I think that's what he was getting at. That if you don't know whether or not it needs a tourniquet, throw one on. High and tight.
I think that's what he was getting at. That if you don't know whether or not it needs a tourniquet, throw one on. High and tight.
Yep. Could have been clearer on that. When you're doing an assessment, it's just easier to TQ a bleeding extremity and move on, then come back and reassess. You don't want to get bogged down assessing a minor bleed that's keeping you from getting to a major one. Wet sticky sleeves or pant legs throw the TQ switch. Truth is, there's a lot more to this rabbit hole and it's not the thread for it but as with guns and ammo: Buy 'em cheap and stack 'em deep.
As was stated: High and tight. Forget that "3-4" above the wound" rule. Put it high on the thigh or deltoid.
For additional items in the aid bag: Stay away from the coagulant powder products. Your money will be better spent buying the impregnated gauzes. Z-fold is the way to go but there's nothing in the world wrong with the rolled stuff. Depending on your budget, you can go pretty big with 'stuff'. If you're starting out and have limited funds you can't go wrong with 4x4s, some abdominal pads, a few rolls of kerlix, a couple of ACE wraps, heavy trauma shears, a couple of NPAs, gloves, a couple rolls of tape, a couple of triangular bandages, and a few 3.25-in 14 gauge catheters. Then build from there as funds allow.
As was stated: High and tight. Forget that "3-4" above the wound" rule. Put it high on the thigh or deltoid.
For additional items in the aid bag: Stay away from the coagulant powder products. Your money will be better spent buying the impregnated gauzes. Z-fold is the way to go but there's nothing in the world wrong with the rolled stuff. Depending on your budget, you can go pretty big with 'stuff'. If you're starting out and have limited funds you can't go wrong with 4x4s, some abdominal pads, a few rolls of kerlix, a couple of ACE wraps, heavy trauma shears, a couple of NPAs, gloves, a couple rolls of tape, a couple of triangular bandages, and a few 3.25-in 14 gauge catheters. Then build from there as funds allow.
This is relevant to my interest. Anaphylactic shock last weekend has made me. . .rethink. . .the priority level of a IFAK/medic bag.
Yikes! They're expensive, but you NEED some Epi-pens. You might consider throwing in some benadryl and pepcid for good measure
Thought id jump in and give my 2c,
Im not sure on the purpose of your kit and the acute/longterm treatment goals you have for it but Your bag looks like a good start no doubt. Just from reading what you had listed I'd include:
-trauma shears for cutting clothing quickly/easily (you may of not listed it)
-some shake-activated hot and cold packs
-good tweezers for removing those unwanted foreign bodies which I think i use more than anything in my pack haha
-you have a NPA but you can get sets of oral pharyngeal airways pretty cheap and if someone is truly unconscious you will manage the airway with the OPA much more effectively
-order some individual wrap medicines and ointments like aspirin, tylenol, benadryl, sting relief, antiseptic wipes, anti-diarrheal meds, oral glucose for hypoglycemia -- this is a fantastic OTC med pack that i would recommend and personally own
http://www.chinookmed.com/cgi-bin/item/01332/s-otc/-Chinook-Medication-Module-
-cheap DISPOSABLE (did i say cheap) personal safety glasses. Sounds kind of dumb but if you manage to be on some arterial bleeds or say a patient vomitting due to overdose then you may be thankful. Eyes and mouth are the quickest way to absorb a blood borne pathogen besides an open wound itself
-in the place of a true suturing kit if you havent been trained, I would say get some steri-strips or derma bond (basically a liquid stitch but not sure on OTC availability) for those lacerations that need closed and may be a while for help
-emergency blanket for hypothermia cases and may not be bad to just throw in a thermometer as well if you are concerned about hyper/hypo thermia
-maybe throw in some splinting material like SAM splints
-maybe some blister protection like Dr. Schauls* Moleform padding to help with any bad blisters forming
-and last something like Nuun electrolyte tablets or other sports electrolyte replacement tablets that are dissolvable. Great for dehydrated situations where risk of electrolyte imbalances are serious and just water wont cut it
Resources:
-http://www.chinookmed.com/ This site is amazing. Lots of good stuff on here and first place i go look for medical supplies
-during paramedic school i found this great deal for students from Thomas EMS. If you are a current EMT or Paramedic student you can get a discount on a thomas pack stocked. great starting point and i have added quite a bit to it. Great deal if you are a student. You do need some verification that you are a student: http://www.thomasems.com/student-212.html
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Here is my input on the the tourniquet discussion for anyone not tired of my rambling already. When i got my EMT-basic license back in 2006 we were taught pressure, elevation, more pressure, and THEN tourniquet as a last resort. Like someone said above though much of pre-hospital and emergency medicine in general evolves around the progression of military medicine and wartime experiences. With the conflicts in Iraq and Afghanistan there were a lot of serious limb injuries. One of the things that was discovered through a lot of data analysis from the field was that the tourniquets were being applied and staying on for much longer periods than what was thought 'safe' at the time due to the extreme circumstances. However, these patients were healing and the opinion began to change.
Flash forward to 2011 when i started paramedic school, in pre-hospital trauma life support (EMS version of the physician Advanced Trauma Life Support), the national guidelines had changed to reflect what was learned in the military. NOW, our hemorrhage algorithm was basically, 1) pressure 2) uncontrolled bleeding after sustained pressure then Tourniquet.
A study from 2007 concluded that a tourniquet left on for 2 hours leaves the patient at little risk of permanent vascular injury due to the tourniquet (mean time for . Progressing beyond this point you are starting to have severe ischemic problems with limb loss at ~6 hours. It is easy to write down numbers and rules but if it comes down to bleeding and dying or not bleeding and maybe/maybe not losing a limb, the choice is much more simple. You're goal is to keep the patient alive in that "golden hour" from onset of injury to definitive care for optimal outcomes.
thanks for listening and hope it wasnt too awful of a read,
-NREMT-Paramedic, Physician Assistant Medical Student
Im not sure on the purpose of your kit and the acute/longterm treatment goals you have for it but Your bag looks like a good start no doubt. Just from reading what you had listed I'd include:
-trauma shears for cutting clothing quickly/easily (you may of not listed it)
-some shake-activated hot and cold packs
-good tweezers for removing those unwanted foreign bodies which I think i use more than anything in my pack haha
-you have a NPA but you can get sets of oral pharyngeal airways pretty cheap and if someone is truly unconscious you will manage the airway with the OPA much more effectively
-order some individual wrap medicines and ointments like aspirin, tylenol, benadryl, sting relief, antiseptic wipes, anti-diarrheal meds, oral glucose for hypoglycemia -- this is a fantastic OTC med pack that i would recommend and personally own
http://www.chinookmed.com/cgi-bin/item/01332/s-otc/-Chinook-Medication-Module-
-cheap DISPOSABLE (did i say cheap) personal safety glasses. Sounds kind of dumb but if you manage to be on some arterial bleeds or say a patient vomitting due to overdose then you may be thankful. Eyes and mouth are the quickest way to absorb a blood borne pathogen besides an open wound itself
-in the place of a true suturing kit if you havent been trained, I would say get some steri-strips or derma bond (basically a liquid stitch but not sure on OTC availability) for those lacerations that need closed and may be a while for help
-emergency blanket for hypothermia cases and may not be bad to just throw in a thermometer as well if you are concerned about hyper/hypo thermia
-maybe throw in some splinting material like SAM splints
-maybe some blister protection like Dr. Schauls* Moleform padding to help with any bad blisters forming
-and last something like Nuun electrolyte tablets or other sports electrolyte replacement tablets that are dissolvable. Great for dehydrated situations where risk of electrolyte imbalances are serious and just water wont cut it
Resources:
-http://www.chinookmed.com/ This site is amazing. Lots of good stuff on here and first place i go look for medical supplies
-during paramedic school i found this great deal for students from Thomas EMS. If you are a current EMT or Paramedic student you can get a discount on a thomas pack stocked. great starting point and i have added quite a bit to it. Great deal if you are a student. You do need some verification that you are a student: http://www.thomasems.com/student-212.html
----------------------------------------------------------------------------------------
Here is my input on the the tourniquet discussion for anyone not tired of my rambling already. When i got my EMT-basic license back in 2006 we were taught pressure, elevation, more pressure, and THEN tourniquet as a last resort. Like someone said above though much of pre-hospital and emergency medicine in general evolves around the progression of military medicine and wartime experiences. With the conflicts in Iraq and Afghanistan there were a lot of serious limb injuries. One of the things that was discovered through a lot of data analysis from the field was that the tourniquets were being applied and staying on for much longer periods than what was thought 'safe' at the time due to the extreme circumstances. However, these patients were healing and the opinion began to change.
Flash forward to 2011 when i started paramedic school, in pre-hospital trauma life support (EMS version of the physician Advanced Trauma Life Support), the national guidelines had changed to reflect what was learned in the military. NOW, our hemorrhage algorithm was basically, 1) pressure 2) uncontrolled bleeding after sustained pressure then Tourniquet.
A study from 2007 concluded that a tourniquet left on for 2 hours leaves the patient at little risk of permanent vascular injury due to the tourniquet (mean time for . Progressing beyond this point you are starting to have severe ischemic problems with limb loss at ~6 hours. It is easy to write down numbers and rules but if it comes down to bleeding and dying or not bleeding and maybe/maybe not losing a limb, the choice is much more simple. You're goal is to keep the patient alive in that "golden hour" from onset of injury to definitive care for optimal outcomes.
thanks for listening and hope it wasnt too awful of a read,
-NREMT-Paramedic, Physician Assistant Medical Student
I think your post was in response to me? That pack isn't a 'long term' type of pack for me. It's more of a 'try to keep them alive until (more) definitive care can be reached' kind of bag.
Some things i have in there, but neglected to list:
2 trauma shears, oral glucose and OPA's. There is a SAM splint in there too.
Some things i have in there, but neglected to list:
2 trauma shears, oral glucose and OPA's. There is a SAM splint in there too.
Just an FYI, I've got a couple crumb snatchers with allergies and we keep lots of these around. No co-pay coupon link below.
https://www.epipen.com/copay-offer/
I appreciate all the info you guys have gone to the trouble to share ... I need to print this off and bring it to the BOB Meeting ... which any of you are welcome to attend ... I'm sure I'm not the only one who'd like to meet each of you and pick your brains ... even if you don't bring your packs ... but if you brought your packs that would be OH SO COOL!! 
this thread is awesome, Im feeling very under prepared here though... Stupid question time, Are epipens prescription only? the reason I ask is I feel like my daughter should carry one but trying to get her to go to a doc is like trying to get me to go we better be dying or its basically not happening so to speak.
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