Surviving an Edged Weapon Attack

[jubaji]

At that point their ego gets involved because its easier to dismiss and mock the training .

Even easier to cry that every disagreement with YOU - because you are in fact a D-bag - constitutes an attack on a 'system.' Maybe copying and pasting other people's words all the time creates an association in your *ahem* mind that you just can't see past.

[jubaji]

Before the whining starts...I copy and pasted it, get over it.

A lot easier than ever using your own words, huh? Just ride on someone else's...

[TTEscrima]

Why anybody, without conducting the same level of research Darren has, would disagree or argue against his material is beyond me.

I understand the place for questioning and retaining a healthy level of cynicism, but when someone has researched the facts and backed it up....what is there to say??

I've found that actual research into violence seems to make many supposed martial artists very uncomfortable.

If they accept that this is real and an area of study that they neglect it would make them reevaluate their training.

At that point their ego gets involved because its easier to dismiss and mock the training than to learn a new skill, or god forbid admit that if your toolbox's answer to a guy with a knife is a suplex then you might be short some tools.

You can see the behavior here all the time, the fact that I've been training JJJ, and BJJ, boxing, wrestling etc before most of them were born is ignored as they rip on the other things we also study.

Of course they try to claim their just ripping me, not the systems, but the thousands upon thousands of times they've trolled everyone who posted in the CMA, Urban Combat and Military tactics forums shows the reality of their mindset.

[WildWest.]

Why anybody, without conducting the same level of research Darren has, would disagree or argue against his material is beyond me.

I understand the place for questioning and retaining a healthy level of cynicism, but when someone has researched the facts and backed it up....what is there to say??

[Tant01]

Forensic pathologists Dominick and Vincent Di Maio point out that especially vulnerable is the left anterior descending coronary artery which supplies the anterior wall of the left ventricle. Stabbing wounds which transect this small vessel may be expected to result in sudden death.

[Tant01]

Reputation function...

I appreciate the work you did on this.. whether i agree or disagree with you.. I can see that you have actually studied the topic

Great job

If you scroll across the "scales" icon on the lower left and click it you can give virtual reputation to the poster...good or bad.

[ProKarateShop]

I appreciate the work you did on this.. whether i agree or disagree with you.. I can see that you have actually studied the topic

Great job

[kingoftheforest]

There are always exceptions to the rule. When my buddy Tyrone was stabbed he was instantly incapacitated and fell to the ground. The blade cut a small artery on his heart muscle and he bled out in a couple minutes despite the best efforts of another friend of mine who attempted to give first aid...His heart stopped beating moments after he fell.

He was revived at a nearby hospital several minutes later but had suffered serious brain damage...

He covers that to some extent in the article. No specifically but he does note that:


3. If an artery is the target, the artery is incompletely transacted. Completely transacted arteries go into vasospasm and retract into their perivascular sheaths which markedly reduces bleeding and even stopping bleeding all together in the case of smaller vessels. On this point Dr Porayko stated that this is the reason the Ghurkhas were trained to twist their knives in the femoral artery after puncturing it- to avoid a clean surgical transaction, thus preventing the vasospasm and retraction into the perivascular sheath, and instead to intentionally cause a hole in the vessel sidewall which is much more lethal.

4. The adventitia (a saran wrap like layer around the blood vessel) does not seal the wound ( The doctors stated that this usually does happen in survivors) and/or a clot does no form after blood pressure drops.

The doctors also noted:

“although exsanguinations (death from blood loss) from a venous injury is much slower that an arterial one (because mean arterial pressure is usually at least 10x central venous pressure), the venous injury is much more difficult to treat and generally if arterial injured patients survive to hospital with manual compression, they will do well whereas major venous injured patients often die even after getting to the operating room”

So your body does attempt to save you, and there do seem to be some natural defenses that enact.

Course the best way to avoid bleeding out, is to avoid being cut.

And the best way to avoid being cut is to sray out of knife fights etc etc....

[Tant01]

There are always exceptions to the rule. When my buddy Tyrone was stabbed he was instantly incapacitated and fell to the ground. The blade cut a small artery on his heart muscle and he bled out in a couple minutes despite the best efforts of another friend of mine who attempted to give first aid...His heart stopped beating moments after he fell.

He was revived at a nearby hospital several minutes later but had suffered serious brain damage...

[kingoftheforest]

I've read some of Darren Laur's articles on the Senshido forum....he researches thoroughly and knows his shit.

Oh yeah. I read this article a while ago when Boar posted it on another forum. Darren deserves the pinnacle of respect from anyone looking for information on the subject of edged weapons in a fight.

This article in itself breaks down what happens when you get cut.

Problem is the opinionators will see it as too much work, and possibly beyond their capacity to understand.

[WildWest.]

I've read some of Darren Laur's articles on the Senshido forum....he researches thoroughly and knows his shit.

[kingoftheforest]

Before the whining starts...I copy and pasted it, get over it.

You mean you didn't rewrite this in your own words and then post it as your own idea?


Shame.

[TTEscrima]

Before the whining starts...I copy and pasted it, get over it.

[TTEscrima]

Surviving an Edged Weapon Attack Part II


In my first article “Unconsciousness and Death Surviving an Edged Weapon Attack”, I concentrated on anatomical targets specific to arteries and veins. As a result of some feedback from a number of readers, more importantly a poster who goes by the name MikeK, they wanted to know what the body’s reactions would be if a knife instead of hitting a major artery or vein, was to instead, hit the lungs or other major blood organ of the body. MikeK provided a link to an article that was written in 1992 by Dr Niru Prasad titled, “Clinical management of stab wound victims, on site and during transportation to hospital”, which can be located at:

Clinical Management of stab wound victim

and should be read by all who teach others how to fight or defend against an edged or pointed weapon.

Of real interest to me in this article, were the following excerpts:

Penetrating injury to the chest.

A stab wound sustained to the chest area may cause tension pneumothorax, open pneumothorax, massive hemothorax, sucking chest wound, flail chest due to fracture ribs,and pericardial tamponade. The victim can also suffer from severe respiratory distress due
to hypoxia, which results from:

A. Diminished blood volume due to bleeding.
B. Contusion of the lungs leading to ventilation failure.
C. Changes in the pressure relationship within the pleural space


leading to displacement of mediastinal structures and collapse of the lung.
Since hypoxia is the most important feature of chest injury, early intervention is designedto ensure that an adequate amount of oxygen is delivered to the portions of the lung capable of normal ventilation and perfusion.

Tension pneumothorax develops when a one-way valve air leak occurs, either from the lung or through the chest wall. The presence of air in the thoracic cavity causes collapse of the lung, mediastinal shift to the opposite side causing interference with venous return, and compression of ventilation to the other lung.

Open pneumothorax causes noisy breathing, and bubbling air and blood from the wound.

Massive hemothorax results from the stab wound disrupting the systemic or pulmonary vessel, and occurs with a loss of 1500 cc or more of blood in the chest cavity. The neck veins may be flat due to severe hypovolemia, or distended due to the mechanical effects of the chest cavity full of blood.

Flail chest develops when a segment of the chest wall does not have any bony continuity with the rest of the thoracic cage.

Pericardial tamponade is caused by a stab wound to the anterior chest area. This frequently leads to a collection of blood in the pericardial sac and a rupture of the aorta or cardiac muscle.

Some further potentially lethal chest injuries caused by stab wounds are:

A. Pulmonary contusion.
B. Disruption of the aorta.
C. Tracheobronchial disruption.
D. Esophageal disruption.
E. Traumatic diaphragmatic hernia.
F. Myocardial contusion.

Stab wound to the chest:

A. Penetrating trauma to the chest
B. he moving object penetrates through the chest.
C. Cardiac tamponade A penetrating heart
wound causes bleeding into the pericardial sac, collection
of blood constricts the heart and impairs heart function.
D. Tension pneumothorax stab wound to the chest puncture's the
lungs and creates a valve like opening in the chest wall. The increase in pleural pressure causes mediastinal shift, decrease in cardiac output, and diminished function of the other lung.

Penetrating trauma to the abdomen:

A. The moving object penetrates the victim's abdomen.

The knife wound may penetrate the
omentum, stomach, large intestine, pancreas, aorta,
and inferior venacava.
B. Stab wound to the lower abdomen may
penetrate through the intestines, kidney, and aorta.


Penetrating injury to the abdomen.

A. A stab wound to the abdomen frequently leads to hemorrhage from the
penetration of major vessels or solid organs, such as the liver or spleen.
B. Perforation of a bowel segment.
C. Evisceration of bowel, content through a penetrating injury.
D. Injury to the kidneys and ureters.
E. Pancreatic injury.
F. Pelvic organ injury.


Given the advancements in medicine since the above noted article was written in 1992, I sent this article to be reviewed by Dr Lorne Porayko, whose credentials I mentioned in my first article. After reviewing the above noted information, Dr Porayko stated that the information was “good to go” but also thought that the below noted information should also accompany Dr Prasad’s article from a combative/self protection perspective:

Specific to chest wounds:

Dr Porayko wanted to add:

“Pneumothorax is the most common penetrating injury to the chest that we see and almost every blunt chest trauma patient I see has at least one (the fractured rib acts like the knife, lacerating the parietal pleura). There are 2 types of pneumothorax: simple and tension. A simple pthx is not life threatening. Air enters the pleural space, the lung collapses and either the hole seals in the pleura (the lining of the lung—looks like saran wrap) or a "sucking chest wound" to the chest wall allows egress of the pthx. These will definite tax your ability to fight as the collapsed lung halves your aerobic capacity (=V02max). Tension pthx means that air enters the space through a ball-valve mechanism—air can enter the pleural space from the airways but cannot drain. This usually leads to sequentially increasing intrathoracic pressures with each subsequent breath. Venous return to the right side of the heart stops after about 10 breaths, leading to cardiac arrest. Prior to that, cardiac output drops precipitously so I would estimate that you would be prostrated (down, can't get up, can't fight) after only 1 breath or three.”


After reading this added information from Dr Porayko, I had a light bulb moment based upon one of my previous articles called, “Gladiator School” that can be located at:

http://www.personalprotectionsystems...diator-school/

In this article the following conversation took place:

“I next asked Bob, if he was going to hit someone with a Shiv, what would be his primary target. I expected to hear; throat, kidney, groin, instead Bob stated; “ under the armpit is the target of choice inside.” This tactic was quite bewildering to me until I asked Bob why. Bob stated that a shiv attack to the throat, kidney, or groin areas were not guaranteed to immediately debilitate/stop an adversary (thus giving the target the ability to fight back), whereas a horizontal strike directly into the armpit would cause an immediate puncture and collapse of a lung which, based upon his personal experience and observations, always caused the victim to buckle (the first thing that came to mind here was the last fight scene from Gladiator the movie when Russell Crowe was stabbed in the side of his rib cage prior to entering the coliseum. Infact when I painted this scene to Bob, he laughed stating “ I saw that movie, in the real world that wound would have immediately collapsed Crowe” ) . From this position, further multiple attacks with the knife to the body could easily take place if needed.”


The type of attack articulated by Bob obviously caused what Dr Prasad and Dr Porayko have described as a tension pneumothorax, so it was no wonder why Bob’s victims dropped so quickly !!!!!!!!!

Specific to abdominal knife wounds

Dr Porayko wanted to add:

Liver lacerations are often contained by the capsule (Glisson's capsule) at least partially, and take hours to kill someone. Unless the portal vein is hit (one big sucker that conducts 20% of the CO per minute) and that is quite deep and well protected, it would take hours to exanguinate (bleed to death). Kidney lacerations are even more contained as the kidney is a retroperitoneal structure. The renal capsule and the peritoneum will usually tamponade (stop) bleeding and they are rarely lethal. Intestinal lacerations do not kill immediately--- they lead to septic shock within 12-36 hrs.

CONCLUSION:

So there you have it, a more complete picture, from a medical perspective, of what “may” happen if you are hit with a knife that cuts or penetrates an artery, vein, lung, or major blood organ, including the heart. All the Doctors that I consulted stated that the risk of unconsciousness and death goes up dramatically in relationship to the number of knife wounds sustained to major arteries, veins, lungs, and blood organs. This is one reason why in my system of edged weapon defence (Pat, Wrap, and Attack) an underlying principle is to minimize the number of time you get hit with the blade by controlling the delivery system. For those who teach others how to fight with a knife, these two articles also provide you with “real” medical information as to the “cause and effect” of specific anatomical targets. Of real interest to me in my research, are the targets of the body that can be attacked in combination with a knife to cause:

1. Psychological and emotional trauma,
2. Exanguination from blood loss, and
3. High likelihood of a very quick physical debilitation

But alas I cannot share all my secrets

One last thing that Dr Porayko stated, and I think is really important to share with all the readers of this article from a survival mindset:

“I've always been amazed how difficult it is to kill someone!”

REMEMBER, Just because you are cut doesn’t mean you are going to die; fight, fight, fight !!!

Respectfully

Darren Laur

[TTEscrima]

This is another excellent piece from Darren Laur.


Unconsciousness and Death
Surviving an Edged Weapon Attack
By Darren Laur
Aug 2009


Recently, I read an article on surviving an edged weapon attack, where the writer spoke specific to knife wounds, as they related to unconsciousness and death, which I found quite troublesome given the fact that his numbers just did not reflect the empirical experience/data that I have witnessed over my 23yrs of being a law enforcement professional.

In this article, the author first quoted a book written by Captain W E Fairburn called “Get Tough: How to Win In Hand-to-Hand Fighting” published in 1942. On page 99 of this text (fig.112) Fairburn provides the following information specific to “loss of consciousness in seconds” and “Death” specific to knife wounds:

Brachial Artery:
Unconsciousness 14 seconds, death 1.5 minutes

Radial Artery:
Unconsciousness 30 seconds, death 2 minutes

Carotid Artery:
Unconsciousness 5 seconds, death 12 seconds

Subclavian Artery:
Unconsciousness 2 seconds, death 3.5 seconds


Heart:
Unconsciousness instantaneous, death 3 seconds

I attempted to locate any medical literature surrounding the time that this book was published to support the above noted data, but I was unable to do so. If anyone reading this can provide me with the medical literature that supports Fairburn’s data from that time period, please send it my way.

Based upon the above noted Fairburn data, I began my literary review of the martial art/self-protection/combatives academia, specific to unconsciousness and death specific to knife wounds, and what I found was very surprising if not troublesome. Much of the data supplied in these books, articles, and papers that I reviewed were just a rehash of Fairburn’s numbers, and others were anecdotal at best, and more often than not just plain negligent. None, and I mean none, cited any medical literature to support their claims. Some stated that they had spoken to a medical professional (doctors and paramedics) to validate their claims, but yet they did not provide the names of these medical professionals, or their credentials, or even medical research links which would have helped validate their published writings.

After reading the above noted martial art, self protection, and combatives academia, and being less than impressed with their reported data specific to unconsciousness and death as it relates to knife wounds, I too decided to connect with the medical professionals. Two of the doctors that I connected with are experts in their field of medicine; both specialize in trauma care and critical care medicine, and have a plethora of firsthand experience in dealing with those who have been injured via an edged or pointed weapon:

Dr Lorne David Porayko:

• Full time Critical Care Medicine/Anaesthesiology specialist in Victoria, Vancouver Island Health Authority
• Critical Care team leader
• Works in conjunction with Dr Christine Hall
• Martial Arts background in Judo (black belt level), MMA, Krav
• Honoured to say that Dr Porayko is one of my full time students

Dr Christine Hall:

• Full time emergency medicine specialist in Victoria, Vancouver Island Health Authority.
• Trauma team leader and educator.
• Previously, program director for emergency medicine at the University of Calgary.
• Master's degree in epidemiology from the University of Calgary.
• Cross-appointed in the department of community health sciences through the faculty of medicine at the University of Calgary and also the faculty of medicine's department of surgery at UBC.


When it comes to unconsciousness or death attributed to an edged weapon attack, we are talking about what the medical community calls “Shock”. Dr Porayko defines shock as, “the development of multi-organ failure due to insufficient oxygen being delivered to the tissue to meet their metabolic needs.”

Specific to shock as it relates to unconsciousness and death, Dr Porayko stated the following to me:

“ A 70kgs (154lbs) male’s circulating blood volume is about 70ml/kg which equals about 5 litres. Cardiac output is about 5-7 litres per minute. All the great vessels of the body act as a conduit of approximately 15-20% of CO/minute which equals about 1 litre per minute. The great vessels include the innominate artery, Subclavian arteries, carotid arteries and some include the iliac arteries. The 4 atria, 2 ventricles and aorta all conduct the full cardiac output thus are well protected in the centre of the body behind the sternum and in front of the thoracolumbar spine.”

So why is the above noted information important, because hemorrhagic shock (blood loss) is based upon how much hydraulic fluid (blood) is leaked from the body. When it comes to understanding hemorrhagic shock, I would guide you to the following links that were provided to me by Dr Porayko:

Critical Care | Full text | Clinical review: Hemorrhagic shock
Table 1

Dr Porayko advised that based upon the above noted link:

• A class II shock category (750-1500ml) would leave “most” dizzy and very weak
• a Class III or Class IV shock category (1500ml-2 litres of blood loss) would leave “most” with the inability to stand up right

Specific to my questions about unconsciousness and death if specific anatomical arteries or veins were cut, and given all the medical variable associated, the Doctors had to make the following assumptions first before they could answer my questions:

1. There is no compression of a lacerated artery underway. This was irrelevant for a lacerated vein due to the fact that a vein can’t be compressed

2. The subject is previously healthy with a normal haemoglobin concentration and has a normal VO2 max prior to being wounded.

3. If an artery is the target, the artery is incompletely transacted. Completely transacted arteries go into vasospasm and retract into their perivascular sheaths which markedly reduces bleeding and even stopping bleeding all together in the case of smaller vessels. On this point Dr Porayko stated that this is the reason the Ghurkhas were trained to twist their knives in the femoral artery after puncturing it- to avoid a clean surgical transaction, thus preventing the vasospasm and retraction into the perivascular sheath, and instead to intentionally cause a hole in the vessel sidewall which is much more lethal.

4. The adventitia (a saran wrap like layer around the blood vessel) does not seal the wound ( The doctors stated that this usually does happen in survivors) and/or a clot does no form after blood pressure drops.

The doctors also noted:

“although exsanguinations (death from blood loss) from a venous injury is much slower that an arterial one (because mean arterial pressure is usually at least 10x central venous pressure), the venous injury is much more difficult to treat and generally if arterial injured patients survive to hospital with manual compression, they will do well whereas major venous injured patients often die even after getting to the operating room”

Of note, both doctors opinioned that the numbers provided by Fairburn and other combative/martial arts instructors that I provided to them for review, specific to times for unconsciousness and/or death, are way too short. Both stated that they believed that these numbers are based upon “complete cessation” of all cardiac output through the involved vessel which is not the norm. In fact Dr Pryayko brought to my attention that during the French revolution when thousands of people were beheaded by guillotine, the attending doctors documented the presence of vital signs in the body for up to two minutes.

So based upon the above 4 “assumptions”, here are the numbers that the doctors I consulted provided specific to a level of hemorrhagic shock taking place which would lead to unconsciousness or death in “most” situations:


Carotid Artery:

Approx 2-20 minutes

Jugular Vein:

Approx 15-60 minutes


Subclavian Artery:

Approx 2-20 minutes. The doctors also noted: “this is a special circumstance anatomically because this vessel is protected by the clavicle and the first rib (sandwiched between them) if the Subclavian artery bleeds, the only way to compress it and repair it is to open the chest by thoracotomy. You cannot compress it. Patients usually die on the scene or en-route to hospital.

Subclavian Vein:

Approx 15-60 minutes

Brachial Artery:

5-60 minutes. The doctors also noted: “pretty unusual to see these without compression by EMS)

Femoral Artery:

5-60 minutes. The doctors also noted: “Pretty unusual to see these without compression by EMS)

Aorta or any part of the heart:

Approx 1-2 minutes. The doctors stated that the heart conducts 100% of cardiac output. Assuming transaction and that the hole does not seal. Ventricular holes do usually seal while the atrial ones do not due to the orientation of the muscle fibres.

Two other areas of note made by the doctors also included:

Popliteal Artery:

Located behind the knee, would be similar (but slightly less) to cutting the femoral artery


Inferior Vena Cava:

Can be attacked via a deep abdominal stab, similar to cutting the Jugular vein

Both doctors stated that these are estimates based upon current medical literature and their first hand experience, but both also stated that there are always exceptions to these estimates. Both gave examples where patients who had received severe knife wound survived even with a heavy loss of blood, some examples:

• One of the doctors has seen several patients with traumatic cardiotomies (a big hole in the heart) survive for 20 minutes before being treated

• One of the doctors treated a patient who had been stabbed in the abdomen, where the knife hit the inferior vena cava, his belly was full of blood, he was conscious, although shocky, an hour after the injury when he arrived in the ER. He survived.

The doctors stated that they have seen patients who have bled out nearly their entire blood volume, but yet are still awake and talking (although looking bad) many many minutes following an injury and survive to tell their story. Dr Porayko stated, “So it is a mistake to underestimate a person’s capacity to compensate for acute hypovolemia and anaemia (hemorrhagic shock), even when very severe. This is especially true in the younger population.

Conclusion

So why did I write this article?

1. Much of the information being propagated in the martial arts, self protection, and combatives industry specific to unconsciousness and death as a result of a knife attack, specific to blood loss, is inaccurate. I wanted to provide those who are looking to share current and accurate medical opinion with the above noted information, hoping that it will go viral in our industry. For those who don’t and continue to teach inaccurate information, shame on you.

2. Those who teach others how to fight with a knife, and state that if you cut or stab a person here or there an attacker will die in seconds, are both wilfully blind and being irresponsible to their student in most cases. Those who teach others how to fight with a knife need to absorb the information in this article, and start teaching from a medically researched knowledge base.

The most important reason for this article, SURVIVAL !!!!!! Words are powerful, and can create our own reality. If you “believe” that you will die in seconds because your radial artery has been cut in a knife attack, and your instructor told you (and you believe him) that you only have 30 seconds to live before you die from blood loss, then you likely will die. As can be seen from the numbers provided by the doctors, even if one receives a severe cut or stab to a major blood vessel or organ, you can still fight for several minutes (not seconds), and even longer, and still survive. As Dr Hall stated, “The decision to survive, it is that intangible thing that cannot be measured, and I think is part of the reason that some people survive and some don’t. You have to decide ahead of time that you are going to live.” Right on Doc !!!!!!!!!!


Respectfully

Darren Laur