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A Controversial View

Discussion in 'First Aid Station' started by DavyJ, Mar 1, 2014.

  1. VinceRN

    VinceRN Loaded Pockets

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    Training, situational awareness and the ability to remain calm in an emergency are far more important, and more useful than any kit. There are few things you can run into that can't be handled with improvised measures by a trained person.

    As for a tourniquet, even here in America we are far more likely to need one for industrial injuries than for gunshots. Few civilians that carry guns will ever see anyone shot, and few gunshot wounds will require a tourniquet.

    I'm an ER nurse, and spent the first 8 years of my career in an ER in downtown LA in the '90s. Out of the hundreds of gunshot wounds I've seen only a couple warranted a tourniquet, and even those were questionable. On the other hand out of the maybe a dozen or so bandsaw injuries I've seen maybe almost half warranted a tourniquet. In the past year I've used them twice, both on deep lacerations.

    Also, more than half the half the patients I have seen come into the ER with tourniquets have been done wrong and were not actually needed.

    The one thing I would recommend carrying besides a knife is tape. It has a million uses outside first aid, but it can also make putting a bulky or pressure dressing, or a splint much easier.

    Sent from my mind using Tapatalk HD
     
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  2. CNeal

    CNeal Loaded Pockets

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    I carry a small FAK on my bag. It is really just a nice boo-boo kit. With a smattering of bandaids, gauze, tape, OTC meds and any RX I or my fam are on at the time. This kit is homemade and tailored to me and mine.
    With that said I keep a very small
    "bleeder kit" in my bag as well. It consists of a 4" izzy, 15 gm Celox a roll of combat gauze and a 3 " ace wrap. I am trained to use them and I carry them because bad things happen to good people and my job as head sheepdog to this family means I can/will not leave their safety in the hands of others.
    Yes I can I.A.O with the best of them but why would I when these things are readily available? What the 6-8 oz they weigh is too much to carry? This is my family we are talking about I do not need a mass casu bag.....sorry folks but the rest of the world be damned I carry for me and mine! I need to stop the bleeding long enough to get them to the pros so I carry a few things to make that possible.


    I take no offense from DavyJ or anyone that has a different point of view, as a matter of fact I learn so much from you all that it amazes me everyday what great and intelligent folks we have around here. I came here to research bags I stay because of the great community.

    Thank you for starting such a thought provoking thread my friend.
     
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  3. FL Woods Bum
    • In Omnia Paratus

    FL Woods Bum Your Grace!

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    Alright, after careful consideration of the points brought up in this thread I have updated my FAK appropriately. I think everyone should be able to agree that this is the best all around compromise.

    :D

    [​IMG]

    It's been a great thread, just had to interject some fun. No Cobra, I won't share.
     
  4. DavyJ

    DavyJ Loaded Pockets

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    Sorry, not buying it, sticking (ha!) with ...


    [​IMG]
    MLP FAK by emptyofclouds, on Flickr

    EDIT: You know these are better coz if you look closely you will see that they added pizzazz!
     
    Last edited by DavyJ, Mar 3, 2014
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  5. Lou_G

    Lou_G Banned

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    I need to add pizzazz to all of my gear now.
     
  6. Templar

    Templar Loaded Pockets

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    I am so glad you posted the OP, as a doctor (admittedly I now work in forensic medicine) my EDC FAK is nothing more than a few plasters and some paracetamol for the morning after. This isn't because I don't want all the cool stuff, I really do, but if I ever happen across an accident what I really want is a paramedic...

    I have answered medical calls on planed before and their doctors kits are huge they even have CDs but I get the feeling some people here carry more.
     
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  7. sungame

    sungame Loaded Pockets

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    I do not EDC a first aid kit of any sort, but keep one in most of my bags. Although I have never used one for anything more serious than cuts (the largest requiring three stitches) and sprains, and hope never to do so, I will continue to keep them there. These are my reasons:

    • I live in Norway. Norwegian law states that if you arrive at the scene of an accident, you have to help. Not helping is actually a crime. Of course, no one can do better than they are trained and equipped for, but you will have to do your best.
    • I do have some first aid training; a standard Red Cross course, a specialized version of this focusing on babies and toddlers, and what we learned in Boy scouts. While this is not much, I believe it is better than nothing. Also, experience has taught me that even with this basic training, I could very well be the best trained person on the scene of an accident.
    • I live in a semi-rural area. Around here, I will never be far from help, but I will always be at least 20 minutes from qualified, professional help. Yes, untrained individuals with a FAK may end up doing more harm than good, but in most cases, I believe that untrained help will be better than none. In some cases, it might even save a life.
    • While a trained professional may be able to improvise a lot in an emergency, improvising will be far harder for the rest of us. Handling an emergency with the right equipment is hard enough, trying to improvise a dressing from your shirt while someone is bleeding all over must be even harder.
    • Even though it might only take the ambulance a couple of minutes to get to the scene of an accident, that may be too long for a seriously wounded individual. As a layman, I will not attempt to "fix" or "cure" a serious injury, but I might have to keep one under control until the professionals arrive. In such a case, a proper bandage might well be the difference between life and death.
    • No, I cannot carry enough bandaging materials to take care of all the victims of a massive, hundred car accident. But neither can I bring more than one copy of myself. In such a case, I believe manpower would probably be a more critical problem than equipment. Also, not being able to help all the victims would be a rather poor excuse for not trying to help some of them.
    • My FAKs are also boo boo kits/comfort kits. And while a splitting headache or a cut on your finger bleeding all over will not kill you, they can certainly ruin your day.
    I understand where the OP is coming from, and @DavyJ does have a couple of pretty good points. Still, I believe that the middle ground is a rather good place to be, in this case as in many others. Therefore, I do not EDC a first aid kit, but I frequently carry one. And even though I see no point in carrying anything that my meager training and a bit of common sense will not tell me how to use, I still think keeping a few bandaids, some pain killer, an elastic bandage and a battle dressing in my bag makes a lot of sense.

    EDIT: A rather important "not" added.
     
    Last edited by sungame, Mar 5, 2014
  8. DavyJ

    DavyJ Loaded Pockets

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    Good post ^^ and good points.

    In order to find what the middle ground is we have to explore and define the extremities first. In starting this thread I had it in the back of my mind that I was positing an almost 'no-FAK' position, and that this was likely to be polarising. I also realised that this position was unlikely to be set in stone. In reality I do carry I FAK in my bag, but in general the bag sits in my office or in the car. That leaves me with a few dressings /bandaids and tape that end up on my person when I am away from my bag. In part this is the crux of my argument. I do not think I would wish to carry a bag containing an extensive medical load-out with me everywhere I go. So, I am advocating the middle ground, as you are Sungame, and I am also suggesting that it is worth critically assessing what is contained within a 'middle ground FAK' in order to bring that which is likely useful and that which is not. Of course, the situations and environments that people find themselves working/living in from day to day will play a significant factor with regard to the content of their FAK - at least it should do, rather than a kitchen sink approach.
     
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  9. sungame

    sungame Loaded Pockets

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    That's a good point, too!

    Perhaps we are not all that different after all...

    This is also very important, and I wholeheartedly agree. Personally, I have multiple kits for different situations. The smaller ones contain only a few bandaids, pain killers, allergy meds, a battle dressing and a few compresses, while my sports and outdoors kits is more substantial.
     
  10. Lane DeCamp

    Lane DeCamp Loaded Pockets

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    A few thoughts. And apologies for speaking out bluntly since I'm new on this forum. I run a company doing catastrophe planning for US and foreign governments, so we're in everything from nuclear disasters to tsunamis to large explosions to epidemics. We work extensively with first responders of all types, military and civilian, in all kinds of circumstances. I guess we take a slightly different perspective on this whole issue.

    First, let's look at what we see as the realistic injuries that need to be treated. Forget gunshots, intentional knife wounds, etc. The biggest crises we see are concussions, shock of various types (generally with cardiac cessation, respiratory problems, etc., often related to drugs, anaphylactic shock, diabetes, etc.), and lung issues (water ingestion, burning and smoke injury, damaging airborne particulates, infections, etc.). For every person with a traumatic penetrating injury there are a dozen with these other issues, and they are usually more critical. If you watch a first responder at a car accident, they'll ignore most of the injuries that produce blood and focus on these kinds of problems. That's what we see too.

    Second, if you have a simple limited accident with traumatic injury, such as a basic car accident, you usually have access to professional first responders -- roads are clear, there's transportation to and from, phones are working, there are tremendous resources a phone call away, etc. You can probably assume you can be on the phone with someone in seconds and be guided through whatever they would ask you to do, and that's the limit of what you should be doing anyway, especially since whoever is on the line is acutely aware of where additional resources are located and when they can arrive. The single most useful thing you can usually do as a non-professional is to cut away enough clothing to check for additional injuries so you can advise by phone. If they want you to do something, they can tell you. That basically is a matter of a pair of 8 inch Lister bandage scissors, which are about as harmless and as fast to use as you can get. Forget gut-hook-type belt cutters and fabric cutters -- they don't work like they're billed when you're in a crisis. Once you can tell someone on your phone what you see, and volunteer to help, they can tell you what is most beneficial.

    Third, this isn't about being heroes. Besides the fact that most heroic actions will be wrong, you can end up facing liability if you're doing something in presumption of being a professional but not being properly trained. And the response to an amazing number of injuries isn't necessarily to solve the injury on the spot. It's breathing, brain function, and heart beat that should be your primarily concerns. Blood loss isn't on that list because the skills to address it are much more advanced and because you very often have internal bleeding which requires different skills to recognize and then to treat. And blood often will distract you from bigger issues. Again, in comparison to what first responders are taught, the average Joe's responses should start with communicating, then with identifying issues, and last with intervening in the case.

    Fourth, human skills trump equipment. If you anticipate finding yourself in a serious critical-care situation, I'd suggest owning an iPad and a few key guides on it to emergency procedures. (Those procedures are not necessarily the same that a first responder would pursue, for the same reason as mentioned above -- you aren't there to fix the problem, just to communicate, identify, and potentially be guided in limited approaches using supplies that you almost certainly won't have planned for.) There are a couple good sailing and mountaineering advanced medicine handbooks, but the best are the recent medical trauma handbooks written for the US military. The Red Cross and similar manuals are far from adequate. The military manuals address what a trained medic has to do, and then what the soldier in the bunker next to you might have to do for you. If you read those books carefully you'll notice that there is no standard first-aid kit for combat situations, and generally over the years the kits have gotten sparser and sparser. It always come back to getting trained help and evacuating the victim to a qualified care location.

    We've gone into major disaster sites where if we brought medical supplies, they were only enough for the first one percent of the casualties we were dealing with. But we didn't need clotting bandages or suture kits or tourniquets anywhere near as much as we did flashlights and scissors, paper and pencils, and phones with charging systems. When I go into a situation, in addition to my own basic load out (heavy on flashlights, batteries, small notebooks and pencils, spare phone and USB backup battery charges or solar panels, and the like), I also carry dozens of LED headlamps, loads of matching batteries, and loads of floor-grade bandage scissors and piles of Telfa pads and tape. All those headlamps and scissors get given away within the first day or two. That's what people need. You have to be able to see and report, you need to expose any hidden injuries, and you need to cover and protect from contamination. After that, it's about dealing with concussions, shock, and respiratory impairment, none of which involve hardware that a FAK will likely include.

    This is a huge topic but the OP generally has the right idea. In all the time spent writing and reading all the posts about first aid kits here and elsewhere, everyone could be reading and taking classes. Save the money spent on first aid kits and keep it super simple. Mostly, just be sure you are calm and your instincts are in line -- to communicate first, report carefully, take direction, and then wait for help. You'll be a godsend to 95% of the injuries you run into, and for the last 5%, it's in the hands of the first responders and God.

    All of this is worth about $0.03 less than a nickel. But we've bought a lot of beers for first responders and ER physicians after marathons of caring for hundreds of people. My people are trained not to give any individual medical care at all. Period. Their job is to make the system work for the first responders and emergency care facilities, which means they are arranging deliveries of generators, water, additional professionals, ambulances from distant locations, and so on and so on. And they are setting up decontamination, quarantines, morgues, and all the other requirements dictated by the particular situation. But we have to train a lot of unintentional caregivers and this is what we focus on. It works pretty well.
     
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  11. T.H.Cone

    T.H.Cone I am senor Fluffy, hear me roar

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    Lane, there is a sub forum here on handguns. Even in the short time you've been here, you've probably seen many pictures of people's EDC that include a firearm. People who carry, do so on the off chance, however unlikely, that they may have to use it to cause trauma in an effort to stop a threat to themselves or others.

    So, while what you said may have merit when talking about the general public, or when dealing with natural disasters, when talking about people who, to varying degrees, go about their day "prepared", to suggest that people who carry a tool every day that can cause trauma should not learn how to treat the common types of trauma associated with the tool and to carry the minimal equipment necessary, is, in my opinion, unwise.

    I suggest that if one is willing to invest the time, money, and effort into a defensive tool, the very least they should do is invest the time, money, and effort into the other side of the equation. We all know that by the time the defensive tool become necessary, there is a very good chance that, even if you stop the threat, that you or others in your charge may be injured as well.

    Also, response time in many locations is not as quick as you are suggesting. In a rural setting, or if you spend time in the outdoors, help is not always as close as you suggest. Not to mention, calling for help is predicated on having a cell signal. Not to mention that cell service can go down even in highly urbanized environments (9/11 comes to mind).

    On top of all that, EMTs will not be allowed to a scene of violence until the LEOs have secured the area, so if something horrific were to happen, you could be right next to fire/rescue and help could be a long way off.

    I also just read an article not that long ago of an off duty LEO who wrecked his car while driving with his arm out the window. But for a tourniquet on the sun visor, applied by the LEO before he lost consciousness, he'd be dead today instead of just a guy with no left arm.

    So, while it is absolutely true that I am way, way, more likely to have to give CPR to a coworker or have to know how to deal with the 10 year-old diabetic neighbor who is often in my house playing with my sons, being prepared for more never hurts. Because, lets face it, you never know.

    All of that said, there is no one right answer. As I've said many time before, we all have to decide the right course of action is for us as individuals.
     
    Last edited by T.H.Cone, Mar 12, 2014
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  12. DavyJ

    DavyJ Loaded Pockets

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    @T.H.Cone, that took me back a few (a lot really) years to when I was training to be a field medic. The juxtaposition between being trained to save lives and being trained to use lethal force in defence of life was difficult to grasp at first (for a young idealistic male). In shooting an enemy combatant in the course of your duties, it is required that you render medical aid to that enemy (assuming you didn't kill them). Once they were injured their status basically changed. It didn't help that my personal weapon was an L1A1 - a weapon that tended to inflict some pretty terrible wounds.

    But I digress. Suprised this thread is still bimbling along. Some really good posts though!
     
  13. kertap75

    kertap75 EDC Junkie!!!!!

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    I liked getting the perspective of someone who trains for and helps organize response for disasters. I look forward to picking his/her brain in other threads. I think for the most part it was good advice too.

    Remember, big brother is watching
     
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  14. T.H.Cone

    T.H.Cone I am senor Fluffy, hear me roar

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    DavyJ, it's not that I think you , Lane, and the others that have a different perspective than mine don't have good ideas or valid points. This forum would be useless if we all saw a given issue the same way. We all have reasons for doing the things we do and feeling a certain way about particular subjects.

    That's how it should be.

    In a world where people are generally becoming ever less self-reliant and few, if any, have even a few Band-Aids in their wallet/purse, a VOK is certainly going to seem like way, way too much. But even one of the tiny, tiny AMK's prepackaged booboo kits would seem overkill as well.
     
  15. Lane DeCamp

    Lane DeCamp Loaded Pockets

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    I appreciate your thoughts and yes, there are a huge number of different scenarios that one could prepare for. I frankly didn't think about those who actually carried firearms on this forum, though by the number of discussions in the various forums, it would seem to be a minority. I would still question the liability and wisdom in treating someone with a serious gunshot wound without specialized training. And short-term care in some of the cases you suggest would involve materials I didn't see in any FAK list on this forum, so I do wonder whether most people are really prepared for what they would have to face with a real gunshot wound.

    On the point that LEOs would secure the area before EMTs are allowed to enter, that position has changed and DHS and other entities have agreed that the best medical care requires immediate deployment. This was demonstrated with extensive data from military field care, and the new recommendation is to have EMTs approach the wounded immediately and either evacuate them or care for them in situ. For some first responders that may not be their preferred approach, but it is becoming the allowed and recommended strategy.

    I would be interested to see how many forum members carrying FAKs can actually diagnose anaphylactic shock and know what to do, or know what is needed for a severe concussion. Our experience in the field, both here and abroad, is that those are the kinds of skills most often lacking. To everyone their own, but is it not reasonable that preparation for the most common needs be prioritized over the less common? Even in the wilderness (and I was a NOLS instructor myself for several years), concussions, shock, flailed chest, and fractures are more likely than offensive weapon injuries, yet I don't see those addressed in the FAK content lists many have proposed. I'm not trying to point fingers at all, just to suggest (somewhat as the OP did) that the reality of the situation is a bit different from what one plans for.

    Thanks for your comments. This is a diverse and intriguing forum with a great cumulated experience.
     
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  16. Cheeser
    • In Omnia Paratus

    Cheeser Hey Bub!

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    I think in general a boo boo kit is fine, Waterless hand cleaner or wipes, some bandaids and some pain meds are usually sufficient. If I'm hiking I'll add a bandage in case my partner has a Sarah Jane Smith moment lol, but thats about it
     
  17. FL Woods Bum
    • In Omnia Paratus

    FL Woods Bum Your Grace!

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    Having lived and worked through Hurricane Andrew, I learned first hand that I and many others that were affected by that hurricane could not count on Emergency Services to be available or sufficiently prepared. No amount of explaining to me how dangerous it is for me to have EMT level first aid kits or how good Emergency Services are now will change the facts of what I saw first hand. Those who lived through Katrina found out what I did and our country had years after Andrew to prepare for another such Hurricane.

    While I don't advocate attempting a complex medical procedure on your neighbor in lieu of calling 911, I also don't subscribe to the idea that I will handicap myself by only buying band-aids and a stick of bubble gum. I would rather have a full mobile hospital and never need it, than need something as simple as Celox or a compression bandage and not have it.

    P.S. The EMTs who often trailed our tree trucks (so we could cut them a path down the highway), actually pillaged my fully stocked EMS bag their third day in as they were short of supplies and weren't expecting a restock for another 8 hours. Sometimes it helps to be more prepared than Emergency Services.
     
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  18. DavyJ

    DavyJ Loaded Pockets

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    Hi Lane, it's interesting that you mention concussions as this type of injury is quite common, particularly among people who play sports or indulge in other highly physical activities. Although there have been several international conferences on concussion in sport - and there exists a Consensus Statement on Concussion - there still remains a great deal of confusion over how to manage a concussion. Hospital doctors will tell you one thing, paramedics another, a sport physio another and so on. What is clear is that in the sporting context, until now, many young people are taking the 'suck it up' approach and carrying on. Anyway, apart from the interest (I've worked for some of the researchers in this area), I re-raise your point simply because concussion is way more likely to be found than a gunshot wound, and thus it would probably be better for people to be prepared for dealing with concussion than the gunshots. Of course, if they can prepared for both then that's great.

    Anaphylactic shock is another good one. There are quite a few members on here who carry epi-pens - whether for themselves or others I am uncertain. However, in considering the 3 Criterion approach I do wonder how many people carry a BP monitor - there are small electronic ones around so i anyone has one speak up and surprise me! :) If the monitor is not available then we are left with skin issues + persistent gastric symptoms AND/OR respiratory compromise. Include lowered BP if you can measure it, but some of the associated effects of low BP such as incontinence will be easy to spot.

    How's that? Dredged from memory. Don't know how accurate that is, haven't seen an Ana in years.

    @FL Woods Bum, commendable stuff there mate! Ultimately you do what you can with what you can lay your hands on.
     
  19. CNeal

    CNeal Loaded Pockets

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    Because as I said before, bad things happen to good people.....[​IMG]....and since we don't have a FAK in our shop I need mine. A little neo, a little superglue, 2 in gauze and some tape. And I am back in the game!
    Without this I am on my way to ER for a couple stitches.
    I keep meaning to put a few steri-strips in my FAK.
     
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  20. DavyJ

    DavyJ Loaded Pockets

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    +1 for using your FAK and skills :D ... but... -1 for getting injured :cry:

    Looks like you came out even! :)
     
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