View Full Version : Kit Buildup - GSW Kit
If you're not looking to deal with things like IEDs and are instead looking only for a range kit, would the contents of your kit be any different? If so, what and why?
Gutshot John
06-15-09, 11:29
If you're not looking to deal with things like IEDs and are instead looking only for a range kit, would the contents of your kit be any different? If so, what and why?
The stuff in an IFAK/Blow out kit is pretty generic and can be used for a variety of injuries. I'd say that there isn't much difference, but I suppose others may disagree. At the average "grunt" level of self/buddy aid you're still dealing with penetrating trauma to the extremities. Control hemorrhage and get help. I wouldn't change what you have with the following caveats:
First the bigger difference would come at the medic level. If you're looking for a more definitive kit for treatment of others beside yourself than many of the stuff used in blast injuries can have cross-over in civilian application, burns for instance or splints for broken bones.
Second I'd recommend is consider that NDs I've seen that resulted in injury (more often than not at very close range) also resulted in multiple entrance and exit wounds. I'd consider being able to treat a minimum of two-sets of holes.
My immediate action kit would not change as the type of injuries would still be traumatic bleeding and possibly tension pneumothorax, which are the two main killers on the battlefield.
I would keep at minimum a tourniquet, 2 kerlex rolls, 4x4 pads, tape, bandage scissors, celox, a couple of cravats, a 14 guage IV catheter, some KY and two pair of gloves.
There is a kit called the Ventilated Operator Kit, basically is designed for gunshot wounds. Tactical Response Gear makes them and they run about 29 dollars, come vacuum packed so they are very compact and will carry in a utility pouch on your vest.
I do recommend them and carried a couple of them on deployments and had some of the troops carrying them as well.
I've treated several gunshot wounds, controlling the bleeding is your primary concern and then if compromised securing a patent airway.
Submariner
06-15-09, 20:36
... 4x4 pads, some KY ....
If you have Kerlix, what do you do with the 4X4's?
KY is for NPA?
The 4x4s are used in conjunction with the kerlex for adding pressure to wounds, after you use your celox if appropriate then slap on some 4x4's and apply pressure while wrapping it with the kerlex, battle dressing, etc.
The KY is used with a glove finger, a 4x4, and IV cath for decompressing a tension pneumothorax, the KY creates a seal in the glove finger, allowing pressure to escape the chest cavity but not allowing air to reenter through the catheter. It is also used to lube npa's and opa's as well.
I forgot to add having a couple of opa's and npa's in the kit as well.
You can also use the IV cath and 4x4's/tape for an emergency cryc kit, these are extreme measures skills that are probably best left for either Paramedic or military medics, but are good to know for the absolute worst case scenarios to save a life if necessary.
There are a lot of seriously hardcore skills taught in some of the military medic schools I have been to over the years, some of them I have used operationally and others only practiced in training.
As always, I advocate doing what you are trained in and can justify in court if it comes to it.
I always think from the mindset I was trained in, help may be hours away or not coming at all so my skills and gear are all I have to rely on, your patient or even you may die while waiting for a medevac if you aren't prepared to deal with the situation.
I received a PM asking about the needle decompression I mentioned, so here is the technique I was trained in, keep in mind this was 20 years ago that I learned this trick before any of the newer techniques came about.
Needle Decompression (once taught at the Academy of Health Sciences Ft. Sam Houston).
Supplies needed: 4x4 gauze, 14 ga. IV cath, KY, Latex glove, tape.
Some indications: Trachial deviation, jugular veins distended, lack of breath sounds on one side.
You take a glove cut off a finger, insert the IV cath through the finger poking it through the tip, then put the KY in the top of the finger above the catheter, the 4x4 goes next to the skin, then needle through it.
Insert needle at either the 2nd intercostal space (above the nipple basically), midclavicular line or 5th intercostal space midaxillary (under the armpit). Remove the actual needle and then tape the catheter in place.
The finger acts as a valve, while the KY acts as a seal to let pressure out but no air in. You still have to monitor this closely and be aware of your patient's condition.
The definitive treatment is a chest tube, not really practical in the field.
It was a field expedient trick we used before we got any other type of seals, and takes up less space as the components can also be used for other tasks if needed.
Again field medicine 20 years ago was alot more improvising than today, but the old tricks still do the job even with the newer toys.
NinjaMedic
06-16-09, 22:43
For a Range Kit I would go with two tourniquets, four pairs of large or extra-large non-latex gloves, two 6" Izzy's with sliders, one pair of trauma shears, (you can substitute a roll of kerlix, and a handfull of 4x4's for one of the Izzy's to save some coin) Throw it all in a ziplock baggie and call it good. Oh and keep a SAM splint and a couple of triangle bandages in the truck. Just a matter of time before someone trips during a drill and dislocates their shoulder, breaks an arm/wrist/collar bone etc. and that stuff can make the ride to the ER much more tolerable. I will argue that is ALL you should need, ever, as an untrained person, in any situation. Anything else will get you in trouble eventually.
In the states it is fairly rare for you (you being 80% of the population) to be further than 30 minutes from an ambulance) and the trouble of having the supplies (i.e. hypodermic 14g 3.5" needle) is just flat out not worth the benefit. Its that simple. All you need is a gloved hand. GSW induced pneumo's typically start as sucking chest wounds in my experience so slap your hand on it and keep the air from entering the thoracic cavity. IT IS A POOR DECISION TO NEEDLE DECOMPRESS ANOTHER CIVILIAN INSIDE THE UNITED STATES. You probably will not need to do it initially in a GSW and you shouldn't do it as a non-medical professional for blunt trauma. If you are first on the scene of someone experiencing a tension pneumothorax secondary to an explosive device oh well.
Honestly even as a paramedic I only carry the above equipment in all of my vehicles with the exception of adding in a C-Collar and BVM (ETA - plus 60 cc syringe as a suction tool). Just aint going to be needing anything else, and unless you routinely experience greater than 1hr ALS response time in your area (which is an incredibly small percentage of the US) then you will no convince me otherwise.
Just my two cents.
great advice.
I tend to think from being trained beyond EMT-P level, as a first responder you should never perform any advanced skills, it will get you in a wreck civilly and criminally.
I could see it being done in an extremely remote area with no comms and long travel times to civilization.
I posted the technique only in response to a direct question.
NinjaMedic
06-17-09, 00:07
I agree FMF_Doc there is certainly always an appropriate application for something.
Thoughts on hemostatic agents for such a kit?
Thoughts on the SWAT-T as a dual-use tourniquet and compression bandage when used with gauze or pads?
BTW, the reason I asked this is that I sometimes get a "why do you need that, just call 911" reaction from some folks to this topic.
Submariner
06-17-09, 06:04
For a Range Kit I would go with two tourniquets, four pairs of large or extra-large non-latex gloves, two 6" Izzy's with sliders, one pair of trauma shears, (you can substitute a roll of kerlix, and a handfull of 4x4's for one of the Izzy's to save some coin) Throw it all in a ziplock baggie and call it good. Oh and keep a SAM splint and a couple of triangle bandages in the truck. Just a matter of time before someone trips during a drill and dislocates their shoulder, breaks an arm/wrist/collar bone etc. and that stuff can make the ride to the ER much more tolerable. I will argue that is ALL you should need, ever, as an untrained person, in any situation. Anything else will get you in trouble eventually.
...
Just my two cents.
OK. This makes sense. Which tourniquet do you suggest and why.
Kits as above are very adequate. Even if you don't know how to use something, someone else might come along that does. Or, go cave man simple and stock a bag with ACE type elastic wraps and maxi pads. Very basic supplies are needed in the first few minutes of a trauma. Training is more important than the specific gear.
Hemostatic agents are certainly appropriate if you have been trained in their use. They are not Magic Dust and need to be employed correctly. We authorize Quick Clot Gauze & Quick Clot ACS as well as some other agents.
Our preferred tourniquet is the TK-4L (Cinchtight/H&H Associates), however we also authorize and appreciate the RMT, SWAT-T, SOF-T, and CAT units.
Get a SLICK litter from ARUC Systems while you are at it. They make the RMT also.
The 'to use advanced skills in the US or not, as a bystander' question is difficult. In general, if you do something that is beyond your scope of training without being licensed and/or not operating under someone else's license is an no-no and can (and has) resulted in charges from battery to homicide, plus civil lawsuits. Remote medical personnel such as SAR team medics often operate under expanded scope of practice rules with a physician backing that up. Unfortunately, even Katrina like settings have produced legal consequences even when the patients would have died without the interventions. We want justice, we get lawyers...
FWIW, I'm more interested in self-treating, or loved-one-treating than worrying about some other guy. Unless maybe it's me that shot him. :D
I've done Search and Rescue since I was 14, ARMY Medic for 4+ years, and Career EMS for 10 years... being such, I always tried to find things that had multiple purposes. Here is a few things that either had multiple purposes, or was simply cost effective compared to buying the actual thing.
Duct Tape... Cheap, and great for keeping dressings/pressure dressings in place. Of course they make WHITE colored tape now so it appears less barbaric...lol Also great for securing Pt's to something or splints if needed.
Tampons/Pads... Both great for GSW's (Gun Shot Wound's). They are made to absorb blood, not much else to say. Although having females in my Units, I always seems to be that godsend on those NOT SO FRESH days...lol
Expired Quick Combo/AED Pads... Don't throw them away, instead clip off the wires and put them in your trauma kit, appropriately marked as NOT to be used to defib. These are great to use as Occlusive dressings. They STICK a hell of a lot better then the ones you can buy, and they are bigger as well.
Razor... I can recall too many times that HAIR got in the way. Use your shears to cut the massive teen wolf patch down to manageable size and razor that chest (if appropriate). I have found that if I have the time to make a better sealing surface it keeps more blood in, and makes less of a mess. This is not always possible, but if it does not impede Pt care, I recommend it. OH, and you can always use it on those days your boss is telling you that you look shaggy... :p (Yeah Baby Yeah)
I'm sure there's more, but that's all I have time for right now...
Rob- for self care and/o treating family then I recommend the VOK from Tactical Response Gear, and the training to use it.
The class teaches self care as part of it's core.
Gutshot John
06-17-09, 09:56
There is a big difference between what the lay person should carry for his own use and what a trained medic is going to have on hand.
As TacMedic mentioned needle decompression is not a likely scenario even for a medic dealing with a GSW as the bullet itself has already made a hole. I'd argue that an airway of some form is probably a bigger priority. If you're carrying a more significant bag (probably as a medic with extended transport times) than a 14 gauge needle might be worthwhile.
People are also getting a bit wrapped up in the tourniquet choice. I recommend the SOF-T. It is the current standard and is pretty easy to learn how to use. That said any tourniquet is better than none. Learn how to use what you own. I don't really see the virtue in using a (SWAT) tourniquet to simply hold on gauze...you probably won't ever see it again. Keep some tape handy.
The lower your training level, the more simplicity (KISSOFF principle) is a virtue. Any kit you get from TacMed Solutions is perfectly adequate to anyone here. If you want to build your own:
Trauma Shears
2x Hemostat (Combat Gauze is what I'd recommend)
4 4x4s and 4 rolls kerlix (OLAES Bandage alternatively)
Surgical (or Duct as someone pointed out works) Tape
Airway (nasopharengeal and maybe a pocket mask)
Gloves
Petroleum Gauze (so small it won't take up any space/add weight, so you might as well have it, just in case you run into a pneumo)
Tourniquet
WITH PROPER TRAINING...You should be able to treat 99% of GSWs with the above.
NinjaMedic
06-17-09, 13:06
At work I do carry hemostatics, however I suppose that I am biased against them since I have yet to need them on a patient. I certainly dont deny that they have there place which is why I have them available it is just something that I have yet to encounter the need for. (since I said that I will probably have to use them tommorow) :p
Also as long as the tourniquet works (in my opinion based on the NAVSEA type studies) then it is all personal preference.
K.L. Davis
07-08-09, 16:31
This is part of this post (https://www.m4carbine.net/showthread.php?p=393845#post393845).
Within the scope of what the orginal idea, feel free to make some suggestions for this kit -- please copy the list before your post and add, subtract or make changes to the existing list. Please give your reason for the changes.
If anyone wants to recap the thread into a kit list?
Could we work backwards on this ... Starting with a basic pre-made kit, what would you add?
e.g., Tac Med IFAK contains:
1 - SOF® Tactical Tourniquet
1 - 4 inch Olaes® Bandage
1 - Petrolatum Gauze
1 - Nasopharyangeal airway 28F
1 - Pair of Gloves, nitrile, Size: Extra large
1 - 2 inch Tape, surgical
1 - Laderal Face shield
1 - Trauma shears
1 - STAT Triage Card
Gutshot John
07-11-09, 08:56
Could we work backwards on this ... Starting with a basic pre-made kit, what would you add?
e.g., Tac Med IFAK contains:
1 - SOF® Tactical Tourniquet
1 - 4 inch Olaes® Bandage
1 - Petrolatum Gauze
1 - Nasopharyangeal airway 28F
1 - Pair of Gloves, nitrile, Size: Extra large
1 - 2 inch Tape, surgical
1 - Laderal Face shield
1 - Trauma shears
1 - STAT Triage Card
If you're talking about a basic kit for self aid in case of GSW, you probably don't need much more. I might add some 4x4s and Kerlix Gauze, maybe some combat gauze too for a hemostat.
If you're talking about a basic kit for self aid in case of GSW, you probably don't need much more. I might add some 4x4s and Kerlix Gauze, maybe some combat gauze too for a hemostat.
I want something relatively small & lightweight that I can keep attached to my range kit in the event someone (self or other) has a suddenly very bad day.
Would more Olaes bandages satisfy the need for 4x4s and Kerlix?
Do you recommend a particular combat gauze?
(and thanks!)
Gutshot John
07-11-09, 16:18
I want something relatively small & lightweight that I can keep attached to my range kit in the event someone (self or other) has a suddenly very bad day.
Check, I think that's a pretty good start.
Would more Olaes bandages satisfy the need for 4x4s and Kerlix?
It would certainly satisfy the need, though the 4x4s/kerlix might be a little more cost effective since they are packaged individually and can be used in a lot of general applications that don't necessarily require you to open the more expensive OLAES. If you're never going to open the kit except in case of GSW, than another OLAES bandage is fine, so long as you've got a more general first aid kit.
Do you recommend a particular combat gauze?(and thanks!)
Combat Gauze is a trademark from QuikClot I believe, but others may make a similar product. Combat Gauze is currently what is being issued per a friend (ex-Corpsman, current PA with the 73CAV/82ABN). He swears by the stuff and the SOF-T Tourniquet.
Thanks, GSJ. Ordered most of it from TacMed and will pick up the easier stuff locally.
Dirk Williams
08-26-09, 11:19
Hate to ask dumb questions, I'm stationed way out by myself in N/E Calif. I carry one tquet, one pack of quik clot, one sucking chest wound plate, one large bandage/gaze on me at all times." Lower Pockets"
I got this set up from my US Forestry Agent partners who spend a great deal of time chasing dope growers here in Northern California. I have an extensive kit in my rig and on my tac vest.
Should I be carrying something else on my person. I rarely work with others, and am away from EMS a fair amount of the time. EMS response time " If I can get them " Is about one hour average. I hate carrying crap I don't need.
DDW
Dirk, I am clearly not a medical professional, however many that I talk to would advocate carrying two of most of the things you list, especially as remote as you may find yourself. For example, if something were to happen to your leg, it may well happen to both, thus requiring two TQs. If you have a need for a chest seal, there's a good chance it's a through-and-through which may require two (I'm very interested in the Halo chest seal for this reason and a local medic friend is supposed to have one or two inbound for us to check out). If one QC doesn't work, you might need to pack it with another (assuming Combat Gauze here), etc. In the case of the trauma dressing there is a version of the Izzy with a sliding pad, which can be used (for example) on an exit wound on an arm or limb.
What I'm leaning towards for my own uses is establishing the risks I expect to face and building kit(s) based on those risks. Each kit will have/has the same basic ingredients (TQ, hemostatic, chest seal, trauma dressing) but some have multiples of those, some add things like boo-boo ingredients, etc. My base kit is for local municipal shooting range use, and I can add to it with layers as I get more remote. Being a non-LE civilian range-use is my primary focus as anarchistic fantasies aren't really my thing.
You could do similar to this by carrying what you list as you state in the pockets, and adding duplicates to the vest etc. Assuming you're LE, I think you'd also want to differentiate between what you carry for self-aid (on your person) vs. victim aid (perhaps in the vehicle). Obviously items intended for self-aid could be used on a victim if the situation warranted, but if they're down, and you're still taking fire and have the potential of getting hit, I'd save that shit for myself! ;)
On a related note, I just got one of the BFG Trauma Kit Now pouches in last night and I am really excited about the possibilities of this thing.
Dirk Williams
08-26-09, 11:47
Thank you for the prompt response. I am Deputy In Modoc County Ca. That's the far NE corner, population maybe 8000 total. A very small dept in which we wear many hats. I'm actually a resident and live about 80 miles from the main office just south of Oregon, and work out of a trailer.
I do have an extensive med kit on my vest, and a spare in my truck, I don't carry them on me for day to day stuff. I daily find myself looking into the next gully or way out in the dessert or on top of a mountain, in volcanic rock terrain.
Sharp, Jagged and possibly lethal if I fall and punch a hole in myself. I'm new on this group and always looking for ways to improve my kit. Being new I'm uninformed as to who's who, Are you in a business that might supply stuff?. If so could you shoot me a link for review.
I'm headed back to my duty station at about 1400 PST.
Respectfully Dirk Williams
No, no business here. Just a survival-minded competition shooter and training junkie and part-time gunwriter when I can convince someone to publish my stuff.
North American Rescue (http://www.narescue.com/) is one of the bigger name suppliers of emergency med gear. Galls actually is carrying more and more emergency management gear all the time as well.
MoJo Medic
08-26-09, 19:55
If I may suggest a med kit to suit yours and other LE requirements - Look at the MoJo vacuum sealed line on Combatmedicalsystems.com. We are an incredibly competitive company born from the Special Ops community (Special Mission Unit) at Fort Bragg, NC. We will customize vacuum sealed kits. We feature small and practical kits with the Combat Gauze, SWAT-T, SOFT-T, CAT, H-Bandage, Bolin Chest Dressing, and Israeli Dressing. We are the Military and LE distributor for the Combat Gauze. Better to purchase from us than others.
For you...I agree with previous comments. Consider a lightweight SAM splint, an OALES bandage (Tactical Medical Solutions), and water purification/drinking device (WaterStick) to round out your kit for outdoor medical and survival scenarios.
Best Regards,
MoJo Med
"You have the best medical kit available, but do you have the MoJo to make a difference?" GOT MOJO?
MoJo Medic
08-27-09, 07:21
http://www.combatmedicalsystems.com/Products/List/1/CategoryID/4/Level/1.aspx
Sorry. Check all their products. They have LE list as well.
Dirk Williams
08-31-09, 10:24
MoJo thank you for the e mail and posting on my question. I do see gear needed on the site. Expect an order soon. For my personal kit I need minimul stuff on my person.
My rationale is simple, if it gets bulky and heavy I'll get lazy and not carry it. My personal gear needs to fit in my cargo pockets comfortably. Left pocket is tquet,and Ackerman chest plate plus a knife.
Right pocket quik clot, battle bandage. Spare truck key,another knife. This gear is reviewed for quality assurance, and loaded before work on my Wed, and comes out when I get back home Sun.
On another note My turf has lots of rattle snakes. Is there a quality reasonably sized snake bite kit available. I'm aware of current protocals however my hospital is several hours away.
My only option now is put a Tquet on above the injection site to possibly manage venom spread, calmly retreat to my unit, and transport myself to nearest facilty while advising the SO.
What is a sam splint, is that a broken leg or arm splint ,and how big are they.
Respectfully, Dirk Williams
MoJo Medic
09-04-09, 20:57
SAM Splint is a flexible splint that can be purchased from several vendors. It is lightweight, comes folded into a package that is about 8 x 4 inches but opens up to splint quite well. It is ideal for splinting for short durations. A very good piece of kit.
Thanks for the response. Not advertising for orders, just showing some items that are available.
As for snakebite kits....you are just too remote to do any more than you mentioned. I would have to agree with your treatment. Maybe keep a bee sting kit so you have some epi, or carry epi-pen. Does your local ER carry the antivenom you would require. I worked with Miami-Dade fire dept 2 years ago while I was with Special Forces, and coordinated for antivenoms to ship to Iraq. They supply just about everything and could keep a dose or two locally.
If you are below tree line and needing to sacrifice weight/bulk. The SAM splint would be one of my first choices to ditch since you can improvise with branches, limbs etc.
this is NOT a bash on the SAM. its tacticool.
Thoughts on the SWAT-T as a dual-use tourniquet and compression bandage when used with gauze or pads?
I like the SWAT-T more as a compression bandage than I do a tourniquet. I carry both on my kit (Tactical SWAT Medic) and I tend to go to the SWAT-T to hold things in place. I like that I can cinch it down a little more and I don't need tape to hold it there. I have not used it in the field as a tourniquet yet, but I just don't feel as if I could get the same stopping power as some of the tourniquets.
I also like the idea of having a lot of material to work with. The SWAT-T works well on obese patients also!!
MoJo Medic
09-07-09, 21:30
Definitely agree in some respects. But the SAM is so light. Consideration is cube space.......do you have the space to carry it. Tree branch does not conform. SAM does. Appreciate the opinion. This is merely mine.
As for the SWAT-T. It is a very good option as a Tourniquet. It is also a GREAT option as a pressure wrap/dressing. Does it beat a windlass tourniquet? That is going to depend on the scenario and status of the casualty or person applying. It is a one-handed option that works.
Best to you all,
MoJo Med
BTW, the reason I asked this is that I sometimes get a "why do you need that, just call 911" reaction from some folks to this topic.
Man that is frustrating. Just like the police can't always save your ass neither can the EMTS or Fire Department. It can easily take 20-30 min for an ambulance to show up where I work, then it is another 20-30 min ride to the ER. That is a long time w/o help. People need to learn to take responsibility and take care of themselves.
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