Contents of a Blow Out Kit.

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    • #62331
      DuaneH
      Participant

        This is a work in progress so be patient:
        I also don’t claim to be a subject matter expert. I am a 66H, M9 in the Army with 20 years experience on the civilian side and have done everything listed below either in an ER or on the side of the road. I have never had to take care of a traumatic injury under combat conditions; however, the Army has said I am an expert and I have had to teach CLS and re-certify 68W’s.
        So if you are a veteran 18D (or other BTDT expert) and tell me that flying bannanna juice works best, then I will defer to your judgement.

        Keep in mind the PERSPECTIVE of this post. Combat trauma being treated by non medical people with what you can carry on your rig.

        There was discussion at the last CRCD class about what goes into a blowout kit. I will elaborate on that. Anytime you strap on your gear, there should be a blowout kit on it. This kit is not for use on anyone but you. It is not to be used for booboos or anything other than traumatic injuries.

        The three most common causes of preventable death on the battlefield are:
        Hemorrhage from extremity wounds
        Tension pneumothorax
        Airway problems

        Ask 10 medical people what should go into an IFAK, and you will get 12 different answers. Here is what the Army puts in theirs and will address the top three.
        http://www.usamma.amedd.army.mil/assets/docs/ifak.pdf

        THE ABOVE IS THE MINIMUM THAT SHOULD GO INTO AN IFAK. ADD MORE AS YOU DESIRE OR HAVE THE SKILL LEVEL FOR. Most important is training not equipment!

        An inexpensive alternative is from here:
        http://shop.thetacticalmedic.com/Tactical-Response-Gear-VOK-Ventilated-Operator-Kit-VOK.htm

        The below is simply what I recommend.

        1.Tourniquet. CAT-T preferred. Two is better. TK4 is OK if your battle buddies know how to use it.

        2.Petroleum Gauze. Old school and low speed but good for sealing chest wounds. Not currently in .mil issue IFAKs but very cheap. Works better than just plastic alone and can be used without addt’ training.

        3.Duct tape. For holding down the petrol gauze.

        4.Israeli Emergency Bandage – 6 inc. Good for large surface area wounds like blast damage or bullet exit wounds. NOT a substitute for a TK, but can be improvised. Also very good for continuous pressure after a wound has been packed with gauze.

        5.Nasopharyngeal Airway, 28-32Fr For establishing a patent airway. Easy to insert (most of the time). Check out YouTube for instructional videos. You can carry an oral airway, BUT it may not work if there is mouth or face damage; however, it requires less training. If you “only” need an oral airway then your airway can be managed with head tilt chin lift or just safety pinning the tongue to the side of the mouth.

        6.PriMed Compressed Gauze Bandage. Two is better. For packing deep wounds to transfer direct pressure.

        7.Quickclot combat gauze. Goes in military Ifaks, but not 100% mandatory.

        8.and of course gloves.

        BELOW ARE GOOD ADDITIONS TO AN IFAK. Some require addt’l training which is why I pulled the needle from the above list and put it below.

        10. 12 -14 gauge needle for pneumothorax decompression. You may not know how to use it, but there may be an EMT or CLS nearby.

        11. Celox or similar. All coagulants work, but you still have to use direct pressure at some point (or ligation) to keep the bleeding from starting again.

        12. Hemostat. Curved preferably.

        13. Lube to insert the NP airway. Not 100% needed but cheap.

        14. Chest seal. Nice to have but relatively expensive and may require addt’l training.

        15. EMT shears.

        You are only limited by what you can carry. Keep in mind that the purpose of the BOK/IFAK is to have it strapped to your kit and on you at all times. You do not want to try and carry a portable hospital on your fighting rig. The list can go on and on and on.

        Please feel free to ask questions. Don’t get butt hurt if I speak out against your suggestion. It may make perfect sense in the perspective of a trained medic or clinical situation, but for this situation we are talking about TC3 protocols applied under field/combat conditions by non medical individuals.

      • #62332
        Max
        Keymaster

          Regarding number five: A nasal airway is sized to the Pt by measuring the space from the tip of the ear to the tip of the mouth. One size does not fit all. I notice that you didn’t include any lube for the airway too.

          You may also want to include an oral airway as there are contraindications to the use of a nasal airway. It can be hard to see battles sign when the Pt is wearing cammo cream.

          I would also recommend two izzys, one 4″ and one 6″, remember you may be dealing with more that one wound.

        • #62333
          JustARandomGuy
          Participant

            Going to need a bigger med pouch… :wacko:

            Couple questions-
            How to carry Duct Tape? Wrap it around a credit card, or some other method?

            Petro gauze- pros cons vs. current chest seal like HALO or such?
            Seems like a current self-adhering chest seal would be the way to go, if available- kill two birds, instead of having to apply two different items under stress/time constraints.

            Aren’t some people allergic to Celox? Fish derivative or something…

          • #62334
            DuaneH
            Participant

              This is the minimum recommended contents. You can add whatever you like, but remember that you may be limited to your pouch size.
              We can go down a rabbit trail about what should go into an IFAK;however, here are the actual contents of an Army IFAK
              http://www.usamma.amedd.army.mil/assets/docs/ifak.pdf

              You will notice my post mimics the contents except I add petrol gauze to seal chest wounds and a 14 ga needle. Something I picked up from here
              http://shop.thetacticalmedic.com/Tactical-Response-Gear-VOK-Ventilated-Operator-Kit-VOK.htm

              As to the NP size: The Army puts 28-32 French in theirs. In the Army medic classes and civilian classes that I have been to, there has been no issue with the NP size. I have seen at least a hundred or more inserted including about 12 times on me. If you are a midget or a giant, then maybe it won’t work. The NP doesn’t have to be perfectly sized to work. It only has to be good enough. The NP is to be used on you and you will most likely be unconscious when it is inserted.

              You can add lube if you like. Blood is a very good lubricant and typically available. If blood isn’t available, then spit works ok too.

              If you want to carry an oral airway or extra Izzy’s That’s fine too. You are only limited by pouch size. I choose to carry extra compressible gauze as their never seems to be enough of that I don’t like using my tshirt.

              Most people won’t know what Battle’s sign is. Combat Lifesavers in the Army are non medical people that are trained to use the stuff in the BOK.

            • #62335
              DuaneH
              Participant

                Duct tape can be wound on itself in a small roll or purchased in a small roll at a camping store.

                Petrol gauze is cheap and beats plastic alone. Halo seals definitely work better but are more expensive. Buy them if you like.

                Don’t carry Celox if you are allergic to it.It is a shellfish deriviate. Combat gauze is made from Kaolin (clay) and fairly inert. I consider them not mandatory, but included combat gauze since the Army does.

              • #62336
                DuaneH
                Participant

                  Here is a good slide presentation:

                  http://www.naemt.org/Education/IGa Intro to TCCC with Notes 2-17-09.pdf

                • #62337
                  Max
                  Keymaster

                    Allow me to correct myself. The proper sizing for a nasal airway is done from the nose to the tip of the ear, not the corner of the mouth. From the corner of the mouth to the ear is the proper technique for the oral airway.

                  • #62338
                    Max
                    Keymaster

                      That’s true, and believe me I am not trying to put a fresh pile into your thread, I am just offering some assistance.

                      My IFAK is prolly much larger than most. I use a Brit canteen pouch for mine. I also carry two CATs. One on my shoulder straps of my kit, and one on the butt stock of the rifle. Ensure that wherever your guys are carrying the CATS, that they can access them with either hand.

                      Both Battles’ sign and “Racoon eyes” are signs of a basular skull fracture. Attempting to insert a nasal airway into a Pt like that is likely to kill them.

                    • #62339
                      DuaneH
                      Participant

                        If anybody is interested, here is Max’s post on TC3 protocols. Short and sweet.

                        http://maxvelocitytactical.blogspot.com/2012/10/combat-lifesaving-procedures-tc3.html

                        Monday, October 22, 2012Combat Lifesaving Procedures (TC3)
                        Tactical Combat Casualty Care (TC3)

                        I had previously posted this elsewhere on a couple of forums so here it is. Some of it is straight from US Army 68W Combat Medical protocols, some pof it is at the CLS (Combat Lifesaver) level, and there is a bit of opinion thrown in there too…..it is partly excerpted from chapters in Contact and Rapid Fire on Casualties:

                        Unlike the normal ABC medical protocol that you will have heard about, the combat protocol for trauma situations is H-A-B-C, which puts hemorrhage before Airway, if it is indicated, but still includes circulation for less serious bleeds and IVs. The other big difference is tourniquets: tourniquets used to be considered a tool of last resort. Now they are considered a tool of first resort in a combat environment. The following article does not presume to attempt to give all the answers, but it is a basic summary.

                        Some procedures that are appropriate in a civilian ambulance situation are not appropriate on the battlefield. Ambulance crews may give fluids to casualties on the way to the hospital, where blood is available. They can, in simple terms, keep putting the fluids in and get definitive care once they arrive at the emergency room. In a battlefield situation, fluids are not given except in specific circumstances. In simple terms, when you go into true shock by losing circulating body fluids (i.e. blood) your blood pressure will drop. As your body responds to the injury and the loss of blood, it will draw blood into the vital organs at the core of the body, at the expense of the limbs. Thus, as blood pressure falls you begin to lose the distal pulses (i.e. in the wrist and foot), then closer and closer to the core until you have no pulses but the heart, and the heart will be the last to give out at the lowest blood pressure. In a combat situation, if you give too much fluid, there is a danger of “blowing the clot” and effectively bleeding out while diluting the blood left in the body, reducing its ability to carry oxygen. Also, fluids frequently given such as Lactated Ringers are rapidly absorbed into tissue so over time they are not really effectively increasing the volume of the blood. Hence the giving of fluids in the ambulance, where in very simple terms you can keep putting it in until you reach the emergency room and blood/plasma products are available. The fluid given for a traumatic wounding on the battlefield is not lactated ringers or similar, but Hextend, which is a starch product. Over roughly an hour, 500cc of Hextend will draw fluids out of surrounding tissue and bulk up to around 800cc. Guidelines state that you can use a maximum of two 500cc bags, 30 minutes apart. The protocol is only to give fluids if there are no radial (or pedal) pulses, which are the pulses in the wrist or foot. The reason is that you want to bring the blood pressure up enough to restore distal circulation to the extremities but no more, because you don’t want to ‘blow any clots’ or cause the casualty to ‘bleed out’. For other injuries such as dehydration other fluids are still given, but not for trauma.

                        The fact is that a large number of combat injuries are not survivable. Sometimes this will be obvious and the casualty has no chance of survival. Other times, survival will depend on appropriate interventions followed by rapid evacuation and definitive surgical care. There is a difference between being able to keep someone alive at the point of wounding and continuing to keep them alive due to the presence or absence of available definitive care. Do what you can to initially prevent death and get them to someone who can help, or worst case read some books on battlefield surgery and do something yourself, even if it’s just cleaning, debriding and suturing wounds and providing antibiotics, hoping that internal injuries and bleeding are not too severe and will heal in time.

                        The use of body armor will reduce the incidence of penetrating trauma sustained in combat to the torso and the damage and resulting internal bleeding. Historically, 90% of combat deaths occur before the casualty reaches the treatment facility. The three major, but potentially survivable causes of death on the battlefield are: extremity hemorrhage exsanguination (severe bleeding), tension pneumothorax (oxygen shortage and low blood pressure due to a collapsed lung, a condition that may progress to cardiac arrest if untreated) and airway obstruction. Historically, the most frequent and preventable of these causes of death is extremity bleeding. Most wounds to the extremities will cause death by bleeding out, and this is preventable. Some combat wounds are simply not survivable and will not respond to medical attention i.e. severe internal bleeding or visible brain matter etc.

                        Care Under Fire:

                        In this phase the casualty is “on the X” at the point of wounding. This is the point of greatest danger for the CLS. An assessment should be made for signs of life (i.e. is the casualty obviously dead). Cover fire should be given and fire superiority achieved. The casualty should be told, if conscious, to either return fire, apply self-aid, crawl to cover or lay still (don’t tell them to “play dead!”). Once it becomes possible to reach the casualty, the only treatment given in the care under fire phase, if required, is a hasty tourniquet “high and tight” on a limb, over the clothing, in order to prevent extremity bleeding. The casualty should be rapidly moved to cover (drag them).

                        Tourniquet application: “high and tight” means right up at the top of the leg or arm, right in the groin (inguinal) or armpit (axial) region. The tourniquet needs to be cinched down tight to stop the bleeding. Use/purchase the CAT – Combat Application Tourniquet.

                        When applying tourniquets, they need to be tight enough to stop the distal pulse i.e. the pulse in the foot or wrist, assuming the limb has not been traumatically amputated. You will not be able to check this pulse at this phase, so just get the tourniquet on tight and check the distal pulse as part of the next phase, tactical field care.

                        Traumatic amputation: get the tourniquet on high and tight and tighten it until the bleeding stops. Note: in some circumstances there will be pulsating arterial bleeding and severe venous bleeding, but other times it is possible that there may be less bleeding initially as the body reacts in shock and “shuts down” the extremities, but bleeding will resume when the body relaxes. So get that tourniquet on tight.

                        Compartment Syndrome: you don’t want to be feeling sorry for the casualty and trying to cinch the tourniquet down ‘only just enough’. Tighten it to stop the distal pulse. If you don’t, the continuing small amount of blood circulation into the limb can cause compartment syndrome, which is a build-up of toxins: when the tourniquet is removed, these toxins flood into the body and can seriously harm the casualty.
                        For an improvised tourniquet, make sure the strap is no less than 2 inches wide, to prevent it cutting into the flesh of the limb.

                        Tactical Field Care:

                        Once the casualty is no longer “on the X”, CLS can move into the Tactical Field Care phase. This is where the CLS conducts the assessment of the casualty and treats the wounds as best as possible according to H-A-B-C:

                        Hemorrhage: During the Tactical Field care phase, any serious extremity bleeding (arterial or serious venous) on a limb, including traumatic amputation, is treated with a tourniquet 2-3 inches above the wound. Axial (armpit), inguinal (groin) and neck wounds are treated by packing with Kerlix or combat gauze (treated with hemostatic agent, commercially available from Quickclot) and wrapping up with ACE type bandage.

                        Once you have dragged the casualty to cover, you will conduct a blood sweep of the neck, axial region, arms, inguinal region and legs. This can be done as a pat down, a “feel” or “claw”, or simply ripping your hands down the limbs. Debate exists as to the best method. Conduct the blood sweep and look at your hands at each stage to see if you have found blood. Once a wound is found, check for exit wounds. Ignore minor bleeds at this stage: you are concerned about pulsating arterial bleeds and any kind of serious bleed where you can see the blood rapidly running out of the body.

                        Beware of deliberate tourniquet application to the lower limbs, below the knee and elbows. The two small bones there may cause problems, particularly with traumatic amputation, and the tourniquet may either not be effective or cause further harm to the casualty. Assess it. Also, if the injury is, for example, below the knee, then don’t put the tourniquet over a joint (i.e. knee), put it above the joint.

                        Airway: CLS can aid the airway by positioning (i.e. head tilt/chin lift to open the airway) and use of the NPA. An NPA should be used for any casualty who is unconscious or who otherwise has an altered mental status.

                        · Consider use of an OPA/NPA and suction. You need to be trained on these items.

                        · Combat medics are trained to carry out a crycothyroidotomy (“crike”) to place a breathing tube though the front of the airway. This is an effective way of quickly opening the airway on the battlefield, particularly for facial trauma of burns to the face and airway.. If you are trained and have the equipment you can use patent airways that insert into the mouth and are of the types that paramedics are be trained to use: Combi-tubes and King Airways.

                        · A crike will save life but assumes that you are heading to a hospital for treatment and repair. The tube will go through the membrane and this will need to be repaired. However, if it is your option to save life, do it and figure out the details later.

                        Breathing: Occlusive (airtight) dressings are used to close any open chest wounds. Check for exit wounds! Check the integrity of the chest: ribs and breast bone. You will have to open body armor to do this. If signs of a pneumo/hemo-thorax develop (progressive respiratory distress, late stages would be a deviated trachea (windpipe) in the neck as a result of the whole lung and heart being pushed to one side by the pressure of the air build up in the chest cavity) then needle chest decompression can be performed (NCD).

                        · If you don’t have a specific occlusive dressing, use something like plastic (or the pressure dressing packet) and tape it down over the chest wound. The Old school method was to tape three sides to let air escape, current thinking is to tape all four sides down to seal the wound.

                        · NCD involves placing a 14 gauge needle, at least 3.25 inches long, into the second intercostal rib space (above the third rib) in the mid-clavicular line (nipple line). This is basically a little below the collar bone, in line above the nipple. The needle is withdrawn and the cannula is left open to air (tape it in place). An immediate rush of air out of the chest indicates the presence of a tension pneumothorax. The manoeuver effectively converts a tension pneumothorax into a simple pneumothorax.
                        o The definitive treatment is to get a chest tube in, in the side of the chest (eighth intercostal space); to drain the blood and air that is filling the chest cavity.

                        You then move on to Circulation (including bleeds and administering a saline lock or fluids), any pain meds you have and that are appropriate, and then the full assessment, which is not covered in detail here. For wounds that do not need a tourniquet or the tourniquet can be converted, then pack the wound and use something like a pressure bandage/Israeli dressing to stop the bleeding. Once you have treated the H-ABCs and conducted the assessment and any interventions you should cover the casualty with a thermal blanket to retain body heat and reduce the risk of hypothermia. You will continue to monitor the casualty and perform interventions as necessary both prior to and during the evacuation.

                      • #62340
                        Max
                        Keymaster

                          Doc Bunny,

                          Would Battle’s sign or racoon eyes present themselves during the time we would be trying to provide an airway on the field? A tough call, Pt needs an airway, but a NPA might kill him.

                          Any other examples of when a NPA might not be the right peg for the hole?

                          Joe

                        • #62341
                          DuaneH
                          Participant

                            Disclaimer: This does not constitute medical or legal advice. Use your own judgement and by all means get trained.

                            I know you posted that to the Doc, but I will try to answer it. Typically both do not appear until several hours later (or days later).

                            From the TC3 perspective: The military considers it better to go ahead and insert an NP airway as that is one of the top three killers on the battlefield. It’s kind of a game of statistics. Across a population of combat injured soldiers, you will save more lives by going ahead and inserting an NP airway than you would kill because of their head trauma.

                            How much more? I have no data, but I would think that is statistically insignificant. Insignificant so long as you are not the one with the Basilar skull fracture.

                            I can’t suggest to you that if you were a non medical person (but trained in CLS or TC3) to go ahead and insert and NP airway, but if you were with me or my family I would want you to do just that.

                            For your reading pleasure about Basilar skull fractures and Battle’s sign occurrence.
                            http://www.nlm.nih.gov/medlineplus/ency/imagepages/3067.htm
                            http://www.wisegeek.org/what-is-battles-sign.htm
                            http://neurosurgery.stanford.edu/patient_care/head_spine.html

                            If you are a trained medical person, (other than the blatantly obvious head injuries) you should look for signs of CSF fluid leaking from the nose or ears and that would indicate Basilar skull fracture and probably necessitate an oral airway, endotracheal tube or cricoidotomy.

                            Other reasons not to insert an NP airway is it just doesn’t go in not matter how much you push or massive facial trauma.

                          • #62342
                            Max
                            Keymaster

                              Thank you Sir.

                              What are the attributes of CSF? Color, density,… as compared to blood? I have not seen or touched CSF.

                              If a “crike” is the only remaining option to establish an airway in the field, this is probably academic, what kind of care issues are we into to repair the tissue damage done by the “crike” procedure?

                              Momento Mori

                              Joe

                            • #62343
                              Max
                              Keymaster

                                Clearly Duane has some knowledge, I never suspected otherwise.

                                My purpose here is NOT to stir the poop, but to help out. My biggest concern with what I see passing as medical training in the Patriot movement is that the classes are taught to teach a person to perform a certain skill, not necessarily why the the skill is being taught. To be clear I am not suggesting that anyone here is doing that, it is a general observation. Without knowing why a certain skill is being performed, or almost more importantly-when not to do something- we are doing the Pt a disservice.

                                Yes, the military has determined that the risk of killing Joe Snuffy by inserting a nasal airway every time is low enough to not be of concern. The military can afford to loose a certain amount of folks, because they have many more. We don’t. It is also possible that we will be practicing medicine on non-combatants who just happened to be in the wrong place at the wrong time. We owe it to our Pt’s and to our country men to do better.

                                Now to the question, and the point.

                                The reason I mandate an oral airway in my group in addition to a nasal is because inserting a nasal airway on a person like that has a high probability of killing them. In candor they will likely die anyway, due to a lack of appropriate follow on care, but it is important to the morale of the group that “doc” don’t give up on anyone. Now Duane is right: Battle’s sign and racoon eyes can take a while to appear, but not always hours. Sometimes it comes on in 15 minutes in my experience. No two Pt’s are the same. Now my question. How do you plan to see them if the Pt is wearing cammo paint? Well obviously, you can’t. There may be some swelling in the facial areas, at least that is often what I see.

                                You have to treat according to MOI- mechanism of injury. If you Pt has been involved in an incident that can reasonably have produced the kind of trauma necessary to induce a skull fracture, than you should be managing the airway in a way that is best for the Pt, not the aidkit. Examples of the kind of trauma that could do it include: a blast injury at close range, an MVA, being struck in the face by debris or parts of trees, etc…If they cannot maintain an airway and can tolerate an artificial one, stick an oral in and be prepared to bag. Both airways are intended for a Pt that is unable to maintain an airway on their own, simply inserting a piece of plastic oftentimes will not be enough. At this point you will nave to take over breathing for them. The Pt may need to be hyperventilated to help lower inter-cranial pressure my need to be tubed to prevent aspiration. We will loose more PT’s due to aspiration and the complications due to it, than from bad airway placement. King-LT is stupid easy to do, and will save lives.

                                Oh yeah, CS fluid is clear and comes out of the ears. It’s a bad thing to see.

                              • #62344
                                Max
                                Keymaster

                                  Thank you Sir Doc.

                                  Doc, Duane, Max and others qualified:

                                  Without sophisticated and well equipped follow on care, what really makes sense to treat in a worst case analysis? Anything other than the most basic boo-boos?

                                  By applying a tourniquet above a severed limb, or a needle decompression, or a chest seal, are we just making ourselves feel better that “Well, I did all that I could.”?

                                  What are the third world stats(or opinions/anecdotes) on injuries that would use CLS techniques and materials, but with no first world follow on care provided?

                                  Momento Mori

                                  Joe

                                • #62345
                                  DuaneH
                                  Participant

                                    A question I have been asked. I have no easy answer, nor do I have enough time in third world countries to answer that. These articles might shed some light on the statistics if you look at it from an historical perspective.
                                    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706344/
                                    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570575/

                                    I usually answer this question like this:

                                    Most people who ask me this question have a limited perspective on a SHTF (or rainy decade) situation. They assume that the when “it” does happen that the world will go MadMax (movie reference). While that is certainly a possibility, I see that as slim. Most likely there will be SOME medical assets available even if it is “just” an EMT or a vet in a barn.

                                    Across the world in areas that are at war, there is definitely a disruption in medical care. That doesn’t mean that it goes away, it just means it may not be as available and advanced meds and techniques may not be available.

                                    You need to ask yourself the question “Are you medically competent enough to know who is going to live or die based on what wounds they receive?” I am not even sure that I am.

                                    Certainly an RPG to the gut with intestines vaporized and the abdominal arteries pumping blood is not survivable even if they were in an OR with a team of surgeons.

                                    How about a simple through and through chest wound? If it is not treated using TC3 protocols, they probably will die; however, based on case studies during WW1 if there are no major vessels hit, they have a good chance of recovering on their own with minimal medical treatment.

                                    If your team is operating in injun country unsupported 50 k from medical assets and one of your team mates steps on an IED and blows off both legs do you just sit there and hold their hand while they die? Seems like the logical thing to do, until a friendly helo buzzes overhead and you realize that you had a chance to save him but you didn’t. See you didn’t realize that you were closer to friendlies than you thought because the lines shifted again.

                                    So yes, within limits you do what you can. Because the price of not doing what you can is high.

                                    My answer is simple: Have hope.

                                    Get as much training as you can and hope that if it does happen, you have some medical assets available.

                                    Have hope that even though the wound looks bad, it is survivable.

                                  • #62346
                                    Max
                                    Keymaster

                                      As said by smarter folks than myself: This is not medical advice, or
                                      legal advice.

                                      Wen it comes to who to treat and frankly, who to let die, you have got yourself quite a pickle there.

                                      First things first: you have the duty to do the most amount of good for the most amount of people. You need to take a good look at your medical resources, your level of training, and how many patients you have. It is immoral to spend an inordinate amount of resources on a single patient when there are others that need care. On the other hand, some people may receive no treatment at all, as their condition does not warrant the expenditure of medical supplies.

                                      I remember reading somewhere that in war (or MCI) 30% of the patients will die no matter what we do and 30% will live whether we help them or not. The goal then is to help the 40% that will die unless we help them right now. I’m not trying to sound cold or cruel, but there it is.

                                      When the world “browns out” and goes into either a wartime footing, or a “dark decade” the outcomes my change, but many types of wounds remain survivable. Do not give up on a person just because a wound looks bad.

                                      I’ll try to post more for you later.

                                    • #62347
                                      RRS
                                      Participant

                                        In the TC3 class there was some discussion of where to procure decompression needles. I’m sure they have been located but in case they have not I did a search and came up with this place.

                                        http://www.narescue.com/ARS_for_Needle_Decompression_(3.25_in.)-CN1ACDE14CD3FD.html

                                        Looks like the same ones MV has access to in the Big Green. Also while going thru the aisles at the local little gun show I came across a guy running a table that had a vacuum packed kit from medicaltactics.com containing shears, nitrile gloves, npa w/lube, Izzy 4″ bandage, ABD pad, roll of medical tape and a mylar blankie for those who get cold while laying down on the job. Let me tell you its vacuum packed up to weapons grade level.

                                      • #62348
                                        wheelsee
                                        Participant

                                          An acronym I’ve seen is “BATS” – Bleeding, Airway, Treat Shock. I still have to remind staff of this in the ED. Even something as simple as finger laceration will lose blood (especially if you see it pumping). Yes, you can put bandages on it, and more bandages, and more bandages……..or you can put a mini-tourniquet (rubber band or IV start band) on it and be done with it while you figure out the rest…….my point – don’t be shy about using a tourniquet……the first rule of trauma I learned was “all bleeding eventually stops“…. hopefully because of something I did versus having HUA and letting it run out…

                                        • #62349
                                          DuaneH
                                          Participant

                                            BATS is a good acronym.

                                            Make it B-BATS and you have a working TC3 protocal

                                            B=Badguys.

                                            To lay people with a short amount of time I use 5 B’s
                                            Badguys
                                            Bleeding
                                            Breathing
                                            Brain
                                            Body.

                                            Lots of things work. HABC is a good acronym too.

                                          • #62350
                                            Corvette
                                            Participant

                                              Good discussion, folks. I might add one point: the CAT tourniquet that was used in a demo at our class in Dec showed something interesting – the windlass broke! It is plastic, and so I used that as motive to replace mine with the TacMed SOF tourniquet.

                                              Basilar skull fracture: good luck! Joe, CSF basically looks like water. Water FLOWING from the nose or ears is a bad prognostic sign… Or as I learned in medical school: “Don’t buy any long playing records” [yeah, I know it dates me, but YOU are older than I am so you get the reference].

                                            • #62351
                                              Max
                                              Keymaster

                                                Hi Doc,

                                                The SOFT-W, the wide version, is what I have. It is different and I believe better than the SOFT standard width tourniquet. Take a look at TacMed’s training videos.

                                                BTW, I still have a turntable, phono preamp,… . But due to my CRAFT, Can’t Remember A F’ing Thing, disease, I can’t figure out how to get my CDs to play on it. <sigh>

                                                Momento Mori

                                                Joe

                                              • #62352
                                                Corvette
                                                Participant

                                                  I remember my first tour being issued a rusty piece of rebar and a triangle bandage as a tourniquet. Good times!

                                                  a few tips

                                                  1. Premade chest seals are only ok at sealing wounds when blood is present. Bring lots of medical tape. I like to fold a piece down so its easy to grab with bloody gloves.

                                                  2. Practice doing TQs, Izzy bandages and taping up yourself one handed. Practice for both hands.

                                                  3. If you cant reach your IFAK with either hand hit yourself in the face until you pass out. When you regain consciousness move your pouches around so you can reach your IFAK with either hand.

                                                  4. Anti hemostatic powder is not magic fairy dust. It has to go INTO the wound, get packed with gauze and a still apply pressure, elevate, etc and so forth. Don’t get that shit in your eyes either.

                                                  5. During a gunfight you don’t stop to help the wounded. He gets a TQ put on or told to knuckle the fuck up and do it himself until the shooting stops. Return fire is the best medicine. You go fucking around playing witch doctor and there will be a lot more blood on the ground.

                                                  6. TREAT FOR SHOCK!!!!!!

                                                  7. I carry a bite stick made out of 550 cord. I’ve never used it but guys biting their tongue off and screaming until they pass out has convinced me its something I want. I made it big enough I wont choke on it provided I still have a jaw.

                                                  8. Wear your fucking eye protection!

                                                • #62353
                                                  IvyMikeCafe
                                                  Participant

                                                    Excellent thread. Excellent. DuaneH, you rock, man.

                                                  • #62354
                                                    HiDesertRat
                                                    Participant

                                                      nasopharyngeal airways are sized according to diameter of the patients nasal passage, if the npa is too small in diameter, the length will be inadequate. if too large, it will not fit at all. the diameter is balanced with the length when it is manufactured. was in the anesthesia for 3 decades. no one looks at length which is secondary, proper fit will ensure the length, all of which creates the airway between the soft palate in the posterior pharynx, and the tongue. lubrication can be blood, mucus, h2o, ky jelly. and insertion should be with the bevel parallel to the septum, and perpendicular to the plane of the face, not upwards following the contours of the nose. nasal passage goes directly back, not up. minimal effort required, some rotation perhaps, no force. some have deviated septum, might require using other side. if major facial trauma and it isnt going easy, plan B is in order, oropharyngeal airway, jaw lift, laryngeal mask airway, esophogeal obturator airway,
                                                      emergency cricothyrotomy are all alternatives. airways are tricky business. dont forget to turn patient on their side if lots of blood or secretions to promote drainage and keep airway open. first make sure you have hemorrhage under control. lots to think about while bullets are flying!

                                                    • #62355
                                                      DuaneH
                                                      Participant

                                                        Actually, you rock. Your article series is great stuff.

                                                      • #62356
                                                        DuaneH
                                                        Participant

                                                          “I remember my first tour being issued a rusty piece of rebar and a triangle bandage as a tourniquet. Good times!”

                                                          Interestingly enough, my first Army field medics course was in 1991 and back then the books said never use a tourniquet unless they are about to die. The SFC teaching it was in Vietnam and he made no bones about what he thought of that. He flat out told us: TK ASAP. And he carried something similar to the rebar and cravat that you mentioned.

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