Bleed control - personal program

sbaker0029 said:
I'm with you on this. I'll give someone I love breaths without a barrier but anyone else is getting just compressions.

Also this is just from my recent refreshers and trainings, seems like in a lot of cases for single rescuer its now being suggested compressions only until someone else arrives for breaths. Not how I learned but they constantly update all this stuff to further make things "better". Obviously every situation is different though.
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Everyone should act within there training and knowledge. The ability to make use of the below in the heat of the moment takes years of experience (and my own experience would be lacking, knowing and being able to apply are not the same).


The AHA heavily focuses on VT/VF type arrests at the expense of other causes. It is also specifically designed for situations where help is close at hand. Most Americans live in cities with faster EMS access and AEDs in many public places. Consequently lay CPR classes are focused on this. ACLS is intended for healthcare providers who will quickly have a team on hand. For a non-respiratory arrest without a reversable cause, in the first 5 minutes or so compressions are the single most important thing to extend myocardial (heart muscle) viability until defibrillation can take place.

Breaths matter more if additional help/defibrillation is 10-15 minutes or more away, however the hard truth is most of those patients will not have neurologically intact survival. High quality compressions with breaths and minimal interruptions makes neurologically intact survival more likely, however giving good compressions for 6 minutes is hard even if one is fit, some people need to be switched off the compressor role in under a minute due to fatigue and decreased quality.

Not every arrest is a VT/VF arrest. For children breaths are significantly more important (of course they are covered by PALS, which is a much better course than ACLS in my opinion). Compressions for most obstructive shock are stupid (fix the pneumo, Etc), compressions for hemorrhagic shock are low on the priority list (stop bleeding, expand volume, if you have deprived the heart of blood long enough to have VT/VF the odds of salvaging that are close to 0 and a clamshell thoracotomy, rather than external compressions, is likely needed). Thanks to ACLS, patients with both of those conditions have life saving treatment delayed for compressions. However, that is improving thanks to stop the bleed and changes in trauma courses.

ACLS is a course for the lowest common denominator, it is intended to give direction and order, which is better than nothing. It achieves that, and saves a lot of lives because of it; however it is frustratingly simplistic and often times rigidly applied.
 
Marbles said:
Everyone should act within there training and knowledge. The ability to make use of the below in the heat of the moment takes years of experience (and my own experience would be lacking, knowing and being able to apply are not the same).


The AHA heavily focuses on VT/VF type arrests at the expense of other causes. It is also specifically designed for situations where help is close at hand. Most Americans live in cities with faster EMS access and AEDs in many public places. Consequently lay CPR classes are focused on this. ACLS is intended for healthcare providers who will quickly have a team on hand. For a non-respiratory arrest without a reversable cause, in the first 5 minutes or so compressions are the single most important thing to extend myocardial (heart muscle) viability until defibrillation can take place.

Breaths matter more if additional help/defibrillation is 10-15 minutes or more away, however the hard truth is most of those patients will not have neurologically intact survival. High quality compressions with breaths and minimal interruptions makes neurologically intact survival more likely, however giving good compressions for 6 minutes is hard even if one is fit, some people need to be switched off the compressor role in under a minute due to fatigue and decreased quality.

Not every arrest is a VT/VF arrest. For children breaths are significantly more important (of course they are covered by PALS, which is a much better course than ACLS in my opinion). Compressions for most obstructive shock are stupid (fix the pneumo, Etc), compressions for hemorrhagic shock are low on the priority list (stop bleeding, expand volume, if you have deprived the heart of blood long enough to have VT/VF the odds of salvaging that are close to 0 and a clamshell thoracotomy, rather than external compressions, is likely needed). Thanks to ACLS, patients with both of those conditions have life saving treatment delayed for compressions. However, that is improving thanks to stop the bleed and changes in trauma courses.

ACLS is a course for the lowest common denominator, it is intended to give direction and order, which is better than nothing. It achieves that, and saves a lot of lives because of it; however it is frustratingly simplistic and often times rigidly applied.
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Thank you for going in depth on this.

I can definitely agree with your last statement that it has become frustratingly simplistic and rigidly applied.
I think you mentioned before, it's been designed for lay people to feel more comfortable in giving aid; therefore taking things down to the most simplistic level.
They way some of this information is presented you'd think that there's an ambulance waiting on every corner and an AED in every room.

I work in an industrial plant in a fairly large industrial area. Most of the plants train together once or twice a year just in case there's a mass casualty event at one plant requiring aid from another.
We've found there's a gap in training and resources out there for our needs and have had to modify a lot of what's out there to tailor to our specific needs.

Sorry to derail your thread a bit @fwafwow
 
I have been reviewing what I am carrying constantly. I have carried a trauma kit for year and conduct monthly medical training when i was in the military. Once I got out the trauma training was non existent and I did a couple of CPR course when I worked for the forest service.

These days, I am back to carrying two separate kits: a trauma kit and a boo-boo kit as they are both commonly referred to. I keep both in my pack, with my other goods that will help me out of a jam……I carry a TQ on my bino harness and keep an extra in with my med kits. I also have a handkerchief in my bino harness.

My trauma kit is from Phokus Research and is small enough to fit in most pouches but contains the necessary items to patch up someone as needed for transport to better care. My boo-boo kit is made by me. It’s a selection of meds, nail clippers, tweezers and eye drops. I also have a selection of band-aids, some gauze, iodine wipes, alcohol wipes and tape. I keep everything in a plastic soap dish.

I am lucky to have a current job that requires medical training, even though it’s not nearly as often as I’d like. I try to take advantage of talking through scenarios with the medical dudes I work with.

This has been a great thread so far.
 
sbaker0029 said:
How do you like #2?
I've almost ordered it a couple times, but keep thinking I should just get the Blue Force Gear one that's similar since it's made in the USA.
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It seems fine. I would have not known about it until I saw this review of it -
. It was $14.99 and the Blue Force version is $94 (bag only) at retail. It makes me question paying $70 for the Live the Creed Recon.
sbaker0029 said:
You're kits are looking good. I like the four different uses/levels you got going.
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Thanks. I'm sure that over time things will change - in part due to apathy, not wanting to carry around as much, etc. My wife just shakes her head, and she doesn't even know the full extent (like that #4 will be in the car, but probably so will #3 - especially if #4 is in the trunk).
 
Dexter Grayson said:
What does the injury list look like that would call for the use of a tourniquet?

How many of y’all carry around AED’s?
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Shaving accidents, skinned knees, paper cuts - etc.

I've been searching for a pocket AED that will fit in my bino harness. The picture below is inspiring, as I need some exercise while carrying around an AED. However, if and when I go running, my hands should be free to gesticulate to neighborhood punks, drink my electrolyte infused water, etc.

1711205989332.png
 
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fwafwow said:
Good to know! What do you suggest or are options?
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Zyrtec (cetirizine). As an Rx (so this is a statement, not a recommendation) it can be used safely at 4x the normal daily dose (two 20 mg doses) for hives. It as effective as Benadryl at an equivalent dose, but due to side effects it would not be advisable to take 4x the standard dose of Benadryl. Zyrtec is also less likely to cause hypotension. The only argument for Benadryl in the literature for emergency management is that it WAS the only antihistamine available IV, however so is cetirizine now, so that argument no longer stands.

Antihistamines do not treat anaphylaxis, alone they can potentially exacerbate it. There use even as an adjunct to epinephrine is debatable, even though it is pretty standard practice the evidence for it is questionable.

If Benadryl was introduced today, with the current second generation antihistamines on the market, I doubt it would get FDA approval even as an Rx.

Quick podcast on it

Urticaria – FOAMcast

foamcast.org foamcast.org

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517288/ "As adjuvant therapies H1‐ and H2‐antihistamines and steroids are also often given, although there is little data to support these uses and in the case of first‐generation, potentially sedating H1‐antihistamine preparations, there is potential to cause harm."

www.health.harvard.edu

Epinephrine is the only effective treatment for anaphylaxis - Harvard Health

Many people have experienced mild allergic reactions to a food, medication, or other allergen, but a severe reaction can be harmful or even fatal. Anaphylaxis must be treated with epinephrine as qu...
www.health.harvard.edu www.health.harvard.edu

Given that it is paywalled and copywrite material, I cannot quote it, but UpToDate, specifically states antihistamines should not be given until AFTER epinephrine has been given and that it only treats itching and hives, not the life threatening concerns in anaphylaxis. That is all antihistamines, but the first generation, like Benadryl, have the real potential to cause harm due to the sedating effects.

You will find plenty of providers (MD's, DO's, PA's, NP's) who still use it. That does not make it right, it just means they are operating using old practices, it takes about 20 years for common medical practice to catch up with the evidence unfortunately.
ddd-shooter said:
Yeah I’m gonna need clarification as well.
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See above
 
fwafwow said:
Another thread (linked below) caused me to want to reassess my readiness with respect to bleed control. If anyone can point me to a good resource, either for implementing a personal program, or on any of the topics below, that would be most appreciated.

Here are the broad steps of what I'm thinking:
  1. Admin stuff - certain parts of this should be admin - like calendaring for:
    • updating gear that expires
    • checking for new info on equipment
    • refreshing training and practice, etc.
    • inventory of current items
  2. Gear - can't have a rabbit hole without a gear component. I would value any authoritative sources
  3. Method -
    • where do I place items - kitchen (not doing currently), cars, luggage,
    • how do I use - EDC (see thread above), in hunting and shooting bags
    • other?
  4. Training -
    • how frequently for basic refresher vs more extensive?
    • who to use (is Dark Angel still well-regarded, alternatives, logistics)?
    • how frequently to practice?
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Your thread is fundamentally flawed.

1711593127261.jpeg
 
Haven't read all the replies, but I have a few things that I do that have helped me and may help other people with their plans.

For background, my Mom is an RN, and was an EMT for around 25 years. Spent many an evening as a youth at EMT trainings/meetings. My sister is also an EMT. Have an uncle and aunt who are also EMT's. And another uncle who was a firefighter in many arenas. So emergency medical response has always been a part of my life. I've spent the last 8 years in the oil and gas industry, with intensive focus on how to prevent the bad thing from happening. So this might not vibe with the thread.

GSW--I hate to admit, but there were times in the past I would hike with a fully loaded firearm. I no longer do that. If I'm carrying a rifle, there's nothing in the chamber until it's time to shoot. If I'm carrying my 44, the hammer is down on an empty chamber (kind of wonder if I shouldn't have the double action down on a full chamber so if the hammer goes back it cycles to an empty chamber.) My 10mm is fully loaded, but does have a double safety.

Bow shot wound-As a guy who's been shot with a compound bow, I always flex my arrows prior to shooting them. No matter what. If I'm stalking a deer, I flex the arrow before it goes on the string. Setting up to call at elk, arrow gets flexed. At the range, with an arrow that has only hit the target, that arrow gets flexed.

Knife slash/stab--One of the most statistically lethal dangers we as hunters are exposed to. One thing I've done, due to a prior job's discovery, I care Showa cut resistant gloves in my kill kit. I've also gotten to prove their effectiveness one night while boning out a bull. The other thing, and even more critical as I've mostly been hunting solo is slowing down the animal breakdown process, and thinking through how I position the animal and make cuts. I do everything I can to always be cutting away from my body. I also got the gut-hook blades for my Havalon, so I use that for making many cuts while skinning. It's actually super handy. Also, I feel the gut-hook side isn't going to go as deep as the not-gut hook side of havalon blade.

This is a great thread, and has my wheels turning and realizing how much I don't know about how to respond to a major injury. How much more training I need. So, not sure if I provided value, but maybe, my post will help others to try and do the prevent method to help minimize injuries everywhere.
 
PNWGATOR said:
Please post your rebuttal and recommended corrections for the of the thread.

Sincerely interested.
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I agree that more detail would be helpful. Giving the benefit of the doubt, perhaps the post is intended to reference something like this (or a similar) study - https://journals.sagepub.com/doi/10.1016/j.wem.2016.11.006. That doesn't provide much in the way of practical advice. Don't plan for emergencies? Plan but do it differently?
 
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