The current rash of traumatic injuries to both safari clients and staff begs the serious question of what to carry and what to do when someone suffers a GSW, is hooked or mauled while in the bush.

Many of us on AR are combat veterans, doctors, EMTs and emergency responders. Most of us have spent many days and nights in remote areas of the world pursuing what most "normal folks" would consider heavily risk involved activities and have received advanced life care training. I am curious as to what recommendations others have for what should be carried for immediate use when a traumatic injury occurs in a remote area.

For at least 10 years I have carried a packet of QuikClot and an Israeli Emergency Bandage. They have been replaced as they expire. These items have been proven to save lives in combat around the world for at least 10 years. Advances in QuikClot over this time have greatly improved the simplicity of use of this hemostatic "blood stopper" agent. These two items weigh only a few ounces and can be carried easily in a belt pouch or cargo pocket. Total cost for these two items is approximately $25 with 2014/15 expiration dates and are available online from eBay and Amazon or at retail outlets such as REI stores.

My current QuikClot of choice is a 6"x4.38"x.25" vacuum packed QuikClot Combat Gauze Z-Fold bandage weighing .75oz having deployed dimensions of 144"x3". This is the military grade product currently issued to all branches of the U.S. military.

My bandage is the FirstCare FCP01 Emergency Bandage, AKA the Israeli bandage, a military trauma & hemorrhage control wound dressing with a non-adherent 4"x7" pad connected to a 4"x 5 yard elasticized wrapping leader w/handle loop, pressure applicator, closure bar and stop & go release. It is in a double vacuum package weighing 2.5oz and measuring 6"x3"x1.25". It is current issue in U.S. military IFAK to all combat individuals.

These items need to be carried on your person, not left in the hunting truck. Should your outfitter/PH have these items available? Certainly they should, but they won't. As in all endeavors, you are ultimately responsible for your own survival in critical incidents. I have discussed these issues with all my hunting partners, including M.D.s and D.D.S. for the past 10 years and all have now purchased and carry these two items. They are inexpensive, light weight, simple to use and can be self-administered.

Oh yeah, we all purchase Global Rescue also, but GR can't help you if you can't stop the bleeding.

Opinions? Comments?

Mike - +1 across the board. I always carry a couple of quick clot packs with me as well, and I leave them with my PH when I depart camp. These packs are life savers, pure and simple. A council lands game scout named Ramens would be alive today had the folks he was with doing problem animal controls work in Dande in 2009 had them in their kit. Ramens was ambushed and grabbed at the neck by a lioness. One shake, and she was gone off into the bush. Poor Ramens bled to death on the way to the clinic. He was another one of the "good guys", and his life may have been saved had they had a few quick clot packs with them.
Mangwana

anybody today who doesn't have knowledge enough to become at least a first responder, is just plain stupid.

+2 Not only do I carry quick clot but all of our cars have quick clot and first aid kits; I also bring some in my range bag when I go to the range.

It has come in handy helping a lady in an accident last fall.

Jim

Quick clot doesn't work like on tv. While it is good, it is only another tool. Pressure is the answer for bleeds. Put the quick clot in for sure, get it in deep, then the Israeli bandage, and maybe even tourniquet.

First responder at a 70 mph roll-over accident last month. Like mentioned above, good compresses and pressure are the best until real lifesaving help arrives. Anything is better than nothing tho!!!!!

I'm a very firm beliver in not only carrying the correct medical equipment, but also having the proper training. Even a simple first reponder/first aid course provides valuable insite into life saving interventions, particularly in the case of trauma.

I'm an EMT at my local volunteer FD, and an ER nurse by profession. I carry a basic trauma kit practically everywhere with me. I carry a formal trauma kit in my truck at all times, and have a basic trauma pouch in my hunting pack and range bag. My basic pouch contains quick-clot trauma dressings x 2, the quick-clot specifically for penetrating trauma (looks like a tampon), and 2 pressure dressings (the aforementioned Israeli dressings). Beyond that, a level head and a means of communication for advanced care/evacuation are some of the best life saving tools you can take into the field. I'm very happy to report that my sportsmen's club has similarly supplied trauma kits at each of our three ranges and makes it part of the club orientation to know where the trauma kits are and basic use of its components. They also regularly run first aid classes for members and their families.

Quick clot times 2. I am on blood thinner and I will use every bit of it in an emergency. Military grade bandages and a good pain killer(oxycontin or dilaudid). They go a long way towards getting the injured out in one piece and comfortable.

Like others, I've had some volunteer fire dept training.

Clean bandana? Clean socks? If a hunter isn't prepared to pack a first aid kit like mentioned above, clean clothing can be carried in a trackers backpack and used either at the hunters convienience or in an emergency.

Were I to be treating a patient I'd all at the same time be calling for medevac, clearing a trail for ground transport and applying first aid. One tracker gets on the radio to call camp to instruct the medivac. The other tracker cuts a trail from the victim to the cruiser while the driver at the cruiser cuts a trail and drives to the victim.

A dirty bandage is better than no bandage since infections can be treated but no blood left in the body because it all drained out leaves little to treat.

Get the patient stabil, get them packaged and get them to a doctor. Now.

I cary quikclot- lawndart sent out a whole suitcase full of it a few years ago that was distibuted through ZPHGA. I have updated mine to the latest standard on every US visit...never needed it ever since it was available!

A decade back we had two PH's shot within a month of each other and everybody remained 'aware' and 'first aid' concious for a couple of years...It would obviously help if you could get a re-supply of quality kit every 3 years when we have to re-qualify our 1st aid certificate, but the great stuff isn't available and we are stuck to 'state of the art 1975'- Their is nothing in our advanced first aid kits that was not in the military first aid kits in 1975 and quite alot of what a military medic carried back then is not available anymore.

It also pisses me off x10 that after negotiating with MARS for PH training and agreeing on the sylibus etc in 1997 they unilaterally decided to stop teaching drips and use thereoff in 2004, because you could pick up a sat phone and call MARS...(average response time to remote location of 9hrs!!!!) Unfortunately, they gambled right on cutting out alot of core training in the PH and nurses corses becuase Government bureacracy in getting a new agency approved for training is too much of a fight and nobody has forced the issue...

Agree with Scott, in my career I've seen few lives saved because of air transport. I've seen patients arrive 12h later by air than road transport would have take. A huge problem in Africa is that the rotary wing aircraft with range, abilty to fly in poor visibilty, navigate and recover patients in difficult terrain is just not affordable, here a Jet Ranger is a big helicopter.

God helps those who help themselves. If the patient is lucky enough to have a survivable wound you need a nylon poncho to make a stretcher, a GPS to navigate accurately, a torch to light the way to get patient evacuated by which ever means possible.

I have huge respect for a PH with a good GPS, who has spent time to map his area on that GPS. When the crap hits the fan the ability to get on a game track, river, drainage line or pan where you can actually walk at night without breaking trail may make a huge amount of difference in the time needed to evacuate.
It may spell the difference between being stuck waiting for death or putting up a fight.

Communication is essential, a satellite phone is just so elegant, don't under estimate a cell phone in Africa, coverage is often surprising. VHF radios are usefull to communicate while hunting but can't get the wheels rolling hundreds of miles away.

Can you visually signal in daytime? How many rescue attempts have been prolonged for lack of a flare, small signal mirror or a box of matches?

People don't think enough about this.

Can you please provide the source for these items and the cost?

Vaughn, there are many places on the internet, just plug in the names and you'll get many "hits" and like LionHunter alluded too, EBay is another source. I carry a full kit in my truck every day as well as my hunting back pack. When I was in Africa hunting with John Sharp, I was impressed at the amount of emergency gear he carries in his truck for events like these and also snake bite stuff.

quote:

Originally posted by Balule:
Agree with Scott, in my career I've seen few lives saved because of air transport. I've seen patients arrive 12h later by air than road transport would have take. A huge problem in Africa is that the rotary wing aircraft with range, abilty to fly in poor visibilty, navigate and recover patients in difficult terrain is just not affordable, here a Jet Ranger is a big helicopter.

God helps those who help themselves. If the patient is lucky enough to have a survivable wound you need a nylon poncho to make a stretcher, a GPS to navigate accurately, a torch to light the way to get patient evacuated by which ever means possible.

I have huge respect for a PH with a good GPS, who has spent time to map his area on that GPS. When the crap hits the fan the ability to get on a game track, river, drainage line or pan where you can actually walk at night without breaking trail may make a huge amount of difference in the time needed to evacuate.
It may spell the difference between being stuck waiting for death or putting up a fight.

Communication is essential, a satellite phone is just so elegant, don't under estimate a cell phone in Africa, coverage is often surprising. VHF radios are usefull to communicate while hunting but can't get the wheels rolling hundreds of miles away.

Can you visually signal in daytime? How many rescue attempts have been prolonged for lack of a flare, small signal mirror or a box of matches?

People don't think enough about this.

Well in truth I was only refering to ground transport as a method of getting the victim closer to air transport if possible. Of course I'd never want to postpone ground transport for hours hoping for the plane.

A mistake we've made here in the past is playing doctor in the ambulance, meaning treating the patient on scene too long and delaying the trip to the doctors and hospital. My preference and I believe the correct response of emt's is to keep moving in some fashion. Stabilize the patient. Package the patient. TRANSPORT THE PATIENT! The MD in the exam room is the final destination and there should be constant effort and motion to get a viable patient there.

In the case of a multi person hunting party, ( trackers, drivers, observers, ph's and clients, ) every person is available and capable of some assistance in an emergency situation. "You apply pressure to the wound, you cut bushes, you stay on the radio, you get the truck turned around!,.......and on. Stay focused on the final destination and stay in motion.

As it applies to ground vs/ air, darned if I'd want to wait six hours to be delivered by air to the doc if theres a doc 3 hours from here via road.

Thanks jorge. I should have read the initial post more carefully. It does indicate that ebay, amazon or REI does have them. I will be over to the local REI here in Vegas this weekend and will check there first. Thanks again.

These guys have some nice kits that are at a reasonable price.
US CAV medical kits
I have one in the pickup.

IFAK = Improved First Aid Kit

Each branch of the U.S. military has designed their own IFAK containing those items they deem most important given their members deployment mission. IFAK is an individual piece of equipment issued to all personnel in a combat zone and designed to be worn on the battle dress.

All branch specific IFAK have the QuikClot and The Emergency Bandage as well as additional items. All the specific content information is readily available via a simple internet search. I started 10 years ago by purchasing the USMC IFAK put together by Z-Medica, the developer and maker of QuikClot, and packaged in a 7"x5"x2.5" nylon canvas pouch that is MOLLE compatible. Over the years I've added items I want to have available in my kit.

Current contents of my IFAK:

(2) Bandage, Muslin, Compressed 37x37x52 inches
(2) H&H Compressed Primed Gauze
(2) TK4 Combat Tourniquet
(1) QuikClot Combat Gauze Z-Folded
(1) The Emergency Bandage 4" Hemorrhage Control Bandage
(1) WaterJel Burn Dressing 4x16 inches
(2) H&H Tape, Combat Medic Reinforcement
(2) Tevdek II 1x30" 5-0 Surgical Sutures
(4) Antibacterial Wipes
(2) Pairs Patient Exam Gloves
(1) EMT Shears, 7.5"
(1) Z-Blade Skinning Scalpel

IFAK with issue contents are available for approximately $50. You can always add or delete items to meet your individual needs.

I've been somewhat reluctant to get in to this. I suspect this will not be a popular opinion.

Obviously, lots of folks have put a lot of thought in to what they want in their first aid kits.

I used to go in the field with a lot of stuff for "what if" and thought I was doing pretty well.

Then we had a sit down in camp one night and talked about it. It turns out 99% of the stuff I had brought was useless, as I was the only one who had any idea what to do with it. Now, I am a physician and have taken all the "intensive" courses for this stuff, so it would go without saying I would know "more" but most of this stuff is actually very field expedient.

If you have duct tape, a plastic bag, a belt, and a couple shirts, you have what most of these kits have. I have been less than impressed with the various thromboplastin products, as pressure is what you need, not some miracle powder. Its my understanding from some of my doc friends in the military that they are getting away from that stuff (quickclot, etc.) anyhow.

Get contact with whatever form of medevac or ambulance you can, and get the person to a properly equipped ER/hospital ASAP. This is actually the first thing in any EMS/BLS sequence.

Instead of sitting here trying to buy "saftey in a package" get off your butt, go to a community college or community center first aid class, and if you want, get some real first responder training (most paramedic squads are volunteer and would welcome the additions...).

As we say about shooting, "It's the indian, not the arrow" and that goes even more for medical life support. You can muddle through without the bandages etc, but you cannot muddle through without a clue as to how to help knowledge wise.

quote:

Originally posted by crbutler:
I've been somewhat reluctant to get in to this.

I'm really not looking for a pissing contest, but...

"Physician, heal thyself." So..., you guys still using leeches to bleed your patients? What is your specialty?

Most M.D.s have less knowledge and experience with emergency medical treatment than a fireman or policeman. Generally one course during one semester of Medical School. And if they happen to be emergency room physicians (only 4% of active, licensed physicians), then they are accustomed to working with a staff of other medical professionals - RNs, PAs, and a full hospital staff of specialists - in an antiseptic hospital emergency room with a multitude of medical technology readily available to them.

QuikClot as "...some miracle powder."? Really? Although the original first generation of Z-Medica QuikCLot was in a granular form, it was discontinued in that form in 2008 - as a product it is only 10 years old and is now in its third generation. It was not designed to be employed by physicians in ERs, but rather by combat corpsmen and medics operating "under fire" in the field.

Some QuikClot Awards:
-2009 Named a Top 10 Greatest Invention - US ARMY
-2003 "Scientific American 50" -Z-Medica founder
-2003 National Museum of Health & Medicine
-2003 Top 10 medical technology breakthrough of 2002

First adopted by the US Marines and now in use by all branches of the US Military. It has helped save innumerable lives. It has proved itself as designed.

If I ever suffer a traumatic injury in the field, I prefer a combat corpsman or medic to a Gynecologist, Dermatologist, Psychiatrist, et.al. And I am fully prepared to provide self-care if necessary.

Some of my best friends and hunting partners are physicians, but I wouldn't want my daughter to marry one.

Mike, I think you missed the point.

I'm not saying that being a Doc makes me better than someone who is doing this all the time, such as a military combat medic, but conversely, most firefighters and policement are not dealing with major trauma all that often either (believe me, I have seen what comes in...)

All quickclot is in activated thrombin. It can stop some bleeding, but it makes an absolute mess to find the source when you go in, and lately they have been going away from it. You will do as well 99% of the time with a good application of pressure. You sound like someone who sells the stuff or owns the company... But this is secondary.

If you have taken BLS and ATLS, then you already know more than 90% of the medical folks out there. My real point is that all the hunters and all the PH's and anyone else out there should at least have BLS training. Having a first aid kit won't give you this knowledge base.

As for your comment that you are fully prepared to administer self care, politely, bull.

Someone who is hit with a large caliber rifle round in a body cavity or hitting a major bone will be in shock and if capable of doing something, will not be mentally functional. You need someone else to do these things, its why health care is a team effort, and why the military has corpsmen instead of giving everyone a bandage and telling them to fix themselves. My medical knowledge would be useless if I am the one shot.

I train with quite a few fellows who were in the sandbox, some of them medics. They state similar comments regarding quick clot, or whatever brand. It is a tool, but just a tool, not magic fairy dust like on TV. Many of them do not use it. Most do not use it first, only if they can not control a bleed. IfI am injured to the point it may come into play, I will use it right away, but only as another tool. Pressure or tourniquet will be primary, along with lowering wound, calming patient and rapid transport.
Also the sterile thing, while important is not the end all. Stop the bleeding, if that means shoving elephant dung into the would and wrpping tight, then do it.

Guys,

I have no fiduciary interest in Z-Medica. I started this thread in hopes of encouraging those on AR who might be unaware of current field proven products available to them and to get them thinking about the issue. I hoped for a positive exchange of ideas.

Some of my Bona Fides: I have taken basic and advanced life saving, beginning in the late 1960's and being updated every three years. I've actually spent over 400 days in combat as a Marine and then spent 25+ years as a first responder/trainer/commander in special operations.

crbutler - You have not stated your medical specialty and you were clearly not in the military, or you would know that every soldier, sailor, airman and Marine in a combat zone IS IN FACT, given an IFAK and trained to administer to others and themselves, because the medics and corpsmen are not immune to injury and death or may not be available. As to the issue of self care, you would be amazed at what a person who is trained, mentally prepared and wants to live is capable of doing for/to themselves.

brent ebeling - That's twice you've alluded to TV. I cannot recall a single instance of a TV show demonstrating the use of QuikClot, let alone presenting it as "magic fairy dust". But perhaps you watch more TV than I. And can you show me where I said it is the only tool, or even the first tool to be employed?

Both of you make assumptions not in evidence and refer to comments made by others who have allegedly been in combat and have observed or used QuikClot, yet you must be aware that these observations are merely anecdotal in nature, are not consistent with current military policy and are not verifiable and therefore add little to the discussion. Do you even realize that QuikClot does not come in granular/powder form but rather is now imbedded into a bandage? Are you actually reading the posts in this thread?

Everyone is entitled to their opinion and is free to act as they see fit. You both make assumptions not supported by fact in this discussion. Unfortunately, your statements could result in a victim not being treated in a manner that could save their life. In the case of my friend the late PH Owain Lewis, he was hit late in the afternoon and, although already deceased, evacuation was not available for approximately 8 hours. Then there is The young PH recently shot in the elbow while in the bush who is described as having almost died from blood loss and had his arm amputated after being evacuated. Sound like a scenario where QuickClot may have been of use? I've never seen an ambulance in the bush of africa and have travelled on foot many miles from the nearest excuse for a road. I have actually helped to "cut" roads into the interior of a few remote bush locations, using only hand tools - it doesn't happen quickly.

I hope that all who read this thread will take the appropriate steps to prepare themselves for the worst case scenario while on safari. If you do, then you will have greatly increased the odds of both you and your hunting party getting out alive. If this thread has made you think then it has accomplished it's goal.

Best wishes and Semper Fi

Mike,

I have stated it here before that I am a primary care (FP) doc.

I have some, but not extensive ER medical experience.

The folks I was talking about were recent deployed surgeons who were over there.

Granting, part of the reason they are not using the thromboplastin dressings is that in general, our casualties make it to a surgical suite of some sort in under an hour, and the time factor that you are dealing with in the African bush is significantly longer, there may be a role for the thromboplastin here, but you also seem to be missing my point. The kit you are recommending is useless if you don't know how to use it. Are there situations where it might help? Absolutely. But if you are not at all trained in wound management, it doesn't make any difference.

As to the quickclot type dressings, you do realize that the activated thromboplastin that makes it clot is a powder (its actually a protein/enzyme) don't you? Its impregnated (dusted if you will) into the gauze of the dressing?

I still feel that rather than buying a $50 kit for emergency trauma (and lets face it, if you really have a bad wound you need a heck of a lot more bandaging than your kit contains, and you will be scavenging what you can find to complete it.) you need basic field training in first aid. Each person of the team should have this training, INCLUDING the client hunters.

Chuck Butler DO

quote:

Originally posted by crbutler:
Mike,

I have stated it here before that I am a primary care (FP) doc.

I have some, but not extensive ER medical experience.

The folks I was talking about were recent deployed surgeons who were over there.

Granting, part of the reason they are not using the thromboplastin dressings is that in general, our casualties make it to a surgical suite of some sort in under an hour, and the time factor that you are dealing with in the African bush is significantly longer, there may be a role for the thromboplastin here, but you also seem to be missing my point. The kit you are recommending is useless if you don't know how to use it. Are there situations where it might help? Absolutely. But if you are not at all trained in wound management, it doesn't make any difference.

As to the quickclot type dressings, you do realize that the activated thromboplastin that makes it clot is a powder (its actually a protein/enzyme) don't you? Its impregnated (dusted if you will) into the gauze of the dressing?

I still feel that rather than buying a $50 kit for emergency trauma (and lets face it, if you really have a bad wound you need a heck of a lot more bandaging than your kit contains, and you will be scavenging what you can find to complete it.) you need basic field training in first aid. Each person of the team should have this training, INCLUDING the client hunters.

Chuck Butler DO

All the training on earth does no good if you have nothing but your bare hands--I cannot understand why any qualified Tech would be against having at least a basic kit.



SSR

Your comment scares me. It sounds like you are saying I have this, I'm good to go. If you have the training, you will get what you think you need. However, if you are the one shot, your kit will not be all that helpful if no one is trained in what to do.

The point is that once you know what you need to do, you can decide what you want to bring.

As I said, you can make do with a cut up shirt, a belt, and duct tape.

My concern is that people buy a "kit" and figure this is it, all I need, because a Doc, or medic said so.

It's useless to have a kit if you are not capable of using it. It may even be worse than useless. Improperly applying a dressing to a sucking chest wound will cause the patient to expire quicker than doing nothing. I would prefer for you to have to buy each piece separate and know how to use each one. My biggest gripe about quick clot products is that people think its magically better than gauze alone. It is not. I would much rather have an EMT with a cut up shirt than an untrained hunter with one of these premade military casualty kits if, god forbid, I get shot.

Dear Dr. Butler,

Please, I invite you to go to the Z-Medica website:
www.z-medica.com
Click on How QuikClot Works on the top of the page
Click on Testimonials on the right side

You will then be able to read the first hand personal experiences of ER and combat physicians using QuikClot. There's lots of other good info on the site as well. I do believe you will learn something.

Kaolin is the active ingredient in QuikClot and it is bonded (not dusted) to the non woven delivery material (gauze bandage), greatly reducing the chance of any unbonded material getting into the wound (and even if it does, there is no evidence to support a problem). It is as safe as standard surgical gauze (The Journal of TRAUMA: "Injury, Infection, and Clinical Care". Volume 68, Number 2, February 2010).

Most deployed physicians, including most likely your friends/associates, spend their time in a rear area field hospital. Very, very few actually deploy to the field with the troops unless they are SpecOps qualified. Perhaps your associates experience was with first generation QuikClot, which did have some post use issues. Current issue is third generation and does not have any documented issues.

Yes, I think you finally understand that there is a distinct difference between a traumatic injury in a combat zone where medevac choppers are on 24/7 standby with rotors turning and flight time to a fully equipped and staffed military field trauma center is 30 minutes or less and so QuikClot may not be required. I do know that africa will demand a walk/carry out to a vehicle, a drive to a dirt airstrip and an aircraft to a metropolitan area where medical care, supplies and equipment may still be 3rd world rudimentary. Each of those phases in the evacuation process may very well take hours, adding up to certain expiration of the "golden hour". In my pre-plan I allow for 2 hours to a vehicle, 2 hours to the airstrip and another 2 hour flight. It could easily be double that and time of day will also play a part.

I am not trying to demean your education, however you are making statements about situations and conditions you have obviously never experienced. I never suggested that training was not necessary, but these products were designed to be employed by 18 year old soldiers with a high school education (or less). This is not brain surgery, it's first aid, for God's sake! All the wrappings not only have printed instructions but also drawings of how to employ them. One can also find instructions online, including videos, so if you live in a remote area you needn't search for an instructional course before using these products. Anybody who plays with firearms knows that a sucking chest wound demands a non-porous dressing. 50 years ago we used the cellophane from cigarette packages. Today the plastic wrapping from the items in your first aid kit will work (or you can buy a seal for your kit). Use your duct tape around the edges and patch both front and back on a through and through wound.

In conclusion, spending $25 or $50 is small insurance when you've paid $10,000-$100,000 for an african safari and $350 for a Global Rescue policy. And most of the respondents in this thread will have had some degree of first aid training, can follow simple instructions and know that what I say is the truth.

Keep well

quote:

Originally posted by crbutler:
Your comment scares me. It sounds like you are saying I have this, I'm good to go. If you have the training, you will get what you think you need. However, if you are the one shot, your kit will not be all that helpful if no one is trained in what to do.

The point is that once you know what you need to do, you can decide what you want to bring.

As I said, you can make do with a cut up shirt, a belt, and duct tape.

My concern is that people buy a "kit" and figure this is it, all I need, because a Doc, or medic said so.

It's useless to have a kit if you are not capable of using it. It may even be worse than useless. Improperly applying a dressing to a sucking chest wound will cause the patient to expire quicker than doing nothing. I would prefer for you to have to buy each piece separate and know how to use each one. My biggest gripe about quick clot products is that people think its magically better than gauze alone. It is not. I would much rather have an EMT with a cut up shirt than an untrained hunter with one of these premade military casualty kits if, god forbid, I get shot.

Doc you may be a good guy but you are coming across as very arrogant.

Please give me one reason to NOT have a firstaid/trama kit.

when we all can go to med school then we can use torn up shirts and duct tape--not that I have seen that much in first response situations here in the states.

Yes I have used duct tape-both on myself and others. a bandage is better than your shirt and a belt-your pants may fall of while running for help.

I believe you are being un-proffesional and parochial in arguing against kits.

SSR

Lionhunter, no intention to hijack your thread. In fact up until recently I ran as a volunteer nationally registered paramedic. I regulalry train with current and recent past medics. I do understand that quick klot is not dust, and it is woven into the gauze. I also stated that I believe in using it. My only concern is that alot of guys think you can dump a pack of granules or wrap with impregnanted gauze and that fixes the problem, much like on the movie "shooter".
Personally I carry similar to your kit. Glad to see the burn gel included, that is something we cna help with immediately that is actually common. of course benadryl, lomotil, pepto, usually flexaril and some type of strong pain relief. Also water purification tablets.

But truly most situations that are life threatening that we will encounter and can actually help in, are massive external blood lose. Again I revert to years of training, pressure.

For what it's worth let me add my two cents. I ve worked in military Ers, multiple Ers in South Africa including th riots and shootings at Bara, Ben taub in Houston, and just came back from camp bullis in San Antonio. I deal daily with bleeding and more often than I like with massive bleeding. ATLS, the trauma course (I once taught) stresses ABCDE ie airway, breathing, circulation, etc but we learnt on the border and bar a was for massive bleeding that needs to be stopped first. Of note, camp bullis is also teaching control bleeding first as I just recently saw in the state of the art battlefield simulator. That means tourniquet first if limb injury, then get out of fire, check airway, breathing etc. Then get IVs in, use packs (none is a miracle bandage or drug although factor IV at $10,000 a pop works pretty well if mechanical bleeding is controlled. Then immobilize injuries and look also for unrecognized penetrating injuries. Check air sounds etc. There should be no delay to get to good er. Princess Diana should never have died from her injury instead some md was trying to,get an IV in an ambulance. Call a helicopter if you can (and I have). So what do I take? A small kit a little like a military one with extras since I know how to use them. Some tips: pack open bleeding wounds and if nothing else duck tape them, use a belt, back pack straps, tie downs or the military type of tourniquets (they have a built in type "pen" to adjust tightness). Here s a trick for small cuts. Weave some thread through super glue on either side of the wound and then weave the two sides together. Use tree branches and duck tape for immobilization but don't cutoff blood supply. Mobility can increase internal bleeding. I ve treated uncountable lung and heart gun and knife injuries and I m afraid that the stats show 1/3 stab injuries cause death and 1/2 bullet injuries including 9mm cause death. Stay safe friends and good luck. This needs an edit but I ve run out of space.

SSR- If you are saying that I should not be saying get some training, then I don't know what else to say. I'm not stating that you need a medical degree, I'm saying take a basic first aid class, and then go from there. Parochialism would be saying that only a doctor can do anything for you. Not so, in most trauma cases, the save is made by the first responder doing the right thing. If I make all the car dealers in the US put a new first aid kit in every car that goes off their lot, do you think it would make any real difference in traffic fatalities? There is a reason that the police and firefighters are required to keep those certifications up...

Note I'm not saying don't take a kit, I'm saying if its a choice between a kit and training, I will take training every time. I'm not saying a full paramedic level, I am saying simple first aid, like they used to teach in school.

Both is ideal, but you will do a lot better with training than with having to pull out reading glasses and read the package first. Quite frankly, why spend $50 for a kit when you can buy the parts needed for about $5, if you don't buy the quick clot, but gauze instead, and the gauze does not have a less than 1 year shelf life.

Mike- You are right that I was wrong about it being activated throboplastin. The kaolin (a mineral) activates the thromboplastin. However, I don't think you read the journal article at all. All its saying is that one of the two products (quick clot I assume, but its not absolutely listed as such) does no more damage to the tissue than plain surgical gauze, and that there was no need for revascularization (vessel transplant) like there was with the older format due to killing of the blood vessel cells. They did acknowledge that some of the mineral was found "downstream" if you will, in the vessel, but that it seemed to have no effect. The study was done on pigs, but that is not unusual in trauma studies.

It specifically said there was no difference in hemodynamic measurements (henatocrit etc.) between the various products. De facto, all the study said was that the two products (kerlix and combat gauze) are safe to use. There was no statement whatsoever that this product was any better than plain surgical gauze. It just costs several times more.

The "endorsements" really are meaningless to me. Every Drug rep that walks comes in with all kinds of glowing reports for me. I've been around long enough that some of the latest greatests have ended up having to be pulled from the market because of unforeseen issues. That quickclot is on its third generation in less than 10 years indicates that by no means is it a mature technology. That on their website they have to put a study that says its as safe as surgical gauze, but show no empirical study showing its better, well, why use it?

If you were in during Vietnam, you probably remember the old MAST trousers... See those around anymore? Yet at the end of the war, every good little paramedic squad had them.

Look, my final point on this is that if you want to get a first aid kit, first go and take the local first aid class. You will learn what to do, and then you can decide what you feel is worth buying. Then get what you want to buy. A $50 kit is not 10 times better than a $5 kit necessarily. Look at what you said above... "anyone with any time around firearms knows..." Really? Lots of folks don't. Military? Yes, I think they get a rather intensive lecture on it in basic, and then again in their advanced training, and then again in their deployment training.

I really feel that you guys want to do right, as do I, but in the ER I have seen several "first aid" attempts by folks who don't know better who have made things worse, sometimes dramatically so. If they had just taken a 4 hour basic first aid class, this would have been avoided.

I know the PH's have such a class. I doubt the trackers have one. I know its available to all of us in the US if we want to make the minimal effort to get it. By all means, get a kit. After you know how to use it. Its similar to the disgust most feel about a client who shows up with a new rifle in some horribly recoiling caliber that he's never shot, with a "boresighting" done at the gunsmith's. It may have a positive outcome, but you have stacked the deck against it.

Hey Brent,

No worries.

Watch which countries you transit with the Benadryl, you could end up in an african jail. 3rd world laws, doncha know? There are other OTC antihistamines that do not cause conflicts. That damn flexaril makes most folks sleepy. I always have Cipro as my antibiotic, Morphine and Vicodin for pain and Ibuprofen for aches and lots more prescription and OTC stuff. I've noted a distinct lack of local drug stores in the bush and if you don't have it, you ain't gonna get it.

I just don't think this stuff is too complicated, but sometimes those of us that know some things ere in unintentionally discouraging others, to the detriment of all.

I don't think I've been unclear, but I will state again that QuikClot is only one of two critical items, the second being an Israeli (The Emergency Bandage) or Cinch Tight bandage, which is used after - on top of - the QuikClot to apply and maintain that direct pressure and free your hands for other tasks during the 6 hour medical evacuation.

Cheers

I was an EMT/firefighter and ran on a busy volunteer department for several years and have a good amount of hands on experience with trauma and have attended a couple of GSW's and knife wounds in my time.

Currently I maintain a NOLS wilderness first aid card and am on a SAR team here in Colorado. I have to agree that a trained EMT/first responder can do more with a tee shirt, duct tape and a belt than most folks could do with a full trauma kit. But I don't agree that the trained or untrained person shouldn't carry some good type of bleeding control material/first aid equipment with them. Just get some training so you'll know what to do when that ugly moment occurs.

Hemcon is better than QuickClot. It can be washed off simply by using Saline. No matter what clot you use DO NOT get it in your eyes!!!

I just take my wife on each trip. She is a Master's education ICU nurse and deals with horrific problems regularly. She can do more with pressure on a wound and some tape than you can imagine.

I've had some experience dealing with GSW, traumatic amputations as well as many other complications from living in the bush in hostile enviornments.

All this talk about quick clotting miricle applications is great as long as you know how and when to use them, but as someone else said in an emergency any piece of clothing and properly dircted pressure will stop bleeding if it can be stopped at all.

They sell kits to build cars, I doubt many of us would know where to begin building one. The same goes for medical kits. You don't have a half hour to review the instruction booklet in an emergency.

If you're really serious about treating someone with a serious GSW you might just want to carry some albumin (Blood expander)for an IV. Sterile bandages work well also. If it's a limb that receives the wound you just might need a morphie serette. Forceps come in handy stopping a bleeder. A Tourniquet can save a limb or a life.

My medical kit probably weighed over 20 pounds in my rucksack, and that didn't count the many drugs, ointments and other items needed to keep a "Grunt" alive until we could chopper him out to a field hospital.

The fact is, more people die from shock from a GSW than from the wound itself. If you're really serious about saving someone's life it would behove you to learn how to deal with and treat shock.

Remember, you'll be out in the bush probably at least a few hours away from a real hospital and professional people trained to deal with traunmatic injuries and wounds.

So here's a simple Cliff Notes method.

Stop the bleeding.

Check for an exit wound.

Make sure the victim can breath.

Begin treating for shock.
Shock Kills!!!

I carry CELOX powder and penetrating wound applicator to stop bleeding. It does not replace tourniquets and pressure, but can surely help stop bleeding - especially as many elderly hunters nowadays are daily taking aspirin or other blood-thinners.

Not trying to start an argument here, but I've worked with medics for the USMC who buy the stuff with their own money and by taking up donations from the troops they serve. (They don't like quick clot due to heating.) If they think that much of it, I'll take $60 worth with me on a hunt for dangerous game.

Here's a 5 year old article on CELOX.

MarineCorpsTimes on CELOX

YMMV,

Don_G,

Thanks for your input. If you prefer Celox, then that's what you should carry.

However, the heating issue with QuikClot was with generation 1 only. Generation 2 arrived in 2005 and current issue is generation 3. There should not be any unexpired generation 1 packets around, since they stopped making it in 2008. I'm afraid your MCTimes article is outdated and there is no reason for corpsmen to buy this stuff as it is and has been part of the supply system since its invention.

BTW, U.S. Navy Corpsmen attached to the USMC are NEVER called "medics".

Semper Fi

Mike,

Semper Fi back at ya. I suspect I got out before you ever went in. (1974, before any of this was ever thought of.)

Unlike others around here (and I'm not singling you out) I'm not a Professional Former Marine, just another guy who did his duty. Maybe I've been around too many Army pukes the last 35 years - like many active-duty Marines attached to other units.

You seem to be up to date, and I'm just operating on the word I get from guys I work with. I was never a medic (or corpsman), nor was I ever wounded. The only shot I ever heard fired in anger while on active duty was by an irate farmer - and he had good cause.

Does QuickClot work on low clotting-factor patients like many of us old farts? I know that originally it did not, and that was a big selling factor for me, and the medics (yes, medics) that I often travelled with through Sept. 2007. Since then I've been desk-bound.

Anyway, if the SAS carries CELOX it can't be all that bad even for young farts. Like I said, I'm not here to start a fight - just weighing in that any of these products can be invaluable in a pinch. BTW, CELOX does still come in granules as well as in impregnated bandages - another plus in my book.

Training IS important, but any of these products can greatly improve the probability of survival when help is hours away and even a 10% extra reduction in bleeding makes a big difference.

quote:

Originally posted by LionHunter:
Guys,

I have no fiduciary interest in Z-Medica. I started this thread in hopes of encouraging those on AR who might be unaware of current field proven products available to them and to get them thinking about the issue. I hoped for a positive exchange of ideas.

Some of my Bona Fides: I have taken basic and advanced life saving, beginning in the late 1960's and being updated every three years. I've actually spent over 400 days in combat as a Marine and then spent 25+ years as a first responder/trainer/commander in special operations.

crbutler - You have not stated your medical specialty and you were clearly not in the military, or you would know that every soldier, sailor, airman and Marine in a combat zone IS IN FACT, given an IFAK and trained to administer to others and themselves, because the medics and corpsmen are not immune to injury and death or may not be available. As to the issue of self care, you would be amazed at what a person who is trained, mentally prepared and wants to live is capable of doing for/to themselves.

brent ebeling - That's twice you've alluded to TV. I cannot recall a single instance of a TV show demonstrating the use of QuikClot, let alone presenting it as "magic fairy dust". But perhaps you watch more TV than I. And can you show me where I said it is the only tool, or even the first tool to be employed?

Both of you make assumptions not in evidence and refer to comments made by others who have allegedly been in combat and have observed or used QuikClot, yet you must be aware that these observations are merely anecdotal in nature, are not consistent with current military policy and are not verifiable and therefore add little to the discussion. Do you even realize that QuikClot does not come in granular/powder form but rather is now imbedded into a bandage? Are you actually reading the posts in this thread?

Everyone is entitled to their opinion and is free to act as they see fit. You both make assumptions not supported by fact in this discussion. Unfortunately, your statements could result in a victim not being treated in a manner that could save their life. In the case of my friend the late PH Owain Lewis, he was hit late in the afternoon and, although already deceased, evacuation was not available for approximately 8 hours. Then there is The young PH recently shot in the elbow while in the bush who is described as having almost died from blood loss and had his arm amputated after being evacuated. Sound like a scenario where QuickClot may have been of use? I've never seen an ambulance in the bush of africa and have travelled on foot many miles from the nearest excuse for a road. I have actually helped to "cut" roads into the interior of a few remote bush locations, using only hand tools - it doesn't happen quickly.

I hope that all who read this thread will take the appropriate steps to prepare themselves for the worst case scenario while on safari. If you do, then you will have greatly increased the odds of both you and your hunting party getting out alive. If this thread has made you think then it has accomplished it's goal.

Best wishes and Semper Fi

my bonafides are 34 years as an anesthesiologist in a level 1 trauma center resuscitating everything from GSW's to traumatic limb amputations, preceded by 4 years working on an ambulance crew while in med school at Nascar tracks around the South. been there, done that- AND NOTHING BEATS HEMOSTASIS LIKE DIRECT PRESSURE ON THE WOUND FOLLOWED BY A TIGHT BANDAGE. it is always better to amputate a limd because of a too tight tourniquet than to have someone bleed to death. with core wounds involving large vessels, all the quick clot in the world is a waste of valuable time. quick clot and pressure bandages are good but at the end of the day- DIRECT WOUND PRESSURE!

A well equiped client is a blessing- you can always relive him of necessary/usefull stuff that he is carrying and add it to your kit.

In the USA you are blessed to be able to go online and buy such stuff. If you have the weight alowance and haul it to Africa it will not be wasted by those who do not enjoy the luxury of buying via the internet! or even from a supplier with all the 'modern' kit. We (the PH's) cannot get it, the aircraft in will not be carrying it because nor can the trauma teams. If you need something fancy or specialised you had better be carrying it or else have great life insurance so your family will benefit.