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AR45fan
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Posted: 1/11/2013 5:07:15 PM
[Last Edit: 1/11/2013 5:08:51 PM by AR45fan]
Not sure if this is the right forum, I didn't see a first-aid forum but lots of first-aid discussions here so...

I teach school and I'm putting something together so I'm better prepared - just in case the worst happens. I don't think I need a full IFAK - we already have rubber gloves and Band-Aids coming out of our ears. What do I NEED to maybe keep a kid alive for 30 minutes until an ambulance arrives? Maybe just blood-clotting bandages and a tourniquet? If you have experience with these things, what are the odds I'll need an airway kit in a shooting?

Before you hit me with "training" - I know I need more training (I have basic first aid, CPR, and AED training) and will seek it out.

Thanks
trobertson5-0
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Posted: 1/11/2013 5:32:48 PM
A couple of CAT tourniquets,curlex,and a ACS bandage or 2 is about as good as you can do. That will stop extremity bleeding long enough to get real medical help there and may save their life.

You are not going to do alot better with a small kit and minimal training,but it's much better than wringing your hands and waiting while they bleed out.

TJR
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lasnyder
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Posted: 1/11/2013 6:11:44 PM
second what trobertson5-0 commented... a couple of the SF tourniquets... couple rolls of Kerlix and Kerlix gauze to pack off a wound... some self adherent tape like Coban... abdominal dressings.... Tampax....couple of Israeli dressings, especially the ones with the slider for a through and through.....I'm not medical but retired school teacher...

cut a pair of door stops for each of your inside opening doors... I used 2x2s with 550 cord to double loop over my external steel doors, though chain and a snap shackle would probably be better...my Seniors could not open the door, provided there was not any clearance where they could get purchase on the edge of the door.... blackout curtain for your door window..

as for the nasal pharangeal airway, you could probably get your school nurse to show you how to install... having one gives you an option

we had two RNs on duty, and they prepositioned trauma supplies in a couple of locations
AR45fan
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Posted: 1/11/2013 6:44:12 PM
[Last Edit: 1/11/2013 6:46:02 PM by AR45fan]
Originally Posted By lasnyder:
second what trobertson5-0 commented... a couple of the SF tourniquets... couple rolls of Kerlix and Kerlix gauze to pack off a wound... some self adherent tape like Coban... abdominal dressings.... Tampax....couple of Israeli dressings, especially the ones with the slider for a through and through.....I'm not medical but retired school teacher...

cut a pair of door stops for each of your inside opening doors... I used 2x2s with 550 cord to double loop over my external steel doors, though chain and a snap shackle would probably be better...my Seniors could not open the door, provided there was not any clearance where they could get purchase on the edge of the door.... blackout curtain for your door window..

as for the nasal pharangeal airway, you could probably get your school nurse to show you how to install... having one gives you an option

we had two RNs on duty, and they prepositioned trauma supplies in a couple of locations


My classroom door opens out so it can't be kicked in, but it has a big glass window. The kids in my building are K-5 so mostly very small little people. Not worried about them. Angry, urban parents with child-custody issues is my main concern. I don't know... my realistic possibility of stopping someone who's after MY kids is limited but if something happens elsewhere in the building (and 99% of the building is elsewhere) I'd like to do more than wring my hands and wait like trobertson said. We have a school nurse two or three half-days a week depending on the week and nothing resembling a trauma kit as far as I know. I'm just doing this on my own. Sort of afraid to mention it to more than a couple close co-workers. Don't want to appear a kook and end up on anyone's RADAR.
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Posted: 1/11/2013 6:51:54 PM
[Last Edit: 1/11/2013 6:52:53 PM by cfcw]
Not much special. I worked at a fire department that covered tons of housing projects. It was not unusual to run 2-3 GSWs in a 24 hour shift. Admittedly, most were small caliber but there was surprisingly little bleeding. We carried gobs of unsterile 4x4" gauze pads , and bags of 4" kling. 95% of the gunshot wounds were covered with 4x4s. We also kept a few abd pads and a couple of trauma dressings in the box.It wouldn't hurt to have a tourniquet but most bleeding will stop with pressure. Oral airway usage is also unlikely in a GSW (in a patient that's going to survive anyway) but they are cheap, so if you know how to use them, why not?.
Waldo
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Posted: 1/11/2013 6:58:45 PM
[Last Edit: 1/11/2013 6:59:01 PM by Waldo]
Depends where you get shot and with what. Hard to deal with compartment syndrome, from a first aid point of view. You pretty much need a cutter for that.




Those who ignore history are doomed to repeat it..
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Posted: 1/11/2013 8:05:04 PM
[Last Edit: 1/11/2013 8:25:25 PM by coal-cracker]
I'm a 68W/Combat Medic, currently serving in the USAR. I instruct CLS and IFAK classes to soldiers.
One of the first things we teach them is if they can learn to treat life-threatening hemorrhage (bleeding) and tension phnemothorax (sucking chest wound), they can save 95% of the preventable deaths due to combat trauma.
Now I'm not gonna expect you to learn how to dart/NCD a kid with a sucking chest wound, but covering the entry (AND EXIT) wound with an occlusive dressing (Halo chest seal) can mean the difference between life and death. As was mentioned above, most bleeds can be stopped with direct pressure/pressure dressing but knowing how to quickly apply a CAT (or similar) tourniquet could also be a lifesaver. We teach soldiers that when in doubt, tourniquet. (Civilian EMS is gradually coming around to more liberal tourniquet use.) If you wanna learn to OPA (oral airway) or NPA (nasal airway) it wouldn't hurt, though I'd lean towards NPA between the two. Just make sure you realize that NPAs (as well as OPAs) come in different sizes so plan your NPAs around the size/age group of the kids.

I'd keep at a minimum...
A couple CAT tourniquets
An Israeli Dressing/ETD or two
Kerlix gauze - you can never have too much
Halo (Occlusive) Dressings
2" med tape

TacMedicCO7
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Posted: 1/11/2013 8:44:22 PM
I teach high school.. I am a TCCC trainer as well. In my past life I was a Tactial Medic. I have a kit I keep with me.

I just started to think some more about this - I am not sure a CAT will work. The plastic part on the CAT frame may not flex enough stop arterial blood flow in the arm on a 5-10 year old. I would suggest a SWAT-T or SOF-T Wide for kiddos.

Just a thought.
Steven61
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Posted: 1/11/2013 8:52:41 PM
[Last Edit: 1/11/2013 8:55:11 PM by Steven61]
3 things you should know

1. bleeding and tourniquet.
2. tension pneumo
3. air way

the 3 preventable causes of death

know how to treat them...its easy

most importantly...dont delay transport to the trauma surgeon

I have trained 18D and 68W CONUS and in Afghanistan

other than those 3 things you should get them to the TS
readyornot
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Posted: 1/11/2013 9:20:11 PM
[Last Edit: 1/11/2013 9:24:45 PM by readyornot]
My wife is a teacher, she also keeps a tool kit (Framing hammer, nails, tape measure, screw drivers) in case she needs to ummm... aaah... fix something in the head with the hammer

ETA, here is the kit I always keep with me. I use a pencil bag I got at the dollar store for a bag



It's going to be epic!
SandHillsHillbilly
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Posted: 1/12/2013 12:52:02 AM
What about some quick clot z-fold and chest seals along with ab pads and some Israeli bandages. Like someone said a couple of adult tqs and a couple for kids.

I would to put some kits together and send them to my sister's school.
Tennessee Squire
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Posted: 1/12/2013 4:27:24 AM
Lot's of useful info here.

I'd stay away from a NPA if you've never been trained to use one, there may be cases you cause even further damage. I know it sounds silly, how hard can it be to shove a tube down a person's nose, but facial trauma is a delicate issue.

Get further training as soon as you can.
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Posted: 1/12/2013 4:51:36 AM
Subscribed.
palmetto
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Posted: 1/12/2013 10:16:17 AM
Originally Posted By Waldo:
Depends where you get shot and with what. Hard to deal with compartment syndrome, from a first aid point of view. You pretty much need a cutter for that.





This. Never saw anyone bleed out from a GSW. They bleed "in". Into the head, chest, belly, etc. Usually just see a little hole for an entry.

I guess if you start seeing more big rifle wounds you might see some extremities spouting blood, but a TK is of no use for most wounds to the body.
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Posted: 1/13/2013 1:22:08 AM
[Last Edit: 1/13/2013 1:23:05 AM by gasdoc09]
Originally Posted By SandHillsHillbilly:
What about some quick clot z-fold and chest seals along with ab pads and some Israeli bandages. Like someone said a couple of adult tqs and a couple for kids.

I think QuikClot / combat gauze is overrated. It's also expensive and it expires. You're in a school in CONUS. Delayed transport to definitive care is not really a risk. Nothing wrong with having the combat gauze, but if you have a budget, then that $40+ might be better spent on more compression dresings & tourniquets.


Originally Posted By palmetto:
Originally Posted By Waldo:
Depends where you get shot and with what. Hard to deal with compartment syndrome, from a first aid point of view. You pretty much need a cutter for that.

This. Never saw anyone bleed out from a GSW. They bleed "in". Into the head, chest, belly, etc. Usually just see a little hole for an entry.

I guess if you start seeing more big rifle wounds you might see some extremities spouting blood, but a TK is of no use for most wounds to the body.

People can and do bleed to death from extremity GSWs. Exsanguination from an extremity wound is by far the #1 cause of preventable combat deaths.

Outside of combat zones where delayed transport may be an issue, compartment syndrome is not a 1st aid / 1st responder risk. Stop the bleeding by any means, get to the hospital.
TacMedicCO7
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Posted: 1/13/2013 6:18:13 PM
I heard back about using tourniquets on small kids -

Col. Kragh (the tourniquet SME for the ISR) has identified no problems or concerns with the use of tourniquets on pediatrics. Obviously very small diameter extremities may be of concern if the are so small the devices cannot be appropriately applied, but in these cases, effective direct pressure bandages should be able to control the bleeding because the extremity is so small in diameter that you can generate the pressure needed circumferentially to control the bleeding.

So stock up on Olaes, ETD, or Izzy's for the little kiddos.

On other notes:
Combat Gauze is great, it is expensive (get creative about buying) but it works and saves lives.

As said above - Extremity Hemorrhage is the leading cause of preventable combat death - People do bleed "out". Even still if no blood hits the ground and all the blood goes "in" they are still bleeding out. The blood is no longer in the container, the blood vessels, where it is supposed to be, so they still bled out.

Time - Anyone who says because you are in a urban area time does not matter is a fool. Go back and listen to the unedited audio from Newtown (or any mass violence incident for that matter) there was/is long delay of getting EMS into the building. Unless your local agencies are using tactical medics do not expect a quick EMS response. April 2009 Pittsburgh, PA is another example of LEO's in an urban area and EMS not able to get to them. I just got done teaching a TCCC class to a church security team, they and their local LEO's know they will be by themselves in their building for a while waiting for EMS. In a large high school that is on lockdown it will take time to clear every room in the building by LE. If you have 60 injured, triage, treatment, and transport will take a while. All this time starts to add up and it is a killer. Plan for the worse and hope for the best, plan to be my yourself for a while and be ready to treat someone yourself if that is in your capabilities and part of your plan.

Stay Safe
palmetto
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Posted: 1/13/2013 6:39:45 PM

People can and do bleed to death from extremity GSWs. Exsanguination from an extremity wound is by far the #1 cause of preventable combat deaths.



That's an interesting stat. Is that GSW only, or does it include other trauma.

In days gone by I used to see a fair number of gunshot wounds, but never noticed a high percentage of wounded limbs. Usually some poor guy with a .22 hole in his chest or belly.. Not much to do in the field but haul ass to the ER.
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TacMedicCO7
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Posted: 1/13/2013 7:35:25 PM
The stat is from TCCC and refers to combat so yes the majority of wounds are gunshots but can include any penetrating trauma.

HERE is a great breakdown of the Three Leading Causes of Preventable Combat Death.
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Posted: 1/13/2013 7:52:37 PM
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AR45fan
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Posted: 1/13/2013 8:04:13 PM
Originally Posted By TacMedicCO7:
The stat is from TCCC and refers to combat so yes the majority of wounds are gunshots but can include any penetrating trauma.

HERE is a great breakdown of the Three Leading Causes of Preventable Combat Death.


Those statistics, with extremity wounds being the big killers in combat, is that due to the prevalence of body armor and explosives nowadays? In a mass civilian shooting, would you see the same distribution of wounds?
TacMedicCO7
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Posted: 1/13/2013 8:47:21 PM
[Last Edit: 1/13/2013 8:59:26 PM by TacMedicCO7]
They are not the big killers, they are the leading causes of Preventable Combat Death. More soldiers die from head, CNS, and cheat traume, but those are not survivable wounds, for the most part. This is all based on an injury already occurring. Not taking into account PPE or anything else. The wound has occurred, is it survivable or non survivable? The point is you should not die from a gunshot wound to the arm, it is a stupid way to die.

TacMedicCO7
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Posted: 1/13/2013 8:56:41 PM
As far as civilian shootings the injury pattern is varied. Newtown was very different from Aurora Theater. All we are doing is using the data and research from the .mil to support why civilian agencies and individuals need this training and these tools. There are so many EMS agencies not carrying tourniquets, even with the mounds of research they still think they are bad. A tourniquet will save someone's life in a high school classroom just as effectively as a in a combat zone.
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Posted: 1/13/2013 11:35:08 PM
The only thing you can't improvise is a hemostatic agent, and those may not be in protocol everywhere and have a varying risk of thrombi.

A commercial tourniquet will hurry things up, which is good, but a pen and a strip of fabric is good too. You need training, especially if you have to justify your treatment decisions when things don't work out.

Trauma requires cold steel and hot lights, period. Surgery and blood products are the only definitive care.
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Posted: 1/14/2013 12:14:06 AM
[Last Edit: 1/14/2013 12:16:04 AM by Country_Boy]
Originally Posted By AR45fan:

Those statistics, with extremity wounds being the big killers in combat, is that due to the prevalence of body armor and explosives nowadays? In a mass civilian shooting, would you see the same distribution of wounds?


Several sources state that the incidence of extremety wounds is due to body armor, and it's obvious the shooters are typically using rifles,

We found some velcro cable ties (1" wide with a black plastic buckle where the free end makes a 180 turn and sticks back on itself that we bought for a mass casuality kit. The reason EMS isn't so fast on TQs is in the civilian world, 99.9% of the time there are multiple responders (a bystander or LEO can hold direct pressure, though we don't want someone without first responder training doing it.) per patient. When there are multiple patients per respnder, responders have other critical duties, or the patient must be carried out, TQs are more likely to be used.. In EMS you rarely need a TQ other then an amputation. Having said that everyone is NOW trained that a TQ does not mean the limb is written off.

Anyway, when applied by a healthy male responder the velcro ties will work. Not tactical, and each one only has about a 40% range due to the velco mating. What fits a petite 1st grader would not fit a big obese 3 grader. Cost was $1 each. Ordered from Mcmaster. Hopefully we will never see if they work.

TacMedicCO7
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Posted: 1/14/2013 7:43:37 AM
Originally Posted By emsjeep:
The only thing you can't improvise is a hemostatic agent, and those may not be in protocol everywhere and have a varying risk of thrombi.

A commercial tourniquet will hurry things up, which is good, but a pen and a strip of fabric is good too. You need training, especially if you have to justify your treatment decisions when things don't work out.


An improvised tourniquet may work, but it is not guaranteed. I have more than one picture of a soldier with "boy scout" tourniquets applied in the early years of Iraq and A-Stan. Those pictures were taken on the Medical Examiners table. I would rather spend the $30 and have the right tool to the job the right way.

I can improvise a chest seal better than a TQ. A nitrile glove, wrapper from your Normal Saline bag, just about anything can be used as a proper chest seal.

The only hemostatic agent that was pulled due to risk of a clot was WoundStat. It had 100% survival and kept bleeding under control for hours in the USAISR Hemostatic study, it was THE BEST hemostatic agent and it was pulled. If there were others that caused a risk I am sure they would be pulled.

Originally Posted By Country_Boy:

We found some velcro cable ties (1" wide with a black plastic buckle where the free end makes a 180 turn and sticks back on itself that we bought for a mass casuality kit. The reason EMS isn't so fast on TQs is in the civilian world, 99.9% of the time there are multiple responders (a bystander or LEO can hold direct pressure, though we don't want someone without first responder training doing it.) per patient. When there are multiple patients per respnder, responders have other critical duties, or the patient must be carried out, TQs are more likely to be used.. In EMS you rarely need a TQ other then an amputation. Having said that everyone is NOW trained that a TQ does not mean the limb is written off.

Anyway, when applied by a healthy male responder the velcro ties will work. Not tactical, and each one only has about a 40% range due to the velco mating. What fits a petite 1st grader would not fit a big obese 3 grader. Cost was $1 each. Ordered from Mcmaster. Hopefully we will never see if they work.



For a kid this would be great, try to find a wider version. For an adult you will see varied success with this implementation (see above)
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Posted: 1/14/2013 8:10:28 AM
AR45fan, I would like to commend you for taking action. We need more teachers like you.