Austere Medicine

Austere Medicine

LiveFire Care Under Fire (Video)

[youtube https://www.youtube.com/watch?v=gRmpnnmmZmo&w=960&h=720]

LiveFire CareunderFire www.CAGmain.com In this video one of our students runs the Live Fire Care under Fire drill here at CAGmain. Its a chance for them to apply both basics courses (TCCC and Intro to Pistol) under timed pressure in a controlled environment. This past week end we ran 7 students total, and only 1 passed in time. This clip runs just over the 5 minute pass mark, but he will get another chance to try in Jan. Each student must have (Mandatory): Passed Intro to pistol and safety Intro to TCCC 2 safetys per student Eye and hearing protection The Drill: -The patient is located behind simulated cover -The student medic must engage targets and move to the patient behind cover. -If the medic breaks the cover box they must shoot a penalty -Timed shots and initiated at 30 seconds then every 60 seconds after -The student MUST engage immediately when the horn blasts, even if mid treatment. In orderTo pass: -The student must hit both steel targets twice per shot sequence (20 yards) -Identify all injuries in sequnce (MARCH) -Treat all injuries -Verbalize for hypothermia blanket and reassess every 15m In this video the student medic was using: The warrior assault systems recon Mk1 (Courtesy of www.ArizonaDefense.com) http://arizonadefensesupply.com/store/#!/WARRIOR-ASSAULT-SYSTEMS-Recon-Shooters-Cut/p/56347282/category=15066506 The CAG Tier 1 IFAK:http://cagmain.com/shop-cag/#!/CAG-Trauma-Packs/c/13147503/offset=0&sort=normal Which uses combat proven products from www.NARescue.com) 1x Gen7 CATTQ: http://cagmain.com/shop-cag/#!/Combat-Application-Tourniquet-C-A-T-Tactical-Black/p/50856842/category=13227550 1x NPA 1 Hyfin chest seal twin pack: http://cagmain.com/shop-cag/#!/Hyfin-Vent-Chest-Seal-Twin-Pack/p/50869901/category=13227552 2x Compressed Gauze 2x 4" ETD dressing:http://cagmain.com/shop-cag/#!/EmergencyTrauma-Dressing-ETD-4-in/p/50856860/category=13227550 This video was made possible by: Arizona Defense Supply www.ArizonaDefenseSupply.com and North American Rescue www.NARescue.com

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Review: NEW Gen 7 CAT Tourniquet (Video)

The Combat Application Tourniquet was initially fielded by USSOCOM in 2004 then fast followed by conventional forces in 2005. In the early years of the Global War on Terrorism (GWOT) and prior to the implementation of modern prefabricated tourniquets, the death rate from extremity exsanguination was 23.3 deaths annually. After full implementation, this number was reduced to 3.5 deaths per year, an 85% decrease in mortality. In 2005 the Combat Application Tourniquet was selected as one of the Army’s top 10 greatest inventions and is recognized as one of the foremost advancements in pre-hospital care during the GWOT with an estimated 1,850 lives saved.https://youtu.be/_1dvKdyHWec Brief History (North American Rescue) The Combat Application Tourniquet was initially fielded by USSOCOM in 2004 then fast followed by conventional forces in 2005. In the early years of the Global War on Terrorism (GWOT) and prior to the implementation of modern prefabricated tourniquets, the death rate from extremity exsanguination was 23.3 deaths annually. After full implementation, this number was reduced to 3.5 deaths per year, an 85% decrease in mortality. In 2005 the Combat Application Tourniquet was selected as one of the Army’s top 10 greatest inventions and is recognized as one of the foremost advancements in pre-hospital care during the GWOT with an estimated 1,850 lives saved. Relentless comprehensive analysis of all deaths from extremity hemorrhage has resulted in evidence-based tourniquet improvements. This approach has yielded critical device improvements to include five refinements in the design of the Combat Application Tourniquet over the last decade. These enhancements were focused on maximizing the effectiveness of the device while minimizing morbidity. Continuous interface with end-users and researchers, literature review and tourniquet applications in both real world and simulated high stress tactical environments have made it clear, that despite tremendous success, tourniquet knowledge gaps exist in the following areas (1) single verses double routing of the band (2) Importance of slack removal prior to engaging the windlass.  Closing these gaps will be accomplished through device enhancements, knowledge products and focused training.   The Combat Application Tourniquet Generation 7 When we began work on the CAT GEN 7 we considered every element that defines a tourniquet designed for combat use. We challenged ourselves to find the best, most forward-looking way possible to enhance performance and maximize application success. But we didn’t do this alone. Leveraging input from after action reviews, researchers, material scientists and you, the end-user, we were able to create the most advanced CAT to date. Every component of the CAT GEN 7 is optimized performance and reliability.  The CAT GEN 7 has a single routing buckle system that  (1) allows for extremely fast application and effective slack removal (2) unifies training standards and eliminates confusion by having a single protocol/directions for all applications.

The Combat Application Tourniquet Generation 7 Requirements Driven Enhancements 

Single Routing Buckle C-A-T® Gen 7 performs better and is easier to use than previous generations, resulting in less blood loss Unified training standards with single protocol/directions for all applications. Windlass Rod Increased diameter for enhanced strength Aggressive ribbing for improved grip Windlass Clip Bilateral beveled entry for rapid windlass lock Bilateral buttress for added strength Windlass Strap Sonic welded to clip for constant contact Color changed to Gray for tactical considerations Stabilization Bar Reinforced, beveled contact bar maintains the plate's integrity and decreases skin pinching  General Studies for the CAT TQ: 001. Tourniquet Problems in War Injuries - 1945 002. Battlefield tourniquet systems.2000 003. Tourniquet Controversy - 2003 004. Tourniquets for hemorrhage control on the battlefield - 2003 005. Tourn Issues MilMed.2004 007. Issues Related to the Use of Tourniquets on the Battlefield - 2005 008. Research on Tourniquet Related Injury for Combat Casualty Care - 2004 009. Surgical Tourniquet Technology Adapted for Military and Prehospital Use - 2004 010. Labortory Evaluation of Battlefield Tourniquets in Human Volunteers - 2005 014. Tourniquet_Evaluation_AUG05 015. A Balanced Approach to Tourniquet Use - 2006 016. Tourniquet 2007 017. Extended Tourniquet Application After Combat Wounds - 2007 018. Practical Tourniquet Use - 2008 018.1 TCCC Doyle Tourniquets PEC 2008 020. Tourniquet Technology on Today's Battlefield 2008 021. Tourniquet Use in Combat Trauma UK Experience - 2008 022. Battle Casualty Survival with Emergency Tourniquet Use to Stop Bleeding - 2009 023. Survival with Emergency Tourniquet Use - 2009 023.1 TK CALL AAR_Jul-09 rebuttal to Johnson 024. Final_tourniquet_working_group_minutes_march_2010 026. The Military Emergency Tourniquet Program's lessons Learned with Devices and Designs - 2011 027. Tourniquets - 2011 028. History of Tourniquet Use 2011 029. Re-Evaluating the Field Tourniquet for the Canadian Forces 030. CAT_Single-Routing_ 031. Tourniquet_Slack_Issue 032. Israeli NSW Feedback_to _the_Field_(FT2F) #11 FT2F #12 - TQ Use in OEF OIF and OND - 16Jul12 [caption id="attachment_2463" align="aligncenter" width="660"]QUALITY RETAIL QUALITY RETAIL[/caption]

Discussion guide to Airways

Anytime we talk about austere medicine, naturally airways come up, and for a variety of reasons. Just to catch up our audience we are going to cover a few basics, so everyone is on the same sheet of music. In this article we wont cover how and when to use a particular airway, but we rather discuss the intended use to hopefully clarify what item does what.Anytime we talk about austere medicine, naturally airways come up, and for a variety of reasons. Just to catch up our audience we are going to cover a few basics, so everyone is on the same sheet of music. In this article we wont cover how and when to use a particular airway, but we rather discuss the intended use to hopefully clarify what item does what.

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Positional Airways. These are free, weigh nothing and often overlooked for sexier, more invasive techniques. A positional airway is exactly what it sounds like, position the patients airway or body in a way that keeps the tongue off the back of the throat, or prevents them from inhaling vomit. i.e. The sniffing position, or roll you patient onto their side AKA the "Frat Boy" or recovery position.

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Adjunct airways. Adjunct airways are temporary airways, that we put in place just to buy us a little time until we can do something a little more definitive. Although in many cases they are all that is needed or ever get used, they fall into the adjunct category simply because better airways are available to skilled providers.

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NPAs or nasal pharyngeal airways. The correct term is NPA but its ok if you call it a nasal trumpet. An NPA is designed to go thru the nasal passage and sit just behind the tongue and keep your patients airway open, essentially keep them from snoring. In order for these to work they have to be sized correctly for the patient before placement. Make sure you keep a variety of sizes handy, I see in training people who just go thru the motions of sizing them up..... These are uncomfortable for the patient but should avoid the gag reflex.

NPA

OPAs or Oral Pharyngeal airways. The correct term is OPA but if you want to call them a J-Tube that's fine as well. OPAs are large, smooth J shaped pipes are bridges that go thru the mouth and lift the tongue off the back of the throat. This will stimulate a gag reflex and they also fall out a easier than an NPA. Its for that reason NPAs tend to be the go to adjunct airway in the field. OPAs will pass more air in most cases, so EMS folks tend to prefer the OPA because it fits in a little better with other treatments they may do later as a provider. [gallery size="medium" link="none" orderby="rand" ids="2543,2542,2544"] Supraglottic Airways (Above the glottis AKA the air flap). I tend to categorize Supraglottic airways between an adjunct and a definitive airway like intubation or crics (we will explain). These airways are designed to go "Blindly" into the back of the throat and isolate the OPENING of the trachea, by either blocking off the esophagus, as in the case of the King Lt. or by chance actually landing in the trachea proper by chance as in the case of a Combitube which does both depending on where it lands.

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Supraglottic airways are procedurally easier than crics and intubation, but are still not considered definitve by most because they do NOT isolate the trachea. The right Supraglottic airway works well enough for anesthesia so they have the chops to save lives, but tend to be priced out the everyday persons IFAK. I like the KING LT by North American Rescue, its as close to Infantry proof as you can get while giving you operating room level performance. [gallery ids="2545,2546,2547" orderby="rand"] Definitive Airways. The goal of most providers is to isolate the trachea, this increases the effectiveness of any treatments they provide and reduces the risk of vomit or any other nasty's getting into the airway. If you ever get to watch an ER run a "mega code", you will notice a sigh of relief once the patient is "tubed" Surgical Airways. This is the first of two definitive airways we will discuss in this article. I've placed these just above the supraglottics, but frankly they are a teachable skill to the laymen provider. I've taught many an operator how to cric, and they have performed the procedure well. The only surgical airway we are concerned about in the field is the CricoThyroidotomy, or "Cric". With out getting into specifics you go in thru a small incision at the base of the Adams apple and slide a tube INTO the trachea. the tube should have an inflatable cuff on the end, so that when you inflate the cuff, gas must pass in and out the tube alone, and fluids cant get into the lungs. This technique bypasses the gag reflex altogether and is a great option for providers dealing with a potentially ugly airway combined with a head injury or disembowelment. This procedure is generally considered safe, im a fan of teaching it to dedicated responders but ill leave that discussion to people with letters behind their name. [gallery size="medium" ids="2548,2549"] Intubation. The gold standard for airways. Using a specialized scope and a properly sized cuffed tube, the provider slides a ET (Endotracheal) Tube directly into the trachea, and when they inflate the cuff they isolate the trachea the same as the cric we mentioned before. This requires a great amount of technique and experience, even seasoned paramedics dread having to do this in the field. A lot can go wrong and we certainly wouldn't recommend this to a laymen. Its good to know about this procedure even if you cant "tube" someone yourself. Ultimately this is where you patient is going if his level of consciousness allows it. This skill is generally for paramedic level providers and above and for good reason. It is entirely possible to use a modified version of this procedure and go thru the nose, but again it requires some skill and clinical hours to learn. [gallery columns="4" ids="2550,2551,2552,2553" orderby="rand"] Certainly there are a myriad of factors that will guide your decision on what to use and when, but that's not for this article. Consider:
  • Pediatrics
  • Individual anatomy
  • Spinal Injuries
  • Head injuries
  • Mass casualties scenarios
In the CAG tier 1 Med Kit we have a variety of positional airways and an NPA. Keep in mind the key to good airway management is a rock solid assessment. Here at Crisis Application Group we teach MARCH (The science is in the sequence) using what ever airway exam your competent in. and make sure to slow down for at least 5 seconds when look listen and feel. Of course if you have any questions hit us up on Facebook and as always thank you. [caption id="attachment_2314" align="aligncenter" width="654"]cagnet GREEN BERET MODERATED FORUM[/caption]