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Old September 17, 2005, 21:24   #1
40calgal
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Complete Medical bags

Where would one find a complete medical bag? I know it won't have meds other than over the counter basics, but I have looked adn there are alot of medical bags out there but not complete, like an EMT's type.
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Old September 17, 2005, 22:00   #2
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Welcome to the 'files 40calgal! For a EMT type bag (with or without supplies) try www.galls.com They carry a lot of EMS stuff.
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Old September 17, 2005, 22:12   #3
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Glad to be here! Tons of amazing info, can't catch up!

I had no idea Galls was an Aramark company! Great link, great info!

Now where would I find a hand pump for the well? Also, I was wondering about small solar panels, one's that could run radio's and small stuff? Yay or nay?
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Old September 17, 2005, 23:06   #4
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Welcome 40calgal,

A hardware or maybe some lumber yards can probably order you the pump. Make sure the 'foot' or back flow valve on the bottom of the down tube is good or you'll be priming all the time.

Rob
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Old September 17, 2005, 23:26   #5
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Re: Complete Medical bags

Quote:
Originally posted by 40calgal
Where would one find a complete medical bag? I know it won't have meds other than over the counter basics, but I have looked adn there are alot of medical bags out there but not complete, like an EMT's type.

Get a little book called Survivalist's Medicine Chest by Ragnar Benson. He saved lots of lives in third world countries using vet meds. He used the same products that are used on humans, but available relatively cheap without a script. Disease and infection will kill way more than bullets in a survival situation. Some Tetramyacin powder, penicillian and disinfectant will go a long way. The school of thought on sutures may still be out.
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Old September 17, 2005, 23:52   #6
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Again great info. I have been looking at the Galls site and there are a few bags I found but would still be lacking things like lidocaine, blood clotting, etc. I guess I could add them, but I was hoping to find a more complete bag, guess us civilians aren't allowed to own them.

Great idea on the hand pump I have looked at hardware stores but didn't find any. I have about 100 gallons stored now but would like to make sure I had unlimited access.

I will definitely be looking for that book. I need to add some more knives to my trusty bag to make sure I have what I need to gut animals if need be.

Any other ideas? Come on I know you guys are all prepared, let me know what you got.
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Old September 18, 2005, 01:09   #7
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Welcome, 40calgal!

Check out Lehmans for shallow well hand pumps, along with tons of other products for self reliant folks. Be sure to order their paper catalog!

Lehmans

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Old September 18, 2005, 10:34   #8
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Way too complicated a question.

Arizona Response SYstems used to be Arizona Rescue Systems and the gunsmithing was only part of the company - another part was wilderness medical equipment. Basically, we sold survival medical kits.

I ended up dropping that part of the business , but learned allot about stocking aid bags - much more of a logistical issue than simply going down to the supply room during the Special Forces medical course and taking whatever I could cram into a bag.

Buying an off the shelf kit is not cost effective - you get stuff you don't need, don't get stuff you do need, and the quantities are never right.

Questions are - how much do you want to spend? How much can it weighh? Whats your level of competence? Can you give an IV? Is it going to be portable or stationary? Is it going to stay in your car? Where do you live? (on the latter two questions, a BP cuff and air splints will melt ina car in AZ)
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Old September 18, 2005, 10:54   #9
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I'll have to agree with Mark on the pre-packed bags. Too much unusable junk, not enough of what you really need.

I scrounged a milsurp medic shoulder bad and packed it myself. Self tayloring the supplies according to your need and capabilities is the only way to go. The vet med suggestion given by Powderfinger is also valuable. Same stuff, different door it goes out of the supply house, lower or -0- liability policy on it, much cheaper price.

Externally applied antibotics are probably OK, as long as you know the patient (or yourself) have no alergic reactions to them. Oral antibotics need to be prescribed by your DR. Talk it over with them, most are more cooperative than not. If they won't help, find another one. Pain killers are a different matter.

A good 1st Responder course is usually available thru your local vo-tech, fire dept or clinic. Time and money well spent.

Rob
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Old September 18, 2005, 13:20   #10
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Thanks for all the nice welcomes, it is my pleasure to be here.

Ok I will try to answer the best I can with the little bit I know. First, I want to make sure I have enough medical supplies to take care of the 5 in my family and at least enough to help others (how many I have no idea). I have taken first responder classes awhile back and feel confident enough to administer IV's, give shots, suture wounds and all the basics. Got more to learn to perform surgery

Now, I would like a platoon size or squad size for my truck with enough field supplies to have with me at all times and for my home SHTF bag I want as much as I can get.

Cost, well I figure it will cost me about $500-$600 for my truck and maybe double for my home. I may be wrong, too high too low? As I said I am trying to make sure I am covered. I have read too many stories about people "thinking" they were ready and then found out the hard way they were in fact not. So, this is where I turn to the experts and let ya'll help me out.

So, is this enough info for a good start? If not what else do you need to know to get a better idea of how to direct me?
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Old September 18, 2005, 16:53   #11
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Are you in the military, or have a family member who is?

If so, see if you can obtain the correspondence course from the John F Kennedy SPecial Warfare Center and School on pharmaceutical calculations, or a pharm-tech skill level one manual.

It will give you the necessary information to adapt the concentrations of animal antibiotics to human dosages - IE, Not all Pennicillian G Potassiums are created equal. Also, antibiotics deteroriate with time so a greater amount is required for same effecacy.

Thats another topic altogether.

I group med supplies into three categories. personal care, immediate response and nursing care.

When I filled the platoon medic role, I carried no pepto-bismio, moleskin, aspirin, motrin or whatever. I had my own, but as I see it, these are the things that every infantryman should have. One more battle dressing for a seriously wounded soldier is more important in the platoon aid bag than a bunch of convenience /comfort supplies that should be carried by the individual. But in a civilian role, you may be dealing with children or irresponsible adults who havn't the ability or in the case of the adults, the motivation - to care for themselves, so a certain amount of convenience items may be needed in the platoon level.

The long term care is the one with sustaining meds (antibiotics) and larger amounts of bulkier items - mostly bandages. Bandages have to be changed.

The platoon level kit, though, it the one that only is meant to stabilize a patient until such time as a higher level of care can be obtained.

Rarely, in normal times, ios one more than 4 hours from a level III trauma center. But I have a friend who was shot in the groin with a .308 from point blank (his own stupid fault) and air evac REFUSED to send a helicopter for evac until a basic EMS vehicle had driven the 20 miles of dirt roads to verify it wasn't a hoax. He had a higher level of care in his jeep than on the ambulance as one of his comapanions had an aid bag I'd packed for him and the training to use. it.

Then there is the issue of training. Some say don't carry anything you aren't trained to use, but the other side is there may be someone else trained to use it who doesn't have it. A member of my church was in a horrible car wreck on I-17. Coming the other way at that exact time were some other members of my church (HMM . . . .. ?) 2 ER doctors and 2 ER nuirses driving home after a football game . .. . .

Ok, thats kindof an overview.

I've been meaning for some time to put together a chart of stuff with categories for "personal" squad level" platoon level" long term care" etc.

P{erhaps this thread is a good motivation to do it.
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Old September 18, 2005, 16:56   #12
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http://www.adventuremedicalkits.com/

This is a good company thats been around a long time. They were one of my suppliers when I offered medical kits. Ironically, it was when the director of the medical side of the business wrote a bad personal check to this company, on my company letterhead, that I fired him, dissolved "arizona Rescue Systems" and dropped the medical side and ARS became "arizona Response Systems"
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Old September 18, 2005, 17:18   #13
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I will look into the information you say I should find. I am sure the hubby has it somewhere from the Military. Wow, I am glad I posted this b/c I think you have alot of good info most people will not think of including myself. I look forward to you being motivated and posting more here. You have given me alot to get busy with so I shall do so. THANKS!

Now, as far as trauma type stuff, like where I live we have recluse spiders, poisonous snakes, can I get antivenom? We have gotten pretty good at living off the land so to speak and using it for building, cooking etc so we are good there, I have well over 100 gallons of water, tents, canned foods, need more MRE's (cheaper price though), we have a meeting place mapped out that my daughter knows by heart.

What else? i know I am forgetting things but I am hoping this thread refreshes my memory as well as that of others and inspires some to really be ready.

Thanks gunplumber I appreciate the help. really I do, wasn't sure how I would be received but that's another day and time. So thanks!
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Old September 18, 2005, 18:37   #14
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Hey Gunplumber,

I've really wanted to try to figure out how much difference there is in the Fire Department Paramedic training and the Military Medic training such as you have.

Do you know where the differences are. It would be nice to know what it is that I don't know.
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Old September 18, 2005, 19:59   #15
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Medical Kits

I just wanted to add my concurrance with all the advice so far posted, especially Gunplumber.

My background: retired urban paramedic after 25 years service, over ten years with a volunteer SAR team, over 15 years Red Cross First Aid and CPR instructor and about 10 years with California State Military Reserve as a medic usually classified as a 91C.

I can't add much to what has been said about kits except to think about small kits for each individual in your group that include only what they can apply to themselves. Think especially about an injured or wounded person only being able to use one hand.

Instead of large 'everything' kits, think about several kits for different needs. Kind of like a "modular" kit break it up for portability. An example would be one kit of medicines, another of dressings/bandages, another with airway, etc. you get the idea.

One area not often covered in medical is prevention/sanitation. Having adequate work gloves and eye protection and USING THEM, will be better than the best 'kit'. Do not forget to think of soap as a medicine. Proper sanitation prevents disease way better than all the medicines after the fact. It isn't as 'glamorous' as giving pills or shots or bandaging a wound but it is a LOT easier that trying to fix mistakes.

I might be able to explain the difference between military medics like 91B and 91C and what is referred to as a Paramedic. The Paramedic in the civilian world is trained to give only immediately needed care until transferring a patient to a higher level of care. We never got any training in the multitude of minor illnesses or wounds. Our job was to provide basic maintenance care and transport. Yes, we had all kinds of 'tricks' for severe heart attacks/injuries but they were all predicated on the belief that the patient would get 'definitive care' within 15-45 minutes.

Military Medics are often called upon to give minor care under 'standing orders'. Depending on their level, they can dispense meds, stitch wounds and order other care until the doctor takes over. Sometimes they are the 'end treatment' provider and a soldier with minor problems only sees them and then returns to their unit ready for duty. At the time I was in CSMR and worked with Cal NG medics, I had way more trauma/emergency experience than they had and they had way more minor medical care experience. These days with the war on, they have probably gotten a lot more severe trauma/medical experience.

I believe training is important but if possible, anyone that is serious about that training should know that they need to back it up with experience using that training. If you are in an other-than-urban area, try getting on a volunteer rescue squad.

My last piece of free advice (worth what you pay for it) is after you get some training and experience, be careful to never take anyone else's "this is how it is done" advice without some skepticism. I used to tell Intern Paramedics that they could 'learn something from everyone, even if it is how NOT to do things'. If your training grounds you well in Anatomy and Physiology, you will have what you need to evaluate advice. I hope this helps.
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Old September 18, 2005, 21:44   #16
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Mark,

I think the thread you meantioned would be welcomed by a lot of members. I have basic EMT training, but nothing like the SF medic school provides. I would be interested in seeing your reccommendations for a basic personal and immediate response kit.

Thanks, Rob
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Old September 18, 2005, 22:56   #17
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Quote:
Originally posted by mr fixit
Hey Gunplumber,

I've really wanted to try to figure out how much difference there is in the Fire Department Paramedic training and the Military Medic training such as you have.

Do you know where the differences are. It would be nice to know what it is that I don't know.
I vcan't speak for civilian training or basic 91A combat medic training as the 18D course is substantially different. It is the same course as taught to the officers in Physician assistant training.

The first 2/3 of the course will certify you in national Registry EMT-P. But we also had extensive minor surgery training that I don't think civilian paramedics need. We also were authorised a whole lot more pharm than most civilians below a PA. Chest tubes, cut downs, crichs, NG intubation, suturing, casting, reading x-rays.

But a whole lot less of the microbiology and chaemistry background that the PA course does.

The Navy seals and Army rangers send their medics to the first 2/3 of the 18D course - up through "trauma III" . The blackhawk down scenario was not at all out of reach for a ranger medic.

I think an 18D grad could easily walk in as a trauma RN, and the best could probably pass the PA exam without too much extra study.

its just what you use it for. Like I have a knack for sutures but couldn't understand the kreb cycle if my lirfe depended on it.


"First Do no Harm" has one meaning when you are 30 minutes from a major trauma center and another when the closest third world excuse for a doctor is 5 days by burro.

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Old September 19, 2005, 00:15   #18
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sounds like we have more than just a few here with some serious training
coming from the novice side, I just wanted to say this:
I can do good first aid, better than the average untrained person.
I have never had really formal training just bits and pieces and a lot of close friends in the medical field who have taught me some things.
Most of what has been mentioned here is beyond my abilities,
but that is no excuse for not having good first aid gear.
As gunplumber says "someone might come along that does"
so I can do basic first aid on myself but I like to have a suture/IV/injection kit in my gear. If you ever travel out of country its a good investment to have your own needles. These items are not expensive either. Like $15 for a one person/one application kit.
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Old September 19, 2005, 12:23   #19
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follows a VERY ROUGH DRAFT, unsorted, raw data, brainstorming.
revision 1, 9/30/05

Individual Squad Platoon Base Camp Notes
Tools
digital thermometer
trauma shears
traction splint
pneumatic antishock garmet (MAST) shock, air splint
stethescope
oral pharangeal airway "J tube" also a bite block
nasao pharangeal airway "J tube"
Endo trachael intubation set, with laryngoscope (#5 macintosh?)
Ambu-bag and pocket mask
permanent marker trachael deviation, PMI, notes
tounge depressors
clamps
18g or 20g needle with catheter IV bolus
14g needle tension hemo/pneumo thorax, needle crich
turkey baster suction, irrigation
Emergency Blanket shock
sphygmomanometer (BP Cuff) assesment, torniquet
flashlight with batteries
wound closure strips (butterflies)
cotton-tipped applicators (Q tips)
30cc or 50cc syringe suction, irrigation
baggies
lighter &/or matches
candle
duct tape
para cord
portable stretcher
IV hanger
lantern
scalpel
constricting band
surgical tubing


Over-the-Counter Medications
ammonia inhalent
Acetaminophen 500mg (Tylenol)
Ibuprofen 200mg (Motrin)
Aspirin
tincture of benzoin
oral diphenhydramine hydrochloride (benadryl)
Antibiotic Ointment
Sunscreen 30 SPF
Zinc Oxide Sunblock
oral rehydration mix
immodium
antacid
dental filling
iodine
silver sulfadiazine 1% cream (Silvadene) burns

Comfort Essentials
cold pack
Moleskin and/or Molefoam


Trauma and Splinting
tourniquet
2x2 sterile dressing
4x4 sterile dressing
cervical collar
basswood splint
wire ladder splint
air splint
finger splint
instant ice pack
non-lubricated condoms and/or 3 way valve
triangular bandage
roller bandage, self adhesive
safety pins
nonpourous, nonadhesive dressing
adhesive tape 2"
adhesive tape 1"
Ace bandages
Conforming Gauze bandage (3")
Water Gel® Burn Dressing 4x4
Non-woven Adhesive Knit (Curlex?)
eye wash
eye pad
Asherman chest seal
Bandaids
Dermabond
Poison
syrup of epicap
activated charcoal


Personal Protection
Laerdal® Pocket Mask
Nitrile Examination Gloves
bite block
sterile gloves
Nitrile Examination Gloves
Antimicrobial Hand Wipes
alergen free baby wipes

Surgery
sutures
hemostats
scalpel #11 & #20
forceps, splinter
forcepts, tissue
small scissors
Dental

Nursing Care
emisis basin
catheter
Reference Material
ST-31-91B
US Army Special Forces Medical Handbook
The Merck Manual
Taber's Cyclopedic Medical Dictionary
Where There is No Doctor
David Werner
Emergency War Surgery
Reprint, SEA Publications/Desert Publications
Where There is no Dentist
Murray Dickson
Trauma Summary, laminated 3x5 cards
patient assessment form

Medication Summary, laminated 3x5 cards

Prescription Medications
500 ml D5W
1000 ml ringers lactate and/or
1000 ml .9% normal saline
IVF and IVF start equipment set
morphine severe pain
meperidin hydrochloride (Demerol) moderate to severe pain
nalbuphine (Nubain) moderate to severe pain
Lidocaine local, injectable
naloxone (Narcan) narcotic antagonist
epinephrine anaphylaxis
aminophyline anaphylactic shock
diphenhydramine hydrochloride (Benadryl) allergy
dexamethasone sodium phosphate (Decadron) cerebral edema / ICP
methylprednisolone (Solu-Medrol) spinal cor trauma
hyrocortisone sodium succinate (Solu-Cortef) severe inflamation, shock
diazepam (Valium) antiseizure
florosemide (Lasix) diuretic
Mannitol diuretic, ICP
Sodium Bicarbonate metabolic acidosis, CPR, shock
sulfamylon 8.5% cream burns
ampicillin broad spectrum antibiotic
gentamycin broad spectrum antibiotic
metronidazole broad spectrum antibiotic
clindamycine broad spectrum antibiotic
cefoxtin broad spectrum antibiotic
ketorolac injectable NSAID
Tequin, Avelox
broad spectrum oral antibiotic
tetanus prophylaxis contaminated wounds
Atropine/D50 (maybe)


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Last edited by gunplumber; September 30, 2005 at 18:03.
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Old September 19, 2005, 14:46   #20
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That's it? Man and here I had my printer ready with 100 sheets of paper waiting to be inked.


No really thanks this is a better start then I thought I would have.

Now just have to figure out how to fit all this in my purse along w.guns and ammo
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Old September 19, 2005, 20:33   #21
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Re: Complete Medical bags

Right on Gplumber,

I am a pharmacist with a fair amount of trauma training in a past life as a ER Tech and the one thing I reinforce to you is that STUFF is nice to have , but TRAINING on how to use it is more important. Its sort of like gun training: it is better to have a 200 dollar gun and 800 dollars worth of training than it is to have a 1000 dollar gun. Looking at the Gplumber's list reminded me of how rusty I am on certain areas and how I need to get my behind in for some more training refreshers in IV 's and trauma bandaging.

As an important little additional note, PLEASE be careful with medication storange and expiration dates! Some (very few mind you) medications actually turn into TOXIC products. Others, will simply start to loose potency after the expiration date and one can just learn how to titrate the increase in dose to cover the situation. Here in Texas , we lose an average of one doctor's wife per year who decides to medicate from the hubby's sample closet and chooses the well known tetracycline well after it has turned. The World Health Organization manual has criteria for determining safety and titration, but as cheap as it is , it seems better to replace it or simply choose another broad spectrum antibiotic.

BTW, All of my kits include Silver Sulfadiazine 1% cream (brand name Silvadene, but the generic is very affordable in 1 lb jars) This is simpley the very best product I have ever seen for burns of any kind, including sunburn.
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Old September 19, 2005, 22:09   #22
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great info , i know im printing this one out , thanks
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Old September 20, 2005, 11:28   #23
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revision 1 on list.

Need some help here guys on organizing the list.

Should IV's go under trauma or tools?

Is a bite block an airway tool or a personal protection tool?

injection benedryl is perscription, oral benedryl is otc.

My meds are what I was trianed in 13 years ago - there may be new and better ones or different named generics, or contraindications unknown at the time I was training. Some feedback from current trauma care folks woud be nice.

Finally, the scenario for which I assume we are preparing this is where a doctor is days or weeks away - not hours. Therefore normal guidances on what certification one should have for what procedures are out the door.

Hypothetical scenario: You are on the second floor of a building in a flood. Your brother has been gutshot by a poor disadvantaged minority who only wanted your brother's tennis shoes. Police are busy saving their own families. You cannot evac. Your patient will probably die from infection, but if you can stabilize him for maybe 5 days, he can be evacuated

Or something like that - where you are own your own for at least a week, if not indefinitely.
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Old September 20, 2005, 11:34   #24
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Old September 20, 2005, 21:55   #25
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Should IV's go under trauma or tools?

Is a bite block an airway tool or a personal protection tool?

injection benedryl is perscription, oral benedryl is otc.
Actually, I would put IV's under drugs/meds.

A bite block is both; an airway tool for the patient, and a personal protection tool for your fingers.

Just my opinion from working on the MICU;
I would group things into:
Drugs/Meds - to include all accutrements such as syringe and needles, IV fluids and tubing and angiocaths.
Airway - ET tubes, bite blocks, oral/nasal airways, EOA's
Bandage/splints Trauma dressings, 4X4's, Occlusive dressings, Burn sheets, Kling/curlex, cravats, splints
General tools- knives, shears, pen lights, Surgery kits(if trained)
Maybe this way you pull outonly one box/bag/pouch instead of going through the whole kit.

And Mark, your senario;
Gut shot? Nothing by mouth, no food, no water. Iv's to keep fluids up, bolus, and titrate to keep BP up. Antibiotics yes, but I have no idea which or how much. It would be a terrible 5 days for everybody.
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Old September 22, 2005, 00:23   #26
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What about a small flask of whiskey, or brandy? Helps with pain and sleep right? Maybe even some B12 drops (instant absorption) to help with energy and nerves. I use this when my legs get real restless. Aer these good things or I am wastin time and moola?
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Old September 22, 2005, 10:56   #27
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As to vitamins, thats a whole 'nother subject - vitmains and herbs in long term care of course have value. I have vitamins in my food storage, but I don't see a need for it to be in a trauma kit.

As for alcohol - while I don't deny that it has a physiological effect, often including relaxation and numbing, its volume to effect is much larger than meds designed for pain relief. I think its a poor choice just based on size and weight. I suspect that the CNS and nephritic effects (bradycardia too?) may contraindicate it in trauma.

As for walking wounded, "relaxed" or not, the last thing I want in a crisis is a bunch of drunks, which (forgive my pessimism) is what I suspect would happen.
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Old September 23, 2005, 12:26   #28
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If this is going to be made a sticky, can I have moderator priviledges in this forum? With thanks to 40 cal Gal for starting the thread, I think I can keep it more streamlined if I can add people's suggestions to the list, rather than making each one a seperate post.
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Old September 30, 2005, 18:05   #29
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slight revision 9/30
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Old October 06, 2005, 19:22   #30
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Howdy and welcome 40calgal! I just ran into this thread out of curiosity. There are about as many ways to make up a medical kit/bag/chest/truck load as there are folks who want them. I certainly believe in borrowing ideas etc. Mark, great list!.

I think medical supplies need to stocked to the level of the mission and the abilities of the user. But more is generally better than less!
With a TEOTWAWKI scenerio I would be be adding surgical tools and ether to my list. The SF Field Medic Guide is a supurb guide to have in the kit.

My medical background is mostly in the Army as a Medic and then a PA. I 've been the defacto medical officer and platoon leader for several Leg Infantry, Arty and Armor Batalions during training and real world Ops. No biggy. Learned alot. My specialty is emergency medicine.

There are a lot of little details when dealing with oral/injectable meds. You won't usually find them in a PDR. Vet meds are definately doable. Ask your local veterinarian for advice. Buy stuff wholesale and split the cost with like minded friends. A lot of country veterinarians have treated the rancher/dairyman and family as well as the sick or injured animal stock. Shoot, I learned how to do IM injections and wound treatment on my Dad's horses way before I treated folks. So, I'll be glad to answer any medical related questions. Oh yeah, Cotex pads make great cheap combat dressings. Use with ace wraps.
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Old October 07, 2005, 17:30   #31
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For prescription drugs like antibiotics, a good alternate source is your good 'ol farm store. Bear in mind that this should be your last avenue since this stuff might not be as refined (read "pure") as the stuff for humans and could also be more potent. Then again, you don't need a prescription either.

A relation of mine uses livestock injectables on his family with no complications aside from the braying laugh they have now.

Did a little searching awhile back on Atrophine and it seems that civilian posession is illegal - at least here in the PRI.

Just recalled a story from a friend that worked for AFaRTS. They were doing a film on Vx and its effects using goats as test subjects. The entire crew was issued several injectors each (just in case). Friend saved one for himself, and gave one of the goats 4 without being noticed!! They laughed their asses off when the lab boys couldn't figure out why that one goat didn't drop when exposed, then dropped dead hours later for no apparent reason!
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Old October 23, 2005, 11:51   #32
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Anyone here have a source for 4x7 Combat Dressings? I have searched all over the web and not found a single source for these.

TIA,

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Old October 23, 2005, 12:51   #33
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Silvadine is very good for burns unless you are allergic to it's components, which includes SULFA medication.
And an interesting story on Veterinary meds: a friend was visiting a pharmaceutical plant where pills were rolling out and there was a divider sending some one way and some another. He asked why and was told "these are for humans and those are for animals". I don't know how far that applies but it was interesting.
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Old December 10, 2005, 13:28   #34
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sulfamylon 8.5% cream burns
ampicillin broad spectrum antibiotic
gentamycin broad spectrum antibiotic
metronidazole broad spectrum antibiotic
clindamycine broad spectrum antibiotic
cefoxtin broad spectrum antibiotic
ketorolac injectable NSAID
Tequin, Avelox


Good set of antibotics but I'd eliminate the gentamycin. Gentamycin/Vancomycin require certain labs (creatine clearance) to be dosed correctly. The other meds cover the organisms these would cover quite well, except Methacillin Resistant Staph Aureus (MSRA). The chances of picking up MSRA outside of a hospital are rare, but unfortunatley becoming less rare every year.

Oh BTW I'm a pharmacist, feel free to ask me questions about meds .

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Old December 30, 2005, 13:22   #35
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Shomer-Tec has QuickClot on clearance right now for $15.99.


Many thanks to Gunplumber and the rest for all the great info.


Tom
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Old December 30, 2005, 14:40   #36
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Quote:
[i]

Oh BTW I'm a pharmacist, feel free to ask me questions about meds .

-Dave [/B]
Couple questions. Since many antibiotics deteriorate in effectiveness with time, and some I understand become dangerous to use, is there a way of determining just how important an "expiration date" is? How many expiration dates are just a manufacturer ploy to get you to buy more?

Since many of us only have sporadic access to antibiotics, it pays to stock up while we can - but not if the stuff isn't going to last.

Also, there seems to be a shift due to poor Pt compliance, in large short term dosages versus smaller doses over a 7-10 day period. Any comments? In a survival situation - one may not have continued access for a long period of time . ..

Also - tetanus toxoid - there seems to also be a lot of new information on effectiveness and duration since last booster. Any contraindications of a booster every so often needed or not? I'd rather have had a booster a year before needing it than search for one when I do need it and its not accessible . . . .
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Old January 09, 2006, 21:03   #37
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Quote:
Originally posted by gunplumber


Couple questions. Since many antibiotics deteriorate in effectiveness with time, and some I understand become dangerous to use, is there a way of determining just how important an "expiration date" is? How many expiration dates are just a manufacturer ploy to get you to buy more?

Since many of us only have sporadic access to antibiotics, it pays to stock up while we can - but not if the stuff isn't going to last.

Also, there seems to be a shift due to poor Pt compliance, in large short term dosages versus smaller doses over a 7-10 day period. Any comments? In a survival situation - one may not have continued access for a long period of time . ..

Also - tetanus toxoid - there seems to also be a lot of new information on effectiveness and duration since last booster. Any contraindications of a booster every so often needed or not? I'd rather have had a booster a year before needing it than search for one when I do need it and its not accessible . . . .

1. Product exp. dates: Actually the expiration dates are not a ploy to get you to buy more, the manufacturers are required to put them on there by the FDA, to insure our drug supply is up to standards. Standard is 90% to 110% of drug activity based on stated amount of active ingrediant(s). But most drug companies put an arbitrary date on the bottle, because it costs too much to do degradation studies.
There is no predicatable way of ensuring product saftey
because each drug reacts very differently to temputature, humidity, UV light, etc . Titrating doses in a survival situation would be mostly a wild guess.

2. Dose/Duration of treatment: It depends on the antibotic actually. Some antibotics are not at all effective if given in large quantitys for a short period of time. The cephlosporin and penicillin class antibotics are good examples of this. There mechanism of action requires that blood levels of the drug have to reach a certain level for a certain period of time. Other classes of antibotics such as the flouroquinolones (Cipro,Levaquin,etc) and Macrolides (Erythromycin,Biaxin,Zithromax), can be given in large doses for a short period of time and are effective. These are examples of course and are not all inclusive. But in a live or die scenario some would be better than none.

3. No complications with Tetnus innocluations more often than every 5 years or so that I'm aware of.

Good questions sir!!!!

-Dave

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Old January 24, 2006, 13:00   #38
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Well, I guess I have to ask this one. Dave, your'e the professional. What about mail order from Mexico? I understand that the Doctor / pharmasist there will even give you a prescription over the phone. Is this a viable ( and legal ) way to fill the med bag ?
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Old March 09, 2006, 10:31   #39
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Although I'm not a RN, PA or MD I can give some info from the perspective of a former USAF medic / civilian emergency medical technician. First of all, even if you choose not to undergo the training necessary to become an EMT or Paramedic the national association of emts (www.naemt.org) offers a class that is invaluable in providing some of the training necessary to manage trauma in the pre-hospital setting. The course is PHTLS (Pre-Hospital Trauma Life Support) and more information can be found at: http://www.naemt.org/PHTLS Even if your not a certified EMT, Nurse or other medical professional you can take the course, you just won't receive the certificate.

Much of this training is stuff you would want to know in a SHTF scenario and will give you the basic training (or a refresher in the training) to start iv's, manage traumatic injuries, perform cricothyrotomies, needle decompressions, etc.. It also goes into more detail regarding specific traumatic injuries such as abdominal injuries, head injuries, etc..

If your squeamish and needle-shy you may want to consider calling the local training center or college that handles EMS training in your area. Most of them are always looking for "patients" to use in class as IV stick dummies or to be used as patients for the student's practical exams. Being stuck a few times tends to get people more used to needles and in turn tends to make you calmer when it comes to performing the skill on someone else. Of course it's no substitute for training.

As far as the scenario that was posted goes the first course of action before the patient is moved any substantial distance would be to control the bleeding and ensure patency of the airway. If the S really has HTF and I'm going to be caring for the victim for 5-7 days before proper medical attention then I must assume that I am going to end up being the victim's primary care.

You have to consider that in normal times a patient with a gut wound if uncomplicated with minimal damage to GI tract and vital organs could 2/3's of the time be discharged from the hospital and well on his way to recovery within that 5-7 day period.

If the victim has a patent airway which is self-maintained then the next course of action would be inspection of the wound site and the surrounding area. Is the abdomen unusually firm or soft? Is there extensive bleeding as if from a major vein, an artery or the liver? If the wound site is substantial and there is free-flowing blood is there foreign matter in the blood that I'd really prefer not to be present? Such as stomach contents, bile, excrement, etc.. Is there an exit wound? Visually retracing the path in my mind between entrance and exit if it's a straight path, soft tissue shot what major organs may have been affected?

Alot of the above information would dictate what the overall course of action would be. As harsh as it sounds, pain management would fairly low on the priorities list. The next steps I would take would be starting 2 IV's, one large bore 14ga or 16ga and a second that although it may never be used I would at least keep as a saline lock and mantain a scheduled flush. Hang a bag of normal saline on the primary IV line and if bleeding is slight to moderate and uncontrolled run it open, if bleeding is heavy and uncontrolled hang a second bag on the second line and run it open also.

Now comes the hard part, If the bleeding is moderate to heavy after attempts to control it then I'd need someone to assist me in rudimentary battlefield surgery. Even with fluid replacement if the bleeding is left uncontrolled the victim will eventually come to a point where the blood circulating is so dilute that it can no longer carry oxygen and death will be forthcoming.

Uncontrolled bleeding in this context includes internal bleeding. The placement of pressure bandages or clotting agents such as the powders of miscellaneous brands that are available do a good job of controlling bleeding in the near term but in a gut shot type wound the bleeding may continue unabated internally.

Scalpels, betadine surgical scrub, sutures, suction and basic surgical equipment should be in every group's inventory of medical supplies. It doesn't necessarily have to be in a person's kit that they carry in the field unless that person is comfortable using it in the field. If something like this were to occur in the field I'd pray for a couple of litter bearers, a litter and that my camp is close.

I'd proceed with very minimal pain management, the administration of narcotic analgesics such as nubain or hypnotic sedatives such as versed would depend greatly on vital signs and patient condition. Field surgery would be focused on finding bleeders and either tying them off or suturing larger bleeders back to restore bloodflow. Once bleeding is controlled then I'd make a survey for lacerations / ruptures to the GI tract and organs and suture the affected areas if I felt comfortable with it and there were an actual need. The thing to keep in mind is that this surgery is not meant to be a long drawn out exploratory surgery but an expedient bleeding control exercise. I'd end the surgery by suturing up the incision except for a 1/2"-3/4" section left as a drain.

Once the bleeding was controlled I'd convert the second IV line to a saline lock, consider placement of a foley cath, and begin administration of IV antibiotics until such time that the patient was capable of receiving oral antibiotics. My choice of antibiotics would probably be doxycycline & pcn by IV if available to cover both anaerobic & aerobic bacteria, IV Cipro could also be considered.

At this point I'd be searching for a physician in the local area that could do a consult and possibly perform a more complete and competent surgery to repair any other damage.

If during the initial treatment it had been a slight to moderate bleed that could be at least partially controlled I would opt for continual fluid replacement and basic medical care to maintain the patient until a more advanced level of provider were available. IV antibiotics would of course still be called for as well as pain management dependent upon pt condition. I really don't consider field surgery to be a minor affair, in fact when you consider the time that it ties up the healthcare provider, the people assisting him / her and the continued need for guards to maintain security in the area it's a huge resource hog.

Everyone should consider getting to know a couple of professional healthcare providers (MD's, RN's, PA's, etc.) in your local area or at the very least keeping a list of healthcare providers that reside in the immediate area of your home or the area you plan to bug out to in a SHTF scenario.

The old standard red cross on white background arm band does still have it's uses. Keep it out of sight in your inventory somewhere but if you end up going to medical professional's homes in an attempt to get aid put it on prior to approaching the house, if their hiding inside glancing out curtain slits it will make them more likely to answer the door.

What do you think? Am I completely flippin psycho?

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Old March 09, 2006, 10:42   #40
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The next steps I would take would be starting 2 IV's, one large bore 14ga or 16ga and a second that although it may never be used I would at least keep as a saline lock and mantain a scheduled flush. Hang a bag of normal saline on the primary IV line and if bleeding is slight to moderate and uncontrolled run it open, if bleeding is heavy and uncontrolled hang a second bag on the second line and run it open also.

I disagree slightly here. I say bolus 2 IVs of RL or NS (bolus = squeeze bags to empty them faster). Then reload both and get a BP assessment before deciding to bolus, normal load, or slow drip the next two.

Burn injuries the treatment is changing a bit - the brooke and modified brooke formula for calculating fluid replacement is maybe in conflict with new developments on fluid overload on burn injuries. I'm locked out of the navy research on this at this time as you have to be active duty.

(jury is out on RL or NS - some schools differentiate - RL for spinal trauma, shock, and NS for vulume replacement - chances are, you'll have to use whatever you've got - consider also saline enema in dehydration injuries)
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Old March 09, 2006, 20:51   #41
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gunplumber,

Of course the infusion of fluids would really depend on bp & rate of loss. It's amazing how fast you can infuse fluids when you run it wide open and throw a spare bp cuff around the iv bag and pump it up.

Although RL is great in burn cases I think my first choice of fluids would be NS in this scenario.

Ideally, every patrol that is leaving your "I'm already bugged out camp" to go out into the field to do recon, forage for food or supplies and the like should have at least one person that is trained to the national registry EMT-I/85 with PHTLS level of training or to the current standards of the US Army Combat Life Saver program.

Another thing that people can do now to prepare is to put up medical texts. Once the SHTF the designated medical guy / gal for your group can read up and expand his / her knowledge during their down time. Although medical texts aren't exactly relaxing reading they can come in handy.

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Old June 24, 2006, 17:23   #42
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So should I feel bad that most of that last was over my head? Looks like I have some catching up to do, till then nobody get shot around me that dident understand the last two post.

Thanks for the info every one lots to think about, lots to learn.
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Old June 25, 2006, 10:44   #43
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Jargon. Every field has it.

It was a pleasure reading "Where there is no doctor" because it was written with no jargon. It wasn't as precise, but it worked.

Anyway, when someone loses blood, it does two things of immediate concern.

Red blood cells carry oxygen. Losing red blood cells reduces oxygen, even when lungs are working fine.

Loss of blood volume makes the whole circulatory "pump" work less efficiently. Just like a loss of freon in the air conditioner - it will still cool, but not very well. In body terms, this is called "shock".

the majority of blood volume is not blood cells, but clear fluid the blood cells float around in.

We cannot replace blood cells in the field because of blood type compatability.

We can replace the "interstitial" fluid between cells.

Two common substances for fluid replacement ar .9% sodium chloride, or "normal saline" or "NS" - called "Normal" because it duplicates the salt content of your body.

The other is "RL" or Ringer's Lactate, or Lactated Ringers. This is another clear fluid, and I really don't know whats in it, but its a more complicated mixture than just salt water.

NS is a good fluid to use for trauma, and for heat injuries and for burns. Some medical professionals believe that RL has benefits in spinal injury, and burns that NS doesn't. In a well stocked hospital, they can choose. In the field, its whatever you've got.

Burns cause massive fluid loss by the cell walls rupturing . Replacing fluids in burns is important.

But its possible to overload a system with fluid, which will cause additional problems.

This dude named Brooke developed a formula for determining how much fluid to replace in burn victims. Brooke Army Medical Center at Ft Sam Houstan is known internationally as one of the best burn centers. I trained there, although not specifically in burns, about 15 years ago.

a "Bolus" is "a whole bunch really fast".

My training recommended in any case involving fluid replacement, to give the first two liters as fast as possible. Someone actually squeezes the IV bags to pump the fluids in faster. I assumed this was to fight off shock, it may also have been because of the difficulty in the field of assessing internal bleeding extent. Even on a healthy person, 2 liters of IV fluid is going to have no ill effect other than "I have to pee". as a "patient" I've had 2-4 IVs every day or so . OTher than railroad tracks on my forearms, it was no big deal.

Anyway, I ramble. The point - or question rather - is how much of what fluides to pump into a victim in what circumstances.

Giving IVs is not difficult, although it does take practice. A piece of moleskin over a very small tube is one way to practice. NOthing beats the real thing. After this one corpman missed my vein 3 times, I got the catheter in with one hand the first try, upside down. Pain is a great motivator for success.. I think its basic first-responder stuff, but there is a potential of some dimwit screwing things up with a needle and causeing more harm, so typicaly its not taught at the basic emt level.
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Old June 30, 2006, 12:17   #44
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Kinda late in game to add this ,, but there's a Colorado based company called

Wilderness Medicine Outfitters

Classes,, supplies ,,books,, including water treatments,,

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Old July 06, 2006, 17:05   #45
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Thumbs up Survival Medicine

Myself was so tuned in with the Fal File's Survival Forum, it so wonderful to learn more things even in our small ways how to save lives in any scenarios like, survival, war, or just the daily way of life, no matter if it is for human or pets. I wish I am a doctor and be sent into remote areas where immediate medical needs are needed in lack of immediate real medical availability is present, but I can't afford the medical university course. I am a volunteer American Red Cross in one part of the Pittsburgh, PA area as a disaster response personell, I learned first aid CPR too, but I'd like to learn more than this alone in case we needed it in the family or friends. I have also saved about 4 or 5 human lives in form of resucitations caused by heart, chocking, drowning and wound, and also one small puppy who accidentally chocked himself with his dog lease and was hanging by the house stair. I am 65 years old now but i don't want to stop from what I love doing...."Saving Lives" that is why I would like to learn more mostly in prepairing emergency medicine that are more complete in a bag.i need to know where to find a supply or distributor.
Thank you.
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Old August 25, 2006, 20:54   #46
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Very intersting thread. It has much usefull info. However I can say first hand that knowing how to do something from reading about it or taking a class is not the same as doing it in the real world. If you are serious about taking on the role of healthcare provider in a SHTF scenario you should consider not just acquiring skills but the ongoing practice of these skills. Working in a local ER as an EMT or with the FD as a volunteer are ways to help maintain these skills.
This is important because all the knowledge in the world helps little if you don't have the experience that goes with it. One of the reasons that real world experience is usefull is that it helps people cope with the "deer in headlights"
reaction when bad things happen. If you take EMT and other courses up the wazoo but never really see the real world uses up close you might freeze up or lose it the first time it happens. If this happens during a time of widespread trouble this could be a fatal problem. So get some exposure to it now to see
if you can handle it and also to help advance clinical skills. Real world practice has its benefits. It does not pay to know how to deal with a theoretical ailment if you do not have the experience to know the ailment when it presents to you.

One of the best methods of preparing for TEOTWAWKI/TSHTF futures is the teamwork approach. No one person can be everything. It doesn't matter what aspect of post disaster survival is being discussed. Whatever the issue multiple people with broad skill sets will survive and thrive much better than individual or family size groups. The time to build these teams is now, before things get out of hand. Yes we should all broaden our skills as best we can and I also know what Robert Heinlein said about specialization being for insects. However
it simply is not possible at the individual level to acquire, maintain and adequately utilize the complex technologies we have. This applies not just to medical care but all areas. We need to be able to function at the community level in a disaster. Groups smaller than this may not have the skills or resources to continue. Groups larger than this can succumb to the problems seen at large population levels such as elitism, welfare mentality etc. For centuries homo sapiens funcioned well surviving at a tribal level. We can do it again if need be.
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Old November 07, 2006, 11:30   #47
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Read get a good understanding on what's in these:

http://www.endtimesreport.com/medical.html
Survival and Austere Medicine


http://www.hesperian.org/publications_download.php
Where There Is No Doctor
Where There Is No Dentist
A Book for Midwives


From there you can move onto EMT, EMT-Paramedic, SOF Medical, and sundry other books.
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Old December 27, 2006, 11:19   #48
nomadcrna
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quote :We can replace the "interstitial" fluid between cells."
[B]Actually you replace the intravascular fluid. Fluid may or may not move interstitially depending on injury. This is called "3rd spacing" and does the patient no good at all.
The intravascular fluid replacement is what helps your BP. Giving rbc, replaces lost rbc.
You can replace blood loss by giving 3cc crystoloid per cc blood lost. Give 1cc of colloid or blood per cc blood lost. You make the decision on when to switch to blood products on patient history and either h&h or by however amount you feel comfortable with losing.
Either RL or NS is fine. If you have Hypertonic saline, some studies show it is superior to rl or ns in acute, severe blood loss.

If you are into a massive blood loss situation and give 10u or more of prbc then you might have problems with a dilutional coagulopathy. You might consider giving FFP and platelets.
[B]
Quote "Anyway, I ramble. The point - or question rather - is how much of what fluides to pump into a victim in what circumstances."
[B]If you have normal vs and no clinical signs of bleeding then you can go easy on the fluids. If you have a hypotensive patient and/or continued blood loss then keep giving fluids. Use either LR or NS.

One note: giving all those fluids along with the blood loss, nekkid patients and such, you really need to think about keeping the patient warm as you are able. Hypothermia can cause major problems.[

Obviously care and treatment will vary depending on skill level and whether you are in the boonies or at a treatment facility. [B]

quote"Scalpels, betadine surgical scrub, sutures, suction and basic surgical equipment should be in every group's inventory of medical supplies. It doesn't necessarily have to be in a person's kit that they carry in the field unless that person is comfortable using it in the field. If something like this were to occur in the field I'd pray for a couple of litter bearers, a litter and that my camp is close.

I'd proceed with very minimal pain management, the administration of narcotic analgesics such as nubain or hypnotic sedatives such as versed would depend greatly on vital signs and patient condition. Field surgery would be focused on finding bleeders and either tying them off or suturing larger bleeders back to restore bloodflow. Once bleeding is controlled then I'd make a survey for lacerations / ruptures to the GI tract and organs and suture the affected areas if I felt comfortable with it and there were an actual need. The thing to keep in mind is that this surgery is not meant to be a long drawn out exploratory surgery but an expedient bleeding control exercise. I'd end the surgery by suturing up the incision except for a 1/2"-3/4" section left as a drain."

[B]I would not recommend the above unless you are a skilled professional and have had training. You will only succeed in killing the patient quicker if you open him him to "fix the bleeding." It sounds easy but withough experience, suction and such your chances of fixing the problem are nil. If you have an open abdominal wound then packing would be the thing to do until you can get the patient to a higher level of care[B]

Note: the above was off the top of my head between cases so please excuse typos, spelling errors or minor/old information.

Ron Ray CRNA, MS

Last edited by nomadcrna; December 27, 2006 at 11:34.
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Old January 12, 2007, 19:06   #49
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I realize this discussion focuses on complete medical kits, but I thought I'd bring up the issue of a blowout kit. This is meant as an emergency kit that has everything to field treat a gunshot wound before professional help arrives.

Ventilated Operator Kit

It includes the following:

1) Cinch Tight Compression "H" Bandage
(1) TK-4 Tourni-Kwik (3” wide 40" long Rugged Combat Tourniquet)
(1) Primed Gauze (crinkle cotton)
(1) Nasopharyngeal Airway (30FR Robertazzi Style)
(1) 14ga x 3 ¼ Catheter (sterile)
(1) Alcohol Prep Pad
(2) Safety Pins (2”) multipurpose
(1) Duct Tape (2”x100” roll)
(1) Set Nitrile N-Dex Gloves
(1) Three gram tube of Surgilube

The same company also made a DVD with instructions on how to use every piece of equipment in this kit. It is NOT a substitute for real medical training, but is enough to get the average layman by in an extreme emergency.

VOK video
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Old January 12, 2007, 23:49   #50
WolfBrother
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Quote:
Originally posted by cliffy109
I realize this discussion focuses on complete medical kits, but I thought I'd bring up the issue of a blowout kit. This is meant as an emergency kit that has everything to field treat a gunshot wound before professional help arrives.

Ventilated Operator Kit

It includes the following:

1) Cinch Tight Compression "H" Bandage
(1) TK-4 Tourni-Kwik (3” wide 40" long Rugged Combat Tourniquet)
(1) Primed Gauze (crinkle cotton)
(1) Nasopharyngeal Airway (30FR Robertazzi Style)
(1) 14ga x 3 ¼ Catheter (sterile)
(1) Alcohol Prep Pad
(2) Safety Pins (2”) multipurpose
(1) Duct Tape (2”x100” roll)
(1) Set Nitrile N-Dex Gloves
(1) Three gram tube of Surgilube

The same company also made a DVD with instructions on how to use every piece of equipment in this kit. It is NOT a substitute for real medical training, but is enough to get the average layman by in an extreme emergency.

VOK video
Nothing but high praise for the company that sells this kit. I bought 5. One for me, one for each vehicle, one for my Cruiser Bag, one for a spare.
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