Thigh Rigs

[hatentx]

There's no such thing as too much medical gear........

May be but there is packing the right kind of gear.  If I packed my aid bag that I carry while I am down range that is a lot of over kill for what I am going to need for CAP.  I am not really going to see gun shots or severed limbs on a CAP mission.  Nor am I going to need to give someone a bag of fluids really.  If they are going to bleed out they will have done so well before I can get to them unless I see the a/c go down then 911 is the better choice and I will just control bleeding best as I can.  But for me to carry and abdominal wound pad in my CAP gear is just wasted space.  You can always argue that there is that one time, but if that was the case then pack me an AED and O2 bottle and everything else in the ER.  Again I am looking for fractures, control bleeding, preventing shock and the stuff of this nature.  Oh yeah and I carry a bunch of nose tubes.  I can never remember what they are called.  As long as they are breathing, not bleeding, not moving a broken limb and not in shock for me as a GTM I am happy and will pack accordingly.  The extra is for the Cadet that twisted an ankle or cut himself for what ever reason or is deydrated

[SJFedor]

There's no such thing as too much medical gear........

You've seen the picture of the cadet with the boombox duct taped to the back of his pack?

Imagine the guy walking around with an LP12 on the back of his pack. That might be too much....

But you're right, there's really no such thing as too much. There's only having too much of the stuff you're not qualified/proficient/trained to use.

[JayT]

Exactly.

We had a cadet show up with an OPA kit once, and thought they were finger splints. They were in his thigh bag.

[SJFedor]

Exactly.

We had a cadet show up with an OPA kit once, and through they were finger splints. They were in his thigh bag.

Ahahahaha. I just fell out of my chair on that one, but I seriously don't doubt it.

Though, no lie, an 8.0 ET tube makes one heck of a good straw when you wanna consume beverages in a hurry. 

[JayT]

Combitubes work also, althrough the flow tappers off near the end.

Does anyone have any experience with that quickclot stuff?

[sarmed1]

I use the thigh rig on my TEMS rig and am pretty happy with it, not to much bulk, just enough to immedietly manage a causulty.  Pretty similar to the one posted, but I packed mine myself.
years ago an SF medic in a regular leg guard unit clued me in on the "battle" pack concept of bag, or vacum packing all the stuff to manage a single casualty.  I have made them myself for numerous areas that I work in Fire, EMS, CAP and the military.  I have kit A & B. 
Kit A:
NPA w/ lubricating jelly
kerlex
5x9 dressing
ACE wrap
vaseline quaze (for chest wound seal)
Tape
Cravat
(its simple and cheap and easily "acquired")
(if I had easy access to quick clot and CAT tourniqets I would add them too)

Kit B:
100cc IV NSS
Tubing
Heplock
Start kit
16, 18, 20 gauge IV catheter
14 gauge 2" catheter
5cc syringe

I have seen quick clot used in animals and am convinced it works, femoral artery laceration and qucik clot with a pressure dressing stopped the bleeding. (in that case it was the older style powder rather than the pocuh/hackysack type but principally the same)

mk

[hatentx]

I have seen quick clot in real life.  Leg severed mid calf.  One guy strapped a turnicet on above the knee while the other was using the quick clot on the exposed stump.  I turned around to help move a casualty to a gator and by time i turned back to see what was going on with the person the bleeding was stopped.

[Eclipse]

Does that quick clot stuff cause any issues for the patient post-trauma when they are trying to clean things up permanently?

[SJFedor]

Does that quick clot stuff cause any issues for the patient post-trauma when they are trying to clean things up permanently?

I'll be sure to ask one of the trauma surgeons tonight, but from my limited observing (only seen 2 people that have had it used on them pre-arrival, we don't use it in facility) no, it didn't matter. Once they're in the OR, they can just rip the clot out if they need to.

[Flying Pig]

I personally didnt like the thigh rig.  It was uncomfortable.  I ended up switching to a Blackhawk backpack.  As it was I had a pistol on one thigh and flashbangs on the other thigh.  I had a body armor vest that had clips on the shoulders that attached to the backpack straps.  I could unclip one strap and the back pack would swing around in front of me.  Of course, we are rarely if ever in the position where we cannot just remove the back pack and arent concerned about running with our gear.
Hoonestly, stick with the backpacks.  Especially when you are tromping through the woods, having stuff strapped to your legs can really be a pain in my opinion.

[Johnny Yuma]

I personally didnt like the thigh rig.  It was uncomfortable.  I ended up switching to a Blackhawk backpack.  As it was I had a pistol on one thigh and flashbangs on the other thigh.  I had a body armor vest that had clips on the shoulders that attached to the backpack straps.  I could unclip one strap and the back pack would swing around in front of me.  Of course, we are rarely if ever in the position where we cannot just remove the back pack and arent concerned about running with our gear.
Hoonestly, stick with the backpacks.  Especially when you are tromping through the woods, having stuff strapped to your legs can really be a pain in my opinion.

Hey, I wanan go out on YOUR ground team!

Nothing says "here I am" like a couple flash bangs!

[cap235629]

oh yeah and a twix bar 

You were taught well.  In our Squadron it has become gospel that the team cannot do anything until Lt. Hobbs has his m&m's (plain!).

At the last training meeting 1 cadet brought them "just in case you forgot"

:clap: 

[SJFedor]

Does that quick clot stuff cause any issues for the patient post-trauma when they are trying to clean things up permanently?

I'll be sure to ask one of the trauma surgeons tonight, but from my limited observing (only seen 2 people that have had it used on them pre-arrival, we don't use it in facility) no, it didn't matter. Once they're in the OR, they can just rip the clot out if they need to.

Follow up:

It's effective stuff, but should be an absolute last line resort. The problem with that stuff is that, as it works, it has a really big exothermic reaction which can actually cause a lot of burns in the surrounding tissues.

[_]

Found this in my local REI store.  It's a Quick Clot Sponge.  The directions on the back shows the sponge being put over a wound and and a roller bandage being wrapped over it to hold it in place.  I guess they get around most concerns by making a product that's "for temporary external use."  They also had quick clot pads almost the same appearance as 4x4 pads.  They're supposed to be rolled up and inserted into the nose to control nose bleeds.

[Flying Pig]

I personally didnt like the thigh rig.  It was uncomfortable.  I ended up switching to a Blackhawk backpack.  As it was I had a pistol on one thigh and flashbangs on the other thigh.  I had a body armor vest that had clips on the shoulders that attached to the backpack straps.  I could unclip one strap and the back pack would swing around in front of me.  Of course, we are rarely if ever in the position where we cannot just remove the back pack and arent concerned about running with our gear.
Hoonestly, stick with the backpacks.  Especially when you are tromping through the woods, having stuff strapped to your legs can really be a pain in my opinion.

Hey, I wanan go out on YOUR ground team!

Nothing says "here I am" like a couple flash bangs!

  Ha.  Sorry.  I was just trying to explain that regardless of what it is in your thigh rig, they can be a pain.  But a Flash Bang sure beats a whistle and calling the victims name.  Of course, you may drive them deeper into the woods!

[openmind]

Does that quick clot stuff cause any issues for the patient post-trauma when they are trying to clean things up permanently?

I'll be sure to ask one of the trauma surgeons tonight, but from my limited observing (only seen 2 people that have had it used on them pre-arrival, we don't use it in facility) no, it didn't matter. Once they're in the OR, they can just rip the clot out if they need to.

Follow up:

It's effective stuff, but should be an absolute last line resort. The problem with that stuff is that, as it works, it has a really big exothermic reaction which can actually cause a lot of burns in the surrounding tissues.

We should probably have a separate thread on these HemoStatic Agents, but here is some quick info, which I present here since they are becoming much more widespread. (Evidence the pic above of them on the shelf at regular stores.)

1.  These items come in at least 3 major forms now:  Loose Granules, Contained Pouches/Sponges, and Treated Gauze/Treated Bandages.  Each has different risks and capabilities and are applicable to different wound types.  NOTE:  The risk of ExoThermic injury has been essentially eliminated from any product you purchase now.  Those risks, real but minor, were limited to the first generation of these agents.  Some of them still get warm, but not Hot.

2.  The Loose Granule types are the oldest, and should almost certainly be the LAST THING YOU TRY, either immediately before or after a Tourniquet, depending upon whether a Tourniquet is applicable to that wound site.  Have no doubt, you are introducing a foreign substance into a wound that CAN migrate away from the wound site.  The US Army has recently stopped their use of Granular HemoStatic Agents due to the risk of Hemolytic Thrombosis.  Essentially, a small bit of the Loose Granules could come loose, work its way up a vein, and cause a clot elsewhere in the body.  Not common, but it can cause a life-threatening complication.  This form of agent is truly meant for serious, life-threatening injuries, not common cut/scratch/bite wounds.

Brands include:  QuickClot, Celox, WoundStat

3.  The Contained Pouch/Sponge types are much safer, in that the material is contained and cannot migrate into the bloodstream.  For this reason they are more commonly sold over the counter and much more widely available.  They are also much more widely applicable to a variety of wounds.  For large lacerations, just pack the bag in like a wad of gauze and leave it.  The ER/ED docs will pull it out when the patient reaches care.  For smaller surface lacs the bag may simply be pressed against the wound continuously.  This works even on relatively small lacerations which normally wouldn't receive any HemoStatic treatment, reducing time to complete clotting and hence the time before hemostasis and a permanent dressing can be applied.  Be aware that use of these topical agents can lead you to dress a wound that needs stitches/staples and you should remember to use good judgement about having the patient seek proper medical care based on the wound characteristics (size, depth, location, etc.) OTHER than the amount of bleeding.

Brands include:  QuickClot ACS+, QuickClot Sport  NOTE: Celox-D is contained in a Dissolvable Bag, that does NOT contain the granules once introduced to the wound site.

4.  The Treated Gauze/Treated Bandage types are as safe as anything.  Their relative effectiveness may be lower than the Granular form, but they are undeniably easier to use.  Use them just like any other gauze packing or outer dressing.  They are not currently contraindicated for any normal skin lacerations, but as always, do not use them on the eyes and avoid using them in the mouth.  The Gauze form can be packed into a large wound just like normal gauze, then removed by the ER/ED docs.  The bandages can be used as normal.  When using either, remember that even with the HemoStatic Agent, it takes time for clotting to complete so leave the Gauze/Bandage in contact with the wound until the bleeding stops.

Brands include:  QuickClot Combat Gauze, Celox Gauze, Hemcon Bandage, Hemcon Kytostat BandAid, ActCel Hemostatic Gauze

Again, a full thread could be written on the uses and misuses of HemoStatic Agents in immediate aid situations.  I would remind everyone that you should always fully consider the ramifications of giving any medical treatment to anyone at any time.  You need to make the decision in an informed manner about whether they need this, and whether you will be the person to provide it.

All that said, my personal FAK that I carry on my person includes a couple of the small QuickClot Sport pouches and a Tourniquet, and my larger bags in my gear and in my car contain QuickClot Combat Gauze, Celox granules, Tourniquets, Israeli Battle Dressings, and lots of plain old cotton gauze.


openmind