Pending deployment

[soulsedition]

Good morning everyone, I've been trolling the forums for a number of years, now.
I'm looking at an upcoming deployment to a combat zone, and am seeking some counsel from a medic that has recently returned stateside concerning loadout planning. I will not be functioning as either of my prior MOS's (19k/68wN3) The army saw it fit to train me to be a 37F :). However i'd like to keep a small and functional aidbag for when SHTF. I've reviewed the forums concerning this matter, but i generally do better with 1-1 conversation. If anyone would be willing to send me a PM it would be greatly appreciated. Main concerns are: 1. Type of injuries to be most prepared for, pulse ox/other equipment that is rugged enough to endure an 18 month deployment, and other 'pearls of wisdom' Please send me a message. Thanks in advance-
Steve

[swatsurgeon]

Little kit contents:
little squirts of saline for eye wash (obtain from local hospital respiratory therapist),
tear packs of antibiotic ointment,
bandaids including large size,
tourniquet (use the MAT, my opinion),
several 14 or 16 gauge 5 - 8 cm chest decompression needles.
Naprosyn/celebrex/ibuprofen/mega multivitamin (if injured, does help)

Why would you need a pulse ox....do you carry oxygen?
Mental status helps with judging PaCO2, and to some degree PaO2.....not much you can do about oxygenation except keep them breathing, for CO2, breath deeper and faster to reduce it, slower and shallower to increase it.

That's all I would think but no in theater perspective, just what I've discussed with deployed personnel and received feedback on.

ss

[soulsedition]

You wouldn't happen to have been in schuykill haven a couple weeks ago, would you?

[crash]

First of what kind of a bag are you looking for? An aidbag, pouch, or just some stuff to keep in your own bag incase SHTF..

Do you / will you have acess to medical supplies?

If its just for when the SHTF fan all you need is the simple stuff, ABC's airway adjuncts, decompression needles, tourniguets, bandages, Ect. If your going to be trying to be a medic and take care of everyone then you'll need bandaids and that stuff..

If you don't have acess to supplies pm me and I'll see if I can help you out...

[soulsedition]

As i haven't been trained as a 37F Soldier yet, all i have is a paper definition of their responsibilities while in the sandbox. I'd be hard pressed to believe that all i'll be doing is riding around with a loudspeaker handing out flyers (not to mention disappointed) Ideally i'll have (black ops nylon CMP aid bag-small) for boots in the sand, and in the vehicle i'll have a larger aid bag. Not knowing the current supply climate over there for restocking an aid bag makes it difficult, but i've been amassing my fair share of stuff, namely gauze/ace wraps, NPA's, a couple CAT's, and a few of the other bandages. 14 gauges shouldn't be a problem for chest decompressions. The other stuff i'm not so sure about.
But seriously, what wins more hearts and minds than providing medical aide?

So in summary:
small CMP aid bag for dismount
Larger blackhawk type for TMC/Mass cas/ restock.

Thanks for all of the input thus far.

[swatsurgeon]

Re-check your CATs, there was a recall a few months back...many defective ones made it out the door.
I have issues with them, but interms of real estate they take up, that is their plus. Sand kills their velcro and we have torn the bars off of them

[D9 (RIP)]

And remember on the CATs that you're probably going to need 2, or at least to fully thread the buckle to apply one on the thigh - esp if your patient hits the gym with regularity. Find your biggest soldier and try in advance so you know what works and what your work arounds are.

Supposedly the velcro issue is resolved with the newest tq. The issue was the stitching on the velcro to the nylon on the tq would come apart and the two would separate with repeated use. I've seen this myself. We heard they were not going to be recalled after all as these tourniquets are a "one-use" item. Maybe set aside a few for training and keep the ones your guys wear out pretty pristine. I've never heard of that velcro problem happening right out of the wrapper, though I could be wrong.

As a "combat medic" current research shows you can make your most money preventing deaths in 3 areas: preventing tension-pnuemos, stopping compressible bleeders, and volume replacement in hypovolemic pts with controlled hemorrhage. I would pack accordingly. I'd probably make sure I had an IO kit. For the rest I would put in some basic gear for the rest of the ABCs and move out.

FWIW

[Fiercely Loyal]

Not knowing the current supply climate over there for restocking an aid bag

But seriously, what wins more hearts and minds than providing medical aide?
.

I am not any anyway claiming a professional knowledge just giving personal experience from a conventional unit. So far it has been an extremely uphill battle for supplies. Hemcon bandages and ACS are like gold. Medics have been unlikely to give things to Soldiers. On a mission in Southern Iraq we made a stop. One person asked for a band aid then suddenly there is a crowd of folks on my Humvee asking for food water and medical supplies. After hollering at the medic to take it somewhere else he closed up shop. Just IMHO if you happen to stop and someone is asking for medical aid, be very SA. Also there is some type of burn dressing with a cooling liquid that works like a charm. We were called to react to an IED detonation on QRF. One soldier had an amputation but was screaming about the burns. Within 3-5 minutes of dressing being applied he was screaming about the tourniquet instead. Hope this helps.

[jevo1976]

I am not any anyway claiming a professional knowledge just giving personal experience from a conventional unit. So far it has been an extremely uphill battle for supplies. Hemcon bandages and ACS are like gold. Medics have been unlikely to give things to Soldiers. On a mission in Southern Iraq we made a stop. One person asked for a band aid then suddenly there is a crowd of folks on my Humvee asking for food water and medical supplies. After hollering at the medic to take it somewhere else he closed up shop. Just IMHO if you happen to stop and someone is asking for medical aid, be very SA. Also there is some type of burn dressing with a cooling liquid that works like a charm. We were called to react to an IED detonation on QRF. One soldier had an amputation but was screaming about the burns. Within 3-5 minutes of dressing being applied he was screaming about the tourniquet instead. Hope this helps.

Fiercely Loyal,

Those are watergel burn dressings that you're speaking of, and you really should know something about burn care/treatment before you begin throwing out advice about it. Yes, it will probably help to relieve his pain, but in burn victims with any more than 10% BSA you are going to put him or her at risk for hypothermia. (Yes even when it's 140 degrees in Iraq.) Think about it - your skin regulates your temperature. Your skin, and its ability to regulate temperature, is now compromised by the burn and now you're going to place liquid on it. Again, this depends on the percentage BSA, but the point is that you need to educate yourself on when to use the watergel dressings. In reality they are rarely indicated for use. I realize that you're trying to help soulsedition, but what happens when someone out there takes your advice and applies the watergels to a WIA with 30% BSA. Guess what, you just helped put this guy into hypothermia and with it a decreased ability to clot, advanced him into shock, and he's now dead - although you've succeeded in the fact that he's not complaining about the pain anymore.

Also, soulsedition, remember that it's the basics that save lives. The Ascherman Chest Seal is alright, but it's an occlusive dressing. Those (occlusives) can be made by you with very little ingenuity - and with supplies that you probably already have available.

All the high-speed stuff you have (or don't have) isn't going to do a lick of good for you or your guys if you don't know when to apply it. If you don't know when to use a pulse-ox then you probably don't need to be carrying one. Swatsurgeon gives good advice. Be good at the basics. Whatever TQT you use, whether it be the CAT, the SOF-T, the MAT, be efficient at using it. The best TQT is the one that works for you and your guys. If you're using the CAT - train with it like the other posters said. Make sure the one in your blow-out kits/aidbag is brand new, and make sure it will fit the legs of your bigger guys.

As for what you will be able to aquire when you get there - go through your COC and talk to the guys you're replacing. Every area is different, and what goes in Baghdad doesn't always go in Tikrit or Kirkuk, and vice versa. This applies to the situation on the ground as well as supply issues. Find a way to get this info. It's your responsibility.

Read Capt Frank Butler's (USN retired) paper on Tactical Combat Casualty Care. Then read the more recent updates to it. Then read it again and again. Know the guidelines by heart - and more importantly know when to apply the guidelines. I recommend you attend a TCCC course if you can. But learn the basics first. TCCC guidelines can easily be found on the net with a Google search. Have I mentioned learn the basics? Anyway, good luck to you.

[soulsedition]

Good copy-
Thanks for all of the info, I'm a true believer in being good at the basics IE ABC's, assessment, and controlling shock. I'm guilty of having a nylon/cordura fetish at times, but understand i'd much rather have experience and a very solid skill set than any piece of gucci gear out there.
I guess my main question was this: what's getting used up quickest when you have wounded soldiers and what have you found yourself wishing you actually had in a given situation.
Thanks again for the input, in the mean time i'll get back to lurking. Also- If anyone here has worked beside or had Psyops assets attached to them, i'd like your input on what there job was, and how it helped your overall mission. With all due respect to opsec concerns.

-Steve

[Eagle5US]

OK Folks....

Lots of good ideas running around but let's try and keep things in perspective. Advocating what "we" would bring (EZ-IO's), do, and what not is great for US SOF guys as independent operators with our unique supervisory parameters and training skill set...not so great for the Combat Medic on the ground.

So-before we get TOO far / advanced in our suggestions...please consider the following:

We have increasing problems here in theater with medics working outside their scope of practice. They see a slide show in Kuwait or Baghdad on their way in and suddenly believe they have the ability to dig shrapnel out of their buddy's gut in the back of the vehicle because "they didn't think it was all that deep. The other common "explanation" is that they read about it / heard about a buddy who did it on the internet and thought since they were out of the US they had no medical regulation or supervision. "I can do anything out here that I think I need to do and you can't fault me for it".
Each medic working "independently" now has a provider assigned as their medical control.
MND-I surgeon's office has had SUCH problems with out of scope and inappropriate treatment that combat medics in the field are now under significant restrictions for meds and practice guidelines. The combat pill pack for conventional troops is gone by the wayside.
Quickclot and Hemecon dressings are being wasted in the MILLIONS of DOLLARS due to inappropriate usage (as a basic field dressing) and are being considered to be taken from the folks on the line (every soldier was supposed to have one). The hydrogel dressings are great in the clinic, not so great for use in the field because by the time they get to us it has become a slimy muddy mess. Guidance is not to use them unless they need the BURN BLANKET...which then indicates a level of severity where the contamination is going to matter very little.
So-let's stick with the basics for these guys going out in sector...

1. Stop the bleeding
- Tourniquets (I carry 8)
- Bandages / ACE wraps (Israeli dressings are the best thing out there / ACE wraps for compression over a rolled up Kerlex are a close second) I carry LOTS

2. Airway / pneumo Stuff (NPA's and OPA's are awesome yet no one has come in with one yet. ) Needle decompression is fast, easy and buys them time to get to my table. Know the signs of badness and do the deed to correct it.


As previously stated...it really does depends on what this young man's capacity is going to be...Medic or not. But let's try and keep the above things in mind when we advise him.
It is understood that folks who have been here before have experiences...and "when I was here we did this / had this available / this is what our guidance was". Try and keep in mind that the battlefield and the people / policies who run it are all fluid and things change. As does the threat being employed by the enemy and the access to advanced care.

Thanks folks-

Eagle

[Guy]

OK Folks....

So-let's stick with the basics for these guys going out in sector...

1. Stop the bleeding
- Tourniquets (I carry 8)
- Bandages / ACE wraps (Israeli dressings are the best thing out there / ACE wraps for compression over a rolled up Kerlex are a close second) I carry LOTS

2. Airway / pneumo Stuff (NPA's and OPA's are awesome yet no one has come in with one yet. ) Needle decompression is fast, easy and buys them time to get to my table. Know the signs of badness and do the deed to correct it.

Thanks folks-

EagleThrow in "LOAD & GO" also!

Take care and stay safe!

[Fiercely Loyal]

Rgr, I copied last. Thank you for the corrective training. Going back to lurking the weapons section.

FL

[ccrn]

Not QP here but I couldnt resist commenting...

I really like what Eagle5US had to say and witnessed some of the same myself. Our medics were very restricted in my conventional unit in what they could do in the field, for the same reasons Im sure.

To the OP, I deployed as 11B having been in healthcare in the civilain sector (RN, EMT). Not once did I use any of those skills while in Iraq as fate would have it. Everytime something happened I ended up taking care of something else like my primary area of responsiblity.

I did get to tend to bumps and bruises on my buddies now and then but found that most of them were well equiped to deal with the emergencies via CLS training etc. It seems funny now but the kids liked me having my stethescope so I kept that in my three day bag for psychological reasons.

I carried extra Tourniquets (5 in my case) and dressings on my person. Our IFAKs already had a TQ, needle for decompression, and dressings in them.

Best to you-

[highspeedmdd]

Just a couple of words to add.

I decided that I was going to be a SF Medic, not just a regular medic. To me, this meant that I was not going to get into the lickie-chewie business. While I had all that kind of aspirin, cough drops, eye drops, etc, I made a basic pack for everyone and made them carry it, along with IV bags, admin kits, etc. I decided I was not going to replace "life saving" equipment/meds space for "feel better in the morning" equipment/meds space. By all means provide that stuff if your guys want it and need it, but I never really felt compelled to carry band aids and cough drops. All of that stuff falls into the "self service" lane.

Also, just remembered. I put in an order to replace the regular field dressing with the small abdominal dressings. You can sew a compass pouch to the outside of another pouch on your kit and fit an abdominal dressing in that thing and it works much better when you have a real injury. The basic field dressing stops absorbing rather quickly if there is a real bleeder. Your guys are better off with the small abdominal dressings.

My 2 pennies...

[Eagle5US]

Just a couple of words to add.

Also, just remembered. I put in an order to replace the regular field dressing with the small abdominal dressings. You can sew a compass pouch to the outside of another pouch on your kit and fit an abdominal dressing in that thing and it works much better when you have a real injury. The basic field dressing stops absorbing rather quickly if there is a real bleeder. Your guys are better off with the small abdominal dressings.

My 2 pennies...

The old dressings are rare in theater (at least in our portion of it) and have been replaced almost exclusively by Israeli dressings...

Eagle