Medkit for the Range

[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”.
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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/f...eprotocols.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 (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.