Blow-Out Kit reccomendations

[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.