Range Trauma Kit

[Dropkick]

With the recent talk of first aid, and trauma kits, I thought I'd let you see what I've got put together.

http://farm8.staticflickr.com/7410/11314546675_99ed7de99f.jpg
Clearly labeled pocket on my range bag.

http://farm8.staticflickr.com/7322/11314673313_a935de0aff.jpg
Two CAT tourniquets and trauma shears bungie corded to the outside.

http://farm8.staticflickr.com/7343/11314673233_5055e88711.jpg
And more good stuff in on the inside.

http://farm4.staticflickr.com/3692/11314595686_3d1cc34929.jpg
And the list of everything, left to right:

Immediate Action Card
HALO Seals
"H" Compression Bandage
QuikClot Combat Gauze LE
Petroleum Gauze (2 packs)
Sharpie (wrapped with duct tape)
Rescue Hook
Safety Pins
Nasopharyngeal Airway
Field Dressing
Space Blanket
Emergency Contact Card
H&H Compressed Gauze
CAT Tourniquets
Nitrile Gloves, two pairs
Trauma Shears

Any questions or comments are welcome!

[Joseph B.]

That's a pretty good kit, I would only recommend tossing in a 4" ace wrap and a roll of athletic tape. Ace wrap is great with use of the H&H gauze and offers some different bandaging methods, also good for stability/immobilize, etc. Athletic tape is a lot better than med tape and there are countless uses. Outside of that, doubling up on chest seals, NPA, combat gauze is never a bad thing, adding a decompress needle if you know how to use one, but for a basic kit I would say you are pretty solid.

[Drang]

Good kit, and I may add a couple of things to mine, thanks for the ideas...

May I ask what, if any, specialized training you've received? I got criticized for having "more of a boo-boo kit" than a trauma kit because I threw in some standard band-aids and painkillers, and have no NPA on there. Not knowing how to use an NPA, I left one out...

[Dropkick]

Good kit, and I may add a couple of things to mine, thanks for the ideas...

May I ask what, if any, specialized training you've received? I got criticized for having "more of a boo-boo kit" than a trauma kit because I threw in some standard band-aids and painkillers, and have no NPA on there. Not knowing how to use an NPA, I left one out...

I recently attended DARK Angel Medical's Tactical Aid Course, review here:
http://pistol-forum.com/showthread.php?10264-Dark-Angel-Medical-Tactical-Aid-Course-Nov-10-amp-11-2013

And I have an Adult and Pediatric First Aid/CPR/AED cert from the American Red Cross.

While neither of those really qualify as dick, it's better than knowing nothing when you're the only person in the position to do something.

[TCinVA]

I'm putting together a new "Oh smurf" FAK now.

- Maxpedition FIGHT
- Prestige medical shears
- SOFT-T
- 6" Emergency Trauma Dressing
- Combat Gauze
- Compressed S-roll gauze
- Israeli bandage
- Nasopharyngeal Airway + lube
- Bolin chest seal
- Nitrile gloves

Once I get the stuff and can package it all up I plan to add some other incidentals:

- Tape of some sort (athletic, medical, probably some duct-tape)
- Light

I'm open to other suggestions.

This kit is going to become my goes-almost-everywhere-I-go kit apart from the kit I keep in the range bag.

[Dropkick]

I'm putting together a new "Oh smurf" FAK now.
- Maxpedition FIGHT
...
This kit is going to become my goes-almost-everywhere-I-go kit apart from the kit I keep in the range bag.

I like the idea of adding a dedicated flashlight to it. I'll have to check to see if I have an extra one laying around that would fit. Also, from the looks of it I think the Maxped FIGHT has about the same capacity as the pouch I used.

I've built a couple kits that fit in my car door pockets, but for a true "everywhere-I-go" kit, I really need something that fits in a (non-cargo) pants pocket. Best I've been able to come up with is something that fits in a large jacket pocket, but that doesn't help when I'm wearing a jacket less than half the year. But I like what you're getting at.

[Josh Runkle]

Why the NPAs but no OPAs? People have to be breathing on their own to use an NPA.

I understand the need to secure the airway, but if I had to have one or the other in a kit, I'd choose an OPA. Are you guys using the NPAs for something else?

[SGT_Calle]

I like the light idea as well, maybe a small headlamp-type light would work best so you have use of both hands?

"They" always seemed to steer us away from Oral airways in CLS, I can't remember specifically why for the life of me though.

[Josh Runkle]

I like the light idea as well, maybe a small headlamp-type light would work best so you have use of both hands?

"They" always seemed to steer us away from Oral airways in CLS, I can't remember specifically why for the life of me though.

I would ASS-U-ME the thinking is gag reflex might be caused by OPA causing aspiration if you don't have suction.

My thinking for range kit is: the NPA is to secure the airway if they go into shock...for the few minutes until EMS arrives. But, this only works if they're breathing, as the NPA has to be inserted as they inhale. So, what if they stop breathing? NPA is useless. What if there's facial trauma? Again, NPA's useless. You could manually open the airway if they're breathing but in shock...this would essentially do the same thing. The OPA is contraindicated by gag reflex, again, open the airway manually. The OPA, however, will work on a person who is not breathing. I understand that the NPA can quickly be cut to size, whereas an OPA is size specific, but most people don't let kids take classes, and there are generally few kids at the range compared to adults. The risk of someone going down from a heart attack or dehydration at a range is generally greater than the risk of a gunshot wound. Using this reasoning, an OPA would seem a better choice if you can only have one item.

[ST911]

Why the NPAs but no OPAs? People have to be breathing on their own to use an NPA.

I understand the need to secure the airway, but if I had to have one or the other in a kit, I'd choose an OPA. Are you guys using the NPAs for something else?

OPAs are rigid, take up space, can move in place, and may not be tolerated. An NPA is compact, can be placed even when the pt is conscious, stay in place, and does the job adequately for the context of use.

[PT Doc]

Petzl headlamp is great for a kit versus hand held.

[Joseph B.]

NPA can also be used for emergency tracheotomy, when there is an oral obstruction (I.e. jaw has been blown apart, airway collapsed/crushed, etc). I still keep a couple of J-tubes in my aid bag (not my IFAK), but NPA would be my first choice and in a basic IFAK, its dual purpose.

I agree with head lamp over hand held for working on trauma, it makes things real easy.

Duct tape is great to have in any bag, but generally once it gets wet from blood, sweat or vomit, it becomes very difficult to handle and apply. BTDT, hints the athletic tape I recommend. But, still ace wraps can fill the void when tape is just not working out.

[cclaxton]

I like the light idea as well, maybe a small headlamp-type light would work best so you have use of both hands?

"They" always seemed to steer us away from Oral airways in CLS, I can't remember specifically why for the life of me though.
http://www.sgna.org/issues/sedationfactsorg/patientcare_safety/airwaymanagement.aspx
Don't forget the note at the end to cut the NPA to the length of the nose to the earlobe to get the length right.

CC

[cclaxton]

I would add:
- Triangular Bandage can be used for Tourniquet, Arm Sling, etc. http://www.henryschein.com/us-en/Shopping/ProductDetails.aspx?productid=4670483&CatalogName=MEDICAL

- 4"x5" Tegaderm bandages
- A few small disposable alcohol preps
- A few general strip bandaids
- Small bottle of sterile eyewash
- medium sized sterile 5"x12" sterile absorbent pads;

CC

[Adam]

Very nice Dropkick!

I think folks often try to mix trauma and FAKs. I don't want band aids and finger splints in my trauma kit. That stuff has its own place.

I agree on adding a light. Wal-Mart has decent Energizer (I think) headlamp for $5. Small and light with just enough like for the task being discussed. I also like a couple of chem lights on a short piece of string. Hang it around your neck for hands free light, hang it on a car antenna to mark a car wreck location for EMS or swing it in the air at night to signal to Life Flight helicopter like its a rave. :D

ETA, here is that headlamp. Buy it wherever you want of course. They work great.

http://www.walmart.com/ip/Energizer-Trailfinder-LED-Headlight/15571829

[shootist26]

what sort of training does one need to get to safely and properly use things like CAT tourniquets, israeli bandage, quik-clot infused gauze, etc?

[Joseph B.]

what sort of training does one need to get to safely and properly use things like CAT tourniquets, israeli bandage, quik-clot infused gauze, etc?

The CAT & Israeli bandage are pretty straight forward, read and follow directions.

Personally I wouldn't recommend the Israeli bandage as a catch all bandage, I prefer H&H compressed Gauze and ace wraps.

Combat gauze, along with learning regular gauze, mainly learning to pack a wound is a big plus. Its not hard, and with a good simulator and some hands on, get a warm and fuzzy, you can be GTG in 20-30 minutes. The main issue is stopping up the bleed and filling the wound cavity, etc. Live tissue is the best, but there are some good simulators.

If you don't have the time.or money to attend a TCCC type course, I would go up to.local fire/EMS house and see if you can get one of the Paramedics to show you this or that, as in "how do I use this CAT" when is your next wound packing class, could I attend, could I pay you to show me, etc. There are a lot of good instructional videos online as well. All that said, sign up for classes when ever you can....

[Totem Polar]

While neither of those really qualify as dick, it's better than knowing nothing when you're the only person in the position to do something.
This statement strikes me as applicable to large parts of life in general.

I wish I had expertise to add to this thread; all I can offer up is appreciation for the experts that we already have around here. I'm learning a ton from this place.

[TCinVA]

So far I have to say I'm not thrilled with the Maxpedition FIGHT bag. It's mainly two great big pockets that obscure the contents of the pockets and don't really allow pulling one thing out without possibly pulling everything else out.

DK - What bag are you using?

[Dropkick]

So far I have to say I'm not thrilled with the Maxpedition FIGHT bag. It's mainly two great big pockets that obscure the contents of the pockets and don't really allow pulling one thing out without possibly pulling everything else out.

DK - What bag are you using?

It's either a Condor or Voodoo Tactical. Nothing high speed. I'm just using it to keep everything organized, not doing HALO jumps or anything.
But if you're looking for something of higher quality, the Emdom BOMB (Blow Out Medical Bag) is very similar.

[DocGKR]

"But, this only works if they're breathing, as the NPA has to be inserted as they inhale. So, what if they stop breathing? NPA is useless."

Hmmm--so all those NPA's we've placed on non-breathing patients didn't actually go in and work??? Wow, and all this time we thought the NPA's were helping us to ventilate the patients until they regained spontaneous respiration....


"What if there's facial trauma? Again, NPA's useless."

Not necessarily; certainly one has to be cautious with specific mid-face trauma, but other areas of facial trauma do not rule out NPA use.

[Josh Runkle]

Hmmm--so all those NPA's we've placed on non-breathing patients didn't actually go in and work??? Wow, and all this time we thought the NPA's were helping us to ventilate the patients until they regained spontaneous respiration....



Not necessarily; certainly one has to be cautious with specific mid-face trauma, but other areas of facial trauma do not rule out NPA use.

As I am not a doctor, I have to follow textbook contraindications.

[Lost River]

I would ASS-U-ME the thinking is gag reflex might be caused by OPA causing aspiration if you don't have suction.

My thinking for range kit is: the NPA is to secure the airway if they go into shock...for the few minutes until EMS arrives. But, this only works if they're breathing, as the NPA has to be inserted as they inhale. So, what if they stop breathing? NPA is useless. What if there's facial trauma? Again, NPA's useless. You could manually open the airway if they're breathing but in shock...this would essentially do the same thing. The OPA is contraindicated by gag reflex, again, open the airway manually. The OPA, however, will work on a person who is not breathing. I understand that the NPA can quickly be cut to size, whereas an OPA is size specific, but most people don't let kids take classes, and there are generally few kids at the range compared to adults. The risk of someone going down from a heart attack or dehydration at a range is generally greater than the risk of a gunshot wound. Using this reasoning, an OPA would seem a better choice if you can only have one item.

Josh,

Perhaps in some parts of the U.S. ems is only "a few minutes away". That being said, many, many places, especially out in the rural West, med personnel can be a lot longer. 15 minutes, 45 minutes, etc. Keeping someone alive during the golden hour, platinum 10 minutes is where it is at. Don't rely on responding meds to get their like the cavalry in the movies, you will likely be disappointed.

Often you will get minimally trained volunteer QRU/firefighters, instead of an actual paramedic. Most QRU personnel that I've been around are only allowed to do very, very basic tasks. Most are not allowed to put in NPAs, dart lungs, do traches, etc.

The thing about NPAs is that when a person has something happen as common as a bee sting and they are allergic, causing anaphylaxis, the nasal tube has a high probability of saving their life. Pretty much everyone has heard of anaphylactic shock. The thing is that a person stung, will have pretty rapid onset of symptoms. One very common issue is the swelling of the throat/occlusion of the airway.

If/when this occurs you have to establish an airway for them ASAP. If you wait until a properly trained med person gets there, and you are hanging out saying "hang on buddy the meds are on their way", it is highly likely it is too late. Once the airway is swollen shut and they are not breathing, trying to put in an NPA tube is a lesson in futility. NPAs need to be utilized in the early stages, even when they are breathing OK on their own. If you don't have lube,take some of their saliva, or yours and run it in. They may cough and gag/ be resistant, but get it done.

If they are still in the early stage and can communicate, ask if the have an Epinephrine injector pen. (epi is basically adrenaline). They may have been panicking and have forgotten they have one in their vehicle, bag, whatever.

Bee stings, even on ranges is more likely than GS trauma. At least from my experience. I did PSD for years overseas and was trained by 18 Deltas. Due to their training, I carried an epi pen in my trauma kit, in case a teammate/Principal/Dignitary went down. The injectors have other uses as well, but that is a whole other topic.

NPAs also need to be deployed as early as possible on Tension Pneumothorax cases as well, even if they are initially breathing OK. I don't feel like typing out the whole reasoning behind that, but do some research and it will be clear.

Try to get some TCCC training someplace if you are stateside. It will be some of the most useful and potentially lifesaving training you can get.

It is easy to kill. Keeping someone alive is a much greater challenge.

Best wishes this Holiday season, and Merry Christmas

[Josh Runkle]

Not necessarily; certainly one has to be cautious with specific mid-face trauma, but other areas of facial trauma do not rule out NPA use.

I'm only a paramedic and protocols in Ohio won't allow us to place with any serious mechanism to the face, for fear of the unseen, like a Le Fort fracture. Paramedics don't carry X-ray machines and aren't trained to rule out such if significant mechanism to the face exists elsewhere.

[Josh Runkle]

Hmmm--so all those NPA's we've placed on non-breathing patients didn't actually go in and work??? Wow, and all this time we thought the NPA's were helping us to ventilate the patients until they regained spontaneous respiration....


Interesting. I'm curious, please share how to do this. So, normally, the glottic opening is closed when they're not breathing. You insert through the vocal chords while they're inhaling, so that you can pass the NPA while the space is opened and not blocked. If you manually lift the epiglottis or lift from the vallecula, obviously you can insert an NPA. This requires extra equipment though, and if you had that, you'd just intubate. I'm not familiar with a method of inserting an NPA on a non-breathing patient. Please share.

[ST911]

Interesting. I'm curious, please share how to do this. So, normally, the glottic opening is closed when they're not breathing. You insert through the vocal chords while they're inhaling, so that you can pass the NPA while the space is opened and not blocked. If you manually lift the epiglottis or lift from the vallecula, obviously you can insert an NPA. This requires extra equipment though, and if you had that, you'd just intubate. I'm not familiar with a method of inserting an NPA on a non-breathing patient. Please share.

Whuuuuuut?

[DocGKR]

"You insert through the vocal chords while they're inhaling, so that you can pass the NPA while the space is opened and not blocked."

Uh....are you talking about NPA's or a nasal endotracheal intubation?

NPA:
http://www.itstactical.com/wp-content/uploads/2009/11/Airway-300x210.jpg
http://webmm.ahrq.gov/media/cases/images/Case208_fig1a.jpg

nasal endotracheal tube:
http://i459.photobucket.com/albums/qq319/DocGKR/S04_i200A_L_zpsa8851e81.gif

[Josh Runkle]

Uh....are you talking about NPA's or a nasal endotracheal intubation?

NPA:
http://www.itstactical.com/wp-content/uploads/2009/11/Airway-300x210.jpg
http://webmm.ahrq.gov/media/cases/images/Case208_fig1a.jpg

nasal endotracheal tube:
http://i459.photobucket.com/albums/qq319/DocGKR/S04_i200A_L_zpsa8851e81.gif

Well, I was talking about nasotracheal intubation. I'm an idiot. Sorry.

[DocGKR]

No worries--glad we are on the same page now. Obviously totally different depth of insertion, different indications, and different techniques.

[Josh Runkle]

Apologies for my ass-hat-tery ;)

[Dropkick]

Tell you what, I'm not too keen on having either of those shoved up my nose if I can't help it. Conscious or not! :p

[SGT_Calle]

I've never seen that nasal endotracheal tube before, that's really interesting. Thanks for sharing it Doc.


Sent from my iPhone using Tapatalk (http://tapatalk.com/m?id=1)

[Dropkick]

Minor update, I swapped out the CAT TQs for SOFTT-W TQs.

[RJ]

Total noob here, but glad to find this thread.

I'm trying to put together a simple IFAK / GSW kit for my range bag, and there are a lot of great ideas here.

I have very minimal first aid training, so my objective is to try focus on stabilize / stop bleeding long enough so I can get to a professional.

Just wanted to post how much I appreciate the discussion.

[BoppaBear]

Great thread! Looking forward to my D.A.M. course in September.

[Dropkick]

Update on Contents:

2x SOFTT-W
Medical Shears

2x Nitrile Gloves
2x H&H Compressed Gauze
Military Cravat Triangular Bandage
Space Blanket
2x Safety Pins

Rescue Cutter
Sharpie Marker
Tape
2x QuickClot Combat Gauze Z-Pack
HALO Seals
NPA
2x Petroleum Gauze
H&H "H" Bandage Flat
Rescue Essentials - Immediate Action Card
Rescue Essentials - MARCH Card

[Dropkick]

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Here's a picture to go along with the previous post's content list.