# Bringing it home: What would you bring to civilian EMS training etc.?



## mycrofft (Mar 20, 2010)

Taking into account what civilian EMS is about and what we/they see and do, and if you were given the magical power to bring one thing from your experience and enact it within civilian EMS, what would it be?
(Think of weak areas like penetrating abdominal wounds, burns, eye injuries, penetrating trauma to limbs, tourniquets and other tools and protocols, or even field stuff like skin treatment, tran sport, etc).

PS: if no one brings it up, I'm going to post later asking about what you wish you had, could get or had been taught before being involved in "conflict medicine".
PPS: Read a book called "The Dressing Station"
http://www.amazon.com/Dressing-Station-Surgeons-Chronicle-Medicine/dp/0802139620


----------



## LucidResq (Mar 20, 2010)

Funny that you have posted this as just yesterday I was checking this out. Wish I could have attended.


----------



## NepoZnati (Mar 21, 2010)

mycrofft said:


> Taking into account what civilian EMS is about and what we/they see and do, and if you were given the magical power to bring one thing from your experience and enact it within civilian EMS, what would it be?
> (Think of weak areas like penetrating abdominal wounds, burns, eye injuries, penetrating trauma to limbs, tourniquets and other tools and protocols, or even field stuff like skin treatment, tran sport, etc).


It is hard for me to answer this question clearly since there is (in my opinion) big difference when we are talking about civilian and military situations... Generally, I think military situation it is simple situation about saving someone's life or limb where civilian situations are filled with worries of insurance, money, political correctness, sexual harassment, being "just a job" idea, etc. *I do not mean to offend anyone here and so please let me explain my self*... My thinking is coming from my military experience and idea of helping someone with all the risks that willingness holds. But, in my class here I was told that some of those EMT who run up the buildings on 9-11 were "stupid" for doing so. Personally, even that I am not full-blooded American, I find that insulting.  

I argued many times with that instructor, asking questions from what I experienced and saw just so he can shut me down every time or say something stupid since he did know the answer to... Example would be his question, *would we provide CPR/help to the person shot to the head with his brain leaking out*? Many followed his lead and say "no" and I said - yes. Why? Because I saw the man shot with the cal.50 in the side of his head, who lost some brain matter and yet after the year I saw him walking, talking and functioning normally. How come my instructor doesn't know that it is medical fact that in the situations where half of brain is gone other half will compensate and take over?? And even so, what about preserving life or organs, so doctors can decide what is best to do next or to use them and save some other life? I was thought to put tourniquets on heavy wounded limbs but always not to tighten up all the way so limb can still survive (unless it is traumatic amputation). Here I heard not to do at all unless I am in some deep wilderness. 

I guess, I just trying to point out dilemma I would have in discussing this with some who are so entrenched in they way of thinking, that they would dismiss everything they don't know or don't understand... I am sorry if I did not answer your questions correctly and if I digress but these things were bothering me for some time.


----------



## MrBrown (Mar 21, 2010)

A little disclipine and pride!

How many people out there say they work with somebody who is either overweight, chain smokes, eats junk food 24/7, has to wrestle thier tummy out from under the steering wheel and/or comes to work with thier shirt hanging out looking like they just woke up?

I don't know about you folk but I like showing up in nice, freshly pressed threads with clean boots, cut hair and adequately shaven.  

How many times have people you know *****ed about going to CCE classes and "oh I don't want to learn this!" or "this jobs suck, I want to go back to the station and watch telly".


----------



## mycrofft (Mar 21, 2010)

*Nepo, I was thinking of you when I posted this.*

My little two cents' worth:
1. Not EVERYONE needs an IV.
2. Tools are nice, talent and temperment are better.
3. An educated and/or experienced background will help prepare you by creating some common sense on which to make unorthodox moves you may be forced into by circumstances.
I'm hoping some of our deployed folks can bring themselves to drop some lines into this.


----------



## NepoZnati (Mar 21, 2010)

*mycrofft,*

not sure if this is in-line with you expectations but once in the filed I witness doctor improvising with the bent wire instead of small fixation device to keep finger in the place (not to retract inside), in the GW to the left arm where IV metacarpal was blow away... That was cool idea that save that guy finger.


----------



## mycrofft (Mar 22, 2010)

*Beats a popsicle stick! Yeah!*

A frequently cited one from Vietnam (U.S. side) was the use of a bloody pair of clean socks to seal a sucking chest gunshot wound.


----------



## mycrofft (Mar 25, 2010)

*I'm surprised no one else had brought up TK's*

or practical on the spot intervention for GSW's.


----------



## Akulahawk (Mar 25, 2010)

I can see going to the TK or using various methods to deal with GSW's. I suspect that some of the "busier" locales could very much benefit from what .mil medics learn. There have to be more and I, for one, would like to learn!

Surely there must be more things that .mil medics would like to see brought over to civilian EMS...


----------



## NepoZnati (Mar 25, 2010)

*"tk" = ?*



mycrofft said:


> I'm surprised no one else had brought up TK's or practical on the spot intervention for GSW's.



Tourniquet, *mycrofft*? If so, I use it and I am fan of it. The way they thought me, I think I would be comfortable using it even now... I always carried one in my pocket for myself, too.


----------



## mycrofft (Mar 26, 2010)

*TK=tourniquet, yes, thanks.*

My apology.
How about military field dressings (compress and fabric tail squeezed flat into a wrapper) versus commercial products? 
What have they taught or given you that failed, or what would you take back to your medic school drop ion thier desk and say "Hey, this works, teach it"?


----------



## NepoZnati (Mar 26, 2010)

*No apologies necessary, my friend.*



mycrofft said:


> .How about military field dressings (compress and fabric tail squeezed flat into a wrapper) versus commercial products?
> What have they taught or given you that failed, or what would you take back to your medic school drop ion thier desk and say "Hey, this works, teach it"?


Oh, those are awesome! I totally spaced out. THANK you for the remind. 

Yeah, that thing is great!! Open up water-proof cover, stretch the both end till sterile gaze show up, put on the wound, wrap it and you are good to go... Plus, bulky fabric on the top imitating additional compression dressing on the wound. Additional to that, that water-proof cover is great occlusive cover for puncture wounds on thorax. I used the, they work. 

Medic school? You meant my EMT school here? Well, I did try to mention thing or two but I was shoot down pretty quickly. If is not something they already know or someone else already told them, no one will listen foreign guy with accent. I hope, american medics have better experience with civis.


----------



## Afflixion (Mar 29, 2010)

NepoZnati said:


> Oh, those are awesome! I totally spaced out. THANK you for the remind.
> 
> Yeah, that thing is great!! Open up water-proof cover, stretch the both end till sterile gaze show up, put on the wound, wrap it and you are good to go... Plus, bulky fabric on the top imitating additional compression dressing on the wound. Additional to that, that water-proof cover is great occlusive cover for puncture wounds on thorax. I used the, they work.
> 
> Medic school? You meant my EMT school here? Well, I did try to mention thing or two but I was shoot down pretty quickly. If is not something they already know or someone else already told them, no one will listen foreign guy with accent. I hope, american medics have better experience with civis.



We don't really use that type of dressing anymore we use what I learned as an Israeli Dressing but now is called Emergency Trauma Dressing, because we don't want to offend the muslim population...I still cal them Israeli dressings seeing as they invented it they deserve credit where credit is due. It is essentially a 6x9 dressing attached to an ACE wrap, works great, with a bit on ingenuity it has hundreds of uses.

What I really like is the new Comat Gauze by Quikclot it doesnt burn or even get hot it is what is replacing the Hemcon dressings (chitosan) works just like kerlix pack it in there hold pressure for 15-30seconds then cover with an Israeli. I think that would do wonders in civilian rural ems with extended transport times. It is easy to remove you pull it out if gets stuck squirt some saline onto it and it releases cleanly.


----------



## EMSLaw (Mar 29, 2010)

I'm surprised it's taken QuickClot so long to make a civilian appearance.  I suppose it's the old, "You don't need to do that, the hospital is only 10 minutes away." thing?  Or is there some other reason?  Are they dangerous in the hands of the already-dangerously-undertrained EMS providers one finds in certain places?


----------



## mycrofft (Mar 29, 2010)

*Good dressing for a mass casualty.*

Sort of like my old standby, bunch of 4X4's and Medirip. Like calf-tying...slap  whipwhip  hands up/done!
Some stuff may trickle across, but it will need to take the time needed for veterans to get promoted high enough to affect their institutions.


----------



## triemal04 (Mar 29, 2010)

EMSLaw said:


> I'm surprised it's taken QuickClot so long to make a civilian appearance.  I suppose it's the old, "You don't need to do that, the hospital is only 10 minutes away." thing?  Or is there some other reason?  Are they dangerous in the hands of the already-dangerously-undertrained EMS providers one finds in certain places?


Actually, several products of that type are/were being used by civilian EMS, just not in any great numbers.  Depending on the details, I suppose the Combat Gauze that afflixion mentioned might come up more, but I don't know.  I had a conversation with a SWAT doctor (yes, they do exist ) a couple years back, and he was against using QuickClot and similar products.  In part because of the shorter time it would take to get into surgery, but also due to debridement issues; he figured more time was being spent cleaning out the wound instead of repairing the damage, when a tourniquet could have been put in place quicker and with the same or better results.


----------



## mycrofft (Apr 1, 2010)

*triemail, or a pressure dressing.*

We need not to get onto the TK bandwagon like we were pushed onto the anti-TK bandwagon decades ago.


----------

