First response GSW treatment?

[Treehopr]

Yes I understand the importance of attending qualified training. It isn't a cost issue, it's time . The one thing most people don't have enough of. I'm sure someone is going to point out that I need to make it a priority, and I am. Just up to the point of having to travel and attend a class. I'd love it, but where I'm at in life and the people I have to be accountable for, leaves me short on availability time.
Me pointing out my profession wasn't done in an effort to somehow diminish my need for some medical knowledge, it was done to position the fact that I know and accept that I'm not a medical professional in any way shape or form.

Thank you to all for addressing my initial questions, it was very helpful!

Understood about time limitations, but I politely note that if you have time to go to a range and shoot you have time to attend formal training. Look up the NAEMT website, there's 8 and 16 hour courses that cover basic self aid and trauma care. Take a vacation day; fit it in to your schedule- the fact that you're posting questions here means you already recognize that it's something worth knowing.

I don't say that to be condescending or dismissive about your concerns, but as someone who has taught hundreds of people in applying TQ's, pressure dressings, etc. - there's things you need to know as far as anatomy and physiology, mechanisms of injury and having actual hands on practice. Applying a TQ or pressure dressing incorrectly isn't going to help someone in a life and death situation.

With respect to Hmac's post, applying pressure isn't that difficult but maintaining pressure is, especially if you're trying to work a cell phone; talk to other responders or if you have to move a patient by yourself. That's for one patient, what if you have two patients that have GSW's?

Regardless of how likely an event is, it won't matter what the statistics are if it happens to you.

[TacMedic556]

Lots of great advice on here already. Training is key. Software then the hardware. TQ - limbs, seal sucking chests (front and back), pack and pressure (QuikClot) junctional areas such as the shoulder and inguinal and pelvic regions.

Scenario A:
Seal the sucking chest wound with a FOX or HALO or comparable quality seal. If one is not available you can use another thin plastic type material or wrapper. The goal is to keep air from rushing into the hole and maintaining the proper pressure in the pleural space. Look for both entrance and exit wounds. Bleeding from the lung, if a major vessel was struck in that region, is not amenable in the field. GET THE PATIENT TO SURGERY.

Scenario B1:
Drop a knee onto the medial (inside) region of the Patients upper thigh, and attempt to immediately provide some direct pressure onto the femoral artery. If another individual can assist have him/her do so. Begin to tourniquet the leg above the wound site immediately. Be sure that the tourniquet is not being placed over things like bulky/filled cargo pockets or drop holsters. IT NEEDS TO DO ITS JOB. Tighten the tourniquet strap and crank the windlass until there is excruciating pain and the bleeding has stopped. If one tourniquet does not suffice, go for a second, and yes there have been large men that required 3 on one leg. Tourniquets of choice: SOF-T and CAT. I like the CAT for self application on my upper appendages when doing one handed drills / self applied. Both are great. After TQ is placed if there are large cavitating wounds present, go ahead and pack them with some z-fold combat gauze (quikclot) or if that is not present Kerlix gauze. Pack the wound and be sure that the hemostatic agent is in contact with the blood vessel that suffered the insult. Hold pressure for three minutes. Then wrap the wound site with an Olaes or Israeli or another pressure dressing. DO NOT REMOVE THE TQ. TQ removal or loosening is for trained medical professionals and higher levels of care / providers.

Scenario B2:
Grey area here. Totally depends on the level of hemorrhage and how controllable it is going to be. Is the blood pressurized? Is it pouring out? How much? Think, there is only 5 liters approximate in the patient, how fast are they losing that 5 liters? If it is a GSW, you would not go wrong by applying a TQ. You cannot see the wound channel, you do not have the level of experience to perhaps know what you are seeing at this time, so you really could not go wrong just applying a TQ and shutting the bleeding down. Better safe than sorry. Let the medical professionals make a decision after you hand over care of your friend or family member, after help has arrived etc. If the wound is a mere superficial laceration, or other injury pattern that is not involving a great vessel/artery, then you can attempt the other means of bleeding control.

My 2 cents anyway. As stated, get some good course work and training. There are lots of resources out there. Just make sure it is from a credible source. There are a lot of individuals who are pretending to know about trauma and medical procedures and devices, and they may have little to no experience or patient contacts. Be wary of the guy that got his 200 hour EMT-B class 3 months ago and has a bunch of patches and stickers, carrying enough medical gear around in his EDC to arrive at a mass casualty incident and wants to show YOU how it is done.

[Drew78]

Great stuff, thanks!

[skylineracer329]

Everyone's pretty much said the right thing, no sense beating a dead horse. If you're using Saran wrap as an occlusive dressing for the chest wound, cover it with gauze first to control the bleeding and then wrap it with the gauze in place. If you're using a commercial chest seal, wipe away as much blood and debris as possible or it might not stick.

Last point, check your local laws. You might open yourself up to a law suit if providing care that's outside your scope of training. Some states have Good Samaritan laws to protect you against law suits, some don't.

[tacti-cool]

as these questions are specific in nature there is a deeper understanding of #1 what you can do #2 what needs to be done..
Traditionally medics are taught the ABC's of medicine.(airway, breathing, circulation) remember these 3 needs are needed to sustain life at a very gross level. find which one you need to address and address it right away.. the order you address them depends on what is going on.


if you have additional questions feel free to message me.

-Nationally registered Paramedic

[City Rat]

The previous posters have all said take a course, you absolutely need to. That said you may not have to travel as far as you think. Call the red cross and see where they do training. Also very useful, go online and see whose offering a wilderness medicine course in your area, call your local outdoors store and see if they are offering a wilderness medicine course. The course design is different but the techniques are the same compression on bleeders is compression on bleeders and a lot of the kit is the same. Good luck.

[Hmac]

Very easy to over-think the value, the tools, and the techniques that are practically useful for untrained or minimally-trained non-professionals in the civilian setting. Personally, I question the value of such courses for most people, as long as the would-be field medic has common sense, rudimentary knowledge, and a cell phone.

[City Rat]

If nothing else the courses have value in de-mystifying tools and techniques as well as providing the participants with basic familiarity through hands on practice with the tools. A great example was the phrase used earlier in the thread regarding a TQ. "... wind it until there is excruciating pain and the blood flow stops" or something to that effect. There is no substitute to applying TQ in a good class on the squirting dummy and seeing really how many times you have to wind it down to stop the flow and then using it on yourself and then on a training buddy to know how painful it really is to apply one of those. At least for me it gave ne meaning to the phrase, " I'm here to help you but some of this is really gonna hurt in order to get you lashed up nice and tight until the lights and sirens get here..." I will never be as good as the 2 SOF medics who taught me but I know from at least that experience and several other courses that I had in the field what will be required when the time comes. Last these skills are perishable and need refreshing and there is value in going to class periodically to refresh the skills learned. You just never know when the call will come, driving down the road and you happen upon an accident or managing a store in the mall and an active shooter develops and victims take refuge in your store... there is a value in taking these classes. Just my .02.

[tower59]

Totally agree with HMAC's succinct recommendations for non-medical personnel suddenly put into the medical role. Put lots of direct pressure on bleeding wounds. That's the right answer most of the time in the field, and tourniquets do play a critical role in major arterial hemorrhage. That being said, a guy with that type of injury to the chest needs to get to the operating room yesterday, and anything that delays definitive treatment will increase the likelihood of a bad outcome.

Regarding seeking additional training, we all can't know how to do everything. If you are interested in learning some first aid skills, by all means, go for it! Just realize, of course, that if you spend 20 hours learning how to diagnose and decompress a tension pneumothorax, that's time you could have spent practicing dry firing, making some extra money to pay off that debt, or more importantly, playing ball with your boys. Lots of choices there, and I wish you the best as you make your decisions!

[City Rat]

Just to be clear my response isn't inconsistent with any of that. In essence, if you are considering putting sometime in to get some training, that there is value in spending your time in that manner. Again best of luck to all.