GSW/Blowout kit.

[00leland00]

I obtained a Blackhawk rig today, and I pieced this together from the supplies I have for the med pouch.
http://i292.photobucket.com/albums/mm37/qball00980/guns/DSCI0495.jpg

Contents include:
-CAT Tourniquet
-Velket Tourniquet
-Compression Bandage
-Shears
-30 Airway
-(6) alcohol wipes
-(2) 4.5"x4yd compressed gauze
-(2) Kerlix
-Ace Bandage
-(2) sets rubber gloves
-37x37x52 bandage with eye cup
-Tape

I'm thinking I need to include safety pins, Duct tape, 14g needle for chest decompression, pain relievers.
Let me add that I do not intend to use anything I am not trained to, but hopefully someone will know how to use on me if necessary. I'm also building a pretty much identical kit, just with duplicates of what is listed above and a couple Sam Splints to go into my range bag.

[rockm4]

Don't stop at this point. A lot of Red Cross agency's offer advanced training in first aid and emergency classes sometimes for low or no cost. check with the local chapter in your community, if they don't offer classes they may can point you in the right direction. :)

[00leland00]

Thanks. I've taken basic first aid/cpr, but I'd like to take a first responder course. An EMT buddy of mine told me they only cost about $150 and they're offered every so often.

[Iraq Ninja]

If you run short of space, toss the eye cup. It is not something you see a lot of in BAKs.

[Gutshot John]

I'd recommend the addition of Combat Gauze or another hemostat like Celox especially in place of the eye cup or even a bit of the compressed gauze.

[00leland00]

I'd recommend the addition of Combat Gauze or another hemostat like Celox especially in place of the eye cup or even a bit of the compressed gauze.

John-
Got a good source for the combat gauze?

Thanks for the input, fellas.

[Gutshot John]

tacmedsolutions.com is the site I like best.

[Outlander Systems]

Leland, have you considered adding this:
http://www.chinookmed.com/cgi-bin/item/05162/s-hemostatics/-QuikClot-ACS%2B----------------------------------

Or this:
http://www.chinookmed.com/cgi-bin/item/12102/s-thoracic_airway/-Asherman-Chest-Seal----------------------------

Warning - Graphic Videos of QuickClot in action:
http://www.youtube.com/watch?v=C3TUKKx0cus

http://www.youtube.com/watch?v=e9xvIbKBJn4

[Outlander Systems]

I'm trying to assemble a GSW kit by acquiring individual components.

In a field-situation, I've considered adding a small bottle of iodine for water treatment. Is this a bad idea?

[Gutshot John]

In a field-situation, I've considered adding a small bottle of iodine for water treatment. Is this a bad idea?

What's wrong with iodine tablets? Much easier to carry, store and use.

[Abraxas]

What's wrong with iodine tablets? Much easier to carry, store and use.
Agreed, but if you use them for water purification, god do they taste horrid!;)

[Iraq Ninja]

I'm trying to assemble a GSW kit by acquiring individual components.

In a field-situation, I've considered adding a small bottle of iodine for water treatment. Is this a bad idea?

Bad idea only if you stick it in your GSW. I prefer to keep only med kit in a GSW. Don't turn it into a survival kit. The more you open a GSW, the more chances you may loose part of it.

Put it in a WTFAI (where the F*&^ am I?) pouch.

[Gutshot John]

Agreed, but if you use them for water purification, god do they taste horrid!;)

They also give me the shits.

I like my miox pen for water purification.

[00leland00]

Leland, have you considered adding this:
http://www.chinookmed.com/cgi-bin/item/05162/s-hemostatics/-QuikClot-ACS%2B----------------------------------

Or this:
http://www.chinookmed.com/cgi-bin/item/12102/s-thoracic_airway/-Asherman-Chest-Seal----------------------------

Warning - Graphic Videos of QuickClot in action:
http://www.youtube.com/watch?v=C3TUKKx0cus

http://www.youtube.com/watch?v=e9xvIbKBJn4

Yeah, I want to add a couple of chest seals and some kind of coagulant, think I like the looks of the combat gauze best.

[Outlander Systems]

I should clarify, since my original wording was abysmal.

My intent was to use tincture of iodine for a surface disinfectant, and water treatment for a wound-wash.

Infection is a big concern of mine. Since I've ruled out any way to procure antibiotics, I'm trying to brainstorm for ideas for infection-mitigation.

What does one do, to treat deep puncture wounds? Every sterilant/antiseptic/etc. that I've found, indicated that it should NOT be used for puncture wounds. Well, what the hell should be used on puncture wounds?

[Iraq Ninja]

Oral broad range antibiotics seems to be the best choice. Why have you ruled them out?

[Iraq Ninja]

Problem with iodine tablets is that they run out. Most have around 50 tablets. Good for short term use.

If you use something like the Polar Pure commercial iodine crystal bottles, they claim it is good for 2000 quarts. This is a good choice for long term water when the pills and batteries are all gone.

[Outlander Systems]

Oral broad range antibiotics seems to be the best choice. Why have you ruled them out?

There's no way to procure them and store them in the event of emergency, short of "faking" an illness.

If there's a legal way to get antibiotics for my medicine cabinet, without going to the doctor, someone shoot me a lead.

[Iraq Ninja]

Don't give up so easily, especially if you are planning for SHTF. I buy mine during my world travels and bring them back.

Here is a starting point:

http://www.coreynahman.com/antibiotics.html

[Outlander Systems]

Don't give up so easily, especially if you are planning for SHTF. I buy mine during my world travels and bring them back.

Here is a starting point:

http://www.coreynahman.com/antibiotics.html

Thanks. You sir, have helped.

My fish have been coughing a lot lately, so I might see what I can do for them.

[RAM Engineer]

Yeah, I want to add a couple of chest seals and some kind of coagulant, think I like the looks of the combat gauze best.

I wouldn't think you'd need more than a single chest seal. If BOTH lungs are punctured you'll probably be DRT.

[00leland00]

I wouldn't think you'd need more than a single chest seal. If BOTH lungs are punctured you'll probably be DRT.

My reasoning was if you had a wound that fully penetrated and exited out the back, wouldn't it be prudent to have one on the front and the back?

[RAM Engineer]

I see where you're coming from, but what I was told, in that case, you tape one hole completely closed and put the ACS on the other hole. I'm sure someone on here would know for sure. It seems like the contents list for every blow-out kit I've ever seen only includes a single ACS.

[Danny Boy]

We've been using Hyfin dressings. But we also needle chest decompress.

Ashermans don't stick too well when there's alot of blood and need to be taped down. Hyfin dressings stick like crazy. If there's an exit wound we tAke the hyfin wrapper and some three inch tape and make another occlusive dressing. Or another Hyfin if there's an obundance.

Patching one hole completely with any air tight sheeting (MRE bag for example) and then using the Ashermans on the other side will help prevent a sucking chest wound from building into a tension pneumothorax. The flutter valve that sticks out should let the air out one way so air build up inside the chest cavity can't start crushing the lung in the affected side. You could also try achieving this by taping a square dressing down on three side leaving one open for air to escape if no seals are available.

[LonghunterCO]

Don't give up so easily, especially if you are planning for SHTF. I buy mine during my world travels and bring them back.

Here is a starting point:

http://www.coreynahman.com/antibiotics.html
thanks for the link.whats the shelf life on anti-biotics?

[Limey-]

As far as flail chests/ wityh a hemothorax, Saran wrap and Defib pads work great. The finger from a rubber glove and a long assed 14G cath for decompression.

[Dualspringfields]

Which one is better?

http://www.chinookmed.com/cgi-bin/item/12101/s-thoracic_airway/-Bolin-Chest-Seal-------------------------------

http://www.chinookmed.com/cgi-bin/item/12102/s-thoracic_airway/-Asherman-Chest-Seal----------------------------

Thanks Casey

[lecyad]

my dept carries asherman chest seal. they seem to work pretty good.

[BaileyMoto]

Believe it or not, the round ECG electrodes work great for small arms fire. Although I am currently in Iraq (contractor), I come from a city where we work quite a few small arms GSW's. Electrodes are very quick and easy to apply and surprisingly work very well. I've used them at least 2 dozen times and have never been questioned by the ER trauma staff...generally I get quite the opposite and am usually praised for the creative use.

Just make sure to mark GSW on them so there is no confusion :p

http://www.superboverseas.com/images/Ecg-electrode-chest-electrode-b.jpg

[Limey-]

Which one is better?

http://www.chinookmed.com/cgi-bin/item/12101/s-thoracic_airway/-Bolin-Chest-Seal-------------------------------

http://www.chinookmed.com/cgi-bin/item/12102/s-thoracic_airway/-Asherman-Chest-Seal----------------------------

Thanks Casey

I carry the Asherman but honestly I tend to use other solutions for large sucking chest wounds along with invasive decompression.

[Limey-]

Believe it or not, the round ECG electrodes work great for small arms fire. Although I am currently in Iraq (contractor), I come from a city where we work quite a few small arms GSW's. Electrodes are very quick and easy to apply and surprisingly work very well. I've used them at least 2 dozen times and have never been questioned by the ER trauma staff...generally I get quite the opposite and am usually praised for the creative use.

Just make sure to mark GSW on them so there is no confusion :p

http://www.superboverseas.com/images/Ecg-electrode-chest-electrode-b.jpg

Got to say I have treated into the hundreds of GSW's and seldomn would this have been helpful. I cannot see an application except for a small caliber entrance wound for which a compression dressing would be more appropriate. I have used Defib pads but they are a quite different product for a different type of wound (chest GSW).

[BaileyMoto]

Got to say I have treated into the hundreds of GSW's and seldomn would this have been helpful. I cannot see an application except for a small caliber entrance wound for which a compression dressing would be more appropriate. I have used Defib pads but they are a quite different product for a different type of wound (chest GSW).

It's extremely quick and effective for just that scenario - small caliber entrance (and often exit) wounds. Not suggesting its better than anything else, just suggesting another option. I'm citing what has worked well for me, especially with multiple holes and limited help.

It stops the bleeding, that's the point, no? :cool:

[Limey-]

It stops the bleeding, that's the point, no

No doubt brother....................

[Six Feet Under]

http://i672.photobucket.com/albums/vv89/longrange308/Gear/GSWkit005.jpg

http://i672.photobucket.com/albums/vv89/longrange308/Gear/GSWkit007.jpg

http://i672.photobucket.com/albums/vv89/longrange308/Gear/GSWkit009.jpg

Contents:

CAT tourniquet
2x 6” Israeli bandage
4.5” roll of Kerlix (4.1 yd long)
Medical tape
1 pair nitrile gloves
1x 2x2 gauze
4x 3x3 gauze
1x 5x9 Surgipad
Hemcon bandage (4x4”)
NPA w/ surgi-lube (size 28F)

Ziploc bag contains the following:

1 pair nitrile gloves
3x 4x4” gauze
2x 3x3” gauze
2x 2x2” gauze
1x 5x9” Surgipad
1x 4” Israeli bandage

I'll probably take out some of the gauze but for right now I wanted something to fill it up. I'm putting a little keychain light and some better tape in there when I get the chance.

[Hmac]

It's extremely quick and effective for just that scenario - small caliber entrance (and often exit) wounds. Not suggesting its better than anything else, just suggesting another option. I'm citing what has worked well for me, especially with multiple holes and limited help.

It stops the bleeding, that's the point, no? :cool:

Do you mean it stops the bleeding to the outside?

[motorwerks]

Thanks. I've taken basic first aid/cpr, but I'd like to take a first responder course. An EMT buddy of mine told me they only cost about $150 and they're offered every so often.

My EMT class was about that with books but that was years ago.

[motorwerks]

Do you mean it stops the bleeding to the outside?

Thats whats he means....... as EMS you cant stop the bleeding on the inside.... thats WAY outside of Civilian Scope of practice, Corpsman yes Paramedic no. Reason being is they want Para-medicine as simple and affective as possible. We have Hospitals with in Driving distance for most incidents and where we don't we have air support normally within 30 minutes. Being a Medic (Military) you may not have that luxury and could be pinned down for who knows how long while they try and get you air support, so they need that extended scope.

[NinjaMedic]

Thats whats he means....... as EMS you cant stop the bleeding on the inside.... thats WAY outside of Civilian Scope of practice, Corpsman yes Paramedic no. Reason being is they want Para-medicine as simple and affective as possible. We have Hospitals with in Driving distance for most incidents and where we don't we have air support normally within 30 minutes. Being a Medic (Military) you may not have that luxury and could be pinned down for who knows how long while they try and get you air support, so they need that extended scope.

Not quite the case . . .

[motorwerks]

Not quite the case . . .

Thats the Case here in California, feel free to explain.

[Hmac]

Not quite the case . . .

Made sense to me. How is he wrong?

[Solo1st]

Putting cute little stickers on GSW's does nothing to stop the source of the bleeding. Just the visible signs that you can see.

The bleeding that is of concern occurs along the wound tract, and the organs that are affected. Slapping a cover on the hole does nothing to address the problem, but it makes providers feel better about the situation.

[Hmac]

Yeh, that was my point. I'd rather the EMT-P's that I work with dress those wounds with gauze. And not those POS paper Toppers.

[BaileyMoto]

Yeh, that was my point. I'd rather the EMT-P's that I work with dress those wounds with gauze. And not those POS paper Toppers.

What point? That EMT's aren't surgeons?

This is true, 'POS paper Toppers' don't 'fix' the problem, but neither does gauze, tape, or whatever other method you chose to use to stop external bleeding. The patient needs a surgeon, end of story.

Sure, gauze is perhaps more 'proper', but once again, the end result is the same for prehospital care. And with that, for small caliber holes, I've found ECG electrodes to work as good, if not better than 'proper' gauze and sometimes they do not...just depends. Not sure about yourself, but I've worked more than 1 GSW patient by myself (no partner), and when you're in the midst of taking vitals, starting lines, listening to lung sounds, talking on the radio, setting up the monitor, etc...all while going down some bumpy dirt road in the middle of trailer park heaven, little tid bits of knowledge that they don't teach you in the classroom may come handy one day.

I only mentioned it as a tool that you can file in the back of your brain in case you are one day in a pinch. But, since everything works perfectly on your rigs, just forget I mentioned it. :)

[Hmac]

What point? That EMT's aren't surgeons?

This is true, 'POS paper Toppers' don't 'fix' the problem, but neither does gauze, tape, or whatever other method you chose to use to stop external bleeding. The patient needs a surgeon, end of story.

Sure, gauze is perhaps more 'proper', but once again, the end result is the same for prehospital care. And with that, for small caliber holes, I've found ECG electrodes to work as good, if not better than 'proper' gauze and sometimes they do not...just depends. Not sure about yourself, but I've worked more than 1 GSW patient by myself (no partner), and when you're in the midst of taking vitals, starting lines, listening to lung sounds, talking on the radio, setting up the monitor, etc...all while going down some bumpy dirt road in the middle of trailer park heaven, little tid bits of knowledge that they don't teach you in the classroom may come handy one day.

I only mentioned it as a tool that you can file in the back of your brain in case you are one day in a pinch. But, since everything works perfectly on your rigs, just forget I mentioned it. :)I am usually on the other end of the pre-hospital chain. I'm the guy in the ER with the very puzzled WTF? look on my face as I peel those EKG pads off of that multi-perforated patient.

The only thing that makes Toppers worthwhile is that they're cheap. It would be nice if they could be absorbent too.

You can run your service they way you want to or the way you're told - doesn't affect me or my patients. Me, I'd rather the EMT's cover those holes with real gauze and real tape so we get some idea if and how much blood/air/shit is coming out of them. OTOH, I do recognize that half-assed measures sometimes need to be taken on a dark back road where the shit has hit the fan. I'd certainly accept that as a reason.

[titsonritz]

I run one of these with pretty much the items shown. I use an “H” bandage in lieu of the izzy.

http://www.originalsoegear.com/medtray.html

[NinjaMedic]

We use expired defib pads as chest seals sometimes but we always write on them in sharpie "GSW" and cut the wires off. It is not unusual for you to place extraneous ECG electrodes on a patient for a multitude of reasons and they are the last thing that a hospital will worry about taking off. I think it is a very bad practice to cover wounds, especially ones small enough to cover with a small unmarked electrode, due to the significantly increased likelihood that the discovery of the wound by the hospital ED staff will be delayed. If it isn't doing anything to stop the hemorrhage then who cares that the blood stays in the body, you aren't making a damn bit of difference and are probably delaying that patient's definitive care. It is not and should not be a common medical practice.

[Six Feet Under]

I added about 10-12 feet of duct tape (way better than the crappy first aid tape I had in there at the time, but that was all I had when I put the thing together), six safety pins, and a pair of shears to my kit a few days ago.

What would you guys recommend in lieu of the one topper pad I MIGHT have in there now that I've changed the stuff around... I'll have to look. lol

[The Doc]

Alright, I gotta chime in on a couple things here. First, don't use stuff (IE ECG electrodes) for stuff other than what they are intended for. If you have NO other choice, that's one thing (as in you're in combat and all you have to make a TQ is a t shirt and a paintbrush). But, if you are a medical professional, and work in the EMS, there is absolutely no reason not to have the proper medical equipment for the job. That just comes down to shitty pre-shift checks and not doing your job properly. We all remember the 6 P's, right?
Second, if an ECG electrode is going to cover a GSW, the chances of that occluding a sucking chest wound makes no difference. Air is lazy. It takes the path of least resistance. In order for air to enter and escape from a chest wound, the open diameter of that hole will have to be 2/3 the size of the trachea. If it isn't, the chances of it creating a pneumo are slim (note, I didn't say none, because there are no absolutes in the study of medicine) IMHO, if you want to add something to that kit, 2 Bolin Chest seals are the way to go. Recent studies have found that the flutter valve on the Asherman or on a 3 sided occlusive don't do much to aid in the relief of the tension caused by air trapped between the pleura and the lung. These studies have been verified by the USASOC surgeon. The army bought into Ashermans because it was made and designed by a SF medic who patented the design. They are now going to other designs for occlusive dressings, such as the Bolin and the Hyfin. If you need a couple of Bolin's or Hyfin's gimme a shout via PM. I might be able to help you out

Doc

[Limey-]

There are quite a variety of practitioners here from Rural EMT's to Tactical Medics. While I agree that in the world of professional EMS rolling around in a Rig or in a well stocked Urban ER there is no place for 'ditch' medicine it is also true that Special Operations whether Civilian or Military has always utilised 'field expediant' and multi application equipment. For a large sucking chest wound I have found the occlusive dressing with a 14g flutter valve works best, The Hyfin and the Bolin are the best issued gear currently. I know 22 SAS and SBS medics carry Demolition adhesive pads in their Bergens for the same purpose.

[programmer]

http://www.aaapetmart.com/fish-antibiotics.html
http://www.aquariumguys.com/bacterial.html

[Hmac]

http://www.aaapetmart.com/fish-antibiotics.html
http://www.aquariumguys.com/bacterial.html

What's your point? Is this in case your fish gets shot?

[motorwerks]

What's your point? Is this in case your fish gets shot?

If SHTF those are better then nothing and will work just as well as people antibiotics.

[Hmac]

If SHTF those are better then nothing and will work just as well as people antibiotics.

Really? How do you know that?

[motorwerks]

I have a friend thats a pharmacist.... and I stayed in a Holiday Inn express last night.

[Hmac]

How will you know when and which antibiotic to give your SHTF patients? Is one just as good as another?

[motorwerks]

If SHTF I'm keeping them for me. :D

[motorwerks]

honestly though if you read the ones on the first page listed they show the human versions name in next to it. Penicillin is Penicillin, doesnt mater whether its for a fish or a people it will fight the same stuff.

[Von Rheydt]

Nice, fish medicine.

Truthfully, in principle it is the same stuff. However, pet meds are supposedly not as refined as human meds.........not that it makes a difference really.

When I started training that involved prescription meds I was given a copy of the British National Formulary. Formulary's detail drug names, use, doses etc. Many small white pills look the same but, the dosages of the active ingredient can vary enormously. GET A COPY OF A DRUG FORMULARY SO THAT YOU CAN ALWAYS CHECK DOSAGES APPLICABLE TO PEOPLE AND ANY OTHER CONTRAINDICTIONS. Anyone considering playing with meds should at the minimum get a copy of a formulary. Better still get some training.

[Hmac]

I wouldn't give anyone a penicillin-based antibiotic unless I knew how to deal with anaphylaxis, including creating a surgical airway.

I certainly agree with the previous post - if you're going to take or give antibiotics, better do some studying. Ampicillin for a gunshot wound...pretty pointless.

And...fish medicine? Right. It's the same thing :jester:

[motorwerks]

I wouldn't give anyone a penicillin-based antibiotic unless I knew how to deal with anaphylaxis, including creating a surgical airway.

I certainly agree with the previous post - if you're going to take or give antibiotics, better do some studying. Ampicillin for a gunshot wound...pretty pointless.

And...fish medicine? Right. It's the same thing :jester:

Well if shit really has hit the proverbial fan and you are fighting an infection, and that's all that's left.... your telling me that you wouldn't give it a shot????? Really. That's basically all I was say'n. I wasn't say'n that if tomorrow I pop a staph infection, I would run to Petco and pull this crap off the shelf. Besides in reality most adults know by now if they are allergic to Penicillin or not.

[motorwerks]

I wouldn't give anyone a penicillin-based antibiotic unless I knew how to deal with anaphylaxis, including creating a surgical airway.

I certainly agree with the previous post - if you're going to take or give antibiotics, better do some studying. Ampicillin for a gunshot wound...pretty pointless.

And...fish medicine? Right. It's the same thing :jester:

Well if shit really has hit the proverbial fan and you are fighting an infection, and that's all that's left.... your telling me that you wouldn't give it a shot????? Really. That's basically all I was say'n. I wasn't say'n that if tomorrow I pop a staph infection, I would run to Petco and pull this crap off the shelf. Besides in reality most adults know by now if they are allergic to Penicillin or not.

[Von Rheydt]

Penicillin allergy. I'm talking to Doc's over here more now and things seem to be similar to UK. I know that in UK Penicillin is not given in the majority of infection cases, rather a derivative or alternative is given........Amoxycillin is the favourite. So even if people have had antibiotics before they may not have had Penicillin.

I know what you mean though, in a situation anything, even pet meds, can be better than waving JuJu beads over an infection. Honey on an infected area is good too, particularly manuka honey if you can get it.

[Hmac]

Penicillin allergy. I'm talking to Doc's over here more now and things seem to be similar to UK. I know that in UK Penicillin is not given in the majority of infection cases, rather a derivative or alternative is given........Amoxycillin is the favourite. So even if people have had antibiotics before they may not have had Penicillin.



There are several penicillin derivatives, all with the same potential for anaphylaxis in the face of a penicillin allergy. If you're allergic to penicillin, you're allergic to amoxicillin and several other such antibiotics, not to mention a 30-50% cross-reactivity to cephalosporins like cephalexin. Additionally, let's be aware that many or most significant infections are caused by bacteria that are resistant to all of the penicillin-based antibiotics. Giving penicillin or similar antibiotic to someone for an abdominal wound, for example, is totally pointless. As to penicillin itself, I can only think of one or two reasons where it would EVER be prescribed these days.

But, sure. If the shit hits the fan, all bets are off. Fish antibiotics, if the right one is given for the right reason, would be better than nothing.




Besides in reality most adults know by now if they are allergic to Penicillin or not.

Unfortunately that's not true. Previously unknown medication allergies happen every single day in a typical hospital or outpatient clinic. That includes penicillin-based drugs, although they are not used very much anymore.



/

[jklaughrey]

I tend to agree Hmac, anything is better than nothing unless of course it kills you dead on the spot. Life over limp, function over form, and all that combat medic mantra they drilled us with. I usually restock my broad spectrum at the local livestock/feed store or vet clinic. But like anything in this world over use of certain antibiotics has rendered them virtually useless in many cases.

[firemike]

How did antibiotics get included in a "BLOW OUT KIT" thread ???

Last resort / end of civilization stuff is a mile away from "stop the F'n hole from leaking long enough to get #1 - EMS (whatever level is available) then #2 the hospital that can truly fix the problem."

I'm cool with big picture preparedness - but info flows much easier when the topic stays on track.