Israel Lessons learned No treatment while in direct engagement No treatment if there is no cover, unless absolutely necessary Know when to call off CPR early (in order to treat other patients if multiple casualties) 234
Call for Help Request an ALS ambulance Try to talk to the EMS dispatcher Patient assessment Pre-arrival instructions EMS response time Hospital notification 235
Tactical care The death rate increases with the time spent in the pre-hospital system. Trauma is a time related disease. Definitive treatment is usually surgical. The priority is fast transportation to an appropriate hospital. 236
Should you wait for the ambulance? EMS response time ALS or BLS response Ground or air ambulance Distance to the nearest hospital Distance to the nearest trauma center Rural or urban area 237
Should you wait for the ambulance? Consider transporting the patient yourself: EMS response time > 10 minutes Close to a trauma center After discussion with the EMS dispatcher In a rural area, consider setting a rendezvous with the ambulance and starting the transportation yourself TIME IS CRITICAL 238
Field Triage: Trauma Center Criteria Penetrating trauma to chest, abdomen, head, neck, groin or extremities proximal to the elbow or knee Glasgow Coma Scale < 14 Respiratory rate < 10 or > 29 Extrication time > 20 minutes (penetrating trauma) 239
On-Scene Helicopter Triage Patient with trauma center criteria Travel time by ground to trauma center> 15 minutes No ALS ambulance Multiple victims 240
Medical Threat Assessment - 1 Resources Hospital Trauma center (definition) EMS (access, response time, ALS or BLS) Air ambulance Know when and how to access it. 241
Medical Threat Assessment - 2 Potential problems Weather Extended operations (over 3 hours) Remote location HazMat, drug lab Known medical problems Have on file the medical history of fugitives (e.g., asthma) 242
Hospital: Advance Work Location, access route Direct phone to emergency department Change of shift Trauma center accreditation 243
EMS: Advance Work 911 access Direct phone number Radio access BLS or ALS service Availability 244
Rural Operations Travel time to hospital Rendezvous with EMS ambulance 245
Medical Threat Assessment High-risk situation: Need for a pre-staged ambulance Need for TEMS personnel 246
247
Medical Kits 248
249
Medical Kits Personal kit Warrant team kit Car kit Range kit 250
Personal Medical Kit Contents: Gloves (2 pairs) Military trauma dressings (2) Tourniquet (1) Rolls of gauze, sterile (2) Container: Zip-loc bag Should be carried at all times 251
Gloves Nitrile best Latex acceptable Avoid vinyl 252
Trauma Dressings Military field dressing ($2.10) Dressing, First Aid, Field, Camouflaged NSN 6510-00-159-4883 4 by 6 ¼ to 7 ¼ inches Made by Elwyn Industries Cederroth Bloodstopper ($2.50) First Care Products Emergency Bandage ($4.20) Israeli bandage NSN 6510-01-460-0849 253
Tourniquets: Triangular Bandages US military triangular bandage Bandage, Muslin, Compressed, Camouflaged, 37 x 37 x 52 inches NSN 6510-00-201-1755 Made by Elwyn Industries Hansaplast Viscose Mitella triangular bandage 96 x 96 x 136 cm Made by Beiersdorf AG Any cheap triangular bandage (37 x 37 x 52 inches) 254
Other Tourniquets Several one-handed tourniquets on the market Do they really work? Rangers (weight!) SEALs 255
Roll of Gauze Disorganized conforming bandage Kerlix 256
Hemostatic Dressings They actively stop the bleeding. Do they really work? Dry fibrin Chitosan Quick Clot www.hemcon.com www.z-medica.com 257
Other Supplies Co-Ban cohesive bandage (sticks only to itself) SAM splint www.samsplint.com Xeroform dressing (non-adherent) Laerdal pocket mask 258
Sources Gall s Bound Tree Adventure Medical Kits www.galls.com www.boundtree.com www.adventuremedicalkits.com Wilderness and travel medical kits Chinook Medical Gear www.chinookmed.com Medical supplies for expeditions 259
Personal Medical Kit Contents: Gloves (2 pairs) Military trauma dressings (2) Tourniquet (1) Rolls of gauze, sterile (2) Container: Zip-loc bag Should be carried at all times 260
Warrant Team Kit Contents - 1: Personal medical kits (at least 2) Dressing materials: Bandage strips, tape wound closure Various trauma dressings, non-adherent dressings 4 x 4 gauze pads Tape Elastic wraps Safety pins 261
Warrant Team Kit Contents - 2: Space blankets Pocket mask Splint EMT shears Cold compresses Medications: acetaminophen, ibuprofen, triple antibiotic ointment Artificial tears (saline) Antiseptic 262
Warrant Team Kit Optional equipment (with additional training): AED Nasopharyngeal airway Oropharyngeal airways C-collar Should be available during training Can be carried in a backpack Can be staged just outside the door 263
Car Kit Similar to the warrant team kit Separate trauma kit and medical kit for minor problems Rigid case 264
Car Kit Similar to the warrant team kit Separate trauma kit and medical kit for minor problems Rigid case 265