First aid in the field

SaltySailor

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Aug 21, 2018
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99
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Palmer, Alaska
I carry quickclot, a body staple kit, and compressed gauze in conjunction with simple band aids. My thought is that most likely, the situation I would need those things is after getting mauled by a bear- whether that be me or a buddy. I can make a tourney out of bunch of things I already carry.
 

Warmsy

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Jul 24, 2020
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I just wanted to clarify the above posters comment about the chest seals. The three major treatable traumas require different things.

I agree with you two above.
 

Marbles

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May 16, 2020
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Anchorage, AK
Very well said. One of my pet peeves is people using antiseptics instead of clean water for irrigating wounds when there is no evidence for their use. Your point about sutures is spot on.

One point I wanted to emphasize was that you were right to put a disclaimer on your improvised tourniquet advice. Recently had a patient in the ER, following a saw accident, that we struggled to control his bleeding with a commercial tourniquet and I cannot imagine myself improvising a proper tourniquet for that scenario in the field. I'd imagine you would have to have a very specific improvisation in mind with lots of practice and forethought to have mouse's fart of a chance to make it back to safety with a bleed that truly required a tourniquet.

Tourniquets are probably one of the simplest devices, yet most people don't actually know how to use them correctly. What follows is just general information for everyone.

The commercial ones are uniformly better than an improvised, even with training. My only reason for an improvised tourniquet in the backcountry is weight reduction and insuring I don't have a kit that ends up being left behind as it is unlikely I will need it. If going into a combat type situation, I would carry two C.A.T.s or S.O.F.T.T.s in first line or second line gear (not in a pack).

The methods of application between a commercial windlass tourniquet (such as the C.A.T.), a commercial elastic tourniquet (such as the R.A.T.S.), and an improvised tourniquet are all different. Just because you can apply one correctly does not mean you will be able to use the others correctly.

Here is an improvised tourniquet during practice. This one is actually obliterating distal pulses, notice how the amount of compression required to actually occlude the femoral artery. It is a little uncomfortable, and hurts if you try to use the muscles that are being compressed.
20201001_164950.jpg

Don't assume you can take a tourniquet off and reapply (this applies to commercial tourniquets as well). When I started there was only enough slack to get the shovel handle under the triangular bandage, notice how much it stretched and the frayed material. I attempted to apply it a second time and it broke before pulses where obliterated.
20201001_165141.jpg

I have also broken a C.A.T. Gen 7 that had been used previously in training.

If you are going to practice, practice on a thigh. Arms are easy, but the muscle mass on the thigh makes it a challenge to get adequate compression. If you fail to get adequate compression with the first tourniquet you apply, leave it in place and apply a second tourniquet 2 inches above it, if possible.
 

Rich M

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Jun 14, 2017
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Orlando
I carry quick clot and some stuff like that. My 80 yo dad usually goes and is on blood thinners. No messing around w him.

Personal I carry quick clot, ace bandage, some bandaid, super glue, tape, and a cutting glove along w some other stuff. Wear the cut glove on my working hand and watch the knife.

Fell last year in snow and landed on a sand stone nub. Just missed tailbone and had purple bruise for a month. Hip still bothers me at times. I worry more about stuff like this but great idea to carry first aid of your choice. Hope you never use it!
 

Marmots

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Sep 15, 2018
Messages
119
Location
Idaho
I'm personally not a fan of quick clot because I've been told tissue that it comes in contact with kind of cures up and a large amount eventually needs to be cut away. The last wilderness first responder course I took said to just use a lot of gauze.

I don't carry a tourniquet on foot, but carry one when I'm going fast around pointy trees, I.e. hunting off a snow machine or a jet boat. The organization Stop the Bleed has free tourniquet application classes all over the country. They also cover a lot of wound packing skills. I think the skills taught in Stop the Bleed are really handy to know for bowhunters, especially when I remember all the times I almost stuck my own ass tripping through mountain mahogany with broadheads falling out of my quiver.
 

Wumbo

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Joined
Jul 29, 2020
Messages
35
Tourniquets are probably one of the simplest devices, yet most people don't actually know how to use them correctly. What follows is just general information for everyone.

The commercial ones are uniformly better than an improvised, even with training. My only reason for an improvised tourniquet in the backcountry is weight reduction and insuring I don't have a kit that ends up being left behind as it is unlikely I will need it. If going into a combat type situation, I would carry two C.A.T.s or S.O.F.T.T.s in first line or second line gear (not in a pack).

The methods of application between a commercial windlass tourniquet (such as the C.A.T.), a commercial elastic tourniquet (such as the R.A.T.S.), and an improvised tourniquet are all different. Just because you can apply one correctly does not mean you will be able to use the others correctly.

Here is an improvised tourniquet during practice. This one is actually obliterating distal pulses, notice how the amount of compression required to actually occlude the femoral artery. It is a little uncomfortable, and hurts if you try to use the muscles that are being compressed.
View attachment 220553

Don't assume you can take a tourniquet off and reapply (this applies to commercial tourniquets as well). When I started there was only enough slack to get the shovel handle under the triangular bandage, notice how much it stretched and the frayed material. I attempted to apply it a second time and it broke before pulses where obliterated.
View attachment 220554

I have also broken a C.A.T. Gen 7 that had been used previously in training.

If you are going to practice, practice on a thigh. Arms are easy, but the muscle mass on the thigh makes it a challenge to get adequate compression. If you fail to get adequate compression with the first tourniquet you apply, leave it in place and apply a second tourniquet 2 inches above it, if possible.
Good demonstration. I'm curious what I could scrounge up in my kit that I could use similarly. Maybe a trekking pole and some paracord
 

Rokbar

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May 8, 2020
Messages
136
Location
WNC
I'm no medical expert, but for a tourniquet just wear a flexible nylon belt at least 2" wide. That's the deal the army used to train you with. A couple of pressure dressings. Hold pressure on said wound and elevate for 5-10 minutes or until bleeding stops. But normally I wear that belt, a couple of pressure dressings, bandaids, naproxen, and may consider iodine tabs for water purification.
 

Marbles

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403
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Anchorage, AK
I feel like I might be getting obnoxious at this point, so sorry. This is just one of those topics I nerd out about.

Good demonstration. I'm curious what I could scrounge up in my kit that I could use similarly. Maybe a trekking pole and some paracord

Ideally you want something 2 inches wide. Para cord would be better than death, but the odds of permanent nerve damage is very high with it. A 1 inch pack strap, while still less than ideal, would be better. What ever you use needs to be pretty flexible or you will not be able to tighten it. Anything less flexible than a seat belt is questionable and should be trialed when you don't need it. I wear a very thin 2 inch belt, but it is too stiff to work. Larger game bags could work if folded into a strip.

My normal plan is to use a section of trekking pole.

I carry quick clot and some stuff like that. My 80 yo dad usually goes and is on blood thinners. No messing around w him.

Whenever your Quick Clot expires I would replace it with Celox. Quick Clot requires a functional clotting cascade (what blood thinners disrupt) and Celox does not.

I'm personally not a fan of quick clot because I've been told tissue that it comes in contact with kind of cures up and a large amount eventually needs to be cut away.

This had more truth to it with the older products. It is not true with the current formulation, nor is it true with Celox. I would not use it on anything other than arterial bleeding though, mainly because there is no point wasting it on venous bleeding.

The two main uses are to get a tourniquet off if extraction times will be longer than 2 to 4 hours. Or to stop arterial bleeding that cannot be treated with a tourniquet, such as the guy who cut is carotid artery with a chainsaw and survived after rapid Celox application. A manual pressure can work, however direct pressure does not work well while moving someone and you loose a person as they cannot let go or do anything else. The same applies with tourniquets. Plus, it takes a decent bit of pressure, my hands started cramping after 20 or 30 minutes the two times I have held pressure for arterial bleeds.
 

Wumbo

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Jul 29, 2020
Messages
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I feel like I might be getting obnoxious at this point, so sorry. This is just one of those topics I nerd out about.



Ideally you want something 2 inches wide. Para cord would be better than death, but the odds of permanent nerve damage is very high with it. A 1 inch pack strap, while still less than ideal, would be better. What ever you use needs to be pretty flexible or you will not be able to tighten it. Anything less flexible than a seat belt is questionable and should be trialed when you don't need it. I wear a very thin 2 inch belt, but it is too stiff to work. Larger game bags could work if folded into a strip.

My normal plan is to use a section of trekking pole.



Whenever your Quick Clot expires I would replace it with Celox. Quick Clot requires a functional clotting cascade (what blood thinners disrupt) and Celox does not.



This had more truth to it with the older products. It is not true with the current formulation, nor is it true with Celox. I would not use it on anything other than arterial bleeding though, mainly because there is no point wasting it on venous bleeding.

The two main uses are to get a tourniquet off if extraction times will be longer than 2 to 4 hours. Or to stop arterial bleeding that cannot be treated with a tourniquet, such as the guy who cut is carotid artery with a chainsaw and survived after rapid Celox application. A manual pressure can work, however direct pressure does not work well while moving someone and you loose a person as they cannot let go or do anything else. The same applies with tourniquets. Plus, it takes a decent bit of pressure, my hands started cramping after 20 or 30 minutes the two times I have held pressure for arterial bleeds.

No apologies necessary, I'm actually appreciative of the thought you've put into it. In that case, I usually wear a thin/flat belt when hunting that came with a pair of Columbia shorts, I believe it is a polyester or nylon webbing. It's roughly 1inch or slightly shorter width and has a plastic buckle and is easily adjustable. I think it would be able to withstand the strain of tightening and would satisfy the larger width requirement
 

Rokbar

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May 8, 2020
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136
Location
WNC
One other medical aspect that is often forgotten because hunting happens in the winter, is a snake bite kit. For summer scouting or fishing trips. I know you attempt to remain calm if bitten. Any of you all have any proven insight on how to deal with a snake bite in the back country?
 

Marbles

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May 16, 2020
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Anchorage, AK
One other medical aspect that is often forgotten because hunting happens in the winter, is a snake bite kit. For summer scouting or fishing trips. I know you attempt to remain calm if bitten. Any of you all have any proven insight on how to deal with a snake bite in the back country?

Auebach's Wilderness Medicine 7th edition has about 40 pages on snake bites. However, they boil down to the only thing that has been shown to help with North American snakes (hemo toxins) is antivenom. Compression dressing have good effect in Australia, but the snakes in question have neuo toxic venom. It is possible (but not known) that a pressure dressing would actually make things worse with hemo toxins.

The other down side of pressure dressings is they require complete immobilization of the patient (not just the limb bitten) to be effective. Plus, the method of application used in Australia takes practice to get it correct. There is another method, but I don't remember the details well enough and my copy of Auebach's is not with me right now.

So, for snakes, prevention, and if that fails, a hospital.
 

Marbles

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Some exerpts from the "Wilderness Medical Society Practice Guidelines for the Treatment of Pitviper Envenomations in the United States and Canada" https://www.wemjournal.org/article/S1080-6032(15)00220-3/fulltext

"There is nothing that can be done in the field to significantly alter the outcome of a serious snakebite, and field first aid should not delay rapid transfer to a facility capable of safely administering antivenom.46 The degree of envenomation cannot be quickly determined with confidence; therefore, any bite by a venomous species must be considered a medical emergency and evaluated by a physician without delay. While en route or waiting for evacuation, first aid and wound care can be administered."

"Snakebites should be approached in a manner similar to that for any other puncture wound or laceration. Without delaying transport, the wound should be quickly cleaned in standard fashion (soap and running water, high-pressure irrigation or an antiseptic solution or both) and a sterile dressing applied to protect the wound."

"There have been no studies directly assessing immobilization alone for the improvement of snakebite outcomes. Limiting movement of the affected area by immobilization with splinting techniques (without compression) may benefit the patient, although no rigorous trials have validated this practice. Depending on the evacuation needs, the affected area should be maintained at the level of the heart: raising it above the heart can cause increased systemic spread of venom, whereas lowering it may lead to increased swelling and local venom activity. However, this practice has not been proved with evidence or clinical trials. Furthermore, the limb and joints should be kept in a functional position in case they swell or the joints become immobile."

"Unfortunately, there are many myths associated with the field care of snake envenomations, some of which can be harmful to the patient. Despite a lack of evidence, many of these techniques have permeated popular culture and historical medical literature, and therefore they are often erroneously applied. The following techniques are of no benefit or are potentially harmful to the patient."
 
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Razz

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Sep 13, 2020
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Location
Teton County Idaho
Aside from bandaids, the most used items in my kit are a small irrigation syringe and povidone iodine applicators. Cleaning a cut before applying any type of dressing or bandaid is key to avoiding infection, especially in the backcountry. These items weigh next to nothing, allow you to flush a cut with clean drinking water and help ward off infection.
 

t-tacker

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Sep 27, 2020
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Check out coursera.com
Free online courses. Might be a little overkill, but 7 hours of instruction you should be pretty well off.
 
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