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swatsurgeon
11-27-2008, 12:34
The thread that Eagle closed (for appropriate reasons IMHO) on medication administration is closely followed by supplies and equipment that people will carry that is potentially out of their scope of practice or command (approved to carry).
I have seen both civilian and military medical personel carrying "far fetched" stuff......can you crack a chest in the field, if you shouldn't/can't, then don't carry the equipment to do it.
The medical powers that be in both the military and less so in the civilian EMS world, have usually been there done that and have planned with those that are deployed to create an equipment list that is practical and appropriate to the level of skill a provider has to maintain efficiency and safety for those they care for. Yes, I have worked with 18D's, PJ's, SEALS who are "advanced" medical providers and can somewhat decide what they will need, mission specific, but they are usually the exception and not the rule.....for a damn good reason. Primum non nocere....first do no harm is a reality and guide that should and must be adhered to. I am a trauma surgeon, I can do practically anything in a hospital but am significantly limited in the field....so I don't carry non-mission essential equipment when deployed as a tactical medic/doc.
Bottom line is stay with what you are trained and authorized to use in the field, improvise when necessary but don't do things that could cause harm by your "good intentions"...........

ss

Cass100199
11-27-2008, 16:21
Completely agree. My aid bag always has the bear minimum required to handle battlefield trauma. The most advanced I get are airway adjuncts and IO. I don't even like to carry crich equipment, but they made that a mandate when I was their in 05.

I think you all misunderstood the last thread. Fortunately I'm not a 19 y/o kid with just enough knowledge to hurt someone. I like to plan for multiple contigencies. Hopefully, the 2 QP's from before are spot on and I will have a higher medical authority close by, so that I don't have to wonder if the algorithms provided in ADTMC are pointing me in the right direction.

cdwmedic03
11-27-2008, 20:29
Totally agree. As I've read before, exposure does not equal certification. I see a lot of medics at the 10 or 20 level that carry scopes and chest tube kits in their bags. I used to be one, I no longer do in my bag that is specifically for tactical applications.
I would like to pose this question to all surgeons or team physicians etc. I know that the majority if not all of you carry your own bags. There are those out there that don't (which puzzles me a little). What do you think about your medics carrying things like 'scopes, surgical airways, and chest tube kits in their bags so it is there in case you get caught without yours? A kind of crossloading between medics.

The Reaper
11-27-2008, 21:35
If you don't like the answer, don't ask the question.

Be polite, especially with QPs, or be gone.

Have a very SF day.

TR

Eagle5US
11-28-2008, 10:57
Totally agree. As I've read before, exposure does not equal certification. I see a lot of medics at the 10 or 20 level that carry scopes and chest tube kits in their bags. I used to be one, I no longer do in my bag that is specifically for tactical applications.
I would like to pose this question to all surgeons or team physicians etc. I know that the majority if not all of you carry your own bags. There are those out there that don't (which puzzles me a little). What do you think about your medics carrying things like 'scopes, surgical airways, and chest tube kits in their bags so it is there in case you get caught without yours? A kind of crossloading between medics.
Prior to OEF / OIF there were a LOT of differences in what was generally packed out by medical folks for patrols / operations. A few things to consider on the modern battlefield:

1. With few exceptions (Special Operation environment being one of them)...you are rarely more than 20 minutes from SOME level of advanced medical care (Level I, II, or III) by ground.

2. I don't carry a laryngoscope - IF I intubate someone on the battlefield, I am then committed to have someone to bag that patient and at least 2-4 more to carry that patient. This patient is already unconscious and without a gag reflex since RSI (rapid sequence intubation) medications are also not carried.

3. I do carry SAS (Surgical Airway Stuff) - A surgical airway can be performed on a conscious patient with a gag reflex and no anesthesia, who is able to breath on his own. Literature demonstrates that this had been done, successfully, numerous times during the Vietnam war. Though a rarity, it has also been performed in this manner in our current world environment.

4. 14ga 3.5in needles - Recent experience has taught us that large bore needle decompression can buy significant time in transport of a patient with a penetrating chest wound and subsequent pneumothorax / tension pneumothorax. Additionally, it can be repeated as needed until a chest tube can be placed. Little is worse for the patient than to have a chest tube that was rapidly and minimally secured be ripped out during transport in the back of a HUMMV or other vehicle. This procedure can be performed in the field, but is unnecessary at that stage of care.

5. IV's (once a staple in trauma care and the battlefield) are getting re-looked at with a close eye. In addition to the studies on "low pressure resuscitation" there are other factors specific to OEF / OIF. Due to the infrequency of successful starts under fire, the time delay in patient transport while they try to start them, and people becoming additional combat wounded while starting IV's...there was recently an RFI for opinions and examples to support either keeping IV's in CLS or removing it altogether.

Medicine is in a constant state of flux based on experience and research. It is a mixed bag that times of war provide some of the greatest advances in medical care.

Absolutely base your packing on your mission - as such, packing will change. It seems the more training that I have, the less "high speed stuff" I feel I need to carry in my medical bag.
There are other items that are / aren't carried...IMHO the "must haves" deal with basic life support. My short list includes the above as well as:

LARGE DRESSINGS (Israeli or other similar)
ACE WRAPS (for compression)
TOURNIQUETS (these have been proven the biggest "life extenders" of this war)
COBAN
KERLEX (for packing inside wounds)
OLD SCHOOL CRAVATS (more uses than I can imagine)
"Stuff" to keep guys alive until they reach a table

This list is not all inclusive, but it is a few things off the top of my head to get this ball rolling. Good question.

Eagle