Why do YOU carry a personal jump/trauma bag?

[MonkeySquasher]

Ok, so it is reasonble then to have a jump bag if you are on duty for a volly service and may be first on scene, before the ambulance?

Exactly. I live 1000ft from the University we cover, where typical response time from our station (approx 5 miles away) to the University is around 5-15 minutes, depending on time of day, staffing, etc. If the dispatch info sounds iffy-to-serious or the ambulance is already en route, I'll go right to the scene.

In just the last two years, just at the University, I've been first on scene (with equipment) for a cardiac arrest, 3 unresponsive ETOHs, a diabetic, a seizure, and an uncontrolled hemorrhage, among others. I don't carry O2 or drugs, so I don't really count SOB/asthma calls, as there's not much I can do past diagnostics and positioning prior to ambulance arrival.

I'm also just down the road from the nursing/rehab facility where we only get called for 911s (but they call the paid service, with better response times, for non-emergent. Go figure!) So when we get a cardiac arrest there, I tend to go to the scene as well. This is probably where my disdain for NH staff comes in, as I'm usually the one showing up and either correcting their actions, or pushing them out of the way to do something right.**

Sometimes it feels like they get paid more to end lives than I get paid to save them. :unsure: lol


**Disclaimer - I realize that not all nursing and NH/Rehab staff are horrible, and many are compassionate intelligent people who are very well trained and good at their jobs.

 

[thatJeffguy]

Never carried one, never plan to.

Can't think of anything I would need it for. If I am doing CPR as a bystander, it is compression only.

If somebody is conscious and bleeding i'll give them instructions.

If somebody is not, if i see the opportunity to safely apply pressure i'll just use some of their cloths.

I am not taking anyones vitals,heart tones, etc. and determining from that if they should or shouldn't seek medical attention. I am always going to encourage them to no matter what I find on assessment.

If somebody is choking, I require no gear.

I am not altering diabetics without a glucometer unless i am related or a close friend and know that they are likely hypoglycemic from history.

I am certainly not giving medications to people I don't know or performing invasive procedures when not working.

I am not hauling around an AED and all the headache that comes with it "just incase."

I am not playing mad scientist and mixing chemicals outside the medical environment if I suspect an ingestion injury.

If I suspect an inhalation or contact injury I am running away, try to keep up.

Nothing I can do for massive burns. Everything i need to care for a minor burn is readily available.

If I suspect a spinal injury and i am inclined to help, I am just going to hold manual stabilization.

babies come out on their own, and if they don't then calling for help and giving instructions is what I am doing unless i am very good friends with the lady.

What else could I possibly need?

Vene,

Usually your posts blow me away with their content and, I'm sad to say, this disappoints me a little bit.

I can tell that you're very intelligent and have a mind for this field. Did you pick this field out of a hat? Why not be an engineer, or an attorney, or a plumber? Those all require mental aptitude, critical thinking and the ability to wrap your mind around a problem that might not have "textbook" answers. Surely it's not the fantastic pay of EMS that attracted you, right?

I recently read an article about tourniquet use, pre-hospital, and it featured a gentleman who was at a rifle range when he caught a .30 caliber bullet through both thighs, severing the popliteal artery in one leg and the femoral in the other. A tactical medic present said that it was the most blood loss he's ever seen. Two responders that happened to be at the range applied tourniquets, improvised, and most likely saved this man's life.

Surely you're not suggesting that you'd just ignore the dying person simply because you're not "on the clock"? I find that to be ignoble and not keeping faith with the profession. We HELP people, we're trained to HELP people. I'm not saying you've got to stop at every car accident and spend four hours on scene, I'm not saying you've got to carry your trauma bag, AED and O2 bottle everywhere you go "just in case", but to think that you'd sit there and watch someone bleed to death, especially knowing that you could easily remedy the situation.... perhaps that mentality would work at McDonalds but I don't see it being applicable in the EMS field.

I'm just a basic EMT myself, but I try to be the most educated basic I can be. I pay for classes out of my own pocket, I miss good shifts at my paying job to travel hours out of my way to take these classes, I purchase quality aid implements to carry in my "go-bag" and I feel that if I were present when "something bad happened", I'd be a bit more concerned than "Well I'm not making my thirteen dollars an hour, :censored::censored::censored::censored: that guy!".

Everyone else that supported Vene's mentality; why are you in this career? The ability to earn a few bucks while ****ing around on the internet and not working? Cool lights and sirens? Doesn't "helping people" come into play at some point?

I'm thinking now of the airline jump kit thread and wondering what you folks would do in that situation; simply sit back and let someone die? Are you really that much of an arrogant :censored::censored::censored::censored::censored: that you'd do that simply because you weren't "on the clock"?

Not all of this is directed at Vene, just at that mentality in general. The mindset of "Screw the family in the van that I just saw run off the road, I'm not earning the gargantuan sum that I do when I'm on duty so MF's can just die!" isn't one that I'm able to understand.

That said, I carry a decent trauma kit with me, including a blow-out kit and two tourniquets. If I'm ever shot, hopefully some paramedic will be around, notice what I've got and not have rectal/cranial insertion disorder and actually be able to save my life. I suppose if I were with friends and one of them were bleeding to death and unconscious, I just might throw a band-aid their direction as wll

If you're looking for jobs that provide minimal training to minimally functional individuals and never require you to do anything;

http://www.mcdonalds.com/us/en/careers.html

Best of luck!

 

[BLSBoy]

I have a legal plan that covers me on/off duty.
I am a $hit magnet. Bad wrecks on fast highways that leave me alone for quite a while until FD/EMS gets there.
The only thing that I have bought was my EMS bunker gear that I use at work, wrote off on my taxes, and have kept me VERY warm and dry during snow season.

My bag, its contents, the ANSI Class II vest have all been paid for by agencies I work for.
I don't stop at every since accident I see, nor do I do anything out of the scope of practice of a First Responder.

 

[JPINFV]

I recently read an article about tourniquet use, pre-hospital, and it featured a gentleman who was at a rifle range when he caught a .30 caliber bullet through both thighs, severing the popliteal artery in one leg and the femoral in the other. A tactical medic present said that it was the most blood loss he's ever seen. Two responders that happened to be at the range applied tourniquets, improvised, and most likely saved this man's life.

Here's a problem with that story and your argument. You don't need any sort of specialized equipment to make a tourniquet. Give me a shirt or rope and a cleaning rod (or really, anything similar, like a stick) and I can make one for you.

Everyone else that supported Vene's mentality; why are you in this career? The ability to earn a few bucks while ****ing around on the internet and not working? Cool lights and sirens? Doesn't "helping people" come into play at some point?

[YOUTUBE]http://www.youtube.com/watch?v=Aa9mNistHSs[/YOUTUBE]

I'm thinking now of the airline jump kit thread and wondering what you folks would do in that situation; simply sit back and let someone die? Are you really that much of an arrogant :censored::censored::censored::censored::censored: that you'd do that simply because you weren't "on the clock"?

Different situations makes this a non-sequitur. There's a big difference between rendering aid, especially care beyond first aid, when EMS is 5-10 minutes away (at most), and 30 minutes to an hour because you have to land the plane first.

Not all of this is directed at Vene, just at that mentality in general. The mindset of "Screw the family in the van that I just saw run off the road, I'm not earning the gargantuan sum that I do when I'm on duty so MF's can just die!" isn't one that I'm able to understand.

Let's think about this one for a minute. How much gear do you really need to help a van off the road? Gloves and gauze at most since you shouldn't be extracting people from the van anyways. Hmm... supplies that most basic commercially available first aid kits have. Nothing special is really needed.

 

[adamjh3]

Vene,
(berevity)

Source: Dozens ignore man dying on NY street.

It's a myth that we have to do this or do that. We have time off like everyone else. Unfortunately there is this misguided belief- the one outgrowth of volunteer EMS and fire services that I have a problem with- that if you don't live for the job, your heart is not in it. I give everything I have when I am on duty to anyone who crosses my path. The moment I am off duty, we play by the law and by my right to self-determination. One does not give that up the day you pass an EMT exam (at least in all but three or four states).

...You don't live there anymore. Also correct me if I am wrong, but I do believe most countries with such regulations stipulate that simply seeking assistance for a person in need (read as: calling for help as you keep on trucking) is sufficient under the law. I don't believe any of them require someone to expose themselves to bloodborne pathogens or actually render direct patient care. My understanding of this was based on an incident I was involved with in rural France while visiting the country for a conference...

(snippets taken from seperate posts.)

This sums up what I would say in response. This gentleman says it way better than I ever could.

 

[emtstudent04]

Now i feel bad. I don't carry anything in my truck and it has come to my attention and something i have thought about a lot lately, that maybe i should carry the basic necessities just in case an emergency does come before me. I think i would carry some gloves, safety glasses, a mask, pocket mask that i received from school and band aids and a bandage. Anything beyond that they better be going to the hospital in an ambulance or having a freind or family member taking them to the emergency room to sit for 3 hours for a broken arm (personal experiance).

 

[thatJeffguy]

Here's a problem with that story and your argument. You don't need any sort of specialized equipment to make a tourniquet. Give me a shirt or rope and a cleaning rod (or really, anything similar, like a stick) and I can make one for you.

Not that this detracts from your point, that being that it's not necessary to carry things which can be improvised, but the article in question was talking about how ineffective improvised tourniquets can be and the increased risk of localized tissue damage from said improvised tourniquets. If the Spanish Windlass was so effective, combat medics wouldn't have invented SOFTT/CAT's etc.

http://www.tacmedsolutions.com/blog/?p=125 <-- the article in question

The belt tourniquet didn't work, the SOFTT did. "Improvising", in this situation, would have caused this man to die (in the opinion of the on-scene medic, not me!).

[YOUTUBE]http://www.youtube.com/watch?v=Aa9mNistHSs[/YOUTUBE]

How will ya impress chicks by driving past an accident?

Different situations makes this a non-sequitur. There's a big difference between rendering aid, especially care beyond first aid, when EMS is 5-10 minutes away (at most), and 30 minutes to an hour because you have to land the plane first.

True. I'd say that my interventions would be, essentially, manage the ABC's until the ambulance arrived. I'd also try for a PMH in case the patient lost consciousness before the ambulance arrived. Obviously I don't necessarily need tools to do this, but they'd sure help. If I drove past a MVC and later heard that the driver died of positional asphyxiation, or airway compromise due to the head being tilted forward and the tongue occluding the oropharynx, I'd know that I could have simply tilted his head and saved his life and I'd have to deal with that for the rest of my life.

Let's think about this one for a minute. How much gear do you really need to help a van off the road? Gloves and gauze at most since you shouldn't be extracting people from the van anyways. Hmm... supplies that most basic commercially available first aid kits have. Nothing special is really needed.

I believe in preparedness. I'd say that any bystander would get the basic "ABC's" dealt with, family and friends get a bit more and I carry gear in my kit (my blowout kit) that would allow a medic to decompress my chest, stop severe bleeding or obtain an airway.

 

[thatJeffguy]

Source: Dozens ignore man dying on NY street.

(snippets taken from seperate posts.)

This sums up what I would say in response. This gentleman says it way better than I ever could.

I don't help people because I'm compelled by the law, I do it because it's the right thing to do. Our job isn't like other jobs. I'm a bartender but I don't feel compelled to help a guy getting bad service when I'm out by pouring him a beer. A IT specialist might not want to bounce around Starbucks on his personal time fixing people's Wi-Fi. However, when you're trained to save a life, you should feel a ethical compulsion to do so if you can. I'm not saying that people should be prosecuted for walking by an injured person, I'm very libertarian in my beliefs and don't like much government or legal intervention at all, I'm simply wondering how someone can be drawn to a field in which we help people, then not want to do that when presented the chance.

 

[TransportJockey]

I don't help people because I'm compelled by the law, I do it because it's the right thing to do. Our job isn't like other jobs. I'm a bartender but I don't feel compelled to help a guy getting bad service when I'm out by pouring him a beer. A IT specialist might not want to bounce around Starbucks on his personal time fixing people's Wi-Fi. However, when you're trained to save a life, you should feel a ethical compulsion to do so if you can. I'm not saying that people should be prosecuted for walking by an injured person, I'm very libertarian in my beliefs and don't like much government or legal intervention at all, I'm simply wondering how someone can be drawn to a field in which we help people, then not want to do that when presented the chance.

I do not and will not feel any compulsion to help if it places me in danger. If someone is bleeding out, and I have PPE and am the only sucker there I will help. But I'm not gonna touch some guys blood without gloves. Screw that. I'm more important than any patient. And if that's not taught since day one in your EMT class, your instructor is an idiot. Scene safety first. That means your safety

 

[thatJeffguy]

I do not and will not feel any compulsion to help if it places me in danger. If someone is bleeding out, and I have PPE and am the only sucker there I will help. But I'm not gonna touch some guys blood without gloves. Screw that. I'm more important than any patient. And if that's not taught since day one in your EMT class, your instructor is an idiot. Scene safety first. That means your safety

Scene safety? I agree completely, but we're not talking about that. I wouldn't rush into a firefight to apply a band-aid, but we're talking about people that feel that it's not their "job" to help a wounded or medically critical person and think it's absurd to carry materials necessary to do that. I mean, we're talking here about WHAT DO YOU CARRY and the first thing you said is that "without gloves..." you wouldn't do anything.

Well, if you're open to suggestions, how about you carry a few pairs of Nitrile gloves with you? I ALWAYS have two pair in my pocket, even when I'm at my fancy cushy bartending job.

Again though, I see your point here. If my father gets shot in the chest and I don't have gloves, he's getting a bare hand to cover his sucking chest wound. If a stranger gets shot in the chest, I'll advise his friends or family on what to do. I'd never advocate putting yourself in danger for a stranger, as for family... that's up to you

I suppose living in a rural area and being an active outdoorsman has given me a different perspective. I've done all sorts of things from bandaging a minor boo-boo on canoe trips (which probably helped more with the childs mental state than anything else) to putting quick pressure on a deep distal forearm laceration in the backcountry. I like to be prepared for those situations and while I feel that KNOWLEDGE is the number one means of preparedness I don't mind carrying a pound of kit with me for that purpose.

 

[adamjh3]

I do not and will not feel any compulsion to help if it places me in danger. If someone is bleeding out, and I have PPE and am the only sucker there I will help. But I'm not gonna touch some guys blood without gloves. Screw that. I'm more important than any patient. And if that's not taught since day one in your EMT class, your instructor is an idiot. Scene safety first. That means your safety

^+1. What about all the people that I won't help after I get Hep C or get struck by a semi on the side of the freeway? Off the clock it's my family, my friends, myself, and then the patient(s).

By the way, I do carry a pair of gloves in my pocket. Never used them, hope I never have to.

 

[Veneficus]

Surely it's not the fantastic pay of EMS that attracted you, right?

My journey through public safety and later medicine has been ever evolving. At no point has it been the money.

I recently read an article about tourniquet use, pre-hospital, and it featured a gentleman who was at a rifle range when he caught a .30 caliber bullet through both thighs, severing the popliteal artery in one leg and the femoral in the other. A tactical medic present said that it was the most blood loss he's ever seen. Two responders that happened to be at the range applied tourniquets, improvised, and most likely saved this man's life.?

I think you may be superimposing what I said onto a very abnormal situation, which would call for measures beyond the commonplace situations I was thinking when I replied. I am quite clever, and I really don't need a bunch of commerical equipment to render aid. I would be willing to bet I could stop esophageal hemorrhage with a party baloon. But it doesn't mean I keep a stash of them for just such an event.

Surely you're not suggesting that you'd just ignore the dying person simply because you're not "on the clock"? I find that to be ignoble and not keeping faith with the profession.

I never suggested I would not help a person in a particularly unforseen event where I thought it could be done safely. Because of the innumerable events possible or even imaginable, I could not hope to detail all of my potential responses. What I consider "safe" is both situation dependent and probably not what most would.

We HELP people, we're trained to HELP people. I'm not saying you've got to stop at every car accident and spend four hours on scene, I'm not saying you've got to carry your trauma bag, AED and O2 bottle everywhere you go "just in case", but to think that you'd sit there and watch someone bleed to death, especially knowing that you could easily remedy the situation.....

I don't usually find myself in the position where my aid is needed. I have rendered aid in the past and have no problem with offering assistance in the future. But I reserve the right to decide what is "safe" intervention based on the circumstances.

perhaps that mentality would work at McDonalds but I don't see it being applicable in the EMS field.

I think you may be superimposing my thoughts of not needing to carry equipment with me to not providing aid. I mentioned about direct pressure because it does stop most bleeding. If I were to make that attempt and it did not, I would review the situation and act accordingly.

I also don't consider a tq, an invasive measure. It was a basic skill when I went to EMT class. (it is also just focal pressure) But if somebody had a simple laceration, I would probably instruct them on how to clean and dress it so they could go to get it properly taken care of if it required suturing. No I am not going to suture it when not acting in some official capacity either paid or volunteer.

I'm just a basic EMT myself, but I try to be the most educated basic I can be. I pay for classes out of my own pocket, I miss good shifts at my paying job to travel hours out of my way to take these classes,

I am no longer a basic EMT, my education will go on as long as I live, I have also paid dearly for it both is dollars (in the sum of hundreds of thousands) and in time.(a little over 2 decades) I have traveled to 4 countries outside of North America to provide care, 3 at my own expense and volunteering months of time. If you read the aircraft thread, I do offer to help when the need arises. I also do not accept reward for it. I do not see the need to purchase or carry personal gear.

I purchase quality aid implements to carry in my "go-bag" and I feel that if I were present when "something bad happened", I'd be a bit more concerned than "Well I'm not making my thirteen dollars an hour, :censored::censored::censored::censored: that guy!".

You would work for $13 an hour? just kidding needed to lighten things up a little. Really though, I love what I do, it is a privilege and I cannot always believe I get paid for it.

Everyone else that supported Vene's mentality; why are you in this career? The ability to earn a few bucks while ****ing around on the internet and not working? Cool lights and sirens? Doesn't "helping people" come into play at some point?

I just thought being a fireman was cool. Again, the ability to render aid is completely seperate from carrying gear. I stand by the position, I am not rendering invasive aid outside of my work environment. (with exception of a major catostrophic event) I am using the airport, the school's or the mall's AED. The aircraft medical kit, or the materials available on hand. There is more than enough compelling evience of the effectiveness of compression only CPR for me not to find benefit putting my lips on somebody or carrying a pocket mask.

I'm thinking now of the airline jump kit thread and wondering what you folks would do in that situation; simply sit back and let someone die? Are you really that much of an arrogant :censored::censored::censored::censored::censored: that you'd do that simply because you weren't "on the clock"?

Read my post there. Aid was asked for and aid was rendered. Even after it was apparent it was not a life or death emergency. I will be on a transatlantic flight again ths month if somebody asks for help, they will be helped in an appropriate way. But I can tell you, in all of my considerable travels, I have only ever been in the situation once where aid was even asked for on a plane. (I fly across the pond an average of 4 times a year)

Not all of this is directed at Vene, just at that mentality in general. The mindset of "Screw the family in the van that I just saw run off the road, I'm not earning the gargantuan sum that I do when I'm on duty so MF's can just die!" isn't one that I'm able to understand.

Actually I stopped at an accident once as well. Which also turned out to be nothing, but it did look impressive. It is not about work or pay, but honestly I can recall every instance where I was not working and somebody required or even requested aid. In all of those instances I offered. Most of them were not serious and the only one that was, after I performed the heimlich, I sat down and finished my dinner after. (and paid the cheque in full)

That said, I carry a decent trauma kit with me, including a blow-out kit and two tourniquets. If I'm ever shot, hopefully some paramedic will be around, notice what I've got and not have rectal/cranial insertion disorder and actually be able to save my life. I suppose if I were with friends and one of them were bleeding to death and unconscious, I just might throw a band-aid their direction as wll .

I was never a boy scout. I guess I wouldn't have been very good at it. I don't leave the house expecting to get shot, hit by a car or any other ill form of fate. I also have only 3 or 4 friends who are not physicians, (or very close to becomming one) or emergency workers of some sort. (LE, medics,firefighters, ER nurses, etc) generally they don't need a lot of input or care when we hang out. For my friends (who are equal to my family), you cannot imagine the lengths I would go. I just never need to.

If you're looking for jobs that provide minimal training to minimally functional individuals and never require you to do anything;

http://www.mcdonalds.com/us/en/careers.html

Best of luck!

It is a running joke in my circle to find the job with the least responsibility. I got Mcds beat soundly. I saw on TV a guy in Australia who makes a living sitting on the beach with a wagner powerpainter charging $10 a person to "paint" them with sunscreen.

My rendering aid (both at work and as a volunteer) has also taken the form of some rather unpleasant tasks that most US EMS workers will never experience.

There is no way to feel like a hero when you tell a teenage sex worker at the free clinic you volunteer (as in miss time with friends and family and don't get paid) she tested HIV positive and then procede to form a care plan knowing it is not the best because the economic resources are not there and educating her on her disease. There is no way to magically "save her life."

It is not as glorious as say pulling a BVM out of your pack and ventilating somebody.

 

[Veneficus]

Not that this detracts from your point, that being that it's not necessary to carry things which can be improvised, but the article in question was talking about how ineffective improvised tourniquets can be and the increased risk of localized tissue damage from said improvised tourniquets. If the Spanish Windlass was so effective, combat medics wouldn't have invented SOFTT/CAT's etc..

Whoever put that belt on should have known it was not going to work. That was not good improvising.

The very tennant of damage control surgery is to save life prior to worrying about recovery.

Both the online trauma forums and several surgical publications have detailed preventable fatalities trying to "preserve function and quality of life" in professional sports figures and other highly active or public persons instead of standard procedures that would have resulted in incomplete recovery.

 

[Sasha]

I carry a trauma bag so i have an excuse to cut off hot guy's clothes

 

[mycrofft]

Thanks for getting us back on subject, finally.

And five is four, we always slide back into the "I'm not gonna treat people on my own time" quagmire. Sheesh.

Sasha, Sasha, Sasha...just go buy those xray glasses they advertise in Popular Science!

 

[firecoins]

I carry a trauma bag so i have an excuse to cut off hot guy's clothes

I am sure you can get him out faster w/o.

 

[JPINFV]

Not that this detracts from your point, that being that it's not necessary to carry things which can be improvised, but the article in question was talking about how ineffective improvised tourniquets can be and the increased risk of localized tissue damage from said improvised tourniquets. If the Spanish Windlass was so effective, combat medics wouldn't have invented SOFTT/CAT's etc.

If I'm applying a tourniquet as a bystander, it's because I think the patient is going to die otherwise. Similarly, I hardly see that article saying that everyone should have a tourniquet in their vehicle just in case. There's a very big difference between having the proper equipment because it's either your job (i.e. medical providers when on duty) or because there's a general expectancy of exposure (i.e. law enforcement officers, who are the targeted population in your link).


The belt tourniquet didn't work, the SOFTT did. "Improvising", in this situation, would have caused this man to die (in the opinion of the on-scene medic, not me!).

Similarly, that's not how you improvise a tourniquet.
A belt would not hold a candle to:

How will ya impress chicks by driving past an accident?

First off, "chicks dig it" is my canned response to the "no true Scotsman" fallacy that get's thrown around all too often in EMS.

Second, phone, 911, not dieing from getting struck by passing vehicles. Now, depending on where the accident is, I may stop. There's a big difference between, say, the 5 in the middle of Camp Pendalton and the 5 at, say, the 5-405 interchange.

To give you an idea: Camp Pendalton is the big area at the bottom of the map of nothingness. The 5/405 is in a highly populated area.
http://maps.google.com/?ie=UTF8&ll=33.500179,-117.614136&spn=0.538227,1.234589&z=10

In one area, by the time I call 911, pull over, walk up, and form even a basic scene safety assessment, the fire department will already be pulling up. The other, should be fairly obvious...

True. I'd say that my interventions would be, essentially, manage the ABC's until the ambulance arrived. I'd also try for a PMH in case the patient lost consciousness before the ambulance arrived. Obviously I don't necessarily need tools to do this, but they'd sure help. If I drove past a MVC and later heard that the driver died of positional asphyxiation, or airway compromise due to the head being tilted forward and the tongue occluding the oropharynx, I'd know that I could have simply tilted his head and saved his life and I'd have to deal with that for the rest of my life.

1. Bolded for emphasis.
2. You don't need tools for a PMH. You don't need tools outside of gloves to provide inline stabilization.
3. PMH is going to be asked again by... well... everyone involved in the chain of care including just about everyone at the hospital anyways...

I believe in preparedness. I'd say that any bystander would get the basic "ABC's" dealt with, family and friends get a bit more and I carry gear in my kit (my blowout kit) that would allow a medic to decompress my chest, stop severe bleeding or obtain an airway.

Why don't you go big or go home?

http://www.zombiehunters.org/forum/viewtopic.php?f=43&t=33826

 

[Sasha]

And five is four, we always slide back into the "I'm not gonna treat people on my own time" quagmire. Sheesh.

Sasha, Sasha, Sasha...just go buy those xray glasses they advertise in Popular Science!

Silly mycrofft, you can't palpate with xray glasses. Excuse me sir, I must check your abs for abnormal masses.

 

[emt_irl]

i thought you meant on the ambulance.. i prefair my own bag and have it stocked up to use when on the ambulance or staged somewhere then take it home with me and leave it locked in the boot(trunk) of the car i wouldnt call myself a whacker but i do have a small ems star of life sticker on the front window(mainly for parking reasons) next to the 3 other discs we have to display in ireland(insurance, road tax and road worthy test) i have driven past many a mvc without a second though, and id only consider breaking it out for a family member or friend if needed. Although i wouldnt go looking for trouble/ accidents etc but if i came upon something serious and i was going to be stuck there anyways in traffic or had to walk right by/over them etc id probally stop to help.

ive a stat packs load n go bag to give you the idea of size and is filled with trauma and bls equipment

 

[usafmedic45]

I was kinda weirded out by the fact that you could even apply them as an EMT.

I could understand why VFD would have them, though.

In some jurisdictions, including one I used to run in, we were issued jump kits and AEDs (thanks to a grant from one of the local residents who had more money than she knew what to do with). Those of us who were ALS qualified were also issued drug boxes we could exchange out with the county ambulance crews when they showed up (the ambulances carried an EMT-I level drug box and an EMT-P level drug box so that staffing could vary depending upon whether the unit in question was a first out truck (EMT-P) or backup (EMT-I)). We were expected to respond POV because in a lot of cases we were able to get to the scene before someone could get to station and get the truck.

The belt tourniquet didn't work, the SOFTT did. "Improvising", in this situation, would have caused this man to die (in the opinion of the on-scene medic, not me!).

You're right. Most people can not produce enough pressure to stop bleeding in the case of an improvised tourniquet, mostly because of a lack of familiarity with the windlass technique. The article I mention below relates a case of why improvisation, especially by the untrained bystander is a bad idea:

However, the safest approach in the case of the marginally trained and inexperienced person with basic first aid training is probably to rely upon simple direct pressure or basic forms of pressure dressing. This is due to a lack of evidence that such persons can effectively recognize the need for a tourniquet and properly apply such a device- especially given the likely need to improvise under such circumstances. [9,62] This last point is illustrated by a case of femoral artery transection by broadhead arrow as the result of a deer hunting accident to which the author responded as an emergency medical technician. The victim's nephew had attempted to place a tourniquet made from the victim's belt prior to going for help. The patient was deceased due to blood loss at the time of the arrival of the author and his coworkers. It was determined that the bystander had improperly placed tourniquet distal to the injury and with insufficient force to be of any utility even if it were in a proper position.

The two referenced articles by the way (9, 62) are, respectively:
Rocko JM, Tischler C, Swan K: Exsanguination in public – a preventable death. Journal of Trauma 1982, 22:635.
National First Aid Science Advisory Board: First aid. Circulation 2005, 112:196-203.

BTW, if the guy was so critical, does anyone else think it odd that he sitting up, or at least in something approaching a low Fowler's?

If I'm applying a tourniquet as a bystander, it's because I think the patient is going to die otherwise.

...or if you have something more pressing to do (airway, etc)?

May I suggest a review of tourniquet use that is up to date? http://wjes.org/content/2/1/28

Based upon the best evidence available from the literature, the following conclusions are drawn:

- Emergency medical personnel, both civilian and military, should be trained in and equipped for the proper use of tourniquets; the focus of first aid training for civilian populations should continue to deemphasize their use and focus instead on early medical assistance and the use of direct pressure to control hemorrhage.

- No patient should exsanguinate from an extremity wound because of the hesitance of a medical professional to utilize a tourniquet to control bleeding due to fear of potential complications.

- In circumstances- such as combat (or the civilian equivalent thereof), high risk of building collapse, fire, or explosions- where expedient movement of the patient is necessary for the safety of the patient and the caregivers, the use of a tourniquet is appropriate to gain control of life threatening hemorrhage

- The existence of a mass casualty incident may be an indication for the use of tourniquets for temporary control of hemorrhage while the situation is brought under control.

- The need for a tourniquet applied to allow movement of a wounded person or during a mass casualty incident should be reevaluated at the earliest possible time;

- The mere presence of an amputation with hemorrhage does not necessitate the use of a tourniquet; most bleeding from such injuries are controllable through use of direct pressure, elevation and packing of the wound. If these actions do not achieve hemostasis, then the use of a tourniquet is indicated.

- Tourniquets may be placed proximal to the site of uncontrollable bleeding around an impaled object; under no circumstances should the tourniquet be applied over the impaled object.

- Tourniquets should not be applied over joints, or over clothing. It should also be at least 3–5 centimeters from the wound margins. The rule of the thumb the author used when teaching was to place it the width of the palm of a hand proximal to the wound whenever possible, as this provides an easy frame of reference.

- Any limb with an applied tourniquet should be fully exposed with removal of all clothing, and the tourniquet should never be covered with an form of bandage. The patient should be clearly marked so as the presence of a tourniquet will be know, along with the time it was placed. It may also be advisable to instruct a conscious patient to tell every medical provider they come in contact with about the presence of a tourniquet.

-Continued bleeding (other than medullary oozing from fracture bones) distal to the site of the tourniquet is a sign of insufficient pressure and a need to tighten the tourniquet further.

-A tourniquet should not be loosened in any patient with obvious signs of shock, amputation that necessitated use of such a device to control bleeding, recurrent hemorrhage upon release of the tourniquet or any case where the hemorrhage associated with the wound would be expected to be uncontrollable by any other means.

- Any tourniquet that has been in place for more than six hours should be left in place until arrival at a facility capable of definitive care.

If the Spanish Windlass was so effective, combat medics wouldn't have invented SOFTT/CAT's etc.

Please get your facts straight. The CAT was actually designed to be applied by wounded persons under fire, which might require placing it on one of their arms. The windlass technique is effective but it, unfortunately is not something that can be done one handed. There was a comparison between the CAT and SOFFT a few years back and several other tourniquet models in utility in self-application and while the CAT and SOFFT both achieved 100% (as opposed to 77-88% occlusion), keep in mind that we are not talking about the scenario depicted in that study. (Walters TJ, Wenke JC, Kauvar DS, McManus JG, Holcomb JB, Baer DG: Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care. 2005 Oct-Dec;9(4):416-22). I do agree that they are a wonderful tool and encourage anyone who is going to be packing a first aid kit to have at least two of them in it. They have a place on every ambulance. My preference is towards the CAT but that is mostly due to my familiarity with and prior use of it.