Medical Thigh Rig

[David_Parker03]

It finally arrived: A NAR (North American Rescue) thigh-rig kit I picked up on fleabay. Most of the items are used...but I'd added a few of my own. They'll be designated (D) from what I've supplied. I've got

- 2 Nasopharyngeal Airways (28F)
- 2 Bolin Chest Seals (D)
- 2 6" Israeli compression bandages (D the old ones expired in '11)
- 2 H&H Compressed Gauze
- 2 5"x9" Abd Pads (D)
- 2 NAR Saline Lock Kits (I'm not a paramedic yet, so I actually don't know how to use them)
- 2 NAR Trauma Tags
- 2 4" Elastic Bandages
- 2 15g CELOX granular packs (D expired in 10/'10 gotta switch those out!)
- 3 NAR Talon gloves (they're black for that Tacticool look:jerkit
- 3 CAT Tourniquets (I think I'd prefer the SOF Tactical tourniquets more...they're just waay more expensive)
- 1 ARS Decompression Needle
- 1 Princeton-Tec Apex Headlamp (D)

Oh, and

- 2 Rolls of medical tape. One cloth, the other plastic.

And of course, no photos means it never happened:

By david_parker03 at 2012-03-06

By david_parker03 at 2012-03-06

Can you think of anything else I might add to streamline it? That is to say, take away??? If I'm lacking or overdoing, lemme know!

And I've already got trauma shears, a good penlight, stethoscope, and blood pressure cuff. The shears and light are in another pouch.

 

[Quirt]

NAR provides great gear and they put together a nice kit(s). I custom ordered a mission specific kit for a client of mine and couldn't be happier.

I'm assuming you're trained and competent in using this kit...i.e. treating non-compressible wounds with the Bolins and tension pneumothorax with the ABS? If so then you realize one ABS is not going to be enough because they tend to plug. Im assuming you know how to pack wounds with the H&H, and the multi-functionality of the Israeli Battle Dressing for both compressible and non-compressible wounds? You have some really nice kit there.

I concur the SOF are much better especially the newer 1.5" wide. They are heavier and more $$ but you should have one on your person if your going into harms way which is what I'm surmising your doing with this primarily TCCC oriented kit anyway.

The only thing I'd say is ditch the black tactical cool Black Talon gloves. When using at night and your doing a blood sweep you cannot see or detect the blood on those black gloves at low light. Don't ask me how I know. Go with the non tac cool med blue! The blue reveal blood under any lighting conditions.

 

[David_Parker03]

@Quirt: I've just gained certification as an EMT. While unemployed, and lack any real-world experience, I'm kindof a dork and practice at home with various things. For instance, I'll use expired Israeli bandages on myself, after cutting apart some old jeans I might be wearing. Or I'll employ the help of a friend. I like to review contra's and indications of various things.

I go in waves of interest and none. Sometimes its medical, and for a week or two I'll be rehashing techniques and approaches. Others its knots, and various ways to tie them and things together...stuff like that. Thanks for the advice though!

Do you have any input concerning Celox or QuikClot? Granular vs. Syringe applicator vs Gauze vs. Z-Roll?

 

[Coal-Cracker]

...

Do you have any input concerning Celox or QuikClot? Granular vs. Syringe applicator vs Gauze vs. Z-Roll?

I was told when I was at Ft. Sam that Celox was being discontinued as an issued item. I've only been issued Quikclot and more currently, Combat Gauze.

 

[Brian.Evans]

I've just gained certification as an EMT. While unemployed, and lack any real-world experience, I'm kindof a dork and practice at home with various things. For instance, I'll use expired Israeli bandages on myself, after cutting apart some old jeans I might be wearing. Or I'll employ the help of a friend. I like to review contra's and indications of various things.

Oh dear Lord. Look, I'm going to say this and I hope you don't take it as me being an ass. I'm assuming you are an EMT-Basic, since you didn't say you just got your paramedic.

Put down the kit and get your head out of your ass for a second. Medical is not something to "play" with. Some of the kit in that bag could make a bad situation worse (at best) or kill someone (at worst) if used improperly. When you're in the [remote] field, your skills have to be spot on, because likely it's just going to be you, no one else to turn to. You. All alone.

You say you'd prefer the SOF tourniquet over the CAT. Have you ever used either in the field? Have you ever used a tourniquet at all on a real patient.

You like black gloves. Again, showing your newness. Black gloves look cool, but as previously stated, don't do dick for actual use. They are a pain. Get blue gloves.

Were you trained on needle decompression as a basic? We aren't in this state. This is the part that could kill someone if used improperly.

You have zero real world experience. Stop being a mall-ninja EMT and go get real experience. Then re-evaluate your kit. It's a neat piece of equipment, but I think you're a LONG way away from needing a TC3 type kit.

Hope you take this the right way. I just came off shift and I'm exhausted, so maybe I'm being a bit harsh, but you need to realize having someone's life in your hands is not a small thing. I'm proud that you've joined the ranks of emergency medicine. Welcome aboard. It's an awesome profession, just treat it with the respect it demands.

Feel free to email me, medicevans at gmail dot com. We can talk more if you'd like.

Brian Evans, CCEMT-P, NREMT-P
Decatur Ambulance Medic 9, Central House

 

[adam0321]

I am on board with medicevans. I have thrown probaly 50+ IV's on live people in a class room or field setting and the first time I had to do it for real it took me 3 tries to get flash. The previous members are spot on about the gloves. Ditch the black ones. As far as the ND's??? That is a tough one, even on a dummy. At least you dont have a laryngoscope. I got to try that on a goat my first time and wound up paralyzing the damn things vocal cords. That is a much harder skill then what it looks like. Is this a kit for someone to use on you? Or to use on someone else. If your intention is to use it on someone else then I would go with more of a shoulder/ACLS type bag as you can lay it out infront of you. If it is a kit meant to be used on yourself then you can cut it down quite a bit. To be honest I have been amazed at what curlex(sp?) would stop/fix. we stopped a femoral bleed once by packing it with curlex and did not even use a t. I like the cat T's but we have broken them before.

Now as far as the skill sets and training go....I'll put it this way and you can take it for what its worth. I have 3 friends(I actualy have a couple more total) one is a flight medic with the 160th SOAR, another is a SARC IDC(special amphibious Recon Corpsman) and another a Air Force PJ. They all agree that it would have to be life and eath for them to even touch a person they did not know. All of these guys have 2+ years a special operations medical training and they are still hesitant about treating someone off the battle fireld. These guys perform firld surgery and one of them I even watch rebuild and afghani's throat under fire. They all say the same thing, it's too risky to want to wait for that one car accident and jump out to play hero. If you dont kill someone by accident rememebr everyone these days has a lawyer. Stay withing your training. I have my EMT-B thru the military, have completed 10+TC3 courses, trained as a DMT and worked on live animals in training, also had the missfourtine to have to work on some friends in combat. All that and I'll be damned if I do little more then give someone I dont know a band-Aid or offer to call 911.

Just my $.02 but you even said yourself you go in phases of interest.

 

[David_Parker03]

@Medicevans: Oh, I hate the black gloves. I don't give a shit about them. I hate tacticool crap. Hence the "jerkoff" sign. Then again, sarcasm is difficult to dispatch through text. If the thigh-rig came in orange I'd be much happier.

And while yes, no real world experience, in my training with CAT and SOF, I find the SOF much easier to thread through the buckles, along with strapping down the torsion bar via SOF's riggers belt-like loop. Would I prefer that the SOF tourniquets and the like lack the TACTICAL SPECIAL RAMBO FORCES BS?? Absolutely. Can you recommend a comprehensive brand that doesn't have those? By all means, please do.

Needle decomp? Oh damn, the thing scares the living hell out of me. That much adrenaline and having to worry about 90 degree placement, mid-clavicular, and NOT puncture the heart? But does it kill me to carry 1 just in case I'm with someone who can? Not really. I've purposefully held off on buying more simply because I've come to the realization that I don't know how to use them. This is why I put in Bolin chest seals, over the HyFin chest seals or other occlusive dressings. I wanted something that vented.

But this is what I asked for: Feedback. MedicEvans, while you come off a little harsh, I blame myself at failing to show my true intentions: I wanted to build a kit, that in the event of say a shooting, or tornado, that I could strap on and run. Is this something I plan on carrying everyday in a bag? Heelllll no. In the trunk? Why not? You're right. Skills have to be DEAD-ON. I don't want to kill anyone. But I also don't want to be helpless when looking at someone. Improvise? Sometimes, sure....but having the right tools is hard to argue against. Is this really where my training should concentrate? Probably not. Its the finer, grayer areas that I should concentrate on. Whats my patient telling me? Hows the ECG reading? Am I wrong? Kinda, maybe?

@Adam0321: Haha, I hear you on the laryngoscope. Years ago, I wanted a set, before I read and talked to people about how friggin' difficult it is to intubate. I'll ditch the Saline-lock kits because, hey, even when I am a paramedic, am I really gonna be stocking up on fluids? No.

After strapping this thing on, I've come to the realization that ITS HUGE. Un-weildingly huge. Cumbersome is an issue. But I haven't been able to find a shoulder rig bag that's affordable complete with straps to neatly organize a relatively small kit.

Sure, I've got a large shoulder bag, that I bought years ago that's got a c-collar, OPA's, trauma pads, hemostats, 4x4s, you name it....but whats the point in having and carrying all of those things, if I don't have rapid transport? I wanted to build a kit that was for something I couldn't ignore. I'm obviously in college, and I like to think that I'm aware of my limitations. But a school shooting? Thats something I can't ignore. It'd be nice to have something that I can grab, and be able to treat those serious injuries. Are 4x4's handy? They seem to be one of the most widely used items from the rotations I've done. But they also seem to be the equivalent of the philips screwdriver. Yes, have a selection. But when dealing with something that needs rapid movement and prompt treatment, wouldn't you rather have a hammer and crowbar? Thats what this kit is.

I'm not trying to be some super man hero-save-them-all. This kit is for that rare event that I can say "Hey you, grab this. Press here." Celox gauze can help with that. This isn't for me pulling over on the side of the road to help a car accident. I don't wanna die in some lame way trying to help someone with a bleeding nose. Its for that ultra-rare SHTF. That kit that helps you employed first responders say "Hey, you know what, that bought this guy a few more seconds."

I'm not going to be pouring over this kit everynight saying "okay...here's my NPA....here's my lube...what are my indications vs. contra's.." Instead, I'll probably be reading up on my text book while applying copious amounts of kerlix wrap to practice, nice, efficient bandages.

Should I still drop it? Did I present my case a little bit clearer? Everything starts large, then eventually gets streamlined. Thats what I want to hear from you guys: streamlining, and input. I just really didn't want to come off as some dickhole playing soldier. The thigh-rig seemed like it'd be handy and efficient. Although, now that I have it, its waay bigger than I imagined.

 

[David_Parker03]

@Quirt: No, I did not know that they tend to clog. Duly noted. Whether or not I'll ditch it, I'm not sure, simply because it takes up little to no-room in the size of the thigh-rig. I like the compressed gauze H&H makes, because it really cuts down on size, and the Israeli compression bandages seem to do a pretty good job for compressing a wound. Nothing like a tourniquet...but good pressure. What are you thoughts on the israeli bandages?

 

[Brian.Evans]

David, I guess I'm still not sure what you're planning to do with this kit? Good that you're not planning on jumping out of cars to help people on the side on the interstate, but I still don't understand what it is that you're doing with it. I have built a pack that was to be deployed to Afghanistan to provide primary care to a few hundred people for a couple months without resupply. We ended up using it slightly differently, but it worked well anyway. That's what I mean,'you build a pack with it's end goal in mind.

If I understand correctly, you want this to be a shtf type pack. Now, say it with me, the definitive care for trauma is surgery. Not a kid with a thigh rig. Surgery. We keep them alive until the docs can cut them open and get the real problem fixed.

For a school shooting scenario I can streamline it for you. Bandages, lots of 'em. Screw 4x4s, if someone's shooting they are gonna be useless. Abd pads, Israeli bandages, compressed gauze. I don't think I'd do quick clot as a lay person (meaning not associated and not actively on an ambulance at that time. I'm a lay person when I'm off shift.). Remember, you try to help, you present yourself as an EMT and you fuck up, you get sued. Toys are fun, but know what I like even better? Keeping my license, and not going to jail for invol manslaughter because in the heat of the moment I decomped a chest that didn't need it, then the needle clogged, causing a tension pneumo and the guy died.

Streamline for hiking in normal (not 390 miles from civilization) scenarios? SAM splints, anti bug/snake/poisonous plant dope, slightly less bandages, triangle bandages, tape, possibly sling making equipment. And again, there is a difference whether this is a just in case thing you carry while hiking, or something you strap on while going out to get someone.


I know it's cool, but I'd drop the thigh pack regardless. Take ten of your closest friends, give them all a bad condition, and then have them simulate a mass casualty event. You will get really tired having that damn pack on your leg real quick. They look cool, but are designed for something totally different than you want to use it for.

Just a word on my previous post. Perhaps it read a bit harsh. I didn't mean it as super harsh, but rather deadly serious. It is hard to settle down and focus as a new EMT. I had the same problem. However, get a job and get some experience. Get in the ditch and work a code, you'll see what works and what doesn't. You'll streamline your personally equipment rapidly. I don't carry a window punch. Know why? Because in 7 years of doing this, I've not a single time had to punch a window. They are neat, but not something I need to carry personally. I've done remote med, and it scares the hell out of me sometimes. I did stuff very far outside my training, but I had the authorization and leeway to do that. It was fun but nervewracking.

It's serious for me in another way that won't really make sense to you at this juncture in your life. That little 3x3 piece of paper let's me do things like keep paying for my five kids somewhere to sleep at night, food on the table, vehicles, college educations, etc. If I mess up and I lose my license because I want to be a hero, I lose everything. I can't do anything else, I have no other marketable skills. That makes it deadly serious to me. I have six other people counting on me every third day when I step onto that truck.

What the take away needs to be is that you need to get some real world experience. We can't and don't save everyone, you can only work on the person in front of you right that second.

Like I said, this is not a game, it's deadly serious. When there's a live gunman still out there and you're trying to treat people, you might get shot. I've seen and treated people getting shot. Do you know what fresh, hot, sticky blood smells like? Do you understand how your body reacts in a very stressful situation like like that? Get some real world experience. You'll understand after a year or two at a busy service.

The offer still stands. Hell, if you are ever in IL, come ride with me some time. It's bound to be a good time.

 

[David_Parker03]

@MedicEvans:

Thanks. You're right: deadly serious is much more apt of the tone you evoked. I'll look for another shoulder rig to transfer the contents towards. In the meantime, as much as I want to get actual life experience, I've got school to concentrate on. Hopefully when that clears up I'll be applying to any rig that will take me.

Thanks for the offer to ride along, sadly I'm in Texas. But I'm looking to eventually move up to Chicago in the future. I really do appreciate the feedback, as it gives me something to chew on and truly consider.

 

[Brian.Evans]

Sorry David, I just now saw you had replied to this thread.

What are you going to school for? Medic or something else?

 

[Killinumsoftly]

Do you have sutchers? I have them in my emergency pack and I also just ordered one of the pre loaded skin staplers. It comes with like 40 staples in it an was only like 10$. I figured it wld be quicker then sitting there stitching someone.
Also I keep 2 of the celox filled syringe type deals. This way if you have a deep hole like bullet wound you can stick it inside and depress it to fill the wound with celox, instead of just pouring it and trying to stuff it inside. I also keep a small torch lighter as I'm a big fan of cauterizing wounds if possible. And another cool thing is the super glue they make specifically for wound treatment. If you can't find that then regular superglue works good.
I am a rock climber and mountaineer and do a lot of guiding so I've seen some big deep wounds from rock or a slip and fall on an ice axe and stuff like that. Usually we are far from help so I like to be able to stop serious bleeding. I also carry 2 of the quick clot sponges because you can use thAt to cover the wound apply pressure and also help the clotting.
Hope I gave you some ideas, I know your kit gave me a couple, it's a very nice set up you have, I like how nice and stream lined it is. I have a serious kit in my truck that is in a toolbox but obviously that's not something I can carry with me. So I'm always looking for good stuff I can fit in my overnight pack

 

[Killinumsoftly]

I've had experience with some pretty bad wounds, nothing like an EMT has seen and I don't have anywhere near his knowledge. But I agree with him, mostly I try to just stop bleeding or slow it and do what I can until real emts get there and bring him to the hospital. The other few things are for when I'm way out and unable to reach anyone for help, I pray I never have to use them but if it's between that and bleeding out I'll take my chances. As for the chest tubes and stuff, I don't have any of that type stuff as I don't know how to use it properly. I have some minor training and a very good friend of my dads was a SF medic, who has shown me some stuff but listening to his story's is crazy. And I'm by no means ready for what those guys go threw. If you served as a medic, I'd like to say thank you for your service, you guys deserve way way more credit and way more money then you get. IMO you guys need to be getting paid millions not some guy because he can throw a baseball fast, this world is ass backwards. Pay the guys you need to save your life the real money not the guy who you'll never meet or even need to meet for any reason.