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Building a FAK vs Buying a FAK, hit or msss

Discussion in 'First Aid Station' started by lotsofstufftogo, Feb 15, 2010.

  1. cap6888
    • In Omnia Paratus

    cap6888 Loaded Pockets

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    I would respectfully disagree with the statement that sterile water loses it's sterility once it leaves the bottle. Are you saying that as the water leaves the bottle and travels several inches through the air to the wound, it becomes contaminated? In an ER that is exactly how a wound is cleaned out. Your example of shards of glass does pose an interesting point though. If there are very, very tiny splinters of glass, then yes, water (under some sort of pressure) may push the glass into the tissue. In this case, forceps or tweezers would be used to remove the objects. But some sort of irrigation of the would would be done first. Dirt or other debris will be flushed out of the wound with simple irrigation. It is the same premise of washing a small cut at home in the sink before applying a band aid. And yes, bottled water is more than likely just as safe as sterile water. But sterile water IS sterile.
     
  2. ObiHann

    ObiHann Loaded Pockets

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    Its the same truth for a bandaid, it is sterile until you open it. A ER is a sterile, controlled environment. In a ER there is no risk of car exhaust, cigarette smoke, pollin, dander, etc getting in the way. Also, you should in most cases NEVER remove foreign debree from a wound, more damage can be caused than prevented. If you have a clump of rocks in a open wound, that could be what clotted around the artery, when you remove it, you start the bleeding again. If it is something sharp, or longer than you think, you can easily shred a nerve or artery by removing it. Red Cross, St John Ambulance, etc all tell you in even the most basic half day first aid courses to not remove anything and be extremely careful when using any liquid. A even more extreme example, what if it is a chemical issue, perhaps you don't even notice. By adding water you can move that chemical further into the wound and cause even further damage.
     
  3. VinnyP
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    All water dilutes the contaminants in the wound and carries them away, that's why we wash them, sterile water adds no new contaminants. Bottled water is designed to be safe for your stomach which is not the same as an open wound as many things can aggravate the stomach that are safe on a wound and, more importantly, visa versa (Put your bottled water under a microscope and compare it to sterile wash). I'd go with bottled water for sure but I'd use sterile wash in preference if I had it. Anything in the air is already on the wound so the water will not be adding anything but will probably be carrying it away.

    As for your chemical comment the first aid treatment for chemical burns is lots of water as well, what do you think most of your body is made up of? Better the reaction is with water you have added than that in your tissues.
     
  4. cap6888
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    cap6888 Loaded Pockets

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    Both Obihann and VinnyP have points on chemical burns. Obi is right in the point that certain alkali chemicals can burn more with water added. But if you continually flush that alkali burn with COPIOUS (I am talking constant running water in large volumes) of water, then it will work.

    I will stand my ground on the sterility issue. Yes sterile items can become contaminated when you open/exposethem. However, as long as you keep them out of any sort of dirty matter, they are better than using something non sterile at all. As far as debris in a wound, i still do agree, there are some items (such as glass) that can cause further damage if not treated properly. But how many of us have scraped gravel/dirt/sand, etc out of a wound? I don't think clumps of rocks would clot around arterial bleeding. If anything, they need to be removed, so the artery can be appropriately manage.

    Disclaimer: Just as an FYI, I am a paramedic, and served as a combat life saver in Iraq. My medical knowledge is a bit more advanced due to my various training. I tend to look at treating wounds differnetly than some.
     
  5. ObiHann

    ObiHann Loaded Pockets

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    I think were starting to all get on the same page. Like you said, some chemicals react with water and require LOTS of it, constant flushing. That's more than you can carry for sure. As for having scraped gravel dirt sand or glass out of a wound, I have seen them all. Shattered glass from a kitchen in a hand, skinning a knee and having rocks and sand embedded, and so on, and so on. And as you said, your treatment is a bit different, because your training is much more advanced. Your trained to be able to remove a lot of the objects within a wound without causing excess damage, but the people that find a guy on the street, or see there buddy with glass in there hand, they are not trained. Heck, I am a first responder and I wouldn't even start ripping debris from a wound.
     
  6. StealthChaser13

    StealthChaser13 Loaded Pockets

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    I'm currently training to be an EMT...we are told you never pour anything into an open wound, no matter what it is (water or otherwise)...you dress it, bandage it, and get the person to the ER; if it needs cleaning out, the ER will do it.
     
  7. cap6888
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    cap6888 Loaded Pockets

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    Yeah, I think we have met in the middle. And you are 100% correct, I think most people on this forum don't have any advanced medical training, so simple is better. And to clarify a point (which I think is the point of contention here) when I talk about removing debris from a wound, I am talking more about "topical" stuff. Things that easily brush away like small gravel or dirt from falling off a bike sort of thing. If something is embedded, and would require some sort of pick up to be removed, then you have entered into another arena for treatment. Flushing a simple wound with either sterile water/bottled water/water from a faucet is still something I would recommend, but use caution when the wound is more serious.
     
  8. ObiHann

    ObiHann Loaded Pockets

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    I think it is extremely important to focus on scope of training. If you are trained to clean a wound and remove and debris, power to you, go for it. If you are not, and you are simply going on what you think, than you can get sued.
     
  9. cap6888
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    cap6888 Loaded Pockets

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    :agree:
     
  10. Atlas

    Atlas Loaded Pockets

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    when you are bleeding heavily and pressure is applied to the wound, its the same thing? so why not try to remove a bit before you press them inward?
     
  11. Viper715

    Viper715 Loaded Pockets

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    My training is older than most in here so I may be out of date. I remeber ABCD; Airway, Breathing , Circulation, Disability or Damage. When it comes to causing damage to underlying tissues by applying pressure to a open and heavily bleeding wound, my guess is if the wound is bad enough to have the need for pressure to control it then you most likely wont see the debris that you need to remove. Also the need to control and stop bleeding for a major injury out weighs the possible damage that "MAY" be caused by the pressure. There are priorities in medical care and keepin the red stuff in the body is even before keeping the extremity working. Same is if they aint breething no need to worry about that bleeding until you get them breathing again.

    When it comes to a wound that you "know" has harmful debris i.e. glass where direct pressure may be a problem you can attempt a pressure point for the paticular are of the body affect in an attempt to control the bleeding. All these scenerios are very dependent on the circumstances of the event and the training of the individual involved. If you aren't trained to do it this day and age then don't try it.

    Like I said I was trained a while ago and have not been fully into the Paramedic world for sometime. I currently only keep my first responder up so if I am wrong then feel free to correct me.
     
  12. cap6888
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    cap6888 Loaded Pockets

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    Viper-

    You are right in the order. Although the current NREMT mindset for bleeding control goes straight from direct pressure to tourniquets nowadays. After doing research in the war, they found that tourniquets work the best, and are not as harmful as once thought.
     
  13. Viper715

    Viper715 Loaded Pockets

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    See there you go my training said almost never use turniquets. I always keep a Cat combat one and Israele ptessure bandage though.
     
  14. StealthChaser13

    StealthChaser13 Loaded Pockets

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    my current EMT (NYS) trainining says tournequits are a last resort...first dirct pressure, then pressure-point(s)
     
  15. ClusterFlux

    ClusterFlux Loaded Pockets

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    Well said! Another thing to keep in mind is that there are slight differences in procedure between Urban and Wilderness medicine. One has to take into account things like infection when patient care is a couple of days rather than an hour or so.

    Same thing here with the Colorado EMS system. Though the studies have shown that the tourniquets work well, the text books still say to use them as a last resort. It makes sense though I mean using a tourniquet on an oozing venous bleed is kinda like bringing a tank to a knife fight: it works but it's kind of overkill. I'm kinda excited to see how the newer clotting agents are working out in places like Iraq.
     
  16. jfirebalrog

    jfirebalrog Empty Pockets

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    The military has switched to what they call TCCC,which emphasizes bleeding control first in trauma(makes sense as arterial bleed =death in 4-6min,and apnea causes little damage in that same period).They also apply tourniquets first in the initial phase of care,as they do not risk damage to the limb for several hours. From the written reports I have read the hemostatics are having mixed results,with the best showings from the wound packing types like quick clot combat gauze.Just as vietnam changed medical care GWOT will.One thing I have seen already is a return to use of Intraosseous fluids for adults,and the beginings of a move away from crystaloid fluids for trauma.
     
  17. ObiHann

    ObiHann Loaded Pockets

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    I went out the other day looking for a pre-built FAK for EDC, it will live in the bottom of my 5.11 Rush 24. I was shooting for the AM Ultralight .9, but when comparing the contents, i went with the .7. For what you loose in gear, you gain in weight and space, and when it comes down to it, both are more than what I need to carry.
     
  18. jehan60188

    jehan60188 Loaded Pockets

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    this. FAK boxes are uniquely shaped/compartmentalized.
    buy a fak. dump it out, and use the box for your own fak.
    or get a red tackle box, and paint a white cross on it.
     
  19. ObiHann

    ObiHann Loaded Pockets

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  20. madkins007

    madkins007 Loaded Pockets

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    Its been interesting to read the discussions between combat-based field treatment and urban-based. I think this highlights one important aspect of FAKs- gear it to your needs and training. A lot of the lists I have seen mentioned here are more suited to a boat at sea than a typical household. To be perfectly frank, if some of these people showed up to help me, I would not let them since some of these suggestions will complicate the follow-up ER care.

    Buy or build? As a trained responder and instructor- build or add-to, to match your training, experience, skills, and willingness to get messy; but don't let your FAK become a red gizmo bag.