Paragon's STOMP II Medical Pack (56k Warning!)

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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Paragon
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by Paragon » Wed Sep 17, 2008 12:29 pm

JIM wrote:Good man Jim, IO-infusion is basically the same as IV-infusion. The BIG is preferred because of lower cost than the EZ-IO, less bulk and easy use. Just look at this:

http://nl.youtube.com/watch?v=mMnYnnbAtVw" onclick="window.open(this.href);return false;

http://nl.youtube.com/watch?v=ZqYr0uVuS8g" onclick="window.open(this.href);return false;

http://www.chinookmed.com/index.cfm/fa/ ... %20Gun.cfm" onclick="window.open(this.href);return false;

Not trying to push you info purchasing one, but I just might get one as well for my aid-bag.

BTW: An EZ-IO is prescription only (not that would be a big problem for you anyway) whiles an BIG is not.
Wow, quite a bit different from the EZ-IO. Looking at the links that you provided makes this appear pretty reasonable, and a fraction of the cost of the EZ-IO -- almost as simple as an EpiPen once the injection site is determined. I will probably go ahead and get one of these. Now all I have to do is locate a cadaver to practice on... :wink:
JIM wrote:Ow, and if you really don't have the room for a Res-Q-Vac, you could also look into this: http://www.chinookmed.com/index.cfm/fa/" onclick="window.open(this.href);return false; ... 20Easy.cfm
Yeah, I saw that but figured it didn't really offer me anything that I didn't already have in the kit, so I went with the RES-Q-VAC that you originally suggested.

Jim

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by painiac » Fri Sep 19, 2008 6:25 pm

Paragon wrote:
Future changes call for switching out the Alcaine eye numbing drops for Tetracaine (does not require refrigeration), replace the Morphine MDV with Fentanyl amps, replace the lactated ringers with additional 6% Hetastarch for increased intravascular volume expansion (again, per TCCC recommendations), replace the 250mL D5W with injectable 50% dextrose amps, and add some additional antibiotics (Azithromycin, Amoxicillin, and possibly Metronidazole). Sux (Suxamethonium) and Versed (Midazolam) would round out the meds, although like the EZ-IO, will have to wait until I pick up some additional training

Jim
Generally very good revisions. Your excellent kit keeps getting a little better.

But please be extremely careful with 50% dextrose. It's dangerous shit. I'm an RN, with a hospital's resources, and I can have a doctor at the patient's side in minutes, and it still scares me to use D50 in a hospital setting. It's hard on the vein at the injection site, and if the vein blows and D50 infiltrates into the surrounding tissue, the patient can end up losing their arm. It's that serious. The severe osmotic shock of such a large concentration causes tissue necrosis. A liter of Dextrose 10% or even 5% is a lot safer and raises the blood sugar practically as fast.

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by BoltAction » Thu Oct 16, 2008 9:54 am

Gunny wrote:Image



+1

Nice kit.
You definitely win. lol.

Who makes those (Below) pill cases? I love the setup with them and would like to buy a few.

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by Paragon » Thu Oct 16, 2008 10:52 am

BoltAction wrote: Who makes those pill cases? I love the setup with them and would like to buy a few.
They are made by iGo (in China) and originally distributed in the US by a company called The Bottle Crew. I picked up several last winter in the sample/travel size aisle at Walmart, but have not seen them since then.

For what they are, they're surprisingly well made and robust.

Jim

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by claren » Fri Oct 17, 2008 2:33 am

Not that it need be said, but amazing kit. Well balanced, well organized. Like most of the other professionals (EMT-B/ED Tech) I was a bit nervous at some of the more "fun" stuff you had in there, when I first read the thread. Then I read further, and it looks like you have the right attitude about it being a stockpile for someone medically trained first, and an amateur-hour surgical suite only under the most dire circumstances.

Some thoughts:

--Consider getting some 1% Lido. The 2% is really only used in circumstances where they need to inject as little as possible to prevent tissue distortion (eyelid, lip, other facial areas). This is mostly a cosmetic concern, to make sure the edges of the lac can be lined up as exactly as possible. With 1%, you are much less likely to make someone lidocaine toxic, which is more likely than it seems. If someone you love gets attacked by a dog, or falls out of a moving car, or anything that can generate a lot of smaller lacerations, you can get them lido toxic surprisingly quick if you numb all those cuts. Something to consider.

--You have some anesthetic with epi in it (Bupivicaine, wasn't it?). I know, I know, the meds are for the medical professionals only. Regardless, suturing is one of the things that dilettantes can and do attempt to do most often, usually with acceptable results. So, just figured I'd state the rule: anything with epi isn't given in the "Fingers, nose, penis, toes" or any other relatively distal point. The epinephrine is in there to reduce bleeding from the lac; it's a vasoconstrictor. This can reduce perfusion unacceptably in areas that have limited vasculature flowing to them to begin with.

--Throw out the Sawyer extractor; It is dead weight. Using it is better than cutting and sucking, but that's more of a reflection on how bad an idea that is, rather than on any usefulness on the part of the Sawyer. There have been at least 2 studies written on its almost complete ineffectiveness (that I have read myself, anyways).

--Why do you have Kelly forceps/hemostats? I know they come in those EMT carry-all belt pouches, but they are largely useless outside of the OR. (The Addison forceps + suture needle clamp are a different story if you need some stitches, obviously)

Go take the NOLS/WMI EMT-B class, like you said you were going to. You'll have a blast and get a good foundation at the same time.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by JIM » Fri Oct 17, 2008 10:35 am

--Throw out the Sawyer extractor; It is dead weight. Using it is better than cutting and sucking, but that's more of a reflection on how bad an idea that is, rather than on any usefulness on the part of the Sawyer. There have been at least 2 studies written on its almost complete ineffectiveness (that I have read myself, anyways).
I don't think so... It may not be effective against snake-bites, but it certainly works for bee-stings, etc.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by claren » Fri Oct 17, 2008 10:44 am

JIM wrote: I don't think so... It may not be effective against snake-bites, but it certainly works for bee-stings, etc.
Good point; the studies I read concerned efficacy w/ snakebite. I haven't heard anything either way about bee-stings. Also, I initially thought it was the older type of extractor, with the simple rubber suction cups and the razor-blade. I can see I was mistaken.

With a bee sting, I can't see this doing any harm. I'd still advise against it if you were bitten by a snake, since the pressure can potentiate the hemotoxic effects of the venom.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by Paragon » Fri Oct 17, 2008 3:03 pm

claren wrote:Not that it need be said, but amazing kit. Well balanced, well organized. Like most of the other professionals (EMT-B/ED Tech) I was a bit nervous at some of the more "fun" stuff you had in there, when I first read the thread. Then I read further, and it looks like you have the right attitude about it being a stockpile for someone medically trained first, and an amateur-hour surgical suite only under the most dire circumstances.
Thanks Claren, I appreciate that. Unfortunately a few people lost sight of that simple fact and were convinced that I was going to be running around looking for people to practice on.
claren wrote:Consider getting some 1% Lido. If someone you love gets attacked by a dog, or falls out of a moving car, or anything that can generate a lot of smaller lacerations, you can get them lido toxic surprisingly quick if you numb all those cuts. Something to consider.
A valid point indeed, although in a scenario such as you describe the solution could always be dilluted with NS.
claren wrote:You have some anesthetic with epi in it (Bupivicaine, wasn't it?). So, just figured I'd state the rule: anything with epi isn't given in the "Fingers, nose, penis, toes" or any other relatively distal point. The epinephrine is in there to reduce bleeding from the lac; it's a vasoconstrictor. This can reduce perfusion unacceptably in areas that have limited vasculature flowing to them to begin with.
Actually the long standing contraindication for the use of epi for digitital blocks has been dropped for quite awhile due to numerous clinical findings that showed the concerns regarding ischemic necrosis complications due to vascoconstriction in digits is without merit. That said, I nevertheless still plan to stick with what I originally said here:
Paragon wrote:As far as the Lidocaine is concerned, you may have better luck speaking with your dentist rather than your doctor. If you are able to get your hands on some Lidocaine, be sure that it doesn't contain Epinephrine. Epi is used to prolong the anesthetic effect of the Lidocaine as well as reduce bleeding, although it has been suggested that vasoconstriction can lead to ischemic necrosis complications (tissue gangrene) in any digital block or end-arterial field (fingers, toes, ear, nose, penis, etc.). Several recent medical studies actually refute this contention, although my belief is it's better to be safe rather than sorry, especially in a PAW scenario.
claren wrote:Throw out the Sawyer extractor; It is dead weight. There have been at least 2 studies written on its almost complete ineffectiveness (that I have read myself, anyways).
I've also reviewed the results of the mock venom extraction study by Alberts, so I would wouldn't attempt to use the extractor to treat a snakebite. As has been mentioned though, the Sawyer kit has some potential merit for treating bee stings, and I myself used it earlier this summer (with inconclusive results) when I was stung on the arm by a yellow jacket.
claren wrote:Why do you have Kelly forceps/hemostats? I know they come in those EMT carry-all belt pouches, but they are largely useless outside of the OR. (The Addison forceps + suture needle clamp are a different story if you need some stitches, obviously)
I have the hemostats just in case exon111 ever needs me to clamp off some bleeders when he's performing "basic" amputations! :wink:

Actually their usefulness may in fact be questionable, although they don't take up much space in the FAK, and they are not something that is easily improvised (in terms of precision hands-off clamping ability) so I'll probably go ahead and keep them in there for now.

BTW, congrats on picking up your ACLS!

Jim

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Update #1

Post by Paragon » Fri Oct 17, 2008 4:40 pm

I wanted to go ahead and post a few photos of some of the items that others had suggested that I add to the FAK, as well as a few other things that I've picked up here and there since I originally posted:

Image

I moved the Albuterol Rescue Inhaler over to the "Airway Kit" and substituted a Primatene Mist inhaler (next to the two EpiPens in Panel #2) to offer an intermediate (i.e., non-invasive) option for the potential treatment of less serious respiratory allergic reactions. The EpiPens remain the primary treatment option for more serious allergic reactions, including anaphylaxis.

Image

I was able to pick up a couple of additional KING LT-D supralaryngeal airways at a decent price off ebay, so I went ahead and added one to my vehicle and camping FAK's (I already have two of these in the STOMP II, and given the availability of the laryngoscope in the STOMP II, I don't really need any additional supralaryngeal airways here).

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As Jim suggested, I added a RES-Q-VAC suction unit with a 40fr flexible Yankauer, as well as an additional 300 mL canister/FSP filter assembly.

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Also as Jim suggested, I picked up a couple of B.I.G. (I/O Bone Injection Gun) intraosseous devices to supplement the existing IV supplies that I have. I had originally only intended to add the adult version (15ga needle x 2.5 cm injection depth) although Chinook mistakenly shipped one of the pediatric versions (18ga needle x 0.5 - 1.5 cm adjustable injection depth) to me instead, so I will probably go ahead and keep it just in case it's ever needed.

Image

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To round out the current IV supplies, I added three (3) large bore 14ga x 2" catheters, a 10 drop/mL Coil-IV administration kit, and a couple of large bore non-DEHP stopcocks. I can’t really envision ever needing anything this big, but a number of people felt the 18ga stuff was a bit wimpy.

I’ve wanted to improve the capability of my field suturing kit for quite some time, but I didn’t really feel that I was knowledgeable enough to do so. I had an opportunity a few weeks ago during some wilderness training to get some additional practice, and I also did a fair amount of independent reading on the subject. Once again, closing a laceration outside of a hospital environment is not something that I really anticipate having to do, but if it ever becomes necessary, then I want to be sure that I have the correct supplies for the job.

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Obviously the likelihood of ever needing to suture internal organs is extremely remote (even in a PAW or EOTWAWKI scenario) so non-absorbable sutures are the preferred choice for subcutaneous tissue closure. 4-0 (.15mm) sutures seem to offer the optimal compromise between tensile strength and size for anything that I’m ever likely to suture. Being synthetic, polypropylene offers exceptional resistance to degradation and tissue reactivity, while being a monofilament suture it offers some additional resistance to infection (over braided sutures).

I purchased three dozen 18” Ethicon Prolene sutures with the 3/8” MultiPass PS-2 reverse cutting needle. Obviously I don’t need this many sutures on-hand, although being fresh they have an expiration of July 2013, so if anyone is looking for just a few packages and doesn’t want to purchase a dozen at a time, shoot me a PM and we’ll work something out.

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Looking over Jim’s STOMP II when he first posted it a few weeks ago I realized that I had completely overlooked the need for sterilized gloves (especially should I ever need to close a wound with sutures) so I added three pairs of these to the FAK.

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I had originally planned on picking up a pulse oximeter at some point, so when exon111 offered the Nonin Onix 9500 new in the package for less than $200, I snagged one. The Pelican case is the Justice Mark II version specifically designed for this SpO2 meter, and is available through Chinook Medical.

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While I was looking over Chinook’s site the other week I ran across theses little QuikClots gauze pads (2g each) intended for nosebleeds. I had not seen these before, so I decided to pick some up to have available the next time I run across a persistent nosebleed.

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I recently saw a bunch of specialty bandages and dressings at the local discount store for 75% off, so I grabbed pretty much everything they had left that had a reasonable expiration date. I really got excited when I saw the Hibastat towelettes thinking that they were perhaps the US equivalent of Hibicet – alas, they are not, so I guess I’ll have to strike up a deal with Jim to get him to ship some to me sometime.

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At $180 an ounce I’ve never tried Neuragen PN, although I’ve heard several people claim it works phenomenally for nerve pain. I’m generally a bit skeptical when it comes to homeopathic treatments, but for 75% off (and another 2.5 years before it expires) I figured what the hell. Anyone here ever use it?

So anyway, that’s where my STOMP II is at currently. I still want to add an AED, an O2 cylinder, and a few miscellaneous items, but I feel that I’m in pretty good shape for anything that may occur. As always, comments or suggestions are always appreciated.

Jim

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by JIM » Fri Oct 17, 2008 5:18 pm

Well..what is there more to say... Come on Doc Simon, Gunny, GanaEMT, Tac Medic and the others... we can go now. Paragon's the new sheriff in town... :twisted:


Nah,but you made some good additions. Definately a good idea to add the 14g. needles. I should have said that.. In a trauma patient, you really want 1 or preferably 2 14g. needles. 'Normal' medical patients usually get a single 18g. just in case.

Ow, a tip: put some clear tape onto the paper-side of the BIG-packaging as it is prone to tear, leaving you with a unsterile BIG...


And I'll PM you regarding the Hibicet.. :wink:
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by painiac » Fri Oct 17, 2008 11:59 pm

I can’t really envision ever needing anything this big, but a number of people felt the 18ga stuff was a bit wimpy.
I have to disagree with them.

You won't be managing a severe trauma patient with blood infusions, and even if you were, a 14g isn't necessary.
It used to be believed that anything smaller than an 18g catheter would hemolyze the RBCs if infused too quickly, but recent research has shown that this is not the case. You can even give blood pretty fast through a 22g catheter if necessary.
Keep in mind also that a 14g IV is very difficult to thread into a vein compared to an 18g.

You won't be infusing a lot of IV fluids super-rapidly, either. Current recommendation for Hetastarch is a max of 2 Liters.
Pushing a shitload of normal saline (or any other fluid, for that matter) for volume expansion in a trauma patient is unhelpful, and recent research strongly suggests that doing so actually causes more harm than good.
I recently saw a bunch of specialty bandages and dressings at the local discount store for 75% off, so I grabbed pretty much everything they had left that had a reasonable expiration date.
Hah! You got those at Big Lots, didn't you?
I just saw what ours had left yesterday: it wasn't anything worth buying. Keep an eye out, though: it seems they do those big drugstore buyouts about once a year, or at least they have for the last 4 or 5 years.
I'd actually anticipate more shitty overpriced drugstore chains (Rite Aid comes immediately to mind) going out of business, given the state of the economy and that their prices are consistently higher than everywhere else on EVERYTHING. They don't even deserve to stay in business.

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by Paragon » Sat Oct 18, 2008 7:27 am

painiac wrote:
Paragon wrote:I recently saw a bunch of specialty bandages and dressings at the local discount store for 75% off, so I grabbed pretty much everything they had left that had a reasonable expiration date.
Hah! You got those at Big Lots, didn't you?
Yeah, a lot of the stuff in there is Chinese junk like you would find in a Dollar Store, although occassionally you can find some pretty good deals. The dressings/bandages that I picked up all had expiration dates that were still a couple of years out, and I also found a bunch of sealed rolls of 2" Durapore surgical tape for $1.50 a roll (about half of what Chinook sells it for).

Jim

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by JIM » Sat Oct 18, 2008 7:36 am

painiac wrote:
I can’t really envision ever needing anything this big, but a number of people felt the 18ga stuff was a bit wimpy.
I have to disagree with them.

You won't be managing a severe trauma patient with blood infusions, and even if you were, a 14g isn't necessary.
It used to be believed that anything smaller than an 18g catheter would hemolyze the RBCs if infused too quickly, but recent research has shown that this is not the case. You can even give blood pretty fast through a 22g catheter if necessary.
Keep in mind also that a 14g IV is very difficult to thread into a vein compared to an 18g.

You won't be infusing a lot of IV fluids super-rapidly, either. Current recommendation for Hetastarch is a max of 2 Liters.
Pushing a shitload of normal saline (or any other fluid, for that matter) for volume expansion in a trauma patient is unhelpful, and recent research strongly suggests that doing so actually causes more harm than good.
Do you have a source of that research? I would like to read it.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by painiac » Sun Oct 19, 2008 2:06 am

I lost the source on the blood administration in a drive format.

The fluid stuff was in the Oct 2007 issue of RN. Looks like the full article is here, complete with their references: http://rn.modernmedicine.com/rnweb/arti ... ?id=463604" onclick="window.open(this.href);return false;

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by claren » Sun Oct 19, 2008 4:07 am

painiac wrote:I have to disagree with them.

You won't be managing a severe trauma patient with blood infusions, and even if you were, a 14g isn't necessary ... Keep in mind also that a 14g IV is very difficult to thread into a vein compared to an 18g.
True, and true. 14g needles tend to be very difficult to thread into anyone who isn't young and healthy already, and (at least in my ED) are being moved away from in favor of 18g needles for those that need "big" caths.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by JIM » Sun Oct 19, 2008 5:26 am

painiac wrote:I lost the source on the blood administration in a drive format.

The fluid stuff was in the Oct 2007 issue of RN. Looks like the full article is here, complete with their references: http://rn.modernmedicine.com/rnweb/arti ... ?id=463604" onclick="window.open(this.href);return false;
Thank you, that was definately an interesting read.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by painiac » Sun Oct 19, 2008 6:17 am

Paragon wrote: Yeah, a lot of the stuff in there is Chinese junk like you would find in a Dollar Store, although occassionally you can find some pretty good deals. The dressings/banda<wbr>ges that I picked up all had expiration dates that were still a couple of years out, and I also found a bunch of sealed rolls of 2" Durapore surgical tape for $1.50 a roll (about half of what Chinook sells it for).

Jim
Sometimes you get lucky. Nearly all the stuff they stock regularly is crap, but closeouts are how they built their business, and closeouts can be great. They used to sell recently outdated food, too, but they changed their policy maybe 5 years ago. Stuff that's outdated gets thrown out now. Food you get there is cheap for other reasons, often because of closeouts.

An example of how this works: Some jackass in a warehouse plows into a pallet of cereal with his forklift and damages a dozen or so boxes. Retail chains will NOT accept this: they prefer to deal by the pallet, and they don't want to dedicate staff to sort it out. So the entire pallet worth of cereal boxes, maybe 90% of which are undamaged, is now unsellable on the retail side. That's where closeout places like Big Lots come in. They buy the damaged pallet cheaply, throw out what's damaged and distribute the rest to their stores to be sold for cheaper than you can get elsewhere.

Also, the drugs they stock all the time are VERY cheap. I can buy any drugs from my hospital pharmacy at 50 cents above their cost, and Big Lots still beats them on prices for most of their OTC stuff.

And the aforementioned drugstore buyouts are awesome if you catch them early.

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by claren » Tue Oct 21, 2008 3:06 am

I forgot to ask earlier: why do you have a Blackwater patch on your bag? Not the most savory of organizations.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by Paragon » Tue Oct 21, 2008 2:20 pm

A couple of buddies that I shoot with are firearms instructors with BW.

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by claren » Tue Oct 21, 2008 3:08 pm

Paragon wrote:A couple of buddies that I shoot with are firearms instructors with BW.
Ahhh. I'm jealous.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by Ovationman » Tue Oct 21, 2008 4:16 pm

I mean no offense but I don't really equate Blackwater with medical help....

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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by JIM » Tue Oct 21, 2008 4:22 pm

You could consider something like this: http://cgi.ebay.com/FIRE-POLICE-AMBULAN ... m153.l1262" onclick="window.open(this.href);return false;

Looks good and I've got the same on my pack (exept it's OD)
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by AlmostJesus » Tue Oct 21, 2008 4:59 pm

I really think that your next priority should be to get an oxygen bottle. You have a lot of drugs in there but oxygen is one of the most basic drugs that can have an impact on a patient. Plus with the pulse oximeter and the oxygen supplies you have now, theres no point in not having it, whats the use of the pulse oximeter if you can't perform an intervention to raise it?
Its getting better though, and I am still pretty jealous.
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Re: Paragon's STOMP II Medical Pack (56k Warning!)

Post by Paragon » Tue Oct 21, 2008 5:20 pm

Ovationman wrote:I mean no offense but I don't really equate Blackwater with medical help....
It's kinda a long story, but the short version is that I'm a graduate of Front Sight so we're always busting each other's balls over who provides the best firearms training. My original range/GSW bag had a Front Sight emblem on it, so when I put together the STOMP II pack I threw a BW emblem in the ID window and nicknamed it the new and improved range/GSW bag. Long term I'll probably put one of the ZS emblems there -- I just haven't gotten around to ordering them.
AlmostJesus wrote:I really think that your next priority should be to get an oxygen bottle.
I don't disagree, although the size/weight of a D cylinder lashed to the bottom of the pack starts to make portability a bit of an issue, and unlike the two assualt packs, the cylinder would need to be physically removed in order to fully open the pack.
AlmostJesus wrote:With the pulse oximeter and the oxygen supplies you have now, theres no point in not having it, whats the use of the pulse oximeter if you can't perform an intervention to raise it?
There is a BVM in there.

Jim

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