Super-sticky-medic-thread

[GiladS]

As an IDF medic it has interested me to know whether other militaries around the world use the same type of touniquet we use here for hemorrhage control in the arms and lower led or whether they use something else.


So this is what we use...

http://img228.imageshack.us/img228/1928/prod83kd3.jpg (http://imageshack.us)

These tourniquets are 2 meters long and made of either silicon, rubber or a combination of the two.

The rubber ones need to be pwedered with talc every once and while (else they may get torn). Silicon is the best as it doesn't tear yet it sometimes slips off blood. The army tried to create a better tourniquet by combining the two materials however the result was a tourniquet that features the disadvantages of both.

[Mrufka]

Something else, check hire http://www.tacmedsolutions.com/07/products/product_detail.php?prod_id=2

[Roy Batty]

We use the C.A.T
http://img104.imageshack.us/img104/4005/300001bhd4.jpg


http://www.narescue.com/Product1.aspx?SID=1&Product_ID=20

[GiladS]

GiladS, can you explain how do you aply your type of tourniquet?

A) You lay the tourniquet in an L like shape over the the limb.

B) Wrap the tourniquet as tightly as possible while the strips on both side of the limb are one over the other.

B) Once you finish wrapping the limb, you tie up the two edges.


http://www.starmed.co.il/Images/Content/FirstAid/111.jpg

http://www.starmed.co.il/Images/Content/FirstAid/112.jpg

[Roy Batty]

I would imagine that in your case only medics and other medical personnel traditionally carry tourniquets with them.

2 soldiers in each 8 to 10 man section are carrying tourniquets, Israeli Bandages, Chest Decompression needles, Quick Clot and a bag of other odds and sods.

Each other soldier carries a few battle dressings and a pocket cpr mask.

[Bulletproof]

The Medics were getting alot of guys coming into the role 3 hospitals with 4 and 5 tournequets on one limb for minor wounds and multiple chest needles in. Guys in the field while meaning well were doing more harm than good in some cases.

Dear God... While talking about medical stuff, does anyone carry tampons? I read a story about soldiers carrying them because it saved the life of one of them. The wound was so deep, the medic couldn't stop the bleeding. By chance, one of them took the wrong medical pack before leaving and there was a couple of tampons in it. The medic took one and "plug" the wound with it. Later the surgeon said it saved the soldier life.

[One Shot Tactical Supply]

Talk to Chris at CTOMS. They are providing the most up to date training for Canadian CF and LE Medics. He also wrote the book on Canadian TCCC.

http://www.ctoms.ca/

[Sloppy Joe2]

Dear God... While talking about medical stuff, does anyone carry tampons? I read a story about soldiers carrying them because it saved the life of one of them. The wound was so deep, the medic couldn't stop the bleeding. By chance, one of them took the wrong medical pack before leaving and there was a couple of tampons in it. The medic took one and "plug" the wound with it. Later the surgeon said it saved the soldier life. our medics went and bought tampons for everyone in our unit, each soldier was given 4. once saw them used to treat an IP's wounds, 1 in the entry, two in the exit. seemed to work well.
every american soldier these days have a CAT issued with their RFI kit before deploying, only thing i dont like about cats is the velcro goes to **** quick and it is not large enough for a big guys thigh.
if i remember right the RFI medic pouch came with
- CAT tourni
- pressure bandage
- surgical tape
- latex gloves
then we had a CLS pack for every truck, not to mention the **** the medics had on em.
chilled fluid bags, a soldiers best friend :D

[cone256]

According to the new CLS (Combat Lifesaver Course) I took a couple weeks ago everyone will be issued a CAT in the new first aid pouch. It'll have some other stuff in it too but I forget. Doc Strauss, one of the medics teaching the class, said that every CLS and soldier for that mater should carry tampons of different sizes so we can plug the holes. I felt like an idiot for buying them but if that's what needs to be in my CLS bag then so be it.

[Beowulf]

This is a post I made in a thread that got deleted


You don't really need a tampon, that's what kerlix is for. Use it the same way, stuff it in the hole and throw a bandage over top of it.

Kerlix is just as absorbent (or more so) than tampons. (Extra absorbent tampons are only designed to absorb 15 to 18 grams or about .5-.6 ounces.)

Kerlix is also supposed to help prevent infection better than a normal tampon. Plus they're free, and already in most CLS bags, just ask for extra.

Kendall AMD dressings contain PHMB (polyhexamethylene biguanide), a bacteria-killing polymer. PHMB attacks bacteria on and within the dressing fabric, helping keep infection out of the wound and limiting cross-contamination.

AMD dressings treated with PHMB are used like standard dressings automatically comply with your facility’s existing protocol.

Here’s how PHMB works:

1. PHMB binds to bacteria’s phospholipid (outer) membrane
2. Disrupts membrane, causing cytoplasm to leak out
3. Cell’s protective layer disintegrates
4. Cell collapses and dies

* PHMB works similarly to dismantle gram-negative bacteria

Effective against:

* Methicillin-resistant Staphylococcus aureus (MRSA)
* Vanocomycin-resistant enterococcus (VRE)
* Acinetobacter Baumannii (MDRAB)
* Staphylococcus aureus
* Staphylococcus epidermitis
* Pseudomonas aeruginosa
* Escherichia coli
* Candida albicans
* Staphylococcus coagulase
* Proteus mirabilis
* Serratia marcescens
* Enterbacter cloacae
* Klebsiella pneumoniae
* Enterococcus faecalis
Beowulf is online now Report Post IP
http://www.kendallamd.com/ProductInformation-HowItWorks.php

[Roy Batty]

Here is my issued TCCC leg bag

http://img337.imageshack.us/img337/8249/ff013sq8.jpg

http://img337.imageshack.us/img337/2530/ff014ck5.jpg

http://img232.imageshack.us/img232/1070/ff015cc7.jpg

The one I carry overseas is Arid Cadpat or Coyote brown. The major components? a CAT tournequet (1 time use only), 2 Ashermans chest seals, 2 packs of Quick Clot, 2 Isreali bandages, 2 Cooks chest decompression needle sets, surgical sicsorrs, Kurlex gauze for wound packing (Tampons are a no-no acording to our Medics), 2 NPAs with lube, 2 big green tri-angular bandages, a handfull of triage cards and assorted tape, gauze and bandaids.

[Sabre]

So basically you guys use 'Russian tourniquet' (screw tourniquet) devices at any scenario.

Here in Israel every soldier usaully carries the small and flexible tourniquets in their pockets (together with their personal dressing).

I would imagine that in your case only medics and other medical personnel traditionally carry tourniquets with them.

Tourniquets went out of fashion for a while, with only medics having them in their kits. Those were the old 'sangway anchor' type, which was just a rubber hose with a hook at one end to secure the live end. The rise in proportion of extremity haemorrhage in combat deaths led to the individual issue of CAT tourniquets.

They are supposed to be an individual issue along with the compression bandage and airways. Now 1 in 4 UK troops are trained as 'Team Medics' and issued with a kit containing a CAT, hemcon dressing, compression dressings, airways, suction easy, IV cannulae and giving sets plus fluid, amongst other things.

Thankfully the new 'doctrine' was filtered down PDQ as soon as it was generated. One PF bloke who sadly lost both legs in a mine blast was treated by his mates using the new principle of stopping massive haemorrhage first. They didn't have CATs issued at the time, so they improvised by using cable ties as tourniquets on his legs, saving his life.

It just goes to show that knowledge is the most important bit of kit.

[HarleyDoc]

I'm taking the Operational and Emergency Medical Skills Course (OEMS) now. It is being given by one of the TCCC founding fathers. I'm willing to try and answer any related deployment medical questions you may have. For example, the A, B, C's of civilian ATLS are out as far as field medicine is concerned. They are replaced by MARCH. The acronym stands for:

M- Massive bleeding
A- Airway
R- Respiration
C- Circulation
H- Head/hypothermia

This is the order for treating a casualty in the field. Like TCCC, the first priority is Fire Superiority!

I'll expand on this and be standing by for questions the rest of this week, so sound off if you have any.

[Beowulf]

Tourniquets went out of fashion for a while, with only medics having them in their kits. Those were the old 'sangway anchor' type, which was just a rubber hose with a hook at one end to secure the live end. The rise in proportion of extremity haemorrhage in combat deaths led to the individual issue of CAT tourniquets.

They are supposed to be an individual issue along with the compression bandage and airways. Now 1 in 4 UK troops are trained as 'Team Medics' and issued with a kit containing a CAT, hemcon dressing, compression dressings, airways, suction easy, IV cannulae and giving sets plus fluid, amongst other things.

Thankfully the new 'doctrine' was filtered down PDQ as soon as it was generated. One PF bloke who sadly lost both legs in a mine blast was treated by his mates using the new principle of stopping massive haemorrhage first. They didn't have CATs issued at the time, so they improvised by using cable ties as tourniquets on his legs, saving his life.

It just goes to show that knowledge is the most important bit of kit.

Cable ties....quick thinking there.

The last I heard the leading causes of preventable death on the battlefield were hypovolemic shock due to exsanguination (bleeding out), tension pneumothorax, or airway problems.

Thus the new training (U.S.) places a lot of emphasis on using the tourniquet early, how to use the Nasopharyngeal Airway, and how to properly diagnose TP and do a needle decompression.

I believe they did away with the "J" Tube, not sure why though.....

[James]

We use the C.A.T
http://img104.imageshack.us/img104/4005/300001bhd4.jpg


http://www.narescue.com/Product1.aspx?SID=1&Product_ID=20

I carry a couple of those in my kit when I'm working. I also carry the new and improved Kwik Clot that comes in a little pouch like a teabag.

[Royal]

Cable ties....quick thinking there.

Indeed - improvise adapt & overcome


I believe they did away with the "J" Tube, not sure why though.....

Oro-pharyngeal Airway?

http://www.healthsystem.virginia.edu/Internet/Anesthesiology-Elective/images/anesth0007.jpg

I was certainly still carrying them last time I got my boots dirty - which, admitedly, is a while ago now p-)

[HarleyDoc]

The oro-pharyngeal is out in the new standards. Here are the current airway requirements:

1) Naso-pharyngeal airway. 20-24 F/ 6.0 diameter lubricated with viscous lidocaine if available, surgi-lube or saliva otherwise. Aim the airway down and rotate toward the ear. A safety pin can be used to adjust length and secure in place.

2) Surgical airway (cricothyroidotomy). -Trained use only. An emergency cric set can be fashioned by cutting an IV drip chamber in half. Find the anatomical landmark of cricothyroid membrane below "adam's apple." Make a longitudinal incision through the skin and visualize the membrane. Take top half of cut IV drip chamber, remove cap on spike that usually goes into IV bag. Insert spike through cricothyroid membrane. If patient needed a surgical airway, there will be a rush of air. The drip chamber needs to be secured in place with 100 mph tape or tac sutures. An ambu-bag can be attached to the drip chamber and the patient ventilated.

3) Suction device. (easy suction device). Also use gravity to facilitate drainage of blood and secretions. This is a reason c-spine is not as stressed in new TCCC standards, since it helps to turn the patient head so they don't drown.

[loganinkosovo]

According to the new CLS (Combat Lifesaver Course) I took a couple weeks ago everyone will be issued a CAT in the new first aid pouch. It'll have some other stuff in it too but I forget. Doc Strauss, one of the medics teaching the class, said that every CLS and soldier for that mater should carry tampons of different sizes so we can plug the holes. I felt like an idiot for buying them but if that's what needs to be in my CLS bag then so be it.

From what I've read SEALs and other people who have to travel light have carried them for years.

What ever works.....use it.

Monistat 7 cream works wonders on Athletes foot and I even cured a case of reoccurring jungle rot with it. Boy, that was a very hard sell to get my Master Sergeant to use it. :)

Just rub the cream between your Affected toes for a week or until the infection goes away.

This stuff is the Sh!t!


http://www.monistat.ca/english/cure_trust.html

[HarleyDoc]

OK guys, let's have a class on tampons. Tampons work very well for what they were designed to do: stop blood from exiting the ****** and running down a womans' leg. They absorb blood, they do not stop the uterus from bleeding. When they are saturated, they are replaced, and the uterus continues to bleed until the lining has been shed and the 28 day cycle repeats. A tampon was not designed to tamponade a severed artery from a bullet wound. If you stick a tampon in a bullet wound, it will absorb blood. This is very different from STOPPING bleeding. You may think the bleeding is stopped, but in reality you just can't see it for a while. In the meantime, the patient continues to exanguinate and slips further into hypovolemic shock.

If you want to stop arterial bleeding, pack the wound with the latest QuickClot tea bags, and/or pack it full of Kerlix gauze or you may have to cut the wound edges open so you can get down to the artery and apply continuous direct pressure, and then pack it with a hemostatic agent like QuickClot and/or Kerlix.

[HarleyDoc]

Civilian ATLS and military TCCC are different systems designed for different environments. Let's talk c-spine control. In civilian ATLS, which was designed to a large degree to deal with blunt trauma from motor vehicle accidents, a medic is trained to secure the airway with c-spine control. In TCCC, we have to consider a GSW or frag injury to the neck. The spinal cord has the consistency and durability of jello. If a GSW hits the vertebral column, it will most likely also sever the cord, and the neurological deficit will be apparent if not outright fatal. Thus a penetrating injury to the neck that has not yet severed the spinal cord, is unlikely to do so in the future. A patient may be harmed more if immobilization of the c-spine that prevents fluids from being drained from the airway. Remember that just putting a c-collar on is NOT spinal immobilization! The patient needs to be secured with head blocks on a long spine board. How many medics carry all the equipment for complete spinal immobilization? Not many, and nor should they. Here's why:

How to rule out c-spine immobilization

No c-spine immobilization is required if:

1) No mechanism of injury
-axial load (hit on top of head)
-traction (hanging type injury)
-flexion-extension (whiplash injury)
-lateral stress
-rotation

2) No pain
3) No tenderness
4) No step-off of vertebral column
5) No distal neurologic deficit
6) No distraction (i.e. drug or alcohol impairment or other very painful injury)
7) No pain when the patient attempts range of motion movements.

[Sabre]

Good posts HarleyDoc. Tampons are fit for purpose only for menstrual bleeding. It's akin to the old 'put on a second/third field dressing if the first bleeds through' mentality. It may treat the medics hypertonic sphincter, but it wont stop the artery from bleeding.

As for C spine control, again good points. Consider of course the mechanism of injury, this may well be an RTC out on ops where civvy street immobilisation would be indicated, but how often do military medics carry spinal boards? Don't compromise the MARCH algorithm for c spine control, although do consider the circumstances (permissive environment etc).

Regarding the 'J tube' or OP airway, it's still in for the UK armed forces. I would imagine the reason why it's 'out' over the pond could be due to personnel putting them in (however correctly) and assuming the airway is safe. Of course, they are just adjuncts and not definitive airways, and as such require just as much monitoring as the airway is still at risk. They are also not well tolerated unless the patient is completely out, in which case they probably need an ET tube. So I would imagine they have been left out in order not to confuse the issue.

[Creeper]

HarleyDoc wrote:
Remember that just putting a c-collar on is NOT spinal immobilization! The patient needs to be secured with head blocks on a long spine board. How many medics carry all the equipment for complete spinal immobilization?

I would like to add to the act of actually securing the Pt's head to the lsb< One should use appropriate blocks(velco) if those are not available take 2" tape across the forehead AND WRAP AROUND THE BOARD fully. Again- wrap around - in a continuous length min. 3X - do same again for the lwr jaw/chin if possible.
This insures - fully that the head / spine is SECURE and IMMOB'D.

just my .02 Euro.

[GiladS]

Here is what an IDF medic carries in his vest (most guys I know, including me, carry spares and extra equipment though):

- 2 silicon/rubber arterial tourniquets
- A 'Russian' arterial tourniquet
- 4 field dressings
- Triangle bandages
- 2 oropharyngeal airways
- An emergency blanket
- Alcohol prep pads
- Gauze dressing pads
- Elastic adhesive bandages
- A Metalline burn dressing
- 4 venflons
- IV set+saline solution bag

Other equipment included are medic scissors (trauma shears) and a angle head flashlight or a head flashlight.

Of course this is what's carried during the routine. In a war a medic or an assistant to him carries a whole backpack.

[DocEbola]

TCCC qualified guys only as far as I know know. The Medics were getting alot of guys coming into the role 3 hospitals with 4 and 5 tournequets on one limb for minor wounds and multiple chest needles in. Guys in the field while meaning well were doing more harm than good in some cases. The TF surgeon put an end to that with the TCCC program.

I'm deploying for the next 2 rotos and as far as our Medics said it's the 2 TCCC guys per section only.

Edit: My wife just got back and she said she was alos issued Quick Clot, a CAT and an Isreali bandage so who knows, maybe it's mid-change or maybe the Medic was wrong. I know that supposidly only TCCC guys carry chest needles and NPAs.
What is TCCC? In the states we use something almost the same, but I want to make sure it means the same.

[Sabre]

There's a few medic threads knocking about at the moment, maybe we should try and combine them into a 'Super-sticky-medic-thread'?

EDIT

"Ask and ye shall receive!"

Thanks Royal, now I just have to think of something to post in it. Perhaps this will work best as an occasional Q&A/update thread.

[Roy Batty]

What is TCCC? In the states we use something almost the same, but I want to make sure it means the same.

Tactical Combat Casualty Care

[LRPV]

There's a few medic threads knocking about at the moment, maybe we should try and combine them into a 'Super-sticky-medic-thread'?

Good idea. Perhaps some kind mod will make it a 'sticky'. It certainly is a thread worth the reading time.

[Royal]

Good idea. Perhaps some kind mod will make it a 'sticky'. It certainly is a thread worth the reading time.

Done - but with warning p-)

Leave the crap out - if you have a relevant comment or info post it - if not put it somewhere else.

PM me with a link, if you know of any other threads that should be merged into this one.

[Sloppy Joe2]

What is TCCC? In the states we use something almost the same, but I want to make sure it means the same. i dont know, but my unit has been using TC3 for while now, it is the future! :)

[Noodverbandje]

What is TCCC? In the states we use something almost the same, but I want to make sure it means the same.


Stages in Tactical Combat Casualty Care(source: Military Edition PHTLS, sixth edition)
Casualty managment during combat missions can be divided into three distinct phases: Care Under Fire, Tactical Field Care, and Casevac Care.
1. Care under fire refers to care rendered at the scene of the injury while both the medic and the casualty are under effective hostile fire. The risk of additional injuries being sustained at any moment is extremely high for both casualty and rescuer. Available medical equipment is limited to that carried by each operator and the medic.
2.Tactical field care is the care rendered once the casualty and his unit are no longer under effective hostile fire. It also applies to situations in wich an injury has occured on a mission, but hostile fire has not yet been encountered. Medical equipment is stil limited to that carried in the field by mission personnel. Time to extraction may range from a few minutes to many hours
3. Casualty evacuation care(Casevac) is the care redered while the casualty is being evacuated by an aircraft, ground vehicle or boat to a higher echelon of care. Any additional personel and medical equipment prestaged in these assets will be available during this phase.

[christopherh]

the british army now is issued with the cat aswell as an israli bandage for compression.

[kayaker]

OK guys, let's have a class on tampons. Tampons work very well for what they were designed to do: stop blood from exiting the ****** and running down a womans' leg. They absorb blood, they do not stop the uterus from bleeding. When they are saturated, they are replaced, and the uterus continues to bleed until the lining has been shed and the 28 day cycle repeats. A tampon was not designed to tamponade a severed artery from a bullet wound. If you stick a tampon in a bullet wound, it will absorb blood. This is very different from STOPPING bleeding. You may think the bleeding is stopped, but in reality you just can't see it for a while. In the meantime, the patient continues to exanguinate and slips further into hypovolemic shock.

If you want to stop arterial bleeding, pack the wound with the latest QuickClot tea bags, and/or pack it full of Kerlix gauze or you may have to cut the wound edges open so you can get down to the artery and apply continuous direct pressure, and then pack it with a hemostatic agent like QuickClot and/or Kerlix.

good post, keep it up.

Another thing to remember is tampons are not sterile and you risk anaphylactic shock when inserting them into a wound.

[Waltzing_Matilda]

Question for HarleyDoc;

Are you guys using Novo7 in the field? If so are there any restrictions? $10,000 bucks per ampoule here in Aussie.

[Search&Rescue]

at about $1 per mcg, high-dose rFVIIa (160 mcg/kg) would cost about $11,000.
It has to be used only in some circumstances.

[DeerPark]

Hi folks,
Has anyone used QuikClot in a real-life situation? What do you think of the stuff?

Cheers.

[imedic]

We've just had a new order of treatment brought in, just wondering if this is the generic standard for most countries.

New order:

M - Massive Haemorrhage
A - Airway
R - Respiration
C - Circulation
H - Head Injury
H - Hypothermia

Old treatment algorithm:

D - Dangers
R - Responsiveness
S - Send for Help
A - Airway
B - Breathing
C - Circulation

Like the old system we still check for scene dangers and LOCs before anything else (so it should kinda read DRSMARCHH).

Basically the big change was to deal with any massive bleed before anything else.

[HarleyDoc]

Question for HarleyDoc;

Are you guys using Novo7 in the field? If so are there any restrictions? $10,000 bucks per ampoule here in Aussie.

I've heard of it being flown in special to the 'Stan, but I have not used it personally. I think it would be restricted to higher echelon level care.

[HarleyDoc]

Hi folks,
Has anyone used QuikClot in a real-life situation? What do you think of the stuff?

Cheers.

QuikClot works very well when applied properly. Try to find the newer "tea bag" formulation as it is much easier to use and doesn't generate heat like the earlier version.

I've seen guys sprinkle QuikClot on a wound like it was powdered sugar going on a donut. Wrong answer. It has to get packed into the wound up against the bleeding vessel and kept in place with some bulk kerlix or similar material.

[James]

QuikClot works very well when applied properly. Try to find the newer "tea bag" formulation as it is much easier to use and doesn't generate heat like the earlier version.

I've got some of that in my kit - it's available from Galls in 25mg and 100mg packs:

http://www.galls.com/style.html?assort=general_catalog&style=FA212
http://www.galls.com/style.html?assort=general_catalog&style=FA213

[jorn]

we also have the c.a.t.in ouwer trauma kit.but only in operations or in missions.we dont get the kit for training in belgium.but they are quit good.

[jorn]

you only use quikclot for major bleedings?and how do you use it?just put the pouder on the wound?

[Sabre]

you only use quikclot for major bleedings?and how do you use it?just put the pouder on the wound?

Conventional methods of haemorrhage control should be used first. Quick clot is a 'failure to control' option. Compressing the wound or pressure point and elevating the limb are the best options for any form of limb bleed. Quick clot is best used for junctional bleeding, so bleeds in the groin, armpit or neck. You also need to be able to see the bleed. Just pouring it in isn't enough. You need to try and apply pressure to slow the bleeding and then clear any pooled blood to visualise the vessel. You need to swiftly clear the blood, pour the granules onto the vessel and reapply pressure. You need to do it virtually as fast as you can say it, otherwise the blood will just pool up again and you either get a nice clot that's floating about, not sat in the vessel blocking it, or it will just wash the granules out of the wound.

The granules have been superceded by the sponges or bags of clotting agents that are easier to place in the wound and positively site on the vessel. They're very good, but they need a practiced medic to use them competently and should only be used when conventional simple methods won't work.

[kayaker]

Conventional methods of haemorrhage control should be used first. Quick clot is a 'failure to control' option. Compressing the wound or pressure point and elevating the limb are the best options for any form of limb bleed. Quick clot is best used for junctional bleeding, so bleeds in the groin, armpit or neck. You also need to be able to see the bleed. Just pouring it in isn't enough. You need to try and apply pressure to slow the bleeding and then clear any pooled blood to visualise the vessel. You need to swiftly clear the blood, pour the granules onto the vessel and reapply pressure. You need to do it virtually as fast as you can say it, otherwise the blood will just pool up again and you either get a nice clot that's floating about, not sat in the vessel blocking it, or it will just wash the granules out of the wound.

The granules have been superceded by the sponges or bags of clotting agents that are easier to place in the wound and positively site on the vessel. They're very good, but they need a practiced medic to use them competently and should only be used when conventional simple methods won't work.

Informative post...

BTW wasn't there a bloke from the military arrested because he used it to treat an injured civvy in the West Midlands?

[jorn]

thanks for the info.what country or army started whit tccc?we got the lessons before we went to lebanon.

[DeerPark]

Conventional methods of haemorrhage control should be used first. Quick clot is a 'failure to control' option. Compressing the wound or pressure point and elevating the limb are the best options for any form of limb bleed. Quick clot is best used for junctional bleeding, so bleeds in the groin, armpit or neck. You also need to be able to see the bleed. Just pouring it in isn't enough. You need to try and apply pressure to slow the bleeding and then clear any pooled blood to visualise the vessel. You need to swiftly clear the blood, pour the granules onto the vessel and reapply pressure. You need to do it virtually as fast as you can say it, otherwise the blood will just pool up again and you either get a nice clot that's floating about, not sat in the vessel blocking it, or it will just wash the granules out of the wound.

The granules have been superceded by the sponges or bags of clotting agents that are easier to place in the wound and positively site on the vessel. They're very good, but they need a practiced medic to use them competently and should only be used when conventional simple methods won't work.

Nice post, this one and the others with pointers on Quikclot.

I reckon this is one of those things which is almost impossible to teach in a classroom, unlike, say for example, teaching a medic how to insert an IV line. You can do this with relative safety with live casualties and botched jobs might result in bad bruises and some blood shed (especially if the medic under training has difficulty finding a vein).

Not so with Quikclot. Even the docs on my end speak about the product without having actually used it.

[Michael12345]

does anyone have pictures or info on current USMC and US Army Medics field equipment?

[ChineseJunk]

I just met Dr Sam Scheinberg of Sam Splint fame. What a great guy.

Has anyone used Celox? How does this compare to Quikclot and which do you prefer?

[dacanadianbomb]

Has anyone ever received or given an IV line into the Jugular?

I read about it in another thread on another forum that during a training ( Dont think it was actually a EMT or MIL clas, it was a private one) , they were taught this. The members of course had to receive and give one.

I think I would most likely **** my pants at the thought of someone IVing my jug. I mean in a training environment.
Anybody have any experience with this kind of stuff?

[Creeper]

I have not ,,yet. My neighbor who was a young 18 Delta from Grp. was on a cert. ride in the Bronx, they p/u a Pt. with Mass. Hemor. ,AO1, blah-blah, did a Jug. IV. the other Medic & EMT were blown away. When they arrived @ receiving facility the Doc. asked ALOT of FAQs.

When you need fluids ,,fast,, and alot of it ,,quick,, and other areas are not accessible,, doing it in the jug may be the correct protocol.

Please consult your leading physician.

[DnA]

2 soldiers in each 8 to 10 man section are carrying tourniquets, Israeli Bandages, Chest Decompression needles, Quick Clot and a bag of other odds and sods.

Each other soldier carries a few battle dressings and a pocket cpr mask.

Out here, as far as I know we all got issued quick clot, isreali bandages, torniquets, etc. I picked up some extra medical supplies from my stores aswell.

TCCC dudes just get more of everything, plus the TCCC kit like chest decompression needles, etc

[imedic]

Hi,

I'm a medic in the NZ Army, with a bit of a problem sorting my kit.

I've got an issue medpack but it's huge, it's good for keeping everything in for doing things like range covers but when pack marching or patrolling it's a right pain.

What a number of people tend to do is strap it to the top of their ALICE packs. Unfortunately this is awkward to carry and ugly. It can be convenient to have all the kit ready at hand but most of the stuff in the pack doesn't need to be readily accessible.

What I'm looking at doing is putting all my meds in a pouch in my pack ie. all the oral analgesia, antiemetics, antibiotics etc.

From there I'll get the emergency drugs and put them in a pouch on the outside of my pack packed so I can get to them easily ie. adrenaline, naloxone, salbutamol etc.

And on my person I'll have a pouch/satchel/pack/bag with my trauma kit in it.

This way when pack marching I can cram the small bag inside my ALICE pack which keeps it out of the way (and my profile slightly smaller).

If patrolling I can simply have the trauma kit with me rather than carting round all my nebulous crap.

Unfortunately all the medpacks I've seen online are also huge - geared more for a mass-casualty situation rather than for being a platoon medic who sees more coughs and colds than bullet holes.

Any recommendations for this situation?

Cheers!

[Vici VII]

Hi, is there anyone still around on this forum? I am interested in the pros and cons for the field use of a tourniquet

[Sloppy Joe2]

Hi, is there anyone still around on this forum? I am interested in the pros and cons for the field use of a tourniquet they are awesome, not much bad about them as long as you dont leave it on for 6-8 hours.

i dont know a better way to say it

[Royal]

Any recommendations for this situation?

Cheers!

Try getting hold of a British PLCE med pack (DPM and same size as a PLCE bergan side pouch).

[Vici VII]

they are awesome, not much bad about them as long as you dont leave it on for 6-8 hours.

i dont know a better way to say it

Thanks for that... I was in a "debate" with an ambulance officer who was totally against this and didn't believe that these even needed to be ever used. I tried to get some scenarios for him to accept, but his come back each time was that the toxin shock (I think) was a larger killer than just treating the wound. i.e. compress, bandage and elevate above the heart.

Cheers
By the way, not wanting to start a war of pros or cons, more just interested on the ways of use and when would be used.

Cheers

[Sloppy Joe2]

Thanks for that... I was in a "debate" with an ambulance officer who was totally against this and didn't believe that these even needed to be ever used. I tried to get some scenarios for him to accept, but his come back each time was that the toxin shock (I think) was a larger killer than just treating the wound. i.e. compress, bandage and elevate above the heart.

Cheers
By the way, not wanting to start a war of pros or cons, more just interested on the ways of use and when would be used.

Cheers the new way of treatment being taught to U.S soldiers and if i remember right our cunuck neighbors is called TCCC (Tactical Combat Casualty Care) and it puts first action protocol for bleeding woundes, ie gunshot woundes and serious shrapnel woundes.

the old CLS method overstated the dangers of using a tourniquet, even if it is left on to long it seen to be a better scenario to lose a limb then to have your casualty bleed out.

you get one on a casualty quickly you seriously increase his survival rate, you have to remember though that the environment that he works in and the one we do have different variables thus certain differences in technique.

[1911-a1]

Hi medics! What do you think i should carry in my EDC pack?

What stuff is important?

[Vici VII]

(snip)
the old CLS method overstated the dangers of using a tourniquet, even if it is left on to long it seen to be a better scenario to lose a limb then to have your casualty bleed out.

Sorry CLS (I hate acronyms ;o)

I used the point above in my discussion, but the come back was that the body goes into shock in a situation like this and one of the natural results of shock is that the arteries contract, i.e. close off the bleed. I would assume not stop the bleed altogether though. As yet I have not been in such a situation, so I can only go on those who have experienced this..

Again he pushed the toxin point. I believe that there was a victim in China (with the quakes) that was crushed and when they released the crushed debris off him, he died as the toxins surged through his body. According to others who saw the item on the news, the victim was talking fine, even though being crushed.

Naturally my next question how would you overcome this. His answer was very slowly. use fluids to fight the toxins and release the debris slowly. Naturally this isn't a firefight and there is no added stress of being shot. Although he did also say that in some instances there is nothing they can do for a crushed victim, as the release will kill instantly and so they just give pain killers and talk to them until the inevitable happens.

By the way, if anyone is reading that this has happened to or they have experienced, I mean no disrespect in those situations.
I am asking to understand more.

Cheers

[Sloppy Joe2]

Sorry CLS (I hate acronyms ;o)

I used the point above in my discussion, but the come back was that the body goes into shock in a situation like this and one of the natural results of shock is that the arteries contract, i.e. close off the bleed. I would assume not stop the bleed altogether though. As yet I have not been in such a situation, so I can only go on those who have experienced this..

Again he pushed the toxin point. I believe that there was a victim in China (with the quakes) that was crushed and when they released the crushed debris off him, he died as the toxins surged through his body. According to others who saw the item on the news, the victim was talking fine, even though being crushed.

Naturally my next question how would you overcome this. His answer was very slowly. use fluids to fight the toxins and release the debris slowly. Naturally this isn't a firefight and there is no added stress of being shot. Although he did also say that in some instances there is nothing they can do for a crushed victim, as the release will kill instantly and so they just give pain killers and talk to them until the inevitable happens.

By the way, if anyone is reading that this has happened to or they have experienced, I mean no disrespect in those situations.
I am asking to understand more.

Cheers
CLS = combat life saver
keep in mind i am not a medic, i only base what i say off of what i was taught for immediate treatment until the casualty could reach the next line of treatment. i have seen casualties crushed under rubble and have never heard of the toxins statement, with the treatment we gave on scene i do not know the result of who lived or died and how. shock does not always set in, and hypervolume shock or something similar to that name is caused by loss of blood so if you can prevent the loss of blood you have a better chance of avoiding shock.
remember though this is info coming from a dumb grunt so dont put complete trust in it :)

[Vici VII]

CLS = combat life saver
keep in mind i am not a medic, i only base what i say off of what i was taught for immediate treatment until the casualty could reach the next line of treatment. i have seen casualties crushed under rubble and have never heard of the toxins statement, with the treatment we gave on scene i do not know the result of who lived or died and how. shock does not always set in, and hypervolume shock or something similar to that name is caused by loss of blood so if you can prevent the loss of blood you have a better chance of avoiding shock.
remember though this is info coming from a dumb grunt so dont put complete trust in it :)

Thanks, it's all very interesting for me...

[1911-a1]

http://zombiehunters.org/zss/?p=76

[Vici VII]

http://zombiehunters.org/zss/?p=76

Thanks, that was interesting... :)

[1911-a1]

I have to get some stuff for my EDC medic kit. All i have now is 40 band-aids...:(


I think I might buy one of these:
Is there anything good in kits like that one in the picture? Im thinking of carrying it in my EDC backpack.

http://uppladdning.com/uploads/20080523_03.24.30_39-559_h.jpg

http://www.shopredcross.org/ProdImages/last.personal.kit.jpg

I guess kits like these contain pretty much the same stuff.

[dacanadianbomb]

Found these two videos surfing around.
!!!Basically, dont try this at home kids!!!
Watching this will not teach you how to use this stuff, nor will it make you a medic, dont be a dink,leave it to the pros.

The thing that kinda makes me wonder is the fact that during the video ( besides beeing in a med environment and not beeing shot at etc) they have suction to aid them in getting the wound "dryer".
If your out in the field, Im seriously wondering how effectively you can just dump it in there, without it getting washed away.Just the pool that formed inside the wound right after beeing cut, looked like it was about a quart of a litre.


these vids are likely
NSFW
http://www.youtube.com/watch?v=EQq_elBE7WY - hemostat
http://www.youtube.com/watch?v=Kn63UeF577Q - quickclot

[Sabre]

Sorry CLS (I hate acronyms ;o)

I used the point above in my discussion, but the come back was that the body goes into shock in a situation like this and one of the natural results of shock is that the arteries contract, i.e. close off the bleed. I would assume not stop the bleed altogether though. As yet I have not been in such a situation, so I can only go on those who have experienced this..


What you get in hypovolaemic shock is peripheral vasoconstriction, in other words, the arteries and veins in the extremities and skin contract and divert the majority of blood flow to the central circulation/organs. This would not affect the main arteries to any meaningful degree. If an artery is completely bisected then it may spasm and reduce blood loss, however an incomplete or oblique transection would leave it open to bleed. Either way the blood loss would still be significant.



Again he pushed the toxin point. I believe that there was a victim in China (with the quakes) that was crushed and when they released the crushed debris off him, he died as the toxins surged through his body. According to others who saw the item on the news, the victim was talking fine, even though being crushed.


This is different to metabolite build up that you would see in prolonged TK use. Crush injuries involve acute, significant muscular damage which releases a large amount of potassium, which is normally in the muscle cells, when the circulation is restored to the affected area (ie when the crushing object is removed). Potassium (and calcium) transfer into muscle cells is part of the mechanism which causes the cells to contract. Having a large volume of potassium entering the blood stream can cause contractile problems in all of the muscles, but the most important is the heart. The intravascular potassium rise caused by a large crush/release type injury can cause fatal arrhythmias fairly quickly.

The 'toxins' produced by long TK use are the products of anaerobic respiration by the cells in the affected limb. This can cause a degree of acidosis, but is rarely a cause of acute arrhythmia and death as with true 'crush' injuries. People undergoing major joint surgery (ie knee replacement) have the blood pushed out of the leg by a large rubber tube and have a TK applied at the groin while the surgery happens, often up to 3-4 hours, sometimes more.



Naturally my next question how would you overcome this. His answer was very slowly. use fluids to fight the toxins and release the debris slowly. Naturally this isn't a firefight and there is no added stress of being shot. Although he did also say that in some instances there is nothing they can do for a crushed victim, as the release will kill instantly and so they just give pain killers and talk to them until the inevitable happens.


What he says here is true, for crush injuries. However as I've said, TK use is different to crush injuries.



By the way, if anyone is reading that this has happened to or they have experienced, I mean no disrespect in those situations.
I am asking to understand more.

Cheers

Don't worry. The only way you can improve treatment for the next patient is by asking everything you can about the last. The most important thing to carry as a medic is up to date knowledge.

[Sabre]

Unfortunately all the medpacks I've seen online are also huge - geared more for a mass-casualty situation rather than for being a platoon medic who sees more coughs and colds than bullet holes.

Any recommendations for this situation?

Cheers!


Try getting hold of a British PLCE med pack (DPM and same size as a PLCE bergan side pouch).

I've been looking for a decent med pack for ages. I have my issued PLCE side pouches:

http://www.army-surplus.co.uk/militarygear/product/lbv26-1.html

a Blackhawk STOMP II:

http://www.amronintl.com/diving/products.cfm?id=2479

and a London Bridge Trading Patrol Med Pack:

http://www.londonbridgetrading.com/m1webgear/ProductDetails.aspx?PartUniqueID=B10AA255-FCE6-422B-8D9B-D57F9CA35E45


I haven't really used the LBT bag as yet, it's well built and the right size, but it could really do with more pockets and elastic to store kit in.

The STOMP is well designed (because it's a rip-off of an LBT bag, I bought it because it's MUCH cheaper than LBT) and holds all the kit I'd need for a vehicle patrol med pack, but weighs an absolute ton with all the kit in. It's basically a bergen.

That's left me using my original PLCE pouches after dropping the cash on the other two! That should be a lesson to us all. What I've done is use two side pouches, one for trauma and one for 'Primary Care'. So all the pills and potions and ointments go in the primary care pack in the bottom of my bergan, and the trauma pouch sits under the lid or in the daysack on an assault. As yet I can't find a better way of doing it with 'green' patrolling.

In addition to that kit, I keep my own FFD, Airway etc in my pocket and have a small blackhawk pouch with an FFD, Hemcon, airways, shears, etc in my webbing for immediate care without a daysack.

[Ubar]

http://ew-trading.co.uk/product.php?cat1=1&cat2=16&pg=2&id=48

An example of a Medic bergen for sale there^

[GiladS]

We use the C.A.T
http://img104.imageshack.us/img104/4005/300001bhd4.jpg


http://www.narescue.com/Product1.aspx?SID=1&Product_ID=20

Has recently entered service among company medics in IDF infantry.

I myself managed to get a hold of one... p-)

[firemedic]

This is a good thread and would be happy to offer any input to questions or discussions. I'm a US Army medic and nurse, and also a civilian paramedic. In regards to TK use the biggest problem I've noticed is simply not tying them tight enough. You really have to crank them down because remember you are trying to occlude an artery that is lying beneath layers of skin, fat, and muscle. Usually the big strong guys tend to put them on correctly. You know if it is tight enough if the victim is screaming how much the TK hurts!. There is just no subtle way to do it. Take enough time to make sure it doesn't slip. And recheck it often. Vasoconstriction doesn't last long, and requires lots of energy on the part of the body to maintain. I've always said better to lose a limb than die. The CAT is a good TK, but make sure you use the one with the metal twist. I've seen the plastic ones break, and the only thing better than one good TK is two good TK's. ..........CW 68W/M6 NREMT-P 345th CSH.

[GiladS]

I met a guy who was with me in the same medics course.

He told me he treated an amputation above the knee caused in a car accident. He used the CAT to stop the hemoraging but it didn't apply enough pressure to stop the blood flow from the Femoral and he needed to add the good old screw tourniquet in order to get the wanted result.

[Nalu]

Every situation is different, the CAT is as good as any other tourniquet. I've seen every TQ failure in the book, from materials failure to application failure - every brand has it's vulnerabilities. As pointed out above, the best thing to do is apply the TQ until bleeding stops, check for clinical response and continue to recheck the TQ in repeat surveys as you treat other problems.

I carry two TQs in my leg rig, along with other trauma kit so that I always have basic emergency kit on my person. For the NZed medic, I feel for you mate. No matter what you do, there will be times when you don't have what you need at hand. Separate your kit into what you need immediate access to when the emergency happens right in front of you (cargo pocket, leg rig), what you need access to in minutes to hours (small med ruck) and what you need access to in hours to days. No need to hump sick call meds around with you on patrols.

Anyone who is still carrying hemostatic powders or granules, change as quickly as you can to impregnated dressings. Please don't use Quick Clot, it's rubbish.

Vici, use TQs. As Sabre points out there are issues with the metabolic waste build-up in an ischemic limb. But that problem is for the surgeons and anaesthesiologists to deal with when it's time to let the TQ down. Keep your patients with massive extremity trauma alive by using good hemostatic resuscitation techniques! This includes the use of tourniquets.

[kayaker]

Nalu,

Could you please elaborate why QC is rubbish? I'm intrigued, as one bloke on this forum own his life to QC and would not deploy again without it.

[Nalu]

I've used and been around QC since 2003 and have dozens of examples of its misuse, downsides and ineffectiveness - and not one of it saving a life or limb. While grateful that military trauma research led us in the direction of hemostatic agents because we now have some very useful products, QC is rubbish and was never the panacea it was billed or received as.

Specifically:
1. It's highly exothermic and damages surrounding tissues.
2. It doesn't "peel away" from the wound as its originators designed/described. At least some, usually most, of it remains granular in the wound and it acts as a foreign body. It is a royal pain in the ass to get out, sometimes require additional debridement of undamaged tissues.
3. You can't pour a powder into a hole (as noted above), so it's nearly useless in the situations in which it is most needed: bleeding that can't be reached.

Whilst very happy this other forum member is still with us, I submit that either:
1. QC wasn't truly needed, or
2. He would have been better served by any of the currently-available agents.

I understand that QC may have been the only available tool at the time and place of his injury - granted. But that is no reason to persist in using it when there are clearly superior products available. Plenty of men well-served by lances and swords in the history of warfare, but how would you feel if you got handed one by the QM before a deployment?

[kayaker]

Thanks for the elaborate reply Nalu. Most insightful. Which hemostatic product(s) would you recommend?

[Kap]

Anyone who is still carrying hemostatic powders or granules, change as quickly as you can to impregnated dressings. Please don't use Quick Clot, it's rubbish.



This is a pretty true post, QC is rubbish in granule form, we switched to the "Combat Gauze" Along with other methods of using Hemcon and the QC ACS.

[can]

Stasilon or A-PAX dressing. Used like a 4x4 but has to be somewhat pushed into the wound. Then dress over like any wound dressing with an 8x or more 4x's. Clots quick. Seen it stop some major bleeding.

[Nalu]

Thanks for the elaborate reply Nalu. Most insightful. Which hemostatic product(s) would you recommend?

The past two deployments I've been using Hemcon, both the flat 4x4 pads and the rolls. When I was home between deployments in 2006, the trauma research guys were testing an impregnated soft gauze roll and my team worked with them a couple of days in the lab. I was impressed. No names yet (not even sure that it had a commercial name when we were using it) as it hasn't been released AFAIK, though I'm pretty sure the science is done and published.

We're also getting some new treated gauze products any day now, it was ordered back in Nov. I believe units coming into theater are getting it for use in medic and CLS bags. When I get home I'll learn more about what's out there. One of the issues when you're deployed is that you only know what's in front of you - what's going on at home and what's coming down the pipeline are often mysteries :|

Again I'd emphasize, as mentioned above, that hemostatic agents are for otherwise uncontrollable hemorrhage. Direct manual pressure, aka "First Aid" as taught to you when you're a Scout, is still the most effective way to control bleeding and should be used first.

[ChineseJunk]

Again I'd emphasize, as mentioned above, that hemostatic agents are for otherwise uncontrollable hemorrhage. Direct manual pressure, aka "First Aid" as taught to you when you're a Scout, is still the most effective way to control bleeding and should be used first.

I met the doctor who invented Celox and added this stuff to my emergency kit after listening to his brief.

He also said the same thing, quoted above.

[Nalu]

We just got word today at Ibn Sina that WoundStat is NOT to be used as a hemostatic dressing due to reports of a DIC-like phenomenon. More to follow on this as the incident(s) are investigated. Combat Gauze is still OK AFAIK.

These type of incidents and warnings underline the fact that new developments aren't always positive ones. What looks good in animal studies and human trials does not always bear out in combat conditions. The physiology of, for example, a blast-injured patient is much different than that of an MVA or stabbing victim, and even more different from an animal under anesthesia with an arterial lesion created with a scalpel.

[kayaker]

Thanks for keeping us up to date with the latest developments, appreciated!

[gilgoul]

Thanks for that... I was in a "debate" with an ambulance officer who was totally against this and didn't believe that these even needed to be ever used. I tried to get some scenarios for him to accept, but his come back each time was that the toxin shock (I think) was a larger killer than just treating the wound. i.e. compress, bandage and elevate above the heart.

Cheers
By the way, not wanting to start a war of pros or cons, more just interested on the ways of use and when would be used.

Cheers

Well,
Tell your ambulance officer that massive blood loss is a quick killer, hypovolemic shock being the bad guy.
True, in a civilian setting, it is rather "rare" (still to debate) to meet traumatic amputation, and massive blood vessel injuries requiring an immediate cessation of blood circulation to a limb.
And the famous toxic shock, in an ideal setting, shouldnt be the first responder's problem.
That's why the IDF uses the rubber or/and silicon tourniquet.
I personnaly prefer the CAT, got two of them, one in my day pack/vest (in reserve) and the other in my car aid pack.

[Creeper]

Toxin shock = sodium bicarbonate via IV push ?

[Sabre]

Toxic shock is not a consequence of tourniquet use. 'Toxic shock' results from vasodilation secondary to cytokine activity and inflammatory mediatiors acting locally in response to a massive infection. That's not the issue in TK use.

Any concerns would be of a metabolic acidosis secondary to anaerobic byproducts being released into the systemic circulation once the TK is released. Nor is there a concern over 'crush injuries' as only a small portion of the muscle mass is being compressed. As has been said before, TKs are used routinely in major joint surgery for many hours without adverse effects. The simple fact is that TKs are PROVEN to save lives in prehospital trauma, where major limb bleeds are being treated.

As for sodium bicarb...its a nasty drug to use. Often it is last line therapy after treating the cause of acidosis. In prehospital care fluids are the best option, oxygen if available will help too.

[Creeper]

As for sodium bicarb...its a nasty drug to use. Often it is last line therapy after treating the cause of acidosis. In prehospital care fluids are the best option, oxygen if available will help too.

Will you elaborate your point on sodium bicarb and the "nastiness" of it.
In the field, I was told that it would be the 1st line.
Right or wrong ,,, .
Please continue.

Thanks for your input.

[Roy Batty]

Well,

I personnaly prefer the CAT, got two of them, one in my day pack/vest (in reserve) and the other in my car aid pack.

I have ditched my CAT(s) in favor of SOF torniquets from TacMed Solutions. The damned windlasses on the CATs break way to easy. The SOF system has all metal parts and it has been invaluble over here in my experiance.

[gilgoul]

I have ditched my CAT(s) in favor of SOF torniquets from TacMed Solutions. The damned windlasses on the CATs break way to easy. The SOF system has all metal parts and it has been invaluble over here in my experiance.

Thanks,

Good to know
I tried one of my CAT (got 3 all in all) the hardest I could, and merelly bent the stickm so I'm a bit surprised.
Anyway, I still keep an IDF rubber tourniquet too at the ready, since the cat doesn't seem adapted to BIG quadriceps.

[Roy Batty]

Another worry with the CATs is that the velcro doesnt hold well after bieng in a very sandy environment (like here) and also tends to release when coated in blood.....:|

The windlass straps need to be tightteded to the point of causing extreme pain (dont try it unless your supervised by trained med staff). All too often they break before getting to that point.

[Sabre]

Will you elaborate your point on sodium bicarb and the "nastiness" of it.
In the field, I was told that it would be the 1st line.
Right or wrong ,,, .
Please continue.

Thanks for your input.

Sodium bicarb is useful in the management of severe hyperkalaemia caused by, for example, crush or burns injuries. The risk of arrhythmias due to raised K+ outweighs the risk of the side effects of bicarb. However, in hospital we prefer to use calcium gluconate, insulin and fluids.

For acidosis, and in particular lactic acidosis, bicarb can actually make things worse. You need adequate ventilation to clear the additional CO2 produced or it can shift into the cells, leading to a drop intracellular pH (ie worsening intracellular acidosis).

If there is also a degree of shock, then the oxygen delivery to the tissues is impaired, creating an acidotic environment. The acidosis actually inhibits the process of glycolysis that results in lactate production. If you give bicarb, that inhibition is removed and anaerobic metabolism continues unchecked. Bicarb also affects how oxygen dissociates from haemoglobin, which can further impair oxygen delivery to the cells.

The best treatment for acidosis is treating the cause. Though this is all a bit irrelevent as in the field, no one is going to be able to check the casualty's pH. I'm sure the '1st line bicarb' you mentioned was for hyperkalaemia secondary to crush injuries. I would have thought, however, that with the likelihood of other injuries on the battlefield, giving bicarb would not be a first response treatment?

[GiladS]

IDF to buy state-of-the-art medical products

By YAAKOV KATZ (yaakovk@jpost.com)

With a large-scale military operation in the Gaza Strip possibly just days away, the IDF Medical Corps is purchasing some of the latest, state-of-the-art medical equipment (http://javascript<b></b>:void(0)) for field units.


In the coming days, the IDF will receive the first shipment of a new micro-respirator that the Medical Corps has developed together with a US manufacturer called Impact.

Until the Second Lebanon War, only brigades were outfitted with battery-operated respirators that weighed some 10 kilograms.

Due to their weight and relatively large size, the respirators were not deployed at the front lines, but kept by medical teams that waited behind the combat units to treat soldiers.
The new respirator weighs 3.5 kg and can also be connected to a standardized gas-mask filter in the event of a chemical or biological-infected battlefield. Each system costs $5,000. A second device being incorporated into field units is called the "Combat Gauze," which is meant to replace the ancient "personal bandage" that every soldier receives upon induction into the IDF.


Manufactured by Connecticut-based Z-Medica, the QuikClot (http://javascript<b></b>:void(0)) Combat Gauze will be supplied to medics and field doctors throughout the IDF. While the old bandage stopped bleeding by placing pressure on a wound, the Combat Gauze uses a hemostatic agent that coagulates blood and prevents blood loss.

Jeffrey Horn, Z-Medica's COO, said that the company had scaled up production of the product to meet Israeli and other international customer's demands.

"The product preserves lives by way of coagulating blood and rapidly clotting blood so you maintain the host blood supply if hurt in trauma," Horn said. "Our product has been tested all over the world (http://javascript<b></b>:void(0)) and was determined to be the best hemostatic agent in the world for an individual."

According to the company, when in direct contact with an open wound, the bandage absorbs the water molecules from the blood. The larger platelet and clotting factor molecules remain in the wound in a highly concentrated form. This promotes extremely rapid natural clotting and prevents severe blood loss.

Each bandage, however, costs about $30, while the old personal bandage costs only a few cents. For this reason the new bandages will only be given to medics and field doctors at this stage, for use in the event of an emergency. The gauze is used by the US military.

Chief IDF Medical Officer Brig.-Gen. Dr. Nachman Ash told The Jerusalem Post (http://javascript<b></b>:void(0)) that the IDF was in close contact with the US military and its medical corps.

"We have learned a lot from the Americans," Ash said. "And we have decided to follow in the footsteps and experience when it comes to products for trauma cases."

Another product the Medical Corps is planning to purchase is called Combat Application Tourniquet (CAT), a small lightweight one-handed tourniquet that completely stops arterial blood flow in an extremity.

CAT uses a band and buckle to fit a wide range of extremities combined with a one-handed windlass system.

The tourniquet currently in use is an elastic band that does not have an attached windlass, or stick, for tightening. Medics are trained today in the IDF to use a stick to tighten the tourniquet in the event of a severe wound.

http://www.jpost.com/servlet/Satellite?cid=1229868836564&pagename=JPost%2FJPArticle%2FShowFull

[Nalu]

The best treatment for acidosis is treating the cause. Though this is all a bit irrelevent as in the field, no one is going to be able to check the casualty's pH. I'm sure the '1st line bicarb' you mentioned was for hyperkalaemia secondary to crush injuries. I would have thought, however, that with the likelihood of other injuries on the battlefield, giving bicarb would not be a first response treatment?

Blood gas measurements are widely available at Level 2 facilities. I agree that bicarb is not a good first line drug for acidosis - treat the hypovolemia. Even for crush injuries, where the degree of hyperkalemia is unknowable by the medic, I don't see much use except as a last resort. You rob Peter to pay Paul with IV bicarb as Sabre explains very well.

Again, I don't think L1 medics (or EMT-Ps in ambulances for that matter) need to be concerned about the effects of the acidosis distal to a TQ. With evac times being 1-2 hours (save for some locations in A'stan) and more often measured in minutes, there should be no hesitation to use a TQ on extremity bleeding not manageable with direct pressure.

Also as I said above, I've seen several modes of materials failure on all the TQ types, with none being notably more reliable than another. By far the most common cause of TQ failure is improper or inadequate placement and not materials failure.

[Creeper]

Thank you for the information. Much appreciated.

[kayaker]

Thank you for the information. Much appreciated.

I echo that, thank you.

[Nalu]

And I forgot to say: keep your patients warm! Even in southern A'stan in the summer when it's >120F every day, trauma patients get cold. The only slightly hyperthermic trauma patients I've seen were ground evacs in the summer with 'Ranger wraps'. Everyone else comes in at least a little cold and sometimes dangerously hypothermic.

[firemedic]

If you can find some CATS with the metal stick grab'em. You can twist the hell out of 'em without snapping. Hard to find though. Also in regards to bicarb, the service I work for still uses it in codes. Older ACLS protocol, but in asystolic or pulseless vfib pts what is it gonna hurt?

[Creeper]

Older ACLS protocol, but in asystolic or pulseless vfib pts what is it gonna hurt?

At least you can bill them for it. Good point though.
In those rhythms can BiCarb be beneficial when , if , you get a Sinus line back ?

[firemedic]

Creeper from what I understand bicarb is used to counteract the metabolic acidosis and I would presume respiratory as well that results from a period of inadequate perfusion secondary to a dysrythmia. Some say it benefits longterm survival rates but its fallen from use kinda like the old precordial thump in a witnessed arrest. I'm sure theres more to it than that but I'm just a medic.:) I've asked some of my friends who work for other services and it looks like its falling out of use. I think Dekalb still uses it but its been a few years since I've looked at their protocols. Hope that helped.

[dacanadianbomb]

"old precordial thump in a witnessed arrest"

If I read this correctly you mean heart arrest?
I was always told to thump the chest at the solar first and then start on the cpr stuff.
I have also heard from a buddy who gives first aid classes that this generally isnt done anymore.

I have also read forum entries where people said pumping was generally a bit more important than pushing air into the pt when doing cpr, as the oxy saturation levels will stay ok for a small time after arrest.Provided you saw the person go to the floor.
I think the whole issue is still personal or service dependant than a worldwide recognised thing.

[Creeper]

"old precordial thump in a witnessed arrest"

If I read this correctly you mean heart arrest?
I was always told to thump the chest at the solar first and then start on the cpr stuff.
I have also heard from a buddy who gives first aid classes that this generally isnt done anymore.

I have also read forum entries where people said pumping was generally a bit more important than pushing air into the pt when doing cpr, as the oxy saturation levels will stay ok for a small time after arrest.Provided you saw the person go to the floor.
I think the whole issue is still personal or service dependant than a worldwide recognised thing.

Arrest= heart attack= myocardial infarction . w/n seconds of a "witnessed" If no proper ALS equipment is available. Thump the sternum to get a pulse back.

RE: Chest Compressions; IF I saw the dude go down and I was alone, Following the traditional protocol i.e : from CPR class 1) Blah 2) Blah. I would drop some air in, (airway is clear of course) but I would focus on saving the vital organs, (brain, heart) ,the core circulation.

I was taught that it takes a few minutes to build pressure w/n the heart for the valves (atrial, septuim, aortic ? [going on memory] ) to open and function. This is important. There is O2 in the blood stream so,, keep it moving. Sure I am not saying that 2 breaths is not necessary BUT,,,


The new algorithm emphasizes minimizing interruptions to chest compressions to maximize the benefits of compressions:
http://www.aafp.org/afp/20060501/practice.html

> never leave a teammate alone on the field. shyte happens.

[Nizzemancer]

As an IDF medic it has interested me to know whether other militaries around the world use the same type of touniquet we use here for hemorrhage control in the arms and lower led or whether they use something else.


So this is what we use...

http://img228.imageshack.us/img228/1928/prod83kd3.jpg (http://imageshack.us)

These tourniquets are 2 meters long and made of either silicon, rubber or a combination of the two.

The rubber ones need to be pwedered with talc every once and while (else they may get torn). Silicon is the best as it doesn't tear yet it sometimes slips off blood. The army tried to create a better tourniquet by combining the two materials however the result was a tourniquet that features the disadvantages of both.

Heh, we have those in our kits as well as the CAT but nobody knew what they were intended for and everyone considers them a waste of space.

Thanks for clearing that up for me.

[Clegg]

Yeah FDF medics have those "Degania Silicone" tourniquets as well.
Pretty good stuff IMO, gives you many options.

[slaveman]

Good info guys...

I'm lucky enough to be working in a happy, little civilian hospital now. But this kind of stuff still really intrests me.

I've seen the celox and pressure bandage method used a few times now. First responders are loving it. When used properly, it seems to work excellent. Cleaning up afterwords is a different story, but stopping the hemmoraging and saving a life is more important.

Some of the MD's have complained about the clotting-agents, but I think it's great. A really small kit can treat some pretty major wounds. Excellent stuff...

Just thought I'd throw that out there. Keep it coming guys...

[Nano]

I need some help trying to learn a few basics on suturing. I sorta hit a wall on the net in finding out how to read suture kit specifications. I have been able to figure out what materials suit what purpose best imho.(natural,synthetic,absorbable,non-asorbable etc)
I need to learn what certain designations mean. For example I understand what the size specification is concerned with. I just can't figure out what the litigating reel(apart from its definition refers to)GU-45 taper,GS-24 taper,P-12 cutting,P-13 cutting, P-10 cutting etc. I basically need a reference source (link or book)that has illustrations(pictures,drawings explaining showing their medical significance).

[Hav218]

I don't post a whole lot, and I don't think I've made a post since I joined the Army. Anyways. My experience: 101st Airborne as a combat medic, tour in Afghanistan 08-09. The main reason I took all these pictures is that I'm setting up the SOP/Standard for our medics in terms of gear/equipment/etc. Hope you enjoy.

NOTE: CAT's are all I had, all my SOF-TT's I had in country were oddly never returned when I linked up with the trauma team at the hospital my casualties went to.

http://i31.photobucket.com/albums/c365/Matt218/SOTech1.jpg
Alright, this is the rig I wear. It is made by SOTech, and has 4 decently sized medical pouches on the front of the vest. It has the ability to carry 6-12 magazines immediately behind the medical pouches, which are retained by velcro. The rear camelback pouch seems to be oversized, which is in no way a problem.

It can connect on either left, right, or the center. The center also has a quick release feature which I am a fan of.

http://i31.photobucket.com/albums/c365/Matt218/SOTech3.jpg
This is showing what is going to be on my right side

Contained in the one on the right:

2 Nasopharyngeal Airways
1 Oropharyngeal Airway
2 Cricothyrotomy Kits
2 Chest Needle Decompressions (14 ga, 1.75") (Not Pictured)
2 Hyphen Chest Seals (Not Pictured)

The pouch to the left of that one:

2 500mL of Lactated Ringers (Kits complete)
1 FAST1 Intraosseous Kit

http://i31.photobucket.com/albums/c365/Matt218/SOTech2.jpg

Left pouch:

4 Combat Gauze
2 QuickClot ACS+
3 HemCon Bandages
2 CAT Tourniquets

Right Pouch:
4 Ace Wraps
4 Kerlix

CamelBak Pouch:
1 3L Camelbak
1 Poleless litter

Internal Map Pouch Left contains a VS17 panel, while the one on the right contains a casualty blanket.

The following is my dismounted rig. I prefer the first, and all in all will usually use that one. This is the setup I used in A'Stan.
http://i31.photobucket.com/albums/c365/Matt218/downsized_1203091437.jpg
This will go over our IOTV or IBA. It is a Blackhawk load carrier that I scrounged up in a ConEx. I'll get better pictures in a day or so.

Load Carrier:
6 M4 Magazines
2 Grenade Pouches
1 Admin Pouch

Medical Drop Leg by North American Rescue Products:
2 CAT Tourniquets
4 NAR S-Gauze (Compressed Gauze)
2 Enhanced Trauma Dressings
Gloves
Alcohol Wipes
Trauma Shears
Pen/Permanant Marker

http://i31.photobucket.com/albums/c365/Matt218/1203091312.jpg

Attached to the Load Carrier is a TSSI M9 bag. This is a low profile medic bag that is designed for dismounted and prolonged operations. I love the things. They are pricey, but thats what NSN numbers are for. Inside it is pretty much the same supplies that are in the SOTech Rig posted above, along with a few different IV/IM medications.

[Creeper]

you are the shyte.

tell me more about your "Hypen Chest Seals". TY

Got NS bolus ? or is this not in your SOP ?

are you prepared for nite time ops ?

TY for your work and posting this here !

Much appreciated !

(Stay safe or fight like Hell)

[Hav218]

http://www.narescue.com/Hyfin-Chest-Seal-P93C196.aspx

Hyfin chest seals are made by the dudes over at North American Rescue Products, who make a lot of the stuff I have on my vest. This things are rediculously sticky. I was given trAshermans when I was in A'Stan, so I replaced them with premade MRE bags cut up along with some Gorilla Tape. Worked better than any Asherman I've ever seen.

NS Bolus? Elaborate? Our over-seeing PA gives us total control. He doesnt order certain SOP's. He lets us work those at our level, as we are the guys on the ground and he is in the hospital or BAS. We have developed our own internal SOP's, and a lot of what we have found out was just alternative methods for doing procedures and interventions.

Night ops? Yes, we all carry NVG's, even on 30 minute day time missions. Those are mounted to the vest as well. With this vest, there actually is a lot of open chest space where you can put various items directly onto your armor carrier, or attach a modular bib to the SO Tech rig.

[Maine Finn]

Creeper, 'bolus' is a method of infusion, not an actual fluid bag.

Hav, was NS something that was considered more practical to use in the BAS/hospital setting, as opposed to out on the ground?

[Maine Finn]

Crap. Double post.

[Hav218]

If someone needs fluids, chances are they are going to need the electrolytes to go with it as well. Thats why I carry LR. Nobody around here really seems to have a valid argument about why you would prefer NS over LR in a trauma patient, so I go with that.

[Maine Finn]

That makes sense. We stocked LR, NS, Hextend, and all that, but for the most part we went with NS as the default for 'right now' fluids, for both trauma and medical patients. Then again, this was Stateside, so obviously other mileage may vary.

[Hav218]

I'll leave Hextand in the truck and the main bag that stays in there. By the time the patient needs an IV, you'll be prepping for evac.

If we are on an air assault in the mountains or something, obviously I will bring a bag or 2 of Hex.

[Creeper]

HAV218: TY 4 the link and info on 'Hyfin'. Do I understand you correctly that a MRE bag and tape(gorilla) made up a chestseal ?

MAINFINN: TY . I stand corrected ! :cantbeli:

[Hav218]

Yeah, the Ashermans absolutely suck. They will not stick to the slightest amount of blood, dirt, sweat, or hair, which when treating a male trauma patient in the desert of Afghanistan, you WILL encounter.

Since I couldn't get the high speed **** while in country, we often just figured out the next best thing. The asherman wrapper and tape is actually a better chest seal than the product inside.

Have any of you guys been to BCT3 aka Live Tissue Lab?

Basically, if you run up on a patient with an entry wound to the chest or upper torso for that matter, you can simply cover it with a gloved hand, and this will occlude it from air in the same way that a chest seal will. This can buy you some time so you arent fumbling around while hes sucking in air.

[Creeper]

The asherman wrapper and tape is actually a better chest seal than the product inside. Well there you go. (note to self).

Thanks man. stay safe.

Happy holidays to all.

Speaking of Asherman: http://www.tactical-life.com/online/tactical-weapons/seal-a-sucking-chest-wound/


Sucking chest wounds require an immediate occlusive dressing. Over the years there have been many suggested field expedient dressings such as aluminum foil, duct tape and cellophane and Vaseline gauze. In the real world it is probably most likely that when the moment arrives you will not have all your medical gear with you and a field expedient occlusive dressing will have to be improvised.

[TraumaDoc]

I was trained as a general surgeon and saw plenty of trauma at Charity Hospital,New Orleans but I was never in combat so I will defer to field medics on that. I will be glad to answer any questions tho.

[TraumaDoc]

I need some help trying to learn a few basics on suturing. I sorta hit a wall on the net in finding out how to read suture kit specifications. I basically need a reference source (link or book)that has illustrations(pictures,drawings explaining showing their medical significance).

Nano: I think that this page will help you.
http://www.ecatalog.ethicon.com/general-info
In common use a cutting needle is used for the skin, the tip has a cutting edge ground into it. Taper needles are used for the gut and deeper tisues. The tip simply tapers to a point and pushes thru the softer inside tissues.
http://www.ecatalog.ethicon.com/sutures-absorbable
These are the types of sutures available and the general usage.
The size of the suture is determined by the use. general use will be 4-0. for the face 5-0 or 6-0. to close a massive abdominal wound retention sutures of 0 or #2 might be used.

Hope this helps.

[TraumaDoc]

That makes sense. We stocked LR, NS, Hextend, and all that, but for the most part we went with NS as the default for 'right now' fluids, for both trauma and medical patients. Then again, this was Stateside, so obviously other mileage may vary.

In the past Normal saline(NS) was generally ordered by the Internal medicinr Docs. Lactated ringers solution (LR)was generally ordered by surgeons. It probably makes no practical difference.

[Maine Finn]

In the past Normal saline(NS) was generally ordered by the Internal medicinr Docs. Lactated ringers solution (LR)was generally ordered by surgeons. It probably makes no practical difference.

Really? That's interesting. Was the difference in fluid choice based on the particular discipline, do you know? (Like, Internal Med vs. Surgery or whatever else?)

We usually hung NS as a first-choice fluid, especially if we needed to push IV meds, or unless some other fluid was ordered. Sometimes there'd be a special order from one of the on-call specialty docs, but the 'fanciest' we usually got was NS with meds or the occasional banana bag. I don't recall ever having to hang LR on a patient. (Having said that, it usually seemed like the really fun/crazy stuff happened when I was off-shift.)

[CombatBoots]

I need some help trying to learn a few basics on suturing.

http://www.youtube.com/watch?v=y_og7HbVMrU

Check this out, 4 part series called "Suturing Under Austere Conditions" by YouTube user USNERDOC.

I would appreciate to hear the opinions of the professionals here of his instructions

Hope it helps.

[TraumaDoc]

Really? That's interesting. Was the difference in fluid choice based on the particular discipline, do you know? (Like, Internal Med vs. Surgery or whatever else?)

the occasional banana bag. I don't recall ever having to hang LR on a patient. (Having said that, it usually seemed like the really fun/crazy stuff happened when I was off-shift.)

Internal Medicine Doctors basically deal with medical problems, Heart attacks, Diabetes, lung problems, etc. They had chosen NS as the best fluid for resusitation. Surgeons deal primarily with trauma and had chosen LR as the fluid of choice. LR contains NS with a little added dextrose,calcium and Lactate(which breaks down into Bicarbonate). Multiple studies have shown that both do a good job of resusitation, probably no advantage either way.
Academic Department Chairmen (otherwise known as God) generally make these decisions.
My informal impression is that NS is becoming the standard, probably for simplicity and possibly cost savings of having only one fluid type to store. Also certain medications cannot be mixed with LR due to the lactate.
Banana bag(def)... a liter of NS with an added vial of Multivitamins for the chronic alcoholic. Same for you?

[Maine Finn]

Internal Medicine Doctors basically deal with medical problems, Heart attacks, Diabetes, lung problems, etc. They had chosen NS as the best fluid for resusitation. Surgeons deal primarily with trauma and had chosen LR as the fluid of choice. LR contains NS with a little added dextrose,calcium and Lactate(which breaks down into Bicarbonate). Multiple studies have shown that both do a good job of resusitation, probably no advantage either way.

Ah. I've never worked directly under an Internal Med doc or a surgeon, so it's interesting that they prefer a particular type of fluid for first-line use. I guess I can sort of understand how surgeons might prefer LR for what's in it, though.


My informal impression is that NS is becoming the standard, probably for simplicity and possibly cost savings of having only one fluid type to store. Also certain medications cannot be mixed with LR due to the lactate.
Banana bag(def)... a liter of NS with an added vial of Multivitamins for the chronic alcoholic. Same for you?

I think, for the most part, it is. At least where I worked last, that was what the docs wrote initial orders for the most. We stocked just about everything (D5W, LR, Hextend, et cetera), but, other than burn patients, I don't recall seeing anybody come in by ambulance with anything other than 0.9% NaCL hanging. (I think EMS crews can only carry certain types of fluids anyway, but that's getting outside of my lane.)

Banana bags came out for the chronic alkies, yeah. It wasn't something we hung very often, though. Half our patient base were military retirees and COPD/CHF was a more common ailment amongst them than alcoholism.

[TraumaDoc]

http://www.youtube.com/watch?v=y_og7HbVMrU

Check this out, 4 part series called "Suturing Under Austere Conditions" by YouTube user USNERDOC.

.

I just viewed the 4 videos by USNERDOC. They were well done and full of good useful information. Thanks for letting us know about them, Combatboots.
He suggested using a Leatherman tool for suturing. While I love my Leatherman I suggest that anyone who works in or around an ER or doctors office can ask for a set of the tools from a disposable suturing kit. Normally thrown away they range from atrocious to very good, especially since they are free to you. Usually there is a needle driver, a hemostat, forceps,and scissors. I keep a set in my emergency kit. My clinic goes thru 3-5 sets a week.

[TraumaDoc]

As I was checking out the videos from USNERDOC I noticed the videos by cyberwapx.

http://www.youtube.com/user/cyberwapx#p/u/27/mfhAuIJPpG4

The surgical videos appear real and Professional. I suspect that they are edited from commercial surgical video's. Nevertheless they are interesting, or you can watch the surgery programs on the cable channel Lifetime.
enjoy. His video's on suturing may be valuable to some of you.
ACS is American Collage of Surgery. I don't know anything about him tho.

[TraumaDoc]

I'm headed to New Orlean's for the holiday.

Happy New Year to all of you.:grin:

[CombatBoots]

Hey, thanks for checking the vid for us.
USNERDOC and NUTNFANCY (another YouTube name who is more of a gear reviewer) seem to echo eachother in a few points, two of them would be weight and size of whatever you carry on you, so a hemostat would not travel with him in every "Level" of his first aid kits, which there are 3 of I believe also a shared concept for both NUTN and USNER.

Thanks for the suggestion on getting the suturing kit and the link and an awesomely great happy new year to you.

[Far]

When someone is bleeding out, they're losing more than volume and RBC's. LR metablolites counteract acidosis and some data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.

[Creeper]

Then counteracting "acidosis" is one of the important key objectives ?

[TraumaDoc]

LR metablolites counteract acidosis and some data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.

I agree that for hemorrhagic shock LR is the better choice for resusitation.
http://www.mdconsult.com/das/citation/body/177283058-2/jorg=journal&source=MI&sp=16372512&sid=0/N/16372512/1.html?issn=
This is a good animal study examining the question. There doesn't seem to have been a true controlled clinical study of the question in humans.
I was trained as a surgeon and to use LR for trauma. I see no reason to change.

[TraumaDoc]

Then counteracting "acidosis" is one of the important key objectives ?

When the body goes into shock there is decreased perfusion.As the cells run low on Oxygen they shift to anaerobic metabolism for energy. This produces more acid metabolites, additionally there is less blood flow to take away the metabolic waste products. As a result the cells and the body as a whole grows more acid(acidosis). The best treatment is to restore adequate perfusion by fluid resusitation. Lactated Ringers (LR) contains a small ammount of Lactate which breaks down into bicarbonate and neutralizes a little bit of acid. Measuring acidosis requires an arterial blood gas (ABG) which is not practical in the field. Didn't you bring your pocket ABG kit?:roll: Giving Bicarbonate is not recommended without first checking the ABG.

[Creeper]

ok Doc, we do not carry carry LR on our bus, but for general discussion sake w/o getting into SOP; lets say somewhere else, in the field , would you hit 2 bags of fluids , one NS and the other LR via bilateral IVs ,(14-16g ac's) in order to succeed the acidotic effect or stick to one bag of LR ?

TY 4 the FAQ's fr a EMT-I !

[Maine Finn]

ok Doc, we do not carry carry LR on our bus, but for general discussion sake w/o getting into SOP; lets say somewhere else, in the field , would you hit 2 bags of fluids , one NS and the other LR via bilateral IVs ,(14-16g ac's) in order to succeed the acidotic effect or stick to one bag of LR ?

TY 4 the FAQ's fr a EMT-I !

First off, how are you going to even determine that acidosis is even occurring if you're in the field?

[TraumaDoc]

lets say somewhere else, in the field , would you hit 2 bags of fluids , one NS and the other LR via bilateral IVs ,(14-16g ac's) in order to succeed the acidotic effect or stick to one bag of LR ?

OK, lets start with fluid choice. I believe that LR is better than NS for resusitation and/or prevention of hemorrhagic shock. On the other hand multiple studies have shown no difference in final outcome using either one. So use what you have and don't worry about it. I prefer LR but I don't lose sleep if the protocol is NS.
Second, How much fluid? Be guided by the patient. If he has a few holes in nonvital areas and is stable than one IV is fine. If he is in shock with BP of 60/palp than two large bore IV's wide open of LR, by my choice, or whatever fluid is available. Restoring body perfusion is the key to your patient's survival .

[TraumaDoc]

While on the topic,let's examine how much fluid to give.
http://trauma.org/archive/history/resuscitation.html started the controversy of permissive hypotension.
http://trauma.org/archive/resus/permhypoeditorial.html Dr Mattox is a true leader in U.S. trauma surgery but this controversy is not even close to being settled. If your military service or EMS has a protocol,FOLLOW IT, You don't want to be court-marshaled or fired for not following protocols.
Time is another problem area. If the patient is 15 min from the OR than the minimalist approach is probably good, But if he is hours from the OR leaving him in shock that long will ensure his death. Definitive answers are hard to obtain, these are badly injured people and many will die no matter what care is provided. To get enough study patients accumulated in order to say one treatment is better than another may be impossable.

[TraumaDoc]

First off, how are you going to even determine that acidosis is even occurring if you're in the field?

Simple answer: don't worry about it. :)

Longer answer: a liter of LR contains 28 mEQ of Lactate which will be converted to bicarbonate in the liver over 1-2 hours. Normal plasma contains 24-31 mEQ of Bicarbonate/L. A 50 mL vial of 8.4% Bicarbonate contains 50 mEQ of Bicarbonate. If the patient is not acidotic any healthy person will easily handle this quantity of Bicarbonate.
During vigorous exercise the demand for ATP to power the muscles is greater than aerobic metabolism can produce and anaerobic metabolism is used to rapidly produce ATP. Inadequate respiration and poor tissue perfusion also will lead to anaerobic metabolism and acidosis.
In short; if they need resusitation they are probably acidotic and if they aren't it will do no harm.

[Creeper]

First off, how are you going to even determine that acidosis is even occurring if you're in the field?

I am not going to spend a second on it. From my short experience, any heavy hemmoraging , (we had one the other day, a severed artery in the arm , dist elbow) can and will cause decreased perfusion, thus decreased perf can and often leads to acidosis. (Am I tracking).

So to cut the train from wrecking, I want to pump fluids down asap. I was concerned if a bilat flow of LR AND NS can demonstrate a significant, positive rebound, per- se.

I do not have a ABG kit on my hip ! Just want to stay ahead of the 8 - ball.

Fr the Doc's link: http://trauma.org/archive/resus/permhypoeditorial.html
in the short of the para,

Should the peripheral pulse be absent, a solution of an acceptably standard fluid is given in aliquots of 25 ml. until a pulse returns. At that point, NO ADDITIONAL FLUID is administered.

[TraumaDoc]

http://trauma.org/archive/resus/permhypoeditorial.html (http://trauma.org/archive/resus/permhypoeditorial.html)
One can then question clinical protocols for patients in the ambulance or in an emergency department. In the field or in the emergency center, blood pressures should basically be abandoned as a tool to determine level of shock or adequacy of resuscitation. The ability for the patient to cerebrate or for the attendant to detect the presence of a peripheral pulse (roughly equivalent to a blood pressure of 80/-) can be used as the major trigger point in therapy. No IV lines should be started if the patient cerebrates normally or if a line is started, the rate of fluid administration should be to keep open only. Some clinicians would desire an intravenous portal just to be available in case the patient "crashes." In the absence of cerebration, the examiner looks for the presence of a radial or pedal pulse. If present, no lines are started and transport or treatment is determined on the basis of diagnosed injury. Should the peripheral pulse be absent, a solution of an acceptably standard fluid is given in aliquots of 25 ml. until a pulse returns. At that point, NO ADDITIONAL FLUID is administered. This approach has been recently used with success in some international military campaigns

Does anyone know of any military actually using this protocol? I for one would hate to defend it in court in the USA.

[Kap]

I have not used that protocol in any form while serving so far in the US Army as a medic. Fluid is given depending on the wounds and severity. Sometimes if only pain is present but no fluid or blood loss, a line or saline lock will be started anyways for pain management medications.

I do not see the point to discontinue administration of fluids if a pulse returns... I would just say finish up the bag. As I have NEVER ran into a case of fluid overload on a patient. I have only ran into that problem with myself when we were practicing IV sticks / fluid therapy. And I must say it definitely sucks, especially when it seems painful / difficult to breathe.

[Maine Finn]

T-Doc - For my part, I don't worry about it. I'm going to hang fluids if I believe a need for fluids exists and that's it. I had asked half-rhetorically, since in the field there isn't any point in checking ABG on a patient. That's something for the next level of care to worry about.

Creeper - Yes, severe blood loss leads to many bad things. The first concern, before almost anything else, is to control the bleeding. There's not much point in running a line on a patient who's losing fluids faster than they're going in. I think, in terms of LR vs. NS, it really doesn't matter if the patient is in that bad a way. Both are volume-expanders and that's the important bit. Get the bleeding controlled, then try for a stick and get the fluids going.

Personally, I would not stop IV therapy outright just because peripheral pulses were regained (if they were absent to begin with). Pulses are good, it means the blood is circulating. Instead, I'd either ease back the rate of infusion or hang a smaller bag. If it's a patient in hemorrhagic shock, keep the bags hanging. Having them tank again is the last thing you want.

[TraumaDoc]

Wound closure

I receive a wilderness medicine newsletter now and then. Two interesting ideas were mentioned for when you are a long way from the ER and can't suture. If there is a large gaping wound Safety pins can be used to close the wound edges temporarily. Second, If a scalp wound needs closing you can take a clump of ten or so hairs and twist them into a string, one on each side of the wound and tie the strings together to close the wound edges.
Of course if you keep your hair high and tight better bring safety pins along.:-(
National Geographic once showed an Amazon Basin medicine man closing a wound with large ants. He would hold the ant(one inch long) by the body,squeeze the wound edges closed and apply the ant to the wound. when the ant bit down he broke the head off. Just like skin staples.
http://ewma.org/fileadmin/user_upload/EWMA/pdf/journals/EWMA_Journal_Vol_4_No_2.pdf Page 21
http://biotherapy.md.huji.ac.il/biosurgery.htm this technique was apparently widely used but personally I prefer staplers.

[Hav218]

These past couple pages have been quite informative. Just wanted to say thanks to you guys for keeping this going. Always something to learn.

+1 on using safety pins to close up eviscerations.

[pascalywood]

I have a question and think this is the best thread to ask it. I might go to Afghanistan this year and was thinking of having my blood type and NKDA tatooed on a few places on my body. What are the best spots that would help the medics if something happened?

[Roy Batty]

As it was explained to me by more than a few medics on my last tour: No medic will take your tattoo as fact. Your blood will be typed and matched at a role 3 facility should you need it. They may not even trust your tags to be correct (you could have had them replaced incorrectly).

Now my opinion; Tatooing your blood type into your elbows ect is almost as FNG, fresh out of basic gay as having a bar-code tatoo of your service number done and then showing it off at the bar while wearing your St Jean platoon shirt with your ID Disks hanging out.Just my opinion though, I could be wrong ;)

[DnA]

Like Sig said, the Medics won't trust what you have written on your kit, or tattooed.. plus they won't be searching your body for a tattooed blood type.. Your get blood typed in KAF while they pump you with O Neg(universal blood type)

Also, you thought about getting your blood type an NKDA tattooed on more than one place on your body?

Anyways, some units have it as SOP to mark kit with blood type, ie on the t-shirt. But, not all.



On a related note, most guys I know that did get blood type tattoos got it done on their inner arm/forearm. An when it comes to kit, most guys tend to mark their blood type on the collar of boots, on the body armour, IFAK, helmet band/helmet cover an some get IR/cloth patches on their sleeves an/or IFAK.

[pascalywood]

Lol, thanks man. Ill keep asking around but it makes sense.

And you got to hate those "look at how badass i am, im on the pat platoon" types :D

[TraumaDoc]

As it was explained to me by more than a few medics on my last tour: No medic will take your tattoo as fact. Your blood will be typed and matched at a role 3 facility should you need it. They may not even trust your tags to be correct (you could have had them replaced incorrectly).
Very true,Canadian, Among ER Doctors Paranoia is considered a healthy survival trait. Don't even trust yourself to be right if the matter is critical,That's why 2 nurses or a doctor and a nurse check each bag of blood before hanging it.
This is a good reference for "Shock and Resusitation" and includes a bit on Transfusions.
http://www.bordeninstitute.army.mil/other_pub/ews/Chp7Shock&Resuscitation.pdf
Please note this statement.

Exsanguinating hemorrhage is the cause of most
preventable deaths during war. Combat casualties in
shock should be assumed to have hemorrhagic shock until proven otherwise. (Pg 7.3)
And this one.
“Dog tag” blood typing wrong 2%–11% of the time.(Pg 7.9)

[pascalywood]

Alright thank you very much, my question is answered

[TraumaDoc]

. What are the best spots that would help the medics if something happened?

This reminded me of some of my High School buddies who were army in Viet Nam. They would keep one dog tag on the chain around their neck and lace the other on their boot. Just in case only one end was found. :-(

[TraumaDoc]

This is a truly AWESOME site. And even better all the books are available in PDF as free downloads. Emergency War Surgery is just one of the available titles.
http://www.bordeninstitute.army.mil/other_pub.html

[Creeper]

Main Finn: I agree w / your pts and your insight.

T Doc: TY 4 UR expertise and Op'd in the matter.

Very good inputs on that subject.

[TraumaDoc]

Personally, I would not stop IV therapy outright just because peripheral pulses were regained (if they were absent to begin with). Pulses are good, it means the blood is circulating. Instead, I'd either ease back the rate of infusion or hang a smaller bag. If it's a patient in hemorrhagic shock, keep the bags hanging. Having them tank again is the last thing you want.

Just to make my position clear. I don't support or encourage the minimalist approach described by Dr Mattox. It is good to keep a patient a little on the dry side,the end points described in Chapter 7 of Emergency War Surgery will keep both you and your patient out of trouble.

[Maine Finn]

Just to make my position clear. I don't support or encourage the minimalist approach described by Dr Mattox. It is good to keep a patient a little on the dry side,the end points described in Chapter 7 of Emergency War Surgery will keep both you and your patient out of trouble.

Point. My experience with running fluids beyond a few hours is pretty limited, as the longest I've had a single patient was ten hours. But. Given that patient's chief complaint and general VS, the bags were hanging from the time they came in to the time they went upstairs. I'd figure it's a bit different for medical patients as opposed to trauma patients, though. At least in terms of what fluids they get and how much. I'm at the low end of the hierarchy too, so most times I'm just doing what both my nurse and the doc/PA tell me to, without necessarily having a whole lot of room to think about it.

I haven't yet really bitten into that EWS link, but it looks like a good read.

[Greek soldier]

Does anyone have any experience with the Celox Granules or the Trauma Gauze? I watched some interesting videos on Youtube, but would like some additional feedback.

[Sabre]

Some interesting posts in the past few pages. Some bits that I picked up on from my practice:

1) Asherman chest seals: as said before they don't stick, we use Dems (explosives) gel to stick them down, basically we peel the back off, put the gel on and put a section of grease/wax paper back on. Not sterile, but better than leaving a sucking chest wound. Interestingly, it seems asherman are going to make a version with a VERY sticky backing based on this ersatz technique.

2) Fluid choice: horses for courses really, surgeons say 'physiological' fluids like hartmans or LR, medics say saline, there's no convincing evidence for either in resus scenarios. Our dept has removed colloid fluids completely, given the minimal benefit in resus and risk of anaphylaxis.

3) Re: Suturing in the field. Suturing is a very useful means of wound closure however the risks of doing it in the field for minor injuries are that you form an abscess due to incomplete or improper cleaning. Ideally, these wounds should be properly cleaned, explored and assessed in a med centre before closure. Although everyone loves to 'stich em up', often the best thing is to simply, irrigate, dress and move the casualty elsewhere. For larger wounds and bleeding, the best option is simple packing/compression and elevation and immediate exfil. You can't mess about in the field trying to acheive haemostasis with suturing, or close very large wounds. Best just evacuate the casualty to a proper facility.

[CombatBoots]

I think anyway about suturing if you haven't done it before on a person, you don't feel 100% sure that you can properly do it and you or your buddy are bleeding, you won't even try it -
You will most likely just grab the simplest of bandages that you have and slap it on, most likely a field dressing because of how the application has been practiced time and time again.

[Nano]

http://www.youtube.com/watch?v=y_og7HbVMrU

Check this out, 4 part series called "Suturing Under Austere Conditions" by YouTube user USNERDOC.

I would appreciate to hear the opinions of the professionals here of his instructions

Hope it helps.


Nano: I think that this page will help you.
http://www.ecatalog.ethicon.com/general-info
In common use a cutting needle is used for the skin, the tip has a cutting edge ground into it. Taper needles are used for the gut and deeper tisues. The tip simply tapers to a point and pushes thru the softer inside tissues.
http://www.ecatalog.ethicon.com/sutures-absorbable
These are the types of sutures available and the general usage.
The size of the suture is determined by the use. general use will be 4-0. for the face 5-0 or 6-0. to close a massive abdominal wound retention sutures of 0 or #2 might be used.

Hope this helps.

Thanks guys just saw this came back to check the thread out and had a nice surprise.

[TraumaDoc]

1) Asherman chest seals: as said before they don't stick, we use Dems (explosives) gel to stick them down, basically we peel the back off, put the gel on and put a section of grease/wax paper back on. Not sterile, but better than leaving a sucking chest wound. Interestingly, it seems asherman are going to make a version with a VERY sticky backing based on this ersatz technique.

3) Re: Suturing in the field. Suturing is a very useful means of wound closure however the risks of doing it in the field for minor injuries are that you form an abscess due to incomplete or improper cleaning. Ideally, these wounds should be properly cleaned, explored and assessed in a med centre before closure. Although everyone loves to 'stich em up', often the best thing is to simply, irrigate, dress and move the casualty elsewhere.

1) This is a good field expediant closure for a sucking chest wound, although I've never used explosive gel. 100mph tape works too. Remember to leave a small gap along the edge not stuck down for air to escape or you can convert a sucking chest wound (bad) to a tension pneumothorax (rapidly lethal).

3) The lowest rate of wound infections, even if those done in surgical procedures,in the OR is about 3%. Dirty wounds, if closed, can have infection rates of 30-50%. A small wound, if left open and bandaged, will almost never get infected. If a flap of skin is gaping open a loose closure with a stitch every 1-2 cm can be helpful.

[TraumaDoc]

I think anyway about suturing if you haven't done it before on a person, you don't feel 100% sure that you can properly do it and you or your buddy are bleeding, you won't even try it -
You will most likely just grab the simplest of bandages that you have and slap it on, most likely a field dressing because of how the application has been practiced time and time again.

This approach will never harm you or your buddy.

[dacanadianbomb]

Currently reading the 6th edition PHTLS military version book.
Nice stuff in the beginning that tries to get you to think about trauma in a different manner.

[Creeper]

Took a civie PHTLS class a few mths for my EMT recert. , bought the same book mil version for the class. I agree that this version is an eye opener. No dry reading in this one.

[Supra Man]

Hey guys, I need some medic related help.

I'm an engineering student and I have a big redesign project to do. I'm choosing to design a extremely light and portable stretcher. From what research I have done, current poleless stretchers are extremely strong, light, and maneuverable but lack any sort of good support for the casualty. Pole litters are heavy, take time to set up, and offer a little more support. A Sked stretcher is quite large but can support the casualty well, but not as well as a very heavy and bulky basket stretcher.

I want to talk with some people who have had first hand experience with evacuating wounded from the battlefield and what improvements need to be done.

[dacanadianbomb]

I am reading several medic related books right no and one of them that is supposd o be geared toward the mil side of things has a few paragraphs relating to HAPE and HACE along with AMS itself.
Reading a book a while ago about PJs , they were doing evac etc at pretty high altitudes.

With the experience gained in the Ghan at the moment, I would be interested if any of the medics and docs have actually sen or treated HACE or HAPE yet.

[pardus]

1) This is a good field expediant closure for a sucking chest wound, although I've never used explosive gel. 100mph tape works too. Remember to leave a small gap along the edge not stuck down for air to escape or you can convert a sucking chest wound (bad) to a tension pneumothorax (rapidly lethal).


Asherman chest seals are now persona non grata, the Hyfin chest seal is the standard, though I know some units are not up to speed on this (mine included), the hyfin uses the dem gel and will stick to everything, it does not have a valve so NCD is most likely (as you know) in fact I know some units require one to be placed immediately after the hyfin is applied.

Interesting article here on lessons learned.

U.S. military medics use old and new techniques to save wounded in Afghanistan (http://www.washingtonpost.com/wp-dyn/content/article/2010/11/01/AR2010110104802_pf.html)

[Creeper]

@ PARDUS :
TY 4 link.
Good stuff.
Continue w ur TTPs.
Tourniquets > given
Trauma Pt > hypotensive > ok
Whole Blood > desired over IV fluids .

Do less than you can and let the body run the show. fr:http://www.washingtonpost.com/wp-dyn/content/article/2010/11/01/AR2010110104802_2.html?sid=ST2010110104926

[dacanadianbomb]

I have been reading the new version of the Military PHTLS book and it has a lot of nice stuff in comparison to the older 6th edition I think it was.

Just finished the Burns chapter, ouch! nasty nasty stuff.

[occamsrazor]

Asherman chest seals are now persona non grata, the Hyfin chest seal is the standard, though I know some units are not up to speed on this (mine included), the hyfin uses the dem gel and will stick to everything, it does not have a valve so NCD is most likely (as you know) in fact I know some units require one to be placed immediately after the hyfin is applied.

I have only basic first aid experience (therefore unable to do a needle decompression) and live in a country where medical facilities may not be close. I've been building a compact (on belt) IFAK-style first aid kit for gunshot wounds and other such trauma. Mainly I have a CAT tourniquet, OLAES dressing, Quikclot gauze etc. I also got a HALO chest seal for possible penetrating chest shots, but after reading a bit I'm concerned that using a non-vented seal without the ability to do a needle compression, I might do more harm than good.

So my question regards the use of chest seals by the inexperienced operator like me who cannot do a needle decompression. Should I:

1. Carry and use the HALO seal, I'll likely do more good than harm and it seems to be a well-regarded seal.
2. Carry and use a vented chest seal - the vent reduces the need for needle decompression (though most vented designs seem to be less well-regarded, no?)
3. Carry no seal - its not the sort of thing an inexperienced operator can benefit from.

I realise there is an argument for carrying equipment for others to use on you, but the likelihood is no-one around me will be medically-trained and the first pro the injured person will see is after a drive to the hospital.

Thanks in advance....

PS - I know getting trained well enough to do the procedure myself would be the ideal option, but realistically it's unlikely to happen anytime soon.

[pardus]

Bottom line, if you have not been properly trained to use a chest seal then you should not use one.
You can kill someone very easily if you don't know how to use it properly.
As for having it so someone can use it on you. I wouldn't worry about it, if they are a trained medic, they can improvise, if they are trained they will probably just kill you using the chest seal.

My .02c


I have only basic first aid experience (therefore unable to do a needle decompression) and live in a country where medical facilities may not be close. I've been building a compact (on belt) IFAK-style first aid kit for gunshot wounds and other such trauma. Mainly I have a CAT tourniquet, OLAES dressing, Quikclot gauze etc. I also got a HALO chest seal for possible penetrating chest shots, but after reading a bit I'm concerned that using a non-vented seal without the ability to do a needle compression, I might do more harm than good.

So my question regards the use of chest seals by the inexperienced operator like me who cannot do a needle decompression. Should I:

1. Carry and use the HALO seal, I'll likely do more good than harm and it seems to be a well-regarded seal.
2. Carry and use a vented chest seal - the vent reduces the need for needle decompression (though most vented designs seem to be less well-regarded, no?)
3. Carry no seal - its not the sort of thing an inexperienced operator can benefit from.

I realise there is an argument for carrying equipment for others to use on you, but the likelihood is no-one around me will be medically-trained and the first pro the injured person will see is after a drive to the hospital.

Thanks in advance....

PS - I know getting trained well enough to do the procedure myself would be the ideal option, but realistically it's unlikely to happen anytime soon.

[Royal]

1) Asherman chest seals: as said before they don't stick, we use Dems (explosives) gel to stick them down, basically we peel the back off, put the gel on and put a section of grease/wax paper back on. Not sterile, but better than leaving a sucking chest wound. Interestingly, it seems asherman are going to make a version with a VERY sticky backing based on this ersatz technique.

I only had to use Asherman seals a few of times in my career, but don't remember adhesion being a problem. All but one were with women or kids - so no issues with a squaddy's hairy chest, but it can't just be that can it? Did they use a different adhesive back in the 90s?


I'm an engineering student and I have a big redesign project to do. I'm choosing to design a extremely light and portable stretcher. From what research I have done, current poleless stretchers are extremely strong, light, and maneuverable but lack any sort of good support for the casualty. Pole litters are heavy, take time to set up, and offer a little more support. A Sked stretcher is quite large but can support the casualty well, but not as well as a very heavy and bulky basket stretcher.

I want to talk with some people who have had first hand experience with evacuating wounded from the battlefield and what improvements need to be done.

The trick would be to make a portable stretcher rigid. I've often wondered why someone hasn't tried to do what an inflatable splint does - taking a mini bottle of compressed air perhaps (as with a D-SMB for recreational diving).

[pardus]

I only had to use Asherman seals a few of times in my career, but don't remember adhesion being a problem. All but one were with women or kids - so no issues with a squaddy's hairy chest, but it can't just be that can it? Did they use a different adhesive back in the 90s?

The big issue with the Asherman from what I was taught was the seal sticking to a wet surface ie blood etc...
Were the body surfaces dry on your patients?

[Royal]

Were the body surfaces dry on your patients?

Through and through GSWs in sub-zero temperatures, so yes. That probably explains it.

[pardus]

Through and through GSWs in sub-zero temperatures, so yes. That probably explains it.

OK, thanks, good to know.

[Rosbach]

Everything about TCCC: videos, teaching material, podcasts, equipment, etc

[Rosbach]

http://www.tcccbelgium.com/apps/videos/videos/show/8514716-afghanistan-medevac

"Golden Hour"

[Rattfink]

Isn't there already a thread started for the Combat Lifesaver's Course? Or was it lost?

[Rosbach]

The Emergency Bandage


http://www.youtube.com/watch?v=S2_EU1T-o-g

[Rosbach]

lost. So time for a refresher course

[Rosbach]

http://www.youtube.com/watch?v=6yXHABPZoYM&amp;feature=related

[FightinBluHen51]

Subscribed.

[tea drinker]

watched some "frontline medic" show on TV, some interesting advancements

[trunk_munkey28]

Tread very carefully with this topic gents... keep your OPSEC in mind.

[w0nder]

here ya go,

http://www.militaryphotos.net/forums/showthread.php?120592-Super-sticky-medic-thread

[Rosbach]

books. Free downloads:


at http://www.vnh.org/

War Surgery in Afghanistan and Iraq, a Series of Cases, 2003-2007, US Army (http://www.bordeninstitute.army.mil/published_volumes/war_surgery/war_surgery.html)

Blast Injury: Translating Research Into Operational Medicine, US Army (PDF) (http://www.bordeninstitute.army.mil/other_pub/blast/Blast_monograph.pdf)

Emergency War Surgery 3rd edition, US DOD (http://www.bordeninstitute.army.mil/other_pub/ews.html) - also in PDF (as a ZIP file) (http://www.bordeninstitute.army.mil/other_pub/ews/EWS.ZIP)

Care of the Combat Amputee, US Army (http://www.bordeninstitute.army.mil/published_volumes/amputee/amputee.html)

Blast Injury: Translating Research Into Operational Medicine, US Army (PDF) (http://www.bordeninstitute.army.mil/other_pub/blast/Blast_monograph.pdf)

Field Hygiene and Sanitation: FM 21-10 | MRCP 4-11.1D, US Army and USMC (PDF) (https://rdl.train.army.mil/soldierPortal/atia/adlsc/view/public/6656-1/fm/21-10/fm21-10.pdf)
Military Preventive Medicine: Mobilization and Deployment Volume 1, US Army (http://www.bordeninstitute.army.mil/published_volumes/mpmVol1/mpmvol1.html)

Military Preventive Medicine: Mobilization and Deployment Volume 2, US Army (http://www.bordeninstitute.army.mil/published_volumes/mpmVol2/mpmvol2.html)

Personal Protective Measures Against Insects and Other Arthropods of Military Significance, AFPMB (PDF) (http://www.afpmb.org/coweb/guidance_targets/ppms/TG36/TG36.pdf)

Put Prevention into Practice, USPSTF (http://www.ahrq.gov/clinic/ppipix.htm)
US Navy Shipboard Pest Control Manual: NAVMED P-5052-26, US Navy (PDF) (http://www.med.navy.mil/directives/Pub/5052-26.pdf)

Defense Against Toxin Weapons, US Army (PDF) (http://www.usamriid.army.mil/education/defensetox/toxdefbook.pdf)

Medical Management of Biological Casualties 6th Edition, USAMRIID (PDF) (http://www.usamriid.army.mil/education/bluebookpdf/USAMRIID BlueBook 6th Edition - Sep 2006.pdf)

Textbook of Military Medicine: Medical Aspects of Biological Warfare, US Army (http://www.bordeninstitute.army.mil/published_volumes/biological_warfare/biological.html)

Medical Management of Chemical Casualties Handbook 3rd Edition, USAMRICD (http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/Manuals/RedHandbook/001TitlePage.htm)

Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare, US Army (http://www.bordeninstitute.army.mil/published_volumes/chemBio/chembio.html)

Multiservice Tactics, Techniques and Procedures for Health Services Support in a Chemical, Biological, Radiological, and Nuclear Environment: FM 4-02.7 | MCRP 4-11.1F | NTTP 4-02.7 | AFTTP(I) 3-42.3, US DOD (https://rdl.train.army.mil/soldierPortal/atia/adlsc/view/public/9563-1/fm/4-02.7/TOC.HTM) - also in PDF (https://rdl.train.army.mil/soldierPortal/atia/adlsc/view/public/9563-1/fm/4-02.7/FM4_02X7.PDF)

Textbook of Military Medicine: Medical Aspects of Biological Warfare, US Army (http://www.bordeninstitute.army.mil/published_volumes/biological_warfare/biological.html)

Treatment of Biological Warfare Agent Casualties: NAVMED P-5042 | MCRP 4-11.1C | AFJMAN 44-156 | FM 8-284, US DOD (PDF) (http://www.med.navy.mil/directives/Pub/5042.pdf)

Medical Management of Chemical Casualties Handbook 3rd Edition, USAMRICD (http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/Manuals/RedHandbook/001TitlePage.htm)

Multiservice Tactics, Techniques, and Procedures for Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries: FM 4-02.285 (FM 8-285) | MCRP 4-11.1A | NTRP 4-02.22 | AFTTP (I) 3-2.69, US DOD (PDF) (http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA473246&Location=U2&doc=GetTRDoc.pdf)


Google books

Wound Ballistics: Basics and Applications by Beat P. Kneubuehl

http://books.google.de/books?id=q4jzcfLhBcYC&pg=PA483&dq=Kneubuehl&hl=de&ei=FbXWTpbmC5KFhQfz4flv&sa=X&oi=book_result&ct=result&resnum=8&ved=0CFUQ6AEwBzge#v=onepage&q&f=false

[JQ24]

This is where I go for TC3 updates and info. http://www.naemt.org/education/PHTLS/TCCC.aspx
It has lots of powerpoint presentations.

There should be some links as well on AKO if you have access to it.

[Rosbach]

This is where I go for TC3 updates and info. http://www.naemt.org/education/PHTLS/TCCC.aspx
It has lots of powerpoint presentations.

There should be some links as well on AKO if you have access to it.

great link. going to check it out in more detail

[Rosbach]

bit vintage, but why not looking up history (some manuals of today are based on it)

A treatise on gunshot wounds (1862) by Longmore, T. (Thomas), Sir, 1816-1895 (http://www.militaryphotos.net/search.php?query=creator%3A%22Longmore%2C+T.+%28Thomas%29%2C+Sir%2C+1816-1895%22)

http://www.archive.org/details/atreatiseonguns00longgoog

[Rosbach]

oro-tracheal intubation




http://vimeo.com/1525396

[Rosbach]

TCCC Guidelines 101101.pdf

http://www.naemt.org/Libraries/PHTLS TCCC/TCCC Guidelines 101101.sflb


Basic Management Planfor Care Under Fire

Basic Management Planfor Tactical Field Care

Basic Management Planfor Tactical Evacuation Care

[Rosbach]

PHTLS podcasts

http://www.phtlspodcast.com/


Trauma A to Z:Rapid Assessment (http://phtlspodcast.com/2008/04/17/trauma-a-to-z-rapid-assessment.aspx)

Basic AirwaySkills (http://phtlspodcast.com/2011/11/25/basic-airway-skills.aspx)
Airway andVentilation (http://phtlspodcast.com/2007/08/12/airway.aspx)
PrehopsitalIntubation with Traumatic Brain Injury (http://phtlspodcast.com/2007/07/27/prehopsital-intubation-with-traumatic-brain-injury.aspx)

Prehospital/BattlefieldTourniquet Use for Major Extremity Trauma (http://phtlspodcast.com/2009/02/06/prehospitalbattlefield-tourniquet-use-for-major-extremity-trauma.aspx)

Trauma A to Z:Thoracic Trauma (http://phtlspodcast.com/2009/02/08/trauma-a-to-z-thoracic-trauma.aspx)
Trauma A to Z:Musculoskeletal Trauma (http://phtlspodcast.com/2009/02/01/trauma-a-to-z-musculoskeletal-trauma.aspx)
Trauma A to Z:Traumatic Brain Injury (http://phtlspodcast.com/2008/08/14/trauma-a-to-z-traumatic-brain-injury.aspx)
Trauma A to Z:Burns (http://phtlspodcast.com/2008/07/16/trauma-a-to-z-burns.aspx)
Trauma A to Z:Rapid Assessment (http://phtlspodcast.com/2008/04/17/trauma-a-to-z-rapid-assessment.aspx)
Trauma A to Z:Abdominal Trauma (http://phtlspodcast.com/2008/04/17/trauma-a-to-z-abdominal-trauma.aspx)

Spinal Trauma (http://phtlspodcast.com/2010/02/18/spinal-trauma.aspx)
SpineImmobilization Following Penetrating Trauma (http://phtlspodcast.com/2010/01/18/spine-immobilization-following-penetrating-trauma.aspx)

Abdominal Traumain Pregnancy (http://phtlspodcast.com/2009/02/19/abdominal-trauma-in-pregnancy.aspx)

Prehospital/BattlefieldTourniquet Use for Major Extremity Trauma (http://phtlspodcast.com/2009/02/06/prehospitalbattlefield-tourniquet-use-for-major-extremity-trauma.aspx)

Pediatric Trauma(Part 1): The Child as a Trauma Patient (http://phtlspodcast.com/2010/12/02/pediatric-trauma-part-1-the-child-as-a-trauma-patient.aspx)
Pediatric Trauma(Part 2): What kills kids (http://phtlspodcast.com/2010/12/11/pediatric-trauma-part-2-what-kills-kids.aspx)
Pediatric Trauma(part 3): Airway and Breathing (http://phtlspodcast.com/2011/01/09/pediatric-trauma-part-3-airway-and-breathing.aspx)
Pediatric Trauma(part 3) - Circulation (http://phtlspodcast.com/2011/11/18/pediatric-trauma-part-3---circulation.aspx)

DisasterManagement (http://phtlspodcast.com/2008/08/31/disaster-management.aspx)
SmokeInhalation: Carbon monoxide and cyanide poisoning (http://phtlspodcast.com/2007/10/15/smoke-inhalation-carbon-monoxide-and-cyanide-poisoning.aspx)
Crush Syndrome:complication of earthquakes and cave-ins (http://phtlspodcast.com/2007/08/19/crush-syndrome-complication-of-earthquakes-and-caveins.aspx)
Heat RelatedIllness (http://phtlspodcast.com/2007/09/15/heat-related-illness.aspx)
Bomb and BlastInjuries (http://phtlspodcast.com/2007/07/01/bomb-and-blast-injuries.aspx)
Introduction toIV fluids (http://phtlspodcast.com/2007/06/14/introduction-to-iv-fluids.aspx)
Fluid Resuscitation:what's new? (http://phtlspodcast.com/2007/06/22/fluid-resuscitation-whats-new.aspx)
Pelvic Fractures (http://phtlspodcast.com/2007/06/07/pelvic-fractures.aspx)

[James]

Stop the bleeding, start the breathing, protect the wound, treat for shock.

or

Airway, breathing, circulation.

[wwjs]

From SAS Survival Secrets
(Worth watching) 8:00 (pt 4/6) - 0:47 (pt 5/6)

http://www.youtube.com/watch?v=0WE4Oc4gB4A&feature=related

http://www.youtube.com/watch?v=j0e8K61px7s&amp;feature=related
but 2:45 - 7:54 (pt 5/6), 1:28 - 5:00 (pt 6/6) is important (because it's easy to remember)

http://www.youtube.com/watch?v=J0rJ5AwrldI&amp;feature=related

[Creeper]

Stop the bleeding, start the breathing, protect the wound, treat for shock.

or

Airway, breathing, circulation.

Excellent.

How bout this:

Secure the X.
M-Massive bleeding.
A-Airway.
R-Respirations.
C-Circulation.
H-Head.
Get off the effing X.

Thanks everybody.

[Rosbach]

Thanks for posting "SAS Survival Secrets". The whole series is worth watching. Peticularly the (poor) guy dealing with several wounded at the same time is almost a role model. But I hear paramedics screaming - I know one who did once - "the guidelines!"

[Rosbach]

http://www.bt.cdc.gov/masscasualties/blastinjuryfacts.asp



Blast Injuries: Fact Sheets for Professionals

adressing topics like:

Prehospital Care (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Care_Prehospital_Eng.pdf)
Crush Injury and Crush Syndrome (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Crush_Eng.pdf)
Ear Blast Injuries (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Ear_Eng.pdf)
Essential Facts (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_EssentialFacts_Eng.pdf)
Blast Extremity Injuries (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Extremity_Eng.pdf)
Eye Blast Injuries (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Eye_Eng.pdf)
Blast Lung Injury (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Lung_Eng.pdf)
Blast Lung Injury: An Overview for Prehospital Care Providers (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Lung_Prehospital_Eng.pdf)
Bombings and Mental Health (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_MentalHealth_Eng.pdf)
Treatment of Older Adults (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_OlderAdults_Eng.pdf)
Pediatrics (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Pediatrics_Eng.pdf)
Post Exposure Prophylaxis for Bloodborne Pathogens (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Postexposure%20_Eng.pdf)
Radiological Dispersal Devices and Radiation Injury (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Radiation_RDD_Eng.pdf)
Radiological Diagnosis (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Radiological_Eng.pdf)
Thermal Injuries (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_ThermalInjuries_Eng.pdf)
Traumatic Brain Injuries (http://www.militaryphotos.net/uploadedFiles/ACEP/Practice_Resources/disater_and_EMS/disaster_preparedness/BlastInjury_Brain%20Injuries_Eng.pdf)
Field Triage Decision Scheme (PDF) (http://www.militaryphotos.net/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=46091)

[Solomon Grundy]

Subscribed as well. Thank you all for this thread, I'm very much interested in Becoming an combat Medic, this thread is good reading. woot

[Rosbach]

It is sundayand I noticed, that my little child TCCC was moved to a foster home


166971

[Rosbach]

http://www.youtube.com/watch?v=yf4mObngAsE

[Rosbach]

EMT Basic Skills - Airway Management


http://www.youtube.com/watch?v=p0CK_DIpgdI

[Rosbach]

Orotracheal Intubation, part I (http://www.google.de/url?sa=t&rct=j&q=orotracheal%20intubation&source=video&cd=1&sqi=2&ved=0CD0QtwIwAA&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DszDcYL2vm0Q&ei=NmbdTrvOFsHT4QSZufiEDg&usg=AFQjCNEEKA0mphgXegiCnJZ5Wd4GTiRnnA)


http://www.youtube.com/watch?v=szDcYL2vm0Q

[Rosbach]

Orotracheal Intubation, part II


http://www.youtube.com/watch?v=cU5ijbJvMsc

[Rosbach]

advice conc. intubation: If an intrvenous medication is necessary, do not trust anybody else in its choice and handling. Or it will turn FUBAR

[Rosbach]

Intubacion visualizacion de glotis

nice one conc "visualization de glotis". On the other hand did our hero not bother to use gloves, probably obtain a consent, inflate the cuff erlier etc




http://www.youtube.com/watch?v=YRYqmedQp5w&amp;feature=related

[Rosbach]

167399167400167401167402

pain relief

[Rosbach]

chest tube insertion



http://www.medicanalife.com/video/8af0588f5cf5397/Chest-Tube-Insertion

[Rosbach]

http://www.youtube.com/watch?v=tLjLHMXYMTA

[Rosbach]

Basic Laceration Repair-Simple Interrupted suture


http://www.youtube.com/watch?v=UFfhrW5kdjk

[imedic]

168277

Anyone know where I can buy the Recon Mountaineer TC3 V2 (In multicam) or CTB V3? I've asked the manufacturers but they only sell them in lots of 100 minimum. Ebay occasionally has them but usually only as a fully stocked kit which I dont need.

[Rosbach]

ConsciousSedation for Minor Procedures in Adults



http://www.youtube.com/watch?v=2CFTAqNBzl8

[Rosbach]

http://www.youtube.com/watch?feature=player_embedded&amp;v=nFORdFxvEnA

[Rosbach]

http://www.youtube.com/watch?v=4AtB65CZSHg&amp;feature=related

[Rosbach]

http://www.youtube.com/watch?v=p2n-MyFONi4&amp;NR=1&amp;feature=endscreen

[Rosbach]

http://www.youtube.com/watch?v=xeG8t-63lrU&amp;feature=related

[Rosbach]

http://www.youtube.com/watch?v=Ge52hGWudec&amp;feature=related

[pardus]

http://www.michaelyon-online.com/watch-your-step.htm

Great video for the Medics.

[wwjs]

Something for this time of a year

http://www.youtube.com/watch?v=67jwAzEOvmY

[Rosbach]

http://www.michaelyon-online.com/watch-your-step.htm

Great video for the Medics.

everything in it for TCCC
by the way, I use a knife to cut off clothes.
if you look up http://www.bordeninstitute.army.mil/published_volumes/war_surgery/war_surgery.html
you´ll find a lot of examples, why you should never give up on somebody

[pardus]

everything in it for TCCC
by the way, I use a knife to cut off clothes.
if you look up http://www.bordeninstitute.army.mil/published_volumes/war_surgery/war_surgery.html
you´ll find a lot of examples, why you should never give up on somebody

You use a knife??

[Rosbach]

You use a knife??


169135


Yes, sometimes. The KM 2000 or the CRKT M16 in its tanto version. Slide it gently under the clothes and cut away from the patient or move parts of clothes over the blade. The movement is less than 3 inches so no bystander will be injured. Works with leather clothes and other tough materials. Given a controlled situation, given no hysterics around.

[pardus]

169135
Given a controlled situation, given no hysterics around.

That would be the fatal flaw in my opinion. Way too much risk of causing further injury.

p.s. I have one of those knives, it is an absolute beast!

[wwjs]

You can use scissors or special knifes to cut seat belts.

http://www.youtube.com/watch?v=57CcagVAMec

[Rosbach]

That would be the fatal flaw in my opinion. Way too much risk of causing further injury.

p.s. I have one of those knives, it is an absolute beast!

No fatalities yet, no injuries yet. And I said: sometimes. Scissors are first choice, but "sometimes" you´re stuck with them. Hence the accompanying swearing.

[pardus]

No fatalities yet, no injuries yet. And I said: sometimes. Scissors are first choice, but "sometimes" you´re stuck with them. Hence the accompanying swearing.

Roger that.

[Rosbach]

http://www.youtube.com/watch?v=kIUKmg_6nak&amp;feature=related

[Rosbach]

Highly recommended books from a NGO medic, who has worked in England, South Africa, Burma, Eritrea, the Amazon, Mozambique, and the United States

Contact Wounds: A War Surgeon's Education by Jonathan Kaplan


169858

The Dressing Station: A Surgeon's Chronicle of War and Medicine (http://www.amazon.com/Dressing-Station-Surgeons-Chronicle-Medicine/dp/0802139620/ref=sr_1_3?s=books&ie=UTF8&qid=1325880938&sr=1-3) byJonathan Kaplan


169859

[kayaker]

Looks like two to watch out for...

[GETSOME]

Wow ,how did i miss this thread,thanks guys.

[Rosbach]

http://www.youtube.com/watch?v=nVem1__qW14

[Rosbach]

http://www.youtube.com/watch?v=FXJvvSbgVTE

[Rosbach]

http://www.youtube.com/watch?v=iGoFQ5zHV48

[Rosbach]

http://www.youtube.com/watch?v=GHfGdpVJuMA

[Rosbach]

http://www.youtube.com/watch?v=da5JaRdo47w

[Rosbach]

http://www.youtube.com/watch?v=ff_vqePp_jw&amp;feature=related

[Rosbach]

http://www.youtube.com/watch?v=NiMREdptAww&amp;feature=related

[Rosbach]

http://www.youtube.com/watch?v=XVdK1g5Wh64&amp;feature=player_embedded#!

[Rosbach]

http://www.youtube.com/watch?v=HeRpYu8cxrY&amp;feature=related

[Rosbach]

http://www.youtube.com/watch?v=01S5Vbrsmx0

[Creeper]

I have to spend time and catch up on ur videos. Thanks. Well done.

[Rosbach]

History


Henry Dunant - AMemory of Solferino
http://www.verwonderenenontdekken.nl/uploadedfiles/15-Henri%20Dunant%20(1862)%20A%20MEMORY%20OF%20SOLFERINO%20(Pdf%2047%20blz.).pdf (http://www.verwonderenenontdekken.nl/uploadedfiles/15-Henri%20Dunant%20(1862)%20A%20MEMORY%20OF%20SOLFERINO%20(Pdf%2047%20blz.).pdf)

History of theRed Cross
http://www.roteskreuz.at/i18n/en/organise/who-we-are/history/ (http://www.roteskreuz.at/i18n/en/organise/who-we-are/history/)

AStory of the Red Cross von Clara Barton
http://www.gutenberg.org/ebooks/30230

Medics, A BriefHistory
http://www.1stcavmedic.com/medic_history.htm

[Rosbach]

History



170439
Memoir ofJonathan Letterman (1883)
http://www.archive.org/details/memoirofjonathan00clem (http://www.archive.org/details/memoirofjonathan00clem)


Combat Medicine1944
http://www.archive.org/details/CombatMedicine (http://www.archive.org/details/CombatMedicine)

..................

[Rosbach]

Big Picture: Army Medicine
http://www.archive.org/details/gov.archives.arc.2569716

[Rosbach]

PREHOSPITAL TRAUMA LIFE SUPPORT (including a DVD), Mosby (7. Dezember 2010)
170726
(probably known to everybody, but I just got so p****d off by another book, called "Tactical Emergency Medicine", it had to be mentioned)

[Arctic1]

Do you have a source for that book?

[Rosbach]

purchased it over amazon.worth every penny

[Arctic1]

Thank you!

[Rosbach]

Chest wound, pneumothorax

Treatment of anopen chest injury


http://www.youtube.com/watch?v=sfk6dqxMvNI

[Rosbach]

Pneumothorax

auskultation, mp3

Normal Breath Sounds
http://www.mediscuss.org/respiratory-auscultation-tips-audio-mp3-examples-71.html (http://www.mediscuss.org/respiratory-auscultation-tips-audio-mp3-examples-71.html)


Absent or Decreased Breath Sounds
http://www.mediscuss.org/respiratory-auscultation-tips-audio-mp3-examples-71-page2.html (http://www.mediscuss.org/respiratory-auscultation-tips-audio-mp3-examples-71-page2.html)

[Rosbach]

steoscopes


http://www.youtube.com/watch?v=5SBRX6jq3GI


recommended (and I´m not getting paid by them): Littmann®

http://www.youtube.com/watch?v=xf_Xe2sHK98&amp;feature=relmfu


the eartips should be soft and sealing like a hearing protection making it easier to use in a noisy environment.

the tubing should have a colour that makes it different to other stetoscopes and therefore easier to find if lost

[Rosbach]

chest x rays


right sided lung collapse, chestdrain, expanded lung
170921

left sided tension pneumothorax: Recording before the event and in acuteevent. Thorax overviews.The excess pressure in the left hemithorax pushes thediaphragm downward. The left heart border is indentedarcuate


170927

CT-scan of a right sided pneumothorax

170930

[Rosbach]

approach

Hyfin OcclusiveChest Seal 3D video in HD
http://www.youtube.com/watch?v=lhSsztkQnAA (http://www.youtube.com/watch?v=lhSsztkQnAA)


Asherman Chest Seal

170932

[Rosbach]

http://www.youtube.com/watch?v=hQlt57AyQmg

http://www.youtube.com/watch?v=wuSg_p2Fe0Q&amp;feature=related

[Rosbach]

Chest Tube Care and Monitoring
http://www.medtrng.com/blackboard/chest_tube_care_and_monitoring.htm (http://www.medtrng.com/blackboard/chest_tube_care_and_monitoring.htm)

[Rosbach]

War drives innovation and in this series, Michael Mosley travels fromthe frontline of war to the frontline of research to uncover the medicalbreakthroughs that are coming out of current conflicts.

Better line might be: Q: Do you have any evidence that this is effective? A: Just by the survival rate.........



Frontline Medicine- episode 1- Survival


http://www.youtube.com/watch?v=_8rKzUk1wPg


Frontline Medicine- episode 2- Rebuilding Lives


http://www.youtube.com/watch?v=JDdoqWZ9pdo&amp;feature=related