# Advice on field kit and legality of usage sought.



## Phlipper (Jul 31, 2010)

As a three-gun and precision rifle competitor I've been carrying a basic IFAK kit on my ruck for a while.  As a first responder, and having had the field medic course for grunts in the Army (and having used those skills as a contractor long ago), I wanted to be able to do what I could in the unlikely event of an accident - always aware of the limits of my scope of practice, of course.  But I'd like to update the kit after the state EMT-B exam.  Suggestions sought:

- Iodine sponge, anti-bacterial gel, alcohol wipes, burn ointment.
- Motrin, Tylenol, and baby aspirin.
- Tweezers, safety pins, scissors, hemostats, knife, and LED light.
- New GI issue tourniquet.
- Assorted bandages from bandaids to 4x4s to 8x8s.
- Asherman chest seal (I assisted on a SCW in Colombia in '89 and will always maintain that an occlusive dressing is essential when you have a long wait for transport after taking one thru the lungs and CAN make a difference.  Our guy lived despite an hour waiting for transport then a one+ hour ride.).
- Two triangle cravats, two rolls of cling wrap, one 3" compression wrap, and roll of 1" tape.
- One 36" SAM splint.
- One QuickClot sponge for injuries that can't be compressed and elevated and won't respond to anything else  (Am seeking further training from those who have used it; a county near me actually carries on the truck.).
- Adult NPA and lube.
- CPR barrier mask.
- BP cuff and stethoscope


Secondly, I have asked this question of EMT-Bs and Paras in my state, but have received conflicting answers: am I risking my certification/job/civil penalties by responding within the full scope of EMT-B practice a situation like this while off duty and in an unofficial capacity?

I have been told ...

"I wouldn't open the kit, or even take one.  I would do nothing more than walk to cellphone range and call ALS."

"I wouldn't do anything more than dress bleeds with bandages and render CPR."

"I would use everything except the QuikClot and the Asherman, cuz a sucking chest wound is going to be DOA that far in the woods and I don't trust that QuickClot stuff."

"I would use absolutely everything in the kit without hesitation as long as I was properly trained for it."

"I would use anything and everything available if one of my friends had catastrophic injuries and the consequences be damned."


What course of action do you guys recommend?  I don't want to risk my certification, but I also don't want to stand around with my thumb up my butt while a friend or  fellow competitor bleeds out in front of me.


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## jjesusfreak01 (Jul 31, 2010)

Hard to say I wouldn't use any one of those things if they were actually necessary. If you are trained in their use then you are probably covered under GS laws if you use them. I probably wouldn't carry a quikclot in my personal pack, but I suppose if you expecting to be treating a gsw from a high powered rifle, then it might be helpful.


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## citizensoldierny (Jul 31, 2010)

When you say IFAK, you do mean the little 8"x8" thing you wear on the IBA correct? If so I seriously think you might have more than a few problems fitting all that stuff in it. As for treating people in an emergency I have and will but can understand why some people are reluctant to.


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## Phlipper (Jul 31, 2010)

citizensoldierny said:


> When you say IFAK, you do mean the little 8"x8" thing you wear on the IBA correct? If so I seriously think you might have more than a few problems fitting all that stuff in it. As for treating people in an emergency I have and will but can understand why some people are reluctant to.



I have a medium MaxP hanging off my ruck now that is going to be too small.  Thinking of getting a MaxP Proteus after the EMT-B cert exam.


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## JPINFV (Jul 31, 2010)

The only thing I can think of is maybe the chest seal and QuickClot *if* it's a protected device. I think everything else is over the counter. The cavet to this, though, is that you're using it at a firearms competition, so the chance that you'll need it is infinitely higher (even if still rare) than the wackers who have kits in their cars "just in case." Similarly, even if something is protected, given that you're at an event, it might be less likely that you'll upset the powers that be if you're doing something technically illegal.


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## zmedic (Jul 31, 2010)

There was some kind of quick clot being sold at an outdoor store last time I was down there (don't remember the brand), so there are some kinds of clotting stuff that is available OTC. 

That being said, I think it would be a little harder to defend using clotting factors and trying to be covered under GS laws. I could see there being issues with being an EMT and using your own QuickClot. Same goes for using your own NPAs. In most states you aren't licensed as an EMT when off duty and therefore aren't supposed to be doing EMT level care. If you are carrying your own gear that the average bystander wouldn't have it is harder to argue that you are just proving first aid. What if someone carried their own backboard and c-collar? Could they collar and board someone as a bystander at a car wreck? Or if they are an EMT in a state that allows them to start IVs (Colorado). Should they have IV supplies in their pack in case they want to start a line when off duty? 

The acid test is to ask yourself, would you feel comfortable standing in front of a jury/state medical board/ your medical director and stating that you did treatment X while off duty? The question isn't "should I carry something that I could use if no one official found out or if there were no complaints. 

To be clear, I'm sure you know how to use a NPA, I can't imagine a way that that you would harm your patient with one as a trained EMT. But knowing how to do something isn't the same as being allowed to do it.


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## Phlipper (Jul 31, 2010)

I guess the way I see it, I'm really prepared to deal with only essential BLS, and even that's going to be rare.  I'm trained and I'm present ... even though it's not likely I'll ever whip out more than a band-aid or some aspirin. 

But in the astronomically unlikely event that a friend has a torso thru and thru and a bandage with gentle pressure isn't working and it's obvious he's going to bleed out before we can get to a road or into cell coverage ... I think I'm going to be very, very thankful I have Quik-Clot in my kit.  What is my license worth compared to a friend or anyone, really, being able to go home to their family eventually vs. the family planning a funeral.  I'll knowingly make that trade any day.

But that's just me.  I'm always interested in other opinions.


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## jjesusfreak01 (Jul 31, 2010)

IVs are generally considered an ALS skill, even though some states allow EMTs to do them. I think a good measure of the care you can give off duty is what can you do within your scope that can be done with basic first aid equipment. You can do tons for trauma just because of the skills you possess, but very little for most medical situations due to lack of equipment and medications. You can always assess to give the medics a leg up when they get on scene. Hemostatic agents are within the EMT scope in my area, but I dont believe we carry them on the trucks due to short transport times.


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## Phlipper (Jul 31, 2010)

> Hemostatic agents are within the EMT scope in my area, but I dont believe we carry them on the trucks due to short transport times.



That makes sense.  

There are a few counties I know of that carry hemostatic agents in NC.  None of the civies I know have used it yet, but I have friends on Fort Bragg that used the older granular formulation in the sandbox.  I'm trying to learn all I can about it so I'll fully understand how to apply it and especially when it is, and is not, appropriate.  Like carrying an NPA when shooting/training, I highly doubt I'll ever have to pull it out of the ruck, but it is nice to know it's there for those once in a lifetime incidents.  Peace of mind, if nothing else.


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## mycrofft (Jul 31, 2010)

*No medical control=limits to practice*

Legally, if you are not under medical control, you cannot use materials requiring MD order or Rx to use.

Civilly, you are best advised to stay within Good Samaritan limits. Being a bystander with a kool kit is one thing, offering your services as a quasi field medic is another. 

Kit contents: pretty danged right on. Little use for clamps or knives (you meant scalpel right?). Add tetrasnips, safety pins are "eh", maybe three total cravats, and some medium sized chem cold packs if you don't ave ice. (Bring some good sandwich or larger baggies to hold ice if it is available, also avulsed digits, medical waste, etc). I like Coban, Medirip, or such.

Oral meds need a MD order unless you just say "Hey, I got a few Tylenols in my kit" and they say "Yeah"..._*per se*_.
All meds start to go bad at 80 deg F and with time. Only disinfectant I find wihtout an expir date is benzalkonium, which is a real lightweight.


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## Wild_Weasel (Jul 31, 2010)

I have discussed this same issue with the Flight Surgeon and ICU Nurse teaching the EMT-B course I’m taking here in Afghanistan to get re-certified.  There are significant differences between Combat Lifesaver (CLS) protocols and civilian EMT-B / First Responder protocols.  Our instructors stress these differences pointing out that CLS skills such as:  wound packing using QwikClot, relieving a tension pneumothorax with 14GA catheter, reevaluating and possibly removing a tourniquet after wound dressing, and not performing CPR are not compatible with the EMT-B / First Responder scope of practice in the civilian environment, in short EMT-Bs shall not perform invasive procedures and perform CPR.  Deviating from the EMT-B / First Responder scope of practice  can and will lead to litigation in the civilian environment.   
As an EMT-B (student) it still amazes me what can be accomplished with a pocket mask, some gauze, and a role of tape in the minutes following trauma or the acute onset of a medical emergency that can make the difference between a positive or negative outcome for the patient.
When traveling out of theater I carry a small kit containing: 4”x4” field dressing, cravat, small role of Duck Tape, nitrile gloves, and compact CPR face shield in a zip lock sandwich bag.  In theater I have a fully stocked CLS bag.

Cheers,
W-W


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## mycrofft (Aug 2, 2010)

*Wild_Weasle, YES! More with less.*

I think LifeAssist etc will not like you for not carrying their $40 shears and etc.
I have a small reverence for SMART splints, but a fx can be handled by splinting to self with padding in many cases using duct tape and cravats.


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## Phlipper (Aug 2, 2010)

mycrofft said:


> I think LifeAssist etc will not like you for not carrying their $40 shears and etc.
> I have a small reverence for SMART splints, but a fx can be handled by splinting to self with padding in many cases using duct tape and cravats.



LOL.  I just carry a big knife.

I crossed off a few things that I can improvise (SAM splint) or that I thought I could do without (NPA), and I traded bottles for single use packets.  Now I can almost fit it all in a Maxpedition M-5.  Only the steth/BP cuff and CPR mask leave me needing something larger.

Thanks for all the feedback.


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## Aidey (Aug 2, 2010)

QuickClot is available over the counter. It may not be the exact same stuff that is available to medical people, but I've seen it at camping/outdoors stores. 

We don't carry it, but the police officers do. We had a case awhile ago where PD was first on scene and applied QuickClot to the patient's stab wound. I have no qualms saying the patient would have died without it.


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## jjesusfreak01 (Aug 3, 2010)

Aidey said:


> QuickClot is available over the counter. It may not be the exact same stuff that is available to medical people, but I've seen it at camping/outdoors stores.
> 
> We don't carry it, but the police officers do. We had a case awhile ago where PD was first on scene and applied QuickClot to the patient's stab wound. I have no qualms saying the patient would have died without it.



Wow, a police officer gave medical care before arrival of EMS. I was watching an episode of Cops the other day and when police saw a stab victim, they gave instructions to a family member to treat the victim, while they sat by and watched.


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## gw812 (Aug 3, 2010)

Can't stress enough, like others earlier, that without medical control limit your treatment to ABC/C-Spine! Considering the setting that QuikClot would be acceptable here in the Lone Star State. Don't bother carrying/utilizing anything more advanced. The fanciest my 'uh-oh' bag in the truck gets is a set of oral airways, a good mask and one-way valve, and an occlusive dressing.


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## Wild_Weasel (Aug 3, 2010)

gw812 said:


> The fanciest my 'uh-oh' bag in the truck gets is a set of oral airways, a good mask and one-way valve, and an occlusive dressing.



? QUESTION ?

The EMT-B as a prerequisite  will have CPR for the Professional, which is a standalone certificate issued by the AHA or AMR.  Does this allow the “off duty EMT-B” to use AEDs and airway adjuncts without medical control and still fall within Good Samaritan statutes?

Cheers,
W-W


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## gw812 (Aug 3, 2010)

With the AED, yes, as any lay rescuer can get that training and utilize it without medical direction. I was already lumping in using an AED as ABC treatment. 
For the adjuncts I'd say no from a legal standpoint. I did AHA and the training did not include adjuncts so I would not count them in. I keep them as a be-ready measure - a bit outside good samaritan practice but to me it's a calculated risk with more payoff than liability. I figure that airway'll help if I'm solo in a difficult CPR situation. I wouldn't push the envelope with anything else.


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## Phlipper (Aug 4, 2010)

Wild_Weasel said:


> ? QUESTION ?
> 
> The EMT-B as a prerequisite  will have CPR for the Professional, which is a standalone certificate issued by the AHA or AMR.  Does this allow the “off duty EMT-B” to use AEDs and airway adjuncts without medical control and still fall within Good Samaritan statutes?
> 
> ...


It does in NC.  The majority of experienced medics I talked to, even the one who said he wouldn't do anything more than walk to cellphone range in a shooting range emergency, said that as long as you're not pushing/dispensing meds or performing an invasive procedure you are legal according to the law.  QwikClot Sport sponges (_not _the old powder), AEDs, occlusive dressings, etc. are fine according to the letter of the law.  You are working the ABCs.  I don't use anything in my kit that isn't within scope and outside medical control.  I took the NPA out only because I can't envision needing it.  But I do carry and will use a tourniquet.  I have trained on them in the Army and in civie EMT class and have used them in a live situation (leg wound, appeared to be femoral artery hit).

I _do _carry baby aspirin, Motrin, Benedryl, and various topical ointments and wipes but they're for me.  However, everyone knows where all that stuff is and might grab a Motrin or some antibiotic salve when putting a bandaid on their owie (I don't do anything less than stab wounds.  "Here's a Band-aid, wuss-boy!" :lol: ).  I've been carrying that stuff to shoots for years.  Big Boy Rules.  

I do find it interesting that one or two paras I spoke to said they would do very, very little in my situation (miles in the woods with GSW).  Perhaps with their years in the field they have seen/read about too many ambulance chasers talking pts into frivolous suits.  I dunno.  Ask me in 10 years I might say the same thing.  :wacko:  Then I met one guy from Bragg (Army medic and civie EMT-P) that carried a chest tube and decomp needle and said he'd use them without a second thought.  He was one of the guys who said a license vs. a life is no choice at all, and that he'd be glad to find a new career if a friend could go home from the hospital rather than to cold storage.


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## Phlipper (Aug 4, 2010)

Here's the field/range packing list I wound up with, if anyone cares.  I am packing it into a medium MaxP Proteus so I can 'man-purse' it to the range or Molle it to the ruck when going to the field or camping out.  Note ... I forgot that I did put the NPA back in after having it explained how and why it might actually be a good thing to have for a GSW.

(2) 8" adhesive pads
(4) 4" gauze pads
(4) 2" gauze pads
(10) Band-Aids, medium
(10) Band-Aids, small
(4 yds) 4" wound dressing
(1) Bolin chest seal
(2) 2" QwikClot Sponges

(2 rolls) cling bandage, 3"
(1) cravat w/ safety pin
(1) self-adhesive compression wrap, 3.5"
(2) finger splints
(1 roll) 1" tape

(1) holster w/ shears, sharp-edged tweezers, x-acto knife, and LED penlight
(1) CAT tourniquet
(1) CPR pocket mask
(1) stethoscope
(1) BP cuff	
(1) NPA, 28F w/ lube

(1 pk) sticky notes w/ pen
(1 pr) magnifying glasses

(4) alcohol prep wipes
(4) antiseptic wipes
(4) hydrocortisone packets
(4) iodine sponge packets
(4) antibiotic ointment packets
(4) burn ointment packets
(4) sting wipe packets
(10) baby aspirin
(10) Motrin, 200mg
(10) Benadryl 25mg
(1 sm bottle) insect spray
(1 sm bottle) sunblock


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## mycrofft (Aug 4, 2010)

*AED can be used when not under medical control if trained..*

..but if Bubba Medic come dittybopping by and starts pulling oxygen, AED, spineboard, KED, etc out of his trunk, questions begin to be asked.

Also, using a clotting agent on a puncture wound...doesn't it have to get into the bleeding site? An avulsion, sure, but a righteous stab wound, maybe an insulted artery or vein... has anyone actually read about any embolii arising from envasculated clotting agents like that?


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## mycrofft (Aug 4, 2010)

*PS: very complicated little kit there. Get em to hire you.*

......................


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## gw812 (Aug 5, 2010)

mycrofft said:


> ...has anyone actually read about any embolii arising from envasculated clotting agents like that?



That's a darn good question, and one I never thought to ask!


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## cfrench (Aug 7, 2010)

gw812 said:


> That's a darn good question, and one I never thought to ask!



Just carry the Quikclot sponge or guaze. The issue will never come up then.


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## cfrench (Aug 7, 2010)

gw812 said:


> That's a darn good question, and one I never thought to ask!



Just carry the Quikclot sponge or guaze. The issue will never come up then. And for what it is worth, Quikclot is sold at Cabelas so I would have no hesitation about using it off duty. NPA's are a different situation. Also, if space is an issue, dump BP cuff and maybe the scope. Taking someones BP is not going to save a life, nor is the incoming EMS crew going to really care probably.


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## jjesusfreak01 (Aug 7, 2010)

cfrench said:


> Just carry the Quikclot sponge or guaze. The issue will never come up then. And for what it is worth, Quikclot is sold at Cabelas so I would have no hesitation about using it off duty. NPA's are a different situation. Also, if space is an issue, dump BP cuff and maybe the scope. Taking someones BP is not going to save a life, nor is the incoming EMS crew going to really care probably.



Absent facial trauma with deformity, in what situation could you possibly injure someone with an NPA (if used correctly)?


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