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CopperHound posted:Jesus Christ, can we go back to talking about first aid? Tourniquets make sense for a range bag or FAK for a workshop or anywhere power tools are being used. I don’t think they make much sense in a bug out bag or wilderness FAK, but you should know how to improvise one, if you’re thinking of carrying one. Cravats and tongue depressors can be used to make an effective improved tourniquet, are lighter and take up less space than a manufactured tourniquet, and have lots of other uses besides. Cravats in particular are a must for splints. Hemostatics are almost certain to sit in your bag until they expire. Chest seals will definitely sit in your bag until they expire. Note on NPAs; they’ll protect the airway of an unconscious or shocky patient, but won’t do anything for blood or vomit. If you think your patient’s airway is at risk, the best thing is to put them in the recovery position (roll them on their side.) The medics can put in an NPA when they transport if they deem it necessary. Include the gloves. You are much more likely to be glad you have gloves than a chest seal, and they’re cheaper. Throw some bandaids in as well.
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May 23, 2022 04:25
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| # ¿ Apr 28, 2024 18:04 |
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A tourniquet would not have done you any good in the linked video since the wound is too high in the groin, and you’d have been wasting time if that was the first thing you reached for. The guys who treated him don’t use one either, you can see them holding direct pressure all the way into the heli. That’s the problem with tourniquets, they work very well but most extremity wounds don’t actually bleed that much and the wounds that do bleed tend to be central (which the femoral artery absolutely is - it’s very difficult to wound it anywhere other than the groin since it’s so deep in the leg that you practically have to cut through to the bone.) I would not recommend using a single tongue depressor for an improvised tq, no. Stack a few and they’ll hold up ok. Honestly the biggest reason to go to a manufactured tq is a durable windlass and a reliable way to secure it, but manufactured tqs are a very recent invention. I looked at the study someone posted a while back about improvised tqs, by the way. The biggest problem was with improvised tqs made with stretchy material. If an appropriate material is used - such as a cravat - an improvised tq was 90% as a effective as the manufactured one, which I expect mostly comes down to the better windlass.
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May 23, 2022 07:23
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rifles posted:Why would you ever plan to have to improvise a piece of kit that takes up basically no room and weighs almost nothing when its job is as important as that of a tourniquet? It's probably the one thing I would never compromise on, because the thought of having to try to improvise one to save a little weight or space in my bag with one arm while I bleed out of my other from a compound fracture or traumatic amputation doesn't sound nice. because traumatic exsanguination from an extremity is extraordinarily rare in civilian contexts. it’s only become a common cause of death in the military since the widespread introduction of body armor, and even there it was like single-digit percentages before the CAT was introduced. it’s much much rarer in the civilian world. i was an emt full time in a busy city for five years and i can count on one hand the number of times i used a tourniquet; we didn’t carry a rapid tourniquet on the ambulance and i never particularly felt like that was a priority to fix even though i had plenty of complaints about our gear almost all tourniquets before about 2010 were “improvised.” i do think the manufactured ones are better but they’re just very low on the list of things to get since the injury they treat are so uncommon. if size and weight aren’t a concern, and your kit is well stocked otherwise, sure go ahead and add them, but i’m disagreeing with the priority that gets placed on them more than having them included at all.
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May 23, 2022 18:03
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pantslesswithwolves posted:While I get what you're saying and can't question your years of experience in EMS, CH's original premise was “the ubiquitous ifak” is ubiquitous in the military trauma context only. there’s no such thing as an all-purpose first aid kit; there are kits built for specific purposes, with specific injuries in mind. i keep a home first aid kit ready with basically bandaids and cold packs, and a kit for day hikes with a bunch of gauze rolls, a few gauze pads and bandaids, cloth tape, bug spray, tick tweezers, cravats and safety pins to secure them, and an ace bandage because the most threatening injury i’m likely to deal with is a rolled ankle, plus a handful of nsaids. I haven’t gone on overnight trips or got off marked trails for the last few years so i don’t bother with more than that, and i haven’t shot guns since i left the army so i don’t have a range bag. I have a couple CATs sitting in the bottom of a tote somewhere but i just don’t have any reason to carry them anywhere or keep them accessible. as for major trauma - it really really depends on what your major potential mechanisms of injury are. for vehicle crashes including bikes, i think a way to protect the cervical spine is a pretty good idea, if you can find space in your bag for a c collar. some kind of appropriate small extraction gear like a seat belt cutter or glass breaker would be ok too. the really gnarly stuff i saw was always industrial accidents, and if you’re doing any kind of work with power tools i think a pretty well stocked first aid kit is totally justified. that’s a situation where a CAT does make sense but only after you’ve got a substantial amount of bandages, including some large pads, plus a mylar blanket or even a hospital-style wool or cotton one. my rule of thumb is that i’d want to be able to treat an evisceration before i start thinking about stocking up on bougie tourniquets. trauma shears are a must as well, for any type of trauma. where are you envisioning this “hot zone” taking place and what sort of injuries do you anticipate during evacuation? if this is like, evacuating in advance of a natural disaster, then i’d say the most important thing you can do is preventative - be as alert as you possibly can to hazards and avoid getting injured at all, since any accident will delay your move to safety. other than that you wouldn’t need any more of a kit than you would bring on a road trip. if you think you’re going to shoot your way out or reenact the day after tomorrow, i really can’t help you. e: what i’m trying to get across is that people don’t just start bleeding for no reason and what kind of bleeding you’re likely to see depends on what the hazards are in your surroundings. if the hazards are guns and you’re wearing body armor that protects your torso, extremity wounds are a relatively serious threat. if there are guns but you’re not wearing body armor, or the threat is from machinery or cars or, i dunno, bears or something, extremity wounds may be less of a concern and the thing you use to treat extremity wounds specifically isn’t as important as in that other context. hypnophant fucked around with this message at 07:04 on May 24, 2022 |
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May 24, 2022 06:58
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absolutely nothing sold in a bottle is going to care, though of course you should make sure you have a way to keep track of expiration dates (or just commit to refreshing everything every two years or so)
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Mar 22, 2023 07:16
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Oysters Autobio posted:Sorry if this is rehashing old debates but I seem to recall talking about CATs with a friend who had more medical training in the civilian side and mentioned that they aren't really common because of some other potential damage to limbs/parts when i left civilian ems (so over ten years ago, jesus), a tourniquet was regarded as an extreme measure which was not to be used if you had other means to control the bleeding. In the six years i worked as an emt, i never needed to apply one, including on some nasty traumas; i remember an industrial accident where a guy’s arm got caught in a conveyor belt and half his bicep was missing. I was able to control the bleeding through direct pressure and elevation and we went cold (without lights and sirens) to the hospital, where the ER doc got hit with a spray of arterial blood when he removed my bandage (which I had just warned him to look out for!! listen to your emt!) arguably i could have used a tourniquet on that one, but demonstrably I didn’t need to. this relied on a couple things though: I was able to adequately assess the injury, and I had the skills to stop the bleeding with less severe methods. It was also a simple enough injury that I could apply my full attention to it; if there was chest trauma as well I probably would have slapped on the tourniquet. It’s a lot easier to train someone to put on a CAT than to properly teach the full spectrum of bleeding control skills, including the assessment skills to determine when the tourniquet is needed. I’d have been a bit pissed if one of the first responders had put a tourniquet on, because I wouldn’t have been able to do my own assessment and I had learned not to trust a first responder’s assessment, but in hindsight it wouldn’t have been wrong for them to do so if that was what they judged appropriate. I’d rather they use a tourney than fail to control bleeding. As for lasting limb damage: it is absolutely untrue that tourniquets are “safe” for limbs. A tourniquet that has been on for longer than an hour or so cannot safely be removed except in an operating room due to the risk of compartment syndrome. What’s more, a tourniquet must be removed within a certain time after application or the limb will die and require amputation. The exact length of this time period is not a closed question, but I would be extremely uncomfortable with tourniquet use in a wilderness scenario where extraction may be delayed, let alone a shtf scenario in which hospitals and ORs may be unavailable for a period of days. Amputations due to tourniquets are extremely rare in the post-MASH era precisely because the emergency medical system is so cautious about their use. You can argue overcautious, but you can’t use the success of that caution to make the point.
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Mar 28, 2023 16:24
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orange juche posted:Tourniquets are very much "Your limb or your life" situation. When I was trained in first aid in the military, they told us that if you put a TQ on, and the person did not get evacuated to proper care very quickly, they were going to lose the limb, basically guaranteed. This isn’t how the military trains tourniquet use any more, at least in combat lifesaver classes. There’s a lot of data from the GWOT showing most preventable deaths are from extremity hemorrhage or tension pneumothorax, so CLS is extremely aggressive about tourniquets and needle decompression and all the cool tactical medics are carrying CATs and ARS needle decompression kits on them at all times and blah blah and that poo poo filters into all the mil-cosplay-adjacent gear space. Which, I can acknowledge, is what this thread is for. The disconnect is, life-threatening extremity hemorrhage is not that common in civilian EMS, and is usually adequately managed without TQ when it occurs. TQs are great when you’re under fire and need to definitively treat the injury as quick as possible so you can return to combat, but they’re usually unnecessary if you have time to properly assess and treat your patient, and there are significant costs to both the patient (risk of ischemic injury) and hospital system (resources required to treat an otherwise simple injury) if they are overused. Tension pneumo, by the way, is an actual loving unicorn - if you surveyed all the career medics at my company, you might find half a dozen who had ever decompressed a chest. I saw a single case of pneumothorax (non-tension) in six years, which was pretty cool, but the only reason I even caught it was because the guy went to sleep off the liquor he’d drank before falling down the stairs, so the injury was around 12 hours old and there was a significant amount of subcutaneous air. I did not decompress this individual, but they did let me stick around in the ER to watch the chest tube get put in.
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Mar 29, 2023 01:59
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