Musings of a Law Enforcement Paramedic – Part 5, by a LEO Medic

This is the conclusion of this five-part article, and this section contains information about gear selection, some tips and tricks that I learned along the way, as long as some links to some training videos.

Gear Selection

I am a huge believer in redundancy. Things break, get dropped, tear, and get lost. When your car is in the shop and you are driving the rental is when you will need the first aid kit you usually keep in the back. Murphy is alive and well.

On My Person

On my person, pretty much everywhere I go whether on duty or off duty, is a tourniquet, gloves, and QuikClot Gauze. This package fits into the thigh pocket of carpenter pants or the cargo pocket of pants or shorts. With these three things, you can stop extremity bleeds, junctional bleeds, have a pressure dressing, and can form an occlusive dressing. It’s kind of like a pocket knife or a spare mag, they weigh nothing, and you feel naked without them. I have an outer vest carrier at work, so I didn’t want to only have gear on my vest, since it is not always on. I wanted it with me. It is when you least expect it and are least prepared for something that it will happen.

Vest

On both my hard plate vest and my soft ballistic armor vest, I have more gloves, a second tourniquet, second QuikClot gauze, compressed gauze, an occlusive dressing, an NPA, trauma shears, a pressure dressing, and two needle decompression needles. Why two? Well, of the last three decompressions we did, two required a second needle, and we dropped the first sterile needle in the mud on the other. Two is one, and one is none. Notice that this is pretty much the contents of the TCCC-approved IFAK.

Patrol Backpack

I have a dedicated medical bag (carried when going to a medical call), and then I also have a patrol backpack (carried when I’m out on law enforcement patrol and away from my vehicle). There is the same IFAK (two separate ones) on the outside of each bag. Was it cheap? Nope. Is it worth it? Absolutely. I would hate to be on an ATV somewhere and need something back in my truck. I hope you are noticing the redundancy here.

In the patrol backpack, I include some abdominal pads, 4x4s, shears, a SAM splint, triangular bandage, and some coban and kerlex. I have a pack of OPA’s and NPA’s, a stethoscope, and an ambu bag. I also have a survival blanket to treat shock. If you are really concerned about space, a CPR mask would do for rescue breathing. For my friends and family (if I was making a personal first aid kit), no mask or a CPR mask would do. For strangers with questionable medical history, I stay far away from vomit, if I can. I also carry two 500 ml IV bags, with a start kit, 10 drop tubing, and an 18 and 20 gauge needle taped to each. I have an emergency drug pouch that comes out of my drug box, if I am leaving it. This has epinephrine, Zofran, Benadryl, a narcotic for pain, and a benzodiazepine, glucagon, and narcan, along with accompanying syringes. This can address most issues someone is going to have before I can get them to higher care. A personal version of this could include ibuprofen, some prescription pain medicine (Vicodin/percoset or the like), and an epi pen if anyone has allergies, or any other things you think you may need. Doctors are very weary of allergic reactions these days, so it is not hard to get a prescription for one. Notice that this is not what I carry when I am expecting a medical call. This is my bag for when I am on patrol, away from my vehicle, just for things that pop up, and an IFAK is on the outside.

Medical Bag

In my medical bag, I divide sections by use– airway, splinting, bleeding, C-spine and strapping, wound cleaning and eye wash. I have pouches for other items.

Airway supplies get one section of the bag (plus a separate box). In this section I include: King airways, OPA, NPA, intubation gear, oxygen masks, and an oxygen bottle.

Splinting gets another section, which contains: SAM’s, vacuum splints, kerlex, triangular bandages, ACE wraps, and tape.

Bleeding Control supplies are in another section, which contains: abdominal pads, a stack of 4x4s, pressure dressing, a tourniquet, more QuikClot, and lots of gauze.

C-spineand Strapping supplies get their own section.

Wound cleaningand eye wash is another.

Diagnostic tools ( Glucometer, BP Cuffs, and similar items) and Personal Protective Equipment/gear, along with hemostats, stapler, and tweezers also get a pouch.

A manual suction unit, IV supplies, and hot/cold supplies go into another pouch. So this pouch has not just the suction unit but also IV bags wrapped the same way, with the start kit, tubing, and catheters taped on. I also have saline locks and some flushes, along with some ice packs, heat packs, and a survival blanket. An IFAK is on the outside of this kit as well. I find this is easier to find what you need, and you have similar things handy when it is divided by use. This kit is my ”go to” one for 99% of calls I deal with.

A few companies make an IFAK that fits in a standard AR mag pouch. These are nice in the third mag slot on a plate carrier. Get creative with it, and plan for redundancy. I have seen a few people recently with ”emergency home defense” style vests, which are basically a soft ballistic panel only in the front of a molle vest, usually with a flashlight, mag pouch, and pistol in a holster. The idea is that it goes by the bed, and if you need it in the middle of the night, you throw it on and have everything needed at hand. I would advise all to add a small IFAK to it as well. If you have a rifle for those bumps in the night, I have also seen a magazine pouch on the butt stock used to hold an IFAK.

Tips

Here are a few tips and tricks learned the hard way:

  • In an austere environment, you don’t have the support, equipment, or time to get behind the eight ball in treatment of someone. Attack problems aggressively. If the patient deteriorates, chances of survival go down. Solve the problems when the person is at their healthiest, if that makes sense.
  • Learn to have an index of suspicion for things. With a chest wound, you are expecting a pneumo and infection, so you are alert for them. If someone is bleeding a lot, expect shock. If someone has diarrhea, expect dehydration. By having an idea of what to expect, you can catch things sooner.
  • In each divided area of my drug box where each separate drug goes, I have a laminated business card size paper with the indication and dose of each drug. Sometimes, your brain fades at the wrong time, and dosing mistakes can kill. Trust your memory but verify.
  • You wouldn’t dream of putting away a dirty gun and your tactical gear a mess. Don’t do it to your medical kit. Restock what you used from your supply closet as soon as you can. If you are out of something, pull it from a secondary kit and rotate it up. I carry three oxygen tanks in my vehicle at work. There have been too many times when you use up one and another call comes in before you can refill the first. You or a loved one will need it at the most inopportune time.
  • There are numerous stories coming back from overseas of engagements with inordinate numbers of preventable casualties dying. In almost all of these, the medics were killed at the onset of action or shortly thereafter. The surviving troops had the training and gear to provide lifesaving care to the wounded parties, but they did not have the right mindset and were unable to. They subconsciously relied on ”the medic” being there, so they didn’t take the training seriously and were not prepared.
  • As ”the medic”, you need to realize that the care you receive will be provided by the ones you are teaching. This is a huge incentive to teach well. I have forced EMT’s I work with to take lead on calls and stood by as their assistant to ensure they are getting practice and not relying on me. Even though it is outside of their scope of practice, I have taught them IV insertion and needle decompression. If I need a needle, I would hate to have my coworkers stand by with no clue. My wife has a notarized letter from me stating my consent for my squad mates to provide that care if needed. If you are the medical one, make your spouse diagnose the kids next time one is sick. Put them into that role now, when the stakes are low and they have you to support them. Murphy says the medic will be the one that takes the random bullet on TEOTWAWKI +1. One of the best gifts you can provide your family is the ability and skills to carry on without you.
  • Expose your patients. Cut off clothes. Modesty has a place. That place is not when someone is dying. You can’t treat something you didn’t find.
  • Two bullet wounds stick out in my mind for being very difficult to locate. The first was a 380 in the arm of an obese male. The arm and fat almost swallowed up the hole. The second was a .223 to the stomach. The entry wound was very difficult to find. Get used to touching your patients. The 223 stomach wound was found by raking fingers across the patient and feeling it. Practice low light or no light care; it will come in handy.
  • A nasal cannula with IV fluid hooked up makes a great eye wash station.
  • Don’t forget to stock a surgical kit or two…or three.
  • Purchase some sterile supplies (usually individually wrapped) and some that are not. For cleaning and field stuff, bulk dressings work. For final bandaging, use sterile dressings if you can. Likewise, get PPE gear, including face shields, masks, and sterile gloves. Regular medical gloves are not sterile. It is as much for the patient’s protection as yours. The last thing you need is to sneeze, cough, or drip sweat into an open wound.
  • Tachycardia of unknown origin is usually dehydration or shock. Pulse of 130 just seconds after a painful event is normal. Pulse of 130 fifteen minutes later is not normal.
  • Get used to performing a rapid trauma assessment. This skill is learned as an EMT, and the skill sheet can be found online (or YouTube it). This should take less than a minute and is done on all trauma patients. It is a head to toe exam for life threats. Feel the scalp and skull for bleeds and dents. Check the eyes, ears, nose, mouth. Feel the c-spine. Look at the neck veins. Check for tracheal tug. Listen to lungs, and feel the rib cage expand. Expose the chest and abdomen. Feel the abdomen. Check for pelvic stability. Check the long bones by putting pressure with one hand high pushing right and the other hand pushing left down low; this will let you know pretty quickly if a long bone is broken. Then, check the back! I have heard stories of people finding exit wounds and using them to locate entrance wounds from gunshots they missed. This should be a habitual process that is the same every time. At 0200, when you just woke up, in the dark, you want this to be second nature.
  • Buy in bulk. A small compound fracture would wipe out the majority of medical supplies most people have. Stock a deep pantry, much deeper than you think. Even a case of IV fluids is not going to last long. The parkland formula for burn victims (fluids given to burn victim in first 24 hours) says that a 75kg person with 20% burns gets 6 liters! That’s half a case! In one day! How many of you have six liters of IV fluid? For that compound fracture, it will take rolls of kerlex and the like to splint it. Vet supply shops often have excellent prices on medical supplies. A bandage past date is still good, too.
  • TEOTWAWKI will have no restock. Part of this is addressed with things like starting saline locks to save fluids if not needed. But you still need to store saline locks and catheters. You should be conservative with your supplies, absolutely, but have enough to treat prophylactically.. Have enough antibiotics to run a cycle without infection being present, if needed. Have a dose in each IFAK. In Patriots, Mary treated Rose with antibiotics after her gunshot with no infection present. Don’t get behind the eight ball. You can always barter any excess, or supply a local triad if the need arises.
  • If you have an oxygen tank, tie a spare wrench to it. Things break at bad times.
  • When doing operating room rotations and doing intubations in medic school, I was all excited for my first one. Instead, the Nurse Anesthetist had me manage the airway for a 30-minute surgery using an OPA and a bag valve mask. His point was that basics work to maintain an airway, so if for some reason you run into an airway problem, realize you can maintain it with the most basic skills.
  • On using a bag valve mask, bag SLOWLY! Once every six seconds is enough. Some bags have a tab that you pull out that blinks a light every six seconds. It is easy to get excited. Over-bagging blows off too much CO2, and constricts blood vessels to the brain, killing people. Remember the person is unconscious. Their oxygen requirement is very low.
  • In your medical preps, do not forget to plan for the ability to quarantine someone. Have disposable bed sheets, et cetera. Do not overlook this. Also, buy some good medical wound cleaning soap, like Hibiclens.
  • I often see people comment that ”as long as what you are putting on the wound is cleaner than the cut, it’s okay. ” I understand the principle, but I disagree with the approach. Do not plan on being sub-par from the start. If it is all you have, I understand, but plan better. The more you can stack the odds in the patient’s favor, the better.
  • Wash your hands. Do not underestimate basic cleanliness. Clean wounds thoroughly. I am aware that they do not meet the current medical requirement, but learn to use your pressure cooker as an autoclave. As stated above, have enough to throw everything away in a quarantine situation, but plan on being conservative and reuse what you can, when you can, if you can.
  • If someone has a radial pulse, their systolic blood pressure is at least 90 and their brain should be perfused. If they have a radial pulse and an altered mental status, think about other things, like hypoglycemia or a head injury.
  • Learn to have a differential diagnosis, even for trauma patients.
  • I keep a small minor first aid kit in my patrol vehicle as well. No use pulling out a huge bag when a fanny pack size one can handle it.
  • Make copies of certifications you obtain, and keep them in your bug out gear. People will try to pass themselves off as lots of stuff. If you present yourself as a RN, have your cert with you.
  • Identify and treat immediate life threats first: Solve problems with airway, breathing, and circulation, including blood supply. Don’t get caught up treating minor injuries simply because they look bad.
  • If you are working a chainsaw or axe, consider keeping a tourniquet close by. These lessons don’t just apply to gunshots.
  • Make your own kit. Know what each item does. Rather than buy pre-made overpriced kits, buy in bulk and make your kits from these supplies. You will have more to restock then. As stated before, shop around. Ebay and vet supply stores can be very inexpensive.
  • Know your kit well enough so you can describe to someone where the specific item you need is. That’s why I started taping everything needed for an IV together. It was easier to ask for the bundle then explain the start kit, tubing, et cetera if someone new happened to be helping. Likewise, learn your partner’s gear.
  • If your partner gets shot, use their IFAK to treat them. Keep yours on you as long as you can. If you get split up later and you get shot, you want to be able to self-treat!
  • If new to medicine, first plan on supplies and care for yourself and immediate family. Then plan for guests and extended family. If you have space, time, money, et cetera, plan on supporting a militia longer term, if needed. The items are not different, just the amounts!
  • I’d recommend setting up your squad for patrol with an IFAK for everyone, and one or two carrying more extensive medical supplies. (It works for the military, and it works for us.)
  • Learn all you can about supportive care. It will return as a major treatment method. Learn about herbal remedies. Start your herb garden now. A remedy book with no garden is not much use. Oftentimes, the herbal remedy is what the pharmaceutical is synthesized from.
  • Embrace team care. If you are caring for someone, practice on having a partner take vital signs, prep IV bags, or draw up medicines. When the need truly arises, it will save precious seconds. A paramedic is only worth as much as his EMT partner.
  • I’d rather have someone with knowledge and no gear over gear with no knowledge. However, since it’s not TEOTWAWKI yet, you don’t have to choose either or. There is no excuse to not have both.

Resource videos to get you started:

QuikClot

CAT, chest seal, and needle decompression

SWAT-T tourniquet

Israeli Dressing

These are all manufacturer videos. YouTube is also a great source for training and review videos.

I hope some of this is useful to some of you. Trauma happens to everyone, both in the present and an apocalyptic future. Get the training now when mistakes are not life and death. Then pass them on!

God Bless! – a LEO medic

Letter Re: Fears for the Future

Hiya Hugh!

The letter addressing the changes in people in recent years highlights what has just recently happened in my family. For the last four years, I have been the “Chicken Little” prepper in my family, sounding the alarm, trying to show the warning signs of the impending crash hurtling our way. My family is a conservative family, but they were still asleep when it came to the reality of just how bad things will be for the unprepared. I remember a debate I had with my dad, where he said that if it all went down and people were coming for his food, et cetera, he would just let them kill him; he would offer no resistance. I have to chock that attitude up to his ethnic background of Mennonite pacifists.

Well, after years of saying my piece, I decided that I would just shut up, and if they ever decided to become preppers, they knew where I was. Then about a month ago, my mom told me she was coming up my way and asked me if I would show her how to store dry goods in mylar bags. Yes! Then just this holiday weekend, she started telling me their plans for having a BOL on the back end of their property with stored water and food. I asked her why they were coming around to prepping, and she said my dad read an article in the local paper about what would happen to us if a CME or EMP fried everything. She also said that everyone and their dog was now selling LTS foods and survival gear. Why? Because people see something bad coming and supply is trying to meet demand for survival supplies.

So, to encourage everyone out there who has felt like your warnings are falling on deaf ears, they are not. You just have to be patient and let them figure it out. You will then have friends and family coming to you for advice on how to be prepared. I have been compiling a quick shopping list to give to friends and family that will supply them with three months to one year worth of food in one trip. I would suggest that everyone else have a quick list to give to others as well. Who knows, when they come around, there might still be time for them to put something together. – R.K.

Economics and Investing:

From our friends at Mac Slavo’s blog: Economist: “This is Far From Over… They Know There Is a Problem Coming”. – J.W.

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Here’s Why the Market Could Crash–Not in Two Years, But Now. – J.W.

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Items from Mr. Econocobas:

Fast-Food Protests: Dozens of Workers Arrested in Strike for Higher Pay

Abenomics Approaches a Moment of Reckoning

Draghi Sees Almost $1 Trillion Stimulus as QE Fight Waits– Article lamenting the fact that inflation isn’t high enough in Europe.

Odds ‘n Sods:

Why Is Independence So Frightening To Some People?. – H.L.

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It’s Official: Public Opinion Of Congress Sinks Below That Of A Used-Car Salesman. – P.L.

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One in Three U.S. Workers Is a Freelancer . – G.G.

“Freelancer” is anyone who is employed on a contingency basis, such as temps, contractors, or part-timers. It’s further proof of the dire straits of our economy.

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Milwaukee Resident Shoots and Kills Gang Member. – J.W.

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When can you legally use a gun against an unarmed person?. – T.P.

Hugh’s Quote of the Day:

“The fathers shall not be put to death for the children, neither shall the children be put to death for the fathers: every man shall be put to death for his own sin.” – Deuteronomy 24:16 (KJV)

Notes for Friday – September 05, 2014

On September 5, 1774, fed up with the meddling of the crown and being mostly independant-minded, our nation’s founding fathers met together in the First Continental Congress, in Philadelphia, laying the foundation of what would become the world’s greatest nation.

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JRH Enterprises is running a sale on their PVS14 P+ Upgraded 3rd Generation Pinnacle Autogated Night vision devices, Brand New with 10 year warranty, normally $3500. On sale for $2995. DELIVERED to include a weapons mount and Infrared Beacon as a bonus! Also on sale is the X320 Thermal Imager which allows you to detect heat signatures up to 750 meters away. Normally $3800. on sale for $2995.

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Today, we present another entry for Round 54 of the SurvivalBlog non-fiction writing contest. The $12,100+ worth of prizes for this round include:

First Prize:

  1. A Gunsite Academy Three Day Course Certificate, good for any one, two, or three course (a $1,195 value),
  2. A course certificate from onPoint Tactical. This certificate will be for the prize winner’s choice of three-day civilian courses. (Excluding those restricted for military or government teams.) Three day onPoint courses normally cost $795,
  3. DRD Tactical is providing a 5.56 NATO QD Billet upper with a hammer forged, chromlined barrel and a hardcase to go with your own AR lower. It will allow any standard AR type rifle to have quick change barrel which can be assembled in less then 1 minute without the use of any tools and a compact carry capability in a hard case or 3-day pack (an $1,100 value),
  4. Gun Mag Warehouseis providing 30 DMPS AR-15 .223/5.56 30 Round Gray Mil Spec w/ Magpul Follower Magazines (a value of $448.95) and a Gun Mag Warehouse T-Shirt. An equivalent prize will be awarded for residents in states with magazine restrictions.
  5. Two cases of Mountain House freeze dried assorted entrees in #10 cans, courtesy of Ready Made Resources (a $350 value),
  6. A $300 gift certificate from CJL Enterprize, for any of their military surplus gear,
  7. A 9-Tray Excalibur Food Dehydrator from Safecastle.com (a $300 value),
  8. A $300 gift certificate from Freeze Dry Guy,
  9. A $250 gift certificate from Sunflower Ammo,
  10. A roll of $10 face value in pre-1965 U.S. 90% silver quarters, courtesy of GoldAndSilverOnline.com, (currently valued at around $180 postpaid),
  11. Both VPN tunnel and DigitalSafe annual subscriptions from Privacy Abroad (a combined value of $195),
  12. KellyKettleUSA.com is donating both an AquaBrick water filtration kit and a Stainless Medium Scout Kelly Kettle Complete Kit with a combined retail value of $304,
  13. TexasgiBrass.com is providing a $300 gift certificate.

Second Prize:

  1. A Glock form factor SIRT laser training pistol and a SIRT AR-15/M4 Laser Training Bolt, courtesy of Next Level Training, which have a combined retail value of $589,
  2. A FloJak EarthStraw “Code Red” 100-foot well pump system (a $500 value), courtesy of FloJak.com,
  3. Acorn Supplies is donating a Deluxe Food Storage Survival Kit with a retail value of $350,
  4. The Ark Instituteis donating a non-GMO, non-hybrid vegetable seed package–enough for two families of four, seed storage materials, a CD-ROM of Geri Guidetti’s book “Build Your Ark! How to Prepare for Self Reliance in Uncertain Times”, and two bottles of Potassium Iodate– a $325 retail value,
  5. $300 worth of ammo from Patriot Firearms and Munitions. (They also offer a 10% discount for all SurvivalBlog readers with coupon code SVB10P),
  6. A $250 gift card from Emergency Essentials,
  7. Twenty Five books, of the winners choice, of any books published by PrepperPress.com (a $270 value),
  8. Two cases of meals, Ready to Eat (MREs), courtesy of CampingSurvival.com (a $180 value),
  9. TexasgiBrass.com is providing a $150 gift certificate,
  10. Organized Prepper is providing a $500 gift certificate, and
  11. RepackBoxis providing a $300 gift certificate to their site.

Third Prize:

  1. A Royal Berkey water filter, courtesy of Directive 21 (a $275 value),
  2. A large handmade clothes drying rack, a washboard, and a Homesteading for Beginners DVD, all courtesy of The Homestead Store, with a combined value of $206,
  3. Expanded sets of both washable feminine pads and liners, donated by Naturally Cozy (a $185 retail value),
  4. Two Super Survival Pack seed collections, a $150 value, courtesy of Seed for Security,
  5. Mayflower Trading is donating a $200 gift certificate for homesteading appliances,
  6. Ambra Le Roy Medical Products in North Carolina is donating a bundle of their traditional wound care and first aid supplies, with a value of $208, and
  7. APEX Gun Parts is donating a $250 purchase credit, and
  8. SurvivalBased.com is donating a $500 gift certificate to their store.
  9. Montie Gearis donating a Y-Shot Slingshot and a Locking Rifle Rack. (a $379 value).

Round 54 ends on September 30st, so get busy writing and e-mail us your entry. Remember that there is a 1,500-word minimum, and that articles on practical “how to” skills for survival have an advantage in the judging.

Musings of a Law Enforcement Paramedic – Part 4, by LEO Medic

Yesterday, we read about TCCC and the “MARCH” priorities of field care. We’ll continue with this five-part article by focusing, today, on emergency treatment for dogs because many of us will be depending ours after the SHTF.

CANINE ALS/TCCC

A very interesting aspect of TCCC that we have found is that it has extremely high carry over to the canine world.

Two of my squad mates have working law enforcement canines assigned to them. In addition, we utilize many search and rescue dogs, from bloodhounds to labs for various missions and searches. I imagine most of you reading plan on having at least one as a part of your security post SHTF. With this many dogs in the environment we currently work in, many of them run into some nasty injuries that can, for the most part, be easily treated. If your dog is part of your security plan, there is an increased likelihood that it may be shot, stabbed, or otherwise injured as well.

I am not a vet. Keep in mind that I am a cop/medic treating a dog. What this means is that the average reader with a desire to learn and some basic gear can provide any of this care, too. Again, this is presented as what I have learned and trained on, and hopefully it will be of some use to the readers. There will come a day when, in addition to playing doctor, you will have to play vet, too. Dogs are very similar to people in emergency care.

First, muzzle any dog you are working on. A proper muzzle does not hurt and is not inhumane. If you own a dog, you should own an appropriate muzzle. An expedient one can be made by going over the dogs nose with cloth or strapping, crossing under the chin, and tying behind the head. In today’s world, using a muzzle may save you a few stitches and a trip to the doctor. In TEOTWAWKI, a dog bite and infection may be a matter of life and death. Play it safe. Make sure you have an Elizabethan collar that fits your dogs as well, to keep them from gnawing on something they shouldn’t.

Like humans, dogs have a normal range for vital signs. For dogs, TPR (temperature, pulse, respiratory rate) is an easy way to think about it. Check your dog’s vital signs on a regular basis in varying conditions, so you have some idea of what ”normal” is.

A dog’s heart rate is between 70-140, with 100 being the average number. You can measure pulse on the femoral equivalent by grabbing the meat of the rear thigh and sliding your hand towards the groin until the pulse is felt. A dog’s temperature runs from 100 degrees to 102.5 degrees. Respiratory rate is 10-30 times a minute.

As a general rule, the dose you would give a small human female will work for a canine, in regards to human medication.

Here is a drug calculator for dogs and some human medications that will work on dogs as well.

Tourniquets work on dogs the same way as people and with the same indication– uncontrolled extremity bleeding. The CATs tourniquets work, but this is one instance that I like the SWAT-T. With the angle of a dog’s leg, it is sometimes easier to get it to stay with the SWAT-T. If you have to wrap it around the body to secure it, make sure you do not tighten the wrap on the part that is around the body. For junctional wounds and gun shots, QuikClot can be used. Do not confuse QuikClot with canine KwikStop (the styptic powder). KwikStop is for surface bleeding only. It is not approved to go inside of any animal. Like people, the wound must be packed, and pressure must be maintained. When bandaging a leg, apply a stirrup first and then padding. Follow with gauze, then coban-style wrap. Wrap all the way down to the toes to help blood return. You can apply pressure dressings to leg bleeds as well, but remember to overwrap all the way to the toe. For pad injuries, clean and apply superglue to the torn pad. Keep clean and wrapped. For suturing, have a pair of battery-operated shears to clear the area around the laceration. Skin staplers are available quite cheaply and do an excellent job of closing wounds. They are fast and fairly painless with no learning curve.

Canines can also get a tension pneumothorax from penetrating trauma and require occlusive dressings. SWAT-Ts work well as a wrap, as does saran wrap, to stay in place on a chest with fur. You can needle decompress a dog.

For a canine airway, make sure the neck is roughly straight. Place gauze on the tongue to get a better grip; then, you can pull the airway open and the tongue free. Dogs can be intubated really easily, sometimes without a blade even, and they do not have laryngospasms.

For allergic reactions, maintain an airway, and remove the allergen if it is still in contact. Canines can receive intramuscular (IM) Benadryl/diphenhydramine, Dexamethasone, or Epinephrine (1:1000) for a more serious reaction. For IM injections, you are aiming for the loin muscle, behind the ribs and in front of the hip, in the meaty strip along the back.

If you suspect poisoning, give the dog an apomorphine tablet in the conjuctival sac, with the tablet placed in the lower eye lid. This will make the dog vomit. A little while after vomiting has stopped, give a bottle of toxiban, which is kind of like activated charcoal for dogs.

For a broken jaw, a medical muzzle can be used to support the jaw. For broken legs, start with a base layer of tape placed vertically on the leg, extending about 6-8” past the bottom of the foot, then stirrup it like a “J”. Wrap the entire leg including the foot, so that blood is able to return and does not get trapped. Rolled up newspaper around the leg can work too, but again wrap all the way down to the foot.

If the dog’s temperature gets above 105 degrees, it can go into heat stroke. Cool rapidly with water and fans. Start cool IV fluids and remove from heat.

For dehydration there are two places to give fluids to dogs. The first is the traditional IV method. Two common places for IV insertion on a canine are on the lower legs. Dog skin is very tough compared to human skin. If you try to use any smaller than an 18 or 20 gauge needle, it is very possible that you will kink or accordion the catheter. You can make a small nick in the vein at the entry site if desired as well for easier insertion.

The second (and much easier) way to give fluids to a dog is in the scruff of the neck. When you scruff a dog, imagine you are making a tent with the skin. You can insert an IV catheter into the skin (from the tail towards the head), and give fluids into the subcutaneous space. It will look funny, as this large mass starts to form under the skin. It’s completely safe. The fluid will work its way down and hang under the chest eventually. The fluid is absorbed over time. I have heard of people doing this by drawing IV fluids up with a 20 ml syringe and giving multiple injections if an IV set up is not available, but I have never tried it this way. We have pre-loaded dogs with fluids if it is a particularly hot day for a ground search before heading afield.

The shock dose for IV fluids for a dog is a 250ml bolus. Do not exceed 500 ml. It is very easy to overload a dog with fluids if given IV, so be careful. Start slow. If it is simple dehydration and not shock, go with the subcutaneous route.

A dog’s blood pressure can be measured, too. Use a pediatric cuff. If it is below 90, treat for shock.

Dogs need to be kept warm after an injury to help prevent shock, and casualty blankets work. Dogs can be given CPR and rescue breathing (mouth to snout). The dog’s heart is where the elbow rests on the chest if you bring the front arm back to the chest. With CPR, while the dog lies on its side, compress 1/3 to ½ the side of the chest at 100 beats per minute. Pulse oximeters work on a hairless part of the dog (lips, ear, or vulva). Dogs can be given the Heimlich maneuver and back blows (5 and 5, like an infant) with an airway obstruction. Do not blindly reach in and start pulling on things though. A dog has bones at the base of the tongue that can be mistaken for an obstruction and will break if pulled on.

I am a firm believer that a dog is a dog and expendable. However, that dog may be a $10,000 trained canine that keeps your family safe or a hunting dog that helps you keep the kids fed. Even the loyal family mutt from the pound may get mauled by a mountain lion protecting the kids or shot alerting you to robbers. Sometimes it may be nothing more than a morale boost to save the dog. Plan ahead, and purchase first-aid supplies for your dog. Have enough so you won’t have to make a choice between treating them or letting them die in order to save the supplies for someone else. With that being said, accept that fact that death happens. It’s a fact of life. Sometimes the most humane act is putting the animal out of its misery. The point of this section is that in addition to expanding your training, I want you to have the option, along with the skills and supplies, to go either way.

Letter: Observations of a Shopkeeper

Greetings,

I write because I wanted to share some observations I have made while working at a tactical shop that sees a large amount of traffic from military, civilians, and police. Some observations on each group when it comes to firearms.

Military – The only ones who seem to really have an understanding about handling, maintaining, and the difficulty of using firearms under the stress of combat, are combat veterans. They are humble, eager to give helpful advice, and never have I once heard one of them say they are looking forward to TSHTF so they can waste their neighbors or hordes of starving unprepared civilians. They prepare and remain vigilant. They are realistic. They have their gear in order and ready to go at any moment. They fear being on the opposite side of a military force and believe that laying low is the best strategy. They train regularly and realistically, with small unit tactics with competent like-minded friends. They realize it takes a team to survive.

Police – This is a hard group to explain. There is a minority of police, many of whom are military veterans, who are very capable and knowledgeable with their weapons. These are the true warriors, ready to fight through any situation. You can tell them apart from the rest because they don’t hesitate to spend money on quality weapons and equipment, and they train regularly. They are physically fit for fighting hand to hand, or running and gunning. Then there are the majority who are somewhat capable and competent but are not real gun fighters. These are the cops who shoot a few times a year, maybe, just to make sure they can still pass their qualification. They are usually not in fighting shape, nor do they spend money on quality guns or optics and so forth. They are not warriors and are likely not capable of training or organizing others.

Civilians – These are the most ignorant of the bunch– no offense intended. Civilians have other life skills and problems to deal with on a daily basis. They simply don’t have a background that relates to gun fighting or prepping on a regular basis. Granted, some civilians are extremely capable, well trained, and wealthy enough to have the finest weapons, equipment, land, and preparations of any of the groups. The majority suffer from one symptom– they don’t know how much they don’t know. The things that most of us preppers consider basic common knowledge is unheard of to them. “Cleaning and lubricating a rifle? Huh? Investing in quality optics or tactical gear? Nah, just buy Condor because it looks the same and is 1/3 the price.” (I might add that it will rip and fail in a week.)

I think when things hit the fan, there are going to be some civilians who surprise everyone and beat the odds, plenty of police who simply dissolve into the masses, while some will do their communities proud and lead the way, and combat veterans who will organize, train, and lead the rest who survive into action to restore and liberate this country.

There will be plenty of dead civilians with brand new AR15’s in their hands that never had the safety removed or that jammed on the first shot because they never cleaned off the packing grease from when they bought it years back. There will be plenty of amateurs who bite the dust early on and a month or two down the road. Only the strong will still be around.

So don’t worry about investing heavily in multiple weapons or having too many spare parts. There will be brand new guns all over the place to cannibalize, and there will be plenty of people who didn’t know how much they didn’t know holding them. Always seek to learn more every day, because it’s what you don’t know that is going to cost you in the end. – R.R.

Economics and Investing:

Video: China’s Unbelievable Ghost City on the Coast. (JWR’s Comment: This is the sort of malinvestment that a “command driven” economy creates. It is one of more than a dozen ghost cities in China that combined have an estimated 60 million empty apartments. Note that the only flourishing market in the city is the free street market, operated by independent merchants who cannot afford to rent any of the millions of square feet of vacant retail space.)

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I just noticed that spot silver dipped below $19 per troy ounce in NY after-hours trading. I consider that a screaming buy! – JWR

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The $1 Trillion Auto Loan Problem

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From Chocolate to Beer, Shrinkflation Hits the Supermarket . – G.G.

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Items from Mr. Econocobas:

Not Just Argentina: Other Nations in Debt Doldrums

I Blame The Central Banks – Chris Martenson– Fantastic article put in plain English that is easier for some folks to understand. My personal opinion is that this was not “defective logic” but rather intentional destruction, however, the results are the same.

Odds ‘n Sods:

Nebraska Medical Center to treat Boston doctor suffering from Ebola. – T.P.

HJL’s Comment: Again, there is no necessity to panic about Ebola being on our own shores. If I had Ebola, I would definitely want to be treated by a U.S. hospital rather than a Liberian one. There is just no comparison in standards of medicine or protections from infectious diseases. Here in the U.S., we have become jaded about the quality of medical care we receive. In spite of the damage caused by Obama Care, the standards of health care in the U.S. are still the highest of any country in the world. Excellent health care in Liberia would be considered sub-standard by even the most backwards town here in the U.S. Ebola has a 60% fatality rate of those infected, mostly because advanced care just isn’t available to them. Notice that the last two patients brought back to the U.S. have recovered remarkably well, and we expect this one to follow.

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An interesting take on the old assumption that guineas eat ticks: Birds May Spread, Not Halt, Fever-Bearing Ticks. – CDV

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Obama Lifts Ban on Libyans Attending U.S. Flight Schools, Training In Nuke Science. – T.P.

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From our neighbors to the north: The Day After Labor. – B.B.

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New York schools drop Michelle O’s lunch program. – P.M.

HJL adds: I can’t blame them. When I was a high school physics teacher, I often ate lunch in the school cafeteria. When Michelle Obama began meddling in the lunch programs, the food became as unappealing as colored cardboard. I ended up taking my own lunch, but I observed many students who simply threw the free lunch away and those who paid for it went elsewhere.

Notes for Thursday – September 04, 2014

September 4, 1862 is the fateful day that General Lee invaded the North with 50,000 troops. Historians will banter back and forth about the real reasons for the civil war, but we will probably never fully understand. It is my personal belief that General Lee was gambling on a quick offensive because the South did not have the resources for a prolonged war. Whatever the case was, President Abraham Lincoln trampled the Constitution and created the foundation for the “Big Brother” government we have today.

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Today, we present another entry for Round 54 of the SurvivalBlog non-fiction writing contest. The $12,100+ worth of prizes for this round include:

First Prize:

  1. A Gunsite Academy Three Day Course Certificate, good for any one, two, or three course (a $1,195 value),
  2. A course certificate from onPoint Tactical. This certificate will be for the prize winner’s choice of three-day civilian courses. (Excluding those restricted for military or government teams.) Three day onPoint courses normally cost $795,
  3. DRD Tactical is providing a 5.56 NATO QD Billet upper with a hammer forged, chromlined barrel and a hardcase to go with your own AR lower. It will allow any standard AR type rifle to have quick change barrel which can be assembled in less then 1 minute without the use of any tools and a compact carry capability in a hard case or 3-day pack (an $1,100 value),
  4. Gun Mag Warehouseis providing 30 DMPS AR-15 .223/5.56 30 Round Gray Mil Spec w/ Magpul Follower Magazines (a value of $448.95) and a Gun Mag Warehouse T-Shirt. An equivalent prize will be awarded for residents in states with magazine restrictions.
  5. Two cases of Mountain House freeze dried assorted entrees in #10 cans, courtesy of Ready Made Resources (a $350 value),
  6. A $300 gift certificate from CJL Enterprize, for any of their military surplus gear,
  7. A 9-Tray Excalibur Food Dehydrator from Safecastle.com (a $300 value),
  8. A $300 gift certificate from Freeze Dry Guy,
  9. A $250 gift certificate from Sunflower Ammo,
  10. A roll of $10 face value in pre-1965 U.S. 90% silver quarters, courtesy of GoldAndSilverOnline.com, (currently valued at around $180 postpaid),
  11. Both VPN tunnel and DigitalSafe annual subscriptions from Privacy Abroad (a combined value of $195),
  12. KellyKettleUSA.com is donating both an AquaBrick water filtration kit and a Stainless Medium Scout Kelly Kettle Complete Kit with a combined retail value of $304,
  13. TexasgiBrass.com is providing a $300 gift certificate.

Second Prize:

  1. A Glock form factor SIRT laser training pistol and a SIRT AR-15/M4 Laser Training Bolt, courtesy of Next Level Training, which have a combined retail value of $589,
  2. A FloJak EarthStraw “Code Red” 100-foot well pump system (a $500 value), courtesy of FloJak.com,
  3. Acorn Supplies is donating a Deluxe Food Storage Survival Kit with a retail value of $350,
  4. The Ark Instituteis donating a non-GMO, non-hybrid vegetable seed package–enough for two families of four, seed storage materials, a CD-ROM of Geri Guidetti’s book “Build Your Ark! How to Prepare for Self Reliance in Uncertain Times”, and two bottles of Potassium Iodate– a $325 retail value,
  5. $300 worth of ammo from Patriot Firearms and Munitions. (They also offer a 10% discount for all SurvivalBlog readers with coupon code SVB10P),
  6. A $250 gift card from Emergency Essentials,
  7. Twenty Five books, of the winners choice, of any books published by PrepperPress.com (a $270 value),
  8. Two cases of meals, Ready to Eat (MREs), courtesy of CampingSurvival.com (a $180 value),
  9. TexasgiBrass.com is providing a $150 gift certificate,
  10. Organized Prepper is providing a $500 gift certificate, and
  11. RepackBoxis providing a $300 gift certificate to their site.

Third Prize:

  1. A Royal Berkey water filter, courtesy of Directive 21 (a $275 value),
  2. A large handmade clothes drying rack, a washboard, and a Homesteading for Beginners DVD, all courtesy of The Homestead Store, with a combined value of $206,
  3. Expanded sets of both washable feminine pads and liners, donated by Naturally Cozy (a $185 retail value),
  4. Two Super Survival Pack seed collections, a $150 value, courtesy of Seed for Security,
  5. Mayflower Trading is donating a $200 gift certificate for homesteading appliances,
  6. Ambra Le Roy Medical Products in North Carolina is donating a bundle of their traditional wound care and first aid supplies, with a value of $208, and
  7. APEX Gun Parts is donating a $250 purchase credit, and
  8. SurvivalBased.com is donating a $500 gift certificate to their store.
  9. Montie Gearis donating a Y-Shot Slingshot and a Locking Rifle Rack. (a $379 value).

Round 54 ends on September 30st, so get busy writing and e-mail us your entry. Remember that there is a 1,500-word minimum, and that articles on practical “how to” skills for survival have an advantage in the judging.

Musings of a Law Enforcement Paramedic – Part 3, by LEO Medic

We are continuing to cover the TCCC “MARCH” Field Care. Yesterday, we covered the “M” representing Massive Hemorrhage. Today, we’ll continue with the A-R-C-H portions and more details to conclude the Tactical Combat Casualty Care Lessons.

AIRWAY

Head tilt/chin lift and jaw thrust are still recommended, as are nasopharyngeal airway (NPA) use. NPAs are preferred over OPA’s (nose vs mouth), because they do not stimulate a gag reflex. I like NPAs because they are a bit more forgiving when it comes to size (nose to ear!) in that fewer sizes fit a wider range of people, and they provide a quick and dirty responsiveness scale. If the patient accepts an NPA without a blink, that is usually not a good sign. A recent change in the airway guidelines has also been to allow a patient with facial trauma (think about a jaw shot off or other injury) to maintain their own airway, if possible, by sitting up and leaning forward. Two soldiers with facial trauma died from blood asphyxiation during drug-assisted intubation attempts after being laid down, and in both instances, they had been able to maintain an airway while leaning forward and sitting up. Don’t fight gravity if you do not have to.

Surgical crics. Even on a loved one, what is the highest level of care you are capable of delivering after the cric? I’m not advocating against learning all you can, but realize the limitations of a SHTF world, and accept the fact that death may be a blessing in some cases.

RESPIRATION

Tension Pnuemothorax-

Any penetrating chest trauma has the potential to cause a pneumothorax. This is when air is inside of the chest but outside of the lung. Air follows the path of least resistance. Respiration is a passive process, in that when the diaphragm retracts, it creates negative pressure in the lungs. This negative pressure pulls air into the lungs. If air has another way into your chest besides through your mouth, it will follow the path of least resistance and take it. If enough air pressure builds up inside of the chest cavity, it can create a tension pneumothorax, where the pressure collapses the lung and inhibits blood flow in the heart, causing death.

An occlusive dressing is an airtight dressing that is placed over a wound to keep any further air from getting in. If you suspect that a pnuemo could develop, use an occlusive dressing. A lot of higher abdominal wounds have the potential to cause a pnuemo, especially if the angle is right, so if the chance is there, be safe and use one. There are commercially available occlusive dressings. I like the Halo chest seals. They come in a resealable Ziploc style pouch, and they come with two in a pouch for entry and exit wounds. They have had no trouble sticking to any chest wounds I have dealt with, assuming you can wipe off the majority of the blood and sweat. Every manufacturer makes one. HyFins are popular as well. Some, like the Asherman Chest seal, come with a built in valve with the idea that it will let any trapped air out, reducing the pressure. However, this valve does not work 100% of the time. Expedient occlusive dressings can also be used. We have used the wrapper on a SWAT-T over the wound and then used the SWAT-T to hold it on. I have heard of IV bag wrappers being used after being taped on, as well as saran wrap being wrapped around a patient. AED pads have been used with very good success, as well.

I am a huge believer in thinking on your feet in a pinch. I am also a huge believer in being prepared. A chest seal is $10 or so. They are worth it. In the second you need one, it is much easier knowing you can go to your IFAK and grab one, instead of having to think of how to construct one. There will be other things to be doing instead of trying to unroll the folded up length of duct tape you have in order to tape something on. A few seals, like the H and H, are semi rolled up. Most other ones are flat, and they can be a problem to carry. I carry my seals in my vest carrier under the panel. It keeps them flat and accessible. There really is no training on occlusive dressings. It’s like putting on a big sticker, but I would encourage you to buy an extra and play with it. Become familiar with it.

In addition to penetrating trauma, chest trauma of any type can cause a pneumo. If anyone with chest trauma, such as a broken rib, is having difficulty breathing, be alert for a pneumo.

The field solution to a tension pneumothorax is a needle decompression. Needle decompression is not covered under any good Samaritan laws and is being presented as a informational study only. So when do you do it? In addition to overall patient deterioration, you will notice lung sounds are greatly diminished or absent on the injury side, as well as a drop in oxygen saturation. This means a lung has collapsed or is in the process of collapsing. (You do have a pulse oximeter and a stethoscope, right?) Do not wait for tracheal tug to alert you to the presence of a tension pneumo, or it may be too late.

There are two locations for needle insertion. First, the needle goes on the injury side. The first location is the second intercostal space, along the midclavicular line. Feel for the middle of your collar bone. Go down to the space between your first and second rib. This is the first intercostal space. Feel and go over the second rib, to between the second and third rib. This is the target. You want to be equal/lateral to the nipple, and angled slightly down on insertion (roughly aimed for the bottom of the shoulder blade) but not towards the heart. You may or may not hear air escape, depending on how loud things are. Another acceptable location is the 4th or 5th intercostal space at the anterior axillary line. (Nurses will recognize this as the location for a chest tube, which is another skill to cross train on.) This is roughly where a vertical line at the front of the armpit and a horizontal line at male nipple level intersect. There are nerves and blood vessels that run on the bottom of each rib. The goal is to skim the needle over the top of the rib. If you strike a rib during insertion, adjust the angle up slightly and try again. Sometimes you can do this without removing the needle fully. Insert as far as it will go. After insertion is made, pull out the needle and leave the catheter. If you have to insert a second or third needle, go right next to the first. A quick and dirty method to get you real close to the first insertion location is to form a ”C” with your hand, and hook the collar bone with your thumb. Your index finger will land pretty close to the second intercostal space.

So what needle do you use? The military did a study of chest wall thickness and found that a 3.25” needle will cover 99% of people. Most companies make a 14 gauge 3.25” needle for this purpose. You can find them for around $11-12, if you shop around. These have a stiffer catheter that is more kink resistant than a normal IV. If all you have are standard IV needles, choose the biggest (gauge and length) that you have and use the secondary location on the anterior axillary line. Length is more important than gauge, if you have to choose. (A 2” 18 gauge is preferred over a 1.25” 14 gauge.)

Needle decompression is scary the first time you do it. The needle is huge. Realize that the person will die if you don’t, and most people will thank you after you do save them. Also, if for some freak chance you were wrong, and they didn’t have a tension pneumo, all you did was cause a minor pneumo that will hurt a little but won’t kill anyone.

So, how do you train for this? We honestly use baby back ribs, with a layer of flank steak over them. We got this idea from a CE at the hospital. The flank steak approximates the chest tissue, so the ribs take a little work to feel beneath, like a real person’s upper chest. It is very similar, and it provides realistic resistance. While you are at it, try intentionally striking a rib, and walking the needle up and over so you are familiar with this. Use a large gauge needle for this, but don’t waste the expensive ones.

CIRCULATION

TCCC takes a slightly different approach to this than most are used to.

CPR– CPR is not part of TCCC, nor should it be. Realize that there are two basic types of cardiac arrest. The first is sometimes called a witnessed cardiac event. Uncle Joe grabs his chest and suddenly falls over. There are multiple causes for this, but the most easily fixable one is a dysrhythmia. Imagine the heart quivering, instead of beating. CPR is started, and blood is circulated long enough to maintain perfusion until an AED or defibrillator gets on the scene, at which point the heart is shocked and the rhythm converts and Uncle Joe is saved. The second type of arrest is a trauma arrest. This is when the heart stops beating because of some external factor that caused it, whether hypovolemia, a bullet in the ventricle, or something else. All of the CPR and shocks on scene will never fix this, because it is not a problem with the heart. Even if this happened on the operating room floor, the outlook is very grim. Field survival rates are virtually nil. TCCC does not advocate wasting energy or risking the mission or further lives to try to save someone who is unsavable.

As a side note, you may want to consider an AED as a group purchase for your retreat.

The circulation intervention for TCCC is IV fluids for prevention of shock. All parties that are injured should be pre-emptively treated for shock. Prevention is much easier and has higher survival rates than waiting to treat. If you wait for dropping blood pressure, it is too late. Altered mental status or tachycardia is often the first clue. The person may be able to answer everything, but responses may be delayed. It could be repetitive questioning. Be alert for minor changes.

TC3 is geared for a small squad unit with limited supplies. This is very appropriate for a SHTF world with no restock. If someone is alert and able to drink fluids by mouth, let them. Don’t waste an IV bag if you don’t have to. On that same note, consider stocking 2x500ml bags vs 1x1000ml bags. During the past year there was a nationwide IV fluid shortage. We were able to still get 500ml bags, so most of our patients got treated with these and saline locks, which is pretty much a temporary port for medication or fluids as needed. There were no issues with this.

There is new update called a ”ruggedized IV.” This is a saline lock that is attached to a standard IV catheter. This is then covered with a large tegaderm dressing. The port is secure and sterile but can be accessed directly through the dressing if it is needed in a hurry. If meds are needed, the needle of the syringe can go directly into the port. If IV fluids are needed, a new needle and catheter are inserted, and the needle is removed, leaving the catheter in place through the dressing and into the port. If you have a casualty who is able to take fluids by mouth, let him, but start a ruggedized IV and establish venous access now, in case it is needed later. In tests, fluid administration was delayed using this set up. In a standard IV set up, a 500 ml bolus took 10 minutes to give. Through the ruggedized IV set up, it took 15 minutes. Using a pressure bag brought the ruggedized IV time down to 12 minutes. If you do not have a pressure bag, a BP cuff or someone squeezing the bag will have the same effect.

Administer fluid boluses as needed to maintain radial pulses. Permissive hypertension may be something to think about, depending on what resources you have available. I suggest you read up on it. It’s worth a separate article, but it’s basically allowing low blood pressure rather than bolusing to get it high at risk of blowing out any clots.

HYPOTHERMIA/HEAD INJURY

Like blood, heat is easier to maintain than replace. All casualties need to be kept warm. Survival blankets are often called casualty blankets for this reason. The body has a fairly narrow range for operating temperature and pH. If either gets too far out of homeostasis, key body processes (like blood clotting factors) may not work. Pre-emptively treat, in this case. If someone gets shot, put them in a blanket and a beanie hat until they get to higher care. You do not want to be behind “the 8 ball” with treating hypothermia and shock. If you live in a cold area, consider keeping heating pads or hand warmers with you. The other ways to treat for shock are to elevate the feet and provide oxygen (along with fluids, as stated above). For head injuries (altered mental status with no signs or mechanism of shock), you need to keep their blood pressure above 90 to maintain brain perfusion and keep oxygen saturation above 90%, as well. This will not undo a brain injury, but it will prevent secondary injury to the brain.

The last aspect of TCCC is medevac or casualty evacuation. Something to work on in this realm is to get geared up, then try to drag and carry each other around. It is not easy. When you are familiar with it, try dragging someone as they or you are shooting. Be sure to remember all of your gun safety; a few dry fire runs should be done first. A couple of points to consider: Drag straps on most vests are nothing more than carrying handles. They rip. Do not rely on them. In a pinch, grabbing the strapping over a shoulder is going to be sturdier. We pre-load a length of rope through the back of our vests, if we think it may be needed. It is thick rope, with a loop on one end and a carabiner on the other, and it’s about 48” long. It can be figure-eighted around arms and shoulders, left in place to disperse the load to the entire back of the vest, or slip knotted around someone’s feet and clipped to your vest. Have some method in place that you have trained on to get someone out of somewhere in a hurry. Be sure to check interventions (tourniquets, dressings, and so forth) after moving someone, as they can come loose or come off.

We have also used casualty bags as lifters/carriers in a pinch as well, and although they’re uncouth they do work.

OTHER ITEMS

One of the most difficult bleeds to control is a high hip arterial bleed. You cannot tourniquet at this location, and it is hard to manually apply enough pressure with the artery at the depth it is. The military solution to this is the CROC clamp that some medics carry. This is pretty much a folding C-clamp, with a flat board for under the buttocks of the victim and a rubber ball at the business end of the clamp. The ball is placed above the site where pressure is wanted, and it is screwed down until the desired effect is reached. It is very difficult to move a patient with this on, as you are pretty much limited to using a backboard to a helicopter and that’s it. We have played around with grip-tightened wood clamps– the quick release ones that clamp down as you pull the trigger– with some success . It worked to occlude blood flow, but it did not stay on well, and we had to modify the clamp ends. Also, do you have a surgical option to fix this injury?

The IFAK contains a rigid eye shield. With eye injuries, pressure is the enemy. You cannot put eye jelly back in. Pressure dressings can squeeze fluid from the eye, making the injury worse. A pressure dressing can also adhere to the eye, causing more damage upon removal. Even a bandage wrapped loosely can cause unsafe pressures. The eye shield is designed to protect the eye without putting pressure on it. One company makes a multipurpose pressure dressing where part of the pressure bar is removable for use as a rigid eye shield. If you can, cover both eyes. Eye movement is reciprocal, so whatever the good eye does, the injured eye does as well. With eyes, prevention truly is the best medicine. Wear protective eyewear anytime you think you may need them. Look up some of the pictures of IED victims where the outline of where their glasses were is all that is intact. The thought of losing sight post-SHTF is pretty horrendous.

The current antibiotic in the IFAK is 400 mg of moxifloxacin. This is a broad spectrum antibiotic. It should be taken ASAP after any penetrating injury with the potential for infection. Moxifloxacin has some mixed side effects. It is not available as a fish antibiotic. It is a member of the Quinolone family of antibiotics. Cipro is part of the quinolone family as well, and is available in a fish form (Fish Flox, or Fish Flox Forte). I am not specifically advocating either, but I am providing a starting point for your own research. Since infection is going to be a killer, I recommend carrying some antibiotic to be taken prophylactically. There is a large inverse correlation between severity of infection and post injury time of first dose.

Letter: Fears for the Future

Hugh,

First let me say “thank you” to you and the staff at Survival Blog for all that you do. I rarely miss your daily posts, and even then it is because occasionally I must work away from home.

Second, I wanted to respond to something said in today’s (9/1) post from the pastor from eastern Washington. He commented about how frequent we seem to hear of people’s concerns about our leadership and of the lack of hope, the concern, and despair that seems to be echoed in faces and voices of people around the country. During my work day, in a professional capacity, I am in people’s homes all day. At a minimum this is a five county area, and occasionally I might be required to be in counties spotting an entire corner of the state. In fairness I feel that I should preface my comments to the state that I live in the central United States, and generally people are possibly more conservative here than in other areas of the country. That said, as of the last couple of years, I have seen a profound change in people. Honestly, I can not remember the last time that there was not a day (not one work day) that at least one, and often multiple persons, have brought up their concern about the direction our country seems to be headed and their fears for the future and also for their children’s and grand children’s future. They often will express a need to start “putting things away” and will spontaneously talk about preparations they are already making. Now, because of my professional capacity in their home, prepping is not a topic I can bring up. That individuals bring this up to a stranger almost daily is a significant change from only a couple of years ago. These are people that run the gamut from just very concerned individuals and families to more often prepping in some manner to full blown hard core peppers and survivalists. – RK

Economics and Investing:

Why Raising the Minimum Wage Will Increase Inflation and Hurt the Economy

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Are Margin Debt Levels Signaling A Market Collapse?

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Items from Mr. Econocobas:

CBO Forecasts $506 Billion Budget Deficit For 2014

U.S. Second-Quarter Growth Revised Higher

Dethrone ‘King Dollar’ – This is an interesting Op-Ed; however, he clearly either doesn’t understand the consequences of what he is advocating or is severely overestimating the fundamentals of the U.S. economy to absorb such a shock– probably both.

S&P Tops 2000 But Weary Consumers On Strike: The Recovery Delusion Gets Obvious