The Importance of Knowing First-Aid

He's right, and as soon as I came back I searched for paramedics with essential knowledge of violent attacks and how to treat them. Through recommendations I met Ian McDevitt and he has been a great source of knowledge for the Realfighting Knife-defense program.

There's too much misinformation out there and with the help of Ian we are starting to dispel the myths. Below his article, Keith Brown, D.O. talks about resulting injuries from targeting specific areas.

WR/ MH editors of SRD

The Basics of Body Fluid Exposure
By Ian McDevitt

Second in priority to actually surviving a street knife fight and rendering first aid to yourself should be concern with exposure to the attackers body fluids. Exposure becomes even more important due to injuries you may have sustained, such as open wounds that could become contaminated.

An open wound becomes an entry point for blood-borne disease. There are two major diseases we are concerned with at this time, they are Hepatitis and HIV.

Hepatitis is a virus that causes inflammation of the liver. There are several different forms, each with the same goal of destroying the infected persons liver functions. Hepatitis is transmitted from exposure to blood, body fluids and feces.

HIV or Human Immunodeficiency Virus Infection is an infection by one of two viruses that progressively destroys white blood cells called Lymphocytes, causing acquired immunodeficiency syndrome (AIDS) and other diseases that result from the impaired immunity.

The transmission of HIV requires contact with body fluids that are contaminated with the virus. Such fluids include blood semen, vaginal secretions, cerebrospinal fluid, and breast milk. HIV is also present in tears, urine and saliva.

Risk for transmission of the above viruses is directly related to the amount of blood you are exposed to and if the area exposed had intact skin or not. Health care workers are made aware that the chances of contracting Hepatitis are several times greater than the chances of contracting HIV.

If you are exposed to another person's blood or body fluids, and you have no wounds, immediate care involves washing the infected area with soap and warm water. Anti-bacterial soap breaks down cell walls and warm water increases the effectiveness of the soap. Getting blood on your skin, which is intact, is not considered a significant exposure.

If exposure includes blood in the eyes or mouth, immediate treatment is to wash the mouth out with water, and flush eyes profusely for several minutes. According to the updated U.S Public health Guidelines for the Management of Occupational Exposures, mucous membrane exposures like eyes and mouth carry an extremely low incidence of transmission.

If you are unlucky enough to get what you think may be contaminated blood directly in a wound, immediate first aid for that wound is required. Treat with basic first aid skills. After bleeding has been stopped, proper wound cleansing is required, cleanse with Betadyne or Povidone Iodine if available.

Do not use Hydrogen Peroxide as it kills living tissue. Do not use bleach, as it should never be taken internally in large amounts. People tend to use Alcohol in its various forms but it has extremely limited effects on viruses. Ordinary tap water would work if that were all that was available. Re-bandage the wound and proceed to the nearest emergency room or casualty area of a local hospital for further care, blood tests, and prophylactic medications if required by a doctor. *****

Ian McDevitt is currently an Intercept Paramedic in Connecticut. He is a former 1st LT. Connecticut ARNG, AIRBORNE, Light infantry. His medical certifications include, Connecticut State Paramedic license, ACLS and PALS instructor, CCEMTP, CONTOMS EMT-Tactical, H&K Tactical Medical School, CONTOMS Chemical and Biological Weapons, FARMEDIC, and Wilderness Paramedic through the World Survival Institute in Tok, Alaska. Tactical training includes, Kni-Com knife Combat, Defensive Folding Knife from SIGARMS, TEES Witness and Dignitary Protection, Blackwater Lodge Tactical Handgun I, II. He is the medical instructor for Northeast Tactical School and the Moderator for He currently trains approximately 300 firefighters in pre-hospital emergency medicine in Northeastern Connecticut and continues to work and train in tactics and EMS.


After spending some time with Ian, going over certain body targets, and the effects of wounds to those areas, he sent the material to a doctor who deals with extremely violent attacks and accidents and his comments are listed below.

Comments about Attacking Specific Targets by Keith Brown, D.O.

Attack on the Carotid Artery and Neck
Carotid - May require more than 1.5", some of the big no neck guys may be several inches in. A partial nick type injury may be able to use the artery's constriction mechanism coupled with the body's compensation mechanisms and limit blood loss, so very slow if any impairment might result. Complete transection with a full on bleed out, most average size males are going to need 15-20 seconds to suffer enough pressure loss to impair their brain function, possibly longer if they are in a hyper-dynamic

Incapacitation would be accelerated by simultaneous transection of the jugular veins. Incapacitation "might" be hastened by vagus nerve injury in the neck leading to a burst of parasympathetic activity, but no guarantee on that. Best tactic: a deep broad penetration and slash from the neck midline or under the ear to the trachea, i.e. the goal is partial decapitation; with a little luck maybe cord injury too. How many patients have you seen with shallow neck injuries - lots, not incapacitating.

Attack on the Trachea
Trachea - if no major vessel involvement, no major incapacitation as long as the airway stays patent. Even if doesn't, how long can you hold your breath for, under maximal exertion - 30 seconds to several minutes depending on your anaerobic capacity. Patients with traches walk around with holes in their trachea for years, not incapacitating.

Attack on base of the Skull
Base of the skull, depends. Transection of the vertebral artery may lead to incapacitation via hypoxia of the cerebellum and loss of motor control, in hours at best. Cord injury of course could be immediately incapacitating. Better tactic is to either go for a cord penetration or a blunt stun blow to the occipital region. Forget stab penetrations of the occipital bone, the bone is thick, very round, designed by mother nature to protect against exactly that.

Attack on the Subclavian
Subclavian - would not be incapacitating for minutes to hours depending on rate of blood loss, which can be quite variable here. A good target for deep penetration though, as the great vessels are not too far away. One technique I was taught was to use an upward thrust from the nipple area until you either hit the clavicle or go between the ribs, then cut to the sternum using the clavicle as a guide. Either side you are pretty much guaranteed a great vessel & trachea hit. If you skip over heavy pec muscles and don't go between the ribs the clavicle acts as a "stop" and you have a good chance of going under it.

Attacks to the Eyes
Eye - very painful and psychologically incapacitating but not physically limiting if you have the m & m's. If you penetrate the socket and pass the blade along the inner floor of the skull, you are going to need to get deep 6" or more - to hit the brainstem. Otherwise you will trigger a subdural bleed by damage to the cavernous sinus and venous structures, but that is a slow incapacitation. The anterior/inferior pole of the frontal lobe may be nice if you are a rocket scientist but has little to do with combat, so no immediately incapacitating injury there.

Attacking the Femoral Artery
Femoral artery - Similar to subclavian, you can sure bleed out from these, but not soon enough to keep you from emptying your weapon, detonating the bomb, etc. Guys that have PTCA usually have it done through the femoral artery, makes a pretty big hole that pressure will usually control. Occasionally they start to bleed like hell after the procedure, but it is an hour's thing, not seconds. Like the subclavian, best to go as deep as possible and cut to the midline, hope to get the internal and or external iliacs - big guns that will incapacitate within minutes or so (this is quite variable of course). Remember the Ranger in Mog who took the groin shot? That sort of thing.

There are no others vascular targets that are incapacitating in anything less than an hour or more at best. Had a big strong healthy 17 year old that a horse kicked, broke his femur and tore his femoral artery in the upper inner thigh. He lost a couple of units into the thigh and it tamponaded off, sent off the ortho and vascular for repair, no biggie. He had a lot of complications and the vascular surgeon left the arterial repair open to the skin, the kids mom was to change dressings on it twice a day - yup, it stuck and she ripped the artery repair clean off.

So this kid has a complete femoral artery transection open to the environment. They live way the fuck out on a ranch. Mom held direct pressure, sort of, on it and they drove to the next ranch over which had it's own airplane & flew him into the hospital. Blood everywhere inside that plane, artery still pulsing. About 90-minutes before he arrives. At the hospital BP 70/30, P150+, hemoglobin 4, still conscious and able to pull a trigger. He did fine.

Attacking from the Ground
Ground targets - Achilles tendon! Joint space of the knee! If you arms like an ape, penetrate up through the floor of the perineum going for the iliacs. Nothing else is worth a fuck. Incapacitate the leg and bring them down to your level where you can get something important, or nail their dick to the ground.

Other targets are always flexor tendons, joints, temple.

Rate of incapacitation is always going to be dictated by physiologic status and m&m's. Only a major CNS damage is immediately incapacitating, as we know too well from all the gunshot data we now have.

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