Stocking supplies for a TEMS bag

[tniuqs]

This statement demonstrates lack of awareness of most elements of tactical medicine.

'zilla

Thanks for the information zilla, about the new Battle Dressings.

I am a curious, rather a black and white statement is it not, care to shed some insite ?

I would assume you are suggesting that tactical EMS should not Armed ?

Or that one should stay and play in a hot zone ?

Or have a big Red Cross on them ..... ?

Just wondering is all.

[Dustdevil]

Let us not forget that most "tactical EMS" does not occur in a so-called "hot zone". If care under fire is all you are prepared for, you are grossly unprepared.

[chbare]

Again, I was not asked and I do not claim to be a tactical medicine expert. However, allow me to throw out a few thoughts. Much of what a civi tac medic will do comes down to the department and team SOP's. My limited experience had me only enter the area with an armed escort after the threat had been resolved and back clear was initiated or completed. I was not armed and provided care only in relative safety. However, much of tactical medicine in fact takes place away from the actual operational theatre.

For example, you will have to provide the team with a threat assessment, ensure adequate work rest cycles, ensure proper environmental supplies, sanitation, medical logistics such as food, water, and equipment, and training of your team members. Much of your work will involve providing your team with the tools, intel, and supplies to complete their job. This should include medical checkups and a medical dossier of your team members. You should also liaise with local medical resources and have plans in place for various scenarios. This means talking to hospitals, EMS agencies, and the such. OPSEC may dictate how far we can take this however. Medical SOP's should also be developed. Knowing about the terrain, flora, fauna, weather, and environmental conditions is important as well. In addition, you will need to set up a staging area, collection point, and have alternate plans in place. All or most of these concepts can be completed without you ever entering the "hot zone" or carrying a weapon.

What I did as a military medic was similar. Of course, I was essentially an infantryman first. However, much of my job was preventative and supportive. For example, prior to our mobilization after Katrina, I was busy attending medical briefings on the environment and obtaining information on the expected medical dangers. In addition, we scrambled and set up a medical assessment process and vaccination station prior to deployment. Following the deployment, we did medical assessment and additional testing if indicated, and provided or arranged for follow up care for health issues.

As far as what to carry, a really subjective situation IMHO. Typically, every team member had a kit on their person with basic supplies. Everybody knew where the kit was located and self and buddy aid was emphasized. I carried a primary bag but would throw it at the door or leave it at the designated CCP in some cases. In addition, I carried what I considered mission critical medical supplies in a pouch on my plate carrier. A pouch that I continue to carry in my rollout bag to this day. Much of our medical care was pre planned with designated aid and litter teams along with designated CCP's. This was coordinated with a specific phase line or LOA depending on the mission however.

Take care,

chbare.

[Doczilla]

Squint-

I do not have much to add to chbare's excellent reply. The greatest threat to a SWAT team (and a military unit) is disease and non-battle injury. The vast majority of what I do with the SWAT teams is sports medicine, minor injury and illness care, etc. SWAT medics and docs preserve fighting strength, maximize performance, and minimize disease and injury exposure. The issue that I take with your previous statement is that it completely ignored this aspect of tactical medicine, which is the heart of the specialty and requires planning and equipment on the part of the OP.

As far as the armed question goes, I would rather be armed to be able to defend myself and my patient. But on a civilian SWAT team, I would rather not have the dual role of operator and medic.

You cannot effectively manage casualties without tactical superiority. You are correct in that the first and best treatment for battle related injury is to eliminate the threat with firepower. This holds true in the civilian environment as well.

I don't think we should wear big red crosses. I prefer my subdued shoulder patch that can only be read within choking distance.

There are varying degrees of "hot zone", depending on where you are, how well defended you are, how far definitive care is, whether or not you have a safe route of egress, etc. Sometimes you have to stay and play because the tactical situation dictates it. The wise medic would be prepared for this.

'zilla

[tniuqs]

I don't think we should wear big red crosses. I prefer my subdued shoulder patch that can only be read within choking distance.

Agreed:

I did very much enjoy what I perceive was a touch of humour in the above comment, good one zilla ! But here in lies part of the problem the tactical PATCH !

I am presently on Standby to transport a Trached Patient an LDT fixed wing interhospital facility transfer but does that make me a Critical Care Paramedic with Flight designation, although I might be ... I try really hard not to get full of myself well .... some days. :shock:

BTW: Before I make points for debate only, I must comment positively on some excellent in-depth information provided with chbare and zilla's experiences and commentary, agreed preventative pro active medicine is a part but in the purest sense of the word "tactical" as this implies up close, in your face, on the two way firing range all sexy, level 3 underwear, all nomexed up, with a 3M glow in the dark "MEDIC" stencilled ones back, read on svp.

Unfortunately when the real preparedness is in depth knowledge is understanding of the types of injuries, ballistic injuries, blast effects, flash burns, bio terrorism AND treatment that you may have to provide .. its is not running around doing the duck and weave, seriously if one has to ask about what is needed in an field pack or vest this could be a clear S/S by the wanker types, or perhaps just an innocent "help me to learn" comment from the OP. Honestly I though Dust would jump all over that concept AND I do see way too many puffy chested out types when the truly prepared just chuckle to themselves queitly.

When we should as elders educate ? as was chbare obvious goal ... besides, I do enjoy poking the bear, hey maybe zillas intent was to stimulate too ... the bugger, hey zilla could be a little old lady knitting and using google ... j/k. :shock: Great Spirit don't fail me now!

Remember SOMEDIC ... a poser only and busted.

I truly hope you see where I am going with this, as many departments and services use this "sexy" carrot in recruitment posters and for public relations for civilian side ONLY, They have no intention to put medics in harms way, we have observed this with Ottawa-Carlton when all they wanted was more warm Paramedic bodies to do transfers .... lots of BS spewed with this category of Tac Medic ... I digress.

Let us not forget that most "tactical EMS" does not occur in a so-called "hot zone". If care under fire is all you are prepared for, you are grossly unprepared.

I do not believe I suggested this at all Dust but then how can you call them Tactical then ? Goes really without saying that any truly professional organisation, may be it the US military (or the civy look a likes) albeit many of those encounter single treats only. The Brits (ps their Medics in most cases are contentious objectors and restricted to no weapons at all and other of your other allies some restricted by the Geneva Convention and adhered too, carry defensive weapons ONLY) yes zactly most of these entities have huge infrastructure and support system's behind them CAS, Medivac, Field Surgical Facilities, but there are OTHER models out in the real world as well, like Independent Close Protection Support Teams moving dignitaries about in hostile environment's in "official" war zone's or "unofficial" and please do not to forget the mercenary Explosive Ordinance Disposal Team medics whose primary role may be top cover or reach out and touch some one a sniper background is the first choice of First Aid with many of those, these I would IMHO only call these True Tactical Medics and its almost sad but no yellow ribbons for them when they get back home either, just a steak and a good bottle from a friend if they get back in one piece.

It all boils down to the definition of a term but then again so does the term prostitution and extortion .... I know this ex wife ... oh never mind

I am forced to quote a very good friend of mine with a ton of field experience in very hot zones:

"We always have a plan ... then the shooting starts" and the plan changes really F**** quick.

You cannot effectively manage casualties without tactical superiority. You are correct in that the first and best treatment for battle related injury is to eliminate the threat with firepower. This holds true in the civilian environment as well.

Could term "Tactical" be extended to it could those that support at Oilpatch Blow outs or Woodland Forest Fire and just in passing "suppressing firepower" does not really help a whole hell of lot, in that environment the term stratigic redeployment, or rapid extraction is oft time jargon "coined" or the basic RUN AWAY just saying there are many applications of this broad term "Tactical Medic" just saying this is my humble opinion only.

Must disagree with that one what if you do not have tactical superiority .... then what ? Personally I like the SKED myself takes way less effort, skid not carry ... and a heads up, just saying EMT- B or P stands for Ed's Moving and Transport as this is MY prime directive.

Just to provoke some discussion:

The new and very serious threat in civilian terrorism is bring a bit of havoc, place a small IED and injure a few, then bring in the support teams .... to then BLOW the infrastructure to istsy bitsy pieces ... this is one of the oldest and one of most effective forms of terrorism ... call 911 and you get a busy signal, a very effective means to an end with these spineless bastards ... opps got a bit emotional there, my bad ? :twisted:

Close support of a team packing a ton of crap just slows one down and a stray round puncturing an O2 tank is a touch unnerving to say the least and then packing a ton of kit, that may or may not be deemed essential in a 2 way firing range, this all depends of the primary role of this or that team, hey perhaps look to the Falklands experience.. the Brits, and superior casualty survival rates too, minimal kit could be packed in that hike in the barrens.

Thing is in the real world there are many are definitions of TACTICAL ... just my 2 cents, well more like .14 in today's market place, with the price of Oil dropping like a freaking stone, why am I paying my blood for gasoline ... now thats terrorism ... ok way off topic I am just bored :oops:

cheers

[Richard B the EMT]

Whatever the equipment, carried or worn, I do agree with the assessment that one does not wear either the red cross or Star Of Life on their outfit, as, presuming sniper fire from "da bad guys", gives them something to target the sniper-scope cross hairs on.

As an EMT never been shot at, but with a ballistic vest issued me, my thing is stopping the hurt, so to speak, not causing it, so I don't know if I'd be involved with having my own firepower. That issue is going to be problematic of the individual and the policies of the agencies or agency involved (follow my mantra: follow local protocols as mine are probably different from yours).

As for treating while in the line of fire, ahhh, NO WAY! A hasty retreat to behind something substantial against incoming fire is heavily encouraged, and don't leave your patient behind.

If you are an inactive USMC (there are no former members!) don't consider it a "retreat", consider it an "advance to the rear"!

[medic82942003]

Go to google and look up Israel Trauma drsg. All the CP Close protection guys in the UK use them. The next generation battle drsg. I look up what they carry and leave another message as far as stuff they use.

[Chief1C]

Here are a few suppliers that sell some nice pre-assembled tactical EMS packages.

Chinook Tactical Medical

North American Rescue

Bound Tree

Progressive Military Medical Supplies

Tactical Response Gear

Edited September 1, 2009 by 4c6

[maverick56]

There's no perfect answer to that other than "it depends", haha. Long or short op? Distance/time from evac, transport and definitive care? Method of ingress - foot, mounted (vehicle), or air insertion? In or outside the hot zone? Expected opposition - weapons, numbers, weather conditions, etc. There are a lot of variables, not to mention state/regional regulations. For example, here in Michigan, hemostatic agents aren't approved for use. I've not done anything (yet) in the way of civilan TEMS, but I do have operational experience as a combat medic and have posted my preferences for both dismounted and light patrols.

For dismounted work (i.e. unsuitable LZ for evac, remote areas, unknown time to further care/evac):

I prefer a smaller aid bag, suplemented with several MOLLE pouches on my IBA(or MOLLE vest). I have even resorted to carrying a CLS bag along with the before mentioned MOLLE pouches. I can fit any quick reach items(Gloves, CAT, Bandages, Skittles, etc) in my Molle Pouches, and a few extra items in the aid bag/CLS bag. In my opinion, any bag is useless if you don't first know where everything is, you should be capable of telling people where any item is over the phone and they be able to find it without any confusion. Second off, seems to me a lot of medics pack way to much shit in their bags to begin with, or at least the bag they carry with them at all times. Pass the buck somewhat, make your soldiers carry their own fluids, along with a few cravats. This will lighten your load considerably and allow you to move less impeded by the weight of a case of LR(plus you can fit more fun stuff in the bag like combi tube and skittles). You can always have your main(or drop bag) in the vehicle to resupply from, but carry that smaller aid bag while your a foot. I have a Black Hawk STOMP II aid bag, with 2 random MOLLE pouches strapped to the outside. It's pretty awesome being set-up like that, because then you have 4 pouches that you can get to quick for rapid treatment.

In the 2 MOLLE pouches I use one for extremity wounds and one for abdominal/chest/head wounds. In the extremities pouch, I keep 3 HemCon's. 3 of the old one handed tourniquets, 2 CAT's, 3 rolls of Kerlix and 3 Ace wraps, plus a couple Bundeswehr dressings that I traded for some crappy Israeli dressings. In the other pouch, I keep 2 medium abdominal dressings, 1 more Kerlix, 2 Vasogauzes, 2 ACS's and some good old Duck tape.

Then there are 2 large pouches on the "outside" of the bag. I use one for airway, and one for my BVM/O2 accessories. In the airway pouch, I keep 1 King LT, 2 ET tubes, Laryngyscope with the big Mac blade and the big Miller blade, my fancy Littman stethoscope, one small Onin pulse-oximeter, 3 Naso's with individual surgilube packets taped to them, 6 j-tubes (varying sizes), a couple 60cc syringes, 4 or 5 10ga catheters and some extra tape, vasogauze and ACS's. In the other pouch, I have an extra O2 regulator, spark free wrenches, a BVM from NARP and some O2 tubing. I kept oxygen in one of the platoon's Bradleys, so in a worst case scenario all of that shit was there for me.

Then in my main compartment, it breaks down into 5 1/2 pouches. There is one zip-up pouch, I use that to keep injectables and sharps, evac tools, burngel, some random sick-call meds and my fancy paramedic reference book. Then there is a small pouch on the outside of that zip-pouch where I keep all of my cravats. Then there are 2 large mesh pouches, one I keep a bunch of kerlix and ace wraps in, and the other I use to hold all of my fluid. I usually carry 3 500's of NS, 3 500's of LR and one 500 Hetastarch. Then there are 2 small mesh pouches, where I keep all of my infusion stuff. I have one FAST-1, 6 saline lock kits, 8 sets of tubing and a handful of 14, 16 and 18 ga catheters for extra. The "1/2" pouch I mentioned is actually where the hydration bladder is supposed to go, but I use it for all of my splints and C-collars. I keep 3 SAM splints, 3 padded wood splints and 1 adjustable C-Collar.

After all of that, there is still one big-ass mesh pouch with 2 internal pouches. I keep a poleless litter in there, plus a VS-17 panel, a thermal blanket, some Field Medical Cards and reference guide, a digital thermometer and my BP cuff.

I only carry that on missions where I know that we're going to be dismounted for a long period of time. It's a bit heavy, but not too bad. I carried it through Samara and Fallujah without any serious issues.

Now, for shorter, hit-it and done missions:

Keep the heavy shit on the trucks! Keep my fully stocked M-5 issue aid bag plus my STOMP II on the medic trac, but I only carry a small Condor patrol pack by Maxpedition. It's designed for CLS, but the design of the bag doesn't change the contents. I usually carry 2-3 cat's on the outside in MOLLE pouches, with Kerlix and some ace bandage.

The main pocket has two 500's of NS, one 500 hextend, and two more 500's LR. I keep all the fluids in ziplock bags with the catheter and IV kit rubber banded together, also two SAM splints, and eye wash solution. The second part has three divided open mesh pockets with an ass load of 4x4's and 2x2's with some butterfly stitches and other assorted baby boo boo bandages, some different sick call meds and topical creams of different types. Then in the rest of the pouch is some more Kerlix, ETB's, a shit load of cravats, 6 inch ace wraps, two combitubes, ACS's and tegaderms and my field reference guide. The small pocket in the front looks like a divider for school bags, but I keep two J tubes, and three NPA's in it, with surgilube, some tweezers, hemostats, a scalpel, trauma sheers, some assorted sharps (14-18 gauge catheters and needles) and FMC's.

The outside has plenty of MOLLE straps and equipment straps at the bottom where I keep a poleless litter. The rest of the stuff like space blankets and hemcons and a couple other cats, I keep in IFAKS on my chest rig. The rest of my soldiers carried IFAKS and they all knew how to apply hemcons, and cats and ACS's and one CLS carried a sked, and the other carried a TALON II. All in all the bag doesn't weigh much at all, and it's a little less wide than the standard M-5 or the STOMP II, so it never gets in the way.

Yeah, so.... Hope I didn't overwhelm you and was somewhat helpful. That's what worked for me, but hey, no medic is the same, we all have different methods and different equipment. Like I said, there are a lot of variables and you have to figure out the system that works for you, meaning trial-and-error and making it part of your training. The main thing is knowing your system, developing SOPs and making sure every member of the team is on board. Have fun!

Edited October 20, 2009 by maverick56