Sunday, November 30, 2014

EDC (Every Day Carry) Installment 2

When planning your every day carry (EDC) load out, you should also consider other scenarios outside of shooting and fighting.  Emergencies arise all the time and while most of us love run and gun, more than likely your ability to save a life will benefit you more than your ability to take one.  Basically, you are more likely to plug a hole in another person than put one in them. It may not be as glamorous, but if you are not looking into it as a cornerstone of your preparedness mindset, you are already behind the power curve. This is why in this installment I would like to discuss medical preparedness.

Medical training is the most overlooked part of preparedness. Most civilians are only trained in basic CPR and possibly the use of an AED.  Neither of these are relevant in the event of traumatic injuries. The clock starts ticking at the moment of injury, and it has been proven that the care provided correctly in the first hour will do more to ensure survival than anything. 

In the past decade, the process of battlefield triage has advanced by leaps and bounds. Many adjuncts that have been proven to save lives have fallen out and back into favor, but there are three universal constants in life saving that need to be adhered to:

  • Keep the patient breathing
  • Keep blood inside the patient
  • Keep the patient warm

Ultimately the how of each of these objectives is not necessarily as important as them just getting done.  However, if you are looking at specifics, let's discuss them for a moment.

Keep the patient breathing. A majority of breathing issues can be mitigated by ensuring the patients airway is not compromised. If the patient is screaming, the patient can breathe.  If the patient is bubbling, the patient can breathe.  Just not very well.  In this phase the goal is to optimize air transfer and in such, oxygen profusion throughout the body. The primary method is to utilize what has become simply known as the rescue position.  Instinct is to put the patient on their back as this is the easiest position for you to assess them in.  This may, however, not be the best position for them to breathe in.  The rescue position allows the patients natural breathing process to occur with minimal hindrance of body mass and gravity.  Secondary methods are pharyngeal airway instruments in conjunction with the rescue position.  Now, obviously it is best to allow the patient to put themselves in a position where they can best breathe if they are conscious, and never place an adjunct where you don't have to.  In extreme circumstances, and if allowed by municipal mandate or law, intubation or cricothyrotomy may be an option.  These should only be used in life or death scenarios and only after extensive training and certification.

Keep blood inside the patient. Severe blood loss caused by trauma is a terrifying thing to see. The important thing to remember is all that red stuff is carrying the oxygen needed to keep the patient alive. The most important thing to combat this problem is tourniquets. Dating back to the civil war, tourniquets have saved countless lives.  With that, they also acquired a negative stigma associated with tissue necrosis, or limb death.  This stigma is false and needs to be remedied. Tourniquets are used in medical procedures lasting several hours and the tissue remains viable with no lasting effects post-op. Proper placement and use of a tourniquet is paramount.  The second thing used is pressure dressings.  An effective pressure dressing can work as well as a tourniquet.  Used in conjunction with a tourniquet, there is no bleed on the body that can't be stopped with the exception of a neck or thoracic vessel transaction. The key technology advancement in this area has been homeostatic agents. These agents have special chemicals that aid the clotting process and help seal the wound. Beyond this, ensure that enough gauze is on hand to properly pack the wound. This is a common underestimation. 

Keep the patient warm. After blood loss or any major trauma has occurred, the patients body temperature will likely drop. Clothing may have been removed or is soaked with various fluids which conducts heat away from the body. Getting the patient dryer than they were is important and then begin rewarming. Rewarming should not degrade any adjuncts nor should it hinder higher medical care from doing their job.  Emergency blankets should always be on hand, as well as a wool blanket of some kind, as wool can retain up to 80 percent of its warming capability, even when completely soaked.  Skin to skin contact is also effective in rewarming as long as the caregiver is not compromised in the process and the patient is consenting. 

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