I’m thinkin’ we put way to much emphasis on this aspect. Look, the vast majority of us ain’t even gonna have access to Level 2 medical care. Just a fact. Sure, some of us have nurses and doctors within our group, but, type flight medical care? Not likely.
I’ll treat your wounds. But if I don’t think you have a chance, I’ll make you as comfortable as possible, relieve you of your gear and hope they are kind to you. If you know sensitive shit that could make my life harder, I shoot you in the head after I relieve you of your gear.
I expect you to do the same to me if I’m the guy with a sucking chest wound. 🙂
Reblogged this on ETC., ETC., & ETC..
Having an reciprocol-type relationship with someone who works in a hospital can be very benificial; hospitals throw a lot of items into a recycle bin; a lot of which can be re-purposed…. paper products, towels, tubes, plastic pans and tubs; mostly the components that would accompany a kit of some type or another…
If you turn it on, make sure you have the storage space, because it comes in bulk. 😃
Used needles are a favorite (just kidding).
IMHO, nothing less comprehensive than a basic (i.e. +/- 110 hour) EMT course, at minimum, is really worth your trouble. (The only possible exception is a decent wilderness/remote medical course, of >40 hrs, offered by someone other than ARC. And that would be the barest of bare bones on a host of topics, most of which you’ll see again in real life.)
CPR is at the level of changing a tire, and pretty much worthless in delayed care scenarios, or anywhere you don’t have any higher level of care – with electrical and chemical cardiac care, and cath lab surgery – available within minutes. Learn how to open an airway by head re-positioning, and you can generally skip the rest, once civilization has gone sideways. In a large traumatic event – say, the WTC collapse – anyone who doesn’t get better after opening their airway by repositioning is going to be black-tagged as “Expectant”, i.e. gonna die soon anyways.
And TCCC is drive-by medicine, focused mainly on delaying care until certain tactical objectives are achieved.
It has value, but primarily only to someone, again, with EMT-level training or better once it shifts to actual medical intervention.
The short-form first aid courses, esp. Red Cross basic and “advanced”, aren’t worth a bucket of warm spit anymore, as they consist of less training that what the Army does in a one-hour training lecture, followed by calling for the (hopefully available) 9-1-1. If there’s no 9-1-1 to call, I guess you’re supposed to sit there with a stupid look on your face.
And without the training, little gear more than an IFAK and basic boo-boo & OTC “snivel” gear is worth the weight.
In short, get real medical training worth the investment (and really, how much is your life, or that of family & tribe, worth to you?), and then get enough appropriate gear to take advantage of that knowledge. (And by “enough”, I mean 10-200X more than you think you’ll ever need or use.)
Take a course in something. It’s too late to take a 100+ hr course an hour after TSHTF, and when someone is spurting arterial blood is a wee bit late to crack open all that shiny kit you never trained on and try to save yourself or someone else. There is no such thing as nitro-packed Doctor-In-A-Can.
You either know this stuff cold, or you or someone else will soon be achieving room temperature.
You’re right, but expect the commensurate level of dedication and morale one encounters in “we shoot the wounded” levels of endeavor.
And if it’s an option, instead of bullet to the temple, always better to leave the soon to be deceased a grenade or claymore, to make a present to whatever enemies they encounter just outside the doorway to Valhalla.
Again, the reality of the situation. I’m looking at a traumatic leg amputation. Dude’s bled out pretty good. I know that back at base camp I got nothing to ameliorate this thing. Do I expend precious resources? Do I direct my people to carry this casualty back further endangering them to attack and capture for a lost cause?
Training is great. But you need the resources and the facilities as well. At the moment, I don’t have either. And neither do most of us.
Just a fact if life. 🙂
In all reality, it’s more probable that you’ll treat 20 minor injuries before a major one. Certainly, it’s better to have medical supplies than to not have them. The most important thing is to actually keep them with you and handy. In my retreat AO, there are several RN’s, one DDS and one MD, and I also know of one retired Orthopedic Surgeon(how many factory workers own waterfront/Island property?). Anyways, in a SHTF moment, you likely won’t have time to go out to buy disinfectants, bandages, scalpels, sutures, splints or crutches. Using basic items as these does NOT require the services of a professional – although some prima donna’s would like to think so.
Are you going to perform brain surgery? No.
Stop the bleeding, dress a wound, or immobilize a limb ? Yup.
Medical kits, based on your skill level and experience.
Not all nurses and doctors have trauma experience, but usually can cover the basics.
Seems the patriot movement should have field medical units/hospitals. I know I can’t hump all that gear anymore. Like I did when in the military. I still have lots of experience and continue to gain more each day.
Using tossed out plastics from hospital, I would be leary, who knows what room that came from, some nasty bug may be lurking on the gear. If it’s un-used, snag it. Also be aware medical facilities have cameras everywhere, so to be snooping around will make you suspect.
Just some thoughts.
Do I expend precious resources? Do I direct my people to carry this casualty back farther endangering them to attack and capture for a lost cause?
If someone doesn’t,
a) they won’t have any “people” to worry about for very long, which is a self-correcting fault, and
b) they’d be a douchebag “leader” of cosmic proportions, which is probably ultimately self-correcting too, eventually.
c) Look up “fragging”, and tell me how long they’ll be directing people who have weapons, the first (and likely last) time they leave someone behind who means more to them than Dear Leader does, come the day.
d) While some may think they’ve weighed the options, they’ve never abandoned someone to death, or worse, actively helped them to shuffle off their mortal coil, over their plaintive cries or pleading looks. (And if anyone has, re-read “b”, above.) It’s a poor specimen of a human being who is willing to fight for their own human rights, but who’d deny the same to their own tribe or family members the minute it costs them something, and they’re now too weak, physically or mentally, to oppose such maltreatment.
People have survived traumatic leg amputations, and worse, going back millennia, with no more medical care than a poultice of dogshit and witch doctoring. You have no excuse not to do better with even the minimums of 21st century medical knowledge and equipment available for nothing more than the resources and the will to get it. PPPPPPP.
It’s one thing to kill your enemies.
Killing your friends, OTOH, is an exercise in slow-motion suicide bombing.
Regardless of where you are or what you’ve got, you do the best you can where you are with what you have, and if someone dies, they die in spite of your best efforts, not because of them. When fate casts the final vote, and you’re really out of options, you might eventually have to do something you don’t like, but only because you literally have no other choices.
Anyone who wants to take on the mantle of deciding who gets a chance to live or die, or thinking they do, is cruising for a comeuppance. Some of which will be delivered from behind, by “your people”. The minute any group perceives the nominal leader as a greater threat to their survival than the nominal enemy, that leader at best will end up naked and staked out on an anthill, and that’s if they really like you.
That’s also utterly overlooking the horrendous mental complications for everyone – including yourself – of doing a half-assed, or no-assed job of preparing for the inevitable casualties. You, and they, may get back after cutting someone else loose, but they’ll be f—ed in the head, probably forever. So in dumping one casualty, you’ll create a lot more, in perpetuity. And if that’s not the case, those are people too emotionally damaged to be worth saving anyways, and hopefully they’ll be the first ones eaten by mutant zombies, or turned into Soylent Green protein crackers by the minions of the evil empire upon capture.
Of course you can’t save everyone. You still try.
You don’t have to like it, you just have to do it.
And brushing people off like something of no more value than the dust from your shoes is simply an excuse for being either too lazy, too afraid, or both, to make some kind of effort to have more options than just a bullet in the temple. Even with endless first-world resources at our disposal, people die at my job regularly; that still doesn’t mean we hold a pillow over their faces to help them along.
Which was exactly the benediction of the original post: stop shucking and jiving about this, or trying to press the “Easy” button, and get busy doing the hard things that are required.
And anyone who has one modern battle rifle managed to amass sufficient resources to put together one helluva lot of medical kit.
For one example:
A young friend of mine was attacked by a grizzly bear 12 days ago while hunting north of Jackson Hole, WY. The bear tore up his hands, scalp, legs, buttocks and ripped out a huge epidermal layer from the back of his head (not a mark on his face!). He is undergoing surgery for skin grafts, they already pinned his fingers back together.
I doubt he had any basic first aid kit with him, let alone a blowout kit (which I have carried every single day for yrs now). Most people are clueless that a basic first aid kit has only bandaids and aspirin, worthless for any kinds of serious wounds. I’ve pushed my friends to get a blowout kit mounted on their packs, so far not one has bothered. Just like with bear spray, they seem to be under the assumption that they can use mine if the need arises.
I carry a first aid kit in the car for my spaniels, for Christ’s sake! NO, I will not be suturing up a 12 inch gash from some woodland creature, and NO I will not be doing eye surgery if they puncture an eye on a protruding stick. However I can use a tourniqet, I do have gauze, benedryl, and pressure bandages at hand. I can also (for now) get them to a vet asap, as I never leave home without a list of emergency vets in my chosen vacation area. I desperately wish, that as a young woman, I had taken advantage of training that my RN mother could have given me for free. That being said, I will interrogate the local junior college for some EMT training. Aesop is correct, I may not be able to save you-but I will try damnably. My mother used to say, there is an open window. You do everything you can when that window is open. Once it closes-only God can open it. And mama was a level 1 trauma nurse.
Definitely good info/advice from the site.
Take every med/first aid course that you can and build on it
and have good books on medical/healing info.
Pool resources to buy an AED and other necessary
and usable medical tech.
Also definitely recommend watching the videos of and if at all possible attending the courses of study provided by Patriot Nurse and other individuals.
And no, there’s no defensible reason to not let a friend/tribe member suffer if you can properly treat them..don’t let little med/health issues become critical (gunshots/knife wounds are another thing but should be planned for so they can be dealt with as well).
Yours in Health and Liberty!
If you do not have any doctors/nurses in your group, consider a DVM or a vet tech. They know how to insert an airway, suture, and push IVs. My dear wife and stepdaughter, both Vet Techs, have doctored me more than once after a Tim Allen “Home Improvement” misadventure; in addition to taking care of our numerous rescued canines and felines.
My screen name is a homage to our late golden retriever-whippet mix who was an excellent watch dog and ground squirrel assassin. The girls rescued him from some clueless white trash. We still mourn him.
I am a member of a small group of medical professionals, who are preparing for an emergency. Our skills include emergency medicine (me), family medicine, general surgeon, vascular surgeon, orthopedic surgeon, a CRNA (anesthesia), an Oral surgeon, a few nurses (hospital and surgical), a few PA’s/ NP’s, and a lab guy (wet and micro).
In addition to our own family preps we have a considerable amount of medical gear. Some is salvaged from hospitals, some is purchased from jobbers or ebay….Nobody not in the hospital end of the medical field has any clue at all, about the sheer volume of this stuff….it is BULKY. My groups supplies are stored in the equivalent of a small aircraft hanger – a combined 9,000 sq foot space with a 16′ ceiling. And we need more room. The goods are actually dispersed to several different locations, combat loaded so each facility has some of everything.
And should our efforts ever be needed, we will be ready. I hope that those who may need our services will be able to get to us.
But, we are probably alone. A lot of the first aid advice I’ve seen seems to think that having the contents of a CLS bag, or even a medic bag, is all that you need: After all, thats what the Army has, right?
Well, yes. The army also has GOD’s own supply chain, with air and ground ambulances, hospitals, people. The entire rest of the US Military to pull security. A wounded warrior might get treated by a CLS and an 68W, but then they have BAS/CSH/Role 2/Zone/CONUS medical facilities less than 48 hours away. Thats the part that people seem to miss.
Will some people have to decide if people get treated? Absolutely, no matter how horrible it may be. I’ve had to do it myself: It’s called triage – sorting. In a mass casualty situation it breaks down quite easily – anyone that can walk over here doesn’t need treatment right now, anyone who isn’t breathing after their head is repositioned doesn’t need treatment ever. Basically finding out who you CAN save, with the resources (time, people, equipment) you have NOW.
In a combat situation, when being pursued by enemies you won’t have CAS and Arty to call to make your break, or dustoffs to get the wounded out. It’s not going to be the third morning of the Battle of Ia Drang, if you’re lucky it might be the last night of Dien Bien Phu. Hard decisions will have to be made, and ideals like leave no man behind are noble, but only for those with GOD’s own supply chain. To pretend otherwise just means that you will ALL die.
In terms of training, I recommend that everyone be trained to first responder level – EMT is just FR with an ambulance ride day and hospital visit shift, which doesn’t add much value. Designated medics should be Wilderness FR or EMT level. Of course, more is better but there is no such thing as a magic IV that will cure a sucking chest wound, and no sutures will fix a broken bone.
In terms of sheer life-saving effort, the most effective things people can do is learn field sanitation and hygiene. Throughout history more fighters have died from food and water borne illnesses (all of which are preventable) than have been killed by direct combat. It may not be terribly sexy, but a clean water source and proper latrine will do more to save lives than all of medical science.
As long as you insist. I’d gladly shoot you in the head.
I’ll even throw a shitty us flag over you too. 🙂
An AED, without the rest of the cardiac chain of life,is a $1000-plus wasted. The secret that the Red Cross and Heart Association don’t like to tell laypeople is that even when EVERYTHING goes by the book after a heart attack (bystander CPR within 3 minutes, AED within 5-6 minutes, Advanced Cardiac Life Support (drugs and airway) within 10 minutes, less than 90 minutes to a cath lab for a stent) the chances of surviving a heart attack to discharge from a hospital are around 1 in 5 (20%). Also, about half of the people who have their first heart attack die from it.
Also, they are maintenance hogs, require expensive and unique batteries and pads replaced on schedule, and when the approved algorithms change the manufacturer will tell you they can’t upgrade your unit but they’ll give you a $50 credit towards the new and improved version.
I have a defibrillator/monitor but don’t plan on it being a major factor. I doubt that many patients will get to me in time.
Most folks would be better off buying a thousand dollars worth of soap, bleach and sterile gauze, they’ll do more good with it.
Just because someone has RN after their name does not magically qualify them for much. A nurse with emergency room or surgical experience maybe…a nurse that has been taking blood pressures and blood samples in a doctors office for 40 years? Probably not.
The same could be said about physicians – but all physicians have a solid grounding in anatomy and physiology, and at least a years experience in a hospital (the intern year).
By the way, lots of medical supplies (durable medical equipment) can be purchased on craigs list or at garage sales…when a loved one dies or gets better, they usually want to sell their crutches, wheel chair, bedside commode, oxygen concentrator (got AC for it?), etc at a small fraction of what it costs new.
Clean them up and put them in storage, along with boxcar lots of bandages and betadine.
Also, when drug stores or 99cent stores go out of business, the bandages are usually there for the right buyer. Most people pass them by.
Thanks, Doc, for your comments as always.
“The most frequent initial presentation of myocardial infarction is sudden death.”
And every minute between arrest and defibrillation (for the only two shockable rhythms) = a decrease in likelihood of any successful resuscitation of 7-10%. Other than cold immersion patients, at arrest+15 minutes, you’re not keeping someone alive, you’re just burning calories by doing CPR.
If someone wants to acquire an AED anyways (along with the basic instruction to use it) that’s their business.
But I wouldn’t put it in the list of the Top 500 Things I’d Get For TSHTF.
Also, labels notwithstanding, $1K worth of soap and sterile gauze don’t expire, and will still be sterile gauze and soap in 50 years. (The bleach will last too, if purchased in solid rather than liquid form.)
I repeat, 10-200X more stuff than you think you’ll ever need or use.
FWIW, a filled 8×20 conex box holds enough medical supplies (not including bed linens) inside to run a Level I trauma center for a week, at 2000 visits/week.
And folks shouldn’t overlook “expired” sterile materials still properly stored in their original packaging. The stuff is frequently given away gratis, simply for the favor of hauling it away from the former owners, who are prohibited from making use of it in the current first-world situation.
Come a major disaster, or worse, a case of “expired” sterile supplies will be a godsend. When the choice is dressing wounds with either
c) the patient’s torn-off t-shirt
d) a case of dry sterile dressings 10 years past their freshness date
option “d” is miles ahead of the other choices.
One other lesson:
Medical adhesives and tape will either delaminate, or harden to the consistency of petrified wood over time, rendering them useless after various intervals.
Brass and stainless steel safety pins, OTOH, work just as well 50 years later as the first day they were packed.
Proof of which is the assortment of safety pins in a vintage pristine corpsman’s Unit One I have in my possession, repacked in exact go-to-war spec in 1966, when its former owner returned from a FMF tour with Marines in Vietnam.
When last I looked, WallyWorld sells a 200-pack assortment of small brass safety pins in their craft aisle for about $8.
You make a good argument for the emergency aid training you write of. However, the training you propose for folks to obtain, is easier said than done. Certainly, it is good stuff (from what little little I know).
My question is wouldn’t it be best if folks were at least trained to clear the airway, apply pressure dressing, and properly use a tourniquet ? Basically, use of the IFAK.
You propose eating the whole enchilada. I’m thinking of taking a bite.
Good videos you posted. Thanks.
More of this, please.
This is the sort of thing that we need to hear more of: undiluted, 200-proof common sense spoken plainly by a professional. The proverbial cold bucket of water to the face does wonders for your focus and your worldview.
When I went down, it was like that Gary Oldman scene from The 5th Element when he broke the glass and all those hidden little robots came flying out of the walls –
– all sorts of people and equipment were put into motion. Some I knew existed, but had little contact with. Most of whom I did not know existed.
Every single one of those very specific people had their jobs to do, and then I was handed off to the next link in the chain. And that chain has a MASSIVE logistical supply train backing it up, with even more people overseeing the whole process to make sure it all went off correctly.
Unless you’re some weird mix of Dr. Michael DeBakey and Big Bang Theory super-genius Sheldon Cooper with a photographic memory, I think it’s impossible for any one person to know or be adept at every skill necessary. Even doctors have to follow the lemma: Nobody knows everything. But everyone knows something.
Not saying don’t bother. Not saying give up. Just saying we need to listen to Doc (sorry Doc – you are now and forever more known to me as “Doc”) and heed his extremely wise advice.
Personally, I’d be extremely interested if he posted semi-regularly. More of: “This is what you should be able to do. This is the stuff you don’t need to worry about. This is mission-critical, while this is nice to have.” And possible ad-hoc stuff for when we get caught out without our gear, like using a pressure cooker as an autoclave to sterilize stuff, or using a tuning fork to diagnose broken bones (forget the frequency, but yes that’s a real thing)…
For someone like me – older and broken and of not much use on a modern battlefield – developing strong secondary skills, like a Medic, to replace those battlefield skills I can’t use anymore is a godsend…
Please, may I have some more?
Heh. Part of the supplies we have are dressings and durable equipment that was put up in Civil Defense Packaged Disaster Hospitals, in the late 1950’s. http://www.civildefensemuseum.com/cdmuseum2/cdeh.html I’d still use most of it, if I needed to (the Xray and Anesthesia machines….probably not).
There was a blog starting that was going to address grid-down medicine, that the owner had asked me to contribute to – but he has seemed to disappear. Perhaps I should re-arrange my life and find time to run such an enterprise but swooping in and contributing to discussions like this takes much less time.
In addition to safety pins, it’s possible to just tie bandages on – even roller bandages, torn from sheets. But, replacing old and deteriorated supplies is a major expense, no doubt about it. Instead of planning on using alcohol wipes, for instance, I have an alcohol pump jar and rolls of cotton wadding https://www.amazon.com/Physician-Supplies-Labeled-Alcohol-Dispenser/dp/B0008GCVU8/ref=sr_1_2_a_it?ie=UTF8&qid=1474901603&sr=8-2&keywords=alcohol+dispenser old school, but it works.
There are lots of medical references that folks should read, but one that is good for really austere conditions is Isersons Improvised Medicine https://www.amazon.com/Improvised-Medicine-Providing-Extreme-Environments/dp/B0083JC9O0/ref=sr_1_2?s=books&ie=UTF8&qid=1474901794&sr=1-2&keywords=iserson
There is some good info in there, along with some rather obvious stuff.
Swoop in anytime, Doc. Comments are fine, or ping me at firstname.lastname@example.org.
I think you understate the sheer volume of stuff that gets used in a hospital. I’ve filled up a huge Rubbermaid Brute 55gal trash can working on a single patient in the emergency department, before they went to surgery and the rest of the hospital.
I agree that there is nothing wrong with expired dressings…as long as they are clean and dry. I tend to keep them in ziplock bags, in addition to whatever other packaging they have. Dressings may turn a little brownish, but clean and dry beats dogshit every time.
Thanks, and you’re welcome.
So, have you been taking first aid classes? Got to have a base of skills before learning the advanced stuff.
I’m going to be off grid the rest of the week (Elk Season!), but would be happy to answer questions, here or privately. email@example.com
Why thanks. Fortunately, you won’t be anywhere to be found when my day comes. But if I gave a shit, you’d be the first one I’d give it to.
When told his stick would have to carry a 150 pound simulated wounded comrade for a week in the bush, the 18 year old frog in the last RLI course exclaimed, “We shoot zee wounded!”
Wasn’t talking to you. Maybe the ebullshit has affected your brain,.
But the offer goes for you too-now that you mention it. FOOL.
By all means, start with the small bite.
That should be the barest ante to get into the game, for everyone.
Uncle covers it for Big Green in about 4 hours.
But given we’re all assuming things are going south, with time to make other better arrangements, getting to the competency of an EMT or better isn’t that much to expect or push.
People in this country now routinely stand around heart attacks and accident victims every day, and not 1 in 100 step in and do anything. That’s lazy and stupid herd mentality in action (or inaction, if you prefer). And people who could be saved die because of it. If things start to slide, medical care will be limited to what you have in your own head, and there won’t be the chance to get proper training then. OJT in the woods of BFE after the fact is a poor substitute for a few weekends, or a paltry semester of night classes at the local JC now. Just as a gun gives you the ability to be personally responsible for self-defense, medical expertise gives you the ability to be personally responsible for your own medical care. (As a bonus, it can save or mitigate a lot of silly-ass trips to overcrowded EDs for basic care, and sort the serious stuff from the petty things you can treat at home). We all need to be, in medical self-care, what the Amish are to self-sufficient food production.
The reason I say EMT is because currently, a basic EMT-level graduate (and no, CNA isn’t anywhere near there – because different emphasis) is trauma-focused, with a strong dose in chronic conditions, and is in many ways educated beyond the knowledge and skill set of the average physician from prior to 1900 or so, probably even beyond trench medicine from as late as WWI. And miles beyond Civil War-era medicine. That’s a monstrous decline in needless casualties in a SHTF scenario, purely with a knowledge of germ theory and how disease and infection is transmitted. We are standing on the shoulders of giants for getting us there.
Also, even if, by some miracle, our decline is some long, slow slide, rather than a precipitous calamitous fall, the number of Katrina/Northridge earthquake/Joplin tornado/LA flooding events is only going to continue, and the odds are that sooner or later, probably when anyone least expects it, it’ll be their turn to step up to the plate.
Give me a baker’s dozen EMT-level players, and I can make a hospital for hundreds to thousands of patients, for months. Add some additional skill levels and equipment, and I can maintain 21st century medical care for hordes, with hardly a hiccup except for the most extreme cases.
Eating the whole enchilada?
That’d be getting a paramedic upgrade, getting a medical job full-time, learning to be a radiology/pharmacy tech, or going to nursing/P.A./vet/dental/medical school.
And loading up a garage or 40′ conex worth of stuff.
Something someone in every group should seriously consider, but not everyone. (The number of older-student nurses and doctors in those schools has risen over time, and it’s a good thing, and do-able for anyone who wants a crack at it. Half my nursing class 25 years ago were not dewy-eyed 18 y.o. Florence Nightengale wannabees looking for a doctor to marry, but instead, 40s Koolaid moms who’d raised their kids, and now wanted a paying profession. After raising teenagers, there isn’t much you’re afraid of in life.)
I was part of that blog effort too, but life intervened, my regular job and PC crashed, and it was months before I could get back to it.
It may be time to rescusitate that effort, somehow.
The school solution for the sergeant in such a course is to point to him, and tell his group he’s the wounded man for the balance of the exercise, and entirely dependent on the good graces of his comrades for every drop of water, bite of food, and whether or not he gets bathroom privileges and clean-up, or just gets to eliminate in his clothing for the balance of the event.
Or, should they choose, he just gets stripped of everything including boots, and left to fend for himself as if near death, in his underpants, and forced to crawl on hands and knees.
It’s an A-list lesson plan, and never fails to drive the point home with gusto.
Sometimes area fire hits the intended target serendipitously.
Happy to oblige.
For future reference, maybe you should try using your glasses when you aim to hit a specific reply key? Just a thought.
But thanks for signing your post.
I work in a West Coast Level I trauma ED now.
Fortunately the folks who fill a trash can or two of trauma leftovers are the exception, and not every 5 minutes 24/7.
But they will happen in bad times, as they do now.
More stuff is always better than less stuff.
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