Medkit for the Range

[Arclight]

As with anything in gear, configuring a medkit is a compromise. If you had everything you could possibly want, you'd be carrying a Level 1 Trauma center and an ICU. If you only carry a band-aid and an Aspirin, you're not prepared for much. With this in mind, what I have here is intended to get you thinking about what you should carry, not prescribing what that is. What you should carry and what I should carry may not be the same for many reasons. It's easy to carry too much and too many people carry nothing. There are hundreds of websites and forum threads that discuss what to carry. Some are good, some are dangerously bad. Make sure you get educated advice that fits your skills and environment. Finally, don't get caught up in "sexy" gear and forget the stuff you actually would use.

Let's start with some questions:

What is this medkit for?
What am I trained to do?
How will I carry it?


What is this medkit for?
Think about the situation you're preparing for. Gunshot wound? Training injuries like sprains/strains? General first aid issues that come up in any activity, including shooting sports? Providing full medical support to dynamic entry training? You get the point.


http://i537.photobucket.com/albums/ff339/ArclightPB/boobooortrauma.jpg


When I'm going to the range, I have three different "medkits". While there is some redundancy, each is for something different. I have my "blowout kit", which is clearly marked and attached to my range bag for immediate penetrating trauma emergencies. I have my "snivel kit" which has band-aids, aspirin, antiseptic wipes and such for everyday minor medical issues (which is in a small ziplock bag and fits in a pocket in the range bag). Finally, as a former medical provider, I have a much larger, more comprehensive kit in my car that encompasses the above items and more advanced/diagnostic care. Why do I mention that? Because each one was born from a different need, and carried/stored according to that need. So ask yourself - what am I trying to prepare for?

What am I trained to do?
This is pretty straightforward. Know your skills, your limitations, and the laws. Be careful with carrying advanced life support gear or medications if you're not certified to use them where you live, even if you know how. The caveat to that, however: Even if you don't have the training, there's still value in having basic emergency supplies with you for the other guy at the range who knows how, but isn't prepared. There are many places to get basic first aid training, and even occasionally ones tailored to recreational shooters. If you don't have any medical knowledge and plan to make a serious hobby of shooting, it's a good investment.


http://soldiersystems.net/blog1/wp-content/uploads/2009/03/tacpack_contents.jpg


How will I carry it?
Do you want to carry a separate emergency bag? If so, will that always be with you or start getting left behind when you have other gear to manage? How much space do you have? This depends on so many factors that I won't try to prescribe something here, but I'll make this suggestion: If you're carrying trauma/"blowout" gear, it's helpful to have it in a clearly marked kit that attaches to your normal range gear and can be easily found and removed by someone unfamiliar with your kit in an emergency.


http://i537.photobucket.com/albums/ff339/ArclightPB/kits.jpg



My only firm recommendation here is this: Don't get caught up in having "just the right gear" and either feel like you have to spend a ton of money or end up getting nothing. Have something with you, even if it's just a couple of triangular bandages and a pair of nitrile gloves in a ziplock in your range bag. Just those tools alone can handle a surprising number of emergencies and may be just what someone needs.... right now. Remember, the life you save may be your own.


Finally, I am neither a doctor nor a lawyer and I didn't stay in a Holiday Inn Express last night. That's my way of reminding you that medical care, like shooting, is serious business and you are responsible for the choices you make.

[ToddG]

Awesome post, ArcLight. I think every serious shooter should have at least basic training in dealing with penetrating injuries, and everyone should keep some kind of kit (like an IFAK (http://www.tacmedsolutions.com/store/Products_Detail.php?ProductID=56)) either on his body or on his range kit 24/7.

Because whether you're just hanging out with friends (http://pistol-training.com/articles/how-i-got-shot) or among fellow experienced shooters (http://pistol-training.com/archives/2474), bad things can happen.

[45R]

I have one of the IFAKs that Todd referenced. Its a great kit, I actually took a Tactical Medicine course to learn how to use the contents.

[jslaker]

A decent medkit has been on my list of things to buy for entirely too long.

Another interesting data point is that NPR did a report on the recent shootings in Tuscon, and the Sheriff's department there credited the fact that they had recently started keeping IFAKs in their patrol cars as a major factor in saving lives that day. The first officers on scene were able to immediately begin rendering aid, buying crucial time until the ambulances showed up.

[peterb]

As a volunteer EMT, I'll echo that you don't need a lot of specialized gear. Simple, multipurpose stuff works fine. Carry a couple of pairs of nitrile gloves in ziplok bags -- the bags can be an airtight dressing if needed. For minor trauma 4x4s and roller gauze or Ace bandages work well if you don't have the all-in-one trauma dressings. Triangular bandages are useful but the commercial ones are usually small and flimsy, so we make our own. Sterile saline is good for irrigation or eyewash -- the little Saljet 30ml containers will fit even a small kit.

Gloves really are important, because the fastest dressing you can apply is usually a gloved hand. I keep a glove pouch on the strap of my first-in bag so I never have to look for my first pair.

I'm certainly not knocking the commercial kits and specialized products. But a few minutes at the local drugstore will get you something a whole lot better than nothing.

If you've got a group/club, organizing a group buy of supplies from one of the big EMS suppliers might make sense.

[Arclight]

A decent medkit has been on my list of things to buy for entirely too long.
...The first officers on scene were able to immediately begin rendering aid, buying crucial time until the ambulances showed up.

Often people get hung up in needing to wait until they find just the right cool pouch and the latest tourniquet. I have nothing against either of those (I have a cool pack and a handful of tourniquets) but start with this:

Go to your local pharmacy/drugstore/online, buy two Triangular Bandages (http://www.amazon.com/DUKAL-747J-TRIANGULAR-BANDAGE-40/dp/B0006GE73Y) and a pair of Nitrile gloves (http://www.amazon.com/Gloves-Nitrile-Latex-Powder-Large/dp/B002TECHP6/ref=sr_1_28?s=hpc&ie=UTF8&qid=1298857786&sr=1-28) or two. Put them in a Ziploc bag, draw a red cross on the bag, and put it in your range bag. Triangulars are the miracle tool for improvised trauma care and cost almost nothing.

If you want to go higher tech and spend more, North American Rescue's Individual Patrol Officer Kit (IPOK-CG Combat Gauze) (http://www.narescue.com/Individual_Patrol_Officer_Kit_%28IPOK-CG_Combat_Gauze%29-CN1C91835F6180.html?BC=01CAD72151F1) is almost ideal for a minimal-skill-required urgent intervention for a GSW, neatly packaged. My range blowout kit is a slightly expanded version of that.

As peterb noted above, you can often improvise things if you won't/can't carry "the tool" for each emergency. For example, I do carry an Asherman chest seal, but I've found they don't stick well so you're just as well off carrying something occlusive (like the wrapper of the IPOK) and some tape. As he noted, a gloved hand does wonders for plugging holes in a pinch.

Other things, it's worth having the "right one". I'm a fan of the CAT-T style of tourniquet because you can put it on yourself one-handed. I also have the SWAT-T because it's cheap and more multipurpose, but it's not what I carry in a situation I might need to stop myself from bleeding out. If you're not sure, do the research and learn for yourself what features are important and why. Just don't let that keep you from getting something in the meantime.

If you're curious, here's what the Pima County folks had (http://www.tacmedsolutions.com/blog/wp-content/uploads/2011/02/Pima-County-Sheriffs-Department-__-Individual-First-Aid-Kits-IFAK-Help-Save-Lives-in-Tucson-Shooting.pdf). Quite similar to what's above.

Hope that helps motivate you to bring something with you next time you go to the range!

[JSGlock34]

The Viking Tactics Tactical Med Kit (http://www.vikingtactics.com/specials.html) is a good place to start (mirrors the Army IFAK in several components); I keep one in the trunk of each car along with a NAR Combat Applications Tourniquet (http://www.narescue.com/C-A-T_-_Combat_Application_Tourniquet-CN33B7051138B3.html).

Having these kits available is great, but I can't stress learning how to use them enough. Take a class regularly. Combat first aid has evolved considerably over the past decade - we've come a long way from just having a bandage on the shoulder of your ALICE gear.

[LittleLebowski]

Because whether you're just hanging out with friends (http://pistol-training.com/articles/how-i-got-shot).

Tis a flesh wound.

[Arclight]

Having these kits available is great, but I can't stress learning how to use them enough. Take a class regularly. Combat first aid has evolved considerably over the past decade.

I still believe it's better to have a basic kit and not know how to use it than have nothing at all (on the chance there's someone there who knows how but wasn't prepared), but clearly this is ideal. Get the gear, learn to use it. You don't have to recertify every year, but 1) you forget things and 2) things change.

I started doing EMS in 1994. If I did then what we consider standard now, I would have been fired and probably been charged with negligence. Fortunately,since then trauma care has gotten both easier and more effective at the basic combat casualty care level.

The other half of formal training is practice. If you get a combat tourniquet like a CAT-T (which I also highly recommend) or a SOF-T or Ratchet, get proficient enough with it that you don't have to think about it at all. If you can barely operate it in your living room on a Saturday afternoon, how will you fare in low light and under stress? Train, then practice, practice, practice.

One tip for the CAT-T and others of that type -- size it to fit over your boot and the upper part of your thigh (or any leg-borne gear you wear like a drop-leg) before you put it back in your kit. That way when you're trying to get it onto a high femoral bleed in a hurry, you're not trying to resize it. That ends badly.

[JSGlock34]

I still believe it's better to have a basic kit and not know how to use it than have nothing at all.

100% agree.

[Mitchell, Esq.]

Sig Saur has a First Aid for Range Officers class which was a 1 day, 8 hour basic intro to trauma care which was very good.

Brief review is here:

The instructor discussed the basic types of injuries on the range, penetrating trauma, eye injuries, catastrophic blood loss and broken bones.


They went into tension pneumothorax, but stayed away from needle decompressions as outside the scope of the class. They wanted the chest injury sealed and went into how to do it, but with the expectation you would be handing off the patient to EMS in short order.

I got the impression they weren’t comfortable with the idea of doing a needle decompression in a basic range first responder class.

Tourniquets, hemostatic agents were covered as were Israeli bandages and improvised seals for sucking chest wounds.

Also…when I asked about a striker fired Sig the answer was “Stay Tuned…” so be on the lookout for something.

I want to get my notes together before doing a class write-up. Also, the class raised some issues about consent to medical care in a school environment. Most releases involve risk of injury due to accidents; however, they are silent on releasing for liability in post accident care by school personnel and I think that is an issue which should be looked at before it comes up for real.

One issue that got me the most was the apparent lack of a consensus over the use of quick clot like agents in a non-tactical environment.

According to the instructor, some medical organizations/medical directors approve of it’s use (to some degree or another) – others don’t and this brings out the shark in me.

It becomes real easy to say the use (however it’s done) or lack of use (failure to be keeping on top of things…shame, shame…) of a hemostatic agent was against the “common course of practice and standard of care” because one doesn’t, from what I heard yesterday, seem to exist outside of a tactical environment.

My solution is sort of brute force – whatever your policy/the policy of the organization you follow on this issue, put it in writing and have students expressly consent to it before training.

It’s hard to sue for something you freely consented to. (Well…harder…)

Also, having people sign off that a safety brief was delivered so people (sharks…) can’t say that one was not given, or that it was insufficient. Or simply video tape that part of the class so when asked if a lecture or brief was given and everyone appeared to understand it you can simply say “here’s the dvd”.
________________


It wasn't Combat Casulaty Care - it was how to deal with a range accident, but applicable to post fight trauma care for the most part.

I bouoght a RESQ-PAK to keep in my coat pocket (Level 1 http://www.resq-pak.com/products.php), and I'm gonna start accumulating more first aid gear as I can get people to steal if for me.

Hell, I may actually buy some myself...

[peterb]

Thank you for the report.

FWIW, here's what the new NH EMS protocols say about hemostatics:
"Control active bleeding using direct pressure, pressure bandages, pressure points,
tourniquets, or as a last resort, consider using a hemostatic bandage. Hemostatic bandages must be of a non-exothermic type that can be washed off with 0.9% NaCl (normal saline)."
http://www.nh.gov/safety/divisions/fstems/ems/advlifesup/documents/11patientcareprotocols.pdf

[Mitchell, Esq.]

This is a med kit for the range for people going shooting suggested by Dave Bruce in his 1st aid for Range Officers class:

Battle Dressings
Israeli Bandages
Tourniquets
Quick Clot
SAM Splints
Dish Washing Gloves
Ace Wraps
Triangle Bandages
Pocket CPR Mask
Asherman Seal/Bolin Chest seal
Trauma Sheers
Medical Tape
Eye Wash

[mnealtx]

Looking at the link the IFAK and browsing around, it seems like the DOK (http://www.tacmedsolutions.com/store/Products_Detail.php?ProductID=48) (Downed Operator Kit) could be an acceptable solution, as well.

The DOK kit omits the petrolatum gauze, airway and pouch of the IFAK (resealable bag for the DOK) but only costs $38 vs the $70 of the IFAK.

[Luxor]

Guy's/Gal's

What ever you get or have just remember to practice applying it. You should do this on a regular basis. Med skills are perishable just like gun skills. When you practice you should do it with gloves on and if possible with something simulating blood.

Try to do this on someone as well as yourself with one hand. On the range when it is really needed is no time figure out when or how somthing is used.

Also, ( and i think Todd does this ) during classes there should be a designated person that will be the go to guy for treatment. There should be a designated vehicle with keys in it and gps set to the nearest hospital. Try to find out what the local ems response times are at your location. Be able to give first responders your location over the phone.

[JV_]

Also, ( and i think Todd does this ) during classes there should be a designated person that will be the go to guy for treatment.People, not person. If you designate one person, and he's the injured one, you'll need another plan.

Make sure you write down the location so someone can read it, and put it in a location that's convenient (easily found). You don't want them transposing numbers or forgetting something important, reading is often better than trying to remember.

[peterb]

Guy's/Gal's

What ever you get or have just remember to practice applying it. You should do this on a regular basis. Med skills are perishable just like gun skills. When you practice you should do it with gloves on and if possible with something simulating blood.

Try to do this on someone as well as yourself with one hand. On the range when it is really needed is no time figure out when or how somthing is used.

Also, ( and i think Todd does this ) during classes there should be a designated person that will be the go to guy for treatment. There should be a designated vehicle with keys in it and gps set to the nearest hospital. Try to find out what the local ems response times are at your location. Be able to give first responders your location over the phone.

Yup. On my first call I had brand-new gear and was trying to start new rolls of tape and bandages with gloves on. It was only embarrassing, but now I leave folded tabs on rolled things.

Whoever calls 911 should stay on the phone with dispatch. If the range isn't well marked, send someone to the gate to meet the ambulance and direct it in.

[Odin Bravo One]

I am not a big fan of CAT tourniquet......that said, I have "heard", and "understand" that they have upgraded their winlass, and corrected prior deficiencies in materials and workmanship. But I will never use one again. I prefer the SOF-T, or other with a metal winlass that will not break when you start applying the kind of pressure needed to stop a major arterial bleed.

There are a lot of good "kits" out there, and while it is tempting to go overboard and want to buy a giant EMT/PARA kit, or go with minimal med gear, the pre-fab IFAK's, and similar really have a good variety for a number of trauma situations. Even if you don't know how to insert an OPA/NPA, or how to properly use Combat Gauze, perhaps there is someone who does. The time to realize you should have included an airway in your kit is not when your shooting buddy can't breathe due to face/airway trauma.

But most importantly, if you are serious.......get some training. I have seen some pretty cool customers get sucked into tending to nasty bleeders that are nothing more than superficial wounds, and ignore the life threatening stuff because "it didn't look as bad". Knowing the difference in what is life threatening and what is not goes a long way.

[MTechnik]

Whoever calls 911 should stay on the phone with dispatch. If the range isn't well marked, send someone to the gate to meet the ambulance and direct it in.

And make it CLEAR that it was an accidental/negligent shooting and the place is currently SAFE to approach.

If you just say there was a shooting at place X and hang up, they may come in SWAT mode, not "Get in and help the bleeder as soon as possible" and seconds count.

[peterb]

Even if you don't know how to insert an OPA/NPA, or how to properly use Combat Gauze, perhaps there is someone who does. The time to realize you should have included an airway in your kit is not when your shooting buddy can't breathe due to face/airway trauma.

With facial trauma, you often do NOT want to put a patient on their back, especially if you don't have suction available. Think about where gravity is taking those fluids, and the importance of a clean airway. Positioning is something you can do with no equipment.


But most importantly, if you are serious.......get some training. I have seen some pretty cool customers get sucked into tending to nasty bleeders that are nothing more than superficial wounds, and ignore the life threatening stuff because "it didn't look as bad". Knowing the difference in what is life threatening and what is not goes a long way.

Yup. Scalp woulds bleed like crazy and make the patient look awful, but are rarely serious. Open fractures sure look serious, but they won't kill your patient in the next couple of minutes. That little hissing noise from his chest might.

It's easy to get tunnel vision. On our volunteer squad, we found that it's good to have someone take a step back and monitor the overall care while others do the hands-on stuff. They can pay attention to the whole patient instead of a specific wound.

[dsa]

Most ranges are in a rural area with a significant ground transport time to the hospital. I suggest that you have GPS coordinates (lat/long) available and provide that information to the 911 dispatcher and request helicopter EMS in the event of an accidental shooting at the range. Where I live that is how to get both of them (ground and air units) coming at the same time. Often times an air unit is not requested until a ground crew is on scene and has performed an assessment, ultimately delaying the time it takes to get the injured to the operating room. Air units usually have a wider scope of practice and are trained to a higher standard. The goal is to preserve as much of the "golden hour" as possible.

[Arclight]

Most ranges are in a rural area with a significant ground transport time to the hospital.

In places like Idaho, maybe, but in many places you're not going to have to do prolonged care even in rural areas thanks to ALS response times. That said, your point about having the right information (GPS coords, knowledge of local systems) ahead of time is excellent advice and should be followed whether you're out on the range in rural Idaho or at the range near me that is a stone's throw from a trauma center.


They went into tension pneumothorax, but stayed away from needle decompressions as outside the scope of the class.

I agree with them on this. And this is one of the skills I was talking about when I mentioned not getting beyond your skills and legal coverage. Knowing how to recognize tension pneumo is good. Having people with one day of medical training think they're equipped to handle it is probably unwise.

If you are in an extremely rural area (45+ min from definitive care) and you're either certified in that location to perform that skill or willing to risk legal repercussions, then it's definitely a good idea to have the tools for doing needle decompressions and similar skills.

However, most people at most ranges most of the time are neither trained for such a task, nor will it be needed. When the time to definitive care is short, you're at greater risk having a needle shoved into your chest by a nervous amateur than you are by waiting 10 minutes. In most jurisdictions, even EMT-B providers cannot do needle decompressions.

As for Quick Clot and Combat Gauze, check the EMS protocols for where you will be operating and see what's allowed. Many places are only recently allowing use of non-exothermic clotting agents, but only under certain circumstances. Further, there have been concerns regarding the powdered versions, and many combat (TCCC) users are sticking to infused gauze (like Combat Gauze) over the old powders.

At the end of the day, you can carry whatever gear you want. Only your judgment can tell you where exigent circumstances outweigh the legal risks of using it. Just remember that medical professionals are called that because they do a lot of learning before they put hands on a patient.

[Arclight]

But since we strayed into the discussion of sticking needles in people's chests, this is for anyone who is looking forward to doing their fist needle decompression of a tension pneumo/hemopneumothorax.

Check out this brief instructional video (http://www.youtube.com/embed/fQqPktj_gFc?rel=0) (which I failed to embed).

Not intended to scare you off from learning and understanding this, but definitely intended to make you think twice before trying this (or letting someone else try this) when it's not absolutely necessary.

[NickDrak]

I carry a TRIK: http://medicaltactics.com/trik.php, and a SOF tourniquet in my med kit for work and for the range.

[John Ralston]

Can someone explain the issue with Quick Clot in actual english, for those of us without a Med Background? I have a few pouches of it in the kit in my Firstaid Packs that I take with me Hunting/Shooting/etc. Sounded like something that might be good to have in an emergency.

Should I take it out? Is there something better?

Also - anyone familiar with http://www.elite1staid.com/site/first_aid.htm

[peterb]

Some of the quick-clotting products are exothermic, meaning that they give off heat as they work. It can be enough heat to damage the surrounding tissue.

The other issue is that they can be difficult to remove from the wound. Cleaning a wound is important for proper healing.

The first-generation granular stuff had these issues. Manufacturers do keep making improvements. I don't know if there's a definitive list of what's good or bad.

My state protocols specify non-exothermic and washable with normal saline, but don't specify any brands.

[John Ralston]

Some of the quick-clotting products are exothermic, meaning that they give off heat as they work. It can be enough heat to damage the surrounding tissue.

The other issue is that they can be difficult to remove from the wound. Cleaning a wound is important for proper healing.

The first-generation granular stuff had these issues. Manufacturers do keep making improvements. I don't know if there's a definitive list of what's good or bad.

My state protocols specify non-exothermic and washable with normal saline, but don't specify any brands.

Thanks - I will check what I have and replace if necessary (and save it for a last resort)

[vaspence]

Don't forget those CPR/AED skills. I honestly worry more about someone keeling over from a heart attack at the range than a gunshot wound. Followed by heat exhaustion/stroke as my next concern. Some of our matches are 4-6 hours long with limited shade.

A lot of good info in this thread.

[Arclight]

Can someone explain the issue with Quick Clot in actual english?

In addition to what Peterb said above about the old, exothermic variety, there were concerns with the granules entering the bloodstream and acting in places they were not intended for (that's bad). Part of this comes from proper application issues. The granules were intended to be introduced to the periphery of the wound, but in the "dynamic environment" (meaning, people are shooting and other people are bleeding, usually in the dark) the granules generally just got dumped into the wound. Because of that, the infused gauze model is currently preferred.

My own experience is with Combat Gauze, but I think the principle is the same for the other varieties -- you pack the wound with gauze that also works actively to stop bleeding.

Does that mean throw out your (likely expensive) granules? Not necessarily, but make sure you know what they are, how to use them properly, and make sure they're not prohibited by local medical protocols.


Also - anyone familiar with...

I'm not familiar with them, but there are lots of decent suppliers out there for medical kits. You sometimes pay a premium for having one pre-built, but unless you have a few people to split supplies with, you will likely end up with a lot of spare stuff around (you can't buy just a couple of 4x4 gauze pads).

I'm a fan of North American Rescue's gear (not affiliated with them in any way, but have used their products and been happy with them). If you're looking for a single-purpose but high-end trauma kit for the range, I like the Individual Patrol Officer Kit - Combat Gauze (http://www.narescue.com/Individual_Patrol_Officer_Kit_%28IPOK-CG_Combat_Gauze%29-CN1C91835F6180.html?BC=01CAD72151F1). Between the CAT-T and the Combat Gauze, it's pricey, but it's hard to beat that for bleeding control.

As vaspence wisely noted, most range issues are thankfully not GSWs. Occasionally they're serious medical events secondary to exertion (like those needing CPR). Most are boo-boos, heat exhaustion, sprains, and so forth. Having a few band-aids, some antiseptic wipes and aspirin will likely serve you well, even if you carry a tourniquet in every pocket.

If you want something more general, you may do well assembling it yourself based on what situations you're preparing for and what skills you have to use it. Alternatively, much of what you'll actually need can be found in hiking/outdoor first aid kits (http://www.rei.com/search?query=aid&button.x=0&button.y=0) which you can supplement with a couple of activity-specific items (like a tourniquet). Those even come with a book on how to use the stuff.

As has been said above a few times, don't get hung up on the cool guy gear -- get good, functional basics, have them with you, and know how to use them.

[Odin Bravo One]

The Combat Gauze is a good piece of gear. If I only carried two pieces of first aid equipment, it would be a SOF-T and Combat Gauze. Used properly, it will stop a severed femoral artery bleed.

[John Ralston]

I am not a big fan of CAT tourniquet......that said, I have "heard", and "understand" that they have upgraded their winlass, and corrected prior deficiencies in materials and workmanship. But I will never use one again. I prefer the SOF-T, or other with a metal winlass that will not break.

Can the SOF-T be applied One handed? From reading the posts above, that is the reason for having a CAT in one's kit.

[MattInFla]

But since we strayed into the discussion of sticking needles in people's chests, this is for anyone who is looking forward to doing their fist needle decompression of a tension pneumo/hemopneumothorax.

Check out this brief instructional video (http://www.youtube.com/embed/fQqPktj_gFc?rel=0) (which I failed to embed).

Not intended to scare you off from learning and understanding this, but definitely intended to make you think twice before trying this (or letting someone else try this) when it's not absolutely necessary.

Absolutely. There's a world of hurt available when that procedure is either incorrectly performed or performed when not indicated. Not something, IMHO, anyone at the BLS level should even be considering. Proper placement of occlusive dressings, and the "burp" are far more appropriate BLS level management of wound with the potential of developing a tension pneumothorax.

Matt

[Odin Bravo One]

Can the SOF-T be applied One handed? From reading the posts above, that is the reason for having a CAT in one's kit.

John,

Yes it can. I would go so far as to say if the tourniquet in question cannot be applied with one hand, then it is essentially useless. You never know when you are going to need it, or the circumstances involved.......or if there will even be anyone else around.

However, for me, the ability to apply a tourniquet one handed is just one criteria. The ability to be applied with sufficient pressure to stop a major arterial bleed should also be considered. The older C-A-T's had a very poor record in this area, and several hundred documented cases of winlass snappage during the course of application. Like I said......there were apparently some material changes, and there is a new and improved C-A-T, but as long as the SOF-T is available, it will be my choice until something better comes along.

[John Ralston]

John,

Yes it can. I would go so far as to say if the tourniquet in question cannot be applied with one hand, then it is essentially useless. You never know when you are going to need it, or the circumstances involved.......or if there will even be anyone else around.

However, for me, the ability to apply a tourniquet one handed is just one criteria. The ability to be applied with sufficient pressure to stop a major arterial bleed should also be considered. The older C-A-T's had a very poor record in this area, and several hundred documented cases of winlass snappage during the course of application. Like I said......there were apparently some material changes, and there is a new and improved C-A-T, but as long as the SOF-T is available, it will be my choice until something better comes along.

Thanks - great info there. I will be getting off my ass and putting together a kit ASAP.

[Arclight]

Can the SOF-T be applied One handed? From reading the posts above, that is the reason for having a CAT in one's kit.

While this has been answered, I'll note for the record that my aforementioned preference for the CAT is a combination of familiarity and ease of use, and because it's easier to positively lock in place with one hand once it's in position. I have at least one SOF-T as well and the metal windlass is definitely sturdy if that's your concern. If your primary issue is the ability to really crank it down (for example, if you or a training partner are disabled or don't have strong hands), a ratcheting model might be a better choice. There are many decent options among a sea of hangers-on.

What I look for in a tourniquet is not so much one model vs. another, but these criteria that boil down to a proven design (this means used "for real" on a scale large enough to matter, by people who know what they're doing):

- Proven ability to stop bleeding (you'd be surprised)
- Ease of use (you have to be able to operate it under stress in low light)
- Ability to fully don one-handed.
- Durability for being carried in harsh conditions over time.

Most of the anecdotal breakages I'm aware of on the old CAT-Ts were from them being used in training and not being able to stand up to repeated heavy use. The new ones have apparently overcome that issue but if you want durable, it's hard to beat the SOF-T.

[John Ralston]

In checking out the IFAK's and other gear on the links above, I found the SOFTT-W (a wider and slightly different version of the SOF-T).

Any thoughts on that one?

[John Ralston]

A couple things I thought to mention, especially for you guys that go to various ranges to teach classes:

1. CPR Mask (although now they recommend compressions only)

2. Benadryl Capsules or Liquid for alergic reactions

You are probably more likely to have someone drop from a heart attack or get someone swelling up from a bee sting than a GSW, and those two items don't take up much room in a kit.

[SmokeJumper]

Some of the quick-clotting products are exothermic, meaning that they give off heat as they work. It can be enough heat to damage the surrounding tissue.

The other issue is that they can be difficult to remove from the wound. Cleaning a wound is important for proper healing.

The first-generation granular stuff had these issues. Manufacturers do keep making improvements. I don't know if there's a definitive list of what's good or bad.

My state protocols specify non-exothermic and washable with normal saline, but don't specify any brands.

I just inquired about the Quikclot with a paramedic that trains with our team. He informed the same as you have, but also advised on new information coming out that these clotting agents can cause or increase the risk of strokes later on. Any info.? Good post by the way

[Arclight]

... but also advised on new information coming out that these clotting agents can cause or increase the risk of strokes later on.

I have heard preliminary concerns about this being an issue for the granule type. As noted above, if small granules are introduced the wrong way they can get into the bloodstream and do bad things. Clotting occurring elsewhere in the circulatory system (especially in the brain) is... problematic. One of the goals of the infused gauze approach was to keep the clotting agents in the wound where it does the most good and the least harm.

That all said, I have not seen a large scale formal study of this, so I'm definitely interested in some solid results. This is a relatively new "technology", medically speaking, so we may discover issues with the infused gauze approach as well. Finally, as with many medical procedures, it's a risk/gain calculus. If I have a 5% risk of stroke but an 80% risk of bleeding to death before definitive care, I'll accept the stroke risk. The goal of the technology improvements, of course, is to imbalance that equation heavily on the gain side.

If you see a reputable medical report on it, please share it with the group. Knowledge helps us all.

[Arclight]

In checking out the IFAK's and other gear on the links above, I found the SOFTT-W (a wider and slightly different version of the SOF-T).
Any thoughts on that one?

With the huge caveat that I've never seen one in person, all I'll say is this:
If it's based off the SOF-T without any real changes other than being wider, then it's probably good to go. I still prefer to give new designs some time to prove themselves before replacing my known-effective solutions (CAT-T, SOF-T, ratchet) with a new model.

See my criteria above for how I choose that kind of gear.


CPR Mask.... Benadryl

I carry both of these things but as you noted, compressions are the crucial part of CPR now so I no longer consider a mask to be necessary in a basic, range type FAK.

I second the Benadryl as being part of a general kit. In an urban (close to care) environment, you likely won't need it, but I carry some in the car at all times, and in my hiking pack. It won't cure a severe allergic reaction, but it might just buy you enough time to get real help before your throat swells shut.

[JSGlock34]

Good article on the use of IFAKs by first responders to the Tucson shooting here (http://www.washingtonpost.com/wp-dyn/content/article/2011/01/21/AR2011012105860.html?hpid=topnews).

[Arclight]

I increasingly feel remiss in not sharing the following observation:

Tourniquets should be carried and can save lives, but their use is still inherently risky. Some prehospital tourniquets are relatively safer than others and proper application of these models helps mitigate the risks.

While modern prehospital care has gotten over the old belief that any limb with a tourniquet applied must be amputated, tourniquets are still a last-resort tool with good reason.

Medical research going back to at least the 1970s shows serious nerve damage in cases of prolonged pressure to tissue. Note that this example from the journal Transactions of the American Neurological Association uses a pneumatic cuff, which is considered less damaging than the narrow, manually tightened cuffs in modern military tourniquets due to the pneumatic cuff's relatively even pressure over the tissue. Pneumatic cuffs are typically used in surgical situations.:
Using a cuff inflated to 1000 mm Hg round- the leg of the baboon for 1 to 2 hours, it had been found that the anatomical lesions were concentrated under the edges of the cuff, with sparing in the centre . Furthermore, the lesions themselves involved displacement of structures within the nerve fibres, suggesting that there had been axoplasmic movement from the site of compression towards uncompressed tissue.(Ochoa, Fowler, Danta, and Gilliatt, 1971) In other words, the edges of the tourniquet compressed the tissue with enough pressure to pinch the long part of the neuron (the axon), causing damage.

One reason I highlight this is that there's a difference in pressures caused by different types of tourniquets. Most notably, elastic band tourniquets can cause extremely high pressures. Many law enforcement agencies select this variety because they are typically cheaper.

Rather than try to recharacterize it all, I'll just share how Tacmedsolutions' blog reported quite clearly the additional risks of elastic band tourniquets:
As noted in the Journal of Medicine and Biomedical Research, “[t]he pressure induced by the rubber bandage increases at a rate of 3 to 4 times the initial pressure when the bandage is stretched after each wrap.”(1)(3) This is dangerous due to the shearing effect generated on the underling tissues, specifically the nerves. In fact, Graham et al found that at above 300mm Hg shearing forces increased exponentially.(2)(3) With RBTs this is concerning as “[t]he pressure applied to the limb could easily exceed the safe limits and put the limb at risk of complications because the rubber bandage is capable of generating pressures in excess of 1000mmHg beneath it.” “At such extremely high pressure,” Ogbemudia continues, “neurovascular damage becomes likely and makes the use of the RBT relatively unsafe.”
[1] Ogbemudia A et al. Adaptation of the rubber bandage for the safe use as tourniquet. Journal of Medicine and biomedical Research 2006; Vol. 5 No. 2 pp-69-74.
[2] Graham B et al. Perinerual pressures under the pneumatic tourniquet in the upper and lower extremity. Journal of Hand Surgery 1992: 17B: 262-6.
[3] McEwen J. A. and Casey V. Measurement of hazardous pressure levels and gradients produced on human limbs by non-pneumatic tourniquets.

In other words, tourniquets can cause lasting damage if they apply too much pressure to the tissue. Elastic band tourniquets are, by nature, most prone to inadvertent overtightening. While any tourniquet is better than no tourniquet if circumstances require one, if you have the option to carry the relatively safer models, and you use them properly and only when needed, your patient's outcome will likely be better.

[Dann-in-Ohio]

This is a link to my thoughts on the subject:

http://godgalsgunsgrub.blogspot.com/2011/07/first-aid-and-thinking-ahead-with-guns.html

Dann in Ohio

[Mitchell, Esq.]

For $25 you can get this:

http://www.adventuremedicalkits.com/product.php?catname=Sportsman&prodname=Trauma Pak with QuikClot®&product=247


Bandage Materials

1 Bandage, Conforming Gauze, 3"
1 Dressing, Gauze, Sterile, 2" x 2", Pkg./2
1 Dressing, Gauze, Sterile, 4" x 4", Pkg./2

Bleeding
1 Gloves, Nitrile (Pair), Hand Wipe
1 QuikClot Sport 25g
1 Trauma Pad, 5" x 9"

Duct Tape
1 Duct Tape, 2" x 26"

Fracture / Sprain
1 Bandage, Triangular

Wound Care
4 After Cuts & Scrapes Antiseptic Wipe

That's what I keep in my glove box in the car, and when I'm in colder weather, in my coat pocket. Another goes with me to the range in my ammo bag in addition to a larger kit in a seperate bag.

[NickA]

For $25 you can get this:

http://www.adventuremedicalkits.com/product.php?catname=Sportsman&prodname=Trauma Pak with QuikClot®&product=247


Bandage Materials

1 Bandage, Conforming Gauze, 3"
1 Dressing, Gauze, Sterile, 2" x 2", Pkg./2
1 Dressing, Gauze, Sterile, 4" x 4", Pkg./2

Bleeding
1 Gloves, Nitrile (Pair), Hand Wipe
1 QuikClot Sport 25g
1 Trauma Pad, 5" x 9"

Duct Tape
1 Duct Tape, 2" x 26"

Fracture / Sprain
1 Bandage, Triangular

Wound Care
4 After Cuts & Scrapes Antiseptic Wipe

That's what I keep in my glove box in the car, and when I'm in colder weather, in my coat pocket. Another goes with me to the range in my ammo bag in addition to a larger kit in a seperate bag.

Just ordered a couple of these from LA Police Gear, on sale for 19.99 and seems to be a good basic kit.
I also threw in a couple of Israeli battle dressings since they're cheap. I haven't seen them mentioned here but did see a brief demo in a class. Are they worth keeping handy or not?

Sent from my PC36100 using Tapatalk

[BWT]

You know, I've seen vehicular related death (it killed her... it was pretty clear) and an AR-15 blew up at the Carbine Match this month.

You know the thought "What if she hadn't been killed?" Ran through my mind.

I might pick up that medical kit. Some things like compression, gauze, etc, might not be a bad idea to keep in the trunk of the car for medical emergencies.

Let's face it, where's most shooting done, remote areas, as cheap as some of that stuff is, it's foolish not to.

[Arclight]

Just ordered a couple of these from LA Police Gear, on sale for 19.99 and seems to be a good basic kit.
I also threw in a couple of Israeli battle dressings since they're cheap. I haven't seen them mentioned here but did see a brief demo in a class. Are they worth keeping handy or not?

They're popular, but if I have limited space it's not what I'd take in a small kit. I've seen them break in training multiple times, so I don't consider them especially reliable. That said, if you have them already and you have space, they're not a bad extra option to have on hand. If they're cheap enough and you haven't spent time hands-on, open one up and practice with it so you know what you're doing (and how durable they are/aren't) before the day comes. Just remember that they're not a substitute for a tourniquet.

[mnealtx]

Did the ones you've seen break do so from being used like a tourniquet, or more 'normal' use?

[Skold]

These seemed like a decent blowout kit with everything vacuum sealed into a package. All you would need to add is a tourniquet and possibly some shears. Here is the link: http://www.itstactical.com/store/its-eta-trauma-kit/

Any thoughts on this kit would be great!

[NickA]

They're popular, but if I have limited space it's not what I'd take in a small kit. I've seen them break in training multiple times, so I don't consider them especially reliable. That said, if you have them already and you have space, they're not a bad extra option to have on hand. If they're cheap enough and you haven't spent time hands-on, open one up and practice with it so you know what you're doing (and how durable they are/aren't) before the day comes. Just remember that they're not a substitute for a tourniquet.

Thanks Arclight. I'll keep the IBD's around if I have room or most likely in the car or around the house for less critical situations. A few questions :
I plan to add some shears to the kit, is there anything else you'd recommend adding for a basic FAK for the range?
Also if I understand right the triangular bandage in that kit can be used as a tourniquet, or should I add a real one?

Sent from my PC36100 using Tapatalk

[Argus]

These seemed like a decent blowout kit with everything vacuum sealed into a package. All you would need to add is a tourniquet and possibly some shears. Here is the link: http://www.itstactical.com/store/its-eta-trauma-kit/

Any thoughts on this kit would be great!

Looks like a nice kit, assuming you've got (or are getting) the knowledge to use all the stuff in it. I've only had basic first aid training, so right now my job would basically be to plug the hole, apply direct pressure and wait for help. Consequently, my first aid kit consists of a CAT tourniquet, an OLAES bandage, some PriMed packed gauze and an ACE wrap, trauma shears and a pair of gloves. For my knowledge level, pretty much anything more than that would just be taking up space.

[TGS]

My background:

EMT-FR. Ran with a BLS squad my senior year in high school and also at my college.

USMC combat first aid stuff.

Okay,

In my USMC training, we were taught to keep at least one gauze/bandage already opened, with the rest sealed/sterilized. The rationale behind this was from experience overseas in having a hard time ripping open the plastic packaging when your hands are soaked in blood....along with all the stuff that comes with stress. This way, you'd still be able to treat an urgent problem......infection can be treated later, keep the patient from bleeding out now.

Thus, my first aid kits have 1 unsterilized, opened gauze/bandage for this purpose.

Thoughts?

[peterb]

Thus, my first aid kits have 1 unsterilized, opened gauze for this purpose.

Thoughts?

Volunteer EMT-B here. I keep a wad of unwrapped 4x4s in the top of my jump kit for similar reasons. Tearing open packages gets harder with gloves and especially with wet gloves. If the need is urgent I can slap some in place with one hand. If it's not as serious I use the unwrapped ones for cleanup before opening the sterile ones to make a proper dressing.

[SamuelBLong]

In my USMC training, we were taught to keep at least one gauze/bandage already opened, with the rest sealed/sterilized. The rationale behind this was from experience overseas in having a hard time ripping open the plastic packaging when your hands are soaked in blood....along with all the stuff that comes with stress. This way, you'd still be able to treat an urgent problem......infection can be treated later, keep the patient from bleeding out now.

Thus, my first aid kits have 1 unsterilized, opened gauze/bandage for this purpose.

Thoughts?


There are bigger things to worry about than infection at the time of a GSW. Let the ER, Surgeons and ICU worry about debridement and infection control. As the on scene responder, your job is to make sure the injured person(s) can get to those people. Stop the bleeding.

As long as the first dressing remains "clean", it doesn't have to be completely sealed in the sterile packaging. Id recommend opening it enough to be easily accessed, but not just flopping around the inside if your IFAK / MedKit / Etc. with no protection.

[Dropkick]

Hmm... that's some interesting food for thought about having pre-opened packages to bandages, etc.

[peterb]

I learned that lesson on one of my first calls. Brand-new EMT, brand-new kit, not used to working in gloves. I spent an embarrassing amount of time trying to start new rolls of tape and get packages open. Now my tape all has folded tabs, and I immediately reach for the trauma shears if packaging gives me any grief. Training with gloves on helps, as do gloves that fit.

On a related note: In an article on using a home vacuum bagger/heat sealer for emergency supplies, the author suggested putting in a large nail so that you could open the bag without tools.

[TGS]

Note to any interested parties: Remember not to go overboard......if you have it, leave the Combat Gauze sealed :)

[Mitchell, Esq.]

Hmm... that's some interesting food for thought about having pre-opened packages to bandages, etc.

Exactly my thoughts.

How does this interact with the ability to use quick clot agents? If the wound already has a bandage on it, do you remove the bandage to apply the QC, or just put the QC impregnated bandage ontop of the bandage already on the wound?

[TGS]

Exactly my thoughts.

How does this interact with the ability to use quick clot agents? If the wound already has a bandage on it, do you remove the bandage to apply the QC, or just put the QC impregnated bandage ontop of the bandage already on the wound?

The proper application of Combat Gauze is to stuff the wound with it...so if the bleeding hasn't stopped by the time you get the combat gauze out, that would involve removing the current bandage, stuffing with Combat Gauze, then reapplying the regular bandage with direct pressure for 2-3 minutes before tying it off. That's how I was taught, so if the more qualified guys on here have something to add, please do.

Even if you use one Combat Gauze and it's still bleeding, you have to remove the combat gauze in order to apply a fresh combat gauze, so I don't see why it'd be different if you've already got a standard bandage on/in the wound.

Video on use of Combat Gauze (http://www.youtube.com/watch?v=C3TUKKx0cus)

[SamuelBLong]

Note to any interested parties: Remember not to go overboard......if you have it, leave the Combat Gauze sealed :)

Its really important that your hemostatics remained sealed and within the expiration date. Don't open them until the moment you're about to use them.

If they're old, cycle them out. Use expired supplies to build a duplicate of your kit so you can train / practice without having to open up a bunch of new stuff.


The proper application of Combat Gauze is to stuff the wound with it...so if the bleeding hasn't stopped by the time you get the combat gauze out, that would involve removing the current bandage, stuffing with Combat Gauze, then reapplying the regular bandage with direct pressure for 2-3 minutes before tying it off. That's how I was taught, so if the more qualified guys on here have something to add, please do.

Even if you use one Combat Gauze and it's still bleeding, you have to remove the combat gauze in order to apply a fresh combat gauze, so I don't see why it'd be different if you've already got a standard bandage on/in the wound.



Correct.

What is most often taught is that the base layer of gauze should not be removed because you will disturb any clot formation that has occurred. However, if the bleeding is that bad that you're moving to a hemostatic, the reduced arterial flow from a tourniquet (if its an area that you can use one) and those existing clots in the base layer of plain gauze / dressings aren't buying you much.

Hemostatics cause large amounts of coagulation right at the moment they are introduced. You end up getting one massive clot that stops the bleeding vs a bunch of small micro clots in that first base layer of the plain dressing only.

Hold pressure on that initial dressing until the hemostatic is open, in hand, and you can see the bleeding. Use that existing soaked through dressing to scoop out any pooled blood. From there its a simple, very quick swap. Remember to hold pressure after application.... thats the same, no matter if you use the powders or the impregnated sponges / gauze.

[Dropkick]

Given F-Trooper05 recent experience,
http://pistol-forum.com/showthread.php?4707-GSW-Special-thanks-to-Todd-Green-and-Jason-Falla
This thread could use a bump.

[vcdgrips]

Any thought on the Tactical Response VOK as a good starting point? I am specifically thinking about the realatively simply TK-4 TourneKwik and the enclosed needle?


http://www.tacticalresponsegear.com/catalog/product_info.php?products_id=2417


David

[JodyH]

I start with a VOK, add a Celox 35g and some EMT shears then put everything in a Spec-Ops Brand large medical pouch.
Has everything you need for immediate gun shot wound care.
The larger more complicated kits are just that... large and complicated.

Honestly... gloves, feminine hygiene pads, duct tape and a tourniquet placed in a plastic Zip-lock makes for a damn good cheap gun shot wound repair kit.
:cool:

[Odin Bravo One]

Careful with the Tourni's.

The CAT was recently (within the last two weeks) the subject of an inter-department memo of an extremely large purchaser that there are cheap knock-off's being produced, marketed, and sold under the same name and NSN.

I have never liked the CAT, but this recent information would certainly cause me to re-think my choices if I had one, or planned on buying one.

[Corlissimo]

Careful with the Tourni's.

The CAT was recently (within the last two weeks) the subject of an inter-department memo of an extremely large purchaser that there are cheap knock-off's being produced, marketed, and sold under the same name and NSN.

I have never liked the CAT, but this recent information would certainly cause me to re-think my choices if I had one, or planned on buying one.

Since I'm new to this subject, and working on my AIWB, a Blowout Kit in high on my list. Actually, I'm kind of embarrassed that it's taken me this long to get to this "epiphany". That said, I'm looking at a couple ready-made kits. Since there's an issue with the CAT, does that mean the SOF-T is the optimum choice?

Please educate me gentlemen.

[Odin Bravo One]

My experience has shown the SOF-T to be the hands down winner long before this recent turn of events.

Pre-made kits are fine. But so are the items Jody H mentions above.

[TCinVA]

When you're used to being on the range with a bunch of guys who have IFAK's and a full-on trauma kit, you can start to take access to the right stuff for granted.

Recently I've been on a couple of trips where mine is the only IFAK around and I'm the only person who has given any thought to the possibility of a GSW. It's time to actually pay attention to what is in my kit.

[Corlissimo]

^^^This hasn't been the case for me TC. For the last couple years I've been shooting on an indoor range with ZERO supervision by any SO/RO (that I'm aware of) and I never really thought about it much.

Lately though, there's been an increasing number of less than safe people there so now I go midday & midweek and I'm usually the only one there. Scary stuff now that my light bulb has gone on re: IFAKs. AIWB has only intensified my drive to find both an EDC kit as well as one for my range bag. I like that kit Todd covered on P-T.com.

--
Sent from my personal Droid. Please excuse any typos, my Droid's kinda stupid. (°_°)

[BaiHu]

I was talking to a buddy of mine about this thread, b/c I don't have much training in first aid, but would like to and he had this to say in an email today:

"A lot of people seem to be asking about kits with decompression needles and NPA's, or have already bought them. I really think this needs to be addressed further than it was touched upon in Arclights, "Medkit for the Range" thread where he posted an excellent video detailing some dangers to decompression needles.

I find it interesting that on a forum where the consensus is to not get involved in saving a strangers' life by using your sidearm simply because of the legal nightmarish possibilities, that people would include these items in a medical kit. And not to be disrespectful, but this really needs to be said: If you're asking, "do you think this is a good kit to get?" then you have absolutely NO business buying a kit with a decompression needle or NPA. If you truly knew how to use those items, you wouldn't be asking what kit to get.

Back to the mention of legal issues. The Good Samaritan Law; look it up for your state or any state you plan on using these items. You really need to consider whether you're OK with using invasive procedures beyond first aid. FWIW, decompression needles are far beyond the level of most EMT's. Consider that the ambulance responding to your range GSW probably isn't staffed by people who are allowed to use or trained on decompression needles. Some states/locales are pretty much always advanced life support (ALS), meaning they have at least one paramedic on board who can do things like decompression needles. The vast majority of the nation's EMS, especially in rural areas where ranges are usually located, is not.

1) In laymans terms, consider that Paramedics go through significant amounts of high quality training (2 years in NJ) but are still not allowed to use decompression needles when off-duty/not in their operating region. Yes, there's some EMS specific laws/protocol concerning "medical direction" going on with this, but it still makes a good point: If they can't, should you be using a decompression needle?

2) Consider that tension pnuemothorax is one of the leading causes of death on a battlefield, yet the last time I checked using decompression needles was removed from the USMC Combat Life Saver curriculum/skills. Should you be using a decompression needle?

So, ask yourself a question. "Am I willing to shoot a person who's obviosly trying to take a strangers' life?" If your answer is "no," then your answer should also be "no" to using invasive, advanced life support techniques and tools. If you're okay with it, or you're only considering to use it on good friends who you know well, have discussed it with and have a mutual understanding with, then no matter what your training on such shouldn't be coming from online videos. This is way beyond basic first aid.

Just so I'm clear, I'm not trying to be a jerk...I think it's AWESOME to see so many people interested in helping their fellow man. It's also pretty common among new EMT's to go out and buy a whole bunch of EMT specific gear, like fully stocked trauma bags that could serve on an ambulance. Yet, they legally aren't covered by the Good Samaritan Law to use much of it when off-duty/not in their region. By doing so, they're opening themselves up to a WHOLE lot of legal repercussions...some states such as Florida seem to be VERY hardcore on this stuff (i.e., it doesn't matter you saved his life, we're coming after you for doing stuff you're not suppose to be doing). I also realize and respect that you're all grown-ups and can make your own decisions, but I really felt this needed to be addressed.

Temper heroism with realism."

Back to your regular schedule convo :D

[Al T.]

A bump. I shamelessly stole this off another board:

I have followed both Morgan Atwood and Ian Wendt for a couple of years now. They both make top notch gear and write great blogs (seriously, go spend a few hours when you have time - you will learn a lot). But I have been waiting for something like this to come out for a very long time, and they recorded a block they taught at Paul-E-Palooza. .. which didn't turn out well for technical reasons... so they generously rerecorded and distributed the material for free on the InterWebz.

Salty language alert, perhaps NSFW.

http://specialcircumstancesinc.blogspot.com/2012/10/blow-out-kit-basics-preface-to.html

http://specialcircumstancesinc.blogspot.com/2012/10/hemostatics-myths-lies-facts.html

[Arclight]

In my USMC training, we were taught to keep at least one gauze/bandage already opened, with the rest sealed/sterilized. The rationale behind this was from experience overseas in having a hard time ripping open the plastic packaging when your hands are soaked in blood....along with all the stuff that comes with stress. This way, you'd still be able to treat an urgent problem......infection can be treated later, keep the patient from bleeding out now.
Thus, my first aid kits have 1 unsterilized, opened gauze/bandage for this purpose.
Thoughts?

I realize this comment was from a while ago, but it warrants a response...

You're spot on that many packages are not easy to open in low light, under stress and forget about with bloody, gloved hands. However, using contaminated equipment (anything open is contaminated) adds serious risk to the patient. Yes, many infections can be treated later and the priority is stopping the blood now -- no argument there-- but why not have both?

My solution (mine, in that I use it, not that I invented it -- a SEAL medic taught it to me) is to slightly dog-ear the edges of the package (gauze, kling wrap, ACS, etc.) and put tiny wings of duct tape folded over itself on each side. They're not open far enough to break the seal, but the technique gives you a lot more grip. Is it as fast as having it unwrapped? No, but it means you still have sterile kit (especially important if you're packing it into a wound) that you can get to.

I suppose you could go so far as to attach one of the wings to the inside of their medkit by little safety pins so when you pull the other side it opens one handed. I never took that step, but it could be worth a try if your kit setup allows that. I wouldn't put that into my go-to kit until I'd played with it a bit.

As with anything worth doing, it takes a little practice and some preparation.

[TGS]

Thanks for the response! I totally get what you're saying. I brought up the legitimate danger of infection in another thread, actually. Totally on board.

The bags we had in the USMC were pretty heavy duty and without room for cutouts, so you can see the difficulty with that when there's not even any cutouts. Wayyyy heavier duty than the packaging most civilian medical gear comes in, like gauze rolls or 4x4's. With gauze rolls and 4x4s, I just leave them sealed up because they're very easy to open.

I've tried adding little wings to packaging with duct tape, but I always seemed to rip off the wings instead of opening the packaging. In my GSW kit for the range, I keep one sealed OLAES because 1) it's a huge bandage and needs to be vacuum packed for size, 2) it's not too difficult to open and 3) I have another bandage already opened which I can use immediately.

But my Israeli dressing is opened. The outer wrapper isn't hard to open with those, but I found the inner clear plastic bag can be a bitch if your hands are wet, shaking, ect. I inspect the Israeli dressing regularly to make sure it's still clean, and it's folded up so that the dressing is covered by itself and can be unfolded with one movement and applied. Soon enough here, it's going to cycle into training use just because it's been opened for about 6 months.

I'm going to order the North American Rescue ETD (http://www.narescue.com/Emergency_Trauma_Dressing_%28ETD%29-CN3628A28F222B.html?BC=8A50801E34A7) to replace the Izzy, simply because it doesn't have the redundant inner wrapper and can be kept sealed while still being easy to open.

[Arclight]

I've tried adding little wings to packaging with duct tape, but I always seemed to rip off the wings instead of opening the packaging.

I've definitely had this problem too. Sometimes it depends on the material of the packaging. One trick that can work, but is a compromise, is to staple the duct tape wings on. It's a compromise because you really don't want small sharp things around where your nitrile gloves will be. I've seen tape, staple, then tape over the staple too. Even with small pieces, that gets chunky, but it seems to work.

Really, someone should just design packaging that has wings built in. I've seen this in other industries....

And yes... you can compromise too. Way back when I started in EMS, we used to carry a lot of nonsterile dressings. The rule was that the sterile dressing is the one that's in contact with the wound and the nonsterile can go over that.

As a side note, this is a good chance to say this: Ideally, your range buddies should have at least some training, even if it's just you going over with them what's in your kit. That way when you're elbow deep in blood, you can turn to a bystander and say "give me the combat gauze" and they'll know what to do. Not a luxury you can count on (and clearly you're thinking ahead to prep your gear which is very smart) but a good use of resources if the situation allows.

[Odin Bravo One]

I dog ear every item in the kit, as well as the outer package. I have safety pins in my kit, but prefer to save those for large abdominal wounds(I.e., guts falling out), and not have in use holding packaging closed. Anything and everything to make getting what you need easier. I also make sure my staple gun is always topped off, even if I know I am done after a few more minutes. You never know when a chest seal will not want to stay put, or you are using an improvised seal, and a staple gun works well for this. Of course safety pins work too, but are slower to apply.

Gorilla Tape, and true 100mph tape work well for dog earring your tabs. Using regular duct tape isn't a good solution as it tears way to easily. The two tapes listed above are not as easily torn, and have phenomenal adhesive strength.

I don't see a lot of use for non-sterile bandages. They will be non-sterile soon enough after being put in use. Unless I am carrying my full trauma kit, I am limited on resources for a blow out kit, range kit, IFAK, or whatever you choose to call it. I am guessing that most shooters, even those with a sizeable kit, are not hauling enough to waste one by letting it get contaminated before it is even put into use. I am not going to allow any of those items to become contaminated if I can help it.

[Arclight]

I don't see a lot of use for non-sterile bandages. ... Unless I am carrying my full trauma kit, I am limited on resources for a blow out kit, range kit, IFAK, or whatever you choose to call it. I am guessing that most shooters, even those with a sizable kit, are not hauling enough to waste one by letting it get contaminated before it is even put into use. I am not going to allow any of those items to become contaminated if I can help it.

Agreed. The solution is to make your sterile stuff open-able when you need it.

And to clarify, the safety pins in the hypothetical situation above were to attach one of the dog-ears to the kit so you can just pull the other one and open the package; they were not to hold the package closed. As before, I'm not advocating for this method, but it's one approach.

Really all of this comes down to training with your gear so you can open it, apply it and get the most value out of it under suboptimal conditions.

[Dropkick]

I also make sure my staple gun is always topped off, even if I know I am done after a few more minutes. You never know when a chest seal will not want to stay put, or you are using an improvised seal, and a staple gun works well for this. Of course safety pins work too, but are slower to apply.

Ugh, I would not want to be the poor sob that gets shot AND THEN needs a chest seal stapled on.

[STS]

I don't have time to read the whole thread so I'll just mention some things I have learned from treating a TON of gunshot wounds. I'd say the most important thing to have is a cell phone. You can have a great med kit, but if someone is critical, time is of the essence. First thing you need to do is getting EMS rolling. You also need to think about where you are at. This is especially important for instructors who travel and teach classes. There are a lot of questions that should be briefed and answered before training/class/shooting starts.

Can an ambulance reach you at the range? Is it better to load the pt into a private vehicle and meet the ambulance at the gate? Depending on gear and training and distances, along with if your cell phone has signal, you may need to load the pt and drive them a ways while you treat them. How far away is the nearest trauma center? Can a Flight for Life helicopter reach your location, or do you need to move the pt to a better spot? Who treats the patient? Who is in charge of activating the 911 system? Which vehicle is the designated vehicle for driving the patient out if needed, and where are the keys kept? What determines if you "stay and play or load and go?"

We train at several ranges and always brief our medical plan first. Two people are designated the incident IC, one primary one secondary (two just in case one of them is the victim). Their job is to activate the 911 system and coordinate/communicate with EMS. They do not take part in patient care at all. Each must have a cell phone. Depending on which range we are at, and the severity of the wound, we decide if it will be better to wait on location for EMS, drive the patient to the gate, down the road, etc to meet EMS, or to get a helicopter rolling. We designate one truck as the "ambulance" if needed and brief that the keys will be above the visor. Next we do a quick run down on medical supplies on hand and what skills each person has. We usually have a mix of cops, firefighters that are EMTs or medics, SWAT medics, military, etc. Briefing this whole plan only takes five minutes but will really cut down on confusion.

Usually when someone gets shot people freak and stop thinking. Everybody starts calling 911 while trying to treat the pt. Each person is doing his own pt assessment and treatment and its a cluster. Guys are ripping open med kits and stuffing this or that at the pt. You don't need ten guys trying to treat a gunshot wound at the range. I's say four max. One to be the gopher and get all the stuff needed out of the kits, one to expose the pt with trauma shears and two to apply treatment and asses. Remember there is only so much you can do at a range. You are basically trying to stabilize the pt as best as possible until more advanced EMS arrives.

[JodyH]

As to opening packages, my emt shears are front and center next to the gloves.
Glove up, expose and eval, open packaging with shears and treat.

Sent from my GT-P7510 using Tapatalk 2

[EMC]

I don't have time to read the whole thread so I'll just mention some things I have learned from treating a TON of gunshot wounds. I'd say the most important thing to have is a cell phone. You can have a great med kit, but if someone is critical, time is of the essence. First thing you need to do is getting EMS rolling. You also need to think about where you are at. This is especially important for instructors who travel and teach classes. There are a lot of questions that should be briefed and answered before training/class/shooting starts.

Can an ambulance reach you at the range? Is it better to load the pt into a private vehicle and meet the ambulance at the gate? Depending on gear and training and distances, along with if your cell phone has signal, you may need to load the pt and drive them a ways while you treat them. How far away is the nearest trauma center? Can a Flight for Life helicopter reach your location, or do you need to move the pt to a better spot? Who treats the patient? Who is in charge of activating the 911 system? Which vehicle is the designated vehicle for driving the patient out if needed, and where are the keys kept? What determines if you "stay and play or load and go?"

We train at several ranges and always brief our medical plan first. Two people are designated the incident IC, one primary one secondary (two just in case one of them is the victim). Their job is to activate the 911 system and coordinate/communicate with EMS. They do not take part in patient care at all. Each must have a cell phone. Depending on which range we are at, and the severity of the wound, we decide if it will be better to wait on location for EMS, drive the patient to the gate, down the road, etc to meet EMS, or to get a helicopter rolling. We designate one truck as the "ambulance" if needed and brief that the keys will be above the visor. Next we do a quick run down on medical supplies on hand and what skills each person has. We usually have a mix of cops, firefighters that are EMTs or medics, SWAT medics, military, etc. Briefing this whole plan only takes five minutes but will really cut down on confusion.

Usually when someone gets shot people freak and stop thinking. Everybody starts calling 911 while trying to treat the pt. Each person is doing his own pt assessment and treatment and its a cluster. Guys are ripping open med kits and stuffing this or that at the pt. You don't need ten guys trying to treat a gunshot wound at the range. I's say four max. One to be the gopher and get all the stuff needed out of the kits, one to expose the pt with trauma shears and two to apply treatment and asses. Remember there is only so much you can do at a range. You are basically trying to stabilize the pt as best as possible until more advanced EMS arrives.

This is great info. Having a good plan, division of labor, and good coms is better than having the perfect kit but no plan.

[BaiHu]

Thought this was worth putting here if you a) know what you are doing and b) just need a one stop shop piece of gear. This looks pretty good form what I've seen and read on this thread:
http://www.youtube.com/watch?v=pqUFs6pOuf4&feature=g-all

[John Ralston]

The Combat Gauze in my range kit has expired, so I need to replace it. Any recommended sources? Prices range from $25 on Amazon to $50+ online. Not sure if I trust an Amazon Retailer selling it at half of the prevailing price on the net.

[BaiHu]

The Combat Gauze in my range kit has expired, so I need to replace it. Any recommended sources? Prices range from $25 on Amazon to $50+ online. Not sure if I trust an Amazon Retailer selling it at half of the prevailing price on the net.

Could be that cheap due to the expiration date. Does it show the date somewhere?

Sent from my SCH-I535 using Tapatalk 2

[Dropkick]

The Combat Gauze in my range kit has expired, so I need to replace it. Any recommended sources? Prices range from $25 on Amazon to $50+ online. Not sure if I trust an Amazon Retailer selling it at half of the prevailing price on the net.

QuikClot Combat Gauze LE (Z-Folded)
http://www.rescue-essentials.com/quikclot-combat-gauze-le-z-folded/

Just bought some from them last week. Their current lot as an expiration date of: 2016-02
They are pretty good about posting the expiration dates in the descriptions of the products.

[John Ralston]

Could be that cheap due to the expiration date. Does it show the date somewhere?

Sent from my SCH-I535 using Tapatalk 2

Nope...and that was my thought too.

[John Ralston]

QuikClot Combat Gauze LE (Z-Folded)
http://www.rescue-essentials.com/quikclot-combat-gauze-le-z-folded/

Just bought some from them last week. Their current lot as an expiration date of: 2016-02
They are pretty good about posting the expiration dates in the descriptions of the products.

Thanks for the link I will check them out.

[RoyGBiv]

Didn't want to start a new thread for this...

Incredible-Yet-Simple Invention Can Seal a Gunshot Wound in 15 Seconds – What It Could Mean for Soldiers (http://www.theblaze.com/stories/2014/02/03/incredible-yet-simple-invention-can-seal-a-gunshot-wound-in-15-seconds-what-it-could-mean-for-soldiers/)

http://www.theblaze.com/wp-content/uploads/2014/02/Screen-Shot-2014-02-03-at-9.21.56-PM-620x465.png

[EMC]

Didn't want to start a new thread for this...

Incredible-Yet-Simple Invention Can Seal a Gunshot Wound in 15 Seconds – What It Could Mean for Soldiers (http://www.theblaze.com/stories/2014/02/03/incredible-yet-simple-invention-can-seal-a-gunshot-wound-in-15-seconds-what-it-could-mean-for-soldiers/)

http://www.theblaze.com/wp-content/uploads/2014/02/Screen-Shot-2014-02-03-at-9.21.56-PM-620x465.png

That looks awesome. It's like a giant penis that delivers mini tampons into wound channels.

[rudy99]

The Combat Gauze in my range kit has expired, so I need to replace it. Any recommended sources? Prices range from $25 on Amazon to $50+ online. Not sure if I trust an Amazon Retailer selling it at half of the prevailing price on the net.

I have purchased some combat gauze through Amazon (I believe Grunt Gear may be the actual seller). If I recall correctly, the expiration date is 2 years out. I'm not sure what the expectation or max shelf life is though.

[BoppaBear]

Didn't want to start a new thread for this...

Incredible-Yet-Simple Invention Can Seal a Gunshot Wound in 15 Seconds – What It Could Mean for Soldiers (http://www.theblaze.com/stories/2014/02/03/incredible-yet-simple-invention-can-seal-a-gunshot-wound-in-15-seconds-what-it-could-mean-for-soldiers/)

http://www.theblaze.com/wp-content/uploads/2014/02/Screen-Shot-2014-02-03-at-9.21.56-PM-620x465.png

Saw this on their FB page yesterday. Looks like something a vet specializing in large farm animals would use!

I'm hoping to get into DAM's September course in my area. Good info for anyone to know.

[Drang]

Just re-read this thread, note to self: Double-check expiration dates on Quick-clot and stuff.
FWIW, I recently added the following to all the first aid kits: Rit-in-the-rain notebooks (3x5 top-spiral bound), Inka pen attached to notebook, and Streamlite penlite attached to PALS Webbing on outside.
The first aid packs on the range bag and the BOBs are Condor tear-away IFAKs, fairly large, so I what I built was more-or-less "boo-boo kits" with the ability to hold some trauma supplies. I've been criticized for having basic first aid/"ouchie" stuff in the range bag's FAK, instead of making it a pure "blowout" kit, but the same person has thus far failed to convince me that I should add airways and pneumothorax stuff to it before I'm able t0 get trained on their use.

I'm hoping that none of that will be useful, as these kits will turn out to never be needed...

[TGS]

Just re-read this thread, note to self: Double-check expiration dates on Quick-clot and stuff.
FWIW, I recently added the following to all the first aid kits: Rit-in-the-rain notebooks (3x5 top-spiral bound), Inka pen attached to notebook, and Streamlite penlite attached to PALS Webbing on outside.
The first aid packs on the range bag and the BOBs are Condor tear-away IFAKs, fairly large, so I what I built was more-or-less "boo-boo kits" with the ability to hold some trauma supplies. I've been criticized for having basic first aid/"ouchie" stuff in the range bag's FAK, instead of making it a pure "blowout" kit, but the same person has thus far failed to convince me that I should add airways and pneumothorax stuff to it before I'm able t0 get trained on their use.

I'm hoping that none of that will be useful, as these kits will turn out to never be needed...

I keep two kits in my range bag....one being my general outdoor first aid kid. It has OTC meds for bee stings, diarrhea, upset stomach, chewable aspirin for heart attacks, benadryl for allergies, ect, in addition to some band-aids and what not. Why on earth would I want to let any of those problems ruin my time at the range (or outdoors in general)?

People get too caught up in living their weekend dream and buying all the ricky recon gear, instead of being practical. Plain and simple.

______________

FWIW, in regards to tourniquets:

Over the last couple weeks we evaluated at my agency whether we wanted to switch to the SOF-TW from our current stock of the standard SOF-T. After myself and 3 other supervisors considered it (including two of our tactical medics in the stack for a tac team), we were too concerned about the possibility of the clip/keeper weaving the tail being caught and loosening the tourniquet when applied, whereas the SOF-T is extremely positive with its screw. We have been pleased thus far with the SOF-T, having applied almost 10 in the last year including one patient who had several applied to several mangled limbs while impinged by a vehicle, to the point that we called a trauma doc to perform amputation in the field.

While the Wide version is still very secure, much more so than the CAT (IMO) or definitely the MAT, we have decided to keep the SOF-T instead of purchasing the wide version. I personally keep a wide version on the outside of my range trauma kit due to its profile without the screw, but I also keep a regular SOF-T on the range bag as well. The SOF-TW still has undeniable efficacy: it saved Robin's life.

[Up1911Fan]

Just ordered a Combat Gauze and TK4. With a pair of gloves I think it should be trim enough to always have on me.