Here's a good one! Share your favorite "trade secret." I know all of us have some sort of trick or two up our sleeves, since we work under a different time crunch. I will share mine first.

Cricothyroidotomy - One of the last ditch effort for an airway. Making this a full surgical procedure isn't always an option, and there have been a few new inventions to help make this an easier task. One is the LifeStat airway device (shown below). Now, I carry one of these in my pocket ONLY because an Army SF Medic gave one to me. I later found out that these things cost around $125 a piece! If you want the GOLD one it can be $200!! Well, I'm sure not too many companies want to spend that kind of money. So, my quick, cheap, and just as effective (if not more) solution is the Macro-Drip Cric Spike. It is a 10gtts IV Drip Chamber cut in half. The spike is wider and larger than a 10ga. needle, and the drip chamber fits perfectly on a BVM. Voila!

-AJ



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This has been a handy Custom Made tool for me as it has kept all of the supplies I would need in to starting an IV. There are pockets on this for all of the supplies needed. After placing your supplies in the roll all you have to do is place the IV bag on top of it and “ROLL” it up, bingo everything you need to start an IV ready for you at your finger tips. This “Roll” is a desert Tan as I took it with me to Iraq for all of my deployments. This also has a grommet on it so you can “Dummy” cord it to your bag just incase you have to take off in a hurry and don’t want to leave it or your remaining supplies lying around. There is also a clear pocket on the outside that you can place a label in to easily identify the contents of the “Roll”. I used this to be able to quickly identify my Hespan from my Normal Saline “Rolls”.
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A much cheaper alternative is to take a ziplock bag or autoclave bag and place all the supplies you need for 1 IV in it. We create these starter kits for our bags and for the operator's squad bags so that all you have to do is grab one bag and the fluid of choice. I keep my hextend seperate from my NS so I don't confuse the two, but I have thought about marking the NS with a blue tape or tag and the Hextend with Red to make it easier to pick out at a glance.
Doc82 has some good points, remember that when your are in the field a lot of the stuff you get taught Civy side EMS/ATLS is only going to cause you problems.
Tips-
-Buy a good pelican case to keep your pain mang. and IM/IV anti-biotics in as well as Marcaine/Sensocaine/Lidocaine in for mixing with the anti-biotics and for nerve blocks.
-Know your CASEVAC/TACEVAC times and plan for the worst one
-Plan for a Hypothermia Wrap, a huge problem in Afghanistan, easy to get blankets and what you need from local Clinics
-Get in well with whatever MEDEVAC/TACEVAC Unit is around, it will pay dividends by doing a face to face with them
-Take the IV bag and cut the hard plastic open down the middles and then take the ziplock bag Doc82 talked about, full of the starter kits, tubing, etc.. and slip it inside the bag and place a dog eared piece of duct tape over it,you will all you need in that self-contained package that way.
-Coban, prepare it before you leave with a piece of tape dog eared over it and then put it inside a ziplock bag with other bits, it makes a fantastic pressure bandage and works better than an Israeli but you HVAE to prep them before going out and keep track of them due to heat screwing them up, hence the dog ear tape.
-DO NOT CARRY O2
-DO NOT CARRY STUFF ON YOUR PERSON THAT IS NOT NEEDED
Quick access "Bleeder kit". Take a Kerlix, ace wrap, or Battle dressing, Chest seal, and a Kravat/triangular bandage. Open all of the items. Keep the Kerlix packaging. Put the Kerlix and acewrap/battle dressing together, put the chest seal around them and the unfold the Kravat/triangular bandage. Thightly roll the kravat around the rest. Use the safety pins that came with the Kravat/triangular bandage to secure the Kravat onto itself. Place the "roll" back into the Kerlix wrapper and staple it shut or put it into a ziplock bag. It is a small setup that can be carried easily in a cargo pocket. It gives you a quick access "bleeder kit that can cover almost any trauma. Good addition to the Individual First Aid kit/blow out kit.
Alan:
Thanks for the discussion.
I first saw your "IV Spike-Cric." at a W-EMT class years back, loved the idea then, still think it is great... 3 reasons: 1) anything that serves more than one purpose is better. 2) it is always good to have a backup plane. 3) larger and more effective than a needle cric. Fortunately, every time I've had to do a Cric., I had an ET tube available and couold just do an Surgical Cric... I will add that the first time I used a pre-made Cric-Needle kit (for the Jet-Vent) the cath. sheard and cumbled... not a fan of needle crics anyway, surgical crics are just far more effective. But the "IV Spike-Cric." is large enough to be effective.
My "Trick of the trade" was using a tampon for GSW. This was before the use of hemastaic agents was readily available, but you could still use it in limited circumstances. A cheap tampon - the type packaged in cardboard sleeves is perfict size small caliber entry wounds. The "Dressing" is designed for blood absorbsion and swells when full causeing pressure/tamponode of the bleeding. The cardboard sleeve allows for easier (not easy/but easier) insertion/placement into the wound. Surgeons don't always like it, but they do have "cords" attached to find/remove as needed. I'm a fan of packing wounds when needed, this is a semi-sterial, cheap, effective (limited) method.
Anyone every try the MRE sleeve along with peanut-butter for a sucking chest wound (they're relativly sterile)??? Also, Never forget, those MRE sleeves are the best damn carriers for just about anything in your kit. If you use an MRE sleeve to carry medical kits, use RED duck tape to ID them so as not to get confused with other MREs or like kits.
I had a corpsman who used to use everyone's veins for IV access (perminate marker) so when they were in shock and viens collapsed, he would know exactly where to go. He also had everyone carry their own IV kit... but he had access to all the supplies he wanted. I always like the idea of every individual having their own kit for use.
Thanks and be safe:
-Tom S.
Alan:
Thanks for the discussion.
I first saw your "IV Spike-Cric." at a W-EMT class years back, loved the idea then, still think it is great... 3 reasons: 1) anything that serves more than one purpose is better. 2) it is always good to have a backup plane. 3) larger and more effective than a needle cric. Fortunately, every time I've had to do a Cric., I had an ET tube available and couold just do an Surgical Cric... I will add that the first time I used a pre-made Cric-Needle kit (for the Jet-Vent) the cath. sheard and cumbled... not a fan of needle crics anyway, surgical crics are just far more effective. But the "IV Spike-Cric." is large enough to be effective.
My "Trick of the trade" was using a tampon for GSW. This was before the use of hemastaic agents was readily available, but you could still use it in limited circumstances. A cheap tampon - the type packaged in cardboard sleeves is perfict size small caliber entry wounds. The "Dressing" is designed for blood absorbsion and swells when full causeing pressure/tamponode of the bleeding. The cardboard sleeve allows for easier (not easy/but easier) insertion/placement into the wound. Surgeons don't always like it, but they do have "cords" attached to find/remove as needed. I'm a fan of packing wounds when needed, this is a semi-sterial, cheap, effective (limited) method.
Anyone every try the MRE sleeve along with peanut-butter for a sucking chest wound (they're relativly sterile)??? Also, Never forget, those MRE sleeves are the best damn carriers for just about anything in your kit. If you use an MRE sleeve to carry medical kits, use RED duck tape to ID them so as not to get confused with other MREs or like kits.
I had a corpsman who used to mark everyone's veins for IV access (perminate marker) so when they were in shock and viens collapsed, he would know exactly where to go. He also had everyone carry their own IV kit... but he had access to all the supplies he wanted. I always like the idea of every individual having their own kit for use.
Thanks and be safe:
-Tom S.
Tom,
As a rule, in the military combat troops at least, the we ALL have our own blowout kit and in that kit is usually the basics-NG Tube, Israeli, either a hemcon or Combat Gauze and QC or Celox and then a few compressed curlex as well. The IV kits we make for our guys are all contained in the Hard Plastic Shell most IVs come in and then just slit them open and insert your IV Starter Kits and tape and dog ear them back up. WE also only carried Hespan or some other Volume Exapander, never NS. If you go to your local Military Base and make nice with the medics I am sure you can get some kits made up for your guys as long as it is not to many.
Also, the Tampon thing does not really work, we have done it to death, not worth it. You can stuff Guaze, Combat Gauze, Celox, etc..all with a better result and no problems with anything causing more damage to the wound track. Just MHO to advise against it is all.
Sean:
Thanks for the info... I was a U.S. Marine (& Combat Lifesaver) and yes, we all had our own kits etc... just addressing the many diferent makeups on this site... some profession, some volunteer, some equipted, some have to "accuire". In any case, I was a Volunteer Medic on a SAR team and had to buy my own gear, and I am currently a L.E.O. and gear pretty much anything I need given to me... so I have had to use what I could get, but currently don't have to worry because I have all the latest I need. But again, thanks for the info.
I still think MRE bags are the best, dropping out off a Helo, hitting the beach, jumping through a window, it is more a case of containment when something burst more than protection itself. Also, when I was in a Raid company, the MRE bag and duck tape was very waterproof.
As for the tampon, can't argue, I have limited experience using it (just usually didn't have one when the case arrised), and yes, had some difficulty with it, but it did work eventually.. but in the end, agree with you, good advice... "X" on the tampon.
Thanks and be safe.
tampons for GSW, works when nothing else will.. however, I'd stay away from it. Last time I carried one for in my trauma kit was 10 years ago. Now I keep them in my Sick call/gen med bag for their intended purpose. Not only am I responsible for the providing care, but also prev-med as well.
Doc82 said:
tampons for GSW, works when nothing else will.. however, I'd stay away from it. Last time I carried one for in my trauma kit was 10 years ago. Now I keep them in my Sick call/gen med bag for their intended purpose. Not only am I responsible for the providing care, but also prev-med as well.

Doc82, I gotta disagree with you on the tampons, we even did it at ATP, why would you stick something up a wound track? If you take the filling out fine, but the plastic tube in it is only going to cause more damage and I have yet to see one Doc at the SOCM refresher say different or after looking at necropsy, just not worth it IMHO ;-)
Tom Sasso said:
Sean:
Thanks for the info... I was a U.S. Marine (& Combat Lifesaver) and yes, we all had our own kits etc... just addressing the many diferent makeups on this site... some profession, some volunteer, some equipted, some have to "accuire". In any case, I was a Volunteer Medic on a SAR team and had to buy my own gear, and I am currently a L.E.O. and gear pretty much anything I need given to me... so I have had to use what I could get, but currently don't have to worry because I have all the latest I need. But again, thanks for the info. I still think MRE bags are the best, dropping out off a Helo, hitting the beach, jumping through a window, it is more a case of containment when something burst more than protection itself. Also, when I was in a Raid company, the MRE bag and duck tape was very waterproof. As for the tampon, can't argue, I have limited experience using it (just usually didn't have one when the case arrised), and yes, had some difficulty with it, but it did work eventually.. but in the end, agree with you, good advice... "X" on the tampon.
Thanks and be safe.

lol, part of that is me, I hate MREs and usually carry Mountain House or Winter MREs, hence would rather just use something else, the hard plastic shell on the IV bags usually did the trick for us, MRE bags I am sure would work, same material more or less. If you are not in the reserves or anything anymore, I am betting you can make contact with a local Medical Unit in the USANG or other base nearby you for kit and to scrounge. We always went scrounging at the AFBs, they always had tons of extra stuff they were never going to use that is super handy. I know we always gave stuff to the local LEO whenever we went anywhere to train, always nice to have a good relationship when one of your junior guys gets stupid on libo ;-)
If you ever need anything just email me on here. -Sean
I'm a big fan of "Macguyverisms=using inexpensive items to solve expensive problems". Many Tac Medics are scrounging for gear or spending their own dimes. Med bags don't necessaryly have to be "jumpable" for the Tac Medic that works CONUS. A good backpack can cost less than $100, add to that some color coded shaving kits (red,blue,green,etc) and you now have a tac medic bag.

We also used to use large ziplock bags and pack them with bandage supplies-kerlix, ace wrap, 4x4s, etc. If I needed bandages I'd just have someoen reach in the pack and throw a ziplock bag.

Expired defib pads= chest seals (free), Ped pads for entrance wound and Adult pads for exit. Designed to stick to sweaty chests and airtight.

Roll down tourniquet- Ace wrap above IV access and roll down, like getting the last bit of toothpaste out of the tube.
-Matt

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