Pre Planning Your Scene

mURPHY rULES! (and how to try to stymie him)

Among the blogs I visit more or less regularly, is “Notes From The Bunker”, featuring the adventures of the thoughtful and experienced Commander Zero. Today (As I write this it is 5 Sept 2019), The Commander reviews thoughts on idiot proofing your kit, particularly your first aid kit. (see for yourself: http://www.commanderzero.com/?p=6547#comments , “Mylar After Two Years Of Exposure”) He makes a mighty compelling case for, in effect, double bagging your first aid supplies, and he has, indeed, harshly tested his packaging. He has not found it wanting.

Aesop of Raconteur Report (ANOTHER regular read! Find him here: https://raconteurreport.blogspot.com/ ) commented on the original post, (found here, from March 15 2015: http://www.commanderzero.com/?p=2511), and, as usual, his comments are insightful, practical, and reflect studies in Advanced Placement courses at The College of Hard Knocks. I reprint them here, because I don’t want you all to miss them.

“1) Any FA kit that isn’t waterproof is worthless. If not now, then when you need it, which is worse. As you’ve discovered, and as I did the first time I was working on a movie set on a rainy day. It’s a mistake you only make once.
2. Mylar is nice, but you can’t see what’s inside. Consider heavy-duty Saran wrap or equiv. as something still see-through, but easier to tear open than mylar or two-hand zip-loks.
3. If you’re any kind of handy with a sewing machine, turning mil-spec poncho materials into pack and bag condoms is a quick and elegant way to make your favorite bag far more water resistant. It also gives you options as far as external appearance, whether more camo’ed, or more non-descript than Tactical Timmy camo patterns in urban use around the unprepared muggles. YMMV.
4. Given your penchants anyways, you can get single-use heat seal clear plastic bagging material too, and simply resolve that if you tear something open for use, you’ll re-stock and re-seal it at the first opportunity.
5. As far as opening, putting a guard-protected single-edge razor or retractable box cutter in the top of the kit is never a bad idea. For some of the sterile wrap crap used in the ED, I need bandage scissors, trauma shears, and/or a hemostat (think ER pliers) just to open the goddam packaging, and that’s indoors in air-conditioned comfort, with two hands.


(THIS PART THAT FOLLOWS IS GOLD, RIGHT HERE!)

6. As a general rule, whether for first aid or any other kind of kit, anything that couldn’t be reliably used during a year’s service in the WWI trenches of the Somme probably isn’t proper kit to rely on, and you’ll find that out at the worst possible moment. Field-test your gear and eliminate the flaws now, when mistakes are free.


7. Just random curiosity, but for a bike kit, why not something along the lines of a screw-top or screw-twist together PVC pipe or somesuch thing, clamped/strapped/zip-tied/etc. to the frame? Bombproof, compact, and totally watertight, and you could size the tube diameter to the largest items, and adjust the length so everything fits. Just thinking out loud there.”

With that preamble, may I direct your attention to my own humble work, from mid June of this year? (https://musingsofastretcherape.wordpress.com/2019/06/14/do-it-yourself-emergency-care/ )

With Commander Zero’s (herinafter referred to as “CZ”) insights, and Aesop’s commentary, I have been stimulated to consider shortcomings in my own arrangements.

I have never had my own kit(s) fail as in Czs experience. Mine are presently indoors or in my vehicle trunk. Previously, for years, my kit rode in the back seat of my dual cab pickup truck. When we loaded up, kids, luggage and all, it went into a tote in the back of the truck, inside a camper shell. That has/had worked out alright for me. On the other hand, I have never done a rainy weekend FTX, either. THAT sort of adventure might have elicited Aesop’s perspective.

Since one of the objectives of much of my hobbies/avocations/off duty activities is preparing for unwanted possibilities, the next generation of my deliberations will be considering how I can benefit from the above insights, and integrate them into my own preps.

For example, if I am compelled to hike my happy ass home from work, due to EMP/Carrington Event/One Minute After/civil disorder/Zombie Apocalypse, what is the likelihood that it will be sunny and seventy outside, versus raining cats and dogs at night in a gale? (Select option “B”, if you please!) Or perhaps mid January, with ass deep snow and wind, at a daytime high temp of 1 degree (for our European readers, that approximates minus 17 degrees C)?

The “I don’t want to freeze my butt solid, to the ground” aspects are likely intuitive, to anybody who has lived in The Midwest for any length of time, but protecting your equipment from those conditions may not be so obvious. (To be honest, this particular aspect had not made it’s way to the front of my own consciousness, until today!)

Broadening this thinking to other aspects of, say, a “Get Me Home” bag, suggests that packing said bag in sub-modules might be clever, if said sub modules are water proof (or, at least, repellent). Again, as of present experience, I’ve had no issues with water etcetera damaging my medic bag, or anything in my “possibles trunk”. That’s fine, until my 13 year old vehicle develops a hole allowing water or whatnot into my trunk.

Or, until I have to hop home in the Oobleck Storm. (or whatever). In those settings, I will regret not acting on CZ’s or Aesop’s insights.

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Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

MAST Trousers

A long, long time ago, in a galaxy not so far away….no, wait. That is not quite right.

So, TINS©, TIWFDASL©, with my partner Doug, and we caught a run for a stabbing. This was a bit out of the ordinary, inasmuch as the preferred mode of interpersonal interaction (based exclusively upon my skewed sample of EMS patients in Da City) was labeled as “a GSW”, or less cryptically, “a shooting”.

In any event, we arrived to find a gentleman who was talking, kinda sweaty, but able to tell us the chain of events that led to our meeting, along with niceties such as his allergies, medications, and previous medical history. Oh, yes: with a solitary stab wound in his chest, just left of center, and around 4-6 cm removed from his sternal margin. (Yep, that means just what you suspect that it means).

We packed him up, after Doug, thinking ahead, had laid out the MAST trousers on the cot.

So, back in the mists of time, shortly after the demise of the horse drawn ambulance (I kid! I kid!), there was this tool, based upon the fighter pilot’s “G Suit”, called the Medical Ant Shock Trousers, or MAST Trousers (Yep, that does, indeed, stand for “Medical Anti Shock Trousers Trousers”. Go figure.) The principle was thought to be that, when you inflated bladders in the legs, and overlying the lower abdomen, you would increase venous resistance, and thereby minimize the amount of blood remaining in the lower extremities, and thereby increase venous blood return to the heart. Since that would increase pre load, and preload is one component of cardiac output, the thinking was that, if we could increase preload, we could increase cardiac output, and that would increase blood pressure. Generally, within certain limits, increased blood pressure in a trauma/shocky patient is held to be A Good Thing.

We were coding merrily along to TTBTCIDC (For those of you keeping score at home, that would be “The Third Best Trauma Center In Da City”). Mr Stabee and I were having a lovely conversation, after a fashion, until he got really quiet. Concerned, I checked his pulse and breathing, finding a considerably weaker, and faster, pulse than previously, along with diminished rate of respirations.

I hollered to Doug that our new friend was circling the drain, and both more alacrity on his part, as well as a heads up to the receiving facility might be really appreciated.

I wrapped him (the patient, not Doug) up in the MAST trousers, and inflated the bladders. Now, we had a protocol of inflating the bladders to pressure “X”, re- assessing the patient, and then either holding there, or adding more pressure. In the spirit of Spinal Tap’s Derek Smalls, I bypassed the intermediate steps, and inflated the bladders, metaphorically, to 11.

To my surprise, out stabbee awakened, and began to converse, asking “What happened?”I obtained a new set of vitals, and wrote them down, as we stopped at TTBTCIDC.

We trotted our friend to the trauma room, and, as I wheeled the cot out of the room, I heard the physician order, “Take those things off of him, now!”

I started to offer our valves and suchlike, in order to wean the pressure off of the bladders, rather than precipitously deflating them, but the sound of ripping velcro was my reply.

Shortly afterward, the code was called, and everybody who had not crowded into the room, now entered.

Before we were done cleaning up the truck and restocking our medic bag, the code had been called. Unsuccessfully.

Fun And Games · Having A Good Partner Is Very Important! · Life in Da City! · Pre Planning Your Scene

“Hey, look! I’m fine!”

Winter in Da City is a special time. The snow, late enough in the season, covers up the litter in the gutters, the layabouts tend to lay about indoors, and generally you can almost convince yourself, if you squint just so, that there is hope for, and in, Da City.

And, then you meet people. Kind of an occupational hazard of being a medic for Da City’ fire department. Most of us held to the TRUTH! Of the aphorism that “sick people suck”. Daily (or nightly- kinda depends on your shift, amirite?) we encountered folks who, well, sucked. Both as people, and at life. Because, after all, the lottery winners infrequently phoned 911 to regale our dispatchers with tales of wonderfulness. Face it: nobody calls the fire department, to gush about he/she just now met The Love Of Their Life, and how this soul brought sunshine into their every day.

So, with that thought in mind, TINS©, TIWFDASL© one lovely wintry afternoon and we (Doug and I) caught a run for a man with a broken leg. Arriving on the scene, we noted the usual choreography of the “He’s In Here!” dance, oh so very popular in Da City.

We entered to find a gentleman on the sofa, ethanol fumes emanating from his every pore. One of the (more) sober bystanders informed us that our guest had fallen while shoveling snow, and broken his leg. I turned to the named patient, and he obligingly illustrated the point by waving his (no shit, notable from across the room, articulated in an unnatural spot between his knee and ankle) leg in the air, declaiming, “Hey! Look! I’m fine! There’s nothing wrong!”

As you may have already surmised, he likely had already been well anesthetized. Then, there was the question: if he broke the shit out of his leg, as he manifestly had, how, and why, had he made his way into the house? And, what parts of this tale remained untold?

I attempted to orient him to current events. “Uh, sir? It sure appears like you have broken your leg. We would very much like to take you to the hospital, to get that fixed up for you!”

“Naw, I’m fine!” was the reply, accompanied by more broke-the-shit-out-of-it leg waggling.

The citizens on the scene were ever so helpful. Or, not so much. They contributed, “He broke his laig! Y’all cain’t leab him here!”

Thank you, Dr. Schweitzer, for your orthopedic consultation. Certainly gonna have to factor that into our clinical decision making!

I looked at Doug, and he looked at me. He handed me the handie talkie, and went to the ambulance to retrieve the cot and assorted helpful goodies. I attempted to elicit something along the lines of allergies, medication and medical history information, figuring that sort of information would be kind of mission critical to our friends in anesthesia. I was certain that a tour of the OR in the presence of the orthopedist was in his future. Oh, and vitals. Vitals would be nice.

Once Doug returned, and I noticed that he had preplanned the upcoming goat rope, including a long backboard, backboard straps, and plenty of roller gauze.

We approached out new friend, and pinned him to the sofa. Doug bandaged his arms…yeah, THAT’S the ticket! Bandaged, not restrained! Once he was hindered from “lending a hand” to the festivities, well, we rolled him onto the spine board, secured him with straps, and, laying a nice wide rigid splint between his legs, secured bandaged them as well.

The foregoing accomplished a couple of things. First, he quit flapping that grotesquely fractured leg around. Secondly, he was a considerably more stable package to carry out to the rig. Finally, all the citizenry was placated by how thoroughly their friend had been splinted. Everybody won!

Once we arrived at TSBTCIDC, and debussed Mr. Leg Fracture, well, the nursing staff couldn’t help but unsecure him, since they simply HAD to evaluate the fracture. That set off an entirely new round of protestations that he, the patient, “was just fine!”, accompanied, again, with the semaphore wig-wagging of the demonstrably unfine fractured leg.

Cool story. I finished my trip sheet, and completed and signed a “Petition for Involuntary Hospitalization”, citing my new friend’s manifest unconcern for a clearly broken leg, documenting his inability to comprehend his need for hospitalization.

All in a day’s work!

Fun And Games · Having A Good Partner Is Very Important! · Pre Planning Your Scene · Protect and Serve

The Leviathian Comes Alive!

So, one time we got dispatched to an unconscious person run on the east side. We arrived to see a number of police officers from DBCPD standing around. One of them pointed out a large slumped soul, leaning up on the steps on a rear stairway of some house.

He was not entirely flaccid, and he WAS breathing on his own, both desirable attributes from my point of view. Even so, leaving him to metabolize towards mobility appeared to be a bad plan, so Porthos and I attempted a hold-him-under-his-arms walking assist. It worked, sort of. Well, it appeared to be working well enough that we could maneuver him to the truck, and thence to TBTCIDC, where he could indeed metabolize to freedom, under the loving and watchful eyes of the TBTCIDC Emergency Department nursing staff. For bonus points, he would then not be our problem.

Porthos and I were making progress, of a sort, toward the ambulance, and the police were doing their police type stuff, when I got the bright idea that perhaps a whiff of an ammonia capsule might energize our guest.

Now, with the wisdom that comes with hindsight, THAT might have a good idea to, ya know, DISCUSS with my partner. That discussion might have elicited several beneficial outcomes, like problem solving IN ADVANCE, and anticipation of ways in which this brainstorm of mine might have turned horribly wrong, for example.

As might have become evident, I did NOT discuss this little plan of mine with my partner, and simply retrieved an ammonia cap from my pocket, snapped it, and allowed Mr. Leviathan to breathe deeply of the healing aroma.

He abruptly, and I mean RIGHT FUCKING NOW! Became considerably less stumbling, and way, way more energetic, shaking loose of my grasp on his arm, and turning on my partner.

This might be a good point in my tale to note that our guest was tall, and big, and outweighed me, as well as Porthos, by a considerable margin. If he should commence to some wrasslin’, well, whichever one of us was the object of his affections, would not enjoy being so objectified.

Porthos had noticed our guest’s reanimation, although he was a fraction of a second slower than I in so noticing, and so King King, our newly energized patient, was advancing upon my partner, hands outstretched, and backing Porthos rapidly into a corner.

I realize that things happen quickly, and it appears that time stands still, nevertheless those officers sure appeared to be statues, while this shambling wreck of a man-mountain was advancing, cornering my partner, presenting a clear and present danger of laying hands on him.

I found my Mag Light in my hand, and advanced, on my toes, behind him. My flash plan was, once he had indeed grabbed Porthos, well, I was going to go for that line drive, featuring his head as the baseball.

So, Ninja like, I was advancing upon Leviathan, Leviathan was advancing on Porthos, the cops were unmoving, and I, catlike, managed to step on his foot.

Good news: he forgot about Porthos.

Bad news: he figured that I was oh, so very much more deserving of his attention than my partner. He began to turn on me, so as to show me some love. Of some sort.

Good news: whatever was the source of his previous lethargy, it slowed his synapses, and so the insight that he would rather be thumping on me, rather than Porthos, took him a not inconsequential amount of time to process, and then to act upon.

Good news: Porthos took that opportunity to zig to Mr. Leviathan’s zag, and begin to beat feet to the truck.

Good news: I accelerated to warp speed promptly, and so managed to arrive at the ambulance about the same time as Porthos.

Good news: our officer friends were, themselves, in motion, and they converged on Mr Leviathan, and dissuaded him from pursuing any further laying-on-of-hands ceremonies.

Indeed, they were so persuasive, that they elected to transport our new friend to TBTCIDC, themselves.

Porthos and I had, well, I suppose you might consider it “a teaching moment” once we were back in service. My ears stopped burning after a couple of hours.

Pre Planning Your Scene · Protect and Serve

Do It Yourself Emergency Care

First disclaimer: LOONNGGG post warning!

Second disclaimer: for the terminally thick, NO, I AM NOT ADVOCATING THAT YOU AVOID PROFESSIONAL MEDICAL CARE. WHEN IT IS AVAILABLE!

Third disclaimer: I apologize for my computer fumble fingery, but the hyperlinks do not show as hyperlinks for most of this post. Feel free to copy and paste the links into your browser.

So, the preceding obligatory disclaimer having been presented, why might you want to be able to provide your own medical care?

Well, if professional medical care is not available, you might have a zero-sum choice to make. Kind of like Graham’s Kill House Rules. (http://grahamcombat.com/the-killhouse-rules/ )

NOBODY IS COMING TO SAVE YOU.
EVERYTHING IS YOUR RESPONSIBILITY.
SAVE WHO NEEDS TO BE SAVED.
KILL WHO NEEDS TO BE KILLED.
ALWAYS BE WORKING.

If, indeed, nobody is coming to save you, in any clinically relevant time frame, then, indeed, EVERYTHING IS YOUR RESPONSIBILITY! Therefore, you can seek out and achieve training at whatever level you are comfortable with, or not. Good luck with extemporizing on your particular slice of Armageddon. (And, just like with defensive firearm use, exactly at what point are you really “good enough”? And are you willing to bet your life, or your family’s lives on that “good enough” level of expertise?) Because, if help will not arrive, or not arrive “in time” (whatever that is in your emergency scene) then either you are ready to act, or you are not.

Even if you do not anticipate a Zombie Apocalypse, because “that will never happen”, how about coming upon a collision, and Tag! You’re IT! As first on the scene? (BTDT) Or, maybe, you, or your dad, or your kid was chopping wood, or clearing brush, or cleaning up after a windstorm, and the axe, or hatchet, or chainsaw slipped and added a laceration to the wonderful day everybody is having? Or, you (or your wife) (or your neighbor) fell from a ladder?

Have you ever had to extemporize an emergency response kit out of your household stuff? I have (Once. A LONG, Long time ago! Never Again!), and, as you may surmise, I did not enjoy it.

Being an old medic, and an old ED RN, I LOATHE surprises. While The Universe cares not a whit about my preferences in that regard, if I anticipate trouble, and put in place preparations and training and action plans, well, surprise is not quite so disturbing.

First of all, read my blog (shameless plug!)

Secondly, read this guy’s blog in general, and this post in particular. He relates that he’s been a nurse for a considerable time, and everything upon which he opines, for which subject I feel a right to have an opinion, he’s right. (his series on first aid/emergency care, Sept 24 2017, to May 13 2018 is PURE GOLD!. Hit his site, find the “first aid” tag, search, read, learn, find your life enriched.)

https://raconteurreport.blogspot.com/2019/06/aom-how-to-build-first-aid-kit.html

Now, full of resolve to improve your life (and the lives of everyone around you, amirite?), go ye and set up your own emergency response kit. Make It Yours! My list, Aesop’s list, FEMA’s list, your old squaddie’s list, don’t mean nuthin’ if you do not know how to use the items you have at hand, and if you do not have the correct items at hand.

About that last thing: let me tell you a little story. TINS©, TIWFDASL© (well, I wasn’t REALLY Fighting Disease And Saving Lives, but, verily, This Is NO Shit!), as my then girlfriend and I were motoring Up North to visit her family. Fat, dumb and happy, I was motoring along, chatting companionably with my girlfriend, when we observed several vehicles pulled over, on the median of the divided highway that led us on our way. Closer examination led to the insight that likely these folks had pulled over due to the minivan on it’s roof, in that selfsame median.

To paraphrase the Noted Medical Ethicist and Moral Philosopher, Han Solo in the trash compactor, “I had a bad feeling about this!” Once I alighted, medic bag in hand, I noted (Thanks be to Crom!) that the nominal patient appeared trivially hurt, with a small amount of bleeding from her head. This was particularly wonderful because I COULD NOT FIND ANY DAMNED GLOVES! I have no excuse (other than being stupid, I suppose…). It is not like I have spent, mmm, oh, let’s see, carry the ‘nought, seven goes into 11…uh, yeah. FORTY FREAKING YEARS, at that point, in the sick people business or anything. So, yeah, having the basics is kind of important.

So, lists. Make the list that you select, YOUR LIST!. Work that bad boy. Repack your kit on every seventh full moon, if that’s how you roll. Solstices and equinoxes work for me. Or, try your birthday, and anniversary, and two national holidays of your choice. But, repack that kit! You thereby get the opportunity to be sure stuff has not expired, that vermin have not spoiled it, that the elements have not f*cked with it. (And automobile trunks, in Michigan, reach not less than 142 degrees F in the summer. I know. I checked. I logged it, somewhere. In winter, well, MFC [mighty fenomenally cold] just about describes things!) For the record, hot and very cold are not good for shelf life (or trunk life, for that matter!)

As an introduction, and starting point for conversation, here’s my
(annotated) list. First, the list and prices

Green Bag
LAPG Bail Out Bag 26
CPR mask 9.2
BVM 10.94
CAT TQ 29
SWAT-T TQ 12
6” IBD 7.55
4” IBD 6.95
gauze 4×4 4.00/100
ABD 5×9 6.32
celox 28.75
Bandage Shears 2.95
tongue blades
Stethoscope
BP cuff
adhesive tape 2 in 2.6
roller gauze 4 in x 3 1
vaseline gauze
elastic bandage 4 in
elastic bandage 2 in
Elastic Bandage 3 in 1.25
Total 159

Now, with commentary and links:

You may notice that I have selected a LA Police Gear Bail Out Bag for my case.( https://lapolicegear.com/tabaoutbag.html $26 bucks) It really doesn’t matter what sort of container you employ for your emergency supplies, so long as it meets your particular needs for security, identification, accessibility, protection and convenience. My choice (in Fire Department Red) is not water resistant, is not neatly compartmentalized, and does not have an IR glint Star of Life embroidered upon it. On the other hand, I know how my stuff inside is organized, it is convenient to sling over my shoulder when the scene requires that I do so. It will fit beneath a van seat, or in a tub in my trunk, and I can work out of it when I have it slung.

Some fire departments use plastic “totes” to organize supplies required for specific types of calls. For example, haz-mat supplies are packed inside specific totes, and the top secured with a cable tie or some such device. An inventory is attached to the top (sealed in plastic) to identify what is inside, as well as out dates of time sensitive components. When properly closed, such bins are drip and dust resistant, resist crushing or jumbling of the contents, and can be convenient to carry when not overfilled. On the other hand, they will not conveniently fit beneath a vehicle seat, may be unwieldy to retrieve and place into action, and may get buried beneath other stuff in a trunk or truck box.

Others of my acquaintance use ammo cans, or plastic fishing tackle boxes. These are generally more convenient to shlep about (unless your tastes run along the lines of a 20 mm ammo can) and are more drip/dust/duh! resistant than the tubs mentioned above. On the other hand, they may overturn with disappointing ease, spilling your supplies into whatever noxious fluid is abundant on your particular scene.

IN THE TOP, OR IN AN OUTSIDE POCKET

Items that I am likely to require promptly are either in the outside pocket or immediately inside the top flap of the bag. These are things that I do not want to be fumbling for as I approach a scene. I will not list what might be considered “everyday carry” items like pocket knife, flashlight(s), CS spray, sidearm, and a cell phone. While these tools help keep the rescuer from becoming a victim of an ambush laid for a “Good Samaritan”, particularly when employed in concert with a Condition Orange mindset. (I did mention I started out in Da City, didn’t I?), these items do not seem to me to be rescue/first aid/emergency medical tools.

First up is several pairs of gloves. (well, now, anyhow!) I am allergic to latex, so I have nitrile gloves. Current practice is to wear gloves anytime you might reasonably anticipate exposure to blood or other bodily fluids: tears, urine, stool, saliva, gastric contents, or any other moist, body-origin material you might imagine (and perhaps a few you might not!). I have so thoroughly incorporated this into my life that I get uneasy caring for my own children (or, at my advanced age, grandchildren!) without gloving first. These are in a zip-lock bag, safety pinned (now!) just inside the top flap of my green bag.

The upside to all this is that scrupulous gloving and thorough hand washing have so far proven highly effective at preventing the spread of the most common blood-borne infections. Diseases spread via airborne droplets (for example, Legionnaires disease), of course, require additional precautions. Others are spread by organisms coming to rest upon environmental surfaces and then accessing a vulnerable host (just like you and I are vulnerable hosts to “the common cold”) by means of unconsciously touching our faces after touching a contaminated surface. For myself, after 40 plus years of patient contact the worst I have brought home has been an occasional upper respiratory infection due to my conscientiously applying the glove/hand wash/hands away from my face regimen. (https://www.harborfreight.com/7-mil-nitrile-powder-free-gloves-50-pc-medium-68504.html $10/box of 50)

The next item I’ll feel a burning need to have in my hands is a bag-valve-mask (BVM). This is a manually operated ventilation tool. It is employed by sealing the mask over the unbreathing patient’s face, squeezing the self inflating bag, and thereby forcing air into your patient’s lungs. Repeat at a rate of approximately 12-20 times a minute. Advantage: no kissing strangers, required for mouth-to-mouth resuscitation. You are able to maintain situational awareness of such things as evolving environmental hazards (like leaking gasoline), or indicators of your patient’s improving condition (…he said, thinking positively!). On the downside, using a BVM is difficult in untutored hands. It is easier (compared to mouth-to-mouth) to force air into the patient’s stomach (which is a bad thing), which will elicit vomiting (which is WHY that is a bad thing!). Aside from the aesthetic issues this presents, vomiting in a profoundly unconscious patient (such as one so unconscious as to have stopped breathing) presents the opportunity for aspiration into the lungs of that which has been vomited, which may be deadly.

Training in use of a BVM will be part of an EMT class which can (OUGHT TO!) be part of the training that I mentioned earlier. I’ll wait here while you go find out when your local community college or rescue squad will be having their next class. Plan on being a part of that class. You will be making your community, and thereby your family, safer.

You can buy your own disposable model (https://www.liveactionsafety.com/lsp-disposable-manual-resuscitator-adult/ ) for around $14. In the hospital, we use these once and discard them. Your local rescue squad or ambulance may shop locally, and you might want to do likewise. Ya know, if you were to volunteer with your local rescue squad, you might be able to obtain things like this at your agency’s cost. All this on top of the good karma from helping to provide a necessary community service. And, besides, becoming known to the locals (police included) as one of “the good guys” can only be a good thing for many reasons. Your phone book likely will provide the contact information you require. I’ll still be here when you get back.

One of the adjuncts to using a BVM is called an oral airway. Oral airways come in sizes, which may be selected according to the size of the patient. Their purpose is to hold the flaccid tongue of a profoundly unconscious patient forward, so that it does not sag against the rear of the throat and thereby block the passage of air into and out of the lungs. The problem it may trigger is, should your patient be other than profoundly unconscious, he or she will vomit. Among other disasters this may cause, the enzymes from the stomach, designed to digest proteins, will (unsurprisingly) begin to digest the proteins found in the delicate tissues of the air sacs (alveoli) of the lungs, with effects you are likely to be able to imagine on your own. Very Bad Thing.

Another way to fail when employing an oral airway is to bunch up the patient’s tongue in the rear of the throat. This blocks air flow, strangling your patient. This device must be restricted to only profoundly unconscious patients, and only if you are schooled in its use. You can buy them individually, or in sets. Before shipping, they go for around $5.00/set. You might elect to buy them one at a time, but at $5 a pop, they aren’t a particularly major investment. (https://www.buyemp.com/product/curaplex-berman-oral-airway-kit )

When I’m confronted by an actively bleeding patient, I reach for an Israeli Battle Dressing. (https://www.bestglide.com/the-emergency-bandage-4inch-military.html $7 each in the 4 inch size, https://www.bestglide.com/the-emergency-bandage-6inch-military.html $7.55 in 6 inch) It consists of a sterile dressing incorporating an elastic bandage to secure the dressing to the wound.

On a side note, should you shop gun shows or surplus stores for your equipment, be wary of old dressings. They present potential issues of failed sterility as well as mustiness or mildew occasioned by improper storage or imperfect packaging.

Another wound care product is QuikClot. (https://www.liveactionsafety.com/quikclot-combat-gauze-z-fold-expire-2023/ $40 each) This is a mineral product, bound to a dressing, which enhances clotting, and thereby slows and limits blood loss in the bleeding patient (common in trauma, surprisingly enough!) One 2008 article (QuikClot Use in Trauma for Hemorrhage Control: Case Series of 103 Documented Uses. Journal of Trauma-Injury Infection & Critical Care. 64(4):1093-1099, April 2008.) reflected the occurrence of burns in several patients, but the manufacturer’s web site reports that changes in packaging and delivery system have addressed this issue.

An alternative you might consider is Celox.
(https://www.emergencysafetysupply.com/celox-blood-clot-gauze-roll/ $29 each, 3 inch x 5 feet) It appears perhaps to be a reasonable alternative to QuikClot. It is derived from shrimp shells, although it seems to not produce allergic reactions in folks otherwise allergic to seafood. I have no personal experience with either product, but the reports are interesting. This goes on my “further research” list!

SECOND TIER SUPPLIES

The preceding items are to be found in the outside pockets or very top of my jump kit. I don’t want to be searching for them when I feel the need for them Right Freaking Now. Beneath the don’t-wanna-wait-for-them items, I have supplies of somewhat lesser immediacy. These allow me to assess the situation in greater detail, or address issues that may come to light that are of less time sensitivity.

Triangular Bandages are useful for slings of injured arms, or may be folded into narrow strips and then used as a means to secure splints or dressings (as “cravat bandages”). If we were to consider them as a backpacker might, they may be used as expedient dust masks, bandannas, head coverings, or washcloths. I buy muslin by the yard at Wal-Mart, and cut it from one corner to the other, forming (surprise!) 2 triangles approximately a yard on a side. I keep 6 to 8 in my kit.

Bandage shears are the most obvious of the prehospital medic’s tools. You can go with Lister style bandage scissors, often found as “nurse’s scissors”, or the plastic and steel “super shears”. Prices range from $4.00 and up (shop around). Frequently employed to trim dressings to the proper size, cut away clothing from wounds, and to cut bandages.

Did you ever notice that a tongue blade/tongue depressor is almost exactly the width of a finger? And just a bit longer than your Mark 1, Mod 0 finger? Exactly like it were designed to be a finger splint, isn’t it? In addition, should you tape three of them together one on top of the other, you have a dandy tool for tightening that “Spanish windlass” you are going to learn about, when your (probably, in 2019, “Wilderness”…) EMT class teaches you how to apply and improvise a traction splint for a fractured femur (thighbone). Finally, if you are unhappy at the thought of wiggling somebody’s fractured femur (broken thighbone) so you may place ties (cravats: remember them?) for a splint, tongue blades are thin, stiff, and very helpful at limiting the wiggling as you place ties beneath the broken bone of your choice. I keep a handful handy.

You can pay a couple of bucks for them at the corner pharmacy, or you might be able to talk your way into several for free, like when you are volunteering at some public service event with your local volunteer fire department, emergency medical service, or amateur radio club.

Stethoscope/Blood Pressure Cuff. A stethoscope allows you to hear the sounds made as air moves into and out of the lungs, and note changes from normal. These changes might occur because your patient has a collapsed lung, or has pneumonia, or heart failure. When you get that far into your EMT class (hint, hint), you will learn how to evaluate these changes, and what sort of treatment decisions you ought to consider when you notice them. In addition, you will learn how to measure, and interpret, your patient’s blood pressure.

I am certain you will know somebody who will go out and get the cardiology deluxe stethoscope, with Wi-Fi, mag wheels, and gold trim. Do not join them in this folly. Spend $10-80 at the same place the local student nurses get their stethoscopes, and spend the difference on your spouse, whose enthusiastic support you will require, anyhow. If you can show your spouse how your expenditure of family money and time on supplies, education, and volunteering promote values that you both agree upon, the both of you will thereby make your family more crisis resistant. If your family is more crisis resistant, then you are not only NOT a drag on community emergency services during an emergency, you all might even be an affirmative community asset during bad times. That cannot fail to be a Good Thing when you get to explain yourself to The Jewish Carpenter. Me, I’m going to require all the help I can get. I’m volunteering!

Adhesive tape (1 inch, 2 inch) secures dressings, holds loose ends of bandages, and provides a single use notepad (tear off a length, tape it to your thigh, and jot notes. You will not lay it down somewhere to be forgotten). If you listen to some friendly and knowledgeable athletic trainer, you can learn how to use it to support sprained ankles or knees if the preferred treatment (rest, ice, elevation) is not possible. Before you employ these tricks, bear in mind that physicians frequently cannot differentiate a sprain from a fracture, even after an x-ray. In my view, except under the most dire possible circumstances, walking on a fractured (or sprained) extremity is a Very Bad Thing. Two rolls each are at hand when I open my green bag. (https://www.galls.com/dynarex-cloth-surgical-tape-6-pack-?PMSRCH=tape $16/box of 6)

I keep 12 to 15 Gauze pad, sterile, 4×4 in my kit. I employ them as eye pads, padding beneath splints, or as (oddly enough) dressing for wounds. Occasionally I encounter a wound bleeding so enthusiastically that a couple of gauze pads will be overwhelmed. Fortunately, I haven’t come across such a wound off duty, but in the hospital we use a “boat” of sterile gauze. This is a plastic tray of ten sponges in one pack. The tray also may be used as a clean basin for wound irrigation/cleansing solution. In the hospital we use sterile saline, you may elect to use the water from your retort pouch, or fresh from the bottle as you purchased it for storage. I would certainly give it some thought. Gauze, 2 per pack, 10 packs per box: https://www.firstaidsuppliesonline.com/first-aid-products/tapes-wraps-dressing/gauze/sterile-gauze-pads-4-x-4-10-box-2/ $4

If you happen to be the purchasing agent for your entire survival community, ambulance service, or the entire Boy Scout Council, you might find the case price from Vitality Medical to be useful. (https://www.vitalitymedical.com/kendall-dermacea-gauze-sponge.html $50) 1200 sterile 4×4 pads for $50 works out to around 4.2 cents each.

Triple padding/ABD padding, sterile, 5×9 inch. (https://www.vitalitymedical.com/invacare-abd-pad.html $0.12 each) These multiple layer absorbent dressings are designed for wounds producing a lot of drainage of either blood or other fluid. They are my first choice for a bulky dressing or splint padding. I keep 6 in my kit. The frugally minded may note that “sanitary napkins” are designed to absorb drainage, are “medically aseptic”, and are available nearly everywhere.

Roller Gauze, 4 inch https://www.galls.com/dynarex-comforming-stretch-gauze-4-inch?PMWTNO=000000000002328&PMSRCH= $4/box of 12) is typically used to secure a dressing (see Gauze Sponge, above) to the wound. I pack 6 in my kit, and they have “found careers” as bandages to secure dressings, securing splints when I run out of triangular bandages, and upon occasion as packing/dressings for vigorously bleeding wounds. In fact, when one is employed as the dressing, and another as the bandage, I can not only dress the wound, but also (since the bulky roll provides a pressure point) apply direct pressure to the bleeding site. This provides an alternative to the Israeli Dressing, cited above.

Vaseline Gauze (sterile, 3×9 inch) (https://www.buyemp.com/product/kendall-vaseline-gauze-pads $9.50/10) is intended to seal wounds penetrating the chest, in order to prevent collapse of your patient’s lung(s). When you seal the defect in the chest wall, your patient will not draw in air through the wound when s/he inhales, and thereby not fill the space between the lung and the chest wall (the pleural space) with air. When you can avoid this, inhaling draws in air through the mouth, trachea and bronchi, and that inflates your lungs, and we think that is a good thing. Myself, I pitch the gauze and tape three sides of the foil package, sterile side towards the wound, forming a flutter valve sort of effect. In this way I allow excess pressure in the pleural space to vent to atmosphere (stopping further lung collapse, I hope), and seal the hole when the pressure inside the chest is less than atmospheric pressure (like when the patient inhales). The only way left to equalize that pressure is by inflating the lungs, already described with approval above.

The other use for Vaseline gauze is when my lips or hands are dry, in which case I use the Vaseline to remedy that little problem.

We all can think of uses for the common elastic bandage, 3 inch and 2 inch (https://www.amazon.com/ProAdvantage-P156003-Latex-Free-Bandages-Self-Closure/dp/B06XT743T3/ref=sr_1_3?keywords=elastic+bandage&qid=1559746937&s=hpc&sr=1-3 3 inch, 10 pack $5.25, and 2 inch https://www.blowoutmedical.com/elastic-bandage-2-inch-x-4-5-yard-3662.html $0.42 each. Two inch is useful for sprains of your wrist or thumb, and the 3 inch is used for an ankle twist/sprain. In addition, I can use them to secure a splint (there is that rule of threes, seen in posts on other blogs), or as the “swathe” part of a sling-and-swathe to immobilize an injured shoulder, or as part of a pressure bandage over a dressed wound that does not want to stop bleeding.

Large Bulb Syringe (for which you can substitute a turkey baster) functions as an expedient means of removing fluids from the airway of someone who is not managing to do so effectively on their own. It will not work nearly as well as a battery powered or pump action suction, such as you might find on your local rescue squad rig, but it won’t cost you $30 (for the manually pumped version seen on Amazon today for that price. Comparison shop.) either. Second best is superior to nothing.

Mylar “Space blankets” protect you or your patient from the hypothermia-inducing effects of the wind, slowing heat loss. Generally colored bright orange on one side and silver on the other, there are signaling opportunities as well. In a pinch, you can improvise shelter from one or two. Amazon sells the generic copy for $10 for a pack of ten (https://www.amazon.com/Primacare-HB-10-Emergency-Thermal-Blanket/dp/B00DZ1NFSK/ref=sxin_0_ac_d_rm?keywords=space+blanket&pd_rd_i=B00DZ1NFSK&pd_rd_r=2123eee5-db98-41a8-867d-fb632b7e1ffa&pd_rd_w=TNeM6&pd_rd_wg=86xXL&pf_rd_p=91b604bb-c371-4573-970f-bed68a552852&pf_rd_r=SJ8DY55TS6GG0J9T2NQR&qid=1559768962&s=gateway&smid=ATVPDKIKX0DER ). Equip your jump kits, and each member of your family with one or two.

Any accident so severe as to convince suspicious old me (alumnus of Da City’s EMS) to stop and offer assistance will not be fixed with a couple of Adhesive Bandages (aka “Band Aids”). I have six in my jump kit, two entire boxes at home (and parceled out among my camper, car, and household kits).

I keep a couple of Ice Packs around, as assorted adventures may bring on modest orthopedic injuries. Ice is helpful for strains, sprains, or overuse of an over aged joint (…not that I would know anything, firsthand, about that…). Choices include “instant cold packs”, or that old picnicker’s standby, a zip lock bag full of ice from the cooler.

Either option has drawbacks. I do not generally drive about with a cooler of ice at hand, although when camping I am likely to do so. Instant cold packs are kind of fragile, and you might find, when you go to place one in service, that you have a leaking mess on your hands. On the other hand, they are more likely to be there when you want one.

The foregoing lists the contents of my “jump kit”. I keep one kit in each vehicle, and another at home. In addition, there are Subordinate Kits, kept in camper, car and home, for lesser sorts of occasions. I have customized each by adding more dressings, triangular bandages, roller gauze, and gloves. In addition, I improved over the baseline “Wally World” $15 first aid kit, by adding zip lock bags of various household medications. I labeled each bag with the name of the med, the out date of that particular bottle, directions for use, and date of packing. I made my selections by inspecting my own medicine cabinet, and pondering which meds I had wished I had kept handy the last time I was out camping, for example. Most everything commonly needed is therefore in the Camper Kit, Car Kit, or House Kit.

The jump kits are reserved for “Holy Fertilizer!” sorts of events. They are not mere “boo-boo boxes”: THAT is why I have subordinate boxes in each vehicle, the camper, and the house. Reserved in this way, I will not find myself hunting (and swearing) in crisis, as I need this or that widget, which some child (or adult) has used, and not restocked.

IFAK OR “BLOW OUT KIT”

The jump kit is kind of bulky, the subordinate (“Band Aid kits) sort of inadequate, in the event of BFD injuries. I have created “Blow Out Kits”, also referred to as IFAK (Immediate First Aid Kits) for the possibility of arterial bleed, GSW, or similar potentially exsanguinating injury. Hey, I shoot recreationally, and , as “TexasUberAlles” noted (https://disqus.com/by/TexasUberAlles/),
“Always wear safety gear-poor judgment is a team sport, and other people get to decide whether you’re on their team without asking you first”. In short I may hold the Cooper Distinguished Professorship In Safe Firearms Handling, but, Cletus in the next bay who does the macarena when the first round of his 32 round magazine gets lodged in his tank top, might inadvertently put a couple of rounds in my chest. Or somebody else’s. Therefore, I have a handy, smaller, trauma and bleeding focused have-it-on-my-belt kit.

Contents first, discussion after.

IFAK
pouch 14.95
4 “ IBD 6.95
Quick Clot 40
4×4 x 12 1
abd x 2 1
roller gauze 4 in x 3 1
TQ 29
triangle bdg x 2
gloves x 6
Tape 2 in 2.6
shears
Total 96.5

Again, I need a pouch or case for the IFAK. Some of the other blogs addressing this issue, including Raconteur Report, have suggested “SAW” ammo pouches, others have suggested M-16 ammo pouches. My take? Well,folks who are alumni of the military, and have in fact been in combat, likely have opinions that you, and I, ought to listen to. Having said that, I have patched up (temporarily) a few bleeding folks in my day, and here’s what I use:

(https://www.opticsplanet.com/red-rock-outdoor-gear-mavrik-small-medic-pouch.html $6.) (Yeah, my spreadsheet excerpt shows a cost of nearly $15. See? It pays to shop around!). Feel free to employ the case that suits you.

Israeli Battle Dressing (see above, $7 or $8)

You may notice that I specified QuikClot in my IFAK, in contrast to Celox in the jump kit. If you have a reason to prefer one over the other (eg, Quikclot), then go for it.

A dozen sterile 4 x 4 gauze dressings. This for fast, initial care. I anticipate buying enough time to go get (or delegate one of My Minions to go get) my jump kit from my vehicle.

I specify 2 ABDs, 5 x 9, for the same reason.

4 inch roller gauze, similarly. When I require additional roller gauze, well, that is why I have a large handful in my jump kit.

CAT Tourniquet, around $30 on sale at Rescue Essentials (https://www.rescue-essentials.com/tourniquets-holders/ ) Alternatively, you can get a SWATT tourniquet, which is a heavy duty elastic band, with imprinting upon it so you can assess how tightly you have wound it, for around $12, but I cannot know how more (or less) effective it is than the CAT. Get your training, get some experience, and form your own opinions. Myself? I have both a CAT on my belt, and a SWATT in my pocket, every day.

For a discussion of triangular bandages, and tape, and shears, well, see the previously presented material.

One comment on the hemostatic agents (that’s the Celox and the Quikclot), among other contents: read the packaging. Some of this stuff has an out date, and my practice is to rotate outdated material (like outdated TQ, IBD, hemostatics, etc) to the “training bin”. While it MIGHT not be a big deal to use outdated IBDs, or TQs, I betcha outdated hemostatics might be litigation bait. In addition, it is simply good practice to check and rotate your stock at regular intervals.

Finally, remember that training comes first. Years and years ago, I heard a story that, in the early days of the Israeli state, the emergency response planners had the budget required to train their personnel to stabilize and transport spine injured patients, or buy the splints (called backboards), but not both. The story relates that the planners elected to train their personnel, and subsequently noted a spine injured kibbutznik transported to the hospital by his comrades, secured effectively to an entire barn door. You! Over there! Yeah, YOU! Go get trained! Pass that training on to your shooting buddies, camp mates, hiking buddies, family, friends, fellow cube dwellers. You will make them safer, you will make yourself safer, and, in the event of another mass casualty incident, you, yeah, YOU!, might be the reason folks survive, or do not lose limbs.

Seize that opportunity.

Thank you all for reading along this far.

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pre Planning Your Scene

Car Fire

So, before Mallory and I had begun to live together, I had one of my ex partners, let’s call him Adam, as my room mate. Mallory would come over from time to time, and the three of us would chat, or share dinner, or simply hangout.

One day, she came into the house, and asked us to hurry out and see what was wrong with her car. Now, this was her baby, one she had purchased because, as she termed it, “I look so good driving that car!” It had been her very first new vehicle, ever.

So, Adam and I threw on some shoes, and trotted out to see what was the matter. She had told us that it was smoking, and once we got outside, it became clear why. The smell of burning plastic emanating from beneath the hood told the tale.

Mallory was starting to get excited, hopping around and beseeching us, “Can’t you guys do something?”

Adam looked the vehicle over, and asked her, “Do you REALLY want us to do something? If we let it burn, or call the fire department, then it will be totaled, and you can get a brand new one. If we extinguish the fire, you are gonna have to get all that burned shit replaced, and it may never be altogether right, again.”

Mallory was nigh unto break dancing by now, and simply couldn’t bear to see “her baby” burn up. Adam asked her again, simply to be certain, “Are you REALLY REALLY sure you want us to do something?Again, she pleaded with us to act. Adam looked at me, I looked at him, and we charged the garden hose, donned work gloves, and sprayed it down through the grill as well as we could. Once it had dampened down, I opened the hood, and stood aside, while he blasted it (or, at least, “blasted it” as much as one is likely to be able to, with a garden hose!). It was evidently sufficient to the task, for soon the smoke stopped, the smell abated, and we were unable to identify any further burning stuff after diligent search.

Mallory called her insurance company, they sent a wrecker, and she got a loaner.

Several weeks later, her car was returned to her. She subsequently had repeated complaints about this, that, or the other thing not performing properly. Soon, she turned to Adam, and admitted, “If I had listened to you, and let it burn, I’d be driving a new car by now!”

Fun And Games Off Duty · Having A Good Partner Is Very Important! · Pre Planning Your Scene

The Great Chocolate Explosion Of 2018

So, TINS©, TIWFDASL©…. Well, alright: I wasn’t FDASL© in this story, I was in my kitchen, fixing to cook some fudge.

The women in my office (where I was a mid-level in an urgent care) had been teasing me about my domestic abilities, and so I had threatened them with offered them home cooked fudge.

The recipe I selected required that I melt baker’s chocolate and butter in a double boiler. Of course, I did not have a double boiler. Instead, I selected two pans, poured some water onto the one, and settled the other into the first, and turned on the range. I noted, in passing, that the fit seemed a bit tight, but, whatthehell, I did not act on this insight.

Remember that thought.

So, I arrayed my ingredients on the counter, and then checked on the progress of my chocolate melting. Experimentally, I wiggled the top pot. At that point I noted a seemingly tight friction fit, and told my wife, washing dishes behind me, that I was starting to be a bit concerned about that. My words were, prophetically enough, “Boy! I sure hope that this top pot doesn’t suddenly loosen from where it is stuck, here! That could be messy!”

My wife came over, gave it an experimental wiggle herself, and concurred with my assessment. “Yep, might want to turn the heat off!”

Of course, I did not. Bright idea, right there!

I diddled around in the kitchen for a few minutes, and then went back to my double boiler/pressure cooker (without release valve). I was explaining to my wife how I planned to safely extricate the top pot from the lower, when my explanation was interrupted. By the top pot ABRUPTLY separating from the lower. At speed. With force. And, with a considerable “BANG!”

The next thing I knew, I was holding the handle of the top pot, with molten chocolate running down my face. I turned from the stove, depositing the pot into the sink, and noted that more liquid was running down my face. Wiping it, I discovered that it was blood. Nice. I returned to the stove, and my wife saw the blood herself.

Ohmigawd! You’re bleeding! You’re on blood thinners! We have to take you to ER!”

Let’s turn off the stove, first, ok?”

She was fixated on my bleeding. “You have to go to urgent care! You’re bleeding!”

I was still sorting out what had happened, and what ought to be done, first, and then next, etc. “Honey? I sort of do this for a living, right? Let’s sort out what’s happening, and then decide what we indeed have to do, first, okay?”

But, you’re bleeding!”

I’ve already figured that much out, thank you. Now, let me take a second to see how badly I’m bleeding, and what else, if anything, is going on, before we panic. Once we know what’s happening, THEN we can panic, Okay?”

She hustled me into the bathroom, and handed me a towel. I sponged off the majority of the blood and chocolate, and saw a superficial appearing wound in the center of my forehead, approx 2 cm long. The blood appeared to be sluggishly dripping from it, and I did not see any other injury. Palpating, I did not feel anything suggesting a depressed skull fracture. My vision was at baseline, I had no numbness or tingling. My ears were sort of ringing (some of that was not new, some of that was readily attributable to the explosion). Otherwise, aside from chocolate EVERYWHERE, I appeared to be unscathed.

I applied some direct pressure, and the bleeding stopped after a couple of minutes.

The Darling Wife and I re entered the kitchen, and set to cleaning up the largest chunks.

A day or two later, my wife and her daughter in law were detail cleaning the kitchen, and discovered a large chocolate chunk behind the stove, and another on the top of the refrigerator. How the heck did they wind up there?