Blow-Out Kit reccomendations

[Slinger646]

We suffered a tragedy yesterday when 2 of our fellow LE officers were killed by rifle fire a few hours away from our jurisdiction.

The good that is coming from this incident is the department is considering ordering GSW kits for each car. Currently, we are issued a very small civillian first aid kit. A few officers have constructed their own kits.

Can you guys reccomend some basic pre-packaged kits? We are looking for something containig the basics for officer application. As with anything government, price is an issue to the bean-counters.

Thanks

[chuckman]

First, sincerest condolences for the loss of your colleagues.

BOK's can be found at Chinook Med, North American Rescue Products, Tac Med Solutions, and about a dozen other sources. Most are essentially the same thing, variations of a theme, and would suit you/your department's needs.

[Slinger646]

Thanks for your thoughts and for the links

I have pieced my kit together over the years and really dont know where to start looking for pre-packaged kits.

[SeriousStudent]

I would also like to extend my sympathies for the loss of your brother officers.

If you contact Jessica at Chinook Medical, she can help you. They offer a government\military discount, and frequently have sales on top of that.

I have shopped with them for years, and been very pleased.

www.chinookmed.com - 1-800-766-1365

They can help you build a set of kits that meet your needs, without going broke.

[zekus480]

First off, my condolences, I've always felt police officers and soldiers were cut from the same bolt of cloth. I am a medic in the Army and teach this a lot. This is a list of the the things you need to have, but get training first. Hit your EMS guys or the docs at your local ED

1) Tourniquet: have one attached to your kit with a rubber band that can be reached with either hand. Have a second on in your FAK

2) Nasopharyngeal Airway: AKA nose hose or nasal trumpet it shout be about the diameter of your pinky finger and the length should be from your earlobe to the tip of your nose. Pack some surgilube with it or some non scented KY jelly to lube it as it goes in. if all else fails use the casualty’s saliva or his blood. Do not use if you suspect a head injury.

3) Chest Seal: HALO, HyFin, or a random piece of plastic taped down. I use gorilla tape after wiping off blood and sweat from the torso. Look for entry and exit wounds, tape up all four sides on both

4) Dart: 14ga 3.25” angiocath for needle decompression (being stateside you may not want to do this if a hospital is within 2 minutes or the Paramedics are on scene)

Additionally I have 2 packages of combat gauze and an Israeli bandage for non life threatening bleeders, or to manage penetrating trauma after the tourniquet has been applied.

Remember that each individual's FAK is for them. Do not use your FAK on your buddy because you might need it later in the fight. Keep your FAK where you can reach it easily in case you need to do self aid, and where your teammates can get to it if they need to do buddy aid. The best thing you can do is have training because survival in these situations is about skills, not stuff. I hope this helps

[3 AE]

One of the least expensive kits on the market for what you are getting. You can add a hemostatic agent of your choice for an extra $35-$40, such as QuikClot Combat Gauze. http://www.austereprovisions.com/ProductDetails.asp?ProductCode=IC3K%2D1

[rob_s]

Second Austere provisions.

Would also say that response time plays a factor in what you choose to include.

Personally, I would not recommend NPAs or needles without extensive training in same. At one time I kept needles in my kit thinking that I may encounter someone else that would be qualified to use it on me, but frankly I'm far more scared of someone that got their training on the internet stabbing away at my chest.

I live in a very urbanized environment where I do most of my training and shooting. I also know response time to the two facilities out of my AO where I do my training. I understand that this is not a 1:1 with your situation but I think that regardless response time plays a role. ETA for EMTs, and ETA to transport to a trauma center.

Regardless, I don't think anyone will disagree that training is a necessity, even if it's only trauma dressing, TQ, chest seal, and tape and gauze. In a department situation with a standard kit it seems to me that uniform training on the issue kit is critical.

[Gutshot John]

Consider the Belt Trauma Kit (BTK) from Z-Medica. Many PDs including NYC issue these to their officers. They're very small and look like the old velcro wallets form the 1980s.

It includes a SWAT-T tourniquet (which requires training especially for self application), Combat Gauze LE (also requires training but no medical certifications), gloves and I believe a CPR face shield. They fit easily on a belt or in a cargo pocket.

They're pretty basic, and only really appropriate to a single extremity wound, but they will buy some time until more definitive medical care arrives and are in a pretty small/convenient/one-use package.

[Slinger646]

Thanks guys, I'm compiling all the various kits and presenting them to the F/Sgt who has a way with selling ideas to the admin.

Im an expired ALS provider and carry my own GSW kit and Jump bag, the pre-packaged kits would be something easy, inexpensive and effective that we could outfit the ground-pounders with.

I have previously dealt with EMP, but the department wants something pre-packed.

Austere provisions seems to have the best bang for the buck.

For those interested in the back-story that set this thread in motion;

http://www.wvva.com/global/story.asp?s=14247725

http://bdtonline.com/local/x814636744/Details-emerge-in-Va-shooting

Again, thanks.

[Gutshot John]

While I recommended the BTK as a quick efficient solution, I'd second recommendations for Austere Provisions for something a bit more comprehensive.

Mike G has been a big help in designing a kit for my organization.

[mkmckinley]

First off, my condolences, I've always felt police officers and soldiers were cut from the same bolt of cloth. I am a medic in the Army and teach this a lot. This is a list of the the things you need to have, but get training first. Hit your EMS guys or the docs at your local ED

1) Tourniquet: have one attached to your kit with a rubber band that can be reached with either hand. Have a second on in your FAK

2) Nasopharyngeal Airway: AKA nose hose or nasal trumpet it shout be about the diameter of your pinky finger and the length should be from your earlobe to the tip of your nose. Pack some surgilube with it or some non scented KY jelly to lube it as it goes in. if all else fails use the casualty’s saliva or his blood. Do not use if you suspect a head injury.

3) Chest Seal: HALO, HyFin, or a random piece of plastic taped down. I use gorilla tape after wiping off blood and sweat from the torso. Look for entry and exit wounds, tape up all four sides on both

4) Dart: 14ga 3.25” angiocath for needle decompression (being stateside you may not want to do this if a hospital is within 2 minutes or the Paramedics are on scene)

Additionally I have 2 packages of combat gauze and an Israeli bandage for non life threatening bleeders, or to manage penetrating trauma after the tourniquet has been applied.

Remember that each individual's FAK is for them. Do not use your FAK on your buddy because you might need it later in the fight. Keep your FAK where you can reach it easily in case you need to do self aid, and where your teammates can get to it if they need to do buddy aid. The best thing you can do is have training because survival in these situations is about skills, not stuff. I hope this helps

Good advice. I'm pretty confident that the military is leading the way in trauma self aid and buddy aid. I suggest you get basic IFAKs and some TCCC classes to learn how to use them. Even one afternoon doing some lectures and a few scenarios could potentially save a life. You basically want one or two tourniquets, a couple packages of hemostatic agent (Combat Gauze is my fovorite), an even number of occlusive chest dressings (I keep 4-6), a few 3-1/2" 14 ga needles for needle decompression, an NPA, and some bulk wound packing materials ( I keep an israeli dressing and a kerlix roll with an ACE wrap). We also carry a 500mL bag of IV fluid and an IV kit but that may not be available in a civilain setting. In the civilian settng you may want to keep a pocket mask handy. Trauma shears are also good to have.

I teach my guys to follow the acronym MARCH

M - massive hemmorhage (put a tourniquet on any limbs with arterial bleeds, stop other arterial bleeds with direct pressure and hemostatic agents. pocket type wounds for instance groin shots get packes with the kerlix and ACE bandage)

A - Airway (make sure the patient has an airway. Unless you're trainied and authorized to intubate or cric you're pretty much relying on an NPA, the recovery postion, or a heimlich maneuver in rare cases)

R - Respirations. (occlude any penetrating ches trauma and perform needle decompression on the affected side. if the patient is inconscious and not breathing at a rate of 12-20 bpm bag them up or down to within that range. Give O2 if available

C - Circulation (Stop veinous bleeds and abrasions, start IV and fluid challenge)

H - Hypothermia/ head injury ( most trauma patients are heading toward hypothia if they've lost much blood. Put a blanket on them. Start monitoring level of consciousness for possible head injury.)

[chuckman]

I forgot to add Austere. I haven't purchased anything from Mike G, but know him (and his biz) in the circles to be locked tight and good to go. Sorry for the ommission. Z-Medica is a well-known and very reputable, I wouldn't have any issue getting any of their products.

As for the supplies, I echo the comments regarding sticking to the basics. There is a difference between a BOK and an IFAK, bit it sounds like you know what those differences are.

[rob_s]

Random thought on this...

How is your EMS organized in your AO? Might you not contact the head, work up a training plan with him, and issue kit at the training events? Kits could be constructed tailored to the specifics of the AO, to include response times and trauma center locations. Much the way new weapons are often issued at the new-weapon-qual?

On a smaller scale, I started down this path with the local shooting club, with kits from Austere, but it got derailed on my end and was of a less critical nature, obviously.

[Gutshot John]

How is your EMS organized in your AO? Might you not contact the head, work up a training plan with him, and issue kit at the training events? Kits could be constructed tailored to the specifics of the AO, to include response times and trauma center locations. Much the way new weapons are often issued at the new-weapon-qual?

That's overthinking the issue quite a bit. Get something basic and effective that you can get done right now. Focus on the most common injury that your average LEO has a chance of treating that will save lives (penetrating trauma to the extremities) and get the proper training. Address the low-hanging fruit rather than every possible option. Honestly most LEOs are going to have very little means of treating a GSW outside of a chest seal, even if you've got that your odds of success are probably pretty low and if an injury requires anything more than that than your success rate is going to drop significantly.

Involving other chefs as to EMS/AO is a surefire recipe to draw out the process into meaninglessness. Remember that having a kit is one thing but without the appropriate training it is of limited value. The more complex the kit, the cost/time of the supporting training will also grow exponentially.

[Slinger646]

Random thought on this...

How is your EMS organized in your AO?


It's compromised of 95% vollies who kick ass in skill, but are sometimes spotty in coverage. I can do a shit-n-get to the ER (a level 82 veterinary clinic) in about 3 minutes from anywhere in town. The nearest top-tier med center is Inova/Fairfax or UVA by helo.

I've already done classes for the squad on Downed LE and the specific challenges presented by uniforms, gear, etc.


Thanks for all the help

[NinjaMedic]

1 - CAT Tourniquet
2pr - Nitrile Gloves, Large
1 - 6" Wide Roll of Kerlix or 6" Izzy with Slider and Kerlix

Place the above in a Heavy Duty Ziplock such as you find at a camping store or one better vacuum seal or heat seal in plastic bag. Issue each officer in your agency a belt pouch. Purpose built IFAK pouches are certainly useable but a Maxpedition type pouch will work just as well. Issue the above packaged kit to each officer and have them store it in their belt pouch. Issue one of the above packaged kits to each vehicle owned or operated by your agency and have it placed between the drivers seat and the B-Post of the vehicle where a person lying supine on the ground next to the divers door or sitting upright in the drivers seat can reach and access it.

That is the sum total of supplies necessary and appropriate for issue to a standard law enforcement patrol officer. Application and use of the supplies needs to be reinforced with annual officer down response training using moulage. Monthly or quarterly drills on self application should be conducted at the precinct or sector level.

More important that anything else you need to have a serious, honest, and open discussion with your partners and shift mates about their wishes for transport if injured. This is the elephant in the room. If your partner is seriously wounded you will have to make the decision of whether or not to transport him in a patrol car or wait for an ambulance. I will not advocate for one or the other as this is an intensely personal decision. Multiple factors have to be weighed including the expected notification and response time of the ambulance, perception of the local EMS agency's competency, distance to the hospital, ability of the ER to react to a Trauma patient with no notification prior to arrival at the door, care needed to survive to the ER, etc.

Most life-threatening firearms related injuries to a law enforcement officer (with the exception of serious hemorrhage from a compressible site) are likely going to involve an area of the body with a high likely hood of spinal injury. The standard of care in the United States for a patient in the Prehospital environment with the potential for a spinal cord injury is to immobilize that person on a long spinal board. Some people argue that the damage will have already occurred during the impact of the projectile or that the c-collar/backboard either has no positive impact on patient outcomes or even potentially a negative impact. Regardless know that this is indeed the standard of care and in a civil suit it will be very difficult to defend either not waiting on an ambulance or not back boarding the person. You need to talk with the EMS crews and make your own decisions about how you want your brothers to take care of you and make those wishes known.

There is not a 100% right answer and everyone has to weigh the risks themselves but don’t wait until one of yall is injured to have the debate on what the right call is.

Just my two cents.

[chuckman]

Some people argue that the damage will have already occurred during the impact of the projectile or that the c-collar/backboard either has no positive impact on patient outcomes or even potentially a negative impact.

This true. A LSB is for transport only and has zero bearing on outcome. The cervical collar is, however, correlated to positive outcomes with cervical spine injury. Just adding a little to your well-written synthesis. I whole-heartedly agree with your assessment of the necessities and the creative way to package them.

[yellowfin]

Are 50g Quik Clot sponges preferable over 25g ones or will the latter suffice most of the time? I'm putting together a few kits (1 for each car, fishing gear bag, hunting pack, and wife's work bag) so I'm wondering which size to get the most of. Ditto with Israeli bandages 4" vs. 6".

[NinjaMedic]

If you are dead set on a hemostatic agent use the Z-Fold Combat Gauze.

As far as size, anything the 4" can do the 6" can do better . . . come to think of it that's what she said. Seriously though get the slider too of you are going with an Izzy as it provides you with a lot more versatility.

[dog guy]

"A LSB is for transport only and has zero bearing on outcome."

NinjaMedic, Chuckman: can either of you point me towards documentation/studies/Information on this subject? I'd like to follow up. If this comes off as thread hijack then PM would be fine. Thanks.

[Gutshot John]

"A LSB is for transport only and has zero bearing on outcome."

NinjaMedic, Chuckman: can either of you point me towards documentation/studies/Information on this subject? I'd like to follow up. If this comes off as thread hijack then PM would be fine. Thanks.

I don't know that you can absolutely say one way or the other as more studies are required to reach a definitive statement as chuckman made. I don't think it's correct/proper to say "zero bearing" as conditions vary.

Ninja simply said it was subject to some debate with some people arguing that it does little to protect an injury that has already been sustained and the length of time/difficulty in applying them may delay transport and/or recognition of other injuries which is absolutely an argument that many are making that has some evidence behind it. I definitely agree that they are subject to significant overuse.

That said spine boards are definitely still part of protocols except when conditions do not allow their use (rapid extrications). LSBs still play a role in other forms of suspected spine compromise.

[chuckman]

I will search for the literature. If I can't find it I will ask our trauma surgeons...they make a point of being right all of the time (just ask them). :)

One way to think about the use of a LSB is to look at its use along a continuum of care. Not only is it removed in the ED, it is removed VERY soon after patient arrival. Aside from having no impact on spinal integrity, LSBs have a profound negative impact in skin integrity. Shoot, if you lay on one yourself you can feel the curvature of your spine and how a good bit of your spine does not contact the board; if you really wanted to preserve spinal integrity, one would put blankets or foam or something under the areas that curve.

Even pre-hospital collars are not considered 'proper' collars for long-term cervical spine immobilization, and are discarded very early in the trauma assessment. Trauma docs, ED docs, neurosurgeons consider pre-hospital collars as extrication collars and for transport.

None of this isn't to say that they are not helpful nor even that they cannot prevent or mitigate existing injury.

Sorry for the derail. Back to the regularly-scheduled thread.

[Gutshot John]

Not only is it removed in the ED, it is removed VERY soon after patient arrival. Aside from having no impact on spinal integrity, LSBs have a profound negative impact in skin integrity.

That depends on a case-by-case basis. Having actually been on a LSB in an ER for over an hour (longest hour of my life) after a motorcycle accident where I had pretty significant internal bleeding it can certainly vary.

You're explanation as to why it has no impact on spinal integrity needs clarification. Under what circumstances? Which protocols? does it have value or when it has none. It's basically a long splint, it keeps the spine straight and protected. Padding is nice but the point of an LSB isn't to prevent all movement (something that's a physical impossibility), just minimize lateral movement and protect it from aggravating injuries.

While I would agree that it's not the panacea that most EMS types seem to think it is (and so apply one in virtually every circumstance whether they need it or not) and that there is little point if the spinal column has been already severed, there is certainly some value in it and you won't see them go anywhere for a very long time to come. They certainly have a place and I think you need to spell out where you think that place lies rather than simply saying it has "zero" impact which is a pretty unequivocal statement. I would definitely be interested in any studies on the subject.

Do LSBs (or even C-Collars) take a back seat when dealing with severe hemorrhage or respiratory distress? Sure they do but that's been accepted practice for a while now.

As is often the case in medicine and EMS, things fall out of favor only to re-emerge later. I can certainly believe that the trend is moving towards less or infrequent use of LSBs, but saying something is of "zero value" is a world away from saying something has "limited value."

[chuckman]

I recognize that my word" zero" has perhaps caused some concern. Upon reflection, I get why. "Zero" represents an all-or-none, subjective statement. I will concede that there might perhaps be some limited value in the use of LSBs pre-hospital, although there is not much evidence to support doing so (that I can find).
I will amend my remarks to say that the American College of Surgeons and the Faculty of Emergency Medicine Physicians believe the use of a LSB is for transport and of little use as a split. Generally this is born out in the ATLS guidelines and in the ATLS text. While I haven't conducted a lit search for EMS use, following are results from a very quick search regarding use of LSBs in the ED:


http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7W60-4HGM7NX-3&_user=38557&_coverDate=11%2F30%2F2005&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_searchStrId=1698197201&_rerunOrigin=google&_acct=C000004358&_version=1&_urlVersion=0&_userid=38557&md5=02c1f48e58c4b8eccaf4c9f8893832b0&searchtype=a

http://www.springerlink.com/content/x420w8u15v86161h/

http://emj.bmj.com/content/18/1/51.full

http://igitur-archive.library.uu.nl/dissertations/2010-0401-200200/lubbert.pdf

[Muddyboots]

One thing LSB or even a half board does do is give you a base to work against for direct pressure or CPR. It also acts like a tray when you are delivering a real mess to the repair shop.

Remember: it's all about stabilize and transport.

Even in a forward position, you don't want to be "practicing medicine," you want to get them to better facilities ASAP. Brilliance in the basics applies to first aid as well as fire arms/tactics. People get caught up in the cool gear and forget that the point is to make or plug holes (as is appropriate for the situation.) Training comes first and gear is secondary. An 18D can do more with a stack of 4X4s and a cravat than a gumby with the best "RCGI super trauma micro bag."

Lastly, on gear, If you don't know how to use it it shouldn't be in your personal kit. Build your own kit based on your skills. For the truck/cruiser kits that gets more complicated but the basics remain the same.

Muddyboots

[Pathfinder Ops]

1 - CAT Tourniquet
2pr - Nitrile Gloves, Large
1 - 6" Wide Roll of Kerlix or 6" Izzy with Slider and Kerlix

Place the above in a Heavy Duty Ziplock such as you find at a camping store or one better vacuum seal or heat seal in plastic bag. Issue each officer in your agency a belt pouch. Purpose built IFAK pouches are certainly useable but a Maxpedition type pouch will work just as well. Issue the above packaged kit to each officer and have them store it in their belt pouch. Issue one of the above packaged kits to each vehicle owned or operated by your agency and have it placed between the drivers seat and the B-Post of the vehicle where a person lying supine on the ground next to the divers door or sitting upright in the drivers seat can reach and access it.

That is the sum total of supplies necessary and appropriate for issue to a standard law enforcement patrol officer. Application and use of the supplies needs to be reinforced with annual officer down response training using moulage. Monthly or quarterly drills on self application should be conducted at the precinct or sector level.

More important that anything else you need to have a serious, honest, and open discussion with your partners and shift mates about their wishes for transport if injured. This is the elephant in the room. If your partner is seriously wounded you will have to make the decision of whether or not to transport him in a patrol car or wait for an ambulance. I will not advocate for one or the other as this is an intensely personal decision. Multiple factors have to be weighed including the expected notification and response time of the ambulance, perception of the local EMS agency's competency, distance to the hospital, ability of the ER to react to a Trauma patient with no notification prior to arrival at the door, care needed to survive to the ER, etc.

Most life-threatening firearms related injuries to a law enforcement officer (with the exception of serious hemorrhage from a compressible site) are likely going to involve an area of the body with a high likely hood of spinal injury. The standard of care in the United States for a patient in the Prehospital environment with the potential for a spinal cord injury is to immobilize that person on a long spinal board. Some people argue that the damage will have already occurred during the impact of the projectile or that the c-collar/backboard either has no positive impact on patient outcomes or even potentially a negative impact. Regardless know that this is indeed the standard of care and in a civil suit it will be very difficult to defend either not waiting on an ambulance or not back boarding the person. You need to talk with the EMS crews and make your own decisions about how you want your brothers to take care of you and make those wishes known.

There is not a 100% right answer and everyone has to weigh the risks themselves but don’t wait until one of yall is injured to have the debate on what the right call is.

Just my two cents.

This from NinjaMedic sounds just about right to me.

I have been a fire service Paramedic in the street for 21 years and the Tactical Medic on our SWAT team since April 2001. I may not be a trauma surgeon but I have a lot of years of seeing what works and what is just fluff. I've also seen stuff that was supposed to the cats ass come and then go because it was BS. I've also seen tourniquets fall out of favor and now, surprise, surprise they are back. Why? Because they work and aren't as scary as everyone thought.

I have trained my officers in self aid/ buddy aid annually ever since I've been on the team and the bottom line is all they really need the vast majority of time is an ability to stop the bleeding.

Nasal trumpets etc are problematic and unless you have the right one (size: length and diameter are major factors). And you need to know how and what to do with one or you could actually complicate an airway. No they aren't rocket science but put the wrong one in or put it in wrong and you could cause a bleed which will cause an airway issue that you didn't have to begin with.

Same goes for folks "Darting" chests and / or bagging people up or down..... This is work best left to a professional.

Unless your formally trained stay away from these things.

The only 2 things I MIGHT add to the statement made by NinjaMedic would be an "Israeli" type compression bandage and or (maybe) the Quik Clot gauze. AND MAYBE if you want to; a commercially made chest seal. They are simple to apply non invasive and even if the pt doesn't have a sucking chest wound, it's not likely to make things worse if it was applied.

Regarding the spinal immobilization (cervical or other): It is on its way out of these treatment protocols because there is very little scientific proof that it has any positive impact in the GSW where there are no signs or symptoms of spinal injuries.

There is some talk that a C-collar's best use for these situations is where the individual is eventually intubated and this facilitates a more secure or stable intubation during transport.

My advice for the lay person (non EMS/ military CLS/ Medic) here is keep it simple. Know when and how to use what you have and before you consider anything invasive (nasal airways, chest decompression needles etc) get off the internet and get some actual training.

[Muddyboots]

This from NinjaMedic sounds just about right to me.

I have been a fire service Paramedic in the street for 21 years and the Tactical Medic on our SWAT team since April 2001. I may not be a trauma surgeon but I have a lot of years of seeing what works and what is just fluff.

...get off the internet and get some actual training.

That^^^

Muddyboots