WWYD Medical Edition - PAW GSW

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

Moderator: ZS Global Moderators

User avatar
zXzGrifterzXz
* * * * *
Posts: 6921
Joined: Sat Feb 12, 2005 8:17 pm
Favorite Zombie Movies: The Romero movies, The Stink of Flesh, Seige of the Dead, Shaun of the Dead, 28 Days later, The remakes of Night and Dawn.
Location: Bensalem, PA

WWYD Medical Edition - PAW GSW

Post by zXzGrifterzXz » Sat Jun 21, 2014 11:16 am

Having been a long time since I put a WWYD thread up on ZS I thought it would be fun to do a series of medical WWYD to help get everyone's mental juices flowing. In these scenarios you are to assume you are trained to your current level of care and are equipped as you would be normally in a PAW. So for example, if you have have the knowledge, training, and access to an AED then you may use it, but if you do not then you cannot.

I am only looking for no more than the initial 5-10 minutes of treatment. I will post the initial scenario and then respond to specific posts with an updated patient status and let you know if they are responding well to your treatment or not. Please realize that this is just an exercise and sometimes no matter what you do your patient may still die but most of the scenarios I present will be things that you could realistically see during a PAW, especially if you are working as your group's "medic."

Scenario #1 - GSW
Assume you are in whatever group you would be in during a PAW that involves economic collapse of your country's government, for whatever reason you were unable to bug out and your group has elected to bug in and shelter inplace for the time being. It has been over a month since said Gov't collapse and things are very bad in your neighborhood. You are functioning as your group's "medic." You are trained to your current level of training and have access only to the medical items you would normally have access to.

You and your group have had trouble with some local gang members who have been raiding homes(both abandoned and occupied) in your area for supplies. To help combat this, your group has selected members to patrol your area to keep an eye out for said bandits. While out on one of these patrols, a few members of your group get into a short exchange of small arms gunfire with the group of bandits. During this exchange of fire a member of your group gets shot and the bandits flee. You and your group are notified about this via a set of motorola 2-way radios that your group has been using to communicate with the patrols. Since you are the group's medic you are sent out with a few more members of your group to render aid to said wounded group member. Upon your arrival you find your patient laying supine in the front yard of a house in your neighborhood. Two members of your patrol team are holding security and another member of the team is frantically trying to stop the bleeding with his bare hands.

Your patient presents supine with a gun shot wound to their right upper chest about 2 inches under their clavicle. Pink frothy bubbles come out of the wound every time the patient inhales. They are semi-conscious(responds to painful stimuli only), they are having obvious difficulty breathing that is rapid and shallow, and you note that they have pale skin which is cool to the touch and they are diaphoretic. Your treatment begins now.
-NREMT - EMT
-NFPA 1006 Rescue Technician
-HAZMAT Technician

My Aid Bag
*Standard medical disclaimer applies to all of my posts, YMMV, Always check CNS before and after, never let the new guy drive, don't attempt anything you read here without proper supervision..... Blah Blah Blah*

IANMCDEVITT
* * * *
Posts: 834
Joined: Mon Oct 03, 2011 1:13 pm

Re: WWYD Medical Edition - PAW GSW

Post by IANMCDEVITT » Sat Jun 21, 2014 12:11 pm

Your scenario's flawed right-off, NO ONE SHOULD BE SUPINE WITH A GSW UNLESS THEY ARE UNRESPONSIVE................Second, don't ever use the phrase "semi-conscious". Your a medical professional now, not some clown (I hope). You can say "responds to painful stimuli only" and elaborate on that.....

User avatar
zXzGrifterzXz
* * * * *
Posts: 6921
Joined: Sat Feb 12, 2005 8:17 pm
Favorite Zombie Movies: The Romero movies, The Stink of Flesh, Seige of the Dead, Shaun of the Dead, 28 Days later, The remakes of Night and Dawn.
Location: Bensalem, PA

Re: WWYD Medical Edition - PAW GSW

Post by zXzGrifterzXz » Sat Jun 21, 2014 1:56 pm

IANMCDEVITT wrote:Your scenario's flawed right-off, NO ONE SHOULD BE SUPINE WITH A GSW UNLESS THEY ARE UNRESPONSIVE................Second, don't ever use the phrase "semi-conscious". Your a medical professional now, not some clown (I hope). You can say "responds to painful stimuli only" and elaborate on that.....
Easy man, that is blue on blue contact. :wink:

You(the provider) didn't place the patient in a supine position, you found him that way. And that is a highly likely way to find someone who has been shot and being cared for by someone who does not have any medical knowledge. You as the provider are more than welcome to position the patient in any way you see fit once you begin providing care.

And as far as using terms like "semi-conscious", I am trying to make sure this is understandable and approachable to both the experienced patient care provider and the novice who is may be helped by reading through these sorts of scenarios and seeing how our more experienced patient care providers react and treat this sort of situation. That is why I am using both medical terms and layman's terms throughout.

Believe me when I say I am not trying to step on anyone's toes, nor do I believe myself more experienced than most of the health care providers on this forum but I found the WWYD scenarios to be a fun exercise in the past and was hoping to bring this sort of mental discussion to the first aid forum. I'm not sure where the hostility is coming from.
-NREMT - EMT
-NFPA 1006 Rescue Technician
-HAZMAT Technician

My Aid Bag
*Standard medical disclaimer applies to all of my posts, YMMV, Always check CNS before and after, never let the new guy drive, don't attempt anything you read here without proper supervision..... Blah Blah Blah*

User avatar
Murph
* * * * *
Posts: 5771
Joined: Fri Jan 11, 2008 11:46 am
Location: Virginia
Contact:

Re: WWYD Medical Edition - PAW GSW

Post by Murph » Sat Jun 21, 2014 4:40 pm

I'll take a crack at this...

I'll glove up
Have my "assistant" secure the patient's weapons
Get the patient trauma naked
Do a head to toe finger sweep to check for other wounds
Use gauze to clean up fluids from the chest wound
Apply chest seal to right upper chest wound
Roll them over into recovery position and check their back for wounds, apply chest seal if necessary
Put them back to supine
Treat for shock by elevating their feet and wrapping them in a space blanket

That's the best I can do... Thoughts?
Does your BOB at least have: water, basic tools, fire, food, first-aid kit, and shelter?
"When planning, prepare for the most likely, and then the most catastrophic."
raptor wrote: Being a gun collector does not make you a prepper.
the_alias wrote: Murph has all the diplomacy of a North Korean warhead, but -he has- a valid point

User avatar
TacAir
* * * * *
Posts: 7935
Joined: Fri Aug 27, 2010 6:01 pm
Contact:

Re: WWYD Medical Edition - PAW GSW

Post by TacAir » Sat Jun 21, 2014 4:51 pm

Realistically?

I'd call the Padre. Because without some serious gear and a surgeon, the next trip this guy takes will over the River Styx.

I do pre-hopital care for the sick and injured. Not miracles. I look forward to the other responses sure to come.
TacAir - I'd rather be a disappointed pessimist than a horrified optimist
**All my books ** some with a different view of the "PAW". Check 'em out.
Adventures in rice storage//Mod your Esbit for better stability

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: WWYD Medical Edition - PAW GSW

Post by DannusMaximus » Sat Jun 21, 2014 5:24 pm

IANMCDEVITT wrote:Your scenario's flawed right-off, NO ONE SHOULD BE SUPINE WITH A GSW UNLESS THEY ARE UNRESPONSIVE................Second, don't ever use the phrase "semi-conscious". Your a medical professional now, not some clown (I hope). You can say "responds to painful stimuli only" and elaborate on that.....
Settle down, Francis...
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: WWYD Medical Edition - PAW GSW

Post by DannusMaximus » Sat Jun 21, 2014 5:31 pm

Murph wrote:I'll take a crack at this...

I'll glove up
Have my "assistant" secure the patient's weapons
Get the patient trauma naked
Do a head to toe finger sweep to check for other wounds
Use gauze to clean up fluids from the chest wound
Apply chest seal to right upper chest wound
Roll them over into recovery position and check their back for wounds, apply chest seal if necessary
Put them back to supine
Treat for shock by elevating their feet and wrapping them in a space blanket

That's the best I can do... Thoughts?
Seems reasonable. I would consider an airway adjunct if they can tolerate it.

Is elevate the legs to treat for shock still taught? It was when I started doing first aid lo these many years ago, but I thought it had gone the way of the do-do.

I have been taught how to decompress a chest wound (we practiced on some pork ribs and practiced finding landmarks on each other), but I've never done one on a person. I suppose I might give a decompression a try if they continue to go down hill - - not going to hurt in all likelihood, and might at least make them more comfortable by improving their breathing.

Homie is probably screwed, long term.
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

User avatar
Murph
* * * * *
Posts: 5771
Joined: Fri Jan 11, 2008 11:46 am
Location: Virginia
Contact:

Re: WWYD Medical Edition - PAW GSW

Post by Murph » Sat Jun 21, 2014 5:35 pm

TacAir wrote:Realistically?
I'd call the Padre. Because without some serious gear and a surgeon, the next trip this guy takes will over the River Styx.
I do pre-hopital care for the sick and injured. Not miracles. I look forward to the other responses sure to come.
Totally agree with you, but I think not trying at all would likely get you voted off PAW-island pretty quick.
Does your BOB at least have: water, basic tools, fire, food, first-aid kit, and shelter?
"When planning, prepare for the most likely, and then the most catastrophic."
raptor wrote: Being a gun collector does not make you a prepper.
the_alias wrote: Murph has all the diplomacy of a North Korean warhead, but -he has- a valid point

User avatar
TacAir
* * * * *
Posts: 7935
Joined: Fri Aug 27, 2010 6:01 pm
Contact:

Re: WWYD Medical Edition - PAW GSW

Post by TacAir » Sat Jun 21, 2014 6:15 pm

Murph wrote:
TacAir wrote:Realistically?
I'd call the Padre. Because without some serious gear and a surgeon, the next trip this guy takes will over the River Styx.
I do pre-hopital care for the sick and injured. Not miracles. I look forward to the other responses sure to come.
Totally agree with you, but I think not trying at all would likely get you voted off PAW-island pretty quick.
Yeah.
I'd seal the wound. Front and back.
I'd at least administer any pain meds that I had (which I don't) and check that the seal is...sealed.
Don't know if I'd still try a McSwain dart though... (which I don't have) A couple of 14Ga needles? Well, same problem, Don't have any of those either.

I suppose I could 'burp' the seal, but that carries additional risk (well, not to me) - and folks did survive these back in the day. Not a lot, but at least some.

The Big Army says to:
(http://www.armystudyguide.com/content/ ... op-5.shtml)
Tell the casualty to completely exhale and hold his breath. If possible, the casualty should hold his breath until the sealing material has been secured. Having the casualty to exhale forces some of the air out of the chest wound.

Tape the top and both sides of the plastic wrapper to the casualty's chest. Leave the bottom edge untaped to form a flutter-type valve to allow air to escape through the chest wound, but keep air from entering the chest wound. (I'd manually do that, to ensure a good seal on inhalation.

I'd place pt. with injured side down. Transport could be problematic.

(shrug) with no CASH, or ER, things could go south fast.

I hope to avoid being stuck on PAW Island....
TacAir - I'd rather be a disappointed pessimist than a horrified optimist
**All my books ** some with a different view of the "PAW". Check 'em out.
Adventures in rice storage//Mod your Esbit for better stability

IANMCDEVITT
* * * *
Posts: 834
Joined: Mon Oct 03, 2011 1:13 pm

Re: WWYD Medical Edition - PAW GSW

Post by IANMCDEVITT » Sat Jun 21, 2014 6:20 pm

Good Dan, Good, at least you can give it back................Wow, Grifter, sorry dude, if that sounded mean.........shit dude, that's not the way I meant it.......But, aaaaa, you gotta have some tougher skin or the first charge nurse, ER charge nurse you turn a F'ed up patient over too is going to have you in tears. Now, since this is your scenario, and you posted it, you take the flak, right?...........after you see a few hundred patient's you will find that people that are able, will present to you on initial contact in what we call their position of comfort, that means that if you respond for a dislocated shoulder (for instance), when you get there and the nature turns out to be what was dispatched, the patient will present in a position that alleviates as much of their pain as possible. That means favoring the affected shoulder, or "self-splinting". In the same respect, a patient that sustains an isolated chest injury, is not hypovolemic, has not sustained any CNS damage, will present sitting up in what we call semi-fowlers, even full fowlers as it is their position of comfort................Now YOUR patient is altered, from that we can conclude three possible things, they HAVE bled out but haven't arrested yet, OR they HAVE sustained CNS damage (which you will only find out with a proper history and PE), OR, you fucked up the scenario........ :lol:..........Another point, about the mental status, if this truly is a learning scenario (this is the goal?) Then I might suggest you start with the proper terminology and use AVPU and elaborate on those, don't get new folks into the habit of using incorrect terminology.....BTW I agree with TacAir (the patient probably won't make it into the rig) Respiratory-to-cardiac arrest. Sorry if I ruffled feathers.

User avatar
zXzGrifterzXz
* * * * *
Posts: 6921
Joined: Sat Feb 12, 2005 8:17 pm
Favorite Zombie Movies: The Romero movies, The Stink of Flesh, Seige of the Dead, Shaun of the Dead, 28 Days later, The remakes of Night and Dawn.
Location: Bensalem, PA

Re: WWYD Medical Edition - PAW GSW

Post by zXzGrifterzXz » Sun Jun 22, 2014 10:28 am

Murph & TacAir,
There is an exit wound. Sealing both wounds has helped improve the patient's breathing but it is still shallow. He still has Pale, cool, and diaphoretic skin even after shock management (though Murph's patient does not respond well to having his legs raised and seems to be causing him a lot more breathing distress so you lower his legs) and he goes unresponsive during your treatment. Despite this, you feel like you have done what you can for him out here and since he is still unstable you elect to transport him back to your home/base of operations as quickly as you can since you don't know if the area is truly safe or if you could be fired on by gang members at any moment.

Sadly, without the definitive critical care of a trauma surgeon/level 1 trauma center, this patient will most likely die but he was a friend of yours for many years before the PAW and you would want to do everything you could for him.



DannusMaximus wrote:Seems reasonable. I would consider an airway adjunct if they can tolerate it.

Is elevate the legs to treat for shock still taught? It was when I started doing first aid lo these many years ago, but I thought it had gone the way of the do-do.

I have been taught how to decompress a chest wound (we practiced on some pork ribs and practiced finding landmarks on each other), but I've never done one on a person. I suppose I might give a decompression a try if they continue to go down hill - - not going to hurt in all likelihood, and might at least make them more comfortable by improving their breathing.
They still teach us to treat shock by elevating legs on non-spinal trauma patients and even to just elevate the foot end of the backboard on patients who have been secured to a long board. Only major contraindications are possible head trauma(they are worried about increased intracranial pressure) and open chest trauma (as it can cause an increase in intrathoracic pressure).

Also, if an Asherman or similar valved chest seal isn't available, NREMT has use use an occlusive dressing that is taped on three sides. The bottom being left untaped so it may drain and burp itself.

Well done you two, and thank you Dan for filing in while I was out yesterday.

Ian, no worries man. I grew up in an east coast italian family. You would have to try pretty hard to tip my apple cart. I look forward to learning as much as I can from you, and if you are ever in Phoenix the first round of cigars and booze are on me.
-NREMT - EMT
-NFPA 1006 Rescue Technician
-HAZMAT Technician

My Aid Bag
*Standard medical disclaimer applies to all of my posts, YMMV, Always check CNS before and after, never let the new guy drive, don't attempt anything you read here without proper supervision..... Blah Blah Blah*

IANMCDEVITT
* * * *
Posts: 834
Joined: Mon Oct 03, 2011 1:13 pm

Re: WWYD Medical Edition - PAW GSW

Post by IANMCDEVITT » Sun Jun 22, 2014 10:56 am

I'll take you up on that someday! Listen! you sound like a good dude! Good luck with EMS! It's not what you think though, things have changed for the worse and will only GET worse.............DON'T TRUST BOOKS, BOOK KNOWLEDGE IS GREAT BUT TOSS THOSE SUCKERS ONCE CLASS IS DONE........Your too sharp a guy to not discover things on your own, find a mentor, someone who you respect and respect their work, PLEASE!....Don't trust many people, let them earn your trust! Don't go in with the crowd in EMS. Most of those people are freaks and misfits....it's not cool to tease drunks or psyches, it's not cool to use large gauge needles on people "just cause you can" or whatever....Your lucky actually because your an older guy going into this field and more mature.......REMEMBER.....It's not what you leave behind in this world, IT'S HOW YOU LIVED YOUR LIFE !!!!!!......ok, back to the battlefield for me.

weatherdude
* *
Posts: 160
Joined: Sat Oct 31, 2009 7:07 pm
Location: Florida

Re: WWYD Medical Edition - PAW GSW

Post by weatherdude » Sun Jun 22, 2014 7:30 pm

BSI on the way, and on arrival secure PT's weapons as Murph said. Quickly make the PT trauma naked and do my blood sweep and try to locate any other GSWs. None, sweet! I'd use chest seal and plastic to seal the sucking chest wounds. I'd have an assistant place a gloved hand over both entry and exit wounds until I was ready to seal it off. Log roll, assess the pt's back and neck for any injuries. Quickly get other vitals and an IV of Hextend or NS started, 16G cath. JVD or Tracheal deviation present, I'd NCD the chest with the member's blow out kit's NCD needle (my group all carries Ventilated Operator Kits.) I'd get him on oxygen, Non-rebreather 15 LPM, treat for shock, and remove casualty back to observation area in a house.

I'm actually learning more and more medicine from my boss, an M.D. who prepps, so I'm learning to deal more with the "Help is not coming" shit, but any tips on what to read, and all that good stuff, I'd love to see!
Johnathan
AHA ACLS, PALS, BLS Training Center Faculty

IANMCDEVITT
* * * *
Posts: 834
Joined: Mon Oct 03, 2011 1:13 pm

Re: WWYD Medical Edition - PAW GSW

Post by IANMCDEVITT » Mon Jun 23, 2014 6:13 am

That's great Weatherdude, you know all the TEXTBOOK answers, BUT, you'd DO NONE OF THAT THERE, THAT'S A TACTICAL FIELD CARE SITUATION...................QUICKLY ADDRESS WHAT YOU ARE SUPPOSED TO ACCORDING TO THE STAGES OF CARE AND MOVE YOUR ASS................you just put everyone there in danger. Try again! (BTW, we no longer use three sided taping so drop that technique folks).

User avatar
Stercutus
* * * * *
Posts: 12270
Joined: Wed Feb 10, 2010 8:16 pm
Location: Bouncing in to Graceland

Re: WWYD Medical Edition - PAW GSW

Post by Stercutus » Mon Jun 23, 2014 6:39 am

That looks like the best answer for field care Weatherdude based upon your skills and equipment available.

Rarely someone survived a lung shot in the Civil War era. I wish there were more studies available on how they did that.
From this day to the ending of the world,
But we in it shall be rememberèd—
We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother

IANMCDEVITT
* * * *
Posts: 834
Joined: Mon Oct 03, 2011 1:13 pm

Re: WWYD Medical Edition - PAW GSW

Post by IANMCDEVITT » Mon Jun 23, 2014 6:50 am

Really, that's the best answer for treatments done during Tactical Field Care? Expose the patient completely? Establish IV access there? Place the patient on O2 there? With just hasty security, if that? while the team is exposed? and the patient's crashing, take time for an IV solution?...............Back to school brother.

User avatar
Stercutus
* * * * *
Posts: 12270
Joined: Wed Feb 10, 2010 8:16 pm
Location: Bouncing in to Graceland

Re: WWYD Medical Edition - PAW GSW

Post by Stercutus » Mon Jun 23, 2014 6:57 am

IANMCDEVITT wrote:Really, that's the best answer for treatments done during Tactical Field Care? Expose the patient completely? Establish IV access there? Place the patient on O2 there? With just hasty security, if that? while the team is exposed? and the patient's crashing, take time for an IV solution?...............Back to school brother.
In the vast majority of your posts it is as though you seize on certain details, misunderstand those details and then expound on them; often in capital letters.
From this day to the ending of the world,
But we in it shall be rememberèd—
We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother

Doctorr Fabulous
ZS Lifetime Member
ZS Lifetime Member
Posts: 12210
Joined: Mon Oct 26, 2009 3:06 pm
Favorite Zombie Movies: Evil Dead, Zombieland, 28 Days/Weeks Later

Re: WWYD Medical Edition - PAW GSW

Post by Doctorr Fabulous » Mon Jun 23, 2014 7:40 am

Chest seal (whatever we have on hand) on both entry and exit. Immobilize the wound-side arm, at least temporarily, and if he still has a weapon bitchslap whoever brought him in like that. Treat for shock, elevate torso to comfort. Cry because that's about all I can do beyond that. Call the NOK.
Opinions subject to change in light of new information.
Image
http://i.imgur.com/wG6ZMjE.jpg

weatherdude
* *
Posts: 160
Joined: Sat Oct 31, 2009 7:07 pm
Location: Florida

Re: WWYD Medical Edition - PAW GSW

Post by weatherdude » Mon Jun 23, 2014 1:48 pm

IANMCDEVITT wrote:That's great Weatherdude, you know all the TEXTBOOK answers, BUT, you'd DO NONE OF THAT THERE, THAT'S A TACTICAL FIELD CARE SITUATION...................QUICKLY ADDRESS WHAT YOU ARE SUPPOSED TO ACCORDING TO THE STAGES OF CARE AND MOVE YOUR ASS................you just put everyone there in danger. Try again! (BTW, we no longer use three sided taping so drop that technique folks).
Thanks for that bud....we taping down all sides now? Stages of TC3....Stop the bleed start the breathing. So seal the chest, stop any bleed, and do the NCD as needed.
Johnathan
AHA ACLS, PALS, BLS Training Center Faculty

User avatar
VXMerlinXV
* * *
Posts: 410
Joined: Fri Sep 12, 2008 7:51 pm
Location: SEPA

Re: WWYD Medical Edition - PAW GSW

Post by VXMerlinXV » Tue Jun 24, 2014 8:54 pm

Ok, late to the party but I still want to play. I answered without reading everyone else's replies first, to keep things honest. So, some guy gets popped on my front lawn, and I decide to render aid there because of...reasons? F that. Two man improvised litter carry back to the house as is.

Once there, chest seal, assess. Second hole? Second seal. Assess. Pneumo? Dart him. Hemo.... eh... maybe improvised chest tube. I wound not feel confident that a needle decompression would make any difference in a pt with a symptomatic hemothorax. Just a wasted needle. I would think about volume expansion, if I felt he needed it, based on what supplies we had left.

Other realistic treatment points:
-Double outer guard now, this could get very Hatfield McCoy in a hurry
-Mentally divvy up his stuff, calling dibs on the primo gear
-Begin mentally writing "this is why we wear armor" tac-med lecture
-Make sure my gear and family are ready to roll out the back door if the bad guys show up out front.
My posts are my opinion, and do not reflect the standing or policy of any group I may be associated with. Nothing typed here should be considered medical advice, or permission from myself or any governing body to perform medical intervention. If this is a medical emergency, please get off your computer and dial the appropriate local response number.

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: WWYD Medical Edition - PAW GSW

Post by DannusMaximus » Thu Jun 26, 2014 2:38 pm

IANMCDEVITT wrote: Try again! (BTW, we no longer use three sided taping so drop that technique folks).
Who is 'we'? A citation or other reasoning for the change would be nice, if only because of this...
zXzGrifterzXz wrote: Also, if an Asherman or similar valved chest seal isn't available, NREMT has use use an occlusive dressing that is taped on three sides. The bottom being left untaped so it may drain and burp itself.
ALSO, in this particular scenario there seems to be great (and understandable) focus on the security situation. That's good, but I'm operating in these scenarios from a 'scene is safe' mindset, meaning my answers are basically focused on the medical treatment to be given, not the tactical situation it's being given in. As far as I'm concerned security has already been handled within the confines of this scenario.

In the real world, obviously, security is always my primary concern. In future scenarios it might be helpful to state if the 'scene is safe' or if we also are supposed to take the tactical considerations into account. Just my $0.02
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

IANMCDEVITT
* * * *
Posts: 834
Joined: Mon Oct 03, 2011 1:13 pm

Re: WWYD Medical Edition - PAW GSW

Post by IANMCDEVITT » Thu Jun 26, 2014 4:49 pm

Fair enough Dan!........First off, please don't quote the registry. That really doesn't give you any more credibility than you already have with me from the give-and-take here on the forum that you and I have had............ A bunch of wanna-be "experts" that insinuated themselves into the field a little over twenty years ago doesn't impress me nor make me put any weight in their policy...........You actually drop in credibility whereas if you honestly told me about your EXPERIENCES in EMS, your words would be worth more thought........Second, Do you mean to tell me that if I posted a citation on the errornet here from some unknown source, you'd change your treatment?......I think your a little smarter than that and would still base your treatment upon your past experiences with similar patient's with similar injuries (based on succesess and failures). Third, I can tell you that I'm pretty sure the International School of Tactical Medicine and I know my medical control doctors all adhere to the four sided occlusive dressing (if no specific chest seal is available). The Dept. of Def, The Dept. of State, all advocate for four sided. The World Wide Protective Services Class or "WhiPS" bodyguards along with the Diplomatic Security Service all are taught it in class in their medical segment and go four sided (I know because it's my info)...........SAS, SBS, and multiple friendly Tier 1 units do four sided.............Now, why? Simply because three sided never worked. It's better to just seal that, both sides, watch your patient positioning (full fowlers) and you are now one-on-one with that patient. TALK TO YOUR PATIENT - at the first sign of SOB, open the seal..............relieve the pressure as much as possible while you move to a CASEVAC or Tactical Casualty Evacuation.................about the security, c'mon dude, you know better than that...........your not safe until you've reached home base Brother.

User avatar
DannusMaximus
ZS Donor
ZS Donor
Posts: 2767
Joined: Wed Nov 19, 2008 9:00 pm
Location: Indiana's Southern Coast

Re: WWYD Medical Edition - PAW GSW

Post by DannusMaximus » Thu Jun 26, 2014 6:53 pm

IANMCDEVITT wrote:Fair enough Dan!........First off, please don't quote the registry. That really doesn't give you any more credibility than you already have with me from the give-and-take here on the forum that you and I have had............ A bunch of wanna-be "experts" that insinuated themselves into the field a little over twenty years ago doesn't impress me nor make me put any weight in their policy...........You actually drop in credibility whereas if you honestly told me about your EXPERIENCES in EMS, your words would be worth more thought........Second, Do you mean to tell me that if I posted a citation on the errornet here from some unknown source, you'd change your treatment?......I think your a little smarter than that and would still base your treatment upon your past experiences with similar patient's with similar injuries (based on succesess and failures). Third, I can tell you that I'm pretty sure the International School of Tactical Medicine and I know my medical control doctors all adhere to the four sided occlusive dressing (if no specific chest seal is available). The Dept. of Def, The Dept. of State, all advocate for four sided. The World Wide Protective Services Class or "WhiPS" bodyguards along with the Diplomatic Security Service all are taught it in class in their medical segment and go four sided (I know because it's my info)...........SAS, SBS, and multiple friendly Tier 1 units do four sided.............Now, why? Simply because three sided never worked. It's better to just seal that, both sides, watch your patient positioning (full fowlers) and you are now one-on-one with that patient. TALK TO YOUR PATIENT - at the first sign of SOB, open the seal..............relieve the pressure as much as possible while you move to a CASEVAC or Tactical Casualty Evacuation.................about the security, c'mon dude, you know better than that...........your not safe until you've reached home base Brother.
I like the thought of monitoring the patient and only unsealing the occlusive dressing when it they become symptomatic. Makes perfect sense. We've actually had people teach in-services that advocate a defib pad as an ad hoc chest seal, which also jives with the theory behind sealing the wound completely.

I wasn't really quoting NREMT standards, but the fact of the matter is that (for good or worse) it IS at least a recognized standard. From a CYA standpoint a treatment advocated by a recognized standard certainly carries more weight than a discussion on a zombie prep website. Given that I'm not particularly into CYA medicine for it's own sake, I tend to try things out that make sense to me within my limited scope of practice. It also helps that I'm just a lowly EMT-B, and a hose-humper to boot - - if one of my attempts at being creative with my EMS response raises any eyebrows among the eleeet paras and ER folks, I can generally just start to drool and grunt things about fires while walking around dragging my knuckles. They really don't expect that much out of us... :clap:

Anectdotally, I've only had one GSW patient that I KNOW had a chest wound which was causing respiratory compromise. I know this because he was gasping for air, turning blue, and a godawful bubbling froth was coming from what used to be his upper ribcage. I packed a shit-ton of trauma pads over the entry and exit, used about every bit of guaze and tape we were carrying to close it all up, and then threw a non-rebreather on him and started chewing my fingernails. His respiratory improvement was sudden and remarkable, and I'm pretty sure it wasn't the NRB causing it.

Thanks for the response and food for thought.
Holmes: "You have arms, I suppose?
Watson: "Yes, I thought it as well to take them."
Holmes: "Most certainly! Keep your revolver near you night and day, and never relax your precautions..."

- The Hound of the Baskervilles

User avatar
Murph
* * * * *
Posts: 5771
Joined: Fri Jan 11, 2008 11:46 am
Location: Virginia
Contact:

Re: WWYD Medical Edition - PAW GSW

Post by Murph » Thu Jun 26, 2014 8:32 pm

Out of curiousity, are there any three-sided seals that are not improvised?
Does your BOB at least have: water, basic tools, fire, food, first-aid kit, and shelter?
"When planning, prepare for the most likely, and then the most catastrophic."
raptor wrote: Being a gun collector does not make you a prepper.
the_alias wrote: Murph has all the diplomacy of a North Korean warhead, but -he has- a valid point

Post Reply

Return to “First Aid”