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.

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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?

Fun With Suits! · Life in Da City! · Pre Planning Your Scene

Alimony

Some back story. When TDWM1 (The Darling Wife Mark 1) and I had met up, she was a single mother of two children, working full time and going to nursing school. And, yes, she was successfully pulling that off. Once it was plain that our relationship was going places, well, I invited her to give up her apartment, move in with me, and let me support everybody. I made as much money in one OT shift, as she made as a nursing aid over an entire week. Or two. I told her, “You can always make a buck. You will not get a second chance to make that grade.”

She accepted my offer, completed Nursing school, got licensed, and we lived happily ever after. Or, at least, several years, happily (or so I thought).

So, fast forward to The Divorce. Let me admit, early in my tale, that she could have been way, way WAY more wretched than she elected to be. For example, had she alleged (falsely, but nonetheless she could have alleged…) that I had threatened her, well, a personal protective order was routine in such events, and until I successfully proved to the judge’s satisfaction that I had NOT threatened anyone, well, all my firearms would have to find new, happy homes. That is one example of wretchedness that she passed by.

On the other hand, getting back to my story, TINS ©, TIWFDASL ©…well, OK. There I was in a courthouse conference room with The Plaintiff (en route to transitioning from TDWM1 to The Wretched EX), her attorney, my attorney and me. Her attorney had just finished describing one of their demands, that I pay The Plaintiff alimony, and I quote, “So that Ms. Stretcher Ape can complete her Bachelor Degree in Nursing, so she can support her children better.”

I looked at my attorney, and he shrugged. With that signal, I dove in.

“Uh, Ma’am? why does your client require alimony in order to complete her BSN?”

“Mr. Stretcher Ape, it seems only fair. After all, she worked to put you through PA school, didn’t she?”

I contemplated this gambit. “You know, you have a point. I think we all agree that we all want fairness. You *do* realize that, while she was earning her associate nursing degree, I paid all of the household expenses for her, the children, and myself, right?”

Everyone at the table nodded, some more warily than others.

“So, since I contributed $1000 every month from my student loans to the family budget, while I was in graduate school, full time, isn’t it reasonable to expect your client to make a similar contribution toward her own education?”

Again nods, some wary.

“And, since I worked night shifts, 12 hours each, every night that I could, during our month long semester breaks, and every holiday shift that I could sneak in, as well isn’t it fair to expect Ms. Stretcher Ape to do likewise?”

The attorney nodded. I continued. “So, if we review my W2 forms, which I am sure our friends at the Friend of the Court have supplied you with, you can see that I contributed around $30,000 every year from my night shift earnings, as well as another $12,000 from my student loans. Isn’t it fair to expect a similar contribution from your client?”

The Plaintiff’s attorney started to bluster, but I held up a hand. “I’m not done yet. Now, you are suggesting all this effort should be directed toward earning her BSN, so that, as you term it, she could provide better for our children, right? This will add up to thousands of hours when your client could be mothering our children, and thousands of dollars in tuition, books, fees, and associated expenses, money that could be spent to the benefit of our children, right? All so that your client can earn a BSN, and earn more money, correct?”

The opposing attorney nodded. “Well, I, myself have a BSN. I am presently employed as an RN, and I can tell you, for a fact, that your client will earn twenty five cents an hour premium, as the holder of a degree in Nursing at the 4 year level! That means that, conservatively, her education investment will have paid for itself in (mumble, mumble, scribble, scribble) somewhere between ten to forty years, depending upon where she takes her classes.”

Opposing counsel leapt to her feet. “I do not believe that the earnings increase that comes with a BSN is so paltry!”

I leaned back, and smiled. “Madam, you have my pay stubs. They reflect that my employer, the largest hospital system in this part of the state, pays twenty five cents an hour. Most hospitals do not pay any sort of premium for that degree.”

Across the table, they leaned into each other, and held a hurried, whispered, conference.

I interjected. “May I make a counter offer? One that you likely will see again, like in court?”

Warily, I received nods of assent.

“Well, since I am a MAN, and a MAN wants what is best for his children I propose that, rather than spend thousands of hours in academics, hours when she could be mothering our children, and rather than spending tens of thousands of dollars, money that could be spent to the advantage of our children, that your client instead spend that time, spend that money, for the betterment of our children. And, since I am a MAN, and, being a MAN, I want to do what is best for our children, for my part, I will offer to pay her, annually, in one lump sum, in addition to whatever other money I am directed to pay, the five hundred dollars annually that she will forgo should she defer her education.”

I sat back.

THAT was the last I heard of alimony!

Fun And Games Off Duty · guns · Life in Da City! · Pre Planning Your Scene

Pedicabo non est mecum

So, TINS, after a time, Mallory had succumbed to my animal magnetism, and we had begun to date. Our relationship progressed, and when her apartment lease came up for renewal, she moved in with me.

Now, understand: Mallory was a very nice woman, and had grown up and lived in one of The Suburbs. I, on the other hand, lived in Da City, right off of Elmward, known as State Highway One. In addition, I lived just south of a neighborhood renowned for arson, drug dealing, and assorted mayhem. Kind of a jakey neighborhood. Still, I could afford to buy my two flat, and the rent from the other apartment paid for my house note.

Mallory, for her part, was, to say the least, skittish. This was not helped by my insisting that she phone me as she left work at TSBTCIDC, and subsequently meeting her at the door with a pistol in my hand.

We went to the range, and she became familiar with my assemblage of firearms. She really liked my Colt Government Model in .380 caliber, and purchased one for herself.

From time to time, she’d call, and ask me if I wanted anything from a drive through on her way home. On one of these side trips, she came home, a bit more frazzled than was her baseline.

She related her story as we ate. It turned out that she pulled up and gave her order, and then pulled to the window. As she was gathering her money to pay for the meal, some character knocked upon her (locked) passenger door, and began to panhandle her.

“Go away. I have nothing for you!”, was her response.

He began to tap more insistently upon her car window, and demand a hand out.

“I told you, I got nothing you want! Go away!”

He seemed to be slow on the uptake. Now, pounding upon her window, he demanded that she give him some money.

Mallory was “dressed to impress”, for sure. She produced the little Colt, directed it his way, and admonished him, “I TOLD you that you do not want what I have for you! Now, do you REALLY want me to let you have it, or do you have someplace else to be? Like, right fucking now?”

As she recounted, “People’s eyes really do get THIS big! He never took his eyes off the pistol, as he backed up across the parking lot, stumbled on the curb stone, and, once he regained his feet, ran to wherever he abruptly realized he’d rather be!”

Then, she replaced the pistol in her purse, and turned to the (likewise wide eyed) fast food employee, and asked, “May I have my change, please? And, my sandwiches? Oh, thank so very much! Have a nice night!”

Fun And Games Off Duty · Fun With Suits! · Pre Planning Your Scene · School Fun And Games

Not Fitting The Mold

So, TINS. I decided after several years as a nursing assistant, that I wanted to be an RN when I grew up. By the time that things lined up, I had already started working for EMS in Da City. So, I set to knocking off the pre-requisite classes I had not already collected, and waited for my Nursing school application to be processed.

Now, at this time, there were very, very, very few men in Nursing. The school I applied to, a community college, had a decidedly  problematic academic tendency among the population from which they drew their students.  So, since I had attended Tremendous State University for a couple of years, it seemed that I was a good candidate to handle collegiate level studies. For these reasons, it developed that I was accepted to this school.

In the course of the intake, I had to interview with an admissions officer. We talked about coursework, and finances. She asked me about what financial aid I had lined up. I admitted that I had none, and planned to pay for school through Da City’s tuition reimbursement program, as well as my earnings.

She did not think much of that idea, for some reason. “Mr. McFee, we do not allow our students to work.”

I was surprised. This was, after all, nearly 1980, and I had thought that liberated women, and various movements to remove barriers had changed things. Simply to be certain that I had heard her correctly, I asked her, “Er, ma’am? you do not ‘allow’ your students to work?”

“That’s right, Mr McFee. We do not allow our students to work.”

“Uh, ma’am, you do realize that I am working full time, have a house, and am my own only source of support, right?”

“Mr. McFee, you need to plan for that. We do not allow our students to work while they are in school.”

“Uh, OK. Uh, ma’am, so, where do you live?”

“Why do you ask me that?”

“Well, I support myself and you are telling me that I cannot work. I suppose that means that I’m moving in with you.”

THAT got her attention! “Mr. McFee! You are NOT moving in with me!”

“Hmm. So, how about you document that you have told me that your experience is that students who work while in school do not perform as well as those who do not. You could note that I have acknowledged that warning, and the school’s extensive experience behind that warning. You could write down that I will elect to work while in school, and therefore, any failure on my part will be in spite of your vehement admonitions. Do you think that will work for you? It is a chance that I am willing to take.”

“Uh, Mr. McFee, please sign here, next to my notes to that effect. Thank you. Welcome to Un-Named Community College School of Nursing. You have selected a challenging course of action, both academically as well as because you have chosen to work. Good luck!”

Fun With Suits! · Pains in my Fifth Point of Contact · Pre Planning Your Scene

Yet ANOTHER Tale of Public School Wonderfulness!

When She Who Must Be Obeyed, and I, and our family had moved to another school district, we, surprisingly enough, registered our children in that new school district. We were provided a sheaf of paperwork to be completed, and, in leafing through my homework assignment, noticed a physical form for each child.

I examined it, and noted that, at the bottom, it required the signature of a “Licensed Health Professional”.

I pointed this out to SWMBO, and she asked me what I intended to do with this insight.

“Well, I’ll perform physicals on our children, document them, and sign the forms. Save us the hassle of a doctor office visit!”

She protested that I was an RN, and that they meant for a doctor to sign the form. I invited her to point out where, on the form, it so stated.

She turned it this way and that, and, finally, was compelled to admit that it did not so state explicitly, “but that is what they meant!”

“Perhaps, that is what they should have said!”, and I went off to retrieve my stethoscope and children.

I performed all the diagnostic maneuvers required, documented my findings, and, at the bottom, where it called for the “signature of a healthcare professional”, I signed it Reltney McFee RN, BSN.

Several days later I took the kids to school for registration and walked into the office. The woman there told me she needed some documentation of address so I gave her a utility bill. She needed some ID for me, and I provided my driver’s license. She needed a phone number, and I provided it. Next she asked for the School physical forms. She examined them, and asked, “Who is this?”, indicating the signature.

“That’s me!” I said. She asked me if I was a physician, and I replied, “No I’m not. I’m an RN.”

“You cannot sign this form!”, she informed me. I leaned over the counter, pointed at my signature, and observed, “Yet, it certainly appears that I have signed it!”

“But, you have to be a doctor to sign this form!”

“No”, I corrected her, “it requires the signature of a licensed health professional. I am a registered Nurse, and am therefore a licensed health professional. Hell, I’m even licensed by the Bureau of Health Professions!”

Unswayed by my logic, she informed me, “Nurses aren’t health professionals!”

I picked up a phone book. “Oddly enough, the Board of Nursing seems to think that nurses are health professionals. It’s a local call: why don’t you call the Board of Nursing in the state capitol, and straighten them out? I’m sure they’d enjoy having you correct their little misunderstanding!”

And then I smiled.

She stuttered a little bit, looked flustered for a little bit, went into the back office and then came back out and said “We’ll take it this time.”

I smiled and said thank you and went on my merry way. Next year the kids came home from school and had these physical forms that need to be filled out. I looked at them: there at the bottom of them it said “signature of Nurse Practitioner, MD, DO, or Physician Assistant”, none of which I was.

My nursing school instructors would have been so proud of me! I was an agent for change, and the school system had changed their forms at my instigation!