medic bags

[isuhawkeye]

I know similar topics have been posted before, but I couldn't find them.

What does everyone carry for a first aid kit?

Heres Mine

[JohnKachenmeister]

I carry a small commercial one that I gutted out the stuff I didn't need and added stuff, like extra 4x4's, that I did need, and I keep it on my survival vest.

My aircrew survival vest + Gall's street pro equipment bag with CAP forms and stuff in it = my 24-hour pack.

The team kit is a lot more extensive, as is the one in the aircraft.

[Stonewall]

Here's mine.  Blackhawk "Special Operations Medic Bag".  Got it free.

If I'm humping a ruck sack in CAP, as in my 72hr gear, I'll use the Combat Lifesaver Bag.  Here is an excellent link to the CLS bag and its contents:  http://www.usamma.army.mil/documents/NEW%20COMBAT%20LIFESAVER%20BAG%20(21SEP06).pdf

[SJFedor]

I know similar topics have been posted before, but I couldn't find them.

What does everyone carry for a first aid kit?

Heres Mine

Is that a bottle of nitro there next to the trauma shears?

I don't see it in there, but you should try to acquire a manual BP cuff to use along with that stethescope.

Especially if that is nitro 

[Stonewall]

I bet they're water purificaiton tablets.  With that strobelight there, it looks like a combo first aid/survival kit.

[SARMedTech]

Stonewall-

You pick  on me about be a medical battle rattler?  Its on now! Im getting Blackhawk's Enhanced ALICE for my med kit  .

Where's your defib,  brother?

[Stonewall]

Where's your defib,  brother?

Used to carry one.  While I got away with a lot of "free" or "donated" gear from my gig in DC, an AED was not something I could accidentally throw in a box when I cleaned out my locker.

[SARMedTech]

Thats funny. Mine fell off the back of a truck. Is the epi pen for cadets who fall asleep during table-tops?

[Stonewall]

Is the epi pen for cadets who fall asleep during table-tops?

When I got that epi-pen, I got a set of 3.  I had my med kit on the floor with everything spread out so I could organize it before putting it into my bag.  I fell asleep and when I woke up, some gauze, an ice pack and an epi-pen had been mauled by my dog.  There was no "juice" left in the pen, so I'm guess my dog ran a marathon in my house while I slept.

[SARMedTech]

Is the epi pen for cadets who fall asleep during table-tops?

When I got that epi-pen, I got a set of 3.  I had my med kit on the floor with everything spread out so I could organize it before putting it into my bag.  I fell asleep and when I woke up, some gauze, an ice pack and an epi-pen had been mauled by my dog.  There was no "juice" left in the pen, so I'm guess my dog ran a marathon in my house while I slept.

I know your using it for a "crucible."

[isuhawkeye]

This is my "Tactical ALS" Bag.  tis from a company called Pro Med Kits (www.promedkits.com).  Ive put this bag through the hardest work.  If you notice black hawk borrows many ideas from these guys.

[Stonewall]

[company called Pro Med Kits (www.promedkits.com)

Holy smokes, their site rocks.  Looks like awesome gear!  Thanks for the link...

SARMedTech, you may want to send back that blackhawk bag you got...

I only have the blackhawk med bag cuz I got it free...

[isuhawkeye]

My blog: www.isuhawkeye.blogspot.com has a few more pics of the pack.

I also love the Battle pack.  Black hawk totally stole the design. 

[Stonewall]

I ain't gonna lie bro.  Your blog is one of only two blogs that I visit on a regular basis.  Been checking yours out off and on for a few months now.  Quality work and I appreciate the work you've done on it.  You definately know your shtuff.

As for Blackhawk, I've never been a huge fan.  As I said in this discussion  http://captalk.net/index.php?topic=1912.0 they've copied most of their gear from other companies to include the original high speed gear companies (military wise) like London Bridge Trading Company and Eagle Industries.  But when my last company bought everything they had to offer, I had no choice.  And I may be picky with gear, but free gear is the best gear.

[isuhawkeye]

thanks for the compliment. 

I don't get much feedback on that site, so I never know if it is useful to anyone.

[Stonewall]

I took a poll once, but didn't see the result so I wasn't sure if it worked or maybe I screwed it up.

[isuhawkeye]

As you know I have been playing with the polls.  Don't have them all figured out yet

[SARMedTech]

I think Im in love with PMK's thigh rig, though I would probably buy it unstocked in order to fill it with the gear that I prefer to use, as far as particular brands, etc. I can really see much including a drag stratcher (with the possible exception of a c-collar that we couldnt get in that thing that would suit our needs both for team care and rehab and lost person care. Now if I can just find an inexpensive pulse oxymeter.  On a side note, are Squadrons allowed to solicit donations of gear? 

[isuhawkeye]

SARmed tech,

The Battle Pack come stocked, and it is great (especially for the tactical environment).  The ALS thigh bag which is larger comes empty. 

These guys should pay me for this testimonial

[flyerthom]

Resume: Volly and paid EMS since 1980, RN Since 1990 mostly ER and ICU, currently a Flight Nurse.

I carry:

1 multi tool
1 pocket knife
4 pairs medium Nitril gloves
1 pocket mask
1 face shield on my key ring.
1 cell phone.
1 pen
1 note book
various gauze rolls
some 4x4's
feminine napkins.
Most of it stuffed into one of those cloth brief cases we got at a national conference.
total cost was less than on of those pre packed band aid cases sold for OSHA compliance.

It takes up very little space. organizes easy and is portable if needed.
what I do not carry

any ALS supplies. Anything invasive such as needles, IV's, intubation equipment, scalpels, epi pens, medications (even OTC's).  Not worth getting sued.

[SARMedTech]

Resume: Volly and paid EMS since 1980, RN Since 1990 mostly ER and ICU, currently a Flight Nurse.

I carry:

1 multi tool
1 pocket knife
4 pairs medium Nitril gloves
1 pocket mask
1 face shield on my key ring.
1 cell phone.
1 pen
1 note book
various gauze rolls
some 4x4's
feminine napkins.
Most of it stuffed into one of those cloth brief cases we got at a national conference.
total cost was less than on of those pre packed band aid cases sold for OSHA compliance.

It takes up very little space. organizes easy and is portable if needed.
what I do not carry

any ALS supplies. Anything invasive such as needles, IV's, intubation equipment, scalpels, epi pens, medications (even OTC's).  Not worth getting sued.

While I respect your opinion and I do not carry needles, IV or intubation gear either (I consider an epi pen a needle) my preference is not to let someone die when I can avoid it. Taught us that in EMT school, they did. Here is my order of operations: human life--->fear of getting sued--->fear of getting 2b'd.

Medical Gear: Mostly pretty cheap
Getting Sued: Expensive
Cost of a 14 year old cadet: Priceless

They may 2b me and sue me, but I would rather be judged by 12 than have some I could have helped be carried by six.

And by the way, using a feminine napkin as a pressure dressing makes it a pressure dressing. Would you use a field expediated stick and cloth tourniquet?  I happen to think the CAT makes more sense and guess what, they do the same thing only one always works and one does once in a while if your lucky AND good. And before the inevitable argument: Im right and youre not.

And by the way, what are you going to do with that multi-tool?  Field tooth extractions? The only difference between a person who says that they will carry the right gear for the right job and the one who says he's gonna use feminine napkins is that one is too scared of an antiquated regulation to function properly with gear designed to do the job and one isnt. Again, if what your thinking is that as long as you stick to "first aide" so you dont get in trouble, I urge you to read the American Red crosses list of injuries requiring first aide...includes little things like field reduction of a broken femur to prevent loss of a leg later in some podunk OR and measures to prevent shock and treat serious burns. Tell me, what in your slapdash kit is going to stop the heat of a second degree burn? Pen? Notebook? Cell Phone?

And application of a tourniquet is first aide, so why improvise when the right tool is in my pack. Thats like saying I will carry a Daisy Air Rife and a box of .177 pellets to Iraq when perfectly good rifles are provided or if I see a drowning man, I will toss him a the milk jug that is sitting right next to a USCG approved life ring or belt.

Will you stop performing CPR when costal cartilage crackles for fear of being sued?

"So Others May Live"

[Duke Dillio]

I personally use the Statpacks Golden Hour pack to carry the following:

Stethoscope and BP kit
EMS tool kit (trauma shears, bandage scissors, penlight, hemostat, folding knife, tourniquet)
CPR mask with O2 inlet
SAM Splint
Burn kit (petro gauze, burn gel)
One set of oro tubes
Dressing kit (mixed band-aids, Kerlix, ace bandages, abdominal pads,2X2's,4X4's)
Some other miscellaneous equipment such as medical tape, notebook, pens, extra batteries for the penlight, and a couple of tampons.
I do carry an assortment of OTC meds like aspirin, benadryl, etc.

I used to carry an IV set but do not carry one anymore.

My feeling on Epi pens is that if someone has a medical condition requiring such a medication, they can carry it themselves.  I just ask where they carry it so I know where it is in the case that I have to administer it to them.  If I were truly worried about the prospect of being sued, I would ask all parents to sign some sort of form letter allowing myself or another senior to dispense the OTC meds, but normally I sit the parent down when the cadet first shows interest in ground ops and talk to them.  I tell them what we carry with us on missions and ask them if they have any concerns.  I haven't had any problems in the past and I am hoping that this continues into the future.

[flyerthom]

While I respect your opinion and I do not carry needles, IV or intubation gear either (I consider an epi pen a needle) my preference is not to let someone die when I can avoid it. Taught us that in EMT school, they did. Here is my order of operations: human life--->fear of getting sued--->fear of getting 2b'd.

Medical Gear: Mostly pretty cheap
Getting Sued: Expensive
Cost of a 14 year old cadet: Priceless

They may 2b me and sue me, but I would rather be judged by 12 than have some I could have helped be carried by six.

And by the way, using a feminine napkin as a pressure dressing makes it a pressure dressing. Would you use a field expediated stick and cloth tourniquet?  I happen to think the CAT makes more sense and guess what, they do the same thing only one always works and one does once in a while if your lucky AND good. And before the inevitable argument: Im right and youre not.

And by the way, what are you going to do with that multi-tool?  Field tooth extractions? The only difference between a person who says that they will carry the right gear for the right job and the one who says he's gonna use feminine napkins is that one is too scared of an antiquated regulation to function properly with gear designed to do the job and one isnt. Again, if what your thinking is that as long as you stick to "first aide" so you dont get in trouble, I urge you to read the American Red crosses list of injuries requiring first aide...includes little things like field reduction of a broken femur to prevent loss of a leg later in some podunk OR and measures to prevent shock and treat serious burns. Tell me, what in your slapdash kit is going to stop the heat of a second degree burn? Pen? Notebook? Cell Phone?

And application of a tourniquet is first aide, so why improvise when the right tool is in my pack. Thats like saying I will carry a Daisy Air Rife and a box of .177 pellets to Iraq when perfectly good rifles are provided or if I see a drowning man, I will toss him a the milk jug that is sitting right next to a USCG approved life ring or belt.

Will you stop performing CPR when costal cartilage crackles for fear of being sued?

"So Others May Live"

Well lets see, considering everything I carry is proven by time and experience and has saved more than one person you are way off base. As for familiarity with Red Cross AFA and "First Aid" I've been on an Ambulance since 1980 and a RN since 1990 most of it ER and ICU now Flight Nursing and Ground Ambulance. I've been through Red Cross Advanced First Aid (now gone) EMT-B, EMT-B instructor, PHTLS, TNCC, ACLS, now ACLS instructor, PALS, NRP, 15 module EMT-P for my Prehospital Nursing (cert in PA - license in NV). ATLS audit yadda yadda...  And before the inevitable remark - maybe it's time to listen and learn before you hurt someone.  Why use a cloth and stick tourniquet? Because it works - every time. Because it distributes the pressure yielding less long term tissue damage and over a greater surface area thus giving a better result.  A thin yank and tug device causes tissue necrosis, nerve necrosis, decreases the chance for re implantation and more often than not does not staunch the blood flow as effectively.  Do no harm, taught me that in EMT school they did. There's a big difference between carrying the "right gear" and carrying stuff for the coolness factor.

Multi tool - multiple uses, all it requires is critical thinking skills.

There's a big difference between carrying the "right gear" and carrying stuff for the coolness factor. There have been many great innovations since I began this profession. Hare and Sager traction splints are two great examples. But there's been as many things rushed out there were the next great thing that have been detrimental (MAST trousers, the Thumper).  The CAT is not used in any ambulance I work on, helicopter I work on or ER I've worked in. Pretty telling. Commercial tourniquets are not used.

Anyone who's been around EMS or "First Aid" will tell you - there is no ALS without good BLS. All the toys in the world do not make good care. I've been to more than one scene when someone with their portable OR was wrapping up a minor wound while the person with the compromised airway was being ignored.

As for that 14 year old cadet - I spent Sunday at my job working my *** off trying to save a 14 year old GSW. Not my first - won't be my last,  but considering that, your last remark was beneath contempt. This is what I do for a profession and that remark was like a 200 hour PP SEL trying to tell an ATP how to fly his jet.  When you can match my credentials you might get away with it, but by then you'll have grown beyond it,


I applaud your enthusiasm  :clap: But success in EMS requires the ability to learn from the experience of others. I've learned that the stuff that is pretty in the catalogues isn't always the best when the rubber meets the road. My kit is simple because it works - every time, proven in action with more than one person still here and with all thier parts.


If you are planning to be around EMS and SAR for a while I recommend:


Medic Life , Creating Success in EMS
Discuss career growth, stress and professionalism.
and
60 second EMT - Rapid BLS/ALS Assessment, Diagnosis and triage
Discusses things like across the room assessment, the need to rely on your head ,and good basics.  not your gear . This is what makes a good clinician - not what's in the bag.

[Stonewall]

Hey, come on, everyone knows looks count.  If you do nothing else right, just sit there and look good.  It's worked for me all around the world.   

FWIW, my training and experience as an EMT-B, Army Combat Life Saver, and now Air Force Self Aid and Buddy Care Instructor has been put to use on limited occasions.  Sure, I've been on 2 different VFDs, but mostly my attention was and is focused on battlefield injuries. 

For the 5 years I spent roaming the globe on a protection detail, there were often times that me and my fellow EMTs (were all EMT-Bs, 1 EMT-P and 1 18D) held the highest level of medical training and carried more gear than the local hospital.  I'm talking places like Laos, Cambodia, Rwanda, and East Timor.  So yeah, we had medical direction under our own agency, an international institution.  Our mission was not just to keep our principal from being shot, but save him from embarassment and prevent/treat sickness due to local conditions.  O2, AED, a few prescribed drugs, epi, IVs, and some other stuff I've since thrown out, were what we carried.

I have personally maintained my status as an EMT in Florida, Virginia and/or nationally since 1991.  Right now, it's only current with Virginia.  Not a big deal though because at this point, I'm here to stop bleeding on a guy that I may have just shot now that I'm a cop.  As a CAP member, I think it's important to draw from as much experience as possible, whether it be medical or leadership.  But it is important to remember that just because one guy does it one way, and it works flawlessly, doesn't mean the other guys' way is stupid.

There is a lot we can learn from each other here, so let us all sit down and have a slice of humble pie and drive on. 





PS:  Free gear is the best gear you can get...

[SARMedTech]

Carrying the right equipment has nothing to do with looking cool. It has to do with the fact that if the right gear is available, improvisation is not necessary.

And by the way, the stick and cloth tourniquet has the same possible complications and potential for nerve and tissue damage as the CAT. With both it is a matter of proper useage and knowing when the decrease the pressure on the tourniquet. Your gear may be inexpensive, but when the chips are down, you get what you pay for. I dont carry garbage gear. Should I do anything less than provide the highest quality care with the best gear available to me? To not do so is like using a hack saw blade for motor vehicle extrication when an extrication saw is on the truck.

What I carry is a duplicate of the CLS pack list, with the exception of things that we have no need for or things above my protocol.

When I am in the field, I practice neither BLS or ALS. I practice what I call FLS: Field Life Support.

You are also making the assumption that I dont have the credentials or experience to allow me to render excellent care. This is also what I do for a living on 5 teams including volunteer fire and rescue, two seperate ALS crews and two TacMed teams.

[Duke Dillio]

Well, that's interesting because I am being yelled at and all I was doing was answering the initial question about what I carry.  So since the personal attack is going, here would be my appropriate response.

First off, I hate nurses.  I worked with them in the ER when I was a tech in Colorado Springs and all I got was a lot of guff and stingers because all I had was a "field license."  The fact of the matter was that I could draw blood from a turnip and most of them were jealous of that fact so I had little respect for people that wanted to play politics and forget about their patients.  I am not saying that you are a bad nurse and I am sure that you are probably better than any of the nurses that I have ever met.  I am simply saying that I have a definate prejudice against nurses.

Next, I have a good lot of experience in the field with the CAP, with AMR (the local ambulance service), and with the Army.  Like Stonewall, I was a combat lifesaver, a combat lifesaver trainer, a nationally registered EMT, and a volunteer firefighter.  I might have done things for the look of it when I was younger but I now have enough experience to know that carrying an AED, an IV setup, and a full airway kit gets heavy and I have never really had any reason to use any of that stuff.  The equipment that I carry in my StatPacks bag is basically bare minimum stuff that I have used on missions in the past.  I don't carry a c-collar although I really should think about getting some for my vehicle.  I don't carry one of those huge metal rescue baskets or a spinal board.  There is simply no reason to.  If I need these things, they can be air dropped with a pair of paramedics if needed.  I have just enough equipment to care for 4 victims for 24 hours max.  As for the multi-tool, I don't need one in my medical pack because I carry one in my ground team gear.  I always recommend carrying the EMT trauma shears because I have never been able to get one of those seatbelt cutters to work and you can cut a penny with them if you want to.

My suggestion would be that before you go attacking someone saying that they are carrying things for show or that they don't know what they are doing, perhaps you should think that maybe they have had some different experience than yours.  My job is not to operate on people in the field.  I'm not really there to stabilize or treat major wounds.  I am simply there to provide primary pre-hospital/first aid care and ship them to professionals like you who can seal them up.  It worked when I had to save my family and I am sure that this pack will work for anything else that I need to do.

[flyerthom]

Well, that's interesting because I am being yelled at and all I was doing was answering the initial question about what I carry.  So since the personal attack is going, here would be my appropriate response.

to do.

I misquoted - then edited. It was for sarmed tech. My apologies.

[Duke Dillio]

Well, that's interesting because I am being yelled at and all I was doing was answering the initial question about what I carry.  So since the personal attack is going, here would be my appropriate response.

to do.

I misquoted - then edited. It was for sarmed tech. My apologies.

No problem.  No hard feelings.  I'm cool, I'm cool.  *strutting*   

[flyerthom]

Carrying the right equipment has nothing to do with looking cool. It has to do with the fact that if the right gear is available, improvisation is not necessary.

And by the way, the stick and cloth tourniquet has the same possible complications and potential for nerve and tissue damage as the CAT. With both it is a matter of proper useage and knowing when the decrease the pressure on the tourniquet. Your gear may be inexpensive, but when the chips are down, you get what you pay for. I dont carry garbage gear. Should I do anything less than provide the highest quality care with the best gear available to me? To not do so is like using a hack saw blade for motor vehicle extrication when an extrication saw is on the truck.

What I carry is a duplicate of the CLS pack list, with the exception of things that we have no need for or things above my protocol.

When I am in the field, I practice neither BLS or ALS. I practice what I call FLS: Field Life Support.

You are also making the assumption that I dont have the credentials or experience to allow me to render excellent care. This is also what I do for a living on 5 teams including volunteer fire and rescue, two seperate ALS crews and two TacMed teams.

My gear is field proven. Review the journals. Commercial tourniquets are no more easy to use and often less so. Narrow band commercial tourniquets do more damage. And how many have you ever needed anyway? And just where did you get a "Field" life support certification? Sounds to me like a cowboy attitude. That's what CAP is afraid of legally. People with cool toys going out and doing "Field" skills.

Have you done ACLS, PALS, PHTLS? These courses really hone the provider. And all of them reinforce good BLS is primary. Not toys, not the latest and greatest but what really gives the best and highest quality care - your head.  Just because the catalogue says something is the best gear doesn't make it so. Just because it's premade doesn't make it so. What is the clinical evidence?

Do read those books I recommended. When I taught EMT I always endorseded them and still do when I have medic students doing skills and nursing students at work.

[SARMedTech]

Carrying the right equipment has nothing to do with looking cool. It has to do with the fact that if the right gear is available, improvisation is not necessary.

And by the way, the stick and cloth tourniquet has the same possible complications and potential for nerve and tissue damage as the CAT. With both it is a matter of proper useage and knowing when the decrease the pressure on the tourniquet. Your gear may be inexpensive, but when the chips are down, you get what you pay for. I dont carry garbage gear. Should I do anything less than provide the highest quality care with the best gear available to me? To not do so is like using a hack saw blade for motor vehicle extrication when an extrication saw is on the truck.

What I carry is a duplicate of the CLS pack list, with the exception of things that we have no need for or things above my protocol.

When I am in the field, I practice neither BLS or ALS. I practice what I call FLS: Field Life Support.

You are also making the assumption that I dont have the credentials or experience to allow me to render excellent care. This is also what I do for a living on 5 teams including volunteer fire and rescue, two seperate ALS crews and two TacMed teams.

My gear is field proven. Review the journals. Commercial tourniquets are no more easy to use and often less so. Narrow band commercial tourniquets do more damage. And how many have you ever needed anyway? And just where did you get a "Field" life support certification? Sounds to me like a cowboy attitude. That's what CAP is afraid of legally. People with cool toys going out and doing "Field" skills.

Have you done ACLS, PALS, PHTLS? These courses really hone the provider. And all of them reinforce good BLS is primary. Not toys, not the latest and greatest but what really gives the best and highest quality care - your head.  Just because the catalogue says something is the best gear doesn't make it so. Just because it's premade doesn't make it so. What is the clinical evidence?

Do read those books I recommended. When I taught EMT I always endorseded them and still do when I have medic students doing skills and nursing students at work.

First- yes I have completed the courses you named. Several years ago and I take refreshers on them about every other year from different providers to try to make sure that the information and skills I am getting are current and the best available.

I dont consider the CAT a toy any more than I do an AED or QuikClot. While all have their shortcomings and complications (ALL medical devices and procedures do) they reflect the best practices now, in 2007. The interesting aspect about all three of these innovations is that they eliminate the necessity for what I call "R and F" medicine: rummage and forage medicine. Do you know where the CAT came from? One of its chief designers was (Col.) Dr. Greg Joillisaint at TRADOC at Fort Monroe, VA helped to develop it because he realized that the true enemy in terms of wounds on the battlefield was having to go looking for bits and pieces to assemble a tourniquet. It was designed because research told him there arent a lot of sticks laying around on the desert in Iraq. At least thats what he said in the journal entitled US Medicine in 2005. He also realized that when you use a handkerchief or other piece of bandage to make the old boy scout tourniquet it can RAPIDLY become soaked with blood, causing it to stretch thus creating the need for continually tightening and adjusting. Its also difficult to use by yourself. In addition, the traditional thinking that a tourniquet needed to be the method of last resort and that it needed to be loosened every 15-20 minutes. With your experience, I am sure you have tried to work with crusty and blood soaked bandages. Not always easy. Since we now know that muscles can exist with diminished oxygenation via circulation in an emergency setting for somewhere in the 2-3 hour window, we know that when we apply the CAT we dont have to keep fiddling with it. Dr. Joillisaint also states that if tissue was going to be viable, that is saved, after massive bleeding amputation or partial amputation, it will usually still be able to be saved at the end of that two to three hour time frame. Always? Of course not. No such word in medicine.

I recently participated in a field medicine training weekend (notice that in my previous post I said I called it Field Life Support, not that it was a certification) in which I taught the use of the CAT. I handed another responder a pressure dressing and gave him an extra present...chopsticks from the Chinese restaurant where we had eaten the night before. I told him to use these as he would sticks found in the field. Only thing was, I put them 20 feet away from him and told him he had a severed femoral artery secondary to a femur fracture and was bleeding out. I had him watch where I laid the chopsticks and then had him start out to find them, opening and closing his eyes every 7 seconds or so to simulate the altered mental status that accompanies shock. I simulated the same injuries, but had a CAT in the first aid pouch on my belt.  22 minutes later he had his improvised tourniquet in place sufficient to arrest bleeding.  My total time with the CAT including getting it out of my aid kit? 1 minute, 14 seconds. What do you suppose would have been his condition after 22 minutes of fiddle-farting around with that improvised tourniquet?  Shall we talk about feminine hygiene products vs actual field dressings next?

You see the things you mentioned are good...if you have nothing else. But when the right tool for the job is available, why improvise? Soldiers are taught to improvise when nothing better is available, when no other technique at their disposal will work. It is possible that the CAT will cause necrosis you mention. Col. Joillisaint disagrees but I believe it is possible. But here is the test: which would you rather have? Someone with necrotic tissue or a dead body? You dont need a chaplain to explain necrotic tissue to a family.

[Major Lord]

The only times I have had to use a tourniquet in the field, I just used a BP cuff. They are also good for pressure dressings.  The downside is that the responding agency makes off with it and you never see it again! How many tourniquets do you think you might need? ( In all fairness, I have had to use clamps on blood vessels in the field, which is a lot more controversial than tourniquets!)

Major Lord

[SARMedTech]

The only times I have had to use a tourniquet in the field, I just used a BP cuff. They are also good for pressure dressings.  The downside is that the responding agency makes off with it and you never see it again! How many tourniquets do you think you might need? ( In all fairness, I have had to use clamps on blood vessels in the field, which is a lot more controversial than tourniquets!)

Major Lord

I also have used BP cuffs are tourniquets, though in the back of an ambulance. I have not yet needed to use a CAT or any other tourniquet in a CAP environment and really hope I never do. Like you, Major (congrats on the upgrade by the way) Ive used clamps to staunch bleeding. The femoral artery has a nasty habit of retreating up into the body when its severed and unfortunately, none of the crews I have ridden with have been equipped with vascular clamps, an entirely different animal than a kelly, which I carry in the "MVA Go Pouch" on my EMS duty belt along with a ring cutter, shears (bandage and trauma) seat belt cutter (which I recently replaced with a good lock blade) and a bunch of nitriles and a center punch.  I wonder if you could use a center punch to put in a burr hole. 

[flyerthom]

Thanks for tuning it down. It seems we've strayed away from the original topic into a different debate. I will also admit I have a bias against commercial tourniquets because I've seen more than one applied wrong, inappropriately and to the patients detriment. A simple one is easier to remove safely and rapidly.  Picture if you will, a two inch superficial lac to a wrist with a tourniquet applied over the bicep! We do need to remember, we're not doing battlefield medicine. In well over 20 years of EMS the only tourniquets I've used were on industrial accidents. I don't think CAP will need to be there. We're far more likely to run into a bleeding dialysis graft where a tourniquet is to be avoided.  A last consideration is, in traumatic amputation veins and arteries will self constrict thus a self tamponade . No need for a tourniquet.

Not everything new is a best practice. In the 80's and 90's MAST trousers were the latest and greatest. It was rushed into the field without much research. The studies that followed showed it was not what it was purported. Many departments have pulled it from their units. It is no longer required for CAAS and CAMTS certification.  I'm not convinced the CAT is a best practice - yet. One person may say it's good. Is it Peer reviewed? PM me with info- journal articles on it.

Getting back to the original topic what's in our kits for CAP or in our car (not what's at work). A kit applies organization. My stuff is where I know where it is. There is no rummage and hunt. And, maybe it's because I've used them, the simple ones are not difficult to do yourself.  It's a matter of training, like anything else.  Kits are also defined by our mission. I'm air crew in CAP. I'm not out in the woods. And when I'm in the car I'm not doing a prolonged resuscitation, I'm doing basics and START triage till EMS arrives. In our graded  SAREXes we've always had good comments on our medical emergency because we did good basics and an ICS 206 form and planned.

One other consideration is cost. Not everyone in CAP has enough spare cash to buy commercial.  Coming in they have to buy uniforms, application fees, membership dues etc. Now we add field gear, safety gear and others. Simple and effective comes to mind, The person needs to buy what he needs and can use, not what he might need just maybe. If he trains with it and - trains like he'll fight so he'll fight like he's trained - it well be just as effective. Not everyone on that ground team is an advanced provider. We need to help them get things they can use at their level.