Rather suddenly and without warning, Andy, who had been quietly attending the course along with the rest of us, collapsed after a shot sounded. There were no instructor commands, but several of us jumped to his assistance. Others created a shield of cover and scanned down range for threats. Terry raked his chest, looking for a wound. Seeing red, Andrew cut his pants away to find a sputtering injury, staining his leg with blood. I grabbed a tourniquet and snaked it up his leg, above the joint and above the wound. The bleeding stopped. We extracted him to hard cover. Despite the Hollywood level special effects, I found I could perform under pressure at this class – a relief. I love my school. Every school day, for the last sixteen years, however, I have wondered when gun violence will hit. I was teaching at Willamette High School in Eugene, Oregon, on May 21st, 1998, when Kip Kinkel shot his parents, then a great number of his peers at Thurston High School, just 12 miles from my classroom. He had planned the attack well before implementing it, and few were surprised by his violence, given years of past affinity for it. Believing that school gun violence is predictable, I listen and watch carefully every day. Parents have left their kids with me, expecting guidance and education. It’s my responsibility to watch after them, applying my personal moral standards and upholding academic and behavioral policy in my district. I listen carefully as kids debate gun laws, and watch attentively as I see boys “air gunning” as they discuss Call of Duty. Each time I do this, however, I wonder how many other teachers take heed of these things — most of our staff know little or nothing about weapons and seem to subscribe to the notion, “if I ignore it, it will go away.” I am a former competitive shooter, and found that learning how to manipulate firearms in hostile simulations educated me and helped allay some of my fears. It is a felony to carry a firearm onto school campuses, except for the rare police officer I see there, so what to do in response to a threat? My district, up until a few weeks ago, had asked teachers to lock down rooms and essentially pretend no one was home. In a similar vein, first aid kits supplied at high schools are great for boo-boo level injuries, but tools for arterial bleeding, tension pneumothorax, and airway management are absent. A few weeks ago, my school showed a film produced by our county, suggesting two new approaches to supplement the “hide and hope” policy. Added to the list was permission to flee campus as well as encouragement for staff to defend their classrooms. In the film, a teacher stood by a locked door, armed with a heavy fire extinguisher. No additional training was offered. I attended Gray Ops’ Tactical Medicine Course on September 20th and 21st. I wanted some training on tactics and medical response, and I looked forward to the hands-on training amidst the stress of live fire. My last truly stressful work experiences were as a Wildlands Fire Fighter in the ‘90s, but had almost 20 years of a cushy teaching job made me soft. The first day of the course was spent primarily in a classroom. John and Gordon embedded personal stories from years of paramedic and law enforcement work, with live videos of LEOs and soldiers. We discussed Pluralistic Ignorance and the need for clear communication without assumptions. Decision making, response to stress, and the survival mindset were presented. Then we dove into the medical aspect of the course. John went through all main categories of traumatic injury, sharing symptoms and treatments, and creating clear connections to larger symptoms or prognoses, such as shock and fatality. John’s attention to detail included medical terminology as well as lay terms, and discussion of popular medical techniques and gear as well as suitable makeshift tools. At the end of the day, we handled equipment and practiced self-aid and peer-aid with several different kinds of tourniquets. The finale was watching Dennis place a Nasopharyngeal Airway on an Annie Mannequin used for CPR training. Day two of the course, we met at Sacramento Valley Shooting Center. Gordon began by reviewing the basic rules of firearm safety, then watching us shoot simply – already drawn with a two-handed grip, then from holster, then one-handed. Slowly the medical aspect of the course was added, first as we mimed caring for a patient, then drew our firearms and engaged a target, then later applying pressure to a wound while shooting one-handed. Extraction techniques were taught, and we worked in small teams to create cover and extract a patient after finding and tending to a wound. Gordon, John, and Dennis built stress into each scenario by surprising us – they would randomly pick one of the four of us to be injured, then announce the wound location and severity – “left femoral artery – spurting blood.” We were forced to communicate clearly – Can the victim help provide pressure? Who had the tourniquet? Who is covering us? Who has a strap to facilitate extraction? Are we ready to extract yet? Can the patient help walk, or do one or two members of the team need to stow arms to help extract? Most participants donned carbines and practiced the same sorts of drills with both weapon systems. The notion of switching guns strategically is not common in the competitive shooting world, so this was a welcome thing to practice. In competitive shooting, if you have a firearm malfunction or run out of ammunition, you tend to stop to clear the malfunction or reload, before resuming a stage or using a second firearm, simply because that’s how it was staged. In the line of duty, neutralizing a threat is eminent, so transitioning to an alternate form of arms is smarter than stopping to deal with a misfeed or empty magazine. Carbine users practiced transitioning between medical care (carbine stowed at the back), use of a carbine (after retrieving it), then alternately, the use of a backup weapon (handgun) against a threat. Not a simple task in a kneeling position, with attention to safety, and a victim lying prone before you. We practiced both carbine retrieval and secondary implementation, finding it was generally more advantageous to go to the pistol in cases where speed of engagement was of utmost importance. We explored the contrast between carbines and handguns further by observing impact of different ammunition on water-filled containers. Since the human body is essentially a water-filled vessel with most organs suspended, the demo was particularly relevant. We observed the impact, water behavior, and resulting “wound” to plastic from a small-caliber high-velocity carbine round and a large-caliber low-velocity pistol round. It was clear why carbines are a wiser choice for defense, and furthermore why gunshot victims of carbines are likely more urgent than those of pistols. Most of us don’t drive ambulances or armored vehicles, but we may have to extract a victim regardless. In many instances, slinging a few extra ballistic vests over the side-windows of a patrol car and heading into the fray could be the difference between ICU and DOA for a coworker or one of my students. Enter mid-sized American sedans. All of the things we practiced this weekend came into play via live scenarios with our instructors. In small teams, we practiced communicating clearly, using hard cover, extraction, and treating injury, all in less than a minute, with a real moving car, live ammunition, and a real victim. Moving 150+ pounds of limp tissue, getting in and out of a car safely, and hitting a threat accurately, are not as easy as they seem. At least we had the adrenaline of a realistic scenario to fuel us. I highly recommend Gray Ops’ Tactical Medicine course for any person looking to take ownership of care and defense in a dangerous situation. For two days after the course, my senses were heightened. As I do every day, I watched the kids and wondered, but perhaps for the first time, I felt prepared to respond assertively and constructively to a threat at school. My trauma kit is never far and I’m much better prepared to use these tools and instruct students and colleagues to help themselves and others with them. At least I will not be alone, looking for a distant LEO or EMT as my only resource for support.