On duty GSW Kit usage AAR

[Lon]

Thursday night at 1828 we got sent to a shots fired call. Right after the first call we get a second call saying it was a robbery and that the victim shot his assailant and the assailant fled on foot. I happened to be the first on scene (Sergeants aren’t supposed to be first on scene are we?) and find the shootee in the front yard of a residence. I roll out of the car with our GSW kit and approached the shootee. He’s pretty incoherent and I do an initial look at him and can see a little blood on his lower right side. I pull up his shirt and see what’s either a entrance or exit wound. It’s not bleeding any longer. So I call out I’ve got him and bust open the GSW kit. Another officer showed up on scene and we roll him over looking for other wounds and pull his shirt up to check his chest. Based on his demeanor I figured he had serious internal injuries so we slapped a chest seal on the wound and as soon as the squad got there with the cot, me and the other Officer lifted him up and put him on the cot. The squad loaded him up and off they went. I sent the Officer who had helped me in the back of the squad with the medics. They cut his shirt off in the medic and found what we now think was the entrance wound high up in his chest. When he got to the ER they immediately cracked his chest open and sewed up an injury to his heart then took him up to the OR. He survived.

From what the docs told my Officer, the bullet did ALOT of damage. He had severe internal bleeding.

After we cleared the scene I watched our body cam video. From the dispatch time to when he left in the squad was less than 7 minutes. Within 28-30 minutes of dispatch time he was in the trauma room getting his chest cracked open. It’s 15 miles from the scene to the ER.

The same Officer who went down with the squad went back there tonight on a separate call and spoke with the surgeon who worked on him. He said the only thing that saved the kid was time. We got him there quick enough that surgery was a viable option. Nothing we could have done in the field would have made things better or more survivable.

Things I learned/had reinforced:
1. Put my damn glove pouch back on my belt. I took it off a while back and figured I’d just use the gloves in the GSW kit. That worked but was slower. Pouch is back on, multi-tool is gone.
2. When looking for injuries really get the clothing out of the way. We pulled his shirt up but were @ 1” too low to see the other wound since it wasn’t bleeding.
3. Trying to treat a GSW injury while simultaneously trying to manage a response to the crime scenes (there were 2) was a PITA. I should have stepped away from treating the victim as soon as the 2nd backup unit arrived.
4. Serious injuries don’t always bleed a lot (which I knew, just a reminder).

There are some other things I learned but since it’s an open criminal case I can’t get into them.

[AMC]

Our car GSW kits include shears....which surprisingly a lot of guys use on nasty trauma cases. Medics are gonna cut away clothing on GSW or stabbing victims anyway, so why wait? And yeah, on a penetrating thoracic or abdominal injury, other than chest seal and bandaging....not much for is to do in the street. Slap a hyfin on the hole and go.

Eta: and yeah... Sergeant first on scene? I get it if I'm just closest.....but I'm probably gonna asking how I beat EVERYONE there.

[Lon]

Our car GSW kits include shears....which surprisingly a lot of guys use on nasty trauma cases. Medics are gonna cut away clothing on GSW or stabbing victims anyway, so why wait? And yeah, on a penetrating thoracic or abdominal injury, other than chest seal and bandaging....not much for is to do in the street. Slap a hyfin on the hole and go.

Eta: and yeah... Sergeant first on scene? I get it if I'm just closest.....but I'm probably gonna asking how I beat EVERYONE there.

Our kits have shears as well, just didn’t think to use them.

As far as first on the scene, all my guys but one were on other calls, so they had to abruptly clear what they were doing and respond. And the last one (who’s also a paramedic) was across town. And of course he was the last one there.

[Hizzie]

Trauma = naked

Most important intervention for that patient is a diesel bolus.

[Gray222]

Good work, seeing a chest cracking is always an interesting sight.

You are correct about gloves you can never have enough and they are never in the right place. I literally have a dozen gloves on me at all times just in case in various pockets and inside every kit.

Scene safety - gloves - shear off clothing - find the wound - stop the bleed as fast and best way possible - scoop to closest police vehicle - notify ER en route so they can prep - run code to ER - relay all info to docs as needed - clean yourself off.

These type of situations usually require a uniform change. I normally ask the hospital for a pair of scrubs and a clear plastic bag. Hell I've got so many photos of me coming back to hq in scrubs a vest and a gun belt with my blood soaked uniform in a bag, it's not even funny.

Having a running list of medical items each person should have on them is important in this context because you know what each guy has and what they used, needs to refill.

Anyone of you guys were wearing heart rate monitor watches or wristbands? I'm always interested to see what heart rate guys were at during this.

[Lon]

We don’t have these very often. And thankfully our medics are usually there PDQ. This has made me think more about a load and go via patrol car.

A heart rate monitor would have been interesting.

[Gray222]

We don’t have these very often. And thankfully our medics are usually there PDQ. This has made me think more about a load and go via patrol car.

A heart rate monitor would have been interesting.

If you need more specific info on scooping (direct policy language) PM me, it's been our standard policy forever.

[ST911]

Always assume more wounds. Patients should be trauma-naked whenever possible. Consider raking tissue with your fingers for penetrations, don't rely solely on sight, blood, or the feel of a flat hand. One technique: https://www.youtube.com/watch?v=uYQmERRjoxg. All of this of course, as tactics and your SA allows.

[JodyH]

I have a small "grab-n-go" GSW kit in addition to a "real" GSW kit in addition to an actual First-Aid medic bag.
All three are located right next to each other in my center console, with the grab-n-go on top.
Anytime I'm around guns the G-n-G comes out and is either on my person or on top of my range bag.
The G-n-G is also great to grab when coming up on a car wreck, shears and gloves on top.

Grab-n-Go GSW kit contents:
Shears
SOFTT-W tourniquet
Gloves
Israeli bandage
QuickClot

Less stuff to paw through to get to the essentials, less stuff to look at so the basics stand out (gloves and shears especially).

If I need the serious stuff it's easily available in the real GSW and either I can retrieve it or preferably someone else can (most of the real stuff is a two-man job anyway).

This threads a great reminder of how important it is to have gloves handy and shears to make a thorough assessment easier.

[Lon]

Our kits include:

CAT-7
Quick Clot
Trauma dressing
Gauze (compressed and 4x4 pads)
Nasopharyngeal airway
Hyfin x2
Shears
Gloves
Roll of kerlix type gauze

They’re attached to the passenger headrest of every car.

[BillSWPA]

Very nice work.

An anesthesiologist made a video discussing gunshot wounds some time ago. That video indicated that internal bleeding is usually what results in the most harm, and that the single most critical thing that can be done is getting the victim to the hospital as quickly as possible.



Sent from my iPhone using Tapatalk

[Totem Polar]

I have a small "grab-n-go" GSW kit in addition to a "real" GSW kit in addition to an actual First-Aid medic bag.
All three are located right next to each other in my center console, with the grab-n-go on top.
Anytime I'm around guns the G-n-G comes out and is either on my person or on top of my range bag.
The G-n-G is also great to grab when coming up on a car wreck, shears and gloves on top.

Grab-n-Go GSW kit contents:
Shears
SOFTT-W tourniquet
Gloves
Israeli bandage
QuickClot

Less stuff to paw through to get to the essentials, less stuff to look at so the basics stand out (gloves and shears especially).

If I need the serious stuff it's easily available in the real GSW and either I can retrieve it or preferably someone else can (most of the real stuff is a two-man job anyway).

This threads a great reminder of how important it is to have gloves handy and shears to make a thorough assessment easier.

A few quick thoughts, since this is in edc, not LEO: first, this^^^
I have pretty much the same items in a mini G-n-G kit, with a duplicate in my wife’s jeep. I also take mine into the range with me, and it’s amazing the looks I got from most of the staff the first time one of them asked what it was; you’d have thought I was carrying a small, live octopus or something. Now, they don’t bat an eye, but I’m still the only person I’ve ever seen with a blowout kit regularly snapped to the strap of my range bag.

Two, valuable AAR Lon, thanks for posting it. Some good take-aways, indeed.

Finally, three: I have to shout out to voodoo_man, among others (also Nephrology) for posting repeated random glove thoughts over the last couple of years. I now have gloves in all my bags, various pockets of all my common jackets/coats, the (heh) glove boxes of all cars, etc., even my music gig bag. May as well: a bulk box from Amazon is so cheap, there’s no compelling reason not to, especially since I am often out driving home later during peak darkness/drunkness hours by profession; I’ve seen a lot of accidents, and been among the first to stop more than just once.

[JodyH]

On gloves.
It's a good idea to have some good leather gloves in the car as well.
The last wreck I came up on was a rollover dump truck in a very rural area (I was the only person on scene until LE arrived 30 minutes after my 911 call).
I had to physically remove the windshield in order to verify that he was a fatality, without leather gloves in my truck I'd have had to either kick out the glass (bad for the person in the car if just injured) or cut my hands up trying to pull it out with makeshift hand protection.
Immediately after that I made sure to put leather gloves in the door pocket of all my vehicles.

[HCM]

Always assume more wounds. Patients should be trauma-naked whenever possible. Consider raking tissue with your fingers for penetrations, don't rely solely on sight, blood, or the feel of a flat hand. One technique: https://www.youtube.com/watch?v=uYQmERRjoxg. All of this of course, as tactics and your SA allows.

Speaking of raking, no black gloves - light colored gloves show blood better.

[Rex G]

Interesting discussion. I had gotten lazy about keeping a trauma kit readily available, because our EMS and fire guys and gals usually arrive first. Even when I was the one who pulled the trigger, once upon a time, an ambulance crew was already on-scene. (Notably, the entrance wound was easy to see, a huge gaping hole, but the bullet was from a different era, not controlled-expansion, not bonded, and very fast, a .357 JHC Hi Shok (not Hydra Shok) at 1400+ f.p.s.)

Gloves, yes; gloves here, gloves there, and a box of gloves in the back of the vehicle.

[Rex G]

On gloves.
It's a good idea to have some good leather gloves in the car as well.
The last wreck I came up on was a rollover dump truck in a very rural area (I was the only person on scene until LE arrived 30 minutes after my 911 call).
I had to physically remove the windshield in order to verify that he was a fatality, without leather gloves in my truck I'd have had to either kick out the glass (bad for the person in the car if just injured) or cut my hands up trying to pull it out with makeshift hand protection.
Immediately after that I made sure to put leather gloves in the door pocket of all my vehicles.

This! I kept Mechanix gloves handy, until I recently misplaced them. Not sure whether the leather is real or faux, but they seem tough enough. Thanks for the reminder to buy more, today, while running errands. Of course, nitrile gloves are necessary, too.

[Totem Polar]

Great point on gloves, both leather and color. Regarding the former I have these: https://www.amazon.com/gp/product/B004BSGVXC/ref=oh_aui_detailpage_o00_s00?ie=UTF8&psc=1

Pretty intense thing to come across while driving around, JodyH

[JodyH]

Pretty intense thing to come across while driving around, JodyH
It happened just seconds before I came across it.
It was dark and I came around a corner and saw a dim light where there shouldn't have been a light out in the pasture (was a busted out side marker light).
I stopped and looked out in the pasture and could make out a truck upside down.
I aimed my headlights at it and ran out there.
First thing I noticed was that it had a roll off dump container on back so I looked for hazmat placards, luckily it was just drilling mud (nasty but harmless).
I know it had just happened because the wheels were still spinning and the diesel engine died as i walked up to the truck.
It was laying on the drivers side and I could see someone inside but in order to assess them I had to yank out the windshield.
Once that was out it was obviously a fatality and no amount of aid was going to help.
What concerned me was there were two Igloo cooler lunchboxes in the truck so I thought there might be someone else that got tossed out.
So for the next 30 minutes waiting for LE I walked a grid pattern in the bushes with my flashlight looking for any sign of someone else.
It turned out he was the only one in the truck, but at least looking for someone else kept me occupied instead of sitting there staring at a truck with a dead guy in it for half an hour.
BTW: 1/2 hour is a looooong time to be the only person at an accident scene, if there had of been severe injuries it would have been 100% on me and what I had in my kit.
That really drove home how important it is to be prepared and have a half-assed idea of what you're doing.

[secondstoryguy]

I have found that getting people trauma-naked is of huge importance and is often neglected. Take care of obvious stuff and then get their clothes off to do a more detailed search for injuries.

On a side note I made a stupid mistake on the last GSW I responded to. I arrived and the guy was down with a GSW and several civilians giving aid. Someone had applied a bulky improvised dressing to his arm that was completely soaked in blood. Someone mentioned he was hit in the arm so I assumed (which is the mother of all fuck-ups) that the GSW was to his arm (brachial artery?) that was bleeding profusely. I applied a tourniquet then discovered that he was hit in the upper chest. It was later determined that he had NO injury to his arm. I didn't want to take the dressing off his arm but I probably should have to inspect the injury and not taken the good samaritans word for it.
As a former combat medic I was a little embarrassed...not the worst mistake I've ever made but lesson learned.

[El Cid]

This! I kept Mechanix gloves handy, until I recently misplaced them. Not sure whether the leather is real or faux, but they seem tough enough. Thanks for the reminder to buy more, today, while running errands. Of course, nitrile gloves are necessary, too.

I love Mechanix for work and shooting. But the gloves I keep in my vehicles for accidents are leather or some other fire resistant material. I figure there is a reasonable chance of fire at a vehicle accident scene and I don't like Mechanix enough to have them melted onto my hands. ;)

And 100% agree with HCM regarding nitrile/latex gloves being light enough to see blood - especially in low light.

[UNM1136]

A couple of years ago I attended a tac-med course and was given a really good IFAK. The trouble was it was in a pouch best attached to a vest. Bulky.

This year with my uniform allowance I picked up a couple of S.O. Tech' Viper IFAK pouches. For the last 12 years or so I have avoided gear on my duty belt between 5 and 7 O'clock. Well, in that amount of time I have been knocked on my back a couple of times, but never felt anything until WELL after the fight. So I took a risk and mounted my LE mini Viper at 6 o'clock. Took a few weeks to get used to. Not bad. I also put two of their TQ carriers at 5 and 7 o'clock (warning, my TQ carriers needed a little surgery to remove a bartack to get them to work like in the videos.). Hyfins, gloves, repaced the shears with a halvolon with a guthook blade installed, celox gause, NPA and Izzie dressing, with two TQs between 5 and 7 o'clock. Not bad at all. The red cross on the kit has caused other officers to inquire. MANY are impressed, especially those that currently carry handcuffs back there. Really happy with this setup.

I also purchased a full sized Viper, filled with SOCOM IFAK items. Gloves, NPA, chito gauze, shears, hyfins, TQ, Izzie bandage. By myself I did not meet S.O. Tech's minimum purchase requirements for the headrest mounting kit, so I went to my local REI and bought a couple of 3/4" straps with fastex and weaved it through the MOLLE and attached the full sized MOLLE Viper pouch to the back of the passenger side head rest of my Ford Explorer PI. I briefed the other 5 or six offices that I hot seat this unit with and they love the concept. Really happy with my purchase.

Pat

[Lon]

I also purchased a full sized Viper, filled with SOCOM IFAK items. Gloves, NPA, chito gauze, shears, hyfins, TQ, Izzie bandage. By myself I did not meet S.O. Tech's minimum purchase requirements for the headrest mounting kit, so I went to my local REI and bought a couple of 3/4" straps with fastex and weaved it through the MOLLE and attached the full sized MOLLE Viper pouch to the back of the passenger side head rest of my Ford Explorer PI. I briefed the other 5 or six offices that I hot seat this unit with and they love the concept. Really happy with my purchase.

Pat

22570

Seriously, I’d like pics of this setup.

[Erick Gelhaus]

Two on-duty uses, one for the aftermath of an OIS and the other a multi-victim dope rip.

In the first use, Israeli dressings (or domestic equivalent) were used of entry wounds to the suspect's torso. There wasn't anything that could be done for the round to the head. Suspect survived for several days;

Second use, quick clot gauze and trauma dressing were used on head wound of one victim (out of three) in a dope rip. That victim survived for a few days. Another victim with a through & through to the jaw as well as a through & through to the lower rear of the skull, was worked up by fire fighters, survived, was operated on by a member here, and is still alive.

In two of our last few OISs, wounds to suspects' limbs were treated were TQs and dressings from newly issued trauma kits purchased off a UASI grant.

[StraitR]

I was 25 yards away from the bathroom and just setting our tray of food down when I heard THIS (http://www.orlandosentinel.com/news/breaking-news/os-seminole-towne-center-mall-gun-20171222-story.html) shot.

The single shot was clearly muffled, not in the same open space. I saw people congregate at bathroom door opening, so I grabbed my ITS EDC kit. Pressed past a few people stopped at the threshold of the bathroom to a place I could look under the stalls. Nobody else went in. Could instantly smell the gunpowder. Two occupants, both with pants around ankles, could see no blood, and no gun.

Last stall was a handicap stall, occupied, and I could see a large amount of shredded and seemingly burnt toilet paper on the ground. Occupant began working quickly to get himself sorted out, and within 10 seconds, emerged from the stall looking up saying "what happened?". I pushed in stall just to make sure there was no blood, no bodies. Obviously, this was the stall in which it happened, but I couldn't find a bullet impact in the 5 seconds I spent looking. At that point, a mall janitor had arrived and radioed for security. Other people started to enter, so I bailed. I went to assist someone in medical need, not work to apprehend a guy at the mall with a gun, so I returned to my family and now cold Bourbon chicken.

Someone must have fingered me, as mall security approached me 20 minutes later and asked for a description. When we were leaving about an hour later, no less than 10 cop cars and lots of cops had him detained in the parking lot.

I'm very thankful the ND happened without injury. Part of me was mad that it happened, but plenty of good people have accidentally discharged firearms, so I said a little prayer and removed my judgment. I really dislike going to malls, especially around this time, but the Mrs wanted the kids to see Santa. Next year, I'm renting a Santa suit.

Thanks @Lon (https://pistol-forum.com/member.php?u=922) for sharing your experience. We simply never know when we'll need this type of information. Added a tactical medical class to my 2018 wishlist.

[wvincent]

I was 25 yards away from the bathroom and just setting our tray of food down when I heard THIS (http://www.orlandosentinel.com/news/breaking-news/os-seminole-towne-center-mall-gun-20171222-story.html) shot.

The single shot was clearly muffled, not in the same open space. I saw people congregate at bathroom door opening, so I grabbed my ITS EDC kit. Pressed past a few people stopped at the threshold of the bathroom to a place I could look under the stalls. Nobody else went in. Could instantly smell the gunpowder. Two occupants, both with pants around ankles, could see no blood, and no gun.

Last stall was a handicap stall, occupied, and I could see a large amount of shredded and seemingly burnt toilet paper on the ground. Occupant began working quickly to get himself sorted out, and within 10 seconds, emerged from the stall looking up saying "what happened?". I pushed in stall just to make sure there was no blood, no bodies. Obviously, this was the stall in which it happened, but I couldn't find a bullet impact in the 5 seconds I spent looking. At that point, a mall janitor had arrived and radioed for security. Other people started to enter, so I bailed. I went to assist someone in medical need, not work to apprehend a guy at the mall with a gun, so I returned to my family and now cold Bourbon chicken.

Someone must have fingered me, as mall security approached me 20 minutes later and asked for a description. When we were leaving about an hour later, no less than 10 cop cars and lots of cops had him detained in the parking lot.

I'm very thankful the ND happened without injury. Part of me was mad that it happened, but plenty of good people have accidentally discharged firearms, so I said a little prayer and removed my judgment. I really dislike going to malls, especially around this time, but the Mrs wanted the kids to see Santa. Next year, I'm renting a Santa suit.

Thanks @Lon (https://pistol-forum.com/member.php?u=922) for sharing your experience. We simply never know when we'll need this type of information. Added a tactical medical class to my 2018 wishlist.

A firearm "fell and discharged?" Any more info on that part of it?

And no one should feel the need to just throw P320 out as a reply, just to douche up my question.

I respect your effort to aid someone, just not sure that I would be running towards the sound of the guns when my family is there with me.

With the limited capacity of an EDC kit, I would hate to burn through it, and and then need something for me and mine if more firearms were to "fire and discharge" in the same area and time frame.

[StraitR]

A firearm "fell and discharged?" Any more info on that part of it?

And no one should feel the need to just throw P320 out as a reply, just to douche up my question.

I respect your effort to aid someone, just not sure that I would be running towards the sound of the guns when my family is there with me.

With the limited capacity of an EDC kit, I would hate to burn through it, and and then need something for me and mine if more firearms were to "fire and discharge" in the same area and time frame.

Nope, no more info. Like I said, after I pushed through and found no bodies or bleeders, I left. It's not my job or care to figure out what happened.

As far as running towards the sound of guns, well that sounds a little more bravado than what transpired. It's really hard to articulate the details of taking in all the visual and auditory information and making a decision. Had you been there, it would seem as crystal clear to you as it did to me.

[wvincent]

Nope, no more info. Like I said, after I pushed through and found no bodies or bleeders, I left. It's not my job or care to figure out what happened.

As far as running towards the sound of guns, well that sounds a little more bravado than what transpired. It's really hard to articulate the details of taking in all the visual and auditory information and making a decision. Had you been there, it would seem as crystal clear to you as it did to me.

Thanks for the clarity in your response. Yeah, I wasn't there, so my mind kind of had to fill in a few of the blank spots.
You know, nice thing about this thread is it reminded me to get over to Dark Angel and get some more stuff ordered before the sale ends.

[UNM1136]

22570

Seriously, I’d like pics of this setup.

Lets give this a try... Just got these pics after shift, there might be some sun glare.

22630
Front view passenger side headrest.


22631
Rear view shot through the cage.

22632
Drivers side view.

22636
Empty IFAK sleve from driver's side.


22633
IFAK removed.


22634
First flaps open.

22635
Second flap open.


All of these were taken in a '14 Explorer Police Interceptor.

Here are the original pics of the Viper Flat IFAK.
https://sotechtactical.com/collections/filledifaks/products/vfifaka1kit

I got one of the closeout MOLLE Viper IFAKs.



And the Factory headrest option. I think I like mine a little better; it still pulls out easily from either side with one hand, despite sliding a little on the headrest as you deploy the kit. The factory option looks less....comfortable, or usable based on the big buckles and mounting on the front of the headrest. Although watching the installation video has given me a couple of ideas to try with mine during downtime.

https://sotechtactical.com/collections/special-order-ifaks/products/copy-of-viper-flat-ifak-a1


pat

[Chuck Whitlock]

On gloves.
It's a good idea to have some good leather gloves in the car as well.
The last wreck I came up on was a rollover dump truck in a very rural area (I was the only person on scene until LE arrived 30 minutes after my 911 call).
I had to physically remove the windshield in order to verify that he was a fatality, without leather gloves in my truck I'd have had to either kick out the glass (bad for the person in the car if just injured) or cut my hands up trying to pull it out with makeshift hand protection.
Immediately after that I made sure to put leather gloves in the door pocket of all my vehicles.


I love Mechanix for work and shooting. But the gloves I keep in my vehicles for accidents are leather or some other fire resistant material. I figure there is a reasonable chance of fire at a vehicle accident scene and I don't like Mechanix enough to have them melted onto my hands. ;)

And 100% agree with HCM regarding nitrile/latex gloves being light enough to see blood - especially in low light.

I keep a pair of 5.11 kevlar gloves in my bag at work. Good for both cut/fire resistance. I've been told that kevlar has a higher flashpoint than nomex. Used them a month or so back to get into a windshield.

[Lon]

Lets give this a try... Just got these pics after shift, there might be some sun glare......



Thanks for the pics. That’s a nice set up. We first tried a visor mount, but guys didn’t like it. So I bought some snap rings and used some 550 cord and had the attach them to the bars from the headrest that go into the seat. Then I tucked the kit in between the seat and B post. Works and is quick to get off and is normally out of the way.

[Lon]

If you’re wondering about the shootee, he should be going home soon. He “died” on the operating room table twice but managed to survive and is out of ICU.

Never woulda guessed he’d make it.

[Doug MacRay]

A lot of good info in this thread. I thought I'd drop by to add something regarding issues that I've seen in the past when it comes to hemostatic gauze (Celox, Quikclot, etc.). These items are being issued to more and more people but training in use of these items are often lacking. I am going to quote a JEMS study that states the importance of proper hemostatic gauze application (emphasis mine):

"Myth #4: Application of hemostatic agents to bleeding wounds will control all external bleeding.

It’s not uncommon to see hemostatic dressings being placed on top of a bleeding wound with the belief it will stop the bleeding. Hemostatic agents (most are bound to gauze but some are still in powder formulations) need to be packed into a wound against the injured vessel and effective compression maintained for at least three minutes.

The technique for packing the wound is critically important and should ideally be taught in a live tissue training environment. Proper technique pushes the hemostatic agent to the bottom of the wound and is successively packed in with a single finger to maintain effective pressure on the bleeding source.

Hemostatic impregnated gauze does enhance bleeding control, but some studies have suggested that the addition of the hemostatic agent enhances the effect of the gauze by about 15%.7–9

Chemical hemostatics won’t substitute for effective control of the injured vessel."

Another important point is that taking the time to properly pack and wrap a heavily hemorrhaging wound on an extremity should be substituted with a quick TQ placement when available. TQ's are relatively safe when critical care is within a few hours reach. If you're not sure whether an extremity wound requires a TQ or not, it's better to err on the side of the TQ. See the link at the bottom of my post for more info on proper TQ use and common errors. Hemostatic agents are largely intended for bleeds where TQ's can't be applied, such as the neck or inguinal areas.

I highly encourage everyone to read and take to heart the "10 Hemorrhage Control Myths" article from JEMS. Personally, I print it out and give it to anyone I know who carries an IFAK or GSW kit. I always highlight numbers 1 through 4, as they are most relevant to first responders with relatively limited medical training. It's important to get the point across that adding more dressing and pressure simply will not stop some bleeds. In some cases it will actually wick blood (and relevant endogenous clotting factors) away from the wound, where they need to be to clot and stop the bleeding. Direct pressure means direct pressure to the source of the bleeding, not just the skin above it. When it comes to Celox or QuikClot, you need to physically insert it into the wound (preferably with a single, gloved finger) in order for it to contact the source of the bleeding and enhance clotting. Throwing hemostatic gauze on the skin above a wound will do absolutely nothing to promote clotting, and may actually slow clotting by wicking away natural clotting factors away from the source of the bleed.

Here is a link to the article, I recommend everyone read it, print it out, and study it periodically as a refresher. And as always, I thank those of you with personal experience in this area for sharing your knowledge on this forum. PF, and the knowledge shared here, is an invaluable resource for those who are on the frontline.

http://www.jems.com/articles/print/volume-39/issue-12/features/10-hemorrhage-control-myths.html

[Nephrology]

If you’re wondering about the shootee, he should be going home soon. He “died” on the operating room table twice but managed to survive and is out of ICU.

Never woulda guessed he’d make it.

He probably arrested on the table. Any GSW that penetrates the chest and requires an emergency thoracotomy is a Big Deal. He's incredibly lucky to be alive. Definitely not the statistically most likely outcome based on the injuries you described. I would be a little surprised if he does not suffer from long term neurological/cognitive defects due to the interruption in the blood supply to his brain.

Strong work, by the way. HCM is right: Trauma loves to hide. You lose nothing but cutting their clothes off right away and locating the injury quickly is very helpful. If EMS calls in a report of a GSW in the chest (vs abdomen, for example), this not only helps dispo the patient to the right hospital but also to mobilize the resources we need in the ER before they hit the doors (including the surgeons who do the thoracotomy).

If you're looking for an excuse to buy more gear, I got a pair of Leatherman Raptors (https://www.leatherman.com/raptor-831741.html) for Christmas from my sister who is an RN. They're really awesome. Tried them out on some old dish towels and they are way better than the ~$10 NAR pair that I used to have. I don't really have an operational need for the seatbelt cutter, window breaker, etc.... but if you're in LE/Fire/EMS I could see this thing being really useful. Can be carried on a belt mounted holster (included) or folded in your pocket, where it takes up about as much space as a large folding blade.

[HCM]

If you’re wondering about the shootee, he should be going home soon. He “died” on the operating room table twice but managed to survive and is out of ICU.

Never woulda guessed he’d make it.

Tattoo to teeth ratio...

[Lon]

I would be a little surprised if he does not suffer from long term neurological/cognitive defects due to the interruption in the blood supply to his brain.

So far he’s not showing any signs of that. Can’t go into specifics but during his interview with our detectives he answered the questions very intelligently, let’s say.

[Nephrology]

So far he’s not showing any signs of that. Can’t go into specifics but during his interview with our detectives he answered the questions very intelligently, let’s say.

Works for me. Lucky dude, seriously.

[Erick Gelhaus]

LAPD officers used one on the trainee who suffered a shattered femur after an ambuah saturday night in Rampart division.

And a reminder TQs aren't just for shootings ... One was recently used to stop a significant brachial artery bleed caused by K9 bite during an attic search for wanted felon (who isn't wanted any more).

[Dave Williams]

My shift has had 4 tourniquets(3 CAT, 1 SOFT) used this past year, 1 chest seal, and 1 pressure dressing. One tourniquet and pressure dressing were on a gunshot wound to the leg, three tourniquets were on a double amputee hit by a train(one was not high enough so another was put on), and the chest seal was used on a gunshot victim. Not sure about the other shifts.

[AMC]

LAPD officers used one on the trainee who suffered a shattered femur after an ambuah saturday night in Rampart division.

And a reminder TQs aren't just for shootings ... One was recently used to stop a significant brachial artery bleed caused by K9 bite during an attic search for wanted felon (who isn't wanted any more).

Didn't see this incident in the news! This past Saturday the 30th?

On point, we wrote two lifesaving awards for officers on my shift/station this past year for tourniquet use. One was a stabbing/slashing of the upper arm/brachial artery, the other was a dog bite behind the knee. One residentially challenged citizen hit another with his skateboard. Victims canine companion took offense and took a bite out of crime. Medics and the ER doc both said the dog bite guy definitely would have bled out without the tourniquet.

[Nephrology]

Didn't see this incident in the news! This past Saturday the 30th?

On point, we wrote two lifesaving awards for officers on my shift/station this past year for tourniquet use. One was a stabbing/slashing of the upper arm/brachial artery, the other was a dog bite behind the knee. One residentially challenged citizen hit another with his skateboard. Victims canine companion took offense and took a bite out of crime. Medics and the ER doc both said the dog bite guy definitely would have bled out without the tourniquet.

the popliteal artery behind the knee is a large artery that can produce significant bleeding. It's also highly prone to kinking and dissection/tearing in bad lower extremity orthopedic injury (think jumpers or high mech MVC victims with significant deformity, open fracture etc). It's one (of many) reasons we always check for pulses in the feet.

[Erick Gelhaus]

Didn't see this incident in the news! This past Saturday the 30th?


Here you go. Friday night
http://ktla.com/2017/12/29/female-police-officer-shot-in-westlake-district-lapd-says/