Help putting a trauma bag together?

[TGS]

Needle decompression in theory is very easy. Needle decompression on fit military age males isn't terribly difficult. The farther you get from that, it becomes exponentially more dangerous and less successful........that much has been definitely studied and proven, with up to 2/3 of professional providers misidentifying the site. At my old job we even had a paramedic with over a decade of experience misidentify the site and puncture the heart of the patient.

Needle D in theory isn't hard. In real life, it's not that hard to fuck up, either, and you likely won't get covered by a good Samaritan law for performing a skill that you're not certified by any accredited body to perform. Good Samaritan laws are almost always reserved for those acting within the scope of their training.

I've never seen professional practitioners act/speak as loosely with applying needle thoracentesis as laymen on gun forums do, in particular. The same applies for this thread, where the only people with known real training and experience are basically saying to slow up. There is simply no good reason in suggesting needle decompression for people who are still at the stage of asking what they should have in a med-kit.

[Qaz98]

Fair point. Well stated.

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[Odin Bravo One]

I hope the OP got some useful information from this discussion.

[gtae07]

Needle decompression in theory is very easy. Needle decompression on fit military age males isn't terribly difficult. The farther you get from that, it becomes exponentially more dangerous and less successful....<snip>
Needle D in theory isn't hard. In real life, it's not that hard to fuck up, either, and you likely won't get covered by a good Samaritan law for performing a skill that you're not certified by any accredited body to perform.

And that is why I'm leaving it out. I know I don't have the training to do it, the chances of me screwing it up are therefore much higher, and the chances of making the situation worse instead of better are therefore also much higher. I can't really think of a plausible situation where me attempting the procedure would be preferable to managing any other problems (bleeding, shock, the sucking chest wound causing tension pneumothorax*, etc.) and waiting for EMS to arrive, even if I'm out in the rural areas I mentioned earlier. I can easily see someone bleeding out in that timeframe, though, so I'm more worried about stopping bleeding and sealing wounds.

I've been trained in CPR, AEDs, basic general trauma care (with the expectation of vehicle and industrial accidents), and other specific things we commonly saw (e.g. diabetic emergencies, drug overdoses). It's been a few years since I left the fire department, though, so I need a refresher.


On CPR mask, BVM, hands-only... all the training I've had has been 30/2, and that's how we did it "for real" on calls (granted, in a "team setting"). I do see the reasoning and logic with hands-only; I just wonder how that might be perceived later as it's different from all of my formal training thus far. I also rode a few calls where a patient had a good airway and pulse, but wasn't really breathing, so we started bagging them. I'd like to have a mask/small BVM available for that if needed.


This thread has been helpful though. Thanks for all the responses. I'll add a couple more pairs of gloves (they're cheap and small, and one trick I picked up was double-gloving so replacing them is easier) and some more gauze, and some wraps.



* yes, I know it's not the only thing that can cause it...

[LJP]

Regarding TQ’s in your kit, you mentioned a toddler. In addition to the TCCC approved TQ’s, I would include at least one SWAT-T or R.A.T.S. in your kit for kids/pets. The SOFT-W or CAT will not work on small extremities. FWIW, civilian paramedic here, 16 years experience and a couple of tactical medicine classes under my belt.


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[holmes168]

Couple items I added to my bag were:
Pen and paper- I want to keep track afterwards what was used and what happened in the incident
1st Aid guide- just a small guide to review when something may happen.

[Dave J]

Strongly concur with the discussion above, and I think the core items were pretty well covered.

For a vehicle kit, I’d consider adding a SAM splint or two, with sufficient ACE wraps to support, since fractures are fairly common in vehicle accidents. Sharpie marker. Cravats have multiple uses, and eye shields don’t take up much space.

[Nephrology]

Very wise move on the needle. Without EXTENSIVE training, no one has any business trying to dart someone's chest.

This is correct. I can post the references if anyone is curious, but bottom line is it they are simply not a good idea for without medical training, and will not be indicated for the vast majority of patients, even with suspected PTX. Get them to a hospital where they can get a chest tube, which is first line.

NPA I've kind of thought the same thing--until I can get some training in one (I never saw one used in practice and only saw an OPA used once that I know of--that was a memorable call!) I'm hesitant to put it in the bag.

More gauze and gloves, not a problem. I buy the gloves in bulk packs from Sam's for working with paint and other things in the workshop, cleaning bathrooms and guns, etc. so not a problem to add a few more. Ace wraps are easy to get too.

NPAs are actually pretty easy to place. Anything more invasive than that I would not advise.

[Nephrology]

Needle decompression in theory is very easy. Needle decompression on fit military age males isn't terribly difficult. The farther you get from that, it becomes exponentially more dangerous and less successful........that much has been definitely studied and proven, with up to 2/3 of professional providers misidentifying the site. At my old job we even had a paramedic with over a decade of experience misidentify the site and puncture the heart of the patient.

Needle D in theory isn't hard. In real life, it's not that hard to fuck up, either, and you likely won't get covered by a good Samaritan law for performing a skill that you're not certified by any accredited body to perform. Good Samaritan laws are almost always reserved for those acting within the scope of their training.

I've never seen professional practitioners act/speak as loosely with applying needle thoracentesis as laymen on gun forums do, in particular. The same applies for this thread, where the only people with known real training and experience are basically saying to slow up. There is simply no good reason in suggesting needle decompression for people who are still at the stage of asking what they should have in a med-kit.

Exactly. People always forget that the first option for treatment of anything is to do nothing, and often times, this is the best choice.

Per the Royal College of Surgeons current guidelines on prehospital management of PTX:

There is considerable risk of iatrogenic pneumothorax if misdiagnosis and decompression is performed. Needle decompression in the absence of a pneumothorax may even create an iatrogenic tension pneumothorax. There is increasing concern regarding the number of needle decompressions being performed without the appropriate clinical indications, leading to significant morbidity and unnecessary interventions for the patient.13

Edit: to the OP, that looks like a good list to me. The splints/cravats suggested are also not bad.

One other helpful exercise for you to consider as you acquire this stuff is how close/not close you are to a hospital with a 24/7 ER, as well as local EMS response times.

Here in metro Denver, an IFAK style kit is plenty for me to leave the house with for everything I do on a routine basis. While I have other medkits and plans to buy into even fancier ones, I know that baby aspirin and two strong shoulders are likely to be the most lifesaving items on my person at any given time. Everything else EMS will have and be able to use way better than me when they roll up.

[Drang]

Good thread; 5 stars, would read again. Subscribed, in fact.

Elsewhere I mentioned that when I took Kelly Grayson's Shooter Self-Care class at the NRA Annual Meeting in 2015 I asked him about putting an NPA in my kit, and he advised against it for a person without training in use of same. Note that this advice was in the context of a class specifically aimed at medical/trauma emergencies on the range, for which we got certificates with his signature on them.
I had not considered the aspect of adding an NPA, or possibly needle decompression, against the possibility that a trained professional might be available without his or her own gear.

Does anyone know of a source of individually wrapped baby aspirin? Seems more practical than adding a small bottle to each kit...