Ignore the gunstore doctors…take the ride

A couple of weeks ago I gave an outline of some of the lessons I took away from the “Experiential Learning Laboratory” put on by Craig Douglas at the 2015 Tactical Conference. As I said in that writeup, I witnessed a lot of interesting reactions to unfamiliar stress. One reaction in particular, though, gave concrete form to a complaint that’s been running around in my head for quite some time about the way people are told to react after a use-of-force event.

There is a lot to worry about in the aftermath of a UOF event like a shooting, but the medical condition and safety of the honest citizen involved is often short changed among them. The average Joe or Jane who has just been involved in a shooting has likely just been exposed to the most intensely stressful event they have ever experienced. The physical effects of this stressful event can be lethal. I want to repeat that for the sake of clarity: Just experiencing the sort of life-or-death stress attendant to a defensive use of force can kill.

In the ELL we saw one gentleman who handled himself magnificently in dealing with the problem, and unlike a lot of us he had absolutely picture-perfect recall of the events he’d just been through. Physically, however, I was concerned we were going to have to have some sort of medical intervention on the spot. If there was a video clip that was used to define “labored breathing” what we saw in those moments would be it. This was the first time he’d ever been in anything like a force-on-force scenario and the physical toll the stress was taking on him was so severe that several bystanders were concerned he was going to have what the medical community refers to as a “major adverse cardiac event.” In other words, a heart attack.

The American Heart Association warns:

Some heart attacks are sudden and intense — the ‘movie heart attack,’ where no one doubts what’s happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Other signs may include breaking out in a cold sweat, nausea or lightheadedness

Adrenaline’s primary function in the body is to rapidly elevate the heart rate, blood pressure, and respiration so that oxygenated blood is supplied to the muscles for fighting or flighting. Experiencing shortness of breath, nausea or lightheadedness, and chest discomfort from adrenaline alone in these situations is fairly common. The severity of these symptoms likely varies with your age, physical fitness, your familiarity with experiencing stress (stress inoculation) and your innate ability to process stress.

So how do you, the layman who doesn’t have advanced medical knowledge, tell the difference between the normal effects of adrenaline and the warning signs of a major cardiac event? To put this as bluntly as possible, you can’t. I’ll point again to what the American Heart Association says on the very same page quoted above:

Learn the signs, but remember this: Even if you’re not sure it’s a heart attack, have it checked out (tell a doctor about your symptoms). Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call 9-1-1 or your emergency response number.” 

I’ve discussed this with a few medical professionals and I assure you that when I posed the scenario of a roughly middle-aged man presenting shortness of breath, a pounding heart/chest discomfort, light headedness and a cold sweat walking into their facility they all said that they would, as a matter of policy, assume that he was experiencing a heart attack and begin remedial action based on that assumption. I’ve been in the emergency room on a busy night waiting to see a doctor and with my own eyes I’ve seen someone exhibiting those symptoms get shoved in a wheel chair and immediately wheeled in for treatment. Doctor’s offices often call ambulances because someone walks in off the street exhibiting those symptoms.

The medical professionals use a combination of observation and testing over an extended period of time to determine whether or not you have had a heart attack. You, the layman, in the aftermath of a fight for your life are in no position to accurately diagnose your heart’s condition.

It’s not just heart attacks, either. In my session with Paul Sharp at the Tactical Conference he talked about an officer at his department who had been in a fight to arrest a suspect. In the fight the officer felt the suspect landing seemingly ineffective blows with the sides of his fist. The officer, being strong and well trained, subdued the suspect using considerably more effective blows. What the officer did not realize at the time was that the suspect had not been “bitch hitting” as the officer originally thought…that seemingly weak fist was actually holding a small knife. The officer had been stabbed several times and did not realize it. In the immediate aftermath of the arrest as backup arrived the officer felt winded, but being a trained fighter he had been winded before and he knew he would catch his breath soon.

Except he didn’t. He got worse. In the dark, wearing a dark uniform and still feeling the effects of adrenaline from a good fight he didn’t realize he had been stabbed multiple times and was bleeding profusely. In the dark, with the dark police uniform other officers didn’t realize it either. The officer came perilously close to bleeding to death surrounded by other police officers because nobody knew how badly he had been hurt.

In the immediate aftermath of a fight you may have absolutely no idea how badly injured you are. Small knives are especially lethal in this regard, as they are usually pulled out by surprise and often the person being stabbed has no clue that it has happened. In Mr. Sharp’s class there was a student who had been stabbed over a dozen times in a fight without realizing it until well after the fight was over.

There are many police departments that mandate a full medical examination of a police officer involved in a use of force precisely because experience has shown that severe, life-threatening conditions can go unnoticed in the immediate aftermath of a fight.

I mention all of this because I’ve heard of a number of instructors out there who are telling students not to call for an ambulance in the aftermath of a fight over concerns about how it looks…to the point where I’ve encountered this idea on forums and in-the-flesh discussions with people. This is utter crap. Gunstore medical experts are no better than gunstore lawyers, folks.

I will argue from now until doomsday that the average joe with little to no medical training is not in a position to accurately assess his medical state in the immediate aftermath of a fight. I would further argue that if cardiac care specialists with years of medical training and experience assume somebody presenting symptoms is having a heart attack until blood tests and observation proves otherwise that it’s the height of stupidity to tell Bob the Accountant that he should ignore the recommendations of the American Heart Association and the Red Cross when he’s experiencing those symptoms because somebody just tried to kill him.

Paul Sharp actually pointed something out to me: If you call 911 reporting you have just been in a fight they are highly likely to ask you if you have been injured. If you know you have been injured, by all means say so…but as I’ve mentioned above you may be severely injured and not know it. The response “I don’t know.” is perfectly valid.

To be clear, I’m not talking about calling for an ambulance as a legal defense strategy. The physical dangers resulting from a fight are plenty of reason to call for an ambulance and, if necessary, take the ride to get checked out. It doesn’t benefit you or your family to successfully ward off a lethal criminal assault only to drop dead from a heart attack 20 minutes after you won the fight because some doofus convinced you that the cops were going to rake you over the coals for pretending to be ill. If some dimwitted detective does try to make an issue of it later it’s pretty easy to point out his own department’s medical response policies to shut him/her up.

Ignore the gunstore doctors…take the ride. If there is any doubt about your medical situation after a shooting, then there is no doubt…get checked out by competent medical professionals immediately.



  1. Caleb: First hand experience speaking…… everything you have written is valid, nail on the head!

  2. One of the talks we’re giving in the Shooter Self Care class next week is about physiological stress factors after a shooting. It’s something everyone needs to consider.

    And on the heart attack signs, spot on. 1 out of 3 heart attack victims has no chest pain whatsoever. Medical professionals will assess for a constellation of symptoms that may indicate a heart attack, called “anginal equivalents.”

    They are a triad including one or more of the following symptoms in patients with risk factors for heart disease: sudden onset of difficulty breathing, weakness, or nausea and vomiting.

    If one of my patients has any of those symptoms, it’s a heart attack until proven otherwise.

    1. I’m really glad to hear you say that, AD…I think this is the kind of input we need more of in the tactical/training/self defense realm. I’d love to hear any input qualified medical pros would like to offer on this sort of thing.

  3. Caleb, great content once again! Are you going to come out with a post “Fitness: The Most Important Weapon to Bring to a Gunfight: Loose Weight and Get Aerobic Exercise”?. You have laid a good rationale for cardiovascular health. These things are completely obvious but to me the truly valuable discussion is about the underlying reasons why people don’t get in shape or even work on their gun handling and what the individual and trainer can do about this.

  4. Tim…this is a subject we started discussing on THE BEST DEFENSE several seasons ago (interestingly enough, after attending Tom Given’s great Tactical Conference). We noted, as you, that there are numerous cases of defenders being stabbed, even shot, and not realizing it while under the effects of the chemical stew generated by “fight or flight.” Secondly, as an OLD GUY, the threat of a symptomless heart attack is very real. Note that in AD’s excellent comment nausea or vomiting combined with risk factors (which may be known or unknown) may be a sign of a heart attack in process. In our experience, nausea and even vomiting is a common after-effect of a high stress event (I could tell you about blowing through the timer trap at the bottom of the Mammoth Mountain Kamikaze Downhill mountain bike race, shakily…weakness…getting off my bike and throwing up big time, but hey).

    We have said that a medical check-up, preferably at an emergency facility like a hospital, after a self-defense event should be the DEFAULT rather than the exception. I have recommended on my podcast that armed citizens need to, as you say, “take the ride,” whether they think they need it or not. It’s something I have discussed with my attorney and my Sweetie.

    Thoughtful article!

    Michael B

  5. Just a note, the byline doesn’t appear on the mobile site. It isn’t on the front page or the article itself.

    Great article Tim.

  6. Great article Tim, I have told all my officers that they should go be evaluated if they are ever involved in a shooting or other traumatic event. The county sheriff mandates it per policy as you stated. They found that your heart rate can go in excess of 200 bpm and stay there for a period of time. If your ticker isn’t conditioned to do that or you have an underlying undiagnosed medical issue you could be in some serious trouble.

  7. Paramedic and ER/trauma RN for over 30 years. I can only reinforce your great write up. Take the ride! Most portamedics I knew insisted the shooter take the ride so they could have time to sort it out (assuming the shooter didn’t appear to be a dirtbag type). Cops get 24 hours to get their feces correlated and find representation. If it works for them it works for me or my patients. Prevents blabbering stupid stuff which could lead to the gray bar motel.

  8. Well written, and well reasoned. I concur, strongly. Getting checked out is good advice. I know of departments that require the officer to get checked if they have been involved in an OIS, even if they are not visibly injured.

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