First-Aid Kits Saved Lives At Tucson Massacre

A Tucson SWAT team medic had been concerned about rising violence in the area and had taken the initiative to create a First Aid kit for all deputies to carry. It became standard-issue last June. Interesting article. These officers were Equipped to Save Lives.


http://www.washingtonpost.com/wp-dyn/content/article/2011/01/21/AR2011012105860.html?hpid=topnews

First-aid kits credited with saving lives in Tucson shooting

...cobbled together the Individual First Aid Kits out of simple items used by combat medics in Iraq and Afghanistan: an emergency bandage pioneered by the Israeli army; a strip of gauze that contains a substance which coagulates blood on contact; a tactical tourniquet; shears that are sturdy and sharp enough to slice off victims' clothing; and sealing material that works especially well on chest wounds.

The items in the kit were each inexpensive; the Israeli bandage, for example, cost only $6, but deputies reached for one "over and over at the scene," Kleinman said.


A link to the First Aid kit contents:

http://pimasheriff.org/about-us/publicat...tucson-shootin/

1 – SOF tactical tourniquet [$25]
2 – Emergency 6” military bandages [$10]
1 – Asherman chest seal [$14]
1 – Quick Clot combat gauze [$40]
1 - Pair of EMT shears [$5]

For further information on how the Pima County Sheriff’s Department implemented these life saving IFAKs, contact Sheriff’s Department Tactical Medic Tom Price at (520) 351-4865.

Looks like the kits are in a Maxpedition pouch or something similar. I researched prices on the contents and put a ballpark amount in brackets (bolded).

i;ve said this before,that bandage and the Clot are the two main items of my canoeing "major bleed" kit.despite some of the down sides that are brought up about the Clot i still think it's the best way to go.both that and the bandage were devised to be applied by the injured person without a lot of prep time.

I am a Quik-Clot skeptic, mostly because I have treated, or been around, a lot of trauma where direct pressure worked very well. These were non-battlefield situations, where obviously the character of the trauma would be different. Most of what I have seen involved falls and fractures, where a lot of splinting was involved.

Obviously, a deputy sheriff's needs are a bit different. Thanks for the post, Dagny - very interesting and informative. BTW, I served under Sheriff Dupnik as a SAR volunteer when he first came into office 1980-1985. He is the real deal - he certainly improved our operations considerably.

Thanks Dagny! I heard an update about the Congress woman yesterday in which they credited the immediate first aid by an officer with greatly aiding her survival. Made me wonder what they had on-hand. Thanks for sharing!

Giffords was really fortunate. An aide was right there and prevented her from choking on her own blood. She arrived at UMC during a shift change, so there was twice the usual staff, and the attending physician had extensive battle experience with penetrating trauma.

“The fate of the wounded rests in the hands of the one that applies the first dressing.” -- Nicholas Senn MD, 1897

The concept of a 'blow out kit' is not new, and I think is a good idea, if you have some training on applying contents. I keep an equivalent in my car, I use an old Countycomm EOD utility bag, and keep nitrile gloves, eye protection, the tourniquet and shears on the outside. I also slipped a benchmade hook into the webbing. I call it my Bloodstopper 2000, meant only to suppress major bleeding until help arrives. There are several versions of these kits, they get discussed in the First Aid forum over on zombiehunters.org - my kit was directly inspired by the contents and organization of a particularly good one discussed there. The kit is organized for at most 2 victims, and is also oriented to non-gun shot trauma and slightly smaller bleeds, that can be accomodated with 4x4s and rolls of kerlix gauze - the idea is if I approach a scene of an accident, I grab this bag and go. Similarly, if you spend alot of time at a shooting range, and something happens, it would be good to have some local kit to provide immediate first aid for gun shots etc.

God bless the folks who responded in Tuscon, and god bless the SWAT team member who looked ahead and pushed for police to be equipped and trained with these kits. You can never dream up a terrible scenario like that, but you should be able to foresee alot of other stuff, and be ready for it. Their focus is on that First Five Minutes, which is a really good focus. Strong work.

Although my experience mostly mimic's yours, I have seen a time or two where the Quick-Clot would have been VERY useful. The information I have seen recommends direct pressure first, then if that is not enough, use the Quick-Clot. That is how I would expect to use it except in the case of a major trama that I clearly cannot stop (or without help could not stop).

Respectfully,

Jerry

I put my faith in direct pressure, I have a couple problems with Quick Clot - first, I don't know how to apply it, and simply dumping QC into a wound to stop bleeding seems to me to create more issues down the line than I care to inflict. I hear stories of surgeons having to deal with Quick-Clot, and often not in a pleasant way. Second, I like the idea of HemCon bandages, a pressure or other bandage that has celox or other blood coagulation products embedded in it - just wrap on a HemCon, keep pressure, and bleeding stops. The advantage there is you remove a bandage later during treatment, you remove the Quick-Clot. The disadvantage is price, they appear to be very expensive. Plus the fact that direct pressure has always worked for me, though I have never encountered a battlefield-type wound. QC is probably a great product in the right hands. I'm betting I don't need it in my particular kit though.

My first add certifications have lapsed, a situation I need to remedy, but what do the Red Cross, etc., say about QC? Any discussions about use/missuse in the medical or emergency literature?

I would be willing to guess that QC is not a panacea or even your first strategy of choice, but that it indeed has its place.

Most of what I have dealt with is blunt force trauma, the result of stumbles and falls in the back country - only a little penetrating trauma - perhaps only two or three gunshot wounds. My experience is alos biased, most likely, because the really bad trauma cases bled out before we could reach them....

Note their kit contains QC *gauze*, not powder.

-john

Given that emergency personnel were on scene in minutes I suspect that what was lacking was training and a willingness to overcome the reticence to get involved. Handkerchiefs, ties, tee shirts, socks, belts can all be pressed into service to cover the gap as the EMTs are coming your way.

I also doubt that quick-clot, or similar, would have made a huge difference. In the time it took to dig out and open you could have installed an expedient tourniquet or simply applied direct pressure.

IMHO the key is to act quickly. Going with whatever you have on hand, even if it is a partial or incomplete solution, is better than the better solution applied when you get back with your kit.

My Red Cross first aid class about a year or so ago did not mention anything other than direct pressure. That includes pressure points, but those were only mentioned briefly during the class.

I took my First Responder recert through the Red Cross just last week. The instructor was an experienced combat medic with time in Iraq amongst other places.

He wasn't big on the powdered blood clotting agents. He did like the bandages with the agents in it however.

Just my 2c.

QuikClot is now in both gauze and "bean bag" form. The old powder product (1st gen) that was difficult to clean out of wounds and was hot hasn't been available for a couple of years. The company now has a couple of different lines of products (OTC, hospital, law enforcement and EMS). The manufacturer's site (www.z-medica.com) has good info on the latest versions of their product. I always carry it in my go kit.

I re-certed my Wilderness First Responder with NOLS a few months ago, and asked specifically about QuikClot. Their take is that direct pressure and well-maintained tourniquets are the better way to go. They argue that QuikClot and similar agents are introducing a foreign substance into an open wound, and if that can be avoided by using alternate techniques, it should.

We also had another guy there who purported to work at the Pentagon - I was in Northern Virginia at the time, so it's plausible, though I didn't ask the guy for identification - and said that this was the military's current procedure too, to only use QC when other treatments were failing. Anybody here able to confirm/deny that?

Look at the estimated component cost on the QC gauze - $40. I can equip alot of layman's First Aid Kits for that cost alone. For an EMT or police first responder I agree, go with what is most effective for what you encounter, which includes QC bandages for gun shots and other open bleeds. I'm happy they could afford that in Tuscon. For my kit and my general experience, I see more head trauma and broken bones than excessive bleeding, which I think is fairly typical of passerby first aid. Why should I carry a relatively expensive (and time expiring) QC bandage for a wound I seldom if ever will treat? With non-QC pressure bandages and TQs, I feel ready enough for a major bleed.

I agree, thanks to your comments and the others on this thread. I had no idea that QC had an expiration date. Is that date affected by storage conditions, particularly temperatures? I store my principal FAK in my solar cooker (automobile).

Thanks for posting this. it just reafirms the fact that for $40 you can add safty and give people a fighting chance.

From the FAQ - http://www.z-medica.com/healthcare/How-QuikClot-Works/FAQs.aspx#faq_1

What is the shelf-life of QuikClot dressings and are there any special storage instructions?An unopened package of QuikClot has a shelf life of three years. The only storage direction is to not leave a pack of QuikClot in direct sunlight for extended periods of time. QuikClot can also be stored in very high or low temperatures (below freezing).

The more important things are 1) understanding of why these tools work and 2) training in using the tools, along with improvisation. QuikClot is sexy and all but if you don't appreciate what led up to its development, you are missing out.

For those who don't know, this is all rooted in "Tactical Combat Casualty Care" or TC3. Google it and read to your heart's content. All the info is open source. Those with a little fortitude will seek out TC3-centric training. There is plenty of it out there now available to civilans.

If you think the local EMTs and paramedics are the go-to people for this, you are wrong. I love EMTs, I am one, and I've worked in the business for years but they are NOT the subject matter experts on dealing with active arterial bleeds due to penetrating trauma when under fire.

Learn WHY to pack a bleed, then HOW, then learn when QC is appropriate. Tourniquets are superb, the old wives' tales about them have been slain, but learn to use a "stick and a rag", then graduate to a CAT or SOFTT-Wide.

Skipping the simpler methods cheats you out of deeper understanding and appreciation. It's like school kids using a calculator before they learn long division. Doing it manually makes you really appreciate the calculator and use it more effectively, plus some day there won't be a calculator when you need one.

There are some good points here about the quick clot. I agree that it's faster and often better to just apply pressure with whatever's on hand in that split second.

However, just a quick note--certain drugs and medical conditions can cause the blood to not clot so easily, turning what would otherwise be manageable bleeding into a real problem. I'm keeping some on hand mainly just for convenience, as it's annoying when a minor wound won't stop bleeding. I doubt I'd actually use it in a serious crisis, I think I'd just maintain pressure until help arrives; I wouldn't want to let up the pressure even for a moment to use the quickclot. There could also be other problems such as misapplying it and confusing the EMTs resulting in some delays.

So even as someone who has a good reason to keep this stuff on hand I'm not expecting to use it for excessive bleeding. It seems like an excellent product, but it should be used with discretion.

Are you saying that is a generally true thing? Because I can assure you that it is not. EMS protocols vary widely by state and even by county. We use drugs in my county that EMS in the next county doesn't use, and vice versa.

We don't carry Vit. K.

Pete

This is one of the selling points of Celox--which doesn't utilize your body's normal clotting process. Although in absolute terms, I have no idea how Celox stacks up against QC for high volume arterial bleeds, so it may not be the best for a trauma blow-out kit.

You're right, I was getting quick clot and celox mixed up. According to their website, Celox does not rely on the body's clotting factors, it uses chitosan which, upon contact with blood, "swells, gels, and sticks together" forming an artificial clot. So it should work exactly the same on good clotting blood as it does on blood that doesn't clot well.