Get a med kit if you don't already have one...

[martin_j001]

Apparently there is an initiative to provide small trauma kits in the Georgia schools for fast response to events with bleeding. New article discussed recent situation where one of the kits was used the day after delivery when a child fell on a playground and suffered an injury (compound fracture?) that had extensive bleeding - the school nurse grabbed the trauma kit and applied a tourniquet that made a big difference until emergency help arrived.

As a GA resident, with a child in daycare who will someday likely attend GA schools, it makes me happy to hear they will have these kits on hand.

[HCM]

Yes, it's always worth doing CPR in the field, unless you think they are dead and do not want to continue care. CPR is designed to help the patient's heart and lungs perfuse and oxygenate their body when they are in cardiac and/or respiratory arrest. If you stop CPR, you have essentially pronounced your patient.

Why bother applying a tourniquet if you've already decided to stop CPR? "Basic trauma care" is 100% unhelpful if your patient's heart has stopped beating. Your heart and brain begin to die after mere minutes without blood - CPR is the only thing you can do in the field to prevent that from happening, if it isn't already too late.

If you watch a patient code being run in the hospital, you'll notice that we are always doing CPR and it takes priority over basically everything except cardioversion. CPR continues without interruption until we get return of spontaneous circulation or until we've decided to pronounce.

As for your statistics, this depends on the study you've read.Overall pre-hospital survival rates for CPR is usually very low for a couple reasons:

1. The patient is often "found down" and could have been in circulatory collapse for 30+ minutes. These patients uniformly do very poorly
2. Some forms of cardiac arrest - i.e. traumatic cardiac arrest - have very low survival at baseline
3. A lot of bystanders do not know how to deliver effective compressions or do proper CPR

Patients do much better if they have a witnessed event and bystanders intiate CPR immediately. This study shows a 70% survival rate or patients who had a witnessed event and got immediate CPR from bystanders. In the group that did not get immediate CPR from bystanders, survival was closer to 30%, largely for reason #1. Here is a very recent article on the subject with more stats that show the stratification of survivors.

Yes, doing CPR on dead people is very unsatisfying and kind of depressing, but it's part of your duty as a first responder to deliver the best care in the field that you can, and the cornerstone of good pre-hospital care is CPR. Cardiovascular disease is the #1 killer worldwide and you are far more likely to need CPR that you will a TQ or chest seal, and even if it doesn't feel like it, is far more likely to save someone as well.

Both mine were witnessed events. Middle aged male adults engaging in physical activity at the time of their event. One dancing at a wedding, the other playing soccer. The only CPR successes I’m personally aware of have been kids, one found face down in a pool and one buried after a cave in playing at a construction site.

Those numbers are pretty far off what I’ve read and what has been provided to us in training. Everything I’ve read has CPR success rates at 10% for adults vs 30-40% for AEDs on adults. We’ve had AED training incorporated into our CPR training for the last 7-8 years.

Getting AED’s was interesting. We are required to have them in holding/ booking areas for detainees but had a big battle getting them in our office and in the field for our employees and the public. We bought AEDs but they were kept locked up for 2 years because we were told we could not have them availible without a medical supervision program provided by a particular GOV agency and the existing contract did not include the requisite fees. It always nice to know who your admin’s priorities are.

[jeep45238]

I'm shocked I somehow missed this, but I can relate:

Last summer the company I was working for had me leave the jobsite to grab some gear from the office and come back. The company is very safety oriented, and informed me when I started working for them that every vehicle had a legit first aid kit, and foolishly I didn't take the time to inspect them first to see what was included. That day I found out the hard way. My medical background is limited to what I learned in brief training classes in the military and in civilian backpacking woodsmanship - enough to deal with bleeding and setting limbs.

I cam across a motorcyclist that lost control on his Harley - overweight, obviously has been riding bikes for decades. No helmet, only protective gear was a leather jacket (with a t shirt, Lee jeans, and sneakers). Pulled over, grabbed the medkit, and ran. I was expecting to come across something very grousome, as I couldn't see his head, chest on the grass (thankfully it was an optical illusion). Bystanders were flooding the area with cellphone picture taking, two ran to their vehicle and fled (likely pipes fell from their truck and caused the accident). I popped open the med kit and found gloves, gauze, bandaids, and asprin. Awesome.

As I was putting on gloves and telling people to back the fuck up one idiot helped this guy roll over before I could get the second set of gloves on. When I looked up a second fellow ran up with a legit med kit, we confirmed quickly that he had medical training, and he was in charge. Broken limbs and lacerations, broken ribs was the extent of his injuries. Right about then EMS showed up, we relayed info, statements were taken, and I show up to the job site over an hour later than what was expected.

I basically did nothing - due to a lack of medical training, available gear, and the quick response of EMS. It stuck with me though, and I told my wife that I want to have a kit in the car and some training.

I haven't had the time or money to do a training class, but my wife did get me a little car kit for bruises/cuts and the like (that's what first aid means to her) - and the more I think about this, the more I want to get trained up and have proper gear in our vehicles.

Thanks for putting this back in the spotlight.

[Nephrology]

Both mine were witnessed events. The only CPR successes I’m personally aware of have been kids, one found face down in a pool and one buried after a cave in playing at a construction site.

Those numbers are pretty far off what I’ve read and what has been provided to us in training. Everything I’ve read has CPR success rates at 10% for adults vs 30-40% for AEDs on adults. We’ve had AED training incorporated into our CPR training for the last 7-8 years.

My second link (here) is a 2017 review from the J American Heart Association that covers a number of recent, large and high quality studies on survival of out-of-hospital cardiac arrest (OHCA). In it, they quote the Institute of Medicine's 2015 report on cardiac arrest survival, which states:

Survival differences across the 5 states were observed in all‐rhythm patients, ranging from 8.0% to 16.1%; in the Utstein subgroup (defined as bystander‐witnessed OHCA with an initial shockable rhythm), survival differences ranged from 26.4% to 44.3%. Survival did increase across EMS agencies that treated >20 OHCAs per year. In this latter group, survival among all‐rhythm patients increased from 2.7% to 26.5%; in the Utstein group, survival increased from 10.0% to 57.0%.

This is some of the highest quality data you'll get on the topic, straight from the horse's mouth. 26.5% survival in all-rhythm patients (i.e. shockable and not shockable rhythms) and 57% in the best case scenario group (Utstein group - witnessed OHCA w/shockable rhythm) is pretty good, IMO.

I know it's frustrating to feel like you "wasted your time" with CPR, but the reality of medicine is that not everyone lives. This does not mean your efforts were wasted.

[HCM]

I'm shocked I somehow missed this, but I can relate:

Last summer the company I was working for had me leave the jobsite to grab some gear from the office and come back. The company is very safety oriented, and informed me when I started working for them that every vehicle had a legit first aid kit, and foolishly I didn't take the time to inspect them first to see what was included. That day I found out the hard way. My medical background is limited to what I learned in brief training classes in the military and in civilian backpacking woodsmanship - enough to deal with bleeding and setting limbs.

I cam across a motorcyclist that lost control on his Harley - overweight, obviously has been riding bikes for decades. No helmet, only protective gear was a leather jacket (with a t shirt, Lee jeans, and sneakers). Pulled over, grabbed the medkit, and ran. I was expecting to come across something very grousome, as I couldn't see his head, chest on the grass (thankfully it was an optical illusion). Bystanders were flooding the area with cellphone picture taking, two ran to their vehicle and fled (likely pipes fell from their truck and caused the accident). I popped open the med kit and found gloves, gauze, bandaids, and asprin. Awesome.

As I was putting on gloves and telling people to back the fuck up one idiot helped this guy roll over before I could get the second set of gloves on. When I looked up a second fellow ran up with a legit med kit, we confirmed quickly that he had medical training, and he was in charge. Broken limbs and lacerations, broken ribs was the extent of his injuries. Right about then EMS showed up, we relayed info, statements were taken, and I show up to the job site over an hour later than what was expected.

I basically did nothing - due to a lack of medical training, available gear, and the quick response of EMS. It stuck with me though, and I told my wife that I want to have a kit in the car and some training.

I haven't had the time or money to do a training class, but my wife did get me a little car kit for bruises/cuts and the like (that's what first aid means to her) - and the more I think about this, the more I want to get trained up and have proper gear in our vehicles.

Thanks for putting this back in the spotlight.

Good on you for thinking this through. Most first aid kits are simply bop-boo kits in my experience. Vehicle accidents are a frequent occurrence.

Came across this at work returning from an interview at a prison - my Parker and I were the first to stop. One guy had some bad lacerations but overall they had seat belts on and were pretty lucky.

[Totem Polar]

Somewhat tangential, but, the private U I work with put out an email offering free CPR and AED training for anyone who wanted it. So I signed up; only me and the dept secretary bothered to take the class. I got a lot out the course, as the online portion covered all sorts of first aid, including TQ use, etc.
when we finished the hands-on part of the course, the trainer said "where do you want your AED?" The secretary now has one in the office, and I’ve got a wall-mount right outside my own office door in another building. Pretty cool. I guess they were serious, and good for them.

[ST911]

Take a CPR class. Do the stuff your patient needs. Have stuff to do it with.
Take a TCCC/TECC/First Aid/Stop the Bleed class. Do stuff your patient needs. Have stuff to do it with.
Be a good human, willing to help.

[Joe in PNG]

Friend of mine, plus her roomate were struck by lightning and basically killed while camping. Happily, the others on the trip knew CPR, and kept them both alive until EMS arrived about an hour later. Both survived.

[MVS]

Hate to necro post but given CPR has a very poor success rate on adults, something like 10%, is it really that much a priority over basic trauama care ?

My dad and and a co- worker both saved young kids with CPR, but personally, I’m 0-2 on adults.

My past experiences would agree with this.However, I have a wife and three daughters who will tell you that they are glad I did CPR on their dad/husband (my coworker) Monday because he is currently recovering. The success here isn't mine, it is the ambulance and medical crew who showed up quickly, but at least it appears as if my work held him over until they got there.

[Sherman A. House DDS]

I’ve done CPR AND rescue breathing many times over the past 30 years...and had varying degrees of success. Sometimes people just aren’t going to pull through. I’ve had great success with tq’s and multisystem trauma patients, some in austere conditions.

With that said, I carry medical supplies as part of my EDC, additional supplies in my vest when I’m on Reserve Police duty, and my truck has two kits AND a MCI bag in it.

I’ve trained with Dark Angel Medical as well as Lone Star Medics and both are TOP NOTCH outfits. They both teach long format classes that will get you studied up quickly.

I teach a 4 hour, vocationally generic course I call, “Civilian Defender Hemorrhage Arrest Course,” that deals with addressing life threatening bleeding and penetrating trauma to the chest. I’ve had church security groups, school teachers, fellow cops, firearms factory employees and even other first responders in it too.

Fortunately (but due to tragic circumstances, like Las Vegas and church shootings) there are classes that DO NOT require hours of investment and study to acquire good, solid skills that you can use when faced with life threatening injuries. I’ve had about 25 saves I’ve heard about with students I’ve trained over the past 12 years.

Here’s a picture of the vehicle setups I run. They are Orca Tactical Tear Off Med kits attached to the headrests. That way, I can grab them and, “go,” or, if I need them for self/buddy rescue in the vehicle, if I’m in the seat still, the kit’s behind my head. I have, “Rescue-Me,” glass punch/seatbelt cutters attached to each bag. I keep additional SOF-T Wides in my door well, as well as one on me and another on my vest. I also keep a separate pediatric kit in my truck that has a RAT and a pressure dressing I can adapt to children or really small adults.

Not sure how I missed this thread before...good work Martin!

The first time I ever did any kind of lifesaving measures on anyone was rescue breathing on my brother when I was 14 and he was 13. He stopped breathing due to a severe hypoglycemic (insulin) reaction/diabetic emergency. We lived in an isolated area and EMS was hospital based and a ways out. Police were there to back me up first, and trade off breathing (it’s hard work). This happened again 2 more times before my brother was 16. I was able to resuscitate him successfully, and the ventilation technique proved successful, as he went on to earn a PhD later in his 20’s...then when I was 16, my neighbor had an MI, and a responding police officer saw me washing my mom’s van (had to wash the van if I wanted to drive it, don’t you know!?!) and knew I was a police cadet with medical experience. He also was resuscitated but died later of his other comorbidities. I’m a tremendous shit magnet, and it’s been an interesting life I’ve lead thus far. I can’t imagine living any other way, and having the right gear is helpful, but having the knowledge and balls to act is IMPERATIVE. I always joke and tell my students that I went to the Angus MacGuyver School Of Medicine, and I can improvise well. But purpose built gear is always better!




civiliandefender.com