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  #1  
Old 18 December 2017, 15:20
GauzeGuy GauzeGuy is offline
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Blow-out kit contents recommendation

I'm putting together individual medical kits for a church security team. I recently joined and found that nothing had been addressed for medical response to an active shooter or other mass casualty scenario.

I need to keep the training and money requirements to a minimum. Towards that end, I've modeled the contents off of a basic "stop the bleed" kit:

CAT TQ (Recon Medical variant)
Kerlix roll
gloves
trauma shears

Questions:

1. I included plain gauze due to cost savings and reasonable efficacy in wound packing (per Watters JM, Van PY, Hamilton GJ, et al. Advanced hemostatic dressings are not superior to gauze for care under fire scenarios.) Nonetheless, given that hemostatic agents are the gold standard, is there a good reason to equip some or all of the kits with Combat Gauze or similar?

2. Do improvised chest seals have any efficacy in treating an open pneumothorax? Would it be best to adopt a commercial device?

3. Related to #2: as the vast majority of the kit users will have minimal training (an hour long stop the bleed course), would it be best to focus their attention on bleeding control, and have higher level responders address airway and breathing concerns?

Any suggestions are appreciated. Thanks for taking the time to review this.
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  #2  
Old 18 December 2017, 15:59
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Church security team?
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Old 18 December 2017, 16:08
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My father's Catholic church in Greenville has 1,500 members per mass, and it has 4 or 5 masses per Sunday, others throughout the week. "Soft Target" by appearances, but has armed plainclothes security at all masses, and they have several extensive med kits stationed around the facility, just in case. Automatic defibrillators, too.

Combat gauze & chest seals are good. Kerlix for stuffing a wound when you're CONUS and an ambulance or five are minutes away, not so much.

Increase your kit count by five. Mass casualty means just that. Enough gear to treat one isn't going to cut it.
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Old 18 December 2017, 16:12
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I would also consider having multiple sets located at various places throughout the church -- if the facility is big enough or sectioned off -- to where that would be of benefit.
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Old 18 December 2017, 17:19
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Emergency bandage in place of the Kerlix...one good option would be Olaes bandage, as it has a gauze roll inside, plus a plastic sheet to use as an improvised chest/wound seal.

Pretty much the same cost as an Izzy bandage, but more versatile.

http://www.tacmedsolutions DOT com/OLAES-Modular-Bandage

Would also recommend aide-memories (laminated), preferably with good graphics...for those that have forgotten something since their last course/refresher training.

$0.02
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Old 18 December 2017, 17:34
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18D answer:

Worry about airway, bleeding control, and hypothermia, in that order.

Open chest injuries are not immediate killers, closed chest injuries are. Improper treatment of an open chest injury will turn it into a closed chest injury. Managing chest compromise requires training, at least at the TC3/CLS level.

Hypothermia in the trauma patient is a major cause of mortality. Even if it is a hot summer day, a trauma patient will become hypothermic. Once their core temp drops to a certain level, they are going to die, period.
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Old 19 December 2017, 01:21
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Hypothermia in the trauma patient is a major cause of mortality. Even if it is a hot summer day, a trauma patient will become hypothermic. Once their core temp drops to a certain level, they are going to die, period.
So true. I see this problem often in wilderness rescue scenarios. Responders chewing the fat waiting for the heli/tech gear set-up/more carriers/whatever, and don't realise the patient at their feet is busy getting hypothermia
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  #8  
Old 19 December 2017, 02:24
GauzeGuy GauzeGuy is offline
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Thanks to all for the recommendations.

1. I'll avoid the chest seals due to the minimal training most team members will have, and the potential for harm.
2. The kits will get a mylar blanket to help prevent hypothermia.
3. I'll include training for manual airway techniques (head tilt/recovery position).
4. The suggestion to have multiple kits available across several locations is a good one.

The only thing I'd like to get additional clarification with is the gauze. The goal will be to stabilize the victim for the first 5-10 minutes, since we're located in the Denver metro area. Considering efficacy, cost and training requirements, what would be the best option between the various hemostatic agents and trauma dressings?
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  #9  
Old 19 December 2017, 06:40
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Quote:
Originally Posted by GauzeGuy View Post
Thanks to all for the recommendations.

1. I'll avoid the chest seals due to the minimal training most team members will have, and the potential for harm.
Good call.
Quote:
2. The kits will get a mylar blanket to help prevent hypothermia.
Great. There are items out now that include keeping the head warm ... *that* is where you will lose the heat!
Quote:
3. I'll include training for manual airway techniques (head tilt/recovery position).
Good idea and emphasise correct technique ... it will pay off with spinal involvement.
Quote:
4. The suggestion to have multiple kits available across several locations is a good one.

The only thing I'd like to get additional clarification with is the gauze. The goal will be to stabilize the victim for the first 5-10 minutes, since we're located in the Denver metro area. Considering efficacy, cost and training requirements, what would be the best option between the various hemostatic agents and trauma dressings?
Gavin said most everything I was thinking as a Medic so here goes from my project management side of brain.

Have you contacted the EMS in your area to ascertain the average response times?

Unlike planning for the field, at home and in metro areas, there is a lot more data mining done on stuff like this. So they should not only give you timings to your LOCSTAT but also average delivery to Trauma/ER Centres located close by.

Do you know what skills the group already possess and tapped into those skill sets?

This will affect everything you are planning for including stores to use.

Just a random thought to throw a spanner in your works.

I have to say, kudos on your application of the 7 P's.

Cheers,
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  #10  
Old 19 December 2017, 12:29
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I have done enough live tissue work where I have just as high a level of confidence in gauze as I do a hemostatic. That takes into consideration some ideal circumstances and I know that alcohol, drugs, hemophilia, blood thinners, hypothermia(to an extent), etc etc are not involved. With that being said if they were involved and you had something that is going to jump start the clotting factors, It would be a value add. Always a good to have item if something isn't stopping bleeding that can't be turned off mechanically.
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  #11  
Old 19 December 2017, 16:28
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Quote:
Originally Posted by gavin View Post
18D answer:

Worry about airway, bleeding control, and hypothermia, in that order.
My counter to this would be:

Given the presumtive scenario, the tenets if TCCC are in full effect.

The first thing we need to teach unarmed civilians is to Run, Hide, Fight; followed by providing bleeding-related self-aid/buddy-aid.

If armed and confident/competent in abilities, they should return fire and eliminate the threat.

Once the shooting stops, then time to wory about MARCH, in that order.

Massive Hemorrhage
Airway
Respirations
Circulation
Hypothermia
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  #12  
Old 19 December 2017, 19:33
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Quote:
Originally Posted by O_Pos View Post
My counter to this would be:

Given the presumtive scenario, the tenets if TCCC are in full effect.

The first thing we need to teach unarmed civilians is to Run, Hide, Fight; followed by providing bleeding-related self-aid/buddy-aid.

If armed and confident/competent in abilities, they should return fire and eliminate the threat.

Once the shooting stops, then time to wory about MARCH, in that order.

Massive Hemorrhage
Airway
Respirations
Circulation
Hypothermia
MARCH is so much better than ABC (especially since AHA has muddied the water with their CAB mnemonic for CPR). I'm a huge proponent of dropping ABC entirely and teaching only MARCH.
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  #13  
Old 19 December 2017, 19:54
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Quote:
Originally Posted by O_Pos View Post
My counter to this would be:

Given the presumtive scenario, the tenets if TCCC are in full effect.
The tenets of TC3 can't be in effect if no one present has been trained in TC3. I am answering Questions 1-3 asked by the OP, not giving him training advice.
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Old 19 December 2017, 19:57
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Originally Posted by firstshirt View Post
MARCH is so much better than ABC (especially since AHA has muddied the water with their CAB mnemonic for CPR). I'm a huge proponent of dropping ABC entirely and teaching only MARCH.
Not disagreeing with you, however, that is outside of what the OP is asking.
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  #15  
Old 19 December 2017, 20:23
Bobbo4030 Bobbo4030 is offline
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Quote:
Originally Posted by GauzeGuy View Post
I'm putting together individual medical kits for a church security team. I recently joined and found that nothing had been addressed for medical response to an active shooter or other mass casualty scenario.

I need to keep the training and money requirements to a minimum. Towards that end, I've modeled the contents off of a basic "stop the bleed" kit:

CAT TQ (Recon Medical variant)
Kerlix roll
gloves
trauma shears

Questions:

1. I included plain gauze due to cost savings and reasonable efficacy in wound packing (per Watters JM, Van PY, Hamilton GJ, et al. Advanced hemostatic dressings are not superior to gauze for care under fire scenarios.) Nonetheless, given that hemostatic agents are the gold standard, is there a good reason to equip some or all of the kits with Combat Gauze or similar?

2. Do improvised chest seals have any efficacy in treating an open pneumothorax? Would it be best to adopt a commercial device?

3. Related to #2: as the vast majority of the kit users will have minimal training (an hour long stop the bleed course), would it be best to focus their attention on bleeding control, and have higher level responders address airway and breathing concerns?

Any suggestions are appreciated. Thanks for taking the time to review this.
I would have it all , if a qualified professional is on site with out needed equipment you have it ready to go...
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  #16  
Old 19 December 2017, 22:22
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Originally Posted by gavin View Post
Not disagreeing with you, however, that is outside of what the OP is asking.
Not meaning to be argumentative, but it doesn't seem any more outside of what the OP is asking than your advice to "...worry about airway, bleeding control, and hypothermia. in that order" Advice that, in my opinion, oversimplifies the issue in a way that MARCH is designed to avoid.
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Old 19 December 2017, 23:51
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If you're still considering adding a hemostatic dressing, you might want to think about the cost and expiration dates of those dressings. You can get a roll of QuikClot Combat Gauze for $30-ish...which will expire in about 18 months, if you're lucky and get a "long" expiration date.

Or you can get a roll of compressed gauze for about $1 (if they gouge you) and it doesn't have an expiration date, yet has similar efficacy (when used properly).

Also remember, that you will have to train people in the use of these kits. To that end, I would emphasize basics, basics, basics. Introduce MARCH because looking for bleeds first isn't a huge logical leap for most people. Then hammer home direct pressure on limbs, and do a fam on the CAT to include MULTIPLE rounds of applying trainers on each other.

And yes, I'd follow up each scenario with packaging the patient in a mylar blanket at a minimum. I read a study a year or two ago that said something like 60% of trauma patients that arrive at US Level I trauma centers are hypothermic to one degree or another. I've really been beating this drum recently at my volunteer agency, and with my EMT's and EMR's at work.
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Old 19 December 2017, 23:53
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What are the group's thoughts on NPA's? We've got 28F NPA's in all of our IFAK's at work and trained everyone on how to use them. (Now, how many people REMEMBER that training is a different question.) I offer it up because NP's are cheap, pretty benign and tough to screw up.
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Old 20 December 2017, 10:37
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The tenets of TC3 can't be in effect if no one present has been trained in TC3. I am answering Questions 1-3 asked by the OP, not giving him training advice.
I would tend to count your initial comment as training advice.

And my point being that I believe that advice to be a bit narrow and somewhat out of order.

We SHOULD be offering people training advice. Priority one in the likely active shooter scenario is threat/danger management.

And then after people have cover and/or threat is mitigated, Massive Hemmorhage should be the initial medical management consideration, followed by ARCH.
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  #20  
Old 20 December 2017, 11:56
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Originally Posted by Medic4070 View Post
What are the group's thoughts on NPA's? We've got 28F NPA's in all of our IFAK's at work and trained everyone on how to use them. (Now, how many people REMEMBER that training is a different question.) I offer it up because NP's are cheap, pretty benign and tough to screw up.
I was going to ask the same question. I see Nasopharyngeal Airway tubes in many IFAKs and "blow-out kits". How often are these being used /employed (in the field), in this case, for GSW? And, how beneficial is it to have in a kit? I have some training and experience with the insertion, but nothing "real life".
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