Call for ideas: Improvising in the field

icefog

icefog

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As an EMS instructor, I've recently received the unenviable task of preparing a 90-minute practical training course on "planning for improvisation" (namely, what to do when a certain resource you need isn't available). It could relate to practically any challenge in the field: diagnosis, treatment, extrication, transport, etc. Some examples of what I've got so far are: improvised Heimlich valve, makeshift pelvic sling, using a SAM splint to get a baby out of the baby seat, using an extrication collar to temporary hold pressure on a neck wound when there's no other way to do it... (I know, I know...)

I'm also looking into some wilderness EMS manuals, trying to dig something out.

I'm aware of the legal issues connected to improvising in the field, and I've got that one covered (actually, that was the easy part).

So, my question is: any ideas I could work into this MacGyver show? Anything you've done or heard of that could be implemented with a reasonable chance of success?

Thanks!
 
icefog said:
As an EMS instructor, I've recently received the unenviable task of preparing a 90-minute practical training course on "planning for improvisation" (namely, what to do when a certain resource you need isn't available). It could relate to practically any challenge in the field: diagnosis, treatment, extrication, transport, etc. Some examples of what I've got so far are: improvised Heimlich valve, makeshift pelvic sling, using a SAM splint to get a baby out of the baby seat, using an extrication collar to temporary hold pressure on a neck wound when there's no other way to do it... (I know, I know...)

I'm also looking into some wilderness EMS manuals, trying to dig something out.

I'm aware of the legal issues connected to improvising in the field, and I've got that one covered (actually, that was the easy part).

So, my question is: any ideas I could work into this MacGyver show? Anything you've done or heard of that could be implemented with a reasonable chance of success?

Thanks!
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Intending no offense,

It has been my experience that a lot of the improvised gimmics are not really needed at all.

They are just techniques that people who don't really have experience or need of medicine in any austere condition like to make up to seem informed.

Most successful improvisation comes from being very knowledgable in basic medical prinicples.

In my experience, high volume critical care and traditional education are the secrets to my success.
 
Emphasize understanding the needs of the task and then reflecting on how you can achieve them. I would stop before each task and ask, "What do we need to accomplish here?" For instance, maybe for a splint the goals are to secure the limb exactly as it's currently positioned, comfortably, and supported against gravity, but leaving space for distal neurovascular monitoring. Now you can look at what you've got and ask how to accomplish those objectives. If you have 'em, doesn't matter if it looks funny. If not, you're just playing make-believe, like cargo cults.
 
I would recommend doing it like real life. Things that you are most likely to forget to restock. Give them a jump bag, but "forget" to put the NC or NRM back in. That SAM splint that you used? "Forget" to put that back in and only have ones that are too short or too long. Forgetting to refill O2 is an easy one, but there are ways to get O2 to people without an O2 bottle. Have your stephoscope break, will these newbies remember in the heat of the moment that you can still palp a BP? While on the subject, tape the knob of the BP cuff open so that there's a slow leak, can they still get you a BP? Do they even need to if we're in a trauma situation and feeling for a radial pulse is all we need? What if we restocked the sterile water but not the nozzle cap? Is there another way to flush out the eyes? We ran out of backboards on this mass casualty, what do we do now?

Think less about what ideas you want them to come up with, but more about common scenarios they might have to deal with. Don't try and make a scenario where you try and get them to come up with the "right" answer, but rather make a scenario that is common and plausible, and let them come up with their own answers. While the questions I posed above may have a particular answer that I would go with, any answer that accomplishes the task is a right answer.
 
Improvised nebulizer: neb treatment + 15ml bottled water + compressed air hose ran into an MRE bag. Decent seal too.
 
Veneficus said:
Did you really do this?
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Yep...got some funny looks, but it worked pretty well.

NTC 2009, the Stryker, Abrams and military trucks draw ambient air into seperate compressed-air system (no oil associated) and the rest was just proper allocation of tape and careful regulation of the air pressure delivered. We didnt have any neb setups or O2 bottles and some asthmatic kid who lied his way through MEPS. All you need is to keep the nozzle just below the surface of the puddle.
 
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Rocketmedic40 said:
Yep...got some funny looks, but it worked pretty well.

NTC 2009, the Stryker, Abrams and military trucks draw ambient air into seperate compressed-air system (no oil associated) and the rest was just proper allocation of tape and careful regulation of the air pressure delivered. We didnt have any neb setups or O2 bottles and some asthmatic kid who lied his way through MEPS. All you need is to keep the nozzle just below the surface of the puddle.
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That is awesome. Great thinking.
 
Stray shots:

I'm curious about the "getting around the legal thing"-thing.

Need to cover those improvs which are apocryphal or seem self-evident to everyone at some point but just do not work.

Good basics and experience make for success with plan C (plans A and B failed). Things like keep a double male oxygen tubing adapter handy, an "O"-ring for the E cylinder yoke, spare A and/or AAA cells, a note pad with cover for when the tablet crumps or the forms all get wet, etc etc. Phone change in the event cell and radio are out. Check air pressure in your spare tire, rehearse changing a tire on your ambulance. If you have a LED flashlight, have an incandescent one as well because of color masking by the LED.
 
mycrofft said:
Things like keep a double male oxygen tubing adapter handy
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Nota bene: a single or double male connector (of great length if needed) can be created by trimming one or both ends off a nasal cannula, non-rebreather tube, double female extension, or any similar tubing. Just wield those shears and snip. The bare tube will insert into a female connector without a problem.
 
Using a nasal cannula connected to a bag of saline to irrigate eyes.

Using a nasal cannula to secure a king airway or combitube. (Plastic on plastic works really well)
 
Rocketmedic40 said:
Improvised nebulizer: neb treatment + 15ml bottled water + compressed air hose ran into an MRE bag. Decent seal too.
Click to expand...

What was the purpose?

Without the baffles the particles would be too large to be of any use to an asthmatic patient.
 
I was in a training class where we were taught that a KED placed upside down can be used to stabilize a pelvis (put the 'head' part under the thighs, and the 'torso' part around the pelvis).

Rolled up and taped towels can be used as improvised head blocks.

A dixie-cup can be used to protect an injured eye.

Wrappers from various supplies can be reused on scene if containers are needed in a pinch. For example, I used a couple of wrappers slipped over a pair of bloody trauma shears and taped in place to keep the blood from being smeared around until we could clean the shears. I've also used wrappers to contain smaller bits of rubbish to minimize the amount of cleanup on scene when a waste basket isn't readily available.

Most of my MacGyvering has been done on injured animals though, and I'm not so sure what I've done there would be much help in the ambulance, since most humans know better than to lick wounds and keep bandages dry.
 
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WEMT Here, gimmicks aren't what we learned. We learned our stuff well with the idea being that if you know why you are doing something, it makes it much easier to improvise. For some of our scenarios, we would be told to "pack as if you were going on a real hiking trip" so that we could see what we would actually have with us. Then sometimes we would go with full equipment associated with SAR teams and have to deal with that. We even spent a day making and then carrying improvised litters.

That being said, yeah, I can improvise a traction splint pretty easily. But it comes down to lots of practice to learn yourself how to think outside the box. I don't think a 90 minute lecture will do it.
 
climberslacker said:
WEMT Here, gimmicks aren't what we learned. We learned our stuff well with the idea being that if you know why you are doing something, it makes it much easier to improvise. For some of our scenarios, we would be told to "pack as if you were going on a real hiking trip" so that we could see what we would actually have with us. Then sometimes we would go with full equipment associated with SAR teams and have to deal with that. We even spent a day making and then carrying improvised litters.

That being said, yeah, I can improvise a traction splint pretty easily. But it comes down to lots of practice to learn yourself how to think outside the box. I don't think a 90 minute lecture will do it.
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and how often do people really used improvised liters, make shift traction splints etc.

Ask around.

Preferably ask people who didn't sell you that class but really do it.
 
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Clipper1 said:
What was the purpose?

Without the baffles the particles would be too large to be of any use to an asthmatic patient.
Click to expand...


Asthma ecacerbation, no neb baffles available. Sorta worked.
 
icefog said:
So, my question is: any ideas I could work into this MacGyver show? Anything you've done or heard of that could be implemented with a reasonable chance of success?

Thanks!
Click to expand...

I think the classic that is often sarcastically joked about; is using a ballpoint pen for a makeshift cricothyrotomy. While I have never done such a thing, I have "heard stories"

On a side note, are you a German Paramedic working in that system or a U.S. military personal stationed in Germany?
 
Veneficus said:
and how often do people really used improvised liters, make shift traction splints etc.

Ask around.

Preferably ask people who didn't sell you that class but really do it.
Click to expand...

Why does it matter "how often" an improvisation is used?
 
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