Kit Buildup - GSW Kit

[rob_s]

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]

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.

[FMF_Doc]

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]

... 4x4 pads, some KY ....

If you have Kerlix, what do you do with the 4X4's?

KY is for NPA?

[FMF_Doc]

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.

[FMF_Doc]

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]

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.

[FMF_Doc]

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]

I agree FMF_Doc there is certainly always an appropriate application for something.

[rob_s]

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?