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swatsurgeon
06-09-2008, 19:07
What would you consider the essentials to have in your personal carry kit? Size is typical leg bag/molle pouch. What are the contents and be specific. I reserve the right to critique and be critical. Realestate and weight as well as utility are all major factors.
This can be a wish list by the way..
If you want a tourniquet you have to specify which one (and why), etc for all equipment. My goal is to find a standardized list that civilians or military "should" carry. Most civilians carry stuff that serves little or no purpose...but it looks cool and chicks dig it.

Ss

FMF DOC
06-09-2008, 19:28
If I'm the Doc I need to know number of personnel on mission, length of mission, ect ect..... But lots of pressure bandages, got to control the bleeding. As far as a tournaquet why have one in med kit when you use your wounded belt.

The Reaper
06-09-2008, 19:44
As far as a tournaquet why have one in med kit when you use your wounded belt.

Because you may need more than one, you may only have one hand to place it, or you may want something more effective than a belt to save your buddy.

TR

desertmedic
06-09-2008, 19:47
In a drop leg rig for the care under fire phase:

1. Tourniquets, CAT (3-4) (Easy access to this type)
2. Surgical cric kits (2) ("home made" and sealed with ET tube, shortened scalpel, "hook" to stabilize trach, alcohol preps, and tube tamer)
3. 12ga decompression needles (4-6 needles) with one way valves
4. A couple Israeli dressings
5. Petroleum gauze/tegaderms
6. Trauma shears
7. Pen light
8. Non-latex gloves

The rest of the bag is stuffed with a few cravats, roller gauze, alcohol preps, etc. Most equipment choices are based on what I can get through the current supply chain. NARP used to make a cric kit like the one described above, but I don't think it is availabe in the compact packaging anymore. Keep a lot more stuff in the aid bag to use when things calm down a bit. Stay safe and standing by for critique/advice,

Desertmedic

swatsurgeon
06-09-2008, 20:17
Let me clarify, this is not the medics kit, this is a kit that is on everyone...you get wounded and you either use the contents on youself or the medic uses it on you, saving his own equipment for others or when your pouch contents are inadequate to care for you.

Ss

MtnGoat
06-09-2008, 20:25
What would you consider the essentials to have in your personal carry kit? Most civilians carry stuff that serves little or no purpose...but it looks cool and chicks dig it.

Ss

I just go down to my Local WALMART.. would that work SS? :p

MtnGoat
06-09-2008, 20:53
OKAY on the real side now...

First off in all side pockets (arms & Legs pockets) 1ea CAT or SOFT Tourniquets; 5 total with one in Chest area. If I'm driving the lead V... I have 1 to 2 ea on my legs (Thighs) if needed, road IED threat. GMVs, M1114s get smokey FAST.

I go for something on side of my kit, waist level. What my Tm Medic hands out. Something along these lines.

2ea "Isreali" Fld Dressings
2ea kerlix gauze
2ea Chest Dressing
2ea Non-latex gloves
1ea Pill Pack
1ea 3" roll coban gauze
1ea 4" Elastic (ACE) Bandage
1ea Medical Shears (not in IFAK, I carry it center of chest area)
1ea Pk Petroleum gauze
1ea one 28fr nasopharyngeal airway with lubricant packet
1ea hemostatic gauze Pk

VXMerlinXV
06-09-2008, 22:19
6” self adhering ACE
3” self adhering ACE
Asherman Chest Seal
Xeroform dressing
2 ABD pads
5 pack of sterile 4X4 gauze
6” Kerlex
14 ga. Angiocath 2.5” length
100 ml Saline eyewash
2 pr. Large gloves
2” roll Durapore
10 blade scalpel
32 fr NPA
Packet surgilube (taped to npa)
In a perfect world a Benchmade Rescue 5, but a pair of trauma shears will do
Hemostat
2 safety pins
All of this fits in a large ziplock, which will fit in a BDU pants pocket.
The kit can be chopped down to fit in a 1 qt canteen pouch, which would contain the 6” ACE, the Kerlex, the ACS, one ABD pad, The 14 ga. IV cath, the eyewash bottle, the gloves, tape, and the NPA with lube.

Razor
06-09-2008, 22:43
I'm assuming we're talking GSW/Blast trauma kit, and not something I'd take with me on a backpacking trip, right?

Razor,
Correct, not for backpacking

Surgicalcric
06-09-2008, 23:01
1. Gloves (PPE)
2. Nasal Airway 7.0 (secure Airway)
3. (2) large safety pins (secure bandage, sling, or to secure airway in a pinch)
4. 14 ga or larger 3” catheter (needle drill)
5. Cinch Tight “H” bandage (large bandage)
6. (2) Cinch Tight priMed gauze roll (smaller vaccum sealed Kerlix)
7. Duct tape (no kit is complete without it)
8. Quick Clot, HemCon, or TraumaDex as you prefer (duh)
9. Tourniquet SOFT-T(there should also be a minimum of 1 more on the soldiers centerline which he can get to with either hand (2 is 1; 1 is none)
10. Pill Pack (Mobic 15mg, Acetaminophen 1000mg, and Gatafloxacin 400mg)
11. Chest seals (Package from item 5 & 6 can be used for occlusive dressings along with duct tape thus saving weight and space)

I think that about covers it.

I am rethinking what I am having my guys carry. There may be changes to this list as I test out a few newer bandages...

Crip

nmap
06-09-2008, 23:16
My goal is to find a standardized list that civilians or military "should" carry. Most civilians carry stuff that serves little or no purpose...but it looks cool and chicks dig it.

Ss

Sir, thank you very much for creating this thread.

I wonder what level of training the civilian is expected to have. I would not know how to use a tourniquet, much less a catheter.

krod
06-10-2008, 08:42
this is what we got on our shoulder:

14g catheter
vacuum sealed kerlex
NPA
HEMCON or quikclot
Asherman or Opsite for chest wounds
Israeli bandage

and a CAT on the front of our kit.

This is vacuum sealed and in our shoulder pocket.

swatsurgeon
06-10-2008, 14:41
Gentlemen,
I will not have computer access again until thursday so I will begin my comments then. Please continue to post what you think is the personal kit contents of choice.
Thanks
ss

Kyobanim
06-10-2008, 15:05
Crip,

Duct tape? I can imagine a use but I'd like to hear it from you. What do you use it for?

Surgicalcric
06-10-2008, 15:13
Kyo:

I use it because it will stick to anything. Though I must admit, sometimes it sticks too well.

Crip

The Reaper
06-10-2008, 15:15
Because it will stick to anything.

Crip


Except WD-40.:D

TR

Surgicalcric
06-10-2008, 15:16
Except WD-40.:D

TR

Nothing sticks to WD-40 Sir...

Crip

rab97
06-10-2008, 15:57
Don't forget PO Antibiotics and pain meds for the conscious patients. We put those in our guys kits as well in addition to the trauma goodies.

mdb23
06-10-2008, 15:58
Quick question.... I am seeing people list non latex gloves as part of their PPE, is that due to possible allergic reaction to the latex ones, or is there another reason as well?

Thanks.

swatsurgeon
06-11-2008, 18:35
OKAY on the real side now...

First off in all side pockets (arms & Legs pockets) 1ea CAT or SOFT Tourniquets; 5 total with one in Chest area. If I'm driving the lead V... I have 1 to 2 ea on my legs (Thighs) if needed, road IED threat. GMVs, M1114s get smokey FAST.

I go for something on side of my kit, waist level. What my Tm Medic hands out. Something along these lines.

2ea "Isreali" Fld Dressings
2ea kerlix gauze
2ea Chest Dressing
2ea Non-latex gloves
1ea Pill Pack
1ea 3" roll coban gauze
1ea 4" Elastic (ACE) Bandage
1ea Medical Shears (not in IFAK, I carry it center of chest area)
1ea Pk Petroleum gauze
1ea one 28fr nasopharyngeal airway with lubricant packet
1ea hemostatic gauze Pk

MtnGoat,
What is a 'chest dressing' and for what purpose? Not meaning to be a wise ass....just trying to understand the 'what' and 'why'. Most people ask for equipment that they have little understanding of it appropriate use and more importantly, it's limitations. What kind of hemostatic gauze? What do you need the kerlex for, or koban, petroleum gauze??


ss

swatsurgeon
06-11-2008, 18:39
6” self adhering ACE
3” self adhering ACE
Asherman Chest Seal
Xeroform dressing
2 ABD pads
5 pack of sterile 4X4 gauze
6” Kerlex
14 ga. Angiocath 2.5” length
100 ml Saline eyewash
2 pr. Large gloves
2” roll Durapore
10 blade scalpel
32 fr NPA
Packet surgilube (taped to npa)
In a perfect world a Benchmade Rescue 5, but a pair of trauma shears will do
Hemostat
2 safety pins
All of this fits in a large ziplock, which will fit in a BDU pants pocket.
The kit can be chopped down to fit in a 1 qt canteen pouch, which would contain the 6” ACE, the Kerlex, the ACS, one ABD pad, The 14 ga. IV cath, the eyewash bottle, the gloves, tape, and the NPA with lube.


okay, so what is the utility of the self adhering ace (and in 2 sizes), the xeroform is used for what, 14G 2.5 inch caths for what? (they wouldn't make it into the Reapers chest...no offense TR, just the truth.

ss

swatsurgeon
06-11-2008, 18:41
1. Gloves (PPE)
2. Nasal Airway 7.0 (secure Airway)
3. (2) large safety pins (secure bandage, sling, or to secure airway in a pinch)
4. 14 ga or larger 3” catheter (needle drill)
5. Cinch Tight “H” bandage (large bandage)
6. (2) Cinch Tight priMed gauze roll (smaller vaccum sealed Kerlix)
7. Duct tape (no kit is complete without it)
8. Quick Clot, HemCon, or TraumaDex as you prefer (duh)
9. Tourniquet SOFT-T(there should also be a minimum of 1 more on the soldiers centerline which he can get to with either hand (2 is 1; 1 is none)
10. Pill Pack (Mobic 15mg, Acetaminophen 1000mg, and Gatafloxacin 400mg)
11. Chest seals (Package from item 5 & 6 can be used for occlusive dressings along with duct tape thus saving weight and space)

I think that about covers it.

I am rethinking what I am having my guys carry. There may be changes to this list as I test out a few newer bandages...

Crip

Surgcric,
what do you do with the chest seal ...and what is it's intended use....and why use it? What is the reason you would want to apply one?
ss

swatsurgeon
06-11-2008, 18:45
Gentlemen,
No one has listed the science/theory behind each component they want to carry.....we need to put real medical theory/facts into play here. Everything you want to carry takes up space and is weight on your person. Everything should have a "real" purpose, not a perceived purpose.
I could carry saran wrap and duct tape and nothing else from what I am reading in these posts......
Your life could and will depend on what you choose to carry. Let's make it the absolute right equipment..for the right reasons and the right uses.
Next.....

ss

I will begin to argue your choices with facts that you may/may not have thought about or heard before, from a trauma surgeons point of view. As an example, 2 significant studies demonstrated that a 3 inch chest decompression needle will make it into the majority of male chests and over a 4 inch could cause serious injury to either lung or heart if placed incorrectly. Less than 3 inches has a 35-40% miss rate into the thoracic cavity.

Surgicalcric
06-11-2008, 21:07
Surgcric,
what do you do with the chest seal ...and what is it's intended use....and why use it? What is the reason you would want to apply one?
ss

I use the outer packaging from the "H" bandages (Israelis) for occlusive dressings (with the duct tape.) Chest seals (improvised, BCS, ACS, defib pads, etc) are applied to penetrating trauma between the umbilicus and chin.

As for the remainder:

1. Gloves (PPE)
2. Nasal Airway 28fr (used as a NPA or can be used for a cric in a pinch)
3. (2) large safety pins (secure bandage, sling, or to secure airway (pin thru tongue then cheek))
4. 14 ga or larger 3” catheter (needle drill)
5. Cinch Tight “H” bandage (pressure dressing, large)
6. (2) Cinch Tight priMed gauze roll (packing wound tracks)
7. Duct tape (no kit is complete without it)
8. Quick Clot, HemCon, or TraumaDex (this depends more on what is available at the time of order than what I want)
9. Tourniquet SOFT-T(there should also be a minimum of 1 more on the soldiers centerline which he can get to with either hand (2 is 1; 1 is none)
10. Pill Pack (Mobic 15mg, Acetaminophen 1000mg, and Gatafloxacin 400mg; for battle wounds where the soldier is conscious, in pain and the medic isnt there, SR, Recon, etc...)

Again, I have been rethinking the kit my guys carry and this is also METT-TC dependent, meaning the kit changes depending on whether we will be fighting in an urban environment (short patrols with medevac/casevac assets close) vs the jungles of South America or the mountains of A-stan (they carry much more stuff (personal sick-call meds, Antimicrobials, IV kits, etc) in the jungle and would on extended patrols in the mountains of A-stan, etc...)

There really isnt a one size fits all solution to this, atleast for the SOF soldiers. We can narrow it down to a bare essentials list for most everything but the truth is the kit will vary greatly depending on the where and for how long factors. The civilian side (LEO) should be much easier to cover though...

Crip

MtnGoat
06-11-2008, 21:31
OKAY on the real side now...

First off in all side pockets (arms & Legs pockets) 1ea CAT or SOFT Tourniquets; 5 total with one in Chest area. If I'm driving the lead V... I have 1 to 2 ea on my legs (Thighs) if needed, road IED threat. GMVs, M1114s get smokey FAST.

I go for something on side of my kit, waist level. What my Tm Medic hands out. Something along these lines.

2ea "Isreali" Fld Dressings
2ea kerlix gauze
2ea Chest Dressing
2ea Non-latex gloves
1ea Pill Pack
1ea 3" roll coban gauze
1ea 4" Elastic (ACE) Bandage
1ea Medical Shears (not in IFAK, I carry it center of chest area)
1ea Pk Petroleum gauze
1ea one 28fr nasopharyngeal airway with lubricant packet
1ea hemostatic gauze Pk


SS

No problem on the why, what and hows..

2ea "Isreali" Fld Dressings ( better & easyer than the standard Mil Field Dressing. Has everything rolled up into one)
2ea kerlix gauze (Pack those GSW.. Takes at least 3 rolls IMHO-E)
2ea Chest Dressing (Asherman Chest Seal is the one issues.. Which SUCK IMHO.. When Rick sold his Company the new "Owners" changed the Dressing Adhesive so now they suck)
2ea Non-latex gloves
1ea Pill Pack [(Mobic 15mg, Acetaminophen 1000mg, and Gatafloxacin 400mg) is the standard issued "drugs" help for that first med "Boost" for the PATs body]
1ea 3" roll coban gauze (Helps make stuff (Dressings) stick when needed)
1ea 4" Elastic (ACE) Bandage [Hold back those Field Pressure dressing and all that Kerlix for thos enasty GSW]
1ea Medical Shears (not in IFAK, I carry it center of chest area) [Cut all he clothes that are around those open wounds, Shapnel and GSWs]
1ea Pk Petroleum gauze (Aids in Chest wound GSW or Shapnel holes-sealing them)
1ea one 28fr nasopharyngeal airway with lubricant packet (Air way through your Nose) [Body needs air and water to OP(live)]
1ea hemostatic gauze Pk [(Quick Clot, HemCon, or TraumaDex) Helps to stop all that red liquid running out of those openings in your body] I know DOCs Surgeons don't like what is can or does to tissue. But....


I would like to add.. Military wise. It helps to have a IFAK, Med Bag, Blow out bag that can be PULLED off the persons BA. It speeds up the Medical Process. That guys BA will be taken off and thrown to the side and now you have to go looking for his IFAK-BOB.

PROs and CONs to both. Just my .02

Peregrino
06-11-2008, 21:40
Keep going guys - we're all learning here. This is a timely discussion from my perspective because I have a couple empty IFAK pouches I need to set up. You're already influencing some of my initial choices. To backstop SS - lets get some "rationales" for the whats & whys. Us "knuckledraggers" need that if we're going to be convinced to carry anything more than the most obvious minimums. I always went with whatever the team medic handed me without a lot of questions. Now it's time to (I have to) do a little more thinking on my own.

VXMerlinXV
06-12-2008, 09:19
okay, so what is the utility of the self adhering ace (and in 2 sizes), the xeroform is used for what, 14G 2.5 inch caths for what? (they wouldn't make it into the Reapers chest...no offense TR, just the truth.

ss

The ace is used in combination with the ABD, gauze, or kerlex to create a pressure dressing. I like the 6” for arm and leg coverage, but I prefer the 3” for heads, hands, and feet. I also like the Ace for the splinting of ankles, used in conjunction with either a SAM or a stick, it covers the R and C in RICE therapy (Rest, Ice, Compression, Elevation). I prefer the self adhering model so I am not relying on little metal clips or tape.
The xeroform is used with the ACS. For multiple penetrating injury to one side of the chest the ACS can be used to occlude the wound allowing the most air passage, and the xeroform can be used to seal the other holes. While I know that history shows us the wrapper or plastic wrap can be used as an occlusive, I think the semi-adherent nature of the xeroform makes it more suited for this purpose.
I like the shorter IV caths because they can also be used for peripheral IV access, and I feel the 3” models give a lot of resistance when you try to advance the catheter when used for this purpose. The deciding factor would be if a 2.5” angiocath could reliably decompress a chest when inserted into the 5th or 6th intercostal space on the midaxilary line, where you would encounter less mass.

x SF med
06-12-2008, 10:06
Hint for the duct tape that Crip carries - a small dab of petrolatum keeps it from sticking to bandages, and other areas where the adhesive might remove derma or cause issues...:rolleyes:

crash
06-12-2008, 21:08
2x CAT tourniquets (amputations)
1x M2 ratchet style tourniquet ( easier to apply, tougher than cat; prob replace cats with 2 more of these, or the sof-t)
2x H&H compressed gauze (wound packing/dressing)
1x civilian compression bandage similar to Israeli (pressure dressing)
1x Israeli bandage (pressure dressing/improvised tq)
2x opa's (keep patent airway / bite block; 2 in case u loose one)
2x npa's (keep patent airway / can be used for cric)
2x 14ga needles (chest decompression / also can be scalpel for cric)
3x asherman chest seals (sucking chest wound)
4x petroleum gauze (sucking chest/exit wound , shrapnel to the thorax)
1x quick clot powder (better to have and not need than need and not have)
1x quick clot sponge "
1x celox "
1x IV starter kit 18ga, alcohol prep, op-site, 10cc flush
1x roll tape
1x scissors
1x pen light
1x sharpie

then of course still have my med pouched and aid bag ect, but I figure if i need any more than that I'm f'd.. advise, recommendations, critics welcome.

krod
06-13-2008, 01:39
Im not a medic... never seen the 14g used for a scalpel. How does it work?

Surgicalcric
06-13-2008, 05:27
...never seen the 14g used for a scalpel. How does it work?

Remove the catheter from the needle, turn needle 90 degrees so the bevel is now facing left or right as opposed to upward and use on a 10-20 degree angle just as you would a scalpel. It takes a lil practice and isnt as fast as using a scalpel but it will work in a pinch.

Crip

swatsurgeon
06-13-2008, 07:15
Gentlemen,
I would like to focus briefly on the equipment used for an open (sucking) chest wound. Multipart answer here:
1)Has anyone dealt with a true open chest wound where there was free movement of air both in and out of the pleural space, and 2) used a 3 sided dressing or asherman type device. What was the result? Did the dressing or device prevent the need to provide positive pressure ventilation (BVM or ETT intubation, etc) and most importantly, was it a true open chest wound?
Ss

shadowflyer
06-13-2008, 07:29
First on scene to a 32 y/o Female with multiple stab wounds to chest and back. PT is combative and bleeding profusely. Once we got PT into back of truck we exposed her and found a wound to left upper chest and neck just above sternal notch, with free air moving in and out of chest wound. PT complaining of having a hard time breathing. 3 side occlusive dressing placed. 2 large bore IV's placed. Fluid challenge with .9 NS started as she had no radials at the time. PT did say it was easier to breathe once we got dressing on. PT was maintaining her own airway at time. By the time we made it out of the apartment complex PT arrested. ACLS protocols followed on rest of way to trauma center. PT pronounced DOA at ER. Autopsy noted aorta and lung laceration. PT bled out before we could get her to OR.


Hope this helps.

JJ

D9
06-13-2008, 10:16
2 torniquets (1 SOF, 1 CAT) carried on person and accessible

2 pr Nitrile Gloves
4 Alcohol swabs
4 Betadyne swabs
2 14 ga Catheters
4 Chest seals, self-adhesive
1 6" self-adhering ACE
1 4" self-adhering ACE
2 Z-Pak Gauze dressings
1 HemCon
1 Quiklot
1 Laminated 9-line card
1 Alcohol pen
1 Marker
Trauma shears (not to be used for hooch construction)

Surgicalcric
06-13-2008, 13:04
...1)Has anyone dealt with a true open chest wound where there was free movement of air both in and out of the pleural space...and used a 3 sided dressing or asherman type device.

Yes. Too many infact, both in the ER and at EMS.


2) What was the result? Did the dressing or device prevent the need to provide positive pressure ventilation (BVM or ETT intubation, etc) and most importantly, was it a true open chest wound?

I have used ACS, defib pads, large tegaderms, and seran wrap.

Of the patients who were conscious, and maintaining their own airways, all claimed relief of the SOB, until pressure built up from the 4-sided dressings requiring a needle-drill.

Of the ones who were ETT'd, O2 sats was higher until pressure increased, resulting in venting becoming more difficult, indicating the need for a needle-drill.

Hope that answered your questions...

Crip

swatsurgeon
06-13-2008, 15:28
Surgcric,
You answered it perfectly.....IF and when a patient becomes symptomatic (non-intubated pt.), time for a 3 sided dressing/ACS, etc. All patients with positive pressure being applied via ETT or BVM, don't need one. A dressing somewhat reduces the future contamination (above and beyond what has already occured). The fact is that you have to watch these people like a hawk....if the open end is not letting go of the air, they get a tension PTX. I haven't found a reliable tape or adhesive that sticks well to the body when it is dirty, slimy from sweat, etc. I haven't tried duct tape but I will now to see if it holds.

Back to the original issue: what method works most reliably for these wounds?
So far multiple people have used different methods to seal the chest. Can we safely say there is no one standard? Any product that can form a barrier to the inflow of air and yet release it when necessary would seem to work......
$15 for an ACS, <$1 for saran wrap and duct tape and everything in between.

Needle decompression for tension PTX: need a needle that is 3-3.5 inches long, longer and placed in the incorrect place, you harpoon the heart or lung potentially. How many to carry on your self??? I say 5. They bend too easily and repeat decompressions are >60-70% likely. Little weight and little size, so more is better. My record was 7 in one side....he lived to the hospital.

Prep pads: alcohol and betadine....why both? Needed at all? Do they sterilize the skin or just act as a method to wipe away some of the grime?

more to follow.

ss

Surgicalcric
06-13-2008, 17:11
Surgcric,
You answered it perfectly.....IF and when a patient becomes symptomatic (non-intubated pt.), time for a 3 sided dressing/ACS, etc. All patients with positive pressure being applied via ETT or BVM, don't need one. A dressing somewhat reduces the future contamination (above and beyond what has already occured). The fact is that you have to watch these people like a hawk....if the open end is not letting go of the air, they get a tension PTX. I haven't found a reliable tape or adhesive that sticks well to the body when it is dirty, slimy from sweat, etc. I haven't tried duct tape but I will now to see if it holds.

I really have used everything from the ACS to moleskin to saran wrap. Also to be honest I was never impressed with the one way valves (as they seemed to fail once blood worked its way into the flutter valve) or with the function of the 3-sided occlusive dressing for the same reason. I cant begin to tell you the number of studies I have read which argue back and forth on whether the 3 sided or 4 sided occlusive dressing is the Gold Standard" for the initial treatment of penetrating trauma to the thorax. Quite frankly I don't really see what the fuss is all about. I understand the theory behind the 3-sided/valved dressings but again have never seen them work very well, OMMV. With either, close attention needs to be paid to the patients respiratory status, for changes signaling a tension PTX, as you mentioned above.

What method works most reliably for these wounds? So far multiple people have used different methods to seal the chest. Can we safely say there is no one standard? Any product that can form a barrier to the inflow of air and yet release it when necessary would seem to work...... $15 for an ACS, <$1 for saran wrap and duct tape and everything in between...

As for adhesive, I have never been that impressed with COTS solutions with the exception of the Hyfin Chest seal (which has an adhesive akin to that on the old ekg pads or moleskin which will take skin and all when removed) however I havent used one on a real patient yet and have only tested the adhesive on a water soaked patient. (More to follow on this as I get back to my civilian job.) The ACS sucks; the BCS seems better but not a 100% solution; saran and duct tape work damn near 100% of the time but causes some obvious skin irritation due to the strength of the adhesive; Defib pads work but who carries them in the field; and large tegaderms / opsites work great due to the material being very flexible. No scientific data to support any of that though, just trial and error.

Needle decompression for tension PTX: need a needle that is 3-3.5 inches long, longer and placed in the incorrect place, you harpoon the heart or lung potentially. How many to carry on your self??? I say 5. They bend too easily and repeat decompressions are >60-70% likely. Little weight and little size, so more is better. My record was 7 in one side....he lived to the hospital.

I agree about the caths, however the caveat being, shorter (2-2.5") will work if you move your site from 2nd ICS MCL to 5th ICS MAL. The bending is spot on with my experiences as well SS and as such one needs to prepare for that. I think my record was 5... I dont know about carrying that many in a BOK, but am not opposed to the idea but would like more discussion on it before I would try to convince my guys to carry more than 2 ea. Hopefully by ythe time someone has drilled someone twice there would be someone else around (the 18D or if working without a medic someone else) with a aidbag or CLS type bag which is over stocked with extra's of the commonly used items...

Prep pads: alcohol and betadine....why both? Needed at all? Do they sterilize the skin or just act as a method to wipe away some of the grime?

I generally just use alcohol to wipe the site clean moreso than trying to sterilize the site itself... I think most providers (emt's, nurses, MD's) do it because they were taught it was the right thing to do and it becomes muscle memory with everything else (iv sticks, injections, etc...) I dont see why we worry about it in a combat setting or the ER for that matter. If the patient has an open chest wound anything foreign micro that can get in got in through the larger hole the foreign object made on its path into the thoracic cavity. The patient will be receiving the antimicrobial of choice once at "bright lights and cold steel" anyways. Not attempting to promote bad medicine or that teaching to cleanse the site is wrong but in the scheme of things its not an issue... If that makes sense...

Enough of me babbling...

Crip

swatsurgeon
06-14-2008, 06:26
Crip,
The issue with decompressing in a lower spce is that with your "muscle memory" if you use or are handed a longer catheter, the risk of a cardiac puncture in the 4th, 5th, 6th interspace increases significantly. I have operated one 2 patients with this issue in the recent past. One had a tamponade and one had an arterial line...thankfully the medic realized it and capped it rather than pulling it out. Hit the left ventricle with a 5 or 7 inch angiocath (hence harpoon). Cook catheter co. Makes a 3.5 inch wire wrapped cath that can't bend or kink in 12 gauge. They double as a needle cric but I use them for the chest. Here is a multipurpose item, which is where I'm trying to go with all kit items.
As far as the skin prep, we remove all field placed lines within 24 hrs anyway, no sterility in the field.
ss

Surgicalcric
06-14-2008, 10:05
SS:

Thanks for the reminder of the hazards associated wtih decompressions in the MAL with longer caths. While on that subject, have you noticed any such inadvertent punctures using shorter caths or is it all based on the longer versions? Just curious.

As for multiple purpose items I am all for it. I am a firm believer in the more educated we are the less we need to carry.

Keep the ideas coming.

Crip

swatsurgeon
06-14-2008, 10:20
I have only seen one cardiac injury with a 2.5 inch needle placed parasternally, 7th space and got the heart.

Surgicalcric
06-14-2008, 10:32
...placed parasternally...

Parasternally... Havent seen nor heard of that method before. Think I may just leave that one out of the toolbox...

Crip

VXMerlinXV
06-21-2008, 09:22
Ok, moving on in the IFAK, the tape. We discussed the idea of Duct tape, which is nice, but has anyone really looked at the difference in effectiveness between that and Kendal's 2” Wet-Pruf? We use the 1” to secure ET tubes and after a quick wipe it will stick reliably to the face despite saliva and mixed gastric contents. Combine it with a tincture of benzoin swab and that tube is there for the duration. Has anybody used it for dressings?

Razor
06-21-2008, 19:52
What's the per foot cost difference between duct tape and waterproof medical tape?

swatsurgeon
06-22-2008, 19:36
What's the per foot cost difference between duct tape and waterproof medical tape?

I guess it depends how you come to obtain the medical tape....:D
What tape do I have access to that is waterproof???? I don't think any of them are.
ss

Razor
06-22-2008, 20:22
I sit corrected--water resistant, rather than water proof. I rather expected that the Wet-Pruf tape Merlin mentioned was much more expensive than duct tape, with little difference in performance, thus giving the edge to duct tape for those of us without access to Class 8 Welfare :D.

VXMerlinXV
06-23-2008, 07:47
The best price I found, other than used (and I'm not a big fan of “used” medical disposables) was about nine cents per foot for the 1”, and fourteen cents per foot for the 2”. The only straightforward advantage I can see is the compact size and the spool it comes in.

The Reaper
06-23-2008, 10:09
The best price I found, other than used (and I'm not a big fan of “used” medical disposables) was about nine cents per foot for the 1”, and fourteen cents per foot for the 2”. The only straightforward advantage I can see is the compact size and the spool it comes in.

Have you seen the small "flattened" rolls of the duct tape for survival use?

They are pretty compact and there are probably more uses for 100 mph tape than surgical tape. Only downsides I can see are sterility (and IIRC, tape is not sealed or sterile) and allergic reactions to the adhesive.

Along with superglue/dermabond, you have some pretty useful items.

TR

VXMerlinXV
06-23-2008, 12:42
I checked out the mini rolls and I think that is just what the doctor ordered. Other than a sensitivity to adhesive, I do not see a lot of downsides to using duct tape as opposed to medical tape.
Going back to the original intent of the thread, looking at most of the lists provided we're looking at a decent size kit, something big enough to need a pants pocket or larger vest pouch. I offered an abbreviated kit, and Krod listed a smaller kit as well. I think that a lot of the kits, including my own larger kit, can be cut down with little detrimental effect. So I suggest the following:
Hemostatic agents: Quick clot, Arista, etc. I think, barring some major advances, these are going to go the way of PASG/MAST quickly. The exothermic reaction is a definite factor, but more than that we were discussing research at work the other day which shows the products do not reliably stop arterial bleeding, which is the whole point. The Quickclot ACS negates the point of the clotting agent, this role is already filled with surgifoam or surgicel. The best I see for these products is large raw peripheral wounds, and these lend themselves to dressings, not powders. I think they can be cut from the kit all together.
Bulk gauze: I know the big wounds require a lot of dressing. But I am looking at the time/treatment ratio, the time it would take to use the majority of one of these IFAKs could be better spent transporting the casualty. I would say one good pressure dressing and one other dressing (ABD pad) should cover needs for the “Care under fire” phase.
Tourniquet: I like the idea of keeping them even more easily accessible than the IFAK. A small dedicated pouch with a tourniquet eliminates digging when you need one. I have always been partial to an inflated BP cuff for this function. There is a quantifiable amount of pressure, and you can slowly deflate the cuff after treating the wound to see if your intervention has reliably stopped the bleeding. I think one is enough for the individual to carry. You have to figure one limb can be controlled by the cuff, a second can be controlled with a pressure dressing, and if you have a third limb with an exanguinating wound you should either consider being kind and opening up the aidbag, or rest assured that one the patients systolic pressure hits 80 most of the the bleeding will stop all on it's own.

I think that these changes should drop some considerable bulk and some weight from the IFAK.

Surgicalcric
06-23-2008, 14:39
I checked out the mini rolls and I think that is just what the doctor ordered. Other than a sensitivity to adhesive, I do not see a lot of downsides to using duct tape as opposed to medical tape.

I have been using duct tape for years in the civilian world for MCI's... Its cheap, works and there is always ample suppliy...


Hemostatic agents: Quick clot, Arista, etc. I think, barring some major advances, these are going to go the way of PASG/MAST quickly. The exothermic reaction is a definite factor, but more than that we were discussing research at work the other day which shows the products do not reliably stop arterial bleeding, which is the whole point. The Quickclot ACS negates the point of the clotting agent, this role is already filled with surgifoam or surgicel. The best I see for these products is large raw peripheral wounds, and these lend themselves to dressings, not powders. I think they can be cut from the kit all together...

You may need to do a lil research on the effectiveness of hemostatic agents outside the confines of the ER/ED or civilian EMS. Out here where bright lights and cold steel may be more than a day away Hemostatic agents have saved many lives and the benefits are more than a fair trade for the little weight.

Surgifoam/surgicel has its place in the spectrum of care. Replacing QC, Hemcon, etc in the combat setting isnt it...

Bulk gauze: I know the big wounds require a lot of dressing. But I am looking at the time/treatment ratio, the time it would take to use the majority of one of these IFAKs could be better spent transporting the casualty. I would say one good pressure dressing and one other dressing (ABD pad) should cover needs for the “Care under fire” phase....

The application of a TQ is all thats indicated for the CUF phase. Pressure dressings and bandaging will be taken care of after fire superiority is gained, the objective cleared or as otherwise indicated or directed. There are many instances where packing wounds is indicated and the use of liberal amounts of kerlix/kling is necessary. I prefer wound packing to wound covering generally.

Tourniquet: I like the idea of keeping them even more easily accessible than the IFAK. A small dedicated pouch with a tourniquet eliminates digging when you need one. I have always been partial to an inflated BP cuff for this function. There is a quantifiable amount of pressure, and you can slowly deflate the cuff after treating the wound to see if your intervention has reliably stopped the bleeding. I think one is enough for the individual to carry. You have to figure one limb can be controlled by the cuff, a second can be controlled with a pressure dressing, and if you have a third limb with an exanguinating wound you should either consider being kind and opening up the aidbag, or rest assured that one the patients systolic pressure hits 80 most of the the bleeding will stop all on it's own...

A BP cuff is considerably larger than a TQ and as such would add bulk to the IFAK and weight too. One TQ is also NEVER enough. Two is one, one is none and sometimes more are needed...

We carry one in the IFAK and one on the soldiers centerline. I have extras in my aidbag and a couple stashed on my vest...


Crip

Razor
06-23-2008, 16:10
Weren't there a couple studies that determined that windlass-style TQs were the only type that could sufficiently stop arterial flow in the field?

swatsurgeon
06-23-2008, 16:31
Weren't there a couple studies that determined that windlass-style TQs were the only type that could sufficiently stop arterial flow in the field?


Actually, flawed studies done by the Dept of the Navy. I have copies and will post when I dig them up.

ss

VXMerlinXV
06-23-2008, 22:39
You may need to do a lil research on the effectiveness of hemostatic agents outside the confines of the ER/ED or civilian EMS. Out here where bright lights and cold steel may be more than a day away Hemostatic agents have saved many lives and the benefits are more than a fair trade for the little weight.

Surgifoam/surgicel has its place in the spectrum of care. Replacing QC, Hemcon, etc in the combat setting isnt it...

The study I am basing this on is referring to field use, not ER. I left my hard copy at work, and will reference it directly tomorrow. The point I was getting at was that twenty years ago MAST was the next big thing, and in theory they work great. In practice MAST did not make a realistic difference in patient outcome, and it took years of collecting data to prove that. The same goes for aggressive fluid resuscitation. Two large bore IV's pouring in Saline were the norm for a good period of time. It is no longer the standard of care, after decades of studies.

I have read Blakes report on tactical care in 2007, and just rechecked the section on hemostatic agents, specifically in the 64 uses of HemCon in combat situations. What I think Blake fails to take into account is the body's natural tendency to shunt off peripheral bleeding. There is nothing to say these wounds would not have eventually stopped bleeding with a pressure dressing. Incidental field data (with 6,000+ wounded in 2007 alone) of a sample of 64 uses may or may not be considered definitive. In Alam's article “Hemorrhage Control in the Battlefield: Role of New Hemostatic Agents” hemostatic agents are given a favorable review, but it is noted that clinical data is mixed, including two parallel studies on a chitin dressing that produced opposite results. It should also be noted that many of these studies observed the effectiveness of hemostatic agents on thoracic and abdominal injuries as opposed to peripheral vascular bleeding. This leads to higher overall success rates, while in my opinion diluting data on realistic field applications.

I like the extended transport time argument for things like PO antibiotics, advanced orthopedic care, and as justification for carrying extra rehydration fluids and effective volume expanders. But the long term data shows exanguination happens in the first 5 minutes, making it a short term problem, the patient with massive peripheral bleeding is either going to be stable or dead in a very short period of time.




A BP cuff is considerably larger than a TQ and as such would add bulk to the IFAK and weight too. One TQ is also NEVER enough. Two is one, one is none and sometimes more are needed..

I agree a BP cuff is larger than a TQ, but I think the BP cuff serves a variety or roles, as opposed to one filled by a TQ. I understand the need for redundancy, and I think the individual might be best served with a variety of equipment, and given the ability to prepack, I would take a cuff first and a TQ second.

The Reaper
06-24-2008, 06:17
First, I find it surprising that an EMT would argue with board certified trauma surgeons and 18Ds, but since I am neither, maybe I am missing something.

I have humped a ruck and been an SF soldier for a few years though, and I would submit that the BP cuff(s) are not going in my kit due to bulk, weight, and difficulty of one handed application under time constraints. I strongly suspect that if you offered your average SF troop (or any soldier, for that matter) a choice, he is going to take the smaller, lighter, non-pneumatic alternative.

IMHO, you are on the wrong track with the HCAs as well, but since you seem to have all of the answers, preach on.

TR

Viking
06-24-2008, 06:41
I carry the same as MTNgoat except I add a couple of needles for decompression. Is anyone else using the Olaes dressings from TMS? I recently replaced my Isrealis with a couple. I put a few of the 6" ones in the truck kit and put a 4" on my carry kit. Your thoughts.

Surgicalcric
06-24-2008, 10:48
The study I am basing this on is referring to field use, not ER. I left my hard copy at work, and will reference it directly tomorrow. The point I was getting at was that twenty years ago MAST was the next big thing, and in theory they work great. In practice MAST did not make a realistic difference in patient outcome, and it took years of collecting data to prove that. The same goes for aggressive fluid resuscitation. Two large bore IV's pouring in Saline were the norm for a good period of time. It is no longer the standard of care, after decades of studies.

I have as well read study after study of the effects of HCA's. My decision to carry and use them is based on the number of lives/limbs saved using HCA's here, where the rubber meets the road. In a couple decades we can revisit this topic as they have with fluid and the MAST. Today they are working.

I have read Blakes report on tactical care in 2007, and just rechecked the section on hemostatic agents, specifically in the 64 uses of HemCon in combat situations. What I think Blake fails to take into account is the body's natural tendency to shunt off peripheral bleeding. There is nothing to say these wounds would not have eventually stopped bleeding with a pressure dressing.

All bleeding eventually stops. There is nothing to say it would have stopped with the use of pressure dressings alone either. BTW, HCA's are used ICW pressure.

Incidental field data (with 6,000+ wounded in 2007 alone) of a sample of 64 uses may or may not be considered definitive. In Alam's article “Hemorrhage Control in the Battlefield: Role of New Hemostatic Agents” hemostatic agents are given a favorable review, but it is noted that clinical data is mixed, including two parallel studies on a chitin dressing that produced opposite results. It should also be noted that many of these studies observed the effectiveness of hemostatic agents on thoracic and abdominal injuries as opposed to peripheral vascular bleeding. This leads to higher overall success rates, while in my opinion diluting data on realistic field applications.

How is the use of HCA's on torso injuries inconsistent with realistic field application? If I did a study on the efficacy of clamping extremity bleeders would the same data not be consistent with use in the torso/ABD as well? People can bleed out from torso wounds just as easily, if not more so due to the complexity of hemcontrol in these areas. In fact, it is easier to gain hem control in the extremities due to the number of available options at hand. Groin/axial bleeds are some of the most difficult to gain hemcontrol on without having surgical access/ligation/clamping available. The same holds true for intra-thorax/ABD bleeds.

I like the extended transport time argument for things like PO antibiotics, advanced orthopedic care, and as justification for carrying extra rehydration fluids and effective volume expanders. But the long term data shows exanguination happens in the first 5 minutes, making it a short term problem, the patient with massive peripheral bleeding is either going to be stable or dead in a very short period of time.

How long does it take to bleed out from a femoral artery or a brachial artery? Less than 5 minutes. The longer we fiddle-fuck trying things that may or may not work the more blood is being spilled in the dirt; once its gone its gone. So, for those areas where the EVAC is extended it is even more important to stop it FAST using whatever tools available. After I have it stopped and all other life threats are dealt with I can think about going back and downgrading TQ's to PDs and PD's to bandages...

I agree a BP cuff is larger than a TQ, but I think the BP cuff serves a variety or roles, as opposed to one filled by a TQ. I understand the need for redundancy, and I think the individual might be best served with a variety of equipment, and given the ability to prepack, I would take a cuff first and a TQ second.

As for you carrying a cuff, you work in a different environment than we do; think about that. Based on years of "lessons learned" from the current conflicts, not to mention past conflicts, and drawing from my experiences in the civilian side (paramedic and trauma tech working in a L1 center) and my time as an 18D, I will take the TQ's, 2 please. They are light, small, and most importantly, they work. They are also not subject to atmospheric pressure changes..

In finishing, HCA's are but another tool for the tool box. They arent the be all, end all for hem control...but they are working and shouldn't be left behind, to save ounces, in hopes that a standard pressure dressing will work.

In EMS there is talk about the "Golden Hour" (the time from injury til arrival at a definitive care facility) and getting the patient to the "bright lights and cold steel" as soon as possible. On the battlefield the SF Medic is often times that definitive care; the bright lights and cold steel...

_____________________________

Merlin:

You are out of your lane...

It is obvious your ideas, methods, education, and surroundings differ from mine/ours somewhat, which is all well and good. However you need to consider your frame of reference and post accordingly. This is a very different world from yours, one I didn't fully understand when I was working in the civilian side of the house either. You are more than welcome to participate but dont fool yourself into thinking that you have any idea about what works and what doesnt, or what is a waste of space on the battlefield even if you have read a report or two...

Crip

swatsurgeon
06-24-2008, 11:45
Crip,
One think I have found and reproduced is that quik-clot stops bone marrow bleeding much more efficiently than hem-com....impressively so. When an IED takes a limb off and you place a tourniquet, the marrow continues to bleed and this can be a major source of blood loss.

ss

Dub
06-24-2008, 12:02
Has Woundstat found it to any of your kits yet? The Dr. that helped develop it lectured to us a while ago on it, I forget why but it was supposed to be superior to quickclot.

Surgicalcric
06-24-2008, 12:11
Crip,
One think I have found and reproduced is that quik-clot stops bone marrow bleeding much more efficiently than hem-com....impressively so. When an IED takes a limb off and you place a tourniquet, the marrow continues to bleed and this can be a major source of blood loss.

ss

Funny thing you should bring that up.

During my recent visit to WRAMC (very sobering place to visit BTW) I spoke with a surgeon about HCA's and he made mention of QC stopping marrow bleeding but I forgot to follow up on it. Had many informative discussions with varying docs while there...

Crip

Surgicalcric
06-24-2008, 12:13
Has Woundstat found it to any of your kits yet?

Short answer, No.

The Dr. that helped develop it lectured to us a while ago on it, I forget why but it was supposed to be superior to quickclot.

No need to wipe the wound clear of fluids...

Crip

Surgicalcric
06-24-2008, 13:02
...Is anyone else using the Olaes dressings from TMS? I recently replaced my Isrealis with a couple. I put a few of the 6" ones in the truck kit and put a 4" on my carry kit. Your thoughts.

I like the Olaes dressings. Received a few for T&E and will be getting some for our next trip to replace the Israelis...

Crip

Doczilla
06-24-2008, 19:47
I guess it depends how you come to obtain the medical tape....:D
What tape do I have access to that is waterproof???? I don't think any of them are.
ss

I think foam chest tube tape is.

'zilla

swatsurgeon
06-24-2008, 20:04
I think foam chest tube tape is.

'zilla

you might be right...it stands the best chance of being waterproof...problem is it is bulky and a bitch to use correctly...not a good choice for field (combat) use.

ss

Doczilla
06-24-2008, 20:31
you might be right...it stands the best chance of being waterproof...problem is it is bulky and a bitch to use correctly...not a good choice for field (combat) use.

I'm with you on that. I like it for the sidelines at the football games, though, as well as our sustained operations bag for SWAT, which rides in the truck. As I digress from the thread.

'zilla

AF Doc
09-22-2008, 18:24
SS --

Great thread, thanks. I don't have any experience providing 'care under fire' and appreciate the input from those who do. But I got the impression from reading through this that you had more to add, e.g TQ review. Any more thoughts? What would your kit look like?

ALCON --

After reading through this thread, anyone change his/her personal kit contents or recommendations? If so, what and why?

Thanks in advance.

LavaDoc
09-22-2008, 19:26
The bag I have on my MTV is a North American Rescue casualty response bag. It came with all sorts of straps, which I promptly cut off, and use the clips in the back to put it on the flak.

Contents:

Top (under flap)

4x 14g, 3 and 1/4 inch needles for chest decompression
Roll of duct tape- for securing bandages, IV tubing, casualty cards, extremities, tube, etc
Finger pulse oximeter- O2 sats and pulse
3 sizes NP airways/surgilube packs- for maintaining airway
2 sizes OP airways- for maintaining airway
Hemostat clipped to loop- various reasons (clamping vessels, hanging IVs, securing gear)
Durapore tape slid through hemostats- for IV tubing, bandages, tube, etc.
2x Rubber IV tourniquets- for vascular access
Pen light- to assess EOMI, PERRLA, or as a small back up light.

Main Compartment

In "Football"- 2x 500 cc NaCL bags for fluid resuscitation/eye irrigation/pressure for flail chest/pressure dressing
4x 14g 2 inch needles, 2x IV tubing, alcohol pads- for IVs
2x 4"x16" WaterJel burn dressings- for burns
2x Kerlix- wound packing, dressing/bandage
2x Ace Wrap- bandage
2x Israeli bandage- pressure dressing
2x H and H Gauze- wound packing, bandage, pressure dressing
1x Big Cinch Abdominal Dressing- abdominal wounds
3x CAT tourniquets- massive extremity hemmorhage
All gauze/Kerlix/bandages are in the plastic, with the end opening cut off to prevent last minute "oh shit" moments.


Side Flap

2x QuikClot ACS- massive hemmorhage not controlled by other means
2x Bolin chest seals- open pneumothorax
2x Benzoin Tincture swabs- prn for extra adhesive with chest seals
1x size 4 King LTD/60cc syringe/lube- to secure airway

Outside Pocket

2x Latex free gloves
Sharpie
4x Casualty cards
Trauma shears


It seems like a lot, but the bag fits nicely on my MTV, doesn't get in the way too much. My bulkier gear (BVM, FAST 1, QuikCric, extra everything, meds, C-collar, splints, etc) goes in my large med bag in the truck. I carry a blowout kit with kerlix, ace wrap, Israeli dressing, 14 g needles, and chest seal in a Ziploc bag in my cargo pocket. I also have a CAT on my flak, and one each in a shoulder and cargo pocket, along with 2 10cc morphine injectors. My Marines have the issued IFAK, so I don't worry too much about not having enough basic material.

Great info on this site, I have learned a lot.


BTW

I like the Olaes dressings. Received a few for T&E and will be getting some for our next trip to replace the Israelis...



I have just seen these on the internet, and would like to know more about them. Any more feedback about them? Our budget out here is pretty good, I'd like to get some if they are worth it.

D9
09-23-2008, 22:50
I'd like to see a few of the above lists fit into a small pouch. I have my doubts. :D

I carry this in my first line kit:

2 CAT Tourniquets (all TQs can fit in the outside part of the SOTECH pouches)
1 SOF Tourniquet
2 Quiklots
2 Hemcons
2 Z-pak Gauze
2 6" ACE
3 Asherman Chest Dressings
Small portion of 100mph tape (yes, I was on a team with Crip)
2 14 GA Catheters
8 Betadyne swabsticks
8 Alcohol prep pads
Trauma shears & rescue knife
Laminated 9-Line CASEVAC cards
1 Sharpie
1 Alcohol pen

For me this kit is for "Care Under Fire," which means I am not going to be doing any lengthy treatments out of this pouch.

Therefore:

1. The tourniquets for uncontrolled extremity bleeds.

2. The Quicklot and Hemcon for other bleeds

3. The catheters and Asherman's for developing tension pneumos

The rest of the stuff is oriented towards getting the patient started on the road to definitive care. The 9-Line card and markers are so I can get this process started and do not send my pt to the rear with bad info or none at all.

LavaDoc
09-24-2008, 20:21
I'd like to see a few of the above lists fit into a small pouch. I have my doubts.

Oh, it fits, but your definition of small must not be the same as mine. :D

whocares175
11-01-2009, 20:59
i know i'm about a year late on this topic but something we carried on everyone when i was in regiment was:

2 cats (obivous reasons, to stop bleeding in a hurry)
1 israeli (can be applied quickly to minor wounds or dress major ones)
1 roll kerlex (to pack wounds)
1 npa (airway access)
1 opa (airway access)
(both sized for that person ahead of time)
1 pill pack (hopefully prevent infxn)
1 3"x3" square of hydrogel (occlusive dressings-sticks to literally anything, better than anything i've ever used)
2 14ga 3" needles w/catheters (needle decompression and if needed in a pinch, needle crics)
1 saline lock kit-18ga, saline lock, tegaderm (used to initially secure iv sites)

this was very small and fit neatly into the little med bag we had.
of course also everyone going through RIP has been trained on tension pneumo's, needle decompression, iv's, needle crics and basic airway adjuncts so none of the equipment in the kit was new. except maybe the hydrogel but once it was explained that it takes the place of the ACS everyone got the idea.
the thinking behind most of this was that initially the most important things are the basics: stopping major bleeding then ABC's. anything beyond that the squad emt carried and anything else beyond him the platoon medic carried.

docstumpy
11-29-2009, 16:41
I keep two pouches on my vest, simply because if you carry the aid bag around out here, youre a definite target. I do my best to look just like my tankers, so I also hand out extra supplies to them, in the way of tourniquets and shears and many other things. Im trying to get my hands on an M9 bag, but until then, Ill continue to dream.

My first pouch is pretty much dedicated to airway:
3 Ashermen Chest Seals
3 packs of Petroleum gauze
3 3.25" 14GA
3 Large McDonald's bendy Straws (Because a full cric kit is too big for this particular pouch)
3 Large Tegaderms
1 Pocket Mask
1 Scalpel
1 Body marker
1 roll of 1/2" tape
and a butt load of alcohol pads

My second pouch is more or less focused on hemorrhage control:
3 ETB's
3 packs of Combat Gauze
3 6" ACE Bandages
3 packs of compressed Gauze

And I have 2 CAT's and 1 SOF Tourniquet on my vest, along with another roll of 1/2" tape and of course my trauma shears. Also, a laminated 9-Line is folded to fit right under my helmet band, just in case I need it for some reason.

The Reaper
11-29-2009, 17:36
I keep two pouches on my vest, simply because if you carry the aid bag around out here, youre a definite target. I do my best to look just like my tankers, so I also hand out extra supplies to them, in the way of tourniquets and shears and many other things. Im trying to get my hands on an M9 bag, but until then, Ill continue to dream.

My first pouch is pretty much dedicated to airway:
3 Ashermen Chest Seals
3 packs of Petroleum gauze
3 3.25" 14GA
3 Large McDonald's bendy Straws (Because a full cric kit is too big for this particular pouch)
3 Large Tegaderms
1 Pocket Mask
1 Scalpel
1 Body marker
1 roll of 1/2" tape
and a butt load of alcohol pads

My second pouch is more or less focused on hemorrhage control:
3 ETB's
3 packs of Combat Gauze
3 6" ACE Bandages
3 packs of compressed Gauze

And I have 2 CAT's and 1 SOF Tourniquet on my vest, along with another roll of 1/2" tape and of course my trauma shears. Also, a laminated 9-Line is folded to fit right under my helmet band, just in case I need it for some reason.

Do some research here (or elsewhere) on the CAT vs. the SOFTT.

TR

docstumpy
11-30-2009, 10:27
Do some research here (or elsewhere) on the CAT vs. the SOFTT.

TR

To be honest, I keep both on my vest for multiple reasons, but the main one is that since Im attached to an armored company, my guys arent too familiar on the SOFTT. Ive given classes and held practical exercises, and even though some of them understand how to use it, Im pretty sure that if Im hit and cant do it myself, my guys would reach for that CAT and have an easier time with it since theyve had the most exposure to it.

Me personally though, I like the SOFTT, especially for some of my bigger tankers. That and last time I used the CAT, I definitely snapped that windlass like twig. Better safe than sorry.

Surgicalcric
11-30-2009, 15:22
...Im pretty sure that if Im hit and cant do it myself, my guys would reach for that CAT and have an easier time with it since theyve had the most exposure to it...

Willing to bet your life on it? I wouldnt be...

Something to think about.....

SwedeGlocker
12-01-2009, 00:05
Are the CATs breaking in training or real world use? I cant find any documented cases where CATs have broken during real world use. During training its more common since the CATs is single use.

A good article to read is:
Practical Use of Emergency Tourniquets to Stop Bleeding in
Major Limb Trauma, J Trauma. 2008;64:S38 –S50.

From the article:
"The most effective tourniquets were the Emergency Medical Tourniquet (92%) and the Combat Application Tourniquet (79%)."

SG note: The SOFT was 66% effective in this study

"Improvised tourniquets were ineffective 67% of the time (10 of 15 limbs, 15 patients, 16 tourniquets) with 10 morbidities (6 amputation injuries, 3
fasciotomies, 1 palsy), and seven limbs continued to bleed."

Brush Okie
12-01-2009, 01:02
The standard first aid unit issued with the addition of these.

Benedryl and eppi

14 g angio cath

10cc syrenge to go with needle for chest decompressions

laytex gloves

extra Kerlex

triangular bandage or two

molle skin

small bottle of iodine

anitbiotic ointment

Tape

docstumpy
12-01-2009, 05:46
Willing to bet your life on it? I wouldnt be...

Something to think about.....
Mind me asking what youre suggestion would be then?
Its my first deployment as a medic, but Ive been wounded before. If something were to happen to me, I have confidence in my tankers.

docstumpy
12-01-2009, 05:52
Are the CATs breaking in training or real world use? I cant find any documented cases where CATs have broken during real world use. During training its more common since the CATs is single use.

A good article to read is:
Practical Use of Emergency Tourniquets to Stop Bleeding in
Major Limb Trauma, J Trauma. 2008;64:S38 –S50.

From the article:
"The most effective tourniquets were the Emergency Medical Tourniquet (92%) and the Combat Application Tourniquet (79%)."

SG note: The SOFT was 66% effective in this study

"Improvised tourniquets were ineffective 67% of the time (10 of 15 limbs, 15 patients, 16 tourniquets) with 10 morbidities (6 amputation injuries, 3
fasciotomies, 1 palsy), and seven limbs continued to bleed."

Ive had to use a CAT three times, and a SOFTT once on actual casualties, and never had a problem with either. But yes, Ive had multiple CATS break, and even a SOFTT during training because of multiple use. But to be honest, it happened after 50 or so practice runs with the same tourniquet being used over and over again.

Surgicalcric
12-01-2009, 06:18
Mind me asking what youre suggestion would be then...

Under the stress of being shot at, blown up, etc... a soldier will grab whatever they get their hands on, not what you hope they will grab for and use. having them make a conscious decision when they should be running on autopilot is not the right decision, IMHO.

Either train your guys to the same proficiency level with the SOFT-T or remove it from your vest.


As for the CAT's, I know of several medics, including myself, who have had several of them break coming right out of the plastic.... OMMV but I stay away from them as much as possible...

docstumpy
12-01-2009, 06:33
Under stress they will grab whatever they get their hands on, not what you hope they will grab for and use.

Either train your guys to the same proficiency level with the SOFT-T or remove it from your vest.


As for the CAT's, I know of several medics, including myself, who have had several of them break coming right out of the plastic.... OMMV but I stay away from them as much as possible...

Thats the exact reasoning I had both on my vest. What a soldier can do during training is one thing, but what he can do while under fire is another, unless the training is up to par. That SOFTT is meant mainly for me and my two qualified CLS tankers.

Do you mainly stick to the SOFTT's or are there other types you use?

The Reaper
12-01-2009, 10:27
You know, if I were a recently trained conventional Army medic, I would probably rely on the airway management and TQ advice of a Chief of Trauma, an Anesthesiologist, and an 18D rather than arguing with them, but that is just me.

TR

Surgicalcric
12-01-2009, 15:47
...Do you mainly stick to the SOFTT's or are there other types you use?

The topic isnt what I use, it is about you being comfortable with your takers spending precious time, which you may not have, differentiating one TQ from the other in the dark, then putting it into use...

If your guys were equally competent with the CAT and SOFT-T I would have less an issue but according to your previous posting that is not the case.

As for what I use/carry, my guys and I carry SOFT-T's (2 center-line on their armor) and I carry a few extras in all of my aid and CASEVAC bags... There are also some CAT's thrown in for those guys who have girl arms that I may run across. My guys are trained on both and are expected to be proficient at using both TQ's just as they are applying pressure dressings, performing needle drills, and crics...after all, my life may be the one depending on it.

Buck
01-03-2010, 13:35
SwatSurgeon, and 18D's..

On one of my teams one time and old 18D was giving a sucking chest wound class, and how to make a field expediant flutter valve, to release preasure, when patient is experiencing a hemothorax. He showed to take a 10 or 12 gauge needle, then cut one finger of a latex glove, drop the needle through the opening of the glove finger you just cut off, so it is sticking out the end of the glove. Then take scissors and cut a V on the open end of the glove finger you cut off. This creates an expedient valve to relieve preasure, but doesn't allow air back into the chest. After reading through this thread, I didn't see anyone mention valves they use for decompression on the needles, just needle lengths to avoid heart sticks. I'm just an 18B, so sorry if I butchered any of the medical terms. My question is either to Swatsurgeon, and any 18D's, have you ever heard of this being used, did it work, or is this a total waste of time to ever consider it, if so, what would be better.

Buck

Surgicalcric
01-03-2010, 15:26
...have you ever heard of this being used, did it work, or is this a total waste of time to ever consider it, if so, what would be better...

I have seen street paramedics use this technique but have never used it myself. The trouble with leaving the catheter in place is the lumen will become kinked or occluded by a clot.

Given this we just use a new needle/catheter each time the patient needs decompressing.

HTH,

Crip

Buck
01-03-2010, 15:55
I have seen street paramedics use this technique but have never used it myself. The trouble with leaving the catheter in place is the lumen will become kinked or occluded by a clot.

Given this we just use a new needle/catheter each time the patient needs decompressing.

HTH,

Crip

Appreciate the clarification Surgicalcric, one question, which I googled, but it says a Lumen refers to amount of light, which I am sure is not the case here. What is a Lumen, in reference to decompression?

Buck

Surgicalcric
01-03-2010, 16:13
... What is a Lumen, in reference to decompression? Buck

The lumen is in reference to the catheter's inner diameter. If the catheter (made from teflon) gets kinked air cannot escape.

Crip

Red Flag 1
01-03-2010, 16:48
I have seen street paramedics use this technique but have never used it myself. The trouble with leaving the catheter in place is the lumen will become kinked or occluded by a clot.

Given this we just use a new needle/catheter each time the patient needs decompressing.

HTH,

Crip

FWIW,

Agree with Crip!!!

My pneumothorax in 1970 was initially treated with a large bore IV cath, 12 ga, MCL below the second rib. Needle was removed leaving only the cath. After a short time on suction, the cath kinked as my lung re-expanded, and the cath was of no further value. Cath was replaced with a real chest tube.

I kind of see the cath idea here similar to using a pellet gun instead of a .50 Cal round.

One way valves for this purpose are mass produced, and take up little room to carry. Use the "real deal" valve when needed. If it fails, you can kick the vendor and not yourself!

My $.02.

RF 1

HowardCohodas
01-03-2010, 17:19
Any thoughts on ARS for Needle Decompression (http://www.narescue.com/Needle-Decompression-Kit-P18C2.aspx) for my personal kit? I have taken the certified first medical responder course.

Surgicalcric
01-03-2010, 17:34
Any thoughts on ARS for Needle Decompression (http://www.narescue.com/Needle-Decompression-Kit-P18C2.aspx) for my personal kit? I have taken the certified first medical responder course.

It is nothing more than a 14ga x 3.25" IV catheter packaged in a plastic tube to prevent it from becoming bent in your kit.

Nothing special about it...

swatsurgeon
01-03-2010, 20:42
The only needle I would stake my/your life on if I had a known delay to have access to a chest tube is made by Cook catheter company. I think I posted a link and picture some time ago.... they are wire wrapped/supported needles in 10 or 12 G than can not kink,collapse and are large enough to have a lower incidence of occlusion from blood/fibrin/clot, etc.
The north american rescue needle is just as the very smart Surgicalcric has stated: it's a basic 3 1/2 inch needle in a fancy package with marketing behind it...no new mousetrap there at all.
Look up the Cook pneumothorax decompression or cric kit...their needle is expensive but the one I carry for a wounded officer...bad guy gets the north american rescue (or similiar) one .......

ss

peepee1
08-25-2010, 10:46
My whole problem with trying to make a small kit is, it ends up turning into a full blown aid bag! I grab something, and then think "That would come in handy"... and again, and again... next thing you know Im thinking I may as well carry my aid bag!?:confused::)
Its the same thing when I pack now! I think about every dang thing that could happen and I have some gadget for it!

doctom54
08-25-2010, 19:02
My whole problem with trying to make a small kit is, it ends up turning into a full blown aid bag! I grab something, and then think "That would come in handy"... and again, and again... next thing you know Im thinking I may as well carry my aid bag!?:confused::)
Its the same thing when I pack now! I think about every dang thing that could happen and I have some gadget for it!

That's OK. You'll grow out of it. I carried an M5 bag, in the car, for about 5 years after I got out of the Army. :)
Now, I keep an Epi-Pen in all my vehicles along with gloves and figure I'll improvise if needed.

Odin21
01-31-2012, 11:15
I'd like to see a few of the above lists fit into a small pouch. I have my doubts. :D

I carry this in my first line kit:

2 CAT Tourniquets (all TQs can fit in the outside part of the SOTECH pouches)
1 SOF Tourniquet
2 Quiklots
2 Hemcons
2 Z-pak Gauze
2 6" ACE
3 Asherman Chest Dressings
Small portion of 100mph tape (yes, I was on a team with Crip)
2 14 GA Catheters
8 Betadyne swabsticks
8 Alcohol prep pads
Trauma shears & rescue knife
Laminated 9-Line CASEVAC cards
1 Sharpie
1 Alcohol pen

For me this kit is for "Care Under Fire," which means I am not going to be doing any lengthy treatments out of this pouch.

Therefore:

1. The tourniquets for uncontrolled extremity bleeds.

2. The Quicklot and Hemcon for other bleeds

3. The catheters and Asherman's for developing tension pneumos

The rest of the stuff is oriented towards getting the patient started on the road to definitive care. The 9-Line card and markers are so I can get this process started and do not send my pt to the rear with bad info or none at all.

I am a National Guard medic with one tour and I know that I have a lot to learn still. Why do you carry 8 betadyne swabs in addition to 8 alcohol pads? I have heard of using alcohol pads to help clean the site before a NCD and I understand that you could do the same thing with betadyne. However, it looks like you only carry 2 14 ga needles for NCDs- do you swab the site multiple times? I was told in 68W school to try to use alcohol before sticking, but that it was not as important as them breathing- "That is what we have ABX later for." Is there another use for betadyne that I am missing? Is sterile technique that important that I need to carry more alcohol pads and betadyne swabs in my vest kit? Thank you so much for your time and guidance.

Cake_14N
01-31-2012, 14:38
I am just a simple civilian so my kit is very simple. I used to be an EMT-I in New Mexico, so in a life or death situation I could start an IV, but without ready access to the supplies (need a prescription to get them here in NM) I left IV off my list.

I need to be able to maintain an airway and stop major bleeding until better equipped help arrives to take over.

To do this I need the following:
Gloves. I use the nitrile gloves you buy in the cleaning section of WalMart. I get 10 pairs in a package for a couple of bucks.
3 piece NPA kit ( sm, med, lg) plus a packet of KY jelly. This lets me at least make an attempt to correctly size the airway for the patient.
6 4x4 gauze pads. Used as a quick dressing for small stuff.
2 x Field dressings. I get them at the local surplus store and check them over to make sure package is intact.
2 x triangular bandages. Multi uses here. Can be folded into a 1.5 to 2 inch wide band and made into a TQ in a pinch. Also used to hold dressings in place.
1 roll med tape, cloth preferred.
6 inch long piece of aluminum dowel. Used to tighten the TQ made from the triangular bandage. It is lightweight and works.
My cell phone to call for better equipped help.

All this ( except the cell phone, its in my pocket) fits inside an old Nalgene water bottle wrapped with about 25 feet of duct tape and fits inside the cup carrier of my car.

bama23
02-10-2012, 17:12
26 y\ o male pt with gsw to L. side upper chest wall from a 7.62 round ( casing found by atlanta pd). Entrance in front, exit wound in back. Pt. vitals: respirations 14. shallow, BP 92/68, P 126 / weak, o2 sat 96 %, warm and sweaty. Pt found lying supine on ground. Found wounds, cleaned blood and lung matter so that we could use sterile 4x4s and packaging from a abdominal dressing to seal off gsw. 3 sided occlusive anterior, 4 sided posterior. 14 g Iv in left arm, 16 g iv right arm, 0.9 % NS hung. Pt went unconsious and was intubated using 8.0 ett. Had to bolus to keep pt bp above 90 systolic. Pt made it to Grady ER where he was evaluated by staff and sent directly to OR. Called ER staff approx 2 hr later to find pt made it into surgery where he died due to blood loss from a slight aortic tear. Dressings did their job, however I had to use several strips of tape to secure them to the skin.


Gentlemen,
I would like to focus briefly on the equipment used for an open (sucking) chest wound. Multipart answer here:
1)Has anyone dealt with a true open chest wound where there was free movement of air both in and out of the pleural space, and 2) used a 3 sided dressing or asherman type device. What was the result? Did the dressing or device prevent the need to provide positive pressure ventilation (BVM or ETT intubation, etc) and most importantly, was it a true open chest wound?
Ss

Surgicalcric
02-10-2012, 20:38
2<<SNIP>>>

Bama23:

This isnt the intro thread. Your first post should have been there, make your next one so.

Attention to detail, attention to detail...

pjbluetogreen
02-16-2012, 22:34
On my Body armor I carried a pull away molle pocket for TCCC/Self aid buddy care type issues that was packed with
2x CAT on the Out side
9 line card and PT tx cards in a small zipper
2x S fold Kerlix
1x ACE
2x 14G NARP Cath
2x NPA
1x Cric Kit with 6.5 Shelly
1x HALO dressing (Chest Seals the best ones i have ever seen 2 come per pack and they are the size of Defib pads very nice)
2x Hemcon Injectors
1x Quick Clot
5x Large Safety Pins (to many uses to mention)
1x Trauma Sheers


:cool:Something else I got in the practice of keeping with me is what I refer to as an "OUCH POUCH" that keeps the little thats that we as medics all so often don't have. Its stocked with
5-10x Band-aids
5x Blister Guard band-aids
1x Sheet Mole Skin
1x Super Glue
5x OpSites great to cover small cuts that have been sealed with Super glue
6x Benyadryl 25 mg
16x 200mg Motrin (Mobic when available)
1x tube Oral Glucose (if available, when not I put 2or 3 Dum Dum Pops in)

This little kit has come in handy more times then I can count so that I don't have to break into my main to treat a small cut or blisters. Just think how often you are asked for a bandaid and don't have one. Just something to think about.

D9
08-28-2012, 23:47
I am a National Guard medic with one tour and I know that I have a lot to learn still. Why do you carry 8 betadyne swabs in addition to 8 alcohol pads? I have heard of using alcohol pads to help clean the site before a NCD and I understand that you could do the same thing with betadyne. However, it looks like you only carry 2 14 ga needles for NCDs- do you swab the site multiple times? I was told in 68W school to try to use alcohol before sticking, but that it was not as important as them breathing- "That is what we have ABX later for." Is there another use for betadyne that I am missing? Is sterile technique that important that I need to carry more alcohol pads and betadyne swabs in my vest kit? Thank you so much for your time and guidance.

Hey Odin,

I'm pretty sure the 8 betadyne and alcohol swabs had more to do with space than it did with anything else. A large 14GA cath for a decomp is an awkward piece of kit to jam into a little pouch. Sometimes, a medic can find him/herself in the position of getting as many of those into the pouch as possible and still finding a little space to cram in a few odds and ends - hence the extra swabs.

Unfortunately, sometimes the pouch dictates what extra few items can be squeezed in.

Personally, if my patient load is such that I've decompressed two chests and there are still more tension pneumos awaiting relief, then I'm probably in my second line equipment and telling my 18E to get our MASCAL protocol rocking - just me.

Remember, your second line is still there.

Additionally, a good medic is treating guys with tension pneumos out of their own kit, not out of his own. Yours are for emergencies (read: kit failures), or for you.

Thanks for the PM. Sorry for the late response. Take care.

D9

Barbarian
07-22-2013, 10:11
My current bug-out/get-home bag's FAK list. Suggestions and advice welcome.

Trauma Kit:
EMT Shears
3.5” Hemostat
Tweezers
Nitrile Gloves
Gorilla Duct Tape
Alcohol Wipes
Ace Bandage
Cravat
Combat Gauze
Quickclot 2x2 (Thanks again. ;))
6" Israeli Battle Dressing- Plan to change to Tac Med Solutions' 4" Olaes Bandage
SOF-T Tourniquet
HALO Chest Seal

Snivel Kit:
Ibuprofen
Benadryl
Imodium
SAM Splint
Neosporin
Moleskin
Gauze
Small bottle of Betadine
Povoiodine Swabs
3-0 Nylon Sutures
Butterfly Sutures
Cyanoacrylate
Med Tape

PiterM
08-22-2013, 03:35
Here's my personal (me & family) medical kit, which I take on any outdoor trip, ride, walk, hike etc. I divided it to two pouches, which are very easy to attach to any of my backpacks via MOLLE attachments. In the pics below attached to me smallest backpack, MR Spartan. Of course if the backpack is bigger than it's even easier to attach. And (of course) all of my backpacks have MOLLE panels. The pouches are long version of Trauma Pouch from ITS Tactical.

Pouch #1 -> Trauma Kit (marked with medical cross and red tab for easy recognition)
- Olaes Modular Bandage
- CELOX
- gloves, trauma shears
- chemical light stick (white) so that I'm never without emergency light
- bandaids, antibacteria swabs, small burns gel
- small antiallergy steroids for kids (just in case)

Pouch #2 -> Adrenaline Kit (black ITS logo pouch)
- EpiPen autoinjector for severe or life-threatening allergy reactions (after multiple bee bites in vital areas like neck etc.). I travel with small kids, who have never been bitten by a bee, so it's "just in case" device.
- I keep it in foam padded Peli case to protect against elements and overheating.

So that's it. My medical kit to deal with bleedings & allergy shocks. From small cust to life-threatening accidents on the trial. If I miss anything important - please, let me know.

swatsurgeon
08-23-2013, 08:03
Here's my personal (me & family) medical kit, which I take on any outdoor trip, ride, walk, hike etc. I divided it to two pouches, which are very easy to attach to any of my backpacks via MOLLE attachments. In the pics below attached to me smallest backpack, MR Spartan. Of course if the backpack is bigger than it's even easier to attach. And (of course) all of my backpacks have MOLLE panels. The pouches are long version of Trauma Pouch from ITS Tactical.

Pouch #1 -> Trauma Kit (marked with medical cross and red tab for easy recognition)
- Olaes Modular Bandage
- CELOX
- gloves, trauma shears
- chemical light stick (white) so that I'm never without emergency light
- bandaids, antibacteria swabs, small burns gel
- small antiallergy steroids for kids (just in case)

Pouch #2 -> Adrenaline Kit (black ITS logo pouch)
- EpiPen autoinjector for severe or life-threatening allergy reactions (after multiple bee bites in vital areas like neck etc.). I travel with small kids, who have never been bitten by a bee, so it's "just in case" device.
- I keep it in foam padded Peli case to protect against elements and overheating.

So that's it. My medical kit to deal with bleedings & allergy shocks. From small cust to life-threatening accidents on the trial. If I miss anything important - please, let me know.

Where's the tourniquet???
Celox?? How about combat gauze as a better choice (personal experience)

98G
08-23-2013, 08:46
Where's the tourniquet???
Celox?? How about combat gauze as a better choice (personal experience)

I am not sure how familiar you are with all the variants but that would likely depend upon which Celox.

UK, Germany and Spain are using Celox that tested highest at the ONR (over CG). The Celox variant that was sold in the US earlier by Sam Medical under-performedv against CG. Both were tested in the ONR study. I don't think the EU ever had much of it. It was intended more for burns.

I will see if I can get a PDF of the ONR study and post it. In the meantime, here is a briefing from MHSRS (the conference formerly known at ATACCC) that summarizes the findings from this and other studies.

I hope this helps explain PiterM's choice. Also of note, I think you will find most SOF units carry ChitoGauze or Celox in their kits. Each did their own testing to confirm their selection.

miclo18d
08-23-2013, 09:47
I was very fortunate to be an 18D when all of these bandages were coming into the inventory. Being in SF we got first dibs on this stuff as it came available. I actually had to look up a bunch of the brand names to see what each one was as there was no brand name for the chitosan bandages when we first got them.

We preferred the chitosan over the quick clot (and its variants) because of the exothermic properties of the quick clot and the HemCons were just not that much more effective at 5 times the cost. The problem with the chitosan at that time (2003+) was that it came in a large 4x4 dressing that was very stiff and very hard to get because the factory was being built. At first we would try stuffing the whole thing in the wound but quickly adapted and started cutting off small pieces and putting that right on the bleeder. As you can see the problems on the battlefield trying to cut a small piece of chitosan. The quick clot was a powder that you just poured into the wound but most people under stress would hardly get enough to the source of the bleed and it was ineffective.

That said seeing that they heard our recommendations for a gauze that could be pushed into the wound these products sound like they will be VERY effective in the future. As of my retirement in 2008 our primary go to for a bleeder was still a TQ and regular rolled gauze and we had a few chitosan bandages each for severe emergency bleeds.

Good to see these products fulfilling their potential!

Trapper John
08-23-2013, 14:09
Where's the tourniquet???
Celox?? How about combat gauze as a better choice (personal experience)

Have to agree with Miclo18d on this one too. The kaolin based combat gauze works by presumably increasing absorption of water. That is why gauze has hemostatic properties. Kaolin just improves that supposedly. I saw a comparison between combat gauze (kaolin hemostatic) versus regular gauze in a controlled hospital setting. No statistical difference in the mean clotting time. I'll try to find that study and post it. As a side note, this is why native Americans used a poultus of clay on wounds (kaolin is a component of clay). That probably is the source of "rub some dirt in it" as 98G was nearly admonished. :D

Kaolin's water adsorption is exothermic and that gives me concern as well. As noted by miclo18d. Also, kaolin is a microparticulate mineral that is not dissolved and provides an excellent surface for biofilm formation and bacterial growth.

On the other hand, chitosan is a pharmaceutical grade natural product derived from the exoskeleton of arthropods. In fact it is the chitosan that provides the agglutination of insect and shell fish heamolymph and protection after their exoskeleton has been breached. Same basic principle in human clotting. Chitosan interacts directly with the platelets to induce clotting factor release. Sound biochemistry and cellular biology IMO. You also don't have those pesky problems of exothermia and surfaces for biofilm formation. JMO

Trapper John
08-23-2013, 15:39
Here's that study I mentioned.

PiterM
08-23-2013, 17:36
Where's the tourniquet???
Celox?? How about combat gauze as a better choice (personal experience)

As I said I'm not in a combat situation. tourniquet is probably the last device I'd ever need. And just in case I have always with me a good piece of paracord, which would work great as a tourniquet (combined with a piece of stick or folding knife to apply good torque).

Celox... easy to find here, and seems to be a good general solution for severe cuts. I'm not afraid of bullet wound. I'm afraid that I can cut myself BADLY with one of my knives when working with them in the wild. For knife cuts and stabs Celox™ Granules seems to be quite OK. Especially combined with OLAES Modular bandaid.

What I really consider (additionally) is Celox Applicator for deep stabs...

The Reaper
08-23-2013, 18:29
As I said I'm not in a combat situation. tourniquet is probably the last device I'd ever need. And just in case I have always with me a good piece of paracord, which would work great as a tourniquet (combined with a piece of stick or folding knife to apply good torque).

Celox... easy to find here, and seems to be a good general solution for severe cuts. I'm not afraid of bullet wound. I'm afraid that I can cut myself BADLY with one of my knives when working with them in the wild. For knife cuts and stabs Celox™ Granules seems to be quite OK. Especially combined with OLAES Modular bandaid.

What I really consider (additionally) is Celox Applicator for deep stabs...

Piter, there are a lot of unanticipated situations where the tourniquet can save lives.

I would encourage you to get a good one (or two) and learn how and when to use it.

You really do not want to use paracord unless there is nothing else.

TR

doctom54
08-23-2013, 18:37
As I said I'm not in a combat situation. tourniquet is probably the last device I'd ever need. And just in case I have always with me a good piece of paracord, which would work great as a tourniquet (combined with a piece of stick or folding knife to apply good torque).

Celox... easy to find here, and seems to be a good general solution for severe cuts. I'm not afraid of bullet wound. I'm afraid that I can cut myself BADLY with one of my knives when working with them in the wild. For knife cuts and stabs Celox™ Granules seems to be quite OK. Especially combined with OLAES Modular bandaid.

What I really consider (additionally) is Celox Applicator for deep stabs...

As a 91B4S at one time and a physician I would say that paracord makes a lousy tourniquet . It is narrow. The wider the better when it comes to a tourniquet. Even with a stick is is hard to get sufficient pressure to stop arterial flow on a limb. Probably would work on a finger.:)

PiterM
08-23-2013, 19:16
good point guys... next medical purchase. One TQ for trauma-pouch, and one to have in the car. You never know, indeed. It may save someone's life.

Surgicalcric
08-23-2013, 21:13
A tourniquet is probably the last device I'd ever need...

So thought everyone who has ever needed a TQ.

MR2
08-23-2013, 22:18
So thought everyone who has ever needed a TQ.

Just the subtle response I was expecting. Drives it home. :lifter

swatsurgeon
08-24-2013, 08:33
So thought everyone who has ever needed a TQ.

PERFECT!!!! anticipate the need, prepare for all.

Problem with granules is if you have a decent sized arterial or venous injury , they could and can get intra vascular and cause BIG problems which is why the US military and law enforcement no longer promote the use of granular products. Send me an address, I'll hook you up.

x SF med
08-24-2013, 14:28
So thought everyone who has ever needed a TQ.

My kit now has 5 TQ's thanks to a SwatSurgeon sending a new Swat-T to go along with my conventional ones...

I have some granular clotting agent and some infused bandage clotting agent too...

direct pressure is best to start, if you have the time - The SWAT-T seems to be the most scalable item I have for that... start light, then go tight, if that don't work - stop the squirt. An 18D mantra from the old days.

miclo18d
08-24-2013, 14:43
As a 91B4S at one time and a physician I would say that paracord makes a lousy tourniquet . It is narrow. The wider the better when it comes to a tourniquet. Even with a stick is is hard to get sufficient pressure to stop arterial flow on a limb. Probably would work on a finger.:)
Read the highlighted comment again! Any TQ that I would carry would be a minimum of 1.5 inches and 2 would be better. Much wider and they become too big to carry and tighten (for a combat TQ)(also if one doesn't stop the bleed and you have two place a second one above the first to make a wider TQ... i.e. on a femoral bleed). As was said your paracord aka shoelace causes A LOT of pain and doesn't stop the bleeding, you would be better to use your shirt in an emergency. Always carry a cravat and you can fold it to be 2 inches wide. There are a ton of aftermarket TQs that work great. Research these as there are a lot of fakes and crappy TQs out there. There is a lot of info on this site about them.

If Quick Clot is all you can get, that will work in a pinch, but not preferred.

The Reaper
08-24-2013, 14:52
The older Quick Clot cooked the tissues and was a real bear to remove.

The granules get hot with any kind of water application, so rinsing them out during treatment was not possible without creating more damage.

The newer formulas are much better, as are the gauze products.

Most of the expedient TQs are hard to place and tighten with one hand. The better designs help with that problem.

TR

swatsurgeon
08-24-2013, 21:30
The older quik clot is the exothermic (granules). Their combat gauze does not cause any temperature change or tissue interaction and is the preferred clot promoting product in my book and I have used all products on the market presently. The gauze is impregnated with kaolin, it's benign and it works when packed correctly. If you go to the z-Medica website they have instructional videos and on line training for its proper use.
As far as tourniquets, the SWAT-T, SOF-T are the two I prefer with the CAT last for ease of use and appropriate apication under stress.

Trapper John
08-25-2013, 10:25
The gauze is impregnated with kaolin, it's benign and it works when packed correctly. If you go to the z-Medica website they have instructional videos and on line training for its proper use.

Hmm, is a vendor's website really the most objective evaluation? ;) Independent studies have shown that chitosan impregnated gauzes work faster than kaolin based products. Probably an important performance criteria - doesn't require the 2-3 minutes of constant pressure and when you are being shot at that could be critical. And as I said, I like the mechanism of action for chitosan over kaolin, but then again I'm a science geek.:D

swatsurgeon
08-25-2013, 14:46
Hmm, is a vendor's website really the most objective evaluation? ;) Independent studies have shown that chitosan impregnated gauzes work faster than kaolin based products. Probably an important performance criteria - doesn't require the 2-3 minutes of constant pressure and when you are being shot at that could be critical. And as I said, I like the mechanism of action for chitosan over kaolin, but then again I'm a science geek.:D

True, but this is all based on personal use not vendors say so. The studies performed had their own issues, I know some of the authors and truthfully, they are both good products, it depends on how you bias the data and real world experience not laboratory data driven by man made lab wounds.........I have had better success in the operating room and trauma room with combat gauze as opposed to chitosan based products.....just my personal experience speaking here.

ss

The Reaper
08-25-2013, 19:13
I would take the word of a trauma surgeon that I knew for it every time, but that is just me.

TR

x SF med
08-26-2013, 11:06
I agree with TR, I'll go with the Trauma Surgeon I know and trust to give me the best guidance he can.

swatsurgeon
08-28-2013, 14:08
Hmm, is a vendor's website really the most objective evaluation? ;) Independent studies have shown that chitosan impregnated gauzes work faster than kaolin based products. Probably an important performance criteria - doesn't require the 2-3 minutes of constant pressure and when you are being shot at that could be critical. And as I said, I like the mechanism of action for chitosan over kaolin, but then again I'm a science geek.:D

Here is the latest article on hemostatis agents by the military: in Journal Of Trauma, August Supplement

Comparison of novel hemostatic dressings with QuikClot
combat gauze in a standardized swine model of
uncontrolled hemorrhage
Jason M. Rall, PhD, Jennifer M. Cox, BS, Adam G. Songer, MD, Ramon F. Cestero, MD,
and James D. Ross, PhD, San Antonio, Texas
BACKGROUND: Uncontrolled hemorrhage is the leading cause of preventable death on the battlefield. The development, testing, and application of
novel hemostatic dressings may lead to a reduction of prehospitalmortality through enhanced point-of-injury hemostatic control. This study
aimed to determine the efficacy of currently available hemostatic dressings as compared with the current Committee for Tactical Combat
Casualty Care Guidelines standard of treatment for hemorrhage control (QuikClot Combat Gauze [QCG]).
METHODS: The femoral artery of anesthetized Yorkshire pigs was isolated and punctured. Free bleeding was allowed to proceed for 45 seconds
before packing of QCG, QuikClot Combat Gauze XL (QCX), Celox Trauma Gauze (CTG), Celox Gauze (CEL), or HemCon ChitoGauze
(HCG), into the wound. After 3 minutes of applied, direct pressure, fluid resuscitation was administered to elevate and maintain a mean
arterial pressure of 60mmHg or greater during the 150-minute observation time.Animal survival, hemostasis, and blood lossweremeasured
as primary end points. Hemodynamic and physiologic parameters, along with markers of coagulation, were recorded and analyzed.
RESULTS: Sixty percent ofQCG-treated animals (controls) survived through the 150-minute observation period.QCX, CEL, andHCGwere observed
to have higher rates of survival in comparison to QCG (70%, 90%, and 70% respectively), although these results were not found to be of
statistical significance in pairwise comparison to QCG. Immediate hemostasis was achieved in 30% of QCG applications, 80% of QCX,
70% of CEL, 60% of HCG, and 30% of CTG-treated animals. Posttreatment blood loss varied from an average of 64 mL/kg with CTG
to 29 mL/kg with CEL, but no significant difference among groups was observed.
CONCLUSION: These results suggest that the novel hemostatic devices perform at least as well as the current Committee on Tactical Combat Casualty
Care standard for point-of-injury hemorrhage control. Despite their different compositions and sizes, the lack of clear superiority of any
agent suggests that contemporary hemostatic dressing technology has potentially reached a plateau for efficacy. (J Trauma Acute Care
Surg. 2013;75: S150YS156. Copyright * 2013 by Lippincott Williams & Wilkins)
KEY WORDS: Hemostatics; hemostatic: dressings; hemostatic: gauze; hemorrhage: swine.

chance
01-02-2014, 23:10
So thought everyone who has ever needed a TQ.

So, having lived thru what you have would you change you original list of items?