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 Post subject: Medical Bag Theory
PostPosted: Mon Oct 24, 2016 8:20 pm 
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Hey guys, I found a fantastic two part journal article written by 18D medics on the theory and methods of packing medical gear. While the piece specifically addresses the role of a Special Forces medic during operations in urban terrain throughout Iraq, I think there are a TON of take away points for anyone interested in disaster medicine. Here are the two links, with some of my initial thoughts below. Please add your own, or feel free to tear mine apart.
https://www.jsomonline.org/Publications/2008347Hetzler.pdf
https://www.jsomonline.org/Publications/2008430Ball.pdf

Thoughts:
Medical load out should never make the assumption that the care of the sick and injured is the main priority of the group.

Assume a delayed evacuation time, and develop plans for care using your materials at hand for less than 12 hours and greater than 12 hours.

Damage control resuscitation guidelines address the lethal trauma triad of hypothermia, coagulopathy, and acidosis. While most/all of us are not packing TXA and blood products, stressing the importance of keeping your trauma patient warm can not be overemphasized. It's not just about comfort or hypothermia prevention, the traumatically injured patient dies faster when cool.

TCCC and PHTLS should be studied, and have directed care since Somalia, but there are limitations to these systems, and disaster medicine is not combat medicine. Looking at combat mortality is good, but looking at disaster mortality, common hiking and sports injury, and local emergency patterns will serve you just as well, if not better. To take that idea a step further, life threats can evolve mid-disaster, no different than the Iraqi IED threats. Freshwater can become more contaminated, and more difficult to purify. A difficult walk out can be made worse due to changing weather conditions. The point being, don't plan for only one thing to go wrong, and don't expect a disaster not to get worse.

Which brings us to the actual packing. A tiered approach works in your favor, even if you're not engaged in urban warfare. The amount you pack for your bob should be different than the amount of medical gear packed in your vehicle, which should be less than the amount of medical gear you keep in your house if you're going to shelter in place. The articles stress the ideas of cross loading and IFAKs, which may work for you. Any disaster for me will be most likely attended by my family, and I can't see the kids each sporting an IFAK. But there are some key ideas that translate well. My individual first aid kit stays on my person if I'm doing anything where I carry a backpack. After that comes the family sized bag, which we break out if we are going on extended hikes/adventures. If we are taking the car, my trunk bag comes with us, in addition to the smaller kits mentioned above. Each of these kits is functional on it's own, but combined gives me "depth of treatment". It also provides a range estimate for each kit. My individual kit needs to get me back to the family bag, which can get me back to my trunk bag, etc. If the distance gets too great, I need to pack heavier.

Conservation of supplies needs to be a consideration when treating in the austere setting.

Kitting for procedures makes sense, and cheat cards will keep you on algorithm. I think this is especially important if you are not a full time healthcare provider.

Rotation of supplies should be a no brainer, as should occasional bag shake downs.

The two is one, one is none mentality warrants repeating, but I like to add my caveat that three is way too many. What I mean is always have a back up, but be able to justify each tape roll, bandage, and airway. These bags get heavy FAST.

If there is any degree of immediate danger to what you're doing, first line medical supplies are warranted. Being able to quickly access life saving supplies will make a difference in your success.

Do not rely on a single method to reach any treatment goal. Your kit should have more than one way to treat bleeding, secure airways, etc. Further, there should be very few one trick ponies in your bag, almost anything you carry should be multipurpose.

Things like hygiene, mobility, and hydration are all medical considerations. You should think about addressing them out of your kit.

The idea of small comforts needing to be met on all levels of kit is important. The care provider should have quick access to basic otc's, baindaids, tape, and 4x4's in order to keep his group as healthy as possible.

I do think it is interesting and worth pointing out that trauma dressings and high volume fluids are not recommended or carried. This is the second SOF source I have come across that favored ACE and Kerlex over the ETD's.

Thanks for reading, I can not wait to hear everyone's thoughts on the topic.


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 Post subject: Re: Medical Bag Theory
PostPosted: Sat Oct 29, 2016 6:57 am 
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Great post. There are a lot of good ideas here.
It cannot be overemphasized that accumulating all the gear you simply have to have "just in case" makes it too hard to transport your kit. I definitely second the point that there really aren't any common injuries that can't be treated with Kerlix, 4x4s, ACE wraps, tape, and basic airway supplies. SAM splints are a great addition, and pretty light. By far the most important things you can have are the requisite knowledge, and the ability to adapt and improvise.

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 Post subject: Re: Medical Bag Theory
PostPosted: Sun Jan 29, 2017 11:34 pm 
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I work EMS in the urban setting, and have had the fortune or misfortune to work a good bit of trauma, including GSWs, bad motorcycle wrecks (which can be the most widespread, systemic trauma I've seen), in addition to a lot of more medical emergencies. Kerlix and ace bandages are wonderful for making pressure bandages. I've stopped arterial bleeding with 4x4s secured with an ace wrap on more then one occasion. Carry at least 2 TQs, as I've seen them fail and need a second one applied for the same injury. Even working with an ambulance full of supplies, a decent sized medical bag that I rarely have to carry very far, and short transport distances to an ER, I do tend to carry mostly things that are multiple-use if possible. Some "one trick ponies" (such as advanced supraglottic airways) are required to be carried, though. I also couldn't tell you the last time I used an OPA for anything; I use either NPAs or supraglottics primarily. I did see a firefighter use an OPA on a heroin OD once, which demonstrated that the patient in fact had no gag reflex, lol.


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 Post subject: Re: Medical Bag Theory
PostPosted: Mon Jan 30, 2017 12:58 am 
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having small kits that you can comfortably carry are worth their weight in platinum (because they're light). you might have the aid bag that can do anything and everything...but how will you feel after trying to get everything into the one room apartment on the 30th floor? and anyway, that's what the ambulance is for

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 Post subject: Re: Medical Bag Theory
PostPosted: Mon Jan 30, 2017 12:54 pm 
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taipan821 wrote:
having small kits that you can comfortably carry are worth their weight in platinum (because they're light). you might have the aid bag that can do anything and everything...but how will you feel after trying to get everything into the one room apartment on the 30th floor? and anyway, that's what the ambulance is for


Exactly, a stepped system of supply gives you both depth of treatment options, and range estimations for the coverage of any given kit.


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 Post subject: Re: Medical Bag Theory
PostPosted: Mon Jan 30, 2017 12:56 pm 
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jdev wrote:
I work EMS in the urban setting, and have had the fortune or misfortune to work a good bit of trauma, including GSWs, bad motorcycle wrecks (which can be the most widespread, systemic trauma I've seen), in addition to a lot of more medical emergencies. Kerlix and ace bandages are wonderful for making pressure bandages. I've stopped arterial bleeding with 4x4s secured with an ace wrap on more then one occasion. Carry at least 2 TQs, as I've seen them fail and need a second one applied for the same injury. Even working with an ambulance full of supplies, a decent sized medical bag that I rarely have to carry very far, and short transport distances to an ER, I do tend to carry mostly things that are multiple-use if possible. Some "one trick ponies" (such as advanced supraglottic airways) are required to be carried, though. I also couldn't tell you the last time I used an OPA for anything; I use either NPAs or supraglottics primarily. I did see a firefighter use an OPA on a heroin OD once, which demonstrated that the patient in fact had no gag reflex, lol.



Curious, as a professional emergency medical responder, has your medical packing for personal use (camping kit, BoB, Trunk bag) changed much as you gained patient care experience?


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 Post subject: Re: Medical Bag Theory
PostPosted: Tue Feb 28, 2017 4:31 pm 
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VXMerlinXV wrote:
jdev wrote:
I work EMS in the urban setting, and have had the fortune or misfortune to work a good bit of trauma, including GSWs, bad motorcycle wrecks (which can be the most widespread, systemic trauma I've seen), in addition to a lot of more medical emergencies. Kerlix and ace bandages are wonderful for making pressure bandages. I've stopped arterial bleeding with 4x4s secured with an ace wrap on more then one occasion. Carry at least 2 TQs, as I've seen them fail and need a second one applied for the same injury. Even working with an ambulance full of supplies, a decent sized medical bag that I rarely have to carry very far, and short transport distances to an ER, I do tend to carry mostly things that are multiple-use if possible. Some "one trick ponies" (such as advanced supraglottic airways) are required to be carried, though. I also couldn't tell you the last time I used an OPA for anything; I use either NPAs or supraglottics primarily. I did see a firefighter use an OPA on a heroin OD once, which demonstrated that the patient in fact had no gag reflex, lol.



Curious, as a professional emergency medical responder, has your medical packing for personal use (camping kit, BoB, Trunk bag) changed much as you gained patient care experience?


Half the time I go camping, I just throw my regular med bag in the trunk too, lol.

However, as far as assembling a kit, it has changed a bit. I see more of what actually works, and how to improvise things with having a minimum of multi-use supplies. I've also simplified and made multiple kits for multiple purposes. I use pre-made kits from reputable suppliers (Adventure Medical Kits and Rescue Essentials are my two personal favorites) as a base, and add/modify contents as I see fit.


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 Post subject: Re: Medical Bag Theory
PostPosted: Tue Feb 28, 2017 11:31 pm 
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jdev wrote:
However, as far as assembling a kit, it has changed a bit. I see more of what actually works, and how to improvise things with having a minimum of multi-use supplies. I've also simplified and made multiple kits for multiple purposes.


You'd be amazed at how much you can do with a triangular bandage and ice pack.

If I can say one thing (with experience gained from ambulance work, rescue, storm damage, flood response, first aid etc) is that a medical kit that solves every problem is unable to be used, it'll be too heavy, too bulky and it will be hard to find the stuff you need. from personal experience our local ambulances carry 4x kits, a general response kit, a resus kit, a dedicated trauma kit and an obsterics kit, not to mention the minitor/defib. we rarely take all five kits with us, instead taking the kits we think we'll need for that job

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 Post subject: Re: Medical Bag Theory
PostPosted: Wed Mar 08, 2017 9:49 am 
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This was a fascinating read. I've been looking at revisiting my entire med bag system, from my home kit, to my vehicle bag, to my patrol bag to my IFAK (which is why I was in this sub forum in the first place). I couldn't have asked for a better resource. One thing I'll say, I agree that multi-use items are the way to go. Less is more.


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 Post subject: Re: Medical Bag Theory
PostPosted: Sat May 20, 2017 6:40 pm 
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taipan821 wrote:
jdev wrote:
However, as far as assembling a kit, it has changed a bit. I see more of what actually works, and how to improvise things with having a minimum of multi-use supplies. I've also simplified and made multiple kits for multiple purposes.


You'd be amazed at how much you can do with a triangular bandage and ice pack.

If I can say one thing (with experience gained from ambulance work, rescue, storm damage, flood response, first aid etc) is that a medical kit that solves every problem is unable to be used, it'll be too heavy, too bulky and it will be hard to find the stuff you need. from personal experience our local ambulances carry 4x kits, a general response kit, a resus kit, a dedicated trauma kit and an obsterics kit, not to mention the minitor/defib. we rarely take all five kits with us, instead taking the kits we think we'll need for that job



Truth on the cravat and ice pack, lol. I'm also considering adding a small hip kit at work in addition to my main bag, for the minor runs that don't require much in the way of gear.


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