Its like this dude read my mind...

Basically the same thing I'm running..

Need Caths though..








CXS

I have a couple of TK4s, and I don't think much of them. They might be sufficient for a brachial artery bleed (although I really question the efficacy with self-application when the dominant arm is useless), but with something like a high femoral bleed with all that surrounding muscle tissue, you need a hell of a lot of tension to compress the artery. The only way you're going to get that is with a windlass setup. The Tk4 is the .25 handgun of the tourniquet world - a hell of a sacrifice in function for a weight / space savings.

Again, to be very specific, I'm not saying the TK-4s are better than or should replace the SOF-T, CAT-T, or CAV's of the world.  They are certainly better at the job, I'm not denying that at all.  I just do not discount their effectiveness in the correct application.

I found a comparison of the majority of Tourniquets out there.  I will see if I can find the link and/or post the pic of the chart.  Dont know how to post pics so if you can give me a hint I will see what I can do about getting the info.  I do recall that the CAT performed the best in all areas with the exception of one.

One of the popular studies tossed around a couple of years ago addressed only the ease of application, without addressing how well they actually occluded blood flow. There was another one in which windlass-style TQs scored suprisingly poorly. We tossed around those results quite a bit, and ended up wondering how the pain involved in a properly tightened TQ affected outcome. I'm not aware of any true studies addressing the effecacy of different TQs in a real patient population.

I got stuck manually tamponading a femoral bleed a couple of years ago. The amount of pressure necessary made a huge impression on me, and has affected my perception of TQs since.

This was about blood occlusion not sure the ease operation was included not that that is not relevant.  I don't advocate the TQ's being the be all end all but I would rather have it and not need it, you know the rest.  To me its like a toolbox each tool has its applications.  I am fairly certain that you are more knowledgeable about the subject than I ever hope to be but if the info I can provide can help one person especially if the TQ's is the one in question then I will provide the info and people can go from there.  In reality it all comes down to when its your time its your time doesn't mean I am not going out guns-a-blazing(just my nature).

http://www.pyng.com/wp/wp-content/uploads/2009/01/militarymedicaltourniquettests.pdf  

This is not the one I had originally found will keep looking.

Oh, I don't mean to come across as arguing at all. I think you're right on the money. I was just recalling earlier conversations about some of the studies performed. Sorry if it came across any other way.

I didn't take it that way.  My apologies that if it seemed like I took it that way.  I just like collate data and share it as well so that others may draw their conclusions.  I am here to learn and I will listen to people of experience ,which I am guessing you are, so that I may further my knowledge base.  So no harm no foul.

Tourniquet evaluation.  It is a large PDF file.   http://www.acep.org/workarea/downloadasset.aspx?id=40782

I have been working on my first aid kit and I almost have it where I want it.  I will snap some pics and post a list when I get a chance.  So, this is a tag.

Just wanted to pass that I've fit an entire Cav Arms Personal First Aid Kit into my HSGI Bleeder pouch.  Well, everything save for the chemlight.  Which I accidentally snapped.  But I was (am) very pleased with myself for getting everything else in there.  Word.  Oh, and the Individual First Aid Kit (also Cav Arms) fits nicely into a Maxpedition 4x6 with room left over for batteries or pens or what have you.

HSGI Bleeder Pouch MC w/tq cover and benchmade model 7 knife.

Yeah, but do you have an entire Cav Arms Personal FAK in there?

no, maybe a half roll of toilet paper,  tampons, duct tape and a airplane bottle of vodka 1oz.

anyone use a military issue SAW pouch as a med. pouch I was wanting something a little bit bigger than most of the designated med pouches I have ran across.

Why? How much are you planning to carry? Are you looking at it for medic duties or as your IFAK? If it's an IFAK, stay simple and keep it small, limited to gun shot wound treatment. Many people choose kits that are too big and stock them with stuff that they aren't trained to use. You don't see huge ones for a reason. If someone needs more than that, they have designated backpacks for those types of duties.

Is anyone running the newer blue force gear Trauma Kit, if so how do you like it?

I was thinking of getting one w/ supplies for a few upcoming courses which require you to have some sort of trauma kit with you.

I don't have one of those Blue Force pre-made packs.

My 1st line belt setup is very similar, though. It's a Nalgene pouch with an ATS pull-out medical pouch. I have a VOK in that one. Same idea; about $10 cheaper but you have to source items from multiple places.

For bang for the buck, I'd also consider a surplus IFAK from eBay. Decent supplies in a pouch for $50.

Posted Via AR15.Com Mobile

Oh, pro tip here - I can get two surplus IFAKs for the price of one blue force gear kit, so I'll roll with that for now :)

Thanks.

No prob. I've been meaning to get one of those myself.

Until I remember there are already something like 4 blowout kits, 2 aid bags, and a zombie ambulance-in-a-bag I haven't used. Surplus can be a great way to load up if you research what you're getting.

Those IFAKs also contain the CAT tourniquet. Despite my ownership of VOKs with TK4s, I still like the CAT better. Open my big bags, and you'll find CATs. IMHO, the IFAK should have a long 14g needle added if it doesn't include one.

Who am I kidding? I want to buy one anyway.

<–––––––– sleepdr is a bit of a medical gear enthusiast. That's a nice way of explaining to my wife where all that money went.

Posted Via AR15.Com Mobile

Agree completely...


As anyone with any tactical med training will attest to... often times caregivers use the patients stuff before you use your own. so your own shit may very well be used on your ass.

That can happen.  Of course, it also sucks if you have an aberrant internal mammary artery or other vessel, and even a trained med provider can't predict that.  Gray's Anatomy or Netter's Atlas of Anatomy show how most people are put together.  Anyone who's seen the insides of bodies will tell you that there are always anatomical exceptions.  Many Americans are obese.  How easy is it to reliably identify the 2nd intercostal space, midclavicular line on someone whose clavicle you can barely identify?  I can answer that - tough.  I stick needles around the clavicle regularly, and it's sometimes challenging.



Keep in mind, though, that zero blood pressure from a tension pneumothorax is also incompatable with life.  If you die due that before hitting the trauma bay, then it's a moot point.  



I'm not saying to carry a full medic's kit, but let's keep this in perspective.  If you get a GSW to the thorax, you may already be in extremis.  There are lots of air- and blood-filled objects in there, and the bullet's wound cavity & path probably already disrupted some.  If you are already dying from a tension pneumothorax, the best possible outcome is to have a quick-thinking bystander decompress it.  The speed that someone can decomensate from a pneumo is dramatic.  If I'm conscious enough to ask, I'll make sure my responder has a clue.  If I'm unconscious from a GSW, I'm probably not doing so well.



You'd have to be very, very unlucky to have the entire following sequence of events happen:

Get shot.

In the chest.

Causing a pneumothorax.

That becomes a tension pneumo.

That is imminently fatal.  (This is where you are dying until someone does something)

Joe Blow sees you, knows how to access your IFAK, and actually recognizes what the needle is for.

He recognizes a tension pneumo.

He attempts the life-saving needle decompression, but inadvertently lacerates an artery.

(Well, you were already dead from the pneumo.  Now you're alive, but bleeding from an artery.  That's still briefly more alive than you were)

You now may survive long enough to get to a trauma surgeon.  You may not, but you were dead already - remember?.



My kits have needles, and I hope never to use or have one used on me in the field.  There are plenty of trained people out there, though.  At my last handgun class, there was another anesthesiologist there.  We briefed each other on my blowout kit in case either of us or another student sustained a serious injury.  



My ATLS (Advanced Trauma Life Support) training won't do much good without the tools to implement it.  If you don't have a needle, and I randomly come across you on the street with a tension pneumo, that's unfortunate.  I'll know why you're dying, but only be able to watch.  (OK, well maybe I'd consider something drastic like a field incisional thoracostomy - I'm probably carrying a pocket knife).



It's an ongoing debate. I just wanted to explain my rationale for carrying needles.

I use a PVS-15 pouch on my rig and a horizontal utility pouch on my belt.  They meet my needs.  Claymore bags are pretty handy too.

Where would one get a 14g needle to include with their IFAK?

You're welcome:

Tactical Response Gear 14 ga. needle

Good find. Compare that needle with the 14g catheters that Chinook or NARP sell at $15-20 each.

IIRC, Dr. Keith Brown (resqdoc on various forums) explained why just using a bare needle like that could arguably be better. No IV catheter to kink or get plugged, among other things. It threw me for a loop when getting my first VOK - thought they messed up building the kit since the website description said "catheter."

Posted Via AR15.Com Mobile

Great post CJ!  Great information.  Thanks to all who contributed!

Just to keep things rolling on this thread:

I have an HSGI bleeder pouch.  Contents include:

Shears (of course!)
Cravat (triangular bandage, ACU camo- ugly, but beats white)
2 pairs of large nitrol gloves in ziplock bag
TK-4 tourniquette
QuikClot Combat Guaze
14 GA needle
AFD 4" bandage

I saw the AFD last year at an EMS conference, and have been a proponant of them ever since.  I love the absorbtion capacity with the ability to wrap the bandage into a pressure dressing with no additional twisting or turning.  Makes it really simple to use, and it sticks to itself just like Coban.

This does all fit in my HSGI puch- barely.  Looks more rounded that square now.  Everything is wrapped in the cravat with the knot loosely tied at the top.  Pull on the cravat knot and it all comes out of the pouch; no digging required.

Very clever!

tag

So, hopefully we'll resurrect this for a short while!  I just picked up a SOtech medical pouch and filled it up :)

http://i761.photobucket.com/albums/xx259/SteveTPirate/011.jpg
http://i761.photobucket.com/albums/xx259/SteveTPirate/012.jpg
http://i761.photobucket.com/albums/xx259/SteveTPirate/013.jpg

I've got shears and quick clot on the outside pocket.  Inside is a burn dressing, small roll of duct tape, a 6" israeli bandage, packed gauze and petroleum gauze, an H bandage, butterfly closures, sterile gloves, ibeprofin, butterfly closures and alcohol wipes.  It's stuffed pretty full right now, but there is room still.  I may rearrange things, since this is the first trauma kit I've made up for when I'm at the range, or for bugging out.  All the gear seems to be good to go :)

This looks like it be useful.

Hello everyone. I am at the point with my first line where I need to fill my BOK. I have had basic FA and CPR training several times and will attend further training in the future. We have a solid FR kit and several FA kits.
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I'm pretty clear on what I'm after here but have a few questions. I've got the basics. Shears, sharpie/ductape, wipes and gloves.
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I checked NARP, TRG, and Chinook for what I want and both Chinook and NARP have what I need but NARP requires a "Medical Device Authorization" for the CAT and decompression needle.
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Chinook has Bolin chest seals? GTG? Work under field conditions?
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Chinook carries the TK-4 but not the CAT. In the event of a wound high on the thigh will the TK-4 occlude the artery? I'm sure it would if I used a lever but in that case a piece of rope would do the same thing.
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I bought a Molle II "Medical Pouch" for this purpose. Its bigger than most use but I would like room for a spare set of eyeglasses. Any tips on a hard case to carry them in? Little off topic but critical for me.
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Chinook sells Isreali bandages in 4" and 6" sizes. Preference? What about using these for a tourniquet? I've seen folks posting about this.
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At this point I'm leaning towards:
2 TK-4 tourniquet
28 fr NPA
2 Isreali bandages 6 or 4?
2 Bolin chest seals
14 ga 3.25" needle
And the basics.
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Unless input points me in a better direction. This is an affordable and competent setup.
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 Any input would be greatly appreciated.

You're on the right track.





Paddyboy30, make sure you have a tourniquet in there.

Thanks for the response. I'll spend some time on ebay and get some CATs. I was concerned about fakes, but 100% seller rating should take care of that. Most of the other items I need are inexpensive enough to buy new.
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When using packaging and duct tape as an occlusive dressing, why tape only 3 sides? I'm sure there is a good reason, I just don't know what it is. Thanks again.

The theory is that, by taping only three sides, you'll create a flutter valve with the plastic pulling tight against the wound when the patient inhales, but with excess pressure venting through the open side during exhalation.
Here's a exercise that'll sell you on buying aHalo, Asherman or Bolin though - go through a self-aid drill. Have someone time you while you rip three lengths of duct tape and tape an occlusive dressing to your own chest. Then have them tine you while you apply a Bolin to yourself. Nevertheless, the duct tape / wrapper trick is too handy, especially with multiple wounds.
I'm starting to prefer the Halo chest seal - they lack the one way valve the Asherman and Bolin have, but they stick very well, and I'm needling the chest any time I suspect a pneumo. It's a trade off though. Another option is expired defib pads - they stick quite well, and are occlusive. If you explain to your local EMS crew that you're stocking occlusives for a boy scout troop FAK, they might be able / willing to set aside expited pads for you. Once again though, no one-way valve like the Asherman / Bolin.
Coughlins sells duct tape with a peel-off backing, packed flat. Absolutely perfect for BOKs, and much easier to use than 'regular' duct tape wrapped around a business card or whatever. I picked a bunch up off of amazon.com
As far as trauma dressings go, the izzy or H bandage are fine, but the Oales dressing from tacmedsolutions.com incorporates a very good pressure dressing, an occlusive dressing and wound packing material all in one, at around the same size / cost of the others.  tacmedsolutions also stocks occlusive dressings and the SOF-T tourniquet, which is on par with the CAT. The TK4 is nice space-wise, but I really, really want a windlass-type TQ, especially for self-application.
If you're going to carry a cath for needle decompression, carry at least two. They can become occluded, and if you don't get relief over the third rib mid-clavicular, you'll have a second to do mid-axillary instead.
Like sleepdr said, if you're going to carry a NPA, carry a packet of surgilube with it. Anyone who tells you you won't need it hasn't placed a nasal airway. Just squeeze a spooge of lube onto the patients chest or whatever, stick the tip of the NPA in it, twist it around to smear the end nad insert the NPA. Remember, straight back into the patient's face, not 'up' into the schnozz.
I will differ slightly with sleepdr on the hemostatics - I believe that, if someone believes they need to carry such, the QC combat gauze or Celox gauze is the best choice. If you need a hemostatic, you should be packing the wound, and either of those lends itself to wound packing better than the QC sponge or granules.
Gear is good, practice is better. If you or anyone else is around south central WI, you're welcome to drop me an IM and come by the station sometime. I'll pull out the dummies and show you how we use this stuff.
Tommy's updated BOK consists of;



1 4" Oales dressing



1 Thin-cinch dressing (comes packed flat, so takes up little room while giving me a second decent pressure dressing. the old .mil is another flat alternative)



2 14G IV caths



1 pack Halo chest seals (2 to a pack)



1 SOF-T tourniquet



1 QC Combat Gauze ( I honestly wouldn't feel under-equipped with standard gauze, but I have it so I carry it.)



2 pr exam gloves



1 section of peel-off backing duct tape



1 NPA, with surgilube



1 mini-sharpie



1 Benchmade 7-hook. (Expensive, and trauma shears work almost as well for clothing, and are a bit more versatile. The 7 hook can make people naked faster than greased elfshit though)
Nothing else in that pouch. No chap-stick, no band-aids, no ibuprofen, no pregnancy-test kit. I have a general FAK elsewhere, but if I have to access my BOK, I don't want anything else getting in my way. I always have a decent light and a knife on my person, and I have a FAK that incorporates everything from bang-aids to a cric kit, but a BOK is a purpose-specific BOK.
 

Thanks for the reply. Last night was the third time I read this thread. I took notes this time so I could look for what I wanted and participate in this conversation. Gotta say I'm a bit overwhelmed right now. I'm keeping up though! Take care and thanks again.

Read this.

TT, I think we actually agree on hemostatics, but I wasn't clear in my post. I like the hemostatic-coated gauze much better than free granules or a a "tea bag." Just haven't gotten around to getting any. Should have specified that I meant the QC Sport gauze as a readily-available item. Some dealers are tightening up their restrictions on to whom they will sell non-"consumer" hemostatics. Like you, I don't feel helpless without the stuff, and am pretty comfortable with boring old packing gauze.



Those Olaes bandages look very trick. The pressure bar also has an eye protector cup. I didn't learn about them until spending oodles of cash on my current medical gear, or would have picked them up.



You make a great argument on the chest seals. My low-pro kits do make some sacrifices in the name of space, but I do carry a few in the big kits. The expired defib pad idea is brilliant!



If you don't have an IV cath with a "safety" device that retracts or blunts the needle automatically (I HATE those things, as they limit some of the specialized things I can do with a needle), then consider not discarding the needle after placing the catheter.  Caths kink and become occluded, and it wouldn't surprise me if they are actually kinked under the skin more often than not.  Probably a decent amount of air is released through the needle on that initial pass.  Keith "RESQDOC" Brown actually prefers a bare needle.  Once doing a single stick to the chest, he'll then just slide the needle under the patient's skin for clean and convenient storage.  If the chest re-expands, he then re-uses the needle for another single-shot needle decompression.

The needle thing makes perfect sense. Thankfully, our 14g aren't safety caths. I'm going to have to remember that little trick.



With the defib pads, we'll literally write 'GSW' across them in sharpie to keep subsequent providers from just ripping them off. The ones I've actually used haven't been expired, and I've been chewed out for the cost involved but when you're in a hurry you're in a hurry.



 

I REALLY need to rethink all this and get squared away before, not when, I find myself trying to figure it out while I am pouring my blood into the dirt.  

I run a RskTkr Down kit on my first line as well as on the side of my RAID.



It comes in a Zulu Tactical pouch that the guys from RskTkr Medical designed.  It does a great job at being large enough to carry what you truly need while not being overly bulky.  You can open it with one hand simply by pulling on the red strap which allows easy access if you need to get to it yourself.



It comes stocked with an OALES bandage, QuickClot ACS, Halo chest seal, SWAT-T tourniquet, NPA, a CPR faceshield, pair of gloves and your choice of either a SOF-T or CAT tourniquet. It also comes with a combat casualty card and a packing list that includes expiration dates.



On top of this I run a CAT attached to my holster via a ranger band, an additional CAT on my rifle stock and an Izzy bandage and old school cravat in a cargo pocket.  

I have posted these in other places, but here you go:










Contents:

2x 6" IBD
4" IBD
Nitrile gloves
NPA (28F)
Kerlix (have since added a 2nd roll to the pouch)
CAT tourniquet
Shears
Sharpie
Various 4x4/2x2 gauze
Duct tape wrapped around a Walmart gift card (takes less room than a roll of tape)
HemCon 4x4 bandage
Surgipad

If I needed to I could make a chest seal from the HemCon wrapper and the duct tape, so I figured there was no reason to put one of those in too (plus I didn't have one and I'm not ordering one $10ish product online and paying $7 to ship it).

For now, it rides around on the passenger seat with me. I also keep a pair of nitrile gloves in my cargo pocket at all times and came close to having to use them for the first time a few weeks ago (guy almost wrecked his motorcycle turning onto a cross street when I was driving down the highway, without a helmet of course). I have first responder training so the only thing I don't "know" how to use is the NPA. I know how it's used, but I've never put one in. Hopefully I'll never have to, and someone else on scene will know what's going on and be able to do it.

What kind of pouch is that?
Dustin

SO Tech IFAK pouch. I'm not 100% sure what the EXACT name of it is, but you should be able to find it with that online if you were interested in it. I'd be able to read it directly off the label but the kit is currently in my trunk.

I'm a medic and I've been working in Iraq/Afghanistan (currently in Afghanistan) for the past 5 years. I've used every piece of equipment in a BOK/IFAK in real world combat situations. IMHO the TK-4 is a piece of junk. The CAT is not too bad, but I've had 2 of the plastic cranks break. I like the SOF-T. It's similar to the CAT, but has a metal crank on it. The Bolin Chest Seal is fantastic. The Ashermans used to be great, but in real world applications, they just don't stick to wet skin. You end up having to use duct tape or 100mph tape to make it stay on. That defeats the purpose of carrying the Asherman if you need to carry something else to make it stick. The Bolin will stick to any thing! It has button valves instead of the flutter valve that the Asherman has, but they work just the same. Big difference is that it actually sticks to your patient! Adding some type of hemostatic agent to your kit is highly reccomended. QuickClot and Hemcon are the big ones out there. Traumadex was recalled by the Army for some reason. Hemcon is not that good for bullet wounds. You have to see the bleeding vessel and use it like a tire patch. This can be very hard to do with bullet wounds, where the bleeding vessel has retracted into the surrounding tissue. IMHO, it'sbetter used for large avulsions (skin flaps). QuickClot works great. They have a new version called Combat Gauze that is even better. It looks just like rolled gauze and you can stuff it in the hole and put a pressure dressing on it. Just remember, QuickClot should only be used on the extremities, mainly the armpits and groin. Anywhere else, you should be able to stop the bleeding with a pressure dressing and/or TQ. Do not use QuickClot in the chest or abdominal cavity. This can cause further harm to your patient, due to the exothermic reaction created by its use. Intestines and lung tissue don't react to well to heat! As far as Isreali bandages go, I carry the 4 inch in my kit. It just saves a bit of space. Another space saver if the OLEAS dressings from Tactical Medical Solutions. They are similar to the Isreali Dressings, but have a pocket behind the actual dressing that has some rolled gauze and an occlusive dressing hidden inside. Hope this info helps!

I heard the newer versions of QuickClot don't run as hot as when it first came out. Is the burning the only reason not to use it in the chest and abdomen?