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

[sigboy40]

Somebody please pass the eye bleach.

[airballrad]

Man-crush??

**BANNED!**

[JollyRoger762]

Ummm, no.

[curphy]

I tried to read through most of the posts (although 147 is a bit much to handle), but I don't recall anyone mentioning the following additions:

Portable suction device/canister - you can improvise one with your irrigation syringe(s), but it won't be nearly as effective as the real thing, and for compromised airways, suction is an absolute necessity.

Also, consider adding suppository meds to supplement the oral ones (i.e. PR analgesics, anti-emetics etc), because if nausea/vomiting is an issue, oral meds are worth about as much as a warm bucket of hamster vomit. You probably had some sort of stool softener (i.e. Senokot or colace) in there, which is a good idea for treating opioid induced constipation, assuming that the person survives and hospitalization is not an option. Did you have nitrostat SL for angina/AMI?

I liked that you added the obstetric kit, since stressful events (PAW) and even minor trauma can cause early/unplanned labor in pregnant women.

You might want to also add a pediatric cervical collar, as well as a couple more sizes of King LTs (I believe I only saw one?). As you mentioned, an AED, oxygen and pulse oximeter would be nice adds. Oximeters are extremely easy to use... you just have to remember that cold can affect the results, as well as shock and even carbon monoxide poisoning, which is why you always treat the patient and not the machine, so to speak. Oxygen can be life saving, and act as a comfort measure and analgesic.

Lol, about all you were missing is packed RBCs, ffp, platelets and concentrated clotting factors

[bbayliss]

You can read about Paragon's additional ACLS module here http://zombiehunters.org/forum/viewtopic.php?f=43&t=44640 he has added most all of your suggestions.

I tried to read through most of the posts (although 147 is a bit much to handle), but I don't recall anyone mentioning the following additions:

Portable suction device/canister - you can improvise one with your irrigation syringe(s), but it won't be nearly as effective as the real thing, and for compromised airways, suction is an absolute necessity.

Also, consider adding suppository meds to supplement the oral ones (i.e. PR analgesics, anti-emetics etc), because if nausea/vomiting is an issue, oral meds are worth about as much as a warm bucket of hamster vomit. You probably had some sort of stool softener (i.e. Senokot or colace) in there, which is a good idea for treating opioid induced constipation, assuming that the person survives and hospitalization is not an option. Did you have nitrostat SL for angina/AMI?

I liked that you added the obstetric kit, since stressful events (PAW) and even minor trauma can cause early/unplanned labor in pregnant women.

You might want to also add a pediatric cervical collar, as well as a couple more sizes of King LTs (I believe I only saw one?). As you mentioned, an AED, oxygen and pulse oximeter would be nice adds. Oximeters are extremely easy to use... you just have to remember that cold can affect the results, as well as shock and even carbon monoxide poisoning, which is why you always treat the patient and not the machine, so to speak. Oxygen can be life saving, and act as a comfort measure and analgesic.

Lol, about all you were missing is packed RBCs, ffp, platelets and concentrated clotting factors

[MEDIKMANN]

I am a Tactical Medic who works with SWAT. A few things I have learned in classes.
1. Tetracaine is a great add for eye injuries. A few drops and you're done. No fighting with blinking while you apply eye bandages.
2. Quick Clot and other products like it a not really a good choice. They are messy and if it's that bad to need Quick Clot all you're going to do is piss off the surgeon. Because they have to spend forever cleaning all the crap out before they can even start to operate. A tourniquet is much faster, no burning, no messy clean up, and much safer. You can titrate a tourniquet. You can't Quick Clot.
3. I'm not sure I understand what you need all this medical equipment. Are you a 1st Responder or just a REALLY prepared citizen? I think it's great if you are just that prepared, but if you're not trained on some of the equipment (like intubation kit or surgical airway kit) then why carry it? Not being critical at all. It's a huge liability! I've been a paramedic in Indiana for years and on the SWAT Team for several months and I can't my medical director to budge on several things. If nothing else think about 1 & 2. Good luck and I hope you never need to use your very diverse bag....I'm very jealous!!!!

[Raybo]

As a Medical provider in endocrinology and internal Medicine with over 20 years of medical experience, 10 of it in military medicine, allow me to offer some thoughts on your Bag. While your bag is very well stocked, it is perhaps too well stocked for the purpose for which I feel you intend it. In fact in some ways it would in several respects be overboard even with my level of training. Allow me to explain without flaming.

As an example you have both Gauze sponges and Eye Pads. This is redundant and wastes space that is better utilized for other supplies. A folded Gauze sponge and 3 strips of tape would do just as well. Look at the items that you carry and if you find an Item for which something else will do an acceptable job plus another job just carry the second item.

I see that you have a Blood glucose monitoring kit and strips. In my practice I insist that my patients replace the meters every 2 years as after that point about 50% are no longer accurate…Not to mention the strips are very perishable and highly Temperature sensitive. Additionally, even if you do find hyperglycemia in a patient, do you have the Meds (insulin) and supplies to safely control it without killing a patient? In the ICU I run insulin drips and have to adjust fluids and Electrolyte balance based on lab work that is run Hourly in the early phases of ICU admission and is based on mathematical protocols that factor all of these issues into the equation. Incorrect management could easily be more fatal that simply providing hydration and watchful waiting.

In a situation in which society as we know it has broken down, medical care would revert back 100 years and simply be a case of triage and doing the best you can with what you have been able to squirrel away. As an example, my average DKA patient who is admitted to the ICU uses enough fluids, supplies and Meds to fill the space of a 55 gallon drum over the 2-3 days they are an inpatient and half of those supplies would be used in the first 12 hours of their care. They also require the training and 24 hour a day availability of highly trained Doctors, Nurses, Laboratory, and respiratory personnel.

When I worked in a MASH hospital we had a virtual train of trucks bringing supplies to run the hospital on a daily basis. The amount of supplies we went through was staggering. As an example; providing care to a critically wounded patient with penetrating trauma of the abd, would fill the back of a short bed pick up truck. In a situation in which the local hospital is not up and running; that wound would be at least 97% Fatal (look at the STATs from the Medical and Surgical history of the War of the Rebellion) . And even if one of my GS friends could operate on that person it would take most of the supplies and meds that you have for maybe a 50% chance of recovery of that patient.

With that now imagine that you and your small band of survivors encounter hostile action and your group suffers 3 casualties.
1. A suspected fracture of the left forearm with a superficial open wound.
2. A laceration to a lower extremity suffered while crossing a mucky body of water.
3. A penetrating wound to the Abdomen.
Now you have to triage the Patients and decide who lives and dies. Do you expend all your resources treating the abdominal wounded Patient? OR do you splint the suspected fracture of the forearm irrigate the laceration and dress it and give them 10 days of antibiotics. And Irrigate and dress the leg wound, and give them 10 days of Antibiotics? While these are unpleasant and tough choices, this is the reality for which you prepare. You cannot save all three with your limited resources.

You would be better off stocking up on antibiotics etc, because splints, Dressings and other devices can be fabricated locally, and that which you carry should be able to do multipule tasks, ie. A 14 ga angiocath can be used for an IV, Emergency airway, and with the addition of a slit Glove finger, a chest drain (1 item 3 uses).

Antibiotics will hedge off the inevitable increased mortality of superficial wounds on weakened, undernourished, exhausted survivors. They are a best bang for you buck and once of weight. Also in the collapse of society once forgotten diseases will make a resurgence. Keeping you vaccinations up to date is also cheap insurance from Hepatitis, cholera, MMR, etc.

I have not tried to flame you, but while you have tried to think of everything under the sun you do not have the training and experience to thoughtfully consider and pack your bag. I do however giver you great kudos for your attempt.

[zenoptic]

WoW what did this cost?

I use Fentanly at work every day. Unless you intubate someone I would shy away from it.

Morphine Sulfate Injection USP, 15 mg/mL! that is quite a high concentration. In trauma it is given 2-4 mg at a time. With little Ativan it goes a long way.

Dito on the narcan. one amp rarely does much. with a serious reversal we often use a narcan gtt (drip ) titrated to effect.

how about a presser? neo, levo, dopamine? just a thought.

love the kit.

[Apache]

I see that you have a Blood glucose monitoring kit and strips. In my practice I insist that my patients replace the meters every 2 years as after that point about 50% are no longer accurate…Not to mention the strips are very perishable and highly Temperature sensitive. Additionally, even if you do find hyperglycemia in a patient, do you have the Meds (insulin) and supplies to safely control it without killing a patient? In the ICU I run insulin drips and have to adjust fluids and Electrolyte balance based on lab work that is run Hourly in the early phases of ICU admission and is based on mathematical protocols that factor all of these issues into the equation. Incorrect management could easily be more fatal that simply providing hydration and watchful waiting.

Hyperglycaemia, although undesirable long term is not especially fatal, hypoglycaemia is fatal and is why I think a glucometer is a damn good investment!

In a situation in which society as we know it has broken down, medical care would revert back 100 years and simply be a case of triage and doing the best you can with what you have been able to squirrel away. As an example, my average DKA patient who is admitted to the ICU uses enough fluids, supplies and Meds to fill the space of a 55 gallon drum over the 2-3 days they are an inpatient and half of those supplies would be used in the first 12 hours of their care. They also require the training and 24 hour a day availability of highly trained Doctors, Nurses, Laboratory, and respiratory personnel.

I'm sure you are correct and this is what would happen in a hospital now, BUT I have saved animals in DKA. All I use is a glucometer a bag of IV dextrose (or two) and intramuscular injections of short acting insulin. Titrate the dextrose to blood glucose level. All quite simple and quite possible almost anywhere.

If society breaks down I do think a Vet might be more use than a Doctor! (I may be biased

[Raybo]

In the human animal failure to monitor K+ and Na+ can and does result in fatal or most often severe neurological results. If the K+ drops below 3.3 mEq/L we hold the insulin, and and give 40 mEq of K+ in each liter until K+ is greater than 3.2. I rarely give Bicarb, as more often than not, fluids and insulin along with proper electrolyte replacement will generally correct all but the most severe Acid/Base disturbance, and pH will general correct with BG management and Fluids. Also, Bicarb should not be given if K+ is less than 3.6. also, when BG drops below 250 I switch IV fluids to D5 1/2NS and then begin to transition them to SQ insulin with Basal/Bolus regimen. I utilize a very comprehensive Protocol for DKA management and the proceding is not at all complete or inclusive.

I have seen improperly Managed DKA patients with severe Neuro deficits. I have one that I consulted on that as a result of his DKA is now in a Nursing facility (I was consulted after he failed a mental status exam, and his BG kept dropping into the 20's and 30's).

And you are spot on about hypoglycemia being more dangerous than hyperglycemia in the short term. Recent studies have shown that attempting to too tightly control BG in ICU pts can result in hypoglycemia and increase Mortality. I now try to target 100-150 for my ICU pts.

Not to snipe at you, but remember we are trained to do this, and we can and do titrate dosages off the top of our heads based on our training and experiance. in lessor trained hands sever hypoglycemia is a probablity. just as it is in my first year residents who struggle to gain the touch to quickly bring down a BG without dumping the Patients BG into the 30-40's.

I feel that sometimes knowing when to say when, is the better part of valor and will save pts needless suffering.

[zenoptic]

And you are spot on about hypoglycemia being more dangerous than hyperglycemia in the short term. Recent studies have shown that attempting to too tightly control BG in ICU pts can result in hypoglycemia and increase Mortality. I now try to target 100-150 for my ICU pts.

Not to snipe at you, but remember we are trained to do this, and we can and do titrate dosages off the top of our heads based on our training and experiance. in lessor trained hands sever hypoglycemia is a probablity. just as it is in my first year residents who struggle to gain the touch to quickly bring down a BG without dumping the Patients BG into the 30-40's.

I feel that sometimes knowing when to say when, is the better part of valor and will save pts needless suffering.

It is all about closing the gap. Protocol! Gone are the days of "seat of your pants" insulin gtt treatment.
of course if SHTF most DKAs will just pass on do to lack of technology. sad but true. however, this is quite a field pack! Load it up with some front line abx and you are set!

[Jester79]

mark for ref

[clockwork]

Impressive set-up.

I will admit I have read most of the replies, but not all; so please excuse me if I am duplicating previous info.
Also, I am not trying to criticize/flame; just observations.
I like the KISS type thinking. No need to stock ____ when ____ will do just as well. That way its simpler, easier, more versatile etc....

May I ask why you have both Levoflaxacin, and Ciproflaxacin? Isn't that a bit redundant, wouldnt it be better just to stock more Levo? Or is it a Levo side effect thing?

Stocking 3x3's, and 4x4's seams odd. Perhaps just pack the 4x4's.

You only have 2 SAM Splints, but enough ACE Bandages and Coban to bandage a horse. Also, again having the 3", and 4" seams a bit redundant. Perhaps just stock the 4". Eliminate some of the ACE and perhaps add a additional SAM. Also, you can use Kerlix to secure SAM's as a alternative to ACE bandages.
I'm sure you know this so sorry If Im preaching; but always be sure to check distal PMS before/after splint application. Especially with the ACE Bandages.

Same thing with the Steri-Strips. You have many variations of essentially the same items.

I know every one here is a fan of insane amounts of tape. And I suppose with good reason. But it seams like 12 rolls of surgical tape up front is a bit space consuming. Perhaps move some of that tape to a less critical area. And do you really need 6 rolls of 1 Inch tape?

Also, on my STOMP, I felt the itty-bitty elastic loops in the front compartment were too small to be of any use. (Were you have all the hemostats) I took a sewing type seam-ripper and carefully removed the seam on every second row, to make the elastic loops a bit larger. I can now fit larger items in them, and it makes that space more useful.

Thank you for posting this. As well as everyone with comments. Very useful stuff.
Clock

[Paragon]

Clock,

I appreciate your comments, and in the past year and a half since I originally posted this, I have actually incorporated many of the suggestions that you have made here. I attribute much of the revisions to the training that I have since completed, as well as having a chance to use the kit during practical training scenarios.

The Levo/Cipro duplication actually had more to do with availability at the time than anything else. The Levaquin has long since expired and been replaced by Keflex, as well as a fresh supply of Cipro.

The number of elastic bandages compared to SAM splints is due to my belief that in a PAW or austere setting, support of a sprained or strained joint would be necessary more often than immobilization of a fracture with a rigid splint, not to mention the likelihood of also using elastic bandages to secure dressings on traumatic wounds.

I have since cut back somewhat (approximately half) on the amount of tape in the pack, making additional room for other items.

Like you, I had very seriously considered modifying the elastic straps on the front compartment, even to the extent of completely removing them. I've actually seen people stuff a dozen pens or pencils in their STOMP II simply because they didn't have anything more useful to store there -- WTF? It just happened that the spacing of the bands worked out very well for the suture instruments that I had on hand, so I'm glad I didn't act too impulsively.

Thanks again for taking the time to share your experience and ideas.

Jim

[Dave Carroll]

ok, i've searched here and the web. what does S.T.O.M.P. stand for? I own one, I should know. lol.

[Paragon]

ok, i've searched here and the web. what does S.T.O.M.P. stand for?

I'm not sure that I've ever seen it exactly, although since the STOMP II was developed for SEAL teams, my guess would be SEAL Team Operations Medic (or Medical) Pack.

Welcome to ZS Dave -- I look forward to seeing you post some reviews of your equipment.

Jim

[clockwork]

Thank you Paragon for your reply.

It would be cool to see a complete update on your bag. Whats new, been replaced... etc...
I've always wondered if it would make sense to stock stuff for a person-to-person blood transfusion.
Ala Chinooks "Blood Donor module". That seams like something you might have.

Thanks
Clock

[BBRAH]

Oh my god! I just spent four hours reading all of the posts associated with Paragon's kit! Amazing! I've been a lurker on ZS for a while and felt compelled to finally join on the basis of this wonderful thread. I was looking for organization ideas for my own pathetic little trauma kit. I've decided instead that I'm going to just move to Paragon's neighborhood. The only thing I can think to add would be an MRI machine. But seriously, I have a couple of very low tech additions to suggest. The first is a bar of soap. Betadine and Hibiclens are great, but do you want to waste those supplies if you have to treat a scrape? Also a bar of soap will not expire or leak and will last indefinitely. The second is equally pedestrian. I like to keep a couple of sealed toothbrushes in my kit. They don't take up much space, they're useful for their intended purpose, and they can also be used to clean and debride if you happen to run out of single-use iodine scrub brushes (with appropriate antiseptic of course). I would also suggest, since you have access to prescription meds, maybe throw in some amphetamines or adderall (for the medical provider, not the patient). Other than that, I don't have anything that you don't already have bigger and better. Keep up the good work!

-BRAH

[aus.templar]

WOW..... in comparison I've only got 4 bandaids

[Paragon]

I've been a lurker on ZS for a while and felt compelled to finally join on the basis of this wonderful thread.

I'm pleased that you enjoyed the thread, and I'm glad that you got a few ideas from it as well. Thanks for positive feedback, as well as the suggestions...

The hand soap isn't a bad idea, although I already have E-Z Scub 160 surgical scrub brushes, as well as a bottle of hand sanitizer in there. I'll have to give that some more thought.

I've never really considered a toothbrush as a first aid item, although I have certainly used them for other cleaning tasks in the past, and dental care in the PAW would take on even greater importance. Since originally posting my STOMP II, I have added several dental currettes and a better quality dental inspection mirror, so perhaps a toothbrush or two would be a good addition. I have a couple of Colgate Wisp toothbrushes that I picked up a few months ago, so perhaps I'l make room for a package of those in the STOMP.

I don't plan to get a script for adderall anytime soon, although you bring up a good point. Perhaps a couple of bottles of 5-Hour energy drink or even some NoDoz tablets would be a good addition to help fight off fatigue and drowsiness.

Thanks again for the comments and ideas.

Jim

[claren]

Perhaps a couple of bottles of 5-Hour energy drink or even some NoDoz tablets would be a good addition to help fight off fatigue and drowsiness.

All my kits have No-doz in them. Aside from the obvious use of increasing alertness, caffeine has synergistic effects with many analgesics and there is some data to suggest it has mild analgesic properties of its own. Hell, that's all Excedrin is, really; acetaminophen, ASA, and caffeine.

From my own entirely anecdotal experience, half a No-doz (100 mg of caffeine), four 200mg Ibuprofen, and two 500mg Tylenol, taken together, help my infrequent migraines about as much as a Lortab. My perceived relief was better when I started adding some caffeine.

[pbaumei]

Nice work, that really is a phenominally well stocked bag. just off the top of my head...

Store medications and anything you really don’t want to get wet in little pelican boxes, dime bags don’t keep the water out and your drugs will turn to mush if you have to go swimming.

Loose some of the ace wraps, and get a lace up ankle brace, it provides much better support, and a lace-up wrist splint too. While useful, all ace wraps are good for is compression, holding things over the skin, and minimal protection, not so much for sprains. Also all ace wraps should be Velcro, those little clips are worthless.

As for Motrin and Tylenol, get some 800s and 500’s they save space, and you get more bang for your buck.

Would recommend a chest tube kit, the old foley trick is a real pain in the ass even for a physician.

I would add some xeroform antibiotic impregnated gauze (like Vaseline gauze, but better), and silvadine ointment for burns.

Mole Skin

As for drugs, I’d add the following
Nitro Spray
Keflex,
Zithromax,
Surfak,
Phenergan,
Zofran,
Albuterol inhailer
Forget the 5hr energy, its mostly caffiene, just go for the adderal, or dexadrine,
and a bottle of nodoz


That said, great job, thanks for the hard work. Nice pics too.

[Paragon]

Thanks for all the useful feedback!

I'll have to look into the velcro-backed Ace elastic bandages again -- I agree the little plastic clips pretty much suck, but most of the velcro-backed ones that I've used in the past wouldn't stay attached. That was several years ago, so perhaps they've gotten better since then...

There's a lot to look at in this thread so it's easy to imagine how you missed them, but there are 800mg Motrin and 500mg Tylenol in the two med kits. Ditto for the Moleskin, Keflex (500mg), Phenegran (25mg), and Proventil (albuterol 90 mcg) rescue inhaler. Although not shown here, I have since added the OTC NoDoz (200mg) caplets. A couple of close friends and coworkers, as well as a neighbor or two, have coronary artery disease, so there's always a vial or two of NitroQuick tablets (0.4mg) close by.

Although not carried in the STOMP II, I actually have two Atrium Express Dry Seal chest drains, various large bore Pleur-Evac thoracic catheters (28Fr), and a couple of BD Heimlich chest drain valves as part of my "home-based hospital" supplies.

The chest drain kits are admittedly beyond my current scope and training, but like a lot of the more advanced items, are merely available should a true PAW-type scenario ever occur. Even in a more limited Katrina-type scenario, I'd lay pretty strong odds that it would be a lot easier to locate someone with the appropriate level of medical training and experience, than to be able to get your hands on some of these items after the SHTF.

Jim

[Voodoo Medic]

I realize this is addressing an old post but...I personally would have to skip the mechanical suction. Takes up to much room and most of them do not work that well. From my three tours in Iraq I have learned that gravity and a toomey syringe or bulb suction take up far less room and are just as effective. Not to mention that it can be a whole lot faster. Just my two cents.