Background: I converted my wife to prepping, working on the “kids”. Thirty Five years in EMS and 22 as an Emergency Medicine physician: prior work with Appleseed and Western Rifle Shooter’s Association travel course on Grid Down Medicine at its inception. Some austere medical and rescue training and operations, no military (I failed the physical). I fully endorse your previous recommendations for the various medical education/training resources cited.
I would like to confirm Walker’s position, that for a mobile/bugout situation humping the ruck, his kit and strategy make a lot of sense. Protection from environmental factors, sanitation, water, and maybe food are all essentials that need to be considered when on the move or on bivy. I would like to focus on three comments, from my experience and training, that bear consideration.
1. The IV kit and saline. In a grid down, without rule of law, etc. scenario, 1000 cc of normal saline, the IV fluid most available outside the military, is of very little use acutely. Old (15th century and forward) logic suggested that a 3:1 ratio of fluid replacement to blood loss would result in symptomatic improvement of the receiver. With the dawn of ‘resuscitation’ science in the early 60’s, IV fluid was applied empirically (by rule of logic, not necessarily science) for several decades, until the wisdom of early surgical intervention for profound hemorrhage took hold (“The Golden Hour”). The current Military Trauma Combat Casualty Care guidelines look at more concentrated solutions for those ‘few’ that would benefit with a system of Medical Evacuation to definitive surgery, and even then, more often with head-injured patients than those with ‘simple’ bleeding wounds. While the benefit of IV replenishment surrounding the performance of definitive, hospital type care, is provable, the volume required to treat a single patient without the probability of logistic support and evacuation would well exceed the capacity to carry, or limit your mobility . [For example, the standard non-blood IV fluid replacement for hemorrhagic (bleeding) shock is 40 cc per kg. That calculates out over 3 Liters for an adult. American College of Surgeons Committee on Trauma, Advanced Trauma Life Support program for Physicians recommend not more that 2 liters per person, plus blood, if hyotension (absent radial pulse/delayed capillary refill/altered mental status) persists. Value / effort ratio is not favorable in the crisis situation, if you have no logistics tail In addition, current data from the war zones has evolved to the recognition that IV therapy to raise the blood pressure in the non head injured patient, without control of the internal bleeding tends to increase the bleeding. (Head injury patients represent a class of patients that are still recommended to raise the blood pressurein spite of the bleeding risk, because what we know about isolated brain injury demands good blood pressure, and we don’t have enough data to withhold therapy while applying our other findings).
2. The same experience resulted in a re-prioritization of immediate life saving care to gain control of lethal (exsanguinating) hemorrhage prior to airway-breathing issues, a major paradigm shift from prior decades of instruction. The mil teaches the Combat Life Saver (infantry) the use of the Naso-pharyngeal airway. There are some risks. But the “combitube” airway, and it’s current replacement, the King (brand) Laryngeal Tracheal Airway (LTA) also pose a logistics dilemma. The Combi-Tube and LTA are both only of use in the victim with no gag, i.e. deeply comatose and unresponsive. We place them for airway protection (though other tubes are better, they require a higher, perishable, skill set) and mostly to permit us to artificially breath for the patient. If you have no logistic to support the medical evacuation, and the device to provide breathing while awaiting that transport, the effort could be considered misdirected. We call this a “triage” decision, and in the grid down, inadequate personnel or equipment to manage, this patient would be “expectant”…awaiting death. Hard reality, but for the good of the rest of the crew, one that needs to be considered.
3. As an old Red Cross First Aider before my other training, I have to second the endorsement on the triangular bandages, and the knowledge to apply in a variety of configurations. For a minimal weight penalty, and an increase in utility to ‘preserve the force’ during evacuation with otherwise minor orthopedic injuries (sprains and strains) I might select to include a 2” or 4” roll of stick to itself roller bandage, known commercially as COBAN, or a roll of 2” athletic tape (a little more substantial than the silk tape, which utility has been amply described by Walker) and the training /skill to use them for foot/ankle/knee/wrist/shoulder/hip bracing.
In summary, I agree with Walker on the “minimalist’ effective 24 hour overland bug out first aid kit, with the notes above. In my opinion, his kit ‘implies’ that there are still rescue resources and advanced tactic medical care available within a few hours, which may not be a true situation. His 72 hour kit is also sound. Think through your likely situation (natural disaster with resources expected in 12-24-72-or longer hours; grid up or down; medical care or transport assist available or not; base camp or mobile) when you select your components.
And finally, the “gear” only allows the prepared mind to manage the hurdles more efficiently, and does not replace training and critical decision making. – Pacer
Letter Re: Gauze and Water: A Combat Medic’s Guide to Preparedness Medicine
