Around here I see a lot of sweet IFAK load outs, full of great gear like tourniquets, combat gauze, Israeli bandages, and TOO RARELY chest seals.

On a serious note, how many of you have been trained in the use of those items? Mostly the combat gauze, but other stuff as well.
They have very simple explanations, but there are some unmentioned finer points to the use of each that make HUGE differences in their effectiveness.

Get medical training. Get smart on blowout kits in general, what to pack them with, and how to CORRECTLY use everything,  or all that stuff might as well just be a beer and some smokes to help ease the guy's passing.

+1,000 And only put necessary shit in there as well. No band-aids, they get in your way.

I disagree on the bandaids. I have had many cuts on deployments with high risk of infection. A few bandaids and single use ointment packs are good to keep at least in pack if nothing else.


 

I'm not saying not to have them, Just to keep them separate.

Yep.  Nothing wrong with bandaids, aspirin, antacid, etc...

But it shouldn't get mixed in with or get in the way of critical items.  You can afford to dig through a pack for some aspirin, when you need a TK or wound packing you need it right then.

Just don't take the aspirin for the pain from having to use a tourniquet.

It has been awhile since my combat lifesaver days and wish I knew of a good set of videos going over this stuff and some of the finer points.  I prep medical supplies here and there and when my two sucking chest wound kits came in today I was like damn, do I remember? I am rusty and may do more harm than good...

Especially with needle decompression

 

^this

I always have band aids in my range bag for boo-boos, but never in my IFAK (blowout kit). I also carry some Tylenol, and aspirin. Aspirin because there's always a chance an old guy's going to have a heart attack, and Tylenol for if there's a bleeding injury. It won't be as awesome as morphine, but it's something, and you don't ever give aspirin, ibuprofen (Motrin/Advil), or naprosyn (Alieve) to a gunshot patient.

I guess up top I didn't say anything about where to get training. There are decent videos by North American Rescue Products, and the company that makes the CAT tourniquet, but that's what I would consider bare minimum. Get Red Cross certified in CPR/ Basic Life Support (mostly to know when not to do it).

The aspirin thing was a joke by the way...

10 times out of 10 I've used it for hung-over-range-day

Medical training huh?

Who actually has budgets for this I ask?  The sad truth is medical and rescue is one of those insurances where people hate paying for it until it is to late or really needed.

Depending on the setting I see guys wearing the most costly equipment they can find - why does a swat cop who makes 50k a year need $5000 in arc teryx outer garments?  The management decided to expend money there is my guess.  How many officers had the management decide instead to do something like this

http://www.policemag.com/channel/careers-training/articles/2014/06/hemorrhage-control.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+POLICE-All+(POLICE+Magazine)


3200 officers issued and trained on this kits use...  not to shabby.  However I train students of various backgrounds and a normal subject is tourniquet use.  Any tourniquet setup however they want, my objective is to have them stop an extremity pulse in 30 seconds or less and annotate a time the TK was applied, how many of you have the metrics on how much time is needed to actually train to that task condition and standard?  I'd be willing to bet my bottom line that the majority of those 3200 police are unable to do just that TCS.  Upon failing that condition they would not be asking what did we really pay for when we got these kits.  It is a great piece of insurance and gives them a warm fuzzy, but are they as proficient in that bleeding control and even recognizing it as the real world would demand of them to fight for their life?  Its up in the air.  I have also seen students sit on an expired patient with no vital signs and start going through the motions they learned in whatever training they had previously.  Stress inoculation is important in a medical setting of any type, some people cannot be talked to in stern fashion without losing focus.  Maybe they had a class on here is a tourniquet, this is the history, this is how you use it, ok great moving on!  But they did not apply this tourniquet in gas masks, in a narrow hallway, over large swat style shoulder pads, to a combative patient, with smoke or gas, at night, with bangers, and live fire going off.  There is no magic to the basic medical kit, in and of itself it is just some NSN sitting on a shelf, however in the hands of a skilled and driven user who pushes themselves to exceed personal goals and raise the bar when it comes to skill sets using whatever med kit they have is when it really becomes something worthy of carrying.  

Instructors used to set ridiculous times for students to tie knots until one leader came down and had each and every one of the instructors tie the same knots in the times they were forcing down on students - to their surprise they were uncapable of tieing those knots - the new standard was the instructors time plus a marginal percentage increase to compensate for a lack of proficiency as a student might have.

I challenge you who may read this to grab that tourniquet and go throw it at everyone in your unit as PC as you can and start a stop watch on how long it takes them to apply it correctly - stopping a pulse - and notating a time.  when they feel they are done and its correct, post the times and will see who needs more training and should carry extra armor and bullets instead of more bandages and tourniquets.

The military recently realized the same thing that a tourniquet was not just an NSN to be issued but it required a certain number of applications and or time spent to gain proficiency which was scientifically measured - See here

https://www.jsomonline.org/SharedScience/2013212Polston.pdf

and one more snippet - find this article for more in depth.

Forward Assessment of 79 Prehospital Battlefield Tourniquets Used in the Current War
Volume 12 Issue 4 Pages 33 - 38
David R King
Gwendolyn M van der Wilden
John F Kragh Jr
Lorne H Blackbourne

Abstract

Introduction: Battlefield tourniquet use can be lifesaving, but most reports are from hospitals with knowledge gaps remaining at the forward surgical team (FST). The quality of tourniquet applications in forward settings remain unknown. The purpose of this case series is to describe observations of tourniquet use at an FST in order to improve clinical performance. Methods: War casualties with tourniquet use presenting to an FST in Afghanistan in 2011 were observed. We identified appliers by training, device effectiveness, injury pattern, and clinical opportunities for improvement. Feedback was given to treating medics. Results: Tourniquet applications (79) were performed by special operations combat medics (47, 59%), flight medics (17, 22%), combat medics (12, 15%), and general surgeons (3, 4%). Most tourniquets were Combat Application Tourniquets (71/79, 90%). With tourniquets in place upon arrival at the FST, most limbs (83%, 54/65) had palpable distal pulses present; 17% were pulseless (11/65). Of all tourniquets, the use was venous in 83% and arterial in 17%. In total, there were 14 arterial injuries, but only 5 had effective arterial tourniquets applied. Discussion: Tourniquets are liberally applied to extremity injuries on the battlefield. 17% were arterial and 83% were venous tourniquets. When ongoing bleeding or distal pulses were appreciated, medics tightened tourniquets under surgeon supervision until distal pulses stopped. Medics were generally surprised at how tight a tourniquet must be to stop arterial flow ? convert a venous tourniquet into an arterial tourniquet. Implications for sustainment training should be considered with regard to this life-saving skill.

note that 83% of TK in this study left palpable distal pulses - were these users of this kit taught that?
later on in that same article they mention I believe even wrong extremities being identified for a TK.


Buy all the high speed low drag carbon fiber batman engineered ninja items you want - but if you don't get the rubber to meet the road I suggest not carrying the extra weight just to feel good having it there.

I don't know how much traffic this forum will get but I figured I'd post here anyway. I'm an EMT and a BLS EMS instructor in Oklahoma. I've noticed a deficit in medical training as far as our local police go and I've been working on making some courses available very cheaply or free. One I've been thinking about trying to bring in is LEFR-TCC as it seems like it is an ideal course. What do you guys think? The basic points, taken from NAEMT's site, are:


Needle decompressions and the like are cool and high speed but I wouldn't want ANYONE that doesn't regularly practice advanced skills anywhere near me. Peripheral IVs are bad enough if they don't keep in practice.

ETA: Just to clarify: the training isn't being done because there isn't anyone around that offers it, we had a PHTLS class about 4 years ago and that's it. Not ragging on the police at all.

I took the Tactical Emergency Medicine class at the Sig Academy yesterday.  A lot of it was refresher stuff, tourniquets, Israeli bandages, etc, but they had some new information too.  I had never seen the proper technique to stuff a wound with gauze, so that was a bonus.  Plus we got to shoot while doing it

Was that Kerry Davis' class? I know he does a Bullets and Bandages class, I'm in the process of bringing him out here to Nebraska for a class.

I pack a kit in my range bag, and it's the same kit I run in competitions. I over-built it a bit on purpose, I spent 5 years as an EMT in a rural community you tend to know what you need and how to use it.

I also keep my EMT books for reference and occasionally brushing up.

First post, I registered last night.

I've taken 2 classes with police training opportunities, all at the young age of 46. Basic and advanced "high threat medical".  It was extremely good to build a new skill set in the basic class and use it in a couple of scenarios. The advanced class ramped things up greatly with with mass casualty simulations in a 4 story fire tower. Flashing strobes in darkness, loud music, sirens, and an active shooter engaging us. Fake blood and all.

I carry 2 kits on patrol, a first aid kit and a high threat medical bag. The bag is a basic 511 Tactical bail out. I carry a bottle of water with 2 snickers bars because I can get stuck several hours in one spot with a rifle, it's already happened to me.
Four TK4 tourniquets, a single Cat tourniquet is on my duty belt; 2 compressed gauze packs; 2 Combat Gauze(Quick Clot); 1 elastic roll; 1 Cinch Tight bandage; 1 ARS needle; 1 pack of Halo chest seals; 1 emergency foil blanket (keep a blood loss victim warm); airway throat tube;  3 rifle magazines; 1 combat rescue sling; rubber gloves; extra flashlight; extra police radio battery; medical scissors; Waterjel burn dressing. Other than the Snickers bars I hope to never use any of it, but I am thankful for the quality training and skill sets I've developed from it. I continue to research the areas I was trained in to strengthen my knowledge base.

I hope to participate more in scenario training.  

This is valuable information readily available, even for people who just go to a range once in a while. People with kids should really be prepared if they hunt, shoot, camp, ext. You never know,  you may need to self medic. A range that I sometimes go to with my kids is so far off the beaten path, who knows when help will arrive if needed?

I've spent several hours working on one of these-

http://www.tommanikin.com/products/manikin

Specifically the GSW version. It allows practice on chest seal, airway, tourniquet application and gauze- has a nice high pelvic bleeder you can't get a TQ on- pretty much ANYTHING you would find in the real world. About as close to the real thing as it gets- consider that the damn thing TALKS to you....and not just in English..Oh, and in case you were wondering, yes, he can even throw up on you.....nice..........Yea, it's damn scary.

About $30,000 a copy.........if you have the means I highly recommend you pick one up.

Just to give people an idea what a sucking chest wound actually looks like, not that these folks treated it well.  You want to have your occlusive dressings already to go, not trying to assemble them like in these videos.  There are several seals on the market you can use, or have pre-fabricated seals using the same materials.  You'll have better adhesion with a clean, shaven epidermis around the wound.  As part of your patient assessment, you should have already checked for through and through penetrating injuries, which will show up in your initial, rapid, and detailed head-to-toe assessments.  Sometimes penetrating injuries can exit in weird places that are easy to miss.

Sucking Chest Wound Part 1



Part 2



Part 3



Part 4

Then you're looking at a needle decompression 2nd intercostal space, mid clavicular line if there is a tension pneumothorax.  

Tension pneumothorax happens when blood and fluid builds up in the pleura or lung space on one side, and starts intruding on the other lung's ability to inflate, which eventually asphyxiates the patient if not relieved.

Needle Decompression

I would strongly advise any human being to take as in-depth of an anatomy & physiology course as possible, starting with as many resources as you can.

Learn the circulatory system of the body like the back of your hand to the major arteries and veins, understanding how oxygenated blood is perfused throughout the body, processed through the capillary beds, into the tissues, cells, loaded with waste & CO2, then sent back via the veins to the lungs to be exhaled with the blood-gas membrane in your alveoli.

Your major bleeders in the periphery are often easy to treat, unless you have a retractive artery proximal to the pelvic cavity and brachial plexus.

Learn anatomical terms and landmarks, reference verbiage, and how to communicate.  If you approach the medical field from the perspective of the IFAK, you will have a little tool in the box, versus knowing what a craftsman has to do.  Get away from approaching trauma medicine from a gear perspective, and learn how things are supposed to look and work with the body, and what to do about different things that go wrong.