Carrying Medical Supplies

[ST911]

In a stateside hospital, you're typically seeing people who are either dead or not by the time the wambulance shows up, anyway. Your sample is biased, to say the least, as you would likely never see the patients that hemostatics would make a difference on since theyre going to the ME instead as they weren't provided that critical first aid we're discussing...

Ive seen more than a few patients who effective combat gauze use would have likely altered their outcomes for the better (i.e. they'd still be alive). Moreso than we used epinephrine for allergic reactions, yet we carried epi and not combat gauze.....

I've heard this put various ways and don't know who to credit... There are three types of trauma patients within this context:

Those that will live no matter what you do.
Those that will die no matter what you do.
Those that will live or die based on you doing the right thing at the right time.

My list: I keep a TQ on my person, an IFAK in my murse or pouch on my gear, and larger aid bags in the cars. I have used the IFAKs and aid bags on multiple occasions over the years.

[Sasage]

I started carrying a Celox Rapid Ribbon , H&H Mini Compression Bandage and flat folded SOFTT-W Generation 3 Tourniquet yesterday. I carry them in my back jeans pockets.

[Nephrology]

In a stateside hospital, you're typically seeing people who are either dead or not by the time the wambulance shows up, anyway. Your sample is biased, to say the least, as you would likely never see the patients that hemostatics would make a difference on since theyre going to the ME instead as they weren't provided that critical first aid we're discussing...

Ive seen more than a few patients who effective combat gauze use would have likely altered their outcomes for the better (i.e. they'd still be alive). Moreso than we used epinephrine for allergic reactions, yet we carried epi and not combat gauze.....

Im not sure if you meant it as I read it, but Id open your opinions to be swayed by people other that ED/surgical attendings who do not provide care outside of a hospital. Last time I checked, care under fire or on scene isn't performed by ED/surgical attendings.

Thanks for the input. You are right - I have 0 experience with prehospital medicine so that biases me to a great extent. Can you elaborate on the pts for whom combat gauze would've helped? And yes, sorry, didn't mean to phrase it as if attendings are the only people with invaluable opinions :P I plan on doing what the nurses tell me to do for the duration of my clinical training...

[breakingtime91]

I started carrying a Celox Rapid Ribbon , H&H Mini Compression Bandage and flat folded SOFTT-W Generation 3 Tourniquet yesterday. I carry them in my back jeans pockets.

thats what I am going to start doing.. that paired with my extra shit in my everyday pack.

[Cookie Monster]

thats what I am going to start doing.. that paired with my extra shit in my everyday pack.

Isn't that long like sitting down with a baseball in your back pocket?

I am curious to find a good way to carry medical stuff on my person.

[breakingtime91]

Isn't that long like sitting down with a baseball in your back pocket?

I am curious to find a good way to carry medical stuff on my person.

https://pistol-forum.com/showthread.php?12616

this is what I plan on carrying, should of specified. I think with Tom's technique will make it stupid easy to carry a tourniquet easily.

[JDM]

I have a SOFTT-W in my back pocket all the time. Folded the way Tom folds them makes it no worse than my wallet.

[TGS]

Thanks for the input. You are right - I have 0 experience with prehospital medicine so that biases me to a great extent. Can you elaborate on the pts for whom combat gauze would've helped? And yes, sorry, didn't mean to phrase it as if attendings are the only people with invaluable opinions :P I plan on doing what the nurses tell me to do for the duration of my clinical training...

The most prominent one I can think of was a dude who had a chainsaw migrate into his thigh via social interaction. Somewhat effective tourniquet + wound packing, 5 minute transport to hospital. Coded enroute due to blood loss; as with most any trauma code, he did not live.

Obviously, there's no way for me to actually prove that combat gauze would have made a difference. From reading about its performance, however, I'm inclined to believe that blood loss would have been slowed enough for him to make it to the trauma bay. The bleed site was very accessible, so effective packing with combat gauze was likely. It was pretty much the textbook situation that combat gauze is needed for.

[voodoo_man]

Just some observations from field use and practicality through experience.

Carry at least two pairs of really good gloves. Find out what your local hospital uses, or what your local rescue squad uses and buy some of them. Have some in your pocket, carry at least two pairs (that's 4) gloves with your kit, you may rip one, you may have another person who needs a pair. Getting blood on your hands sucks, getting blood on your hands and you have open wounds (lots of people do and do not even consider it) may be deadly...

I've used TQ's a bunch of times on duty, before they issued us the sof-t. I carried two CAT's with me on duty, now I carry three and the issued sof-t. The sof-t is super easy to get on people who are fat, have lots of clothing (winter) and/or are fighting you when you try to put one on them (yes they do that sometimes). The CAT's are good, but you need sheers to get them on a lot of the time because you need to get the clothing off. Once you get the TQ on, you need to get the area of bleeding under control, H-bandages are a really good general purpose bandage that will help target a specific area, or if you don't want to use a TQ, an israeli bandage will work too.

I stopped using quikclot and now only use Celox. I have used the z-fold RAPID on a few occasions and it works super quick on big wounds. It is overkill for nearly anything short of large stab and gunshot wound punctures of arteries. I like the RAPID because its a gauze and not a powder. The 2g personal use pouches are great for small cuts that won't stop bleeding, the 15g are also good for a big bleed (think a good cut down a meaty part). The RAPID is my "go to" in terms of carry. Celox also makes a Blood Clotting Granule Applicator and Plunger Set, though I have not used it I have little doubt it works really well on gunshots and deep cuts (assuming they are not fatal to begin with). Remember that some of these wounds will require you to open them enough to "stuff" the gauze inside.

FOX Chest seals (from biostat) are the best chest seals I've ever used. I have used the HALO chest seals twice and they are meh at best. One didn't seal right, the other wouldn't stick (lots of blood). I've used one FOX chest seal on a guy who took a bullet on an angle (right below the top right clavical on the front pectoral entry, bottom left pelvic girdle exit), and once I stuck it on, the doc's at the ER had trouble getting it off. It heats up in your hand if you hold it long enough. Awesome for what they are.

In my big trauma bag at work (part of the go bag) I have two TPK (tension pneumothorax kit). Unless you have been shown how to do this please do not try. I've never had to do this on a person (thankfully) though I have seen it done by ER docs and medics. I carry them because I do not want to be in a situation where someone needs the tension relieved and med-evac is not possible.

One of our guys was a combat medic who deployed a few times so he carries all the above and a airway kit (and the supporting items). I've seen him use it prior to medics arriving on location, crazy stuff, research at your own discretion.

Summarize the above:

Stuff I carry on duty:

Lots of rubber gloves
Lots of TQ's (CAT and SOF-T)
Sheers
H-bandages
Israeli Bandages
CELOX RAPID
FOX Chest Seals
TPK
Random bandages
Hydrogen Peroxide topical - just in case you get blood/etc on you or scratched/stabbed/cut

Stuff I carry off duty:

CAT and/or SOF-T (usually SOF-T) (keep one in a cargo pocket)
CELOX RAPID
FOX Chest SEALS
H-Bandges (2)
Rubber Glove (two sets)
Sheers
Pocket Hydrogen Peroxide

Other considerations:

Where I work I am nearly always within a 3-10 minute (running code) drive from one of the nations finest level 1 trauma centers. This is the best method of care in the vast majority of situations. I have transported shot persons to these places as fast as possible because that is how their lives will be saved, not me trying to do my best on the street when transport to a level 1 ER is close by. The only times I have ever not immediately transported is when the person would have bled to death prior to getting there (mostly stabbings and partial amputation) that require immediate TQ application and/or blood flow restriction (this is where the RAPID has been used and works well), when the person had no heartbeat up on arrival (CPR then wait for another unit to transport while CPR is done in the back of the squad en route to an ER and/or waiting for medic to arrive and then running code for them - clearing traffic - to get to an ER) and/or when the person was already dead or had obviously no possibility of life (agonal gasps, brain matter visible, etc). So doing a quick triage at the location is important just as the safety of the scene. You cannot do anything to anyone if the scene is still volatile. You cannot work on people if you are putting yourself in harms way, regardless of the person, their condition or anything anything. You have to stay safe and do not put yourself into a position which will require responding persons to have to deal with two issues instead of one.

Quick transport is best when viable, always know where your closest level 1 trauma center is and how to get there, if you cannot get there within the Golden Hour, or "golden time" for very serious trauma, you may want to consider other options based on your location and available items in terms of preparation and sustaining of care until medical personnel arrive.

[JAD]

And doesn't require a ruler.

Man, there are a lot of libertarians on this forum.