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**Mags** · 05-06-2009, 09:13 PM

...............Comments welcomed and encouraged............:)

**TAZDEVIL** · 05-06-2009, 09:48 PM

"IS THERE A DOCTOR IN THE HOUSE?".....WOW:eek:... any for sale? Wouldn't mind having a self-made first aid kit ... to go buy each thing is a little pricey., one of the things i suggest getting is "Burn gel" made by ZEE. Excellent stuff for burns.

**Lostinoz** · 05-06-2009, 10:14 PM

Mags, I am so impressed with all that you have both gear-wise and medically speaking. I guess the one thing I would like to know is, if you remember where, to name some of the places where you purchased your items, especially if online (?) I would even like to know where you get your bags. :)

**Mags** · 05-06-2009, 10:28 PM

Taz, I have Water Gel packets in the AMK's. Water Gel packets/dressings in my "trunk bag," and STOMPII pack. That's pretty much it for burns other than sterile dressings. I do like the Water Gel products.

Lost, I will post some links but I'll do it over in the Gear Forum in my BOB thread.

Thanks for reading/looking/commenting!:)

**Mags** · 05-06-2009, 11:08 PM

Here's a great link for current Mil Trauma COA's.

http://www.tacmedsolutions.com/blog/wp- ... 090204.pdf Bad link I guess. Text posted below.

Also wanted to say that the "Combat Medic Field Reference" book is a great resource.

xxxxTEXT FROM LINKxxxx
Tactical Combat Casualty Care Guidelines
February 2009
* The only change in these updated TCCC guidelines from the July 2008 version is that WoundStat has been removed as a recommended hemostatic agent. All changes to the guidelines made since those published in the 2006 Sixth Edition of the PHTLS Manual are shown in bold text.
Basic Management Plan for Care Under Fire
1. Return fire and take cover.
2. Direct or expect casualty to remain engaged as a combatant if
appropriate.
3. Direct casualty to move to cover and apply self-aid if able.
4. Try to keep the casualty from sustaining additional wounds.
5. Airway management is generally best deferred until the Tactical Field
Care phase.
6. Stop life-threatening external hemorrhage if tactically feasible:
- Direct casualty to control hemorrhage by self-aid if able.
- Use a CoTCCC-recommended tourniquet for hemorrhage that is
anatomically amenable to tourniquet application.
- Apply the tourniquet proximal to the bleeding site, over the uniform,
tighten, and move the casualty to cover.
Basic Management Plan for Tactical Field Care
1. Casualties with an altered mental status should be disarmed
immediately.
2. Airway Management
a. Unconscious casualty without airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Place casualty in the recovery position
b. Casualty with airway obstruction or impending airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Allow casualty to assume any position that best protects the
airway, to include sitting up.
- Place unconscious casualty in the recovery position.
- If previous measures unsuccessful:
- Surgical cricothyroidotomy (with lidocaine if
conscious)
3. Breathing
a. In a casualty with progressive respiratory distress and
known or suspected torso trauma, consider a tension
pneumothorax and decompress the chest on the side of the injury
with a 14-gauge, 3.25 inch needle/catheter unit inserted in the
second intercostal space at the midclavicular line. Ensure that the
needle entry into the chest is not medial to the nipple line and is
not directed towards the heart.
b. All open and/or sucking chest wounds should be treated by
immediately applying an occlusive material to cover the defect
and securing it in place. Monitor the casualty for the potential
development of a subsequent tension pneumothorax.
4. Bleeding
a. Assess for unrecognized hemorrhage and control all sources of
bleeding. If not already done, use a CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomically amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound.
b. For compressible hemorrhage not amenable to tourniquet use or
as an adjunct to tourniquet removal (if evacuation time is
anticipated to be longer than two hours), use Combat Gauze as
the hemostatic agent of choice. Combat Gauze should be applied
with at least 3 minutes of direct pressure. Before releasing any
tourniquet on a casualty who has been resuscitated for
2
hemorrhagic shock, ensure a positive response to resuscitation
efforts (i.e., a peripheral pulse normal in character and normal
mentation if there is no traumatic brain injury (TBI).
c. Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so, move tourniquet from over uniform and apply directly to skin 2-3 inches above wound. If a tourniquet is not needed, use other techniques to control bleeding.
d. When time and the tactical situation permit, a distal pulse check
should be accomplished. If a distal pulse is still present, consider
additional tightening of the tourniquet or the use of a second
tourniquet, side by side and proximal to the first, to eliminate the distal pulse.
e. Expose and clearly mark all tourniquet sites with the time of
tourniquet application. Use an indelible marker.
5. Intravenous (IV) access
- Start an 18-gauge IV or saline lock if indicated.
- If resuscitation is required and IV access is not obtainable, use the
intraosseous (IO) route.
6. Fluid resuscitation
Assess for hemorrhagic shock; altered mental status (in the absence
of head injury) and weak or absent peripheral pulses are the best field
indicators of shock.
a. If not in shock:
- No IV fluids necessary
- PO fluids permissible if conscious and can swallow
b. If in shock:
- Hextend, 500-mL IV bolus
- Repeat once after 30 minutes if still in shock.
- No more than 1000 mL of Hextend
c. Continued efforts to resuscitate must be weighed against
logistical and tactical considerations and the risk of incurring
further casualties.
d. If a casualty with TBI is unconscious and has no peripheral pulse,
resuscitate to restore the radial pulse.
7. Prevention of hypothermia
a. Minimize casualty’s exposure to the elements. Keep protective
gear on or with the casualty if feasible.
b. Replace wet clothing with dry if possible.
c. Apply Ready-Heat Blanket to torso.
d. Wrap in Blizzard Rescue Blanket.
e. Put Thermo-Lite Hypothermia Prevention System Cap on the
casualty’s head, under the helmet.
f. Apply additional interventions as needed and available.
3
g. If mentioned gear is not available, use dry blankets, poncho liners,
sleeping bags, body bags, or anything that will retain heat and
keep the casualty dry.
8. Penetrating Eye Trauma
If a penetrating eye injury is noted or suspected:
a) Perform a rapid field test of visual acuity.
b) Cover the eye with a rigid eye shield (NOT a pressure patch.)
c) Ensure that the 400 mg moxifloxacin tablet in the combat pill pack
is taken if possible and that IV/IM antibiotics are given as outlined
below if oral moxifloxacin cannot be taken.
9. Monitoring
Pulse oximetry should be available as an adjunct to clinical monitoring.
Readings may be misleading in the settings of shock or marked hypothermia.
10. Inspect and dress known wounds.
11. Check for additional wounds.
12. Provide analgesia as necessary.
a. Able to fight:
These medications should be carried by the combatant and self-
administered as soon as possible after the wound is sustained.
- Mobic, 15 mg PO once a day
- Tylenol, 650-mg bilayer caplet, 2 PO every 8 hours
b. Unable to fight:
Note: Have naloxone readily available whenever administering
opiates.
- Does not otherwise require IV/IO access
- Oral transmucosal fentanyl citrate (OTFC), 800 ug
transbuccally
- Recommend taping lozenge-on-a-stick to
casualty’s finger as an added safety measure
- Reassess in 15 minutes
- Add second lozenge, in other cheek, as
necessary to control severe pain.
- Monitor for respiratory depression.
- IV or IO access obtained:
- Morphine sulfate, 5 mg IV/IO
- Reassess in 10 minutes.
- Repeat dose every 10 minutes as necessary to
control severe pain.
- Monitor for respiratory depression
- Promethazine, 25 mg IV/IM/IO every 6 hours as needed for
nausea or for synergistic analgesic effect
4
13. Splint fractures and recheck pulse.
14. Antibiotics: recommended for all open combat wounds
a. If able to take PO:
- Moxifloxacin, 400 mg PO one a day
b. If unable to take PO (shock, unconsciousness):
- Cefotetan, 2 g IV (slow push over 3-5 minutes) or IM every
12 hours
or
- Ertapenem, 1 g IV/IM once a day
15. Communicate with the casualty if possible.
- Encourage; reassure
- Explain care
16. Cardiopulmonary resuscitation (CPR)
Resuscitation on the battlefield for victims of blast or penetrating
trauma who have no pulse, no ventilations, and no other signs of life
will not be successful and should not be attempted.
17. Documentation of Care
Document clinical assessments, treatments rendered, and changes
in the casualty’s status on a TCCC Casualty Card. Forward this
information with the casualty to the next level of care.
5
Basic Management Plan for Tactical Evacuation Care
* The new term “Tactical Evacuation” includes both Casualty Evacuation (CASEVAC) and Medical Evacuation (MEDEVAC) as defined in Joint Publication 4-02.
1. Airway Management
a. Unconscious casualty without airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Place casualty in the recovery position
b. Casualty with airway obstruction or impending airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Allow casualty to assume any position that best
protects the airway, to include sitting up.
- Place unconscious casualty in the recovery position.
- If above measures unsuccessful:
- Laryngeal Mask Airway (LMA)/intubating LMA or
- Combitube or
- Endotracheal intubation or
- Surgical cricothyroidotomy (with lidocaine if
conscious).
c. Spinal immobilization is not necessary for casualties with
penetrating trauma.
2. Breathing
a. In a casualty with progressive respiratory distress and
known or suspected torso trauma, consider a tension
pneumothorax and decompress the chest on the side of the injury
with a 14-gauge, 3.25 inch needle/catheter unit inserted in the
second intercostal space at the midclavicular line. Ensure that the
needle entry into the chest is not medial to the nipple line and is
not directed towards the heart.
b. Consider chest tube insertion if no improvement and/or long
transport is anticipated.
c. Most combat casualties do not require supplemental oxygen, but
administration of oxygen may be of benefit for the following types
of casualties:
- Low oxygen saturation by pulse oximetry
- Injuries associated with impaired oxygenation
- Unconscious casualty
- Casualty with TBI (maintain oxygen saturation > 90%)
- Casualty in shock
- Casualty at altitude
d. All open and/or sucking chest wounds should be treated by
immediately applying an occlusive material to cover the defect
6
and securing it in place. Monitor the casualty for the potential
development of a subsequent tension pneumothorax.
3. Bleeding
a. Assess for unrecognized hemorrhage and control all sources of
bleeding. If not already done, use a CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomically amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound.
b. For compressible hemorrhage not amenable to tourniquet use or
as an adjunct to tourniquet removal (if evacuation time is
anticipated to be longer than two hours), use Combat Gauze as
the hemostatic agent of choice. Combat Gauze should be applied
with at least 3 minutes of direct pressure. Before releasing any
tourniquet on a casualty who has been resuscitated for
hemorrhagic shock, ensure a positive response to resuscitation
efforts (i.e., a peripheral pulse normal in character and normal
mentation if there is no TBI.)
c. Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so, move tourniquet from over uniform and apply directly to skin 2-3 inches above wound. If a tourniquet is not needed, use other techniques to control bleeding.
d. When time and the tactical situation permit, a distal pulse check
should be accomplished. If a distal pulse is still present, consider
additional tightening of the tourniquet or the use of a second
tourniquet, side by side and proximal to the first, to eliminate the distal pulse.
e. Expose and clearly mark all tourniquet sites with the time of
tourniquet application. Use an indelible marker.
4. Intravenous (IV) access
a. Reassess need for IV access.
- If indicated, start an 18-gauge IV or saline lock
- If resuscitation is required and IV access is not obtainable,
use intraosseous (IO) route.
5. Fluid resuscitation
Reassess for hemorrhagic shock (altered mental status in the
absence of brain injury and/or change in pulse character.)
a. If not in shock:
- No IV fluids necessary.
- PO fluids permissible if conscious and can swallow.
b. If in shock:
- Hextend 500-mL IV bolus.
- Repeat once after 30 minutes if still in shock.
7
- No more than 1000 mL of Hextend.
c. Continue resuscitation with packed red blood cells (PRBCs),
Hextend, or Lactated Ringer’s solution (LR) as indicated.
d. If a casualty with TBI is unconscious and has a weak or absent
peripheral pulse, resuscitate as necessary to maintain a systolic
blood pressure of 90 mmHg or above.
6. Prevention of hypothermia
a. Minimize casualty’s exposure to the elements. Keep protective
gear on or with the casualty if feasible.
b. Continue Ready-Heat Blanket, Blizzard Rescue Wrap, and Thermo-
Lite Cap.
c. Apply additional interventions as needed.
d. Use the Thermal Angel or other portable fluid warmer on all IV
sites, if possible.
e. Protect the casualty from wind if doors must be kept open.
7. Penetrating Eye Trauma
If a penetrating eye injury is noted or suspected:
a) Perform a rapid field test of visual acuity.
b) Cover the eye with a rigid eye shield (NOT a pressure patch).
c) Ensure that the 400 mg moxifloxacin tablet in the combat pill pack
is taken if possible and that IV/IM antibiotics are given as outlined
below if oral moxifloxacin cannot be taken.
8. Monitoring
Institute pulse oximetry and other electronic monitoring of vital signs, if
indicated.
9. Inspect and dress known wounds if not already done.
10. Check for additional wounds.
11. Provide analgesia as necessary.
a. Able to fight:
- Mobic, 15 mg PO once a day
- Tylenol, 650-mg bilayered caplet, 2 PO every 8 hours
b. Unable to fight:
Note: Have naloxone readily available whenever
administering opiates.
- Does not otherwise require IV/IO access:
- Oral transmucosal fentanyl citrate (OTFC) 800 ug
transbuccally
- Recommend taping lozenge-on-a-stick to
casualty’s finger as an added safety measure.
- Reassess in 15 minutes.
8
- Add second lozenge, in other cheek, as
necessary to control severe pain.
- Monitor for respiratory depression.
- IV or IO access obtained:
- Morphine sulfate, 5 mg IV/IO
- Reassess in 10 minutes
- Repeat dose every 10 minutes as necessary to
control severe pain.
- Monitor for respiratory depression.
- Promethazine, 25 mg IV/IM/IO every 6 hours as needed for
nausea or for synergistic analgesic effect.
12. Reassess fractures and recheck pulses.
13. Antibiotics: recommended for all open combat wounds
a. If able to take PO:
- Moxifloxacin, 400 mg PO once a day
b. If unable to take PO (shock, unconsciousness):
- Cefotetan, 2 g IV (slow push over 3-5 minutes) or IM every 12
hours,
or
- Ertapenem, 1 g IV/IM once a day
14. The Pneumatic Antishock Garment (PASG) may be useful for stabilizing
pelvic fractures and controlling pelvic and abdominal bleeding.
Application and extended use must be carefully monitored. The PASG
is contraindicated for casualties with thoracic or brain injuries.
15. Documentation of Care
Document clinical assessments, treatments rendered, and changes in
casualty’s status on a TCCC Casualty Card. Forward this information
with the casualty to the next level of care.

**Lostinoz** · 05-06-2009, 11:23 PM

Mags, I found these on scribd and thought they may come in handy. What is your opinion of them? Just whenever you get an op to browse through them.

http://www.scribd.com/doc/2092703/US-Army-Special-Forces-Medical-Handbook-ST-3191B

http://www.scribd.com/doc/432343/Usmc-Mcrp-302g-First-Aid

http://www.scribd.com/doc/299034/FM-2176-US-Army-Survival-Manual

I haven't read through them all, just wanted to see which ones would be good to save when I do have time to go over them.

**Mags** · 05-07-2009, 06:32 PM

First two are FM's I have. I like them, lots of info. I also have the third but, think that there are too many other quality commercial civilian survival manuals out there. They have newwer information, better pics and graphics, and relate more to gear you already know and can purchase easily. They cover all the same info plus more and some are even entertaining while doing it. (Cody Lundin's 98.6 Degrees comes to mind.)

Sidebar;
I like the internet forums but wish they did more to "vet" the people posting on them. An Army Private heading to Iraq for the first time doesn't need tacticool gear recommendations from a pimply faced airsoft player setting in his parents basement. Just as people here don't need gear picks and reviews posted by people that either do not even own the gear or have spent anytime using it. I know of a review post to include impressions and conclusions on a hammock that was just delivered to the kid that afternoon. He hadn't even slept in it but gave it a whooping 2 thumbs up.

Rant over.....:rolleyes:

**Lostinoz** · 05-07-2009, 09:18 PM

Sidebar;
I like the internet forums but wish they did more to "vet" the people posting on them. An Army Private heading to Iraq for the first time doesn't need tacticool gear recommendations from a pimply faced airsoft player setting in his parents basement. Just as people here don't need gear picks and reviews posted by people that either do not even own the gear or have spent anytime using it. I know of a review post to include impressions and conclusions on a hammock that was just delivered to the kid that afternoon. He hadn't even slept in it but gave it a whooping 2 thumbs up.

Rant over.....:rolleyes:[/QUOTE]

Ok, Ok! I'm sorry I recommended the chicken coupon and you didn't get your chicken, but I DON'T recall recommending a hammock to anyone??? :D :p

Seriously, you have such an extensive first aid set up! Again, where would you START, especially on a limited budget and what area of focus do you recommend for beginners. I know the training is the most important area and that is being taken care of through classes, CERT, books, etc.

Would you suggest practice drills on family? Any video suggestions?

I know these questions probably sound dumb, but your information is so good and I feel at such a loss when trying to put something together... :(

**Mags** · 05-07-2009, 09:32 PM

Hey hey hey, quit blowin' smoke there lady.:o;) Just ask, if I can answer your question I'd be happy to! No stroking needed.....

It is like pulling teeth round here. You ever done any interrogation work?!

**Lostinoz** · 05-07-2009, 09:46 PM

Originally posted by Mags View Post

Hey hey hey, quit blowin' smoke there lady.:o;) Just ask, if I can answer your question I'd be happy to! No stroking needed.....

It is like pulling teeth round here. You ever done any interrogation work?!

Blowing smoke? Me? Nah, just a charming Southern Lady. ;) Sometimes we "ladies" can be a bit intimidated by you Big Boys. :p Ha. Ha. Ha. :eek:

Like I said, our first aid kit is in dire need of help. I have looked at the Adventure Kits and feel that would be a good place to start (?) What items did you feel needed to be added to the pre-filled ones you bought?

**Mags** · 05-07-2009, 10:01 PM

Touche' Ma'am:D

So I really like the AMK's commercial kits for treatment of outdoor camping/hiking type injuries but they need to be augmented with some trauma gear IMHO for our use in BOB's. Many worry 'bout looters and bands of thugs roving about. Many people will be BO armed. It just makes sence then that you would have the gear to treat more traumatic injuries like GSW's. Also need to add a supply of personal meds you need.

When bugging out as a team (family) everybody should have a basic kit in their gear but lists should be made so gear is crossleveled and not duplicated. You'll only have so much room and be able to carry so much wieght.

The AMK kits come packed light and waterproof. The outer bag is thin and light but strong. Since they are packed in bags and not hard cases you can jam them into pack spaces where a hard kit wouldn't fit.

IMHO

**Lostinoz** · 05-07-2009, 10:08 PM

Originally posted by Mags View Post

Touche' Ma'am:D

So I really like the AMK's commercial kits for treatment of outdoor camping/hiking type injuries but they need to be augmented with some trauma gear IMHO for our use in BOB's. Many worry 'bout looters and bands of thugs roving about. Many people will be BO armed. It just makes sence then that you would have the gear to treat more traumatic injuries like GSW's. Also need to add a supply of personal meds you need.

When bugging out as a team (family) everybody should have a basic kit in their gear but lists should be made so gear is crossleveled and not duplicated. You'll only have so much room and be able to carry so much wieght.

The AMK kits come packed light and waterproof. The outer bag is thin and light but strong. Since they are packed in bags and not hard cases you can jam them into pack spaces where a hard kit wouldn't fit.

IMHO

As a scenario...

Suppose there is a member in your group who has run out of blood pressure medication due to short supply. How would you go about stocking up on something like that?

I like the staggered idea and will go with that, no duplicates. GSWs, I shudder at the thought. Which manual, class, etc., has prepared you to deal with that type of injury? Blood doesn't bother me, so that isn't the issue, afraid of screwing up..that bothers me.

**Mags** · 05-07-2009, 10:29 PM

That's why we train! and train and train!

I think FEMA and the Red Cross both recommend a reserve supply of meds, especially maintenance drugs. Go to your personal physician with this info in hand and request a 30 to 90 day reserve supply. It's not like your asking for oxycotin or percocets. All he/she can say is no. Maybe look into a new Dr.

Each person gets a complete basic kit. It's the extra's and specialized kit that you don't want/need to duplicate.

I have 3 tours in Iraq with hundreds of missions. I know how to handle that type of injury from past practice. Lets not forget that we're BO with loved ones. We want to avoid a shootout at ALL costs. It's an option but should be the last option.

**Lostinoz** · 05-07-2009, 10:34 PM

Originally posted by Mags View Post

That's why we train! and train and train!

I think FEMA and the Red Cross both recommend a reserve supply of meds, especially maintenance drugs. Go to your personal physician with this info in hand and request a 30 to 90 day reserve supply. It's not like your asking for oxycotin or percocets. All he/she can say is no. Maybe look into a new Dr.

Each person gets a complete basic kit. It's the extra's and specialized kit that you don't want/need to duplicate.

I have 3 tours in Iraq with hundreds of missions. I know how to handle that type of injury from past practice. Lets not forget that we're BO with loved ones. We want to avoid a shootout at ALL costs. It's an option but should be the last option.

I agree and "hope" I am never in a BO situation under extreme circumstances. The good thing is that I am never afraid to TRY something new and continue to learn daily.

Hope the interrogation hasn't been too tough on ya! :D I do like to pick brains.

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My Medical Equipment (Various Kits/Levels)

My Medical Equipment (Various Kits/Levels)

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