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#212005 - 11/28/10 01:29 AM Re: Range Trauma Kit - Need Some Help. [Re: Alan_Romania]
hikermor Offline
Geezer in Chief
Geezer

Registered: 08/26/06
Posts: 7367
Loc: southern Cal
Originally Posted By: Alan_Romania
GPS Coordinates WGS84 is the Datum to use when given GPS coordinates to Aircraft.



Interesting point. Many of the topo maps in my area are NAD27. It makes about an 80 meter difference, which good signaling ought to be able to overcome
_________________________
Geezer in Chief

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#212014 - 11/28/10 02:57 PM Re: Range Trauma Kit - Need Some Help. [Re: Alan_Romania]
GreyHiro333 Offline
Stranger

Registered: 02/06/09
Posts: 6
I carry both the old US bandage and Israeli battle bandage in my range bag and in my war bag. Just make sure you buy an extra one to play with and try out. Also a quick Google search a few years back when I bought my first Israeli battle bandage I found several good company video clips on how to use it. Here's one link to get you started:

http://www.firstcareproducts.com/apage/2123.php

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#212015 - 11/28/10 03:34 PM Re: Range Trauma Kit - Need Some Help. [Re: hikermor]
Alan_Romania Offline

Addict

Registered: 06/29/05
Posts: 631
Loc: Arizona
Originally Posted By: hikermor
Originally Posted By: Alan_Romania
GPS Coordinates WGS84 is the Datum to use when given GPS coordinates to Aircraft.

Interesting point. Many of the topo maps in my area are NAD27. It makes about an 80 meter difference, which good signaling ought to be able to overcome


It can be up to 400m in some areas.
_________________________
"Trust in God --and press-check. You cannot ignore danger and call it faith." -Duke

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#212016 - 11/28/10 03:36 PM Re: Range Trauma Kit - Need Some Help. [Re: cliff]
Alan_Romania Offline

Addict

Registered: 06/29/05
Posts: 631
Loc: Arizona
Originally Posted By: cliff
Alan!!

Long time! You going to be there in January again?

.....CLIFF
(like, who else?)


I am hoping for a day or two, but the beginning of January is looking pretty ugly this year...

Don't forget an Umbrella wink
_________________________
"Trust in God --and press-check. You cannot ignore danger and call it faith." -Duke

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#213124 - 12/16/10 02:04 AM Re: Range Trauma Kit - Need Some Help. [Re: chaosmagnet]
chaosmagnet Offline
Sheriff
Carpal Tunnel

Registered: 12/03/09
Posts: 3436
Loc: USA
Originally Posted By: chaosmagnet
I'm taking a one-day course for firearms instructors on treating gunshot wounds in mid-December. I'll be sure to post something after the class.


The class was extremely interesting. It wasn't a general first aid course, and while there was some overlap with what I learned in the CERT first aid module, this class was focused on traumatic injury. While other students had CPR certification I was the only CERT member and clearly had the most first aid training going in.

I'll try to hit the high spots of the class and then talk about equipment.

Our lead instructor was an Army combat medic in Iraq, a civilian paramedic, and is now a police officer. Our training was based on his practical experiences as well as the evidence-based medicine learned by the Army and the hospital systems he worked in as a civilian. He covered far more than I can put into this post, with excellent slides and some good hands-on drills.

Most important is the combat mindset. I won't talk about it here other than to say that complacency kills.

Next most important are tactics -- knowing what interventions to use for a given situation.

After tactics come skills -- practicing those interventions so that you can perform them correctly under stress.

Last and least is gear. Gear, he said, is "the weak person's crutch." He believes in having the right gear but the best gear is worthless unless you train and practice with it. If you don't have it with you, it's worthless. Even fifty yards away in the parking lot is too far.

There are three kinds of casualties: People who will live if you do nothing, people who will die no matter what you do, and people who will live if you apply the correct interventions immediately. We focused on that last category.

Getting to definitive care as quickly as possible with a live patient is the goal. As firearms instructors we should know about the local hospitals, know where the nearest trauma center is, and liase appropriately with the local EMS, before holding a class. If the local EMS is professional and nearby, you're probably best off calling an ambulance. If the trauma center is ten minutes away but the volunteer FD ambulance is thirty minutes away, you're probably best off transporting the casualty yourself.

The three most common killers for casualties who could otherwise be saved are loss of blood, tension pneumothorax, and airway issues. We learned interventions designed to keep casualties alive long enough to get to definitive care.

For loss of blood, we learned about direct pressure, packing wounds (gauze is good, tampons work but are invasive and can cause us liability problems) pressure dressings, tourniquets, and hemostatic agents, with good drills on applying them.

For tension pneumothorax, we learned about occlusive dressings, both pre-made ones (and like MDinana says, avoid the Asherman), petrolatum gauze with tape, and "ghetto-fabulous" field-expedient dressings made out of a plastic bag and tape. We learned about needle decompression but were told very sternly that it is too invasive and out of our scope of practice. If we use needle decompression we'll face significant civil liability.

For airway issues, we learned how to use a nasopharyngeal airway (NPA) and an oropharyngeal airway.

We all had questions about gear. Since we were all firearms instructors, RSOs, or LEOs, we were focused on equipment we could carry with us to treat a single wound in the field. For that purpose he recommends the Army issue IFAK. The IFAK contains:
  • CAT Tourniquet
  • Compressed gauze
  • Compression bandage
  • Gloves
  • Tape
  • NPA

With an Army IFAK I can do almost everything he taught us to do, using the package for the compression bandage as an occlusive dressing. He says that the issue tape is crap and should be replaced with duct tape. His favorite compression bandage is the Israeli Battle Dressing. His favorite tourniquet is the CAT, with the SOFTT being a close second. His favorite hemostatic agent for deep wounds that can't be addressed with a tourniquet is CELOX-A, with QuickClot Combat Gauze highly recommended as well.

I have what North American Rescue calls a USCG IFAK coming. I consider the it to be pretty complete. I'll be adding the following to it:
  • another pair of gloves
  • duct tape
  • shears
  • Laerdal CPR face shield
  • a travel package of aspirin
  • a travel package of Benadryl
  • CELOX-A


I'm considering this a supplement to my regular first aid kit and it's going to be on my person when I'm on the firing line. The aspirin and Benadryl will be reserved for cardiac issues and anaphylactic shock, respectively. Running back to the car when someone is bleeding is not an option.

It can't be said too often or too forcefully: If you want to be able to help people who are hurt at the range, get some training.

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#213229 - 12/17/10 12:43 PM Re: Range Trauma Kit - Need Some Help. [Re: cliff]
Murph Offline
Stranger

Registered: 12/06/10
Posts: 20
Loc: Virginia
Nice run down ChaosMagnet. I think there are two things worth highlighting in your post. The first is you listed out the instructor's "favorites." In my experience, it seems like every instructor has their own. So it goes without saying that students' preferences might differ too. It's always good to see what your options are, and see if something works better for you. Which comes to my second part, make sure you get training / practice using the stuff you have. smile
_________________________
-Murph-

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#213238 - 12/17/10 04:42 PM Re: Range Trauma Kit - Need Some Help. [Re: chaosmagnet]
MDinana Offline
Pooh-Bah

Registered: 03/08/07
Posts: 2196
Loc: Beer&Cheese country
Great synopsis.

I'd hesitate about giving benadryl. It can be fine for mild problems, but if the person's airway is truly closing off, shoving something down it and trying to get them to swallow may be the proverbial "straw that broke the horse's back," and occlude that last little space they're breathing down.

If the trauma center is 10 minutes away, and you're transporting by car, for the love of everything holy, CALL and let them know you're en route. 2 minutes of controlled prep will help a lot better than the catastrophic chaos of a "homeboy ambulance" delivery. Get the direct number if you can, even if it's to the charge nurse.

Some things he probably didn't add:
- keep the patient warm. Even in Iraq they should be keeping a blanket on folks Cooling off weakens blood clotting and jacks up the blood pH, making it easier to bleed.
- I also like athletic tape. ANY plastic can work - bandage wrapper, sandwich bag, spare latex glove, 55-gal drum bag (probably should cut off the slack). You can seal the wound with a gloved hand while you get the bandage ready; ideally you'd have someone helping you.
- The 'flutter valve' concept is nice, but may not work. I've heard good and bad about it, and "tape on three sides" versus "tape all 4 sides" of a bandage arguments. Do whatever your local area EMS does.
-maybe add something to your liability waivers about the lack of immediate EMS, allowing you to perform basic first aid?

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#213239 - 12/17/10 05:28 PM Re: Range Trauma Kit - Need Some Help. [Re: MDinana]
paramedicpete Offline
Pooh-Bah

Registered: 04/09/02
Posts: 1920
Loc: Frederick, Maryland
A couple of things with occlusive dressings:

Keep the occlusive dressing just slightly larger than the wound. If the occlusive dressing is too large, you essentially create a secondary pleural space.

Check for exit wounds. If found, apply an occlusive dressing to any additional sites.

Try to apply and seal the occlusive dressing when the patient exhales.

If possible transport with the injured side down, but monitor patient’s condition constantly.

If the patient complains of an increase in difficultly to breath, a decrease in the level of conscious and/or distension (enlargement/engorgement) of the jugular veins (large veins in the neck), you may have “burp” the occlusive dressing to relive trapped air and/or blood.

Pete

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#213240 - 12/17/10 05:31 PM Re: Range Trauma Kit - Need Some Help. [Re: MDinana]
chaosmagnet Offline
Sheriff
Carpal Tunnel

Registered: 12/03/09
Posts: 3436
Loc: USA
Originally Posted By: MDinana
I'd hesitate about giving benadryl. It can be fine for mild problems, but if the person's airway is truly closing off, shoving something down it and trying to get them to swallow may be the proverbial "straw that broke the horse's back," and occlude that last little space they're breathing down.


That's a great point. I'd never give someone a pill to swallow if they were having breathing problems.

Quote:
If the trauma center is 10 minutes away, and you're transporting by car, for the love of everything holy, CALL and let them know you're en route. 2 minutes of controlled prep will help a lot better than the catastrophic chaos of a "homeboy ambulance" delivery. Get the direct number if you can, even if it's to the charge nurse.


This was addressed at length in class. Ideally (assuming transport by private car) we have one person driving, one person treating the casualty, and one person navigating and being on the phone with the ER.

Quote:
Some things he probably didn't add:
- keep the patient warm. Even in Iraq they should be keeping a blanket on folks Cooling off weakens blood clotting and jacks up the blood pH, making it easier to bleed.


This was covered briefly in class.

Quote:
- I also like athletic tape. ANY plastic can work - bandage wrapper, sandwich bag, spare latex glove, 55-gal drum bag (probably should cut off the slack). You can seal the wound with a gloved hand while you get the bandage ready; ideally you'd have someone helping you.


I hadn't thought or heard of using athletic tape in this capacity, thank you.

Quote:
- The 'flutter valve' concept is nice, but may not work. I've heard good and bad about it, and "tape on three sides" versus "tape all 4 sides" of a bandage arguments. Do whatever your local area EMS does.


For myself, I'm not enough in their confidence to know that. I'll have to see if I can find out.

Quote:
-maybe add something to your liability waivers about the lack of immediate EMS, allowing you to perform basic first aid?


That's a very good idea.

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#213241 - 12/17/10 05:32 PM Re: Range Trauma Kit - Need Some Help. [Re: Murph]
chaosmagnet Offline
Sheriff
Carpal Tunnel

Registered: 12/03/09
Posts: 3436
Loc: USA
Originally Posted By: Murph
Nice run down ChaosMagnet. I think there are two things worth highlighting in your post. The first is you listed out the instructor's "favorites." In my experience, it seems like every instructor has their own. So it goes without saying that students' preferences might differ too. It's always good to see what your options are, and see if something works better for you. Which comes to my second part, make sure you get training / practice using the stuff you have. smile


Are you sure you weren't in my class :-) ? Our instructor said this to us almost word-for-word. For myself, I agree wholeheartedly.

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