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Old 06-23-2008, 06:47   #46
VXMerlinXV
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The best price I found, other than used (and I'm not a big fan of “used” medical disposables) was about nine cents per foot for the 1”, and fourteen cents per foot for the 2”. The only straightforward advantage I can see is the compact size and the spool it comes in.
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Old 06-23-2008, 09:09   #47
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The best price I found, other than used (and I'm not a big fan of “used” medical disposables) was about nine cents per foot for the 1”, and fourteen cents per foot for the 2”. The only straightforward advantage I can see is the compact size and the spool it comes in.
Have you seen the small "flattened" rolls of the duct tape for survival use?

They are pretty compact and there are probably more uses for 100 mph tape than surgical tape. Only downsides I can see are sterility (and IIRC, tape is not sealed or sterile) and allergic reactions to the adhesive.

Along with superglue/dermabond, you have some pretty useful items.

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Old 06-23-2008, 11:42   #48
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I checked out the mini rolls and I think that is just what the doctor ordered. Other than a sensitivity to adhesive, I do not see a lot of downsides to using duct tape as opposed to medical tape.
Going back to the original intent of the thread, looking at most of the lists provided we're looking at a decent size kit, something big enough to need a pants pocket or larger vest pouch. I offered an abbreviated kit, and Krod listed a smaller kit as well. I think that a lot of the kits, including my own larger kit, can be cut down with little detrimental effect. So I suggest the following:
Hemostatic agents: Quick clot, Arista, etc. I think, barring some major advances, these are going to go the way of PASG/MAST quickly. The exothermic reaction is a definite factor, but more than that we were discussing research at work the other day which shows the products do not reliably stop arterial bleeding, which is the whole point. The Quickclot ACS negates the point of the clotting agent, this role is already filled with surgifoam or surgicel. The best I see for these products is large raw peripheral wounds, and these lend themselves to dressings, not powders. I think they can be cut from the kit all together.
Bulk gauze: I know the big wounds require a lot of dressing. But I am looking at the time/treatment ratio, the time it would take to use the majority of one of these IFAKs could be better spent transporting the casualty. I would say one good pressure dressing and one other dressing (ABD pad) should cover needs for the “Care under fire” phase.
Tourniquet: I like the idea of keeping them even more easily accessible than the IFAK. A small dedicated pouch with a tourniquet eliminates digging when you need one. I have always been partial to an inflated BP cuff for this function. There is a quantifiable amount of pressure, and you can slowly deflate the cuff after treating the wound to see if your intervention has reliably stopped the bleeding. I think one is enough for the individual to carry. You have to figure one limb can be controlled by the cuff, a second can be controlled with a pressure dressing, and if you have a third limb with an exanguinating wound you should either consider being kind and opening up the aidbag, or rest assured that one the patients systolic pressure hits 80 most of the the bleeding will stop all on it's own.

I think that these changes should drop some considerable bulk and some weight from the IFAK.
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Old 06-23-2008, 13:39   #49
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I checked out the mini rolls and I think that is just what the doctor ordered. Other than a sensitivity to adhesive, I do not see a lot of downsides to using duct tape as opposed to medical tape.
I have been using duct tape for years in the civilian world for MCI's... Its cheap, works and there is always ample suppliy...


Quote:
Hemostatic agents: Quick clot, Arista, etc. I think, barring some major advances, these are going to go the way of PASG/MAST quickly. The exothermic reaction is a definite factor, but more than that we were discussing research at work the other day which shows the products do not reliably stop arterial bleeding, which is the whole point. The Quickclot ACS negates the point of the clotting agent, this role is already filled with surgifoam or surgicel. The best I see for these products is large raw peripheral wounds, and these lend themselves to dressings, not powders. I think they can be cut from the kit all together...
You may need to do a lil research on the effectiveness of hemostatic agents outside the confines of the ER/ED or civilian EMS. Out here where bright lights and cold steel may be more than a day away Hemostatic agents have saved many lives and the benefits are more than a fair trade for the little weight.

Surgifoam/surgicel has its place in the spectrum of care. Replacing QC, Hemcon, etc in the combat setting isnt it...

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Bulk gauze: I know the big wounds require a lot of dressing. But I am looking at the time/treatment ratio, the time it would take to use the majority of one of these IFAKs could be better spent transporting the casualty. I would say one good pressure dressing and one other dressing (ABD pad) should cover needs for the “Care under fire” phase....
The application of a TQ is all thats indicated for the CUF phase. Pressure dressings and bandaging will be taken care of after fire superiority is gained, the objective cleared or as otherwise indicated or directed. There are many instances where packing wounds is indicated and the use of liberal amounts of kerlix/kling is necessary. I prefer wound packing to wound covering generally.

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Tourniquet: I like the idea of keeping them even more easily accessible than the IFAK. A small dedicated pouch with a tourniquet eliminates digging when you need one. I have always been partial to an inflated BP cuff for this function. There is a quantifiable amount of pressure, and you can slowly deflate the cuff after treating the wound to see if your intervention has reliably stopped the bleeding. I think one is enough for the individual to carry. You have to figure one limb can be controlled by the cuff, a second can be controlled with a pressure dressing, and if you have a third limb with an exanguinating wound you should either consider being kind and opening up the aidbag, or rest assured that one the patients systolic pressure hits 80 most of the the bleeding will stop all on it's own...
A BP cuff is considerably larger than a TQ and as such would add bulk to the IFAK and weight too. One TQ is also NEVER enough. Two is one, one is none and sometimes more are needed...

We carry one in the IFAK and one on the soldiers centerline. I have extras in my aidbag and a couple stashed on my vest...


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Old 06-23-2008, 15:10   #50
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Weren't there a couple studies that determined that windlass-style TQs were the only type that could sufficiently stop arterial flow in the field?
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Old 06-23-2008, 15:31   #51
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Weren't there a couple studies that determined that windlass-style TQs were the only type that could sufficiently stop arterial flow in the field?

Actually, flawed studies done by the Dept of the Navy. I have copies and will post when I dig them up.

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Old 06-23-2008, 21:39   #52
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You may need to do a lil research on the effectiveness of hemostatic agents outside the confines of the ER/ED or civilian EMS. Out here where bright lights and cold steel may be more than a day away Hemostatic agents have saved many lives and the benefits are more than a fair trade for the little weight.

Surgifoam/surgicel has its place in the spectrum of care. Replacing QC, Hemcon, etc in the combat setting isnt it...
The study I am basing this on is referring to field use, not ER. I left my hard copy at work, and will reference it directly tomorrow. The point I was getting at was that twenty years ago MAST was the next big thing, and in theory they work great. In practice MAST did not make a realistic difference in patient outcome, and it took years of collecting data to prove that. The same goes for aggressive fluid resuscitation. Two large bore IV's pouring in Saline were the norm for a good period of time. It is no longer the standard of care, after decades of studies.

I have read Blakes report on tactical care in 2007, and just rechecked the section on hemostatic agents, specifically in the 64 uses of HemCon in combat situations. What I think Blake fails to take into account is the body's natural tendency to shunt off peripheral bleeding. There is nothing to say these wounds would not have eventually stopped bleeding with a pressure dressing. Incidental field data (with 6,000+ wounded in 2007 alone) of a sample of 64 uses may or may not be considered definitive. In Alam's article “Hemorrhage Control in the Battlefield: Role of New Hemostatic Agents” hemostatic agents are given a favorable review, but it is noted that clinical data is mixed, including two parallel studies on a chitin dressing that produced opposite results. It should also be noted that many of these studies observed the effectiveness of hemostatic agents on thoracic and abdominal injuries as opposed to peripheral vascular bleeding. This leads to higher overall success rates, while in my opinion diluting data on realistic field applications.

I like the extended transport time argument for things like PO antibiotics, advanced orthopedic care, and as justification for carrying extra rehydration fluids and effective volume expanders. But the long term data shows exanguination happens in the first 5 minutes, making it a short term problem, the patient with massive peripheral bleeding is either going to be stable or dead in a very short period of time.



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A BP cuff is considerably larger than a TQ and as such would add bulk to the IFAK and weight too. One TQ is also NEVER enough. Two is one, one is none and sometimes more are needed..
I agree a BP cuff is larger than a TQ, but I think the BP cuff serves a variety or roles, as opposed to one filled by a TQ. I understand the need for redundancy, and I think the individual might be best served with a variety of equipment, and given the ability to prepack, I would take a cuff first and a TQ second.
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Old 06-24-2008, 05:17   #53
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First, I find it surprising that an EMT would argue with board certified trauma surgeons and 18Ds, but since I am neither, maybe I am missing something.

I have humped a ruck and been an SF soldier for a few years though, and I would submit that the BP cuff(s) are not going in my kit due to bulk, weight, and difficulty of one handed application under time constraints. I strongly suspect that if you offered your average SF troop (or any soldier, for that matter) a choice, he is going to take the smaller, lighter, non-pneumatic alternative.

IMHO, you are on the wrong track with the HCAs as well, but since you seem to have all of the answers, preach on.

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Old 06-24-2008, 05:41   #54
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I carry the same as MTNgoat except I add a couple of needles for decompression. Is anyone else using the Olaes dressings from TMS? I recently replaced my Isrealis with a couple. I put a few of the 6" ones in the truck kit and put a 4" on my carry kit. Your thoughts.
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Old 06-24-2008, 09:48   #55
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Originally Posted by VXMerlinXV View Post
The study I am basing this on is referring to field use, not ER. I left my hard copy at work, and will reference it directly tomorrow. The point I was getting at was that twenty years ago MAST was the next big thing, and in theory they work great. In practice MAST did not make a realistic difference in patient outcome, and it took years of collecting data to prove that. The same goes for aggressive fluid resuscitation. Two large bore IV's pouring in Saline were the norm for a good period of time. It is no longer the standard of care, after decades of studies.
I have as well read study after study of the effects of HCA's. My decision to carry and use them is based on the number of lives/limbs saved using HCA's here, where the rubber meets the road. In a couple decades we can revisit this topic as they have with fluid and the MAST. Today they are working.

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I have read Blakes report on tactical care in 2007, and just rechecked the section on hemostatic agents, specifically in the 64 uses of HemCon in combat situations. What I think Blake fails to take into account is the body's natural tendency to shunt off peripheral bleeding. There is nothing to say these wounds would not have eventually stopped bleeding with a pressure dressing.
All bleeding eventually stops. There is nothing to say it would have stopped with the use of pressure dressings alone either. BTW, HCA's are used ICW pressure.

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Incidental field data (with 6,000+ wounded in 2007 alone) of a sample of 64 uses may or may not be considered definitive. In Alam's article “Hemorrhage Control in the Battlefield: Role of New Hemostatic Agents” hemostatic agents are given a favorable review, but it is noted that clinical data is mixed, including two parallel studies on a chitin dressing that produced opposite results. It should also be noted that many of these studies observed the effectiveness of hemostatic agents on thoracic and abdominal injuries as opposed to peripheral vascular bleeding. This leads to higher overall success rates, while in my opinion diluting data on realistic field applications.
How is the use of HCA's on torso injuries inconsistent with realistic field application? If I did a study on the efficacy of clamping extremity bleeders would the same data not be consistent with use in the torso/ABD as well? People can bleed out from torso wounds just as easily, if not more so due to the complexity of hemcontrol in these areas. In fact, it is easier to gain hem control in the extremities due to the number of available options at hand. Groin/axial bleeds are some of the most difficult to gain hemcontrol on without having surgical access/ligation/clamping available. The same holds true for intra-thorax/ABD bleeds.

Quote:
I like the extended transport time argument for things like PO antibiotics, advanced orthopedic care, and as justification for carrying extra rehydration fluids and effective volume expanders. But the long term data shows exanguination happens in the first 5 minutes, making it a short term problem, the patient with massive peripheral bleeding is either going to be stable or dead in a very short period of time.
How long does it take to bleed out from a femoral artery or a brachial artery? Less than 5 minutes. The longer we fiddle-fuck trying things that may or may not work the more blood is being spilled in the dirt; once its gone its gone. So, for those areas where the EVAC is extended it is even more important to stop it FAST using whatever tools available. After I have it stopped and all other life threats are dealt with I can think about going back and downgrading TQ's to PDs and PD's to bandages...

Quote:
I agree a BP cuff is larger than a TQ, but I think the BP cuff serves a variety or roles, as opposed to one filled by a TQ. I understand the need for redundancy, and I think the individual might be best served with a variety of equipment, and given the ability to prepack, I would take a cuff first and a TQ second.
As for you carrying a cuff, you work in a different environment than we do; think about that. Based on years of "lessons learned" from the current conflicts, not to mention past conflicts, and drawing from my experiences in the civilian side (paramedic and trauma tech working in a L1 center) and my time as an 18D, I will take the TQ's, 2 please. They are light, small, and most importantly, they work. They are also not subject to atmospheric pressure changes..

In finishing, HCA's are but another tool for the tool box. They arent the be all, end all for hem control...but they are working and shouldn't be left behind, to save ounces, in hopes that a standard pressure dressing will work.

In EMS there is talk about the "Golden Hour" (the time from injury til arrival at a definitive care facility) and getting the patient to the "bright lights and cold steel" as soon as possible. On the battlefield the SF Medic is often times that definitive care; the bright lights and cold steel...

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Merlin:

You are out of your lane...

It is obvious your ideas, methods, education, and surroundings differ from mine/ours somewhat, which is all well and good. However you need to consider your frame of reference and post accordingly. This is a very different world from yours, one I didn't fully understand when I was working in the civilian side of the house either. You are more than welcome to participate but dont fool yourself into thinking that you have any idea about what works and what doesnt, or what is a waste of space on the battlefield even if you have read a report or two...

Crip
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Old 06-24-2008, 10:45   #56
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Crip,
One think I have found and reproduced is that quik-clot stops bone marrow bleeding much more efficiently than hem-com....impressively so. When an IED takes a limb off and you place a tourniquet, the marrow continues to bleed and this can be a major source of blood loss.

ss
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(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 06-24-2008, 11:02   #57
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Has Woundstat found it to any of your kits yet? The Dr. that helped develop it lectured to us a while ago on it, I forget why but it was supposed to be superior to quickclot.
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Old 06-24-2008, 11:11   #58
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Crip,
One think I have found and reproduced is that quik-clot stops bone marrow bleeding much more efficiently than hem-com....impressively so. When an IED takes a limb off and you place a tourniquet, the marrow continues to bleed and this can be a major source of blood loss.

ss
Funny thing you should bring that up.

During my recent visit to WRAMC (very sobering place to visit BTW) I spoke with a surgeon about HCA's and he made mention of QC stopping marrow bleeding but I forgot to follow up on it. Had many informative discussions with varying docs while there...

Crip
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Old 06-24-2008, 11:13   #59
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Has Woundstat found it to any of your kits yet?
Short answer, No.

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The Dr. that helped develop it lectured to us a while ago on it, I forget why but it was supposed to be superior to quickclot.
No need to wipe the wound clear of fluids...

Crip
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Old 06-24-2008, 12:02   #60
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...Is anyone else using the Olaes dressings from TMS? I recently replaced my Isrealis with a couple. I put a few of the 6" ones in the truck kit and put a 4" on my carry kit. Your thoughts.
I like the Olaes dressings. Received a few for T&E and will be getting some for our next trip to replace the Israelis...

Crip
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