Glock 19 of IFAKs?

[Totem Polar]

I would just note re: the NPA that there is no replacement for hands on practice.... but I am doubtful you will find a lot of willing volunteers. I would consider leaving this out.

You’re a doc; I’m a musician. With that acknowledged upfront, I’d say it depends on the application (most likely event for use of the kit). I’ve been lubed and tubed btw, and I agree that it’s a bit of a drag.

Or, listen to Larry S, above.

What about adding an Asherman seal to this kit, instead?

https://www.tacmedsolutions.com/TacM...-Operator-IFAK

[Yute]

You could buy direct from Stop the Bleed.

If operating around firearms or pointy objects, I would prefer to have two tourniquets.

Personally I would leave an NPA in an IFAK especially if you have one already. If it's not within your scope then don't use it, but someone who is trained can.

Like nasal airways, chest seals are not technically within the scope of lay person first aid. Again if you have the space, you can add one in for someone else to use, but given constraints on budget, I would prefer to spend the money on another tourniquet.

Of course, you then get into the question about the utility of chest seals in general, i.e. do people actually die from sucking chest wounds (probably not) and are we potentially doing more harm than good by sealing them up thereby risking a fatal tension pneumothorax...

[ST911]

I would just note re: the NPA that there is no replacement for hands on practice.... but I am doubtful you will find a lot of willing volunteers. I would consider leaving this out.

You'd be surprised. A buddy of mine drops an NPA on himself while he instructs the procedure. Great parlor trick. I can usually find a volunteer in most classes, some repeats. Strange folks.

I'd never use a medical device I'm unfamiliar with, unless there's a nephrologist nearby. If you're serious, I'll remove this piece.

Leave it, someone else helping you might use it.

We were told they’re going away from NPAs in the field, at least in our region of CT. I don’t carry any in any IFAKs I have. I’m not slinging a BVM or O2 off duty, coupled with head trauma being a contraindication, not worth the space it takes up. My .02 Sent from my iPhone using Tapatalk

Haven't seen any sign of them going away, but it could be a local thing.

And the cannulate-your-brain thing isn't a thing, now discussed and debunked in the last several classes I've been through.

Like nasal airways, chest seals are not technically within the scope of lay person first aid. Again if you have the space, you can add one in for someone else to use, but given constraints on budget, I would prefer to spend the money on another tourniquet. Of course, you then get into the question about the utility of chest seals in general, i.e. do people actually die from sucking chest wounds (probably not) and are we potentially doing more harm than good by sealing them up thereby risking a fatal tension pneumothorax...

Good discussion. My norm with lay folks is to teach protection of the wound which has a default sealing-ish property and keep watching the CABs. Where class time and student ability allows, conventional improvised and manufactured seals. A lot of my students are rural/remote/denied areas where response and transport times are extended and a scw/tpx is an issue.

[Larry Sellers]

You'd be surprised. A buddy of mine drops an NPA on himself while he instructs the procedure. Great parlor trick. I can usually find a volunteer in most classes, some repeats. Strange folks.



Leave it, someone else helping you might use it.



Haven't seen any sign of them going away, but it could be a local thing.

And the cannulate-your-brain thing isn't a thing, now discussed and debunked in the last several classes I've been through.



Good discussion. My norm with lay folks is to teach protection of the wound which has a default sealing-ish property and keep watching the CABs. Where class time and student ability allows, conventional improvised and manufactured seals. A lot of my students are rural/remote/denied areas where response and transport times are extended and a scw/tpx is an issue.

Definitely local. Which means nothing to the rest of the world...for example: on duty I can not use or “carry” hemostatic gauze. But when I get in my truck to go home I have it with me at all times to use.

Go figure.

Thanks for that clarification as well, didn’t know it was debunked!


Sent from my iPhone using Tapatalk

[Nephrology]

You’re a doc; I’m a musician. With that acknowledged upfront, I’d say it depends on the application (most likely event for use of the kit). I’ve been lubed and tubed btw, and I agree that it’s a bit of a drag.

Or, listen to Larry S, above.

What about adding an Asherman seal to this kit, instead?

https://www.tacmedsolutions.com/TacM...-Operator-IFAK

re: NPA I mostly don't see what utility it has in a pre-hospital setting for bystander first aid. In addition to its contraindication in setting of head/ENT trauma, it is of limited use if you're not going to bag.

If they are obtunded but breathing spontaneously with atraumatic airway, IMO you will get a ton more mileage out of simple jaw thrust. Certainly enough for EMS to arrive in urban metro USA. If you're going to bag then NPA is a different story. but in that case, why not just leave the NPA with your BVM? Not something I would put in an IFAK. I feel NPA (just like OPA) should be part of an airway management kit. When I put one together I will probably throw those in there, but that's not a priority for me right now.

I'm not in EMS and have exactly one ridealong's worth of pre-hospital experience so maybe there are other uses for NPAs I am not aware of, but personally I do not carry them in my IFAKs.

You'd be surprised. A buddy of mine drops an NPA on himself while he instructs the procedure. Great parlor trick. I can usually find a volunteer in most classes, some repeats. Strange folks.

It takes all kinds.... I've had an NG tube dropped before and it was the most terrible thing that's ever happened to me (seriously). Couldn't pay me to get an adjunct airway placed w/o an appropriate amount of propofol first.

[Yute]

All good points. Personally I like having more (properly sized) airways available during mass casualty incidents for the patients unable to protect their airways but this is likely not a concern for the average civilian. Be comfortable with placing people in the recovery position unless they have a concern for c-spine injury.

Personally my everyday medical kit carry is a TQ, x1 Hemostatic gauze, x1 Z-Paked gauze for packing, and x1 flat pressure bandage along with 2 sets of gloves.

Range kit is that plus an additional TQ, chest seal, NPA, decompression needle.

My deployment armor setup is my own IFAK which essentially contains all the above, plus another TQ righter lower right pants pocket (unit SOP); plus duplicate IFAK supplies for 1-2 patients in addition to my ALS bag. A lot of "basic" stuff goes a long way.

FYI I just put in an order from NAR and it is working again.

[WobblyPossum]

Of course, you then get into the question about the utility of chest seals in general, i.e. do people actually die from sucking chest wounds (probably not) and are we potentially doing more harm than good by sealing them up thereby risking a fatal tension pneumothorax...

Maybe it’s time for me to take a TCCC refresher course, because I thought tension pneumothorax was what happened when you don’t seal a ducking chest wound and air continues to enter the chest cavity.

[Yute]

Maybe it’s time for me to take a TCCC refresher course, because I thought tension pneumothorax was what happened when you don’t seal a ducking chest wound and air continues to enter the chest cavity.

Common misconception and I hear it frequently taught even by high level providers. A lot of confusion stems from the terminology - differences between an open, tension and simple pneumothorax. Chest seals are ostensibly used on open chest wounds/open pneumothorax (same thing) to “improve breathing mechanics” - not the treatment of a simple or tension pneumothorax. What this actually means is debatable - there is no good evidence to support the idea that you have to seal an open wound to improve survival. You can absolutely kill someone by sealing an open chest wound with an underlying lung air leak into the pleural cavity, which causes a tension pneumothorax due to a buildup of pressure (which the open chest wound would have relieved) Less likely to happen with a vented chest seal, but vents get clogged all the time. If using a chest seal, it is vital to monitor the casualty and if develops signs of a tension pneumothorax the prompt removal of the dressing is indicated first, followed by needle decompression, then more procedures that require sharp tools and tubes.

Edit to add: no evidence to support use of improvised 3 sided dressing

[WobblyPossum]

Common misconception and I hear it frequently taught even by high level providers. A lot of confusion stems from the terminology - differences between an open, tension and simple pneumothorax. Chest seals are ostensibly used on open chest wounds/open pneumothorax (same thing) to “improve breathing mechanics” - not the treatment of a simple or tension pneumothorax. What this actually means is debatable - there is no good evidence to support the idea that you have to seal an open wound to improve survival. You can absolutely kill someone by sealing an open chest wound with an underlying lung air leak into the pleural cavity, which causes a tension pneumothorax due to a buildup of pressure (which the open chest wound would have relieved) Less likely to happen with a vented chest seal, but vents get clogged all the time. If using a chest seal, it is vital to monitor the casualty and if develops signs of a tension pneumothorax the prompt removal of the dressing is indicated first, followed by needle decompression, then more procedures that require sharp tools and tubes.

Edit to add: no evidence to support use of improvised 3 sided dressing

This is why I love this forum.

[TGS]

Like nasal airways, chest seals are not technically within the scope of lay person first aid.

This is the first time I've heard this. It's a skill taught in layperson classes.

re: NPA I mostly don't see what utility it has in a pre-hospital setting for bystander first aid. In addition to its contraindication in setting of head/ENT trauma, it is of limited use if you're not going to bag.

If they are obtunded but breathing spontaneously with atraumatic airway, IMO you will get a ton more mileage out of simple jaw thrust. Certainly enough for EMS to arrive in urban metro USA. If you're going to bag then NPA is a different story. but in that case, why not just leave the NPA with your BVM? Not something I would put in an IFAK. I feel NPA (just like OPA) should be part of an airway management kit. When I put one together I will probably throw those in there, but that's not a priority for me right now.

I'm not in EMS and have exactly one ridealong's worth of pre-hospital experience so maybe there are other uses for NPAs I am not aware of, but personally I do not carry them in my IFAKs.

Specific application to TCCC or even domestic MCIs depending on agency protocols.

In the use of the MARCH algorithm, I can't hold a jaw trust on one patient and simultaneously move to do MA on another. NPAs are space efficient, the brain-tubing concern is more of a extremely low probability hypothetical, and NPAs allow me to perform M and A on a patient and then move on to the other patients in my vicinity before going back around and reassessing/addressing RCH.

An unconscious casualty can still have spontaneous breathing but be in danger of losing their airway, and recovery position isn't always an option. Patient movement is a surefire portion where this can matter......you can't hold a jaw-thrust while moving somebody unless you've got a stretcher and being VERY deliberate (slow) and coordinated as a team, and most improvised patient movement techniques can induce an airway obstruction. An NPA mitigates all of this, regardless of whether you need to assist ventilations or not.

For these reasons, NPAs have a strong place in IFAKs. I don't teach them in my lay person classes but that's a decision based 100% in liability management in 21st century America rather than any actual good reason.