Backcountry First Aid & Survival Kits, By Travis Bertrand

realunlucky

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After Ryan stabbed himself in the leg I've been looking at upgrading mine as well. I've basically never carried anything for that situation. Thanks for the excellent insight Travis.

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Beckjhong

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Great article and starting point. You made me nervous at first when I saw the sutures! I was on board after that.

I would heavily recommend having a separate “blow out” kit that is close to hand (ie; cargo pants pocket) with a tourniquet and hemostatic—for the unusual but life threatening bleed.

I personally carry a SWAT tourniquet rubber-banded to a pack of z-fold gauze. It’s 4.69oz and approximates a deck of cards. No, the SWAT isn’t my favorite tourniquet—I think the CAT is the best out there. But matching my knowledge and experience to my needs, it works for me. Should you substitute a CAT, it would not be a great sacrifice in either weight or space.

Check out bleedingcontrol.org, or feel free to hit me up with comments/questions.



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Travis Bertrand

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@Travis Bertrand do you think an Israeli bandage would be overkill?
no not at all as it can't hurt. I do not carry one however due to weight reasons and the chances it will actually save my life. You carry multiple tourniquets with you already (shoelaces, paracord, belt to name a few) and that will stop all major bleeding to an extremity. If you have a major blood loss elsewhere, chances are grim of making it out alive. How long is it going to take for you to activate the emergency response system? hit the SOS button, communicate via text that you need a helicopter, that helicopter to fly to you, find a helispot, land, make their way to you, transport you to the helicopter, and the flight to definitive care. I factored all of that in when making the decision not to.
 

Travis Bertrand

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Great article and starting point. You made me nervous at first when I saw the sutures! I was on board after that.

I would heavily recommend having a separate “blow out” kit that is close to hand (ie; cargo pants pocket) with a tourniquet and hemostatic—for the unusual but life threatening bleed.

I personally carry a SWAT tourniquet rubber-banded to a pack of z-fold gauze. It’s 4.69oz and approximates a deck of cards. No, the SWAT isn’t my favorite tourniquet—I think the CAT is the best out there. But matching my knowledge and experience to my needs, it works for me. Should you substitute a CAT, it would not be a great sacrifice in either weight or space.

Check out bleedingcontrol.org, or feel free to hit me up with comments/questions.



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see post 6
 

Beckjhong

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see post 6
Travis, it is dangerous (and outdated) medical advice to advocate makeshift tourniquets.

-shoelaces and paracord are highly likely to cause neurovascular damage and risk the limb on which it is placed

-a belt is highly unlikely to be tightened enough to be effective. In the Boston marathon bombing, 27 makeshift tourniquets were applied. Zero were effective.

-we have good medical evidence from the battlefield that tourniquets can be left applied for 4 hours without risking the limb. There is anecdotal evidence that up to 6 hours may have limited neurovascular damage not affective limb salvageability.

-effective commercial tourniquets are readily available and ineffective. There is no reason not to have one.


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Danimal

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Good article. There is no perfect kit and kits should be tailored to the capabilities of their owners as you have mentioned. The common things like allergy, blisters, splinters, altitude sickness, dehydration, exposure are very real and common issues. We worry about the big stuff even when these big events are relatively rare occurrences.

I do want to make a point about bleeding wounds though. Tourniquets, no tourniquets, clotting agents and the different types all have mixed evidence of effectiveness. It is normal and good to have these discussions and debates. There is no "hard" rules of when and where to use what when it comes to wounds.

That being said, as a physician assistant who has worked in ED, Trauma, and Plastic Surgery for 15 years now there are some general rules that I think people forget when they are placed in situations where "bleeding" is an issue. First general rule is, "life before limb". Hemorrhagic shock is real and deadly, if there is a wound that is causing hypovolemia then all measures should be taken to combat that. Often times direct pressure on a vessel is much more effective then a tourniquet or clotting agent. If you can hold pressure and stop the bleeding you are winning.

Too often first responders or the untrained will address a wound with some type of bulky dressing, tourniquet, quick clot, or some other ineffective means and they will simply conceal an issue and not truly address an issue. An ABD can hold a lot of blood. I remember vividly an elderly woman who came to us after a fall and sustained a superficial temporal artery laceration. She was hypovolemic and in shock. EMS assumed she had a TBI (traumatic brain injury) and I took a giant blood soaked dressing off of her head and there was a obvious little "pumper" that was the cause of a huge blood loss and her symptoms. By simply holding direct pressure with my finger tip the bleeding stopped and she began to recover.

Second general rule is activating the EMS system is still the most important aspect. The quicker we get people in the the OR the better they do at surviving their injuries. Worrying about cleanliness, or long term outcomes is moot if you can't survive the injury. If an adult goes into cardiac arrest due to an acute traumatic event, their survival rate is only about 6%. Don't underestimate the ability to slow and stop bleeding with your own hands or the hands of your hunting buddy, and then immediately focus on getting advanced help at all costs.

Hope everyone has a safe season and the med kit never has to be used.
 

robby denning

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Travis, it is dangerous (and outdated) medical advice to advocate makeshift tourniquets.

-shoelaces and paracord are highly likely to cause neurovascular damage and risk the limb on which it is placed

-a belt is highly unlikely to be tightened enough to be effective. In the Boston marathon bombing, 27 makeshift tourniquets were applied. Zero were effective.

-we have good medical evidence from the battlefield that tourniquets can be left applied for 4 hours without risking the limb. There is anecdotal evidence that up to 6 hours may have limited neurovascular damage not affective limb salvageability.

-effective commercial tourniquets are readily available and ineffective. There is no reason not to have one.


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If you're an expert in class, please feel free to submit a query for a published article on this subject. Here are our guidelines:


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Hey man, nice article.

Also a paramedic here... few things I add that I personally think are essential.

CAT tourniquet - Few things I could imaging being worse than a severed artery from a trip onto a broad head or ND and bleeding out on the side of the mountain.

Some short of occlusive for open chest wounds, I prefer expired pedi cardiac patches. I cut the cord off. Small and light weight. I also carry a 14ga needle for decompression but that’s probably beyond most folks proficiency.

Benadryl - You mentioned allergic reactions... I once had a friend get stung by a bee dragging out a wild hog. He started to have a systemic allergic reaction. Luckily one of our hunting partners had Benadryl in his truck. Getting that in his system I believe kept him from going too far down the toilet until we could get him to the hospital.
 

fwafwow

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Hey man, nice article.

Also a paramedic here... few things I add that I personally think are essential.

CAT tourniquet - Few things I could imaging being worse than a severed artery from a trip onto a broad head or ND and bleeding out on the side of the mountain.

Some short of occlusive for open chest wounds, I prefer expired pedi cardiac patches. I cut the cord off. Small and light weight. I also carry a 14ga needle for decompression but that’s probably beyond most folks proficiency.

Benadryl - You mentioned allergic reactions... I once had a friend get stung by a bee dragging out a wild hog. He started to have a systemic allergic reaction. Luckily one of our hunting partners had Benadryl in his truck. Getting that in his system I believe kept him from going too far down the toilet until we could get him to the hospital.
Civilian here, but I took the Dark Angel Medical training program a couple of years ago (I recommend it - but hey, maybe I don't know any better) and believed their emphasis on having a tourniquet. The video they show of a guy getting shot in the leg - and dying in ~45 seconds - still haunts me. I have one in every car and always have one with me in the field. Since I'm going LW for elk in CO, my trauma kit has been narrowed down to a CAT tourniquet, Z-fold Celox and a pair of gloves (total weight 135 grams). My hunting partner is former military and he's carrying about the same thing. I also have a boo-boo kit with minimal band-aids, neosporin, etc. (weighing a total of 17 grams). I figure if I need to stop major bleeding, I want the trauma kit. If I'm short on *other* stuff, I can improvise on those items and still survive.

We will have Benadryl and some other Rx meds, but when weight isn't an issue I carry an EpiPen, even though I've never had an allergic reaction.

Great article - reminded me I need to pick up a few more CATs!
 

ffparamedic

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Travis, it is dangerous (and outdated) medical advice to advocate makeshift tourniquets.

-shoelaces and paracord are highly likely to cause neurovascular damage and risk the limb on which it is placed

-a belt is highly unlikely to be tightened enough to be effective. In the Boston marathon bombing, 27 makeshift tourniquets were applied. Zero were effective.

-we have good medical evidence from the battlefield that tourniquets can be left applied for 4 hours without risking the limb. There is anecdotal evidence that up to 6 hours may have limited neurovascular damage not affective limb salvageability.

-effective commercial tourniquets are readily available and ineffective. There is no reason not to have one.


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I agree wholeheartedly with this.

#1 It is impossible to tie a belt or shoelace single hand around an upper extremity.

#2 a shoelace is not wide enough to stop blood flow.

#3 a belt, while wide enough does not ratchet or windlass in a great enough manner to stop blood flow.

#4 the cognitive load of an injury severe enough to need a TQ will leave you fumbling with a ready TQ, much less a makeshift one.

But, to each his own. And great article Travis.

** I am an expert on the subject and have written an article for Rokslide on the subject.




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Beckjhong

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It appears I ruffled some feathers, and I apologize. I’m not looking to blow anybody up, but I don’t want folks getting hurt because of bad advice either.

I suppose my bona fides are in order. I spent twelve years on the ambulance, half as an ent and half as a medic, in a busy suburban system. I also spent 8 years as a firefighter. I am now a PA with experience in the emergency room (urban and rural), with my previous job as medical school faculty at a level one trauma center as part of the trauma and acute care surgery service. I am also an instructor for Stop the Bleed. I now provide rural urgent care services. I spent a lot of time outside, but I’m a very green hunter and angler—I’m here to soak up all the knowledge in that area I can.

If there is interest in a Rokslide article on hemorrhage control, I’d be happy to provide one, but I’m not out looking for articles to write.

I highly recommend everyone check out stopthebleed.org. It is a national effort between FEMA and the American college of surgeons to educate 300 million Americans in how to manage life threatening bleeding. The courses are all free. If there’s interest, I’m happy to do a google hangout course or similar as well. You buy your own tourniquets, but my time is yours for free.

As always, PM me with any questions or comments you have.


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CaseyU

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Great write up Travis! Definitely gave me a couple extra ideas to add to mine. The only thing that I have in mine that was not mentioned and have used multiple times (not that its absolutely nesecarry but it sure can keep things from getting messy). And thats super glue. So many uses and they have little single use packs. Obviously tourniquets are a hot topic. I have carried one in my line gear for 12 years now. But with swinging sharp tools, running chainsaws on the regular, and a variety of other duties thay could lead to a major incident. I think its important, but as far as me in the wilderness? Not a chance. I would never tell anyone not to carry one. Rather encourage people to carry what they are compentant to use and comforatable knowing they have it. I'm with you buddy. Space and weight. Great write up brotha!

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Danimal

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-effective commercial tourniquets are readily available and ineffective. There is no reason not to have one.


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This was a confusing component of your first post. EFFECTIVE or INEFFECTIVE? All tourniquets or "makeshift" tourniquets? Like I have mentioned before, "tourniquet" discussion is dynamic and ever changing but stopping bleed, and the importance of doing so, is undeniably important. Thanks again for everyone's great input.
 

Beckjhong

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This was a confusing component of your first post. EFFECTIVE or INEFFECTIVE? All tourniquets or "makeshift" tourniquets? Like I have mentioned before, "tourniquet" discussion is dynamic and ever changing but stopping bleed, and the importance of doing so, is undeniably important. Thanks again for everyone's great input.
Effective! Thanks for catching that. I’m not sure the tourniquet discussion is ever changing, but stopping the bleed is our common goal. Certainly it doesn’t take the place of applying pressure or elevating a limb—stop the bleed also teaches a stepwise approach. However, for the layperson who doesn’t see bleeding often, if there’s any question about whether to apply a tourniquet, then apply the tourniquet! They are safe to use, and the risks of delaying tourniquet application in a serious bleed do not outweigh the risks of “early” or “aggressive” tourniquet application in a more minor bleed.


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Mike7

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Travis, I too would carry multiple ways to make a fire over a tourniquet!

Not that tourniquets aren't cool and can be quite effective, but I would do this because the odds that you are going to die in the backcountry from overwhelming blood loss are slim to none, where at least the odds of dying from hypothermia are actually measurable.

Anyone who wants to carry a tourniquet on their person for every hunt, regardless of the type or length of hunt, then more power to them, but for those who wish to review the literature/statistics and apply the same lightweight principles to their first aid kit that they do to everything else, then I think a reasonable case could be made for possibly leaving a tourniquet in the vehicle, at least for the non-tacticool folks.

I think part of the reason for this, which non-medical folks may not realize, is that your main arteries in your body happen to be in pretty protected locations, and unlike in battle, people walking around the woods are generally not trying to knife or shoot you. So in all likelihood, you are most likely to really need the knowledge of a hemorrhage control class when you are at home and not in the woods.

Since falls, getting lost, drowning, heart attack, avalanche/rock slide, hypothermia, & dehydration/heat stroke are by far and away some of the leading causes of backcountry death regardless of what medical kit you have along, then it would seem that planning appropriately would mean having the following items on hand maybe before contemplating the tourniquet...

a good GPS, trekking poles, a good head lamp or two, water wings if appropriate or at least a knowledge of river safety, aspirin, knowledge of avalanche conditions, a healthy fear of heights, good set of warm clothing/sleeping bag and fire starting kit, and water storage/purification abilities.
 

fwafwow

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Travis, I too would carry multiple ways to make a fire over a tourniquet!

Not that tourniquets aren't cool and can be quite effective, but I would do this because the odds that you are going to die in the backcountry from overwhelming blood loss are slim to none, where at least the odds of dying from hypothermia are actually measurable.

Anyone who wants to carry a tourniquet on their person for every hunt, regardless of the type or length of hunt, then more power to them, but for those who wish to review the literature/statistics and apply the same lightweight principles to their first aid kit that they do to everything else, then I think a reasonable case could be made for possibly leaving a tourniquet in the vehicle, at least for the non-tacticool folks.

I think part of the reason for this, which non-medical folks may not realize, is that your main arteries in your body happen to be in pretty protected locations, and unlike in battle, people walking around the woods are generally not trying to knife or shoot you. So in all likelihood, you are most likely to really need the knowledge of a hemorrhage control class when you are at home and not in the woods.

Since falls, getting lost, drowning, heart attack, avalanche/rock slide, hypothermia, & dehydration/heat stroke are by far and away some of the leading causes of backcountry death regardless of what medical kit you have along, then it would seem that planning appropriately would mean having the following items on hand maybe before contemplating the tourniquet...

a good GPS, trekking poles, a good head lamp or two, water wings if appropriate or at least a knowledge of river safety, aspirin, knowledge of avalanche conditions, a healthy fear of heights, good set of warm clothing/sleeping bag and fire starting kit, and water storage/purification abilities.
This is a great point. Personally I don't view the items on your list as mutually exclusive to carrying a tourniquet.

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