, trying to go ahead and grab that gun out of your holster when you are trying to draw. You spend several hundred dollars on a quality weapon, don't skim on the holster. Get a good quality holster. Avoid the cheap nylon holsters made by Uncle Mike's. Uncle Mike's make some cool stuff, some cool gun cases and little pistol sleeves and stuff like that. But their holsters are not duty-quality holsters. Avoid the cheap plastic holsters out there, such as the ones made by Fobus, or any holster that comes as part of a kit when you purchase the gun. "Ooh, buy Glock and it comes with a holster, extra magazine, a cleaning kit or whatever." Yeah. It's gonna be a cheap piece of junk, and not suitable as a duty holster. Universal holsters. Again, caution right there. There are some rare exceptions. The Blackhawk on the boar is fairly decent retention holster, but many of the universal holsters, again, they're, you can't do everything for everything. And so, stick with something that is really specifically made for the gun that you're carrying. I'm also gonna say caution, in terms of with the Serpa style holsters. Basically, they are used, the safety mechanism retention mechanism on the holster is deactivated with the trigger finger by pushing inwards towards the body. So, as the gun is drawn from a holster, particularly under intensive stress, the trigger finger is actually moving into the direction of the trigger guard, and basically enhancing the possibility of an unintentional discharge. You know, I've seen a lot of people who go and carry the Serpa holsters. I certainly have played around with them, myself. Some firearm schools and some trainers absolutely forbid students from bringing Serpa style holsters to their classes. So, again, buyer beware. Now, of course also there are some instructors out there who won't let their students do appendix carry, in their classes, and I'm a big fan of appendix carry. So, again, take my advice here as you may. Some useful accessories. Red dot, the micro red dot handgun optics, they've been used by competitive shooters for years with really great success. They are becoming increasingly popular now among civilian and law enforcement shooters, as well as on the military side, military special operations. And it probably won't take long until most military pistols have a micro red dot. I'm not going to discuss these in detail here. I would refer you to Dr. John Wipfler's section newsletter from two, three newsletters ago. A great article on the red dot optic for pistols. Now, like a quality holster, a quality micro red dot is one that's going to live up to the demands of duty and it's gonna cost you. It's gonna cost you some money. If the price sounds too good to be true, it's probably too good to be true. Now, for duty purposes, a quality weapon light, such as the ones manufactured by Streamlight or by Surefire. They provide enhanced target identification in low-light conditions. I think you also, if you're going to put one of those onto your duty weapon, you need to train in low-light shooting. You have to be aware that weapon lights are not, by any means, meant to replace handheld flashlights. Any place where you are going, and you are pointing that weapon light, you are also pointing the muzzle of your firearm. So you should also, still, have a quality handheld light and be able to manipulate that light in conjunction with the handgun as well. Now, lasers. Lasers can be useful, particularly if you're going and turning from nontraditional positions where you cannot access your sight. You've been knocked to the ground. You're attempting to go ahead and to shoot behind cover, lasers are an excellent option. They certainly go ahead and up the price, in terms of for, if you're getting a weapon light with a laser, you can get lasers that are special-built for the particular platform. Look to companies like Crimson Trace. The red lasers are traditionally the most popular. Green lasers, now, are becoming increasingly popular because of the ease of picking them up on your target, but they also increase your price. Some accessories to avoid. Do not, absolutely never ever, under any circumstances, put any sort of controversial graphics or writing on your duty pistols. This is I just, I Googled, "punish your handgun accessories." Bam! And look at all this stuff, and went ahead and popped up. Now, that skull may look really cool on the slide cover plate of your handgun or on your grips, but when it is projected huge up onto the wall in front of a grand jury, who is trying to decide if your actions in a shooting were justified, is that really the image that you want to go ahead and to project? And I will tell you that the answer is absolutely not. Do not ever deactivate any safety mechanisms on your handgun. The Springfield XD pistols have a grip safety. The 1911 has a grip safety. People are concerned, "Oh, there could be a circumstance where I'm hurt, I'm injured. I'm under stress. I don't have a good grip on the pistol, and so it's not going to fire." Deactivating that safety is just setting you up for a whole host of liability, should you actually use that gun in a shooting. So, you are deactivating the safety mechanisms on this weapon. Once again, how is that going to play out in front of a grand jury? Modifications to the trigger are suspect, but not deal breakers. As a general rule, if you're going to do trigger modifications on your duty pistol, and let me just back up here and say that, with the major manufacturers now, Glock and Smith and Wesson, they really continue to improve their triggers. So, oftentimes, their out-of-the-box trigger on those pistols is excellent. If you're going to modify or put in a drop in trigger, avoid a trigger pull that's lighter than the factory specifications for the duty gun, as opposed to, for a target handgun. So, and some of these drop in triggers can actually help enhance your pistol handling, give you a smoother pull, eliminate creep, allow for a cleaner break, and that's okay, but you have to be cautious that what you are not doing is going to be perceived as giving that handgun a hair trigger. And again, just talking about avoiding some of these accessories that are out there. So this is a picture of Daniel Shaver. He was fatally shot in 2016 in Mesa, Arizona by Officer Philip Brailsford. I was at, it was, I got that up. Some sort of motel. There was a call to police that somebody was going and waving a weapon, like a rifle, outside the window. And it was Shaver. He was intoxicated and he was waving a pellet gun outside the window. Ultimately, what ended up happening was, again, in his intoxicated state, he had a hard time following officer commands. He's, again, a father of two, this guy, and he was intoxicated, but he was unarmed and he was shot to death by Officer Brailsford. Brailsford, who also married, who's a father of one, ended up being criminally tried. This is one of the things that he had put on his weapon, on the inside of the dust cover. You can all read that there, and obviously something that did not go over well. He also had "Molon labe" also on his weapon, also, and those were used by the plaintiff's attorneys to really try and make this look like a, somebody who is itching to go ahead and shoot somebody and kill them. Again, Brailsford, he was criminally tried. He was ultimately acquitted. He suffered severe, and suffers severe PTSD, secondary, not only to the shooting, but the subsequent criminal trial. He had to declare bankruptcy and, ultimately, was medically retired. So you just gotta be careful, as far as for what you do out there. And, last but not least, just understanding training. Just go and push yourselves beyond the basics. Get out there, get advanced training. Do force on force. Take an extreme close quarters class, Learn how to go ahead and to use integrated weapons. So things like, not only your handgun, but how would you integrate in OC? What about impact weapons? There's so much stuff out there for you to go ahead and learn. Never should, basically, be in a situation where you never stop learning. Remember, it's amateurs are all about the equipment. Students are all about the techniques. But the experts, it's all about tactics. Continuing to go ahead and to learn tactics, to make themselves a better armed tactical medical professional. Again, some of the resources that I mentioned, and, of course, anybody has any questions, please don't hesitate to contact me. Of course, either through ACEP or through Wright State university. Are there any questions on anything that I've covered tonight? And, by the way, I have no idea what's up there on chat. I did not have a chance to look at that, so. Oh! The disclosure for learners, and a little loving message from one of my buddies, Dr. Pickett, who luckily sent it directly to me, and not to all of you as a group, and I will not read it out loud. Anything? Questions, concerns, death threats for me, anything. Fanboys gonna send me any hate mail. Ah, okay. Hand up. Yes? Is it Robert?

[Robert Margalies] I'm Margalies. Pardon my voice. I was a spotter at a charity banquet, and I really overdid it. But... I'd like to add something to what you were saying at the very end in terms of tactics. I really believe that mindset is a critical component of any engagement. And, I absolutely agree with your summary, but I would throw in that mindset is critical. You have to be, not only trained, you have to be competent and confident in what you're going to do. Thank you. And, by the way, nice summary of ballistics.

[Brian Springer] Thank you. Thank you. Well, again, yeah. It's so, just, so Greg Ellifritz, I met him back when he was still a police officer. He was also one of the trainers at Tactical Defense Institute. Taken a number of classes. I've had the living crap beaten out of me by Greg and this big suit many, many times. He's a guy who, when you, if you take a look at this blog, where just even the thought in terms of his desire to go ahead and really take a look in terms of real, effective ballistics, he's just, he's a guy where, if you put a bunch of people on a desert island and said only one of you is getting off of here alive, it would be him.

[Robert Margalies] I go back on what you were talking about, in terms of training, and getting into force on force training. I think that one of the things we cheat our police officers on is the ability to go hand-to-hand. Very few officers get anywhere near as adequate training in the academy, it's after the academy. I think the same thing is true for our armed medical professionals. If we're gonna be there, we really need to be able to be there. And it's not a question of size, it's a question of knowing what to do.

[Brian Springer] Yep. Not the dog in the fight. It's the fight in the dog.

[Man] You have a very good point. Brian Springer, thank you very much for excellent . Quick question. One of the negative things about the prices out there, especially now we've got inflation of over 8% now, can you comment about airsoft pistols, and there's quite a variety of that out there. What why is that a possible good training addition to the tactical medical professional, getting into handgun shooting. Like, explain a little bit about that.

[Brian Springer] So airsoft, I can tell you airsoft in particular, or just in terms of-

[Man] Just, the concept of getting, it's like a, let's say for example, the doc goes out or the paramedic, whoever's the tactical medical person, go out and they pick up a Glock 19. You can actually go out and purchase a Glock 19 airsoft pistol that is powered by nitrogen gas, some of 'em are CO2-powered, that are relatively lot less expensive to shoot, but they still have lot, largely, the same weight and feel of the real thing. And so, that's actually effective, and a couple different benefits there. But you , if you wanna comment on that for people then-

[Brian Springer] Yeah. Yeah. So, and which really, which factors into, to force on force training, and when I'm talking about force on force training, I'm not just talking about extreme close quarters force on force. Even the use of airsoft, and setting up actual force on force scenarios, I think is an excellent idea. Optimally, in terms of for force on force, if you have the ability to go ahead and actually use simunitions, or again, some of the other, the simulated firearms that are out there, that basically are firing these paint pellet, again, not your paintball stuff, but actual like simunitions, that's ideal in terms of going and upping the ante in terms of actual stress. If you know that the thing's gonna sting you when it hits you, that's gonna up the ante in terms of stress, and trying to avoid getting hit. It enables you to see if you actually are firing rounds where you actually have gone and hit somebody, which can be fairly enlightening in terms of where you may initially be aiming, and where your rounds actually land, based on what you do when you pull the trigger, what the target is doing when you go and you pull the trigger, et cetera. I am, I'm a huge fan of that type of training. I think, honestly, airsoft is just fine. Airsoft certainly does create a level of realism, which is not gonna be there if you're just going bang, bang, bang, and using your finger gun. But then, I would say that's a start. From there, optimally, if you're working with an agency, find somebody who is actually capable of supervising simunition training, and push it up to that.

[Woman] Along those lines, what do you think about video simulation?

[Brian Springer] Yeah. Video simulation. So, video simulation seems to be best in terms of helping with the decision-making process, to the extent that it tests the actual skills of weapon craft, is a little more iffy. I think if you can actually do the video simulations, that's a great way to go ahead and to really start going and helping with medical decision-making in those type of situations, medical decision making. Man, you could tell I've been a doctor longer than I've been a cop. That will help me with decision making in terms of in an actual shooting. But, and in spite of the stresses that it generates, it still is not the same as going at it with another human being. So, absolutely plays an important role, and a fantastic supplement to force on force training, but not a replacement, in my humble opinion.

[Jeremy Ackerman] Yeah. I think a downside of a lot of the airsoft guns is I've yet to find an airsoft gun that the trigger matches triggers on the so-called "real versions" of the guns. They're excellent for target acquisition, for getting your weapon and basic manipulations. Some of them, important things, like reloads and the manual arms are actually slightly different, and things like how hard you have to pull a slide back are substantially different. So, you have to understand the strengths of the platform. You know, my team does a lot of training with simunitions. Some of our guns, we use simunitions. Some, we use another brand, similar product, UTM, which are both platforms that let you use your actual duty weapons with their actual triggers and most of their operating mechanism, but firing these paintballs or chalk balls. And I will say the UTM in simunition pellets hurt a lot more than airsoft.

[Brian Springer] Yes. I was tempted to put a couple of pictures up of some of my wounds from some close quarter simunition battles, but yeah, y'all didn't really want to see my furry belly anyway. So, thought I'd spare ya.

[Man] That's funny. Yeah. I agree with Jeremy's comments entirely though. You know, these simunitions that used by the tactical teams, they're great training and the beauty of those is that, whenever an officer or a suspect gets struck by them, especially if the perpetrators wearing a ballistic vest and they get struck twice in the chest, after the melee, after the gun fights over, the tech guys goes, "Yep. I tagged you twice when he came in a room," and the person wearing ballistic vest, of course, did not feel it. And, of course, they immediately argued back, "No, you didn't. You shot at me, you didn't hit me." And the tactical officer points to his chest said, "Well, what are those two blue marks on your chest there?" And looked down like, "Oh yeah, I guess you did tag me." So, if you use airsoft, they typically don't leave a mark. And, but the, like Dr. Ackerman said, "The SIM you cannot get an airsoft pistol that's gonna exactly simulate your real pistol, but they do offer some manufacture advantages. Right now, this past week and this week, I'm training six of our merchant medicine residents. And one of the things we're practicing on is, handgun includes holstering it, and drawing from holster and shooting. And let me tell you this, when you're teaching six emergency medicine residents, couple 'em second, couple third years, how do you take a loaded gun airsoft, that it be, and put it into holster and taking out and shooting it. When they have airsoft, I'm much less afraid for their toes and their legs, as opposed to real thing. Matter of fact, I would not train them with the real thing just 'cause inherent dangers, but it does allow them to learn lessons in a little more forgivable environment. And the accuracy are actually pretty phenomenal, they're actually pretty darn good. You certainly hit a one-foot target out to 30 feet, every shot with those things. So, actually, they're increasingly made better and very good, very good addition to your training regimen. So, it's a very, there's options, good available options, and pros and cons of each one of em. So, thank you for your comments here, Dr. Springer. Appreciate that.

[Brian Springer] Well, if that's all, again, please, any questions, feel free to contact me anytime, and I'll be easy to track now, just if you forget where it's like, "What is that guy?" Just Springer tactical medicine, and my Wright State email address will pop up, so. Please, please, again, anything, any questions at all or comments, don't hesitate to send 'em. Even if they're nasty, feel free to troll me too. I love it.

[John] Well, thank you so much. Any last questions for Dr. Springer? Go ahead and unmute and ask question if you have any. And if, not, we can, I'd like to offer up a round of applause for Dr. Springer, and you can clap on your own time there, and we'll look forward to having this recorded and saved on the website. So, if your members only there, this will be listed up, and thank you, Deanna. And thank you, Rick Murray, for your supporting that area. This lecture will be available for members. So, if you wanna utilize this in the future to help train your fellow staff and fellow tactical medical providers, that'd be awesome, so. Meantime, thank you very much, Dr. Springer, and hope everybody has a great evening.

[Brian Springer] Thank you all. It's really honor and pleasure to be working with you all, and hope to see you all at ACEP in a couple months.

[John] Look forward to that. Thank you so much. All right. Good night!