Let's talk bare-bones BOK

[rob_s]

From the TCCC:
60% Extremity Hemorrhage
33% Tension Pneumothorax
6% Airway Obstruction

Let's assume, for the purposes here, that we're talking about being stateside and with 30 minute response time from EMS and 60 minutes to get to an emergency room or trauma center.

Let's also have a goal of an AR double-mag pouch (or triple if needed) as a size limit.

I think anyone/everyone would include a tourniquet or two.

Trauma dressing (Israeli, Oales, Cinch-Tight, Thin-Cinch, 4" vs 6", etc.) seems to be a common theme.

NPA?

Better to use a dedicated chest seal or rely on the wrapper from the trauma bandage and some tape?

Hemostatics seem to illicit some controversy, but better to have and not need? Worthless stateside with 30 minute EMS response?

[Submariner]

You have, no doubt, already read the Doc Gunn AAR on p. 72 of the Dec. SWAT, an issue in which you have an article.

He recommends a tourniquet on the vest or in the range bag along with the basic kit.

The key is having the skill to identify which tool needs to be used and how to properly use it. Tools can be good or better. What do you want to do and how much do you want to spend to do it?

But you already knew this.

ETA: I went with the IBD because there is cheap training available which has recently been updated:

http://www.ps-med.com/bandage/bandage_training.html

The six inch IBD (with slider,) NPA, and catheter, all wrapped with three strips of tape, will fit in single Eagle M4 pouch. There is room for an Ascherman if you desire. With a TK-4 in a Blue Force Tourniquet NOW! StrapTM and the Eagle single, you have used three vertical PAL rows.

[rob_s]

You have, no doubt, already read the Doc Gunn AAR on p. 72 of the Dec. SWAT, an issue in which you have an article.

Part of the impetus for this thread

The needle thing bugs me. I haven't been trained on it, but I've been told that the training should be a lot more than just "stick here".

graphic example of common dangers of needle decompression! GRAPHIC

I'd also be interested to know how quickly tension pneumothorax kills. If it takes hours, and stateside EMT response is 60 minutes or less, then it may not be needed in the kind of range kit I'm thinking of for use on established ranges.

Obviously there is an argument to be made that if you're on an established range why not have a full bag with 2-3 of everything you might ever need, but I'd like to skip that argument for now.

[Submariner]

I'd also be interested to know how quickly tension pneumothorax kills.

Good question! This wasn't addressed. I surmise that it can be quick; otherwise the catheter would not be included in the kit. Let me contact him and find out what he says.

Did you strip off the outer wrapping? I think I'd do that with mine.

No. It is a tight wrap. The outer cover has instructions. The tear points are on the ends so the wrapper is large enough to use for the Ascherman substitute. The tear point on the inner wrap is in the center and makes the inner wrap virtually unusable.

One more point: medical supply houses generally say federal law requires them to have a prescription before hey will ship catheters. Tactical Response sells the same 3.25-inch decompression needle included in their VOK without a prescription. It is needle only, though, no catheter.

[Danny Boy]

TPT can vary in time. Getting them to definitive care should be more of a priority.

NCD's - Get training on them. They're not difficult when you know what body part is where.

[PPGMD]

NCD's - Get training on them. They're not difficult when you know what body part is where.

+1

Not only that, but often there are people there that might be better trained then you are. Those people, may not have their own kit with them, or their kit may not be close by.

Anyways suggestions:
http://www.tacticalresponsegear.com/...oducts_id=4154

Fits in a double, or triple Mag Pouch.

And it can fit the items that you are most likely to need:
Pressure Dressing (I like the H-bandage)
Quikclot Combat Gauze
TK-4
NPA
Decompression Needle

Of course you can vary the contents.

[Danny Boy]

Tactical Response sells the same 3.25-inch decompression needle included in their VOK without a prescription. It is needle only, though, no catheter.

They have the 14 gauge 3.25 NCD catheters listed on their site. I can't find them without the cath.

[Submariner]

They have the 14 gauge 3.25 NCD catheters listed on their site. I can't find them without the cath.

I bought nine of them. They call them catheters but they are only the needle. I complained about the ad to no avail.

Remember, we are talking Tactical Response.

I will do you better than an m4 mag pouch.

I kept this kit in an M18 smoke grenade pouch on my chest for my entire time in Iraq:
...
1-14gax3.25" needle or catheter

Good idea on the Mk 18 pouch. I have a couple of Eagle 1 Qt. Canteen/GP MOLLE pouches I bought cheap ($15) which provide more space.

Would you (or anyone) please compare/contrast the efficacy of needle vs. needle/catheter? 3.25" vs. 2"?

[Bullwinkle]

I'd also be interested to know how quickly tension pneumothorax kills. If it takes hours, and stateside EMT response is 60 minutes or less, then it may not be needed in the kind of range kit I'm thinking of for use on established ranges.

guy died on me after we darted his chest twice with a 10ga, was 15 min from accident to hospital and he died as we pulled into the hospital.

[Submariner]

At the LMS No Light/Low Light Skill Builder Class in Alliance, OH, we spoke with Mikey G about a really bare bones BOK using cheap Eagle frag pouches. This might go on a war belt and is in keeping with the no needles/NPA position taken by many.



Contents:

Gloves

Primed Gauze:
Packing material
Basic bandage (make your own bandage with duct tape)
Tie off for perforated bowel (this is an advanced skill obviously)
Improvised TQ with a windlass

TK4:
Tourniquet
Pressure dressing when used with primed gauze
Basic sling

Duct Tape:
Tape
Improvised TQ with windlass
Joint taping
Occlusive dressing
Improvised Steri strips

Packaging:
Occlusive dressings (either for open ABD/Chest wounds or for water resistant wound protection in particularly dirty enviros)

Two Safety pins:

Pin the tongue out of the way for compromised airways
Use to improvise a sling with pt's t-shirt
Foreign body/splinter removal
Temporary wound closure