jdonovan wrote:I decided against IIIa as I don't expect carbine threats, and rifles will make even a IIIa look like it wasn't even there.
IIIA just does higher velocity pistol rounds for penetration (e.g. a "9mm" round @ ~1400fps, aka .357 SIG) and larger calibers for blunt trauma (e.g. .44Mag).
jdonovan wrote:Oh I also added an IAFK and clotting agents to the range bag. The girl and I are both first responders, and those things added to my BLS kit give me quite a few more options for treating injuries until the local responders get there.
Being a first responder is great, but the first thing they will tell you in a combat trauma course is, combat trauma is different. Also, the US military has significantly revamped their combat trauma courses extensively since about mid-2000s due to Iraq and Afghanistan. We gained a lot of experience with it (unfortunately) and learned that most of the traditional first aid (e.g. boy scouts, first responder training, old military training, etc.) wasn't working too well. This includes gunshots.
Significant changes (as far as I'm aware) are:
1. If there is significant trauma to a limb, tourniquets are the
first response. Of course you apply direct pressure while attempting to put a CAT on, but it's only intended to reduce blood loss while you apply the CAT. If you have to choose between the two, apply the CAT. When you apply the CAT, apply it as high as possible; do not attempt to apply it lower as it's less effective. The CAT can be applied one handed with is a huge benefit if you have put one on yourself. Of course that only works if you practice putting them on yourself (which should be part of any good course you take). Interestingly, what use to be a small part of a trauma course is now easily half of it!
This is direct contradiction to the previous idea that tourniquets are more a last resort and have dire consequences. The reality is that surgeons use tourniquets all the time in operating rooms in the US to minimize blood loss with no side affects. In general, if the tourniquet is left on for less than 2 hours there is a extremely small probability of causing any additional damage to the limb and that usually buys you enough time to get help/evacuated. Same would be true in a accidental range shooting. As you approach 2 hours you need to make a decision about removing it or not. Never do so with amputations or partials or patients at risk of shock. Loosening is done half a turn at a time with 5-10mins intervals checking on the wound for blood loss. If a tourniquet is on for more than 6 hours, never remove it as you'll likely kill the patient.
Oh ya, tourniquets hurt. Don't let your patient convince you that it's on too tight because it hurts. Crank it down until the blood stops. Add two if you must.
2. QuickClot/Celox/Etc. are not silver bullets and will not work if you don't use them properly (duh). We sent guys in the field with these early in the war, but didn't train them on their use so results were very poor. You
must pour them directly on the source of the significant blood loose (usually artery/vein) and then apply direct pressure. Direct pressure doesn't mean surface pressure, it usually means (in this case with severe trauma) sticking your hand in the wound to apply it properly. These are to be used only after a tourniquet has been applied (when appropriate) and not in place of. Also, never apply them to torso and head wounds. Armpits and groin are the best uses because you can't apply a tourniquet. With the head you run the risk of causing pressure on the brain and with the torso your not going to do anything useful and probably will do something harmful.
Like all tools you have to learn how to use them and I fear many people buying them think its a dump and forgot application (not you per se).
3. Never give them an IV unless you're about to do a field transfusion (interestingly you don't have to worry about blood types for a one time field use any more...I don't know what it requires when you get to the hospital though). If they need fluids, do it by the mouth. Saline kind of acts like a mild poison when given to those with serious blood loss (salt is absorbed by the surrounding tissue) and worse yet it raises the blood pressure (more fluid) which runs a significant risk of blowing out the clot!
4. Never perform CPR (obviously we're only talking about sever combat trauma). You will kill them buy blowing out the clot(s).
A good course covers so much more, but those are kind of the highlights of changes or things people should be aware of. Not all of them have made it back to civilian courses yet and even in the military it's not known unless you've had a recent course and have been deployed to a war zone.