Let's talk bare-bones BOK

[Iraq Ninja]

Using a mag pouch is a good idea. Not sure if I have mentioned this before, but it is not a good idea to simply pack the stuff in the pouch. What I do is use a bit of duct tape to link the stuff together in a snake like fashion. It doesn't take much.

What you are trying to avoid is pulling out one thing, and something else falls out on to the ground, or in a back seat of a moving vehicle.

I know a few companies make fancy nylon inserts, but they take up room too. Plus, the stuff can still fall out even if it is retained.

[MIKE G]

......

[Gutshot John]

While you may be clever enough to figure out how to use one item, figuring out the order of the items is just as important.

Anyone care to share a step by step treatment of a GSW to the thigh immediately above the knee with pulsatile bleeding? If you have been to a good quality class you should have a step by step protocol for bleeding control.

Just for the sake of reducing confusion, hemostats are a metallic clamp used to grasp tissue, usually a blood vessel. Hemostatic agents are material put into a wound to aid in bleeding control by formation of a matrix.

DOC

God Bless my medical brethren but sometimes overthinking an issue is something of an issue. I'm sure it might matter to a combat medic the vagaries of GSWs to the thigh immediately above the knee with pulsatile bleeding, but for the average civilian who just had an accident on the range and who has to self-treat above the knee, below the knee, in the arm. So long as it's not in the vitals it doesn't really matter. If it is in the vitals... well hopefully EMS is close by or there is a trained medic on hand. Even still the point is probably moot and even if recoverable we're talking well beyond "bare bones."

"Hemostat" in common usage applies to clamps as well as hemostatic agents. Both stabilize blood loss. I'm pretty sure everyone is smart enough to know what was meant.

As for a "protocol" it really doesn't need to be that complicated. In fact simpler is lots better. Is it a good idea to have an idea of what you need to do? Sure but it won't take much more than 10 minutes on google to get a good idea.

Is taking a class a good idea? Absolutely, but in the interim it's also a good idea to have the rudiments of hemorrhage control on your person. Since you've already been shot, there is ZERO downside regardless of your training level.

[MIKE G]

.....

[Submariner]

They have the 14 gauge 3.25 NCD catheters listed on their site. I can't find them without the cath.

I bought nine of them. They call them catheters but they are only the needle. I complained about the ad to no avail.

Remember, we are talking Tactical Response.

I will do you better than an m4 mag pouch.

I kept this kit in an M18 smoke grenade pouch on my chest for my entire time in Iraq:
...
1-14gax3.25" needle or catheter

Good idea on the Mk 18 pouch. I have a couple of Eagle 1 Qt. Canteen/GP MOLLE pouches I bought cheap ($15) which provide more space.

Would you (or anyone) please compare/contrast the efficacy of needle vs. needle/catheter? 3.25" vs. 2"?

[rob_s]

Using a mag pouch is a good idea. Not sure if I have mentioned this before, but it is not a good idea to simply pack the stuff in the pouch. What I do is use a bit of duct tape to link the stuff together in a snake like fashion. It doesn't take much.

What you are trying to avoid is pulling out one thing, and something else falls out on to the ground, or in a back seat of a moving vehicle.

I know a few companies make fancy nylon inserts, but they take up room too. Plus, the stuff can still fall out even if it is retained.

That extra room eaten up by the insert is a concern of mine as well. I really like the Trauma Kit NOW! as it has a lot of nice features, but it definitely takes up a lot of room inside the pouch.

One thing that a friend, who is a local SWAT medic, does for his team is assemble their kits and vacuum seal them with a Foodsaver-type device. He then cuts notches all around so that they can open them from any side. Yes, one could have everything fall on the ground once extracted, or may need the item at the bottom of the bag not the top, but it's a good way to keep everything together, and I think it does have more application for what I'm talking about here with a range kit.

Which is one advantage of the inserts. you pull it out, open it up, and the thing that you need are sitting right there in front of you, laid out for you to choose from.

part of the reason I'm trying to narrow down my kit is so that I can also be more specific about the carriage with the custom nylon guy today. Right now I have only one side of the TKN filled, which makes me wonder if I can't cut off the other side and reduce the pouch thickness by at least 30%. This is the list of what comes in the filled TKN, with the items I've included in bold, and what I've added in italics.

(1) Cinch-Tight Combat Dressing NSN 6510-01-503-2109
(1) PriMed Compressed Gauze NSN 6510-01-503-2117
(1) TK4 Combat Tourniquet NSN 6515-01-542-
(1) Combat Medic Reinforced Tape NSN 6510-01-549-0927
(1) Petrolatum Gauze Pad 3"x9"
(4) Nitrile Surgical Gloves
(2) .25g Quick Clot Sponge
(1) Bolin Chest Seal

[Iraq Ninja]

Rob,

I would not suggest cutting the insert down. I like expandability.

My personal rule of thumb is to have at least two bandages on my person.

[MIKE G]

.......

[Gutshot John]

One of the more interesting recent developments in battlefield trauma is the far broader applicability of a tourniquet.

When I first began a tourniquet was the method of last resort due to fears of nerve damage/amputation. More recent experience has proven the flaws of that notion. There are recent studies which indicate that there is little significant long-term damage or risk of amputation even after a tourniquet has been applied for hours.

In terms of hemostats I don't believe in the "magic dust" medium. While it beats nothing the more advanced impregnated mediums are far more effective and easy to use. ACS but preferably Combat Gauze by QuikClot. Interestingly enough I also think it becomes something of a crutch.

Two or more extra bandages is an excellent idea because one bullet often makes two holes and occasionally more.

What I would do if I was self-treating a GSW to extremity...

1. Apply tourniquet immediately to stop catastophic blood loss (they come with instructions, read them before you get shot),
2. *OPTIONAL - Apply hemostat quickly (using combat gauze or ACS a monkey could do this by packing (stuffing) it into the wound),
3. Apply pressure-type bandage/s quickly and securely,
4. Call 911 for escort along the way if no EMS nearby,
5. Get going to the hospital, time is of the essence - drive if you have to but don't kill yourself or anyone else along the way

Take it or leave it as you will.

[Fireguy275]

My daily carry kit is a CAT TQ, 4" Ace bandage, HH compressed gauze, Celox, and pair of gloves in a waterproof zip-up pouch that I bought from REI. Fits in the side cargo pocket of my pants.

I am wanting to go smaller though (wallet sized) for times when I'm not wearing cargo pants and am planning to vacuum-seal a packet of Combat gauze with a Swat TQ and a pair of gloves.