OEMS, some tips...

Akulahawk

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3x may be a stretch, but don't quote me...i think it's more along 1.5-2x. Still a fairly large amount in the long run.... In combat, when you have a guy who's lost 3 liters, do you really have enough crystalloids to replace that? or even give him a reasonable chance or survival? Which takes us back to the length of time for some MEDEVACS to arrive...1 hour might not be the time you're getting, it may be a lengthy time. I suppose this may be more of a situation dependent type of choice. If they're your guys, you should already be making sure they are well-hydrated warriors. All good points that are brought up though. I just don't think any medic is carrying around 9 bags of NS or LR to replace large quantities of fluid over long periods of time. I tend to roll with 1L LR, 1.5L NS, and 1L Hetastarch... sometimes with some Dex, depending on how I feel about things, all by personal choice, with my operators each carrying their own 500mL Hetastarch. Keep the faith though guys...I like hearing people discuss things like this...we're only making military medicine better.
Here's exactly why Military Combat Medicine is taking the lead in trauma care. When you're dealing with an extended evac time, the normal rules just don't apply... and you have to seriously begin to worry about perfusion to end-organs while not popping the clot. The Trauma Docs are learning TONS about this and training the field medics and corpsmen what has been learned. I just hope that some of what has been learned can be readily translated back into the civilian world for better trauma care.
 

arsenicbassist

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It's comin', it's comin'...I've seen a few places implementing some "new" methods. I must admit that I learn a great deal from all of the people in this forum. Not because we're all insane medical genuises...but because we've all had different experiences and we're not too stubborn to learn from our brethren.
 
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HNcorpsman

HNcorpsman

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it will probably be a good 10 years before some of these new methods are used... In all honesty i don't see a big difference between the uses of NS and LR... If I have a Pt who is bleeding internally i will NOT give them IV fluids!! now if they have a extremity amputation, but i stop the bleeding i might consider giving them 500 mL... but no more... Like what has been said before you really don't want to risk popping that clot, the bodies BP goes down for a reason when someone looses blood... the lower the blood pressure the easier it is too clot... like i have said before if they have that radial pulse then there pressure is high enough to maintain life... once you loose it give the fluids until you regain the pulse... simple as that!
 

Summit

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What is hetastarch exactly?

And this thread is a very interesting read from the wilderness point of view.

Fluid resuscitation in the field is about worthless unless you're going to sit on it for a lengthy period. Studies show that around 63% of GSW pts survived after recieving IV fluids in the field....while around 70% survived with no fluids. Point being, don't waste time unless you are certain.

That's rather uninformative statistic. What percentage of the 70% would have indicated IV resus and for the 63% did they receive adequate and are these numbers controlled for confounding variables?
 

arsenicbassist

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What is hetastarch exactly?

And this thread is a very interesting read from the wilderness point of view.



That's rather uninformative statistic. What percentage of the 70% would have indicated IV resus and for the 63% did they receive adequate and are these numbers controlled for confounding variables?

I think the same thing myself. I'm sure there are certain variables that push one way or the other. Regardless, we've all thrown in some interesting things and have probably learned a thing or two...or at least questioned a thing or two. My guess would be a lot of the mistakes occur from blowing the clot or treating too aggressively. And from wilderness type SAR, check out hypertonics such as 6% NS in Dextran, makes for a good read if you're sitting for patients over a long period.

Remote EMT-P
 

arsenicbassist

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Hetastarch is a colloidal VE with a half-life of about 30 hours. Last a good long while. We basically use it because it causes a significant increase in circulating volume. Great for unit tactics. There are some good reads on it, and occassionally you can find a non-military physician who can tell you a little more about it. I'd write more, but I'm having dinner. I'll get back later on it though.
 
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HNcorpsman

HNcorpsman

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but he is absolutely right... in the field, in combat having IV access is not important, unless the evac will be longer than 2 hours... when i go out on patrols... i will take my M9 med bag (very small) but all i have in it is, mainly tourniquets , cinch tights, quick clot, NPAs, King Lt, surgical kit i maid, bowline chest seal, 14g extra long needle cath for tension pneumo, you know just the quick stuff... and then in the convoy vic's i will have my big med bag with usually 4 IVs, morphine, other what nots. then back at the FOB/COP i will have my set up... kind of like little echelons in the first echelon on care...
 

Akulahawk

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I think the same thing myself. I'm sure there are certain variables that push one way or the other. Regardless, we've all thrown in some interesting things and have probably learned a thing or two...or at least questioned a thing or two. My guess would be a lot of the mistakes occur from blowing the clot or treating too aggressively. And from wilderness type SAR, check out hypertonics such as 6% NS in Dextran, makes for a good read if you're sitting for patients over a long period.

Remote EMT-P
HSD is an interesting idea... and has been studied somewhat. It's been a while since I've seen any studies...
 

Luno

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Summit

What is hetastarch exactly?

And this thread is a very interesting read from the wilderness point of view.



That's rather uninformative statistic. What percentage of the 70% would have indicated IV resus and for the 63% did they receive adequate and are these numbers controlled for confounding variables?

Actually it's a very informative statistic, however there are pieces missing, I'll try to locate the study again, but it's Vietnam era stuff, and if I remember correctly the study was concerning penetrating torso trauma, rather than extremity GSW.
 

newguy

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i loved OEMS, buttttt..........

Man I loved OEMS, just loved it. And for me not being an EMT or a Military Medic it was an EYE opener and I LEARNED SO MUCH!!! I did the course on Wheeler Army Airfield, HI next to Schofield. I was on a waiting list for 2 years, and YES it was worth the wait.

i loved OEMS but this chick (Army medic) complained about the "training aids" that was used for the class, and it went on the news and the course is no longer offered to 25ID.
 
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HNcorpsman

HNcorpsman

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did you go through the longer course (week long lecture and pig lab) or just the pig lab? was Dr. Hagmann there? yes, i agree, OEMS was definitally the best class/course i have every taken in my entire life, lectures where very pertinent, and usefull, and the lab was invaluable... thankfully the military paid for me to fly from japan to NC, and payed for the class as well... haha i had a good time, now im saving lives in Afghanistan with the techniques Dr. hasgmann taught and gave me, i am a better corpsman and a better EMT just by taking that course...
 

newguy

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did you go through the longer course (week long lecture and pig lab) or just the pig lab? was Dr. Hagmann there? yes, i agree, OEMS was definitally the best class/course i have every taken in my entire life, lectures where very pertinent, and usefull, and the lab was invaluable... thankfully the military paid for me to fly from japan to NC, and payed for the class as well... haha i had a good time, now im saving lives in Afghanistan with the techniques Dr. hasgmann taught and gave me, i am a better corpsman and a better EMT just by taking that course...

hey doc whats up? hey i took the standard 2 week course. yes Doc Hagmann was there so were some Army SF Medic and i think there was a couple of PMC Medic. I did the pig lab too, can't talk much about it..you know how it is..but you're right, definately the best class I've ever been to.

hopefully after i get my NREMT-P I can get a job as a PMC Medic. Keep doing good things in A'Stan, Iraq is pretty quiet right now...
 
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HNcorpsman

HNcorpsman

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cool, cool, when i went there were 4 FMF corpsman including us, 3 PJs and a couple of SEAL corpsman... righto, im ready to slay the taliban from here to pakistan...
 

newguy

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hahaha i don't want to slay...but if i have to i'd rather do it in the private sector were they have better weapons and gear and a better pay check. we all fight for the same thing, i just want to get paid more. cause honestly...i don't think (we) military personnel are getting paid enough while we're out in front lines...
 
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HNcorpsman

HNcorpsman

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i just get mad when someone in kuwait gets the same entiltlements as i do... im here on the FRONT lines of afghanistan, going on convoys and patrols getting shot at almost every other day, while at the same time some guy in kuwait gets the same hostile fire pay, and harzadous duty pay as i do yet, has never shot his weapon or been fired upon... WTF?? im not mad at the person just the people who decide the pay entitlements.
 

newguy

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i just get mad when someone in kuwait gets the same entiltlements as i do... im here on the FRONT lines of afghanistan, going on convoys and patrols getting shot at almost every other day, while at the same time some guy in kuwait gets the same hostile fire pay, and harzadous duty pay as i do yet, has never shot his weapon or been fired upon... WTF?? im not mad at the person just the people who decide the pay entitlements.

dude, i'm on the same page as you are. there should be different pays, front line pays and then support personnel pay. but then again when i see paw prints, triple canopy, aegis and other contractors...i get a little jealous...better weapons, gear and pay. its like private school (PMCs) vs. private school (military). rather than paying PMCs, they should focus the money on military personnel.
 
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