Quote:
Originally Posted by cdwmedic03
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.
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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.
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