Officer Down Bleeder Kit

I have been wanting to build a bleeder kit for some time for use on injured officers which is small and within my skill level to use. Being trained only as a Basic First Responder/Basic First Aid/CPR/AED by the Red Cross and having "NEVER" been issued any first aid gear except a protective mask for rescue breathing 20yrs ago by my department I feel the need to be able to do something to help save a follow officers life besides the current SOP of placing a shot or stabbed officer into a patrol vehicle and taking off for the nearest hospital which is 15 minutes away at best from the area I patrol. As many already know the Philadelphia PD has lost several Officers in the past two years and having been involved in a gun fight and seeing another officer shot right in front of me I just have to have some gear which may make a difference one day.

I was thinking the following gear times three,

Gloves, Rescue Breathing Mask, Sheers and some medical Tape

http://specopstech.com/newwebsite/co...s/celox_35.jpg
Celox Hemostatic Granules (35g)

http://specopstech.com/newwebsite/co...auze_small.jpg
Celox Gauze (MCC-ROLL)

http://specopstech.com/newwebsite/co...BAND_small.jpg
Multi-Trauma Pad

http://specopstech.com/newwebsite/co...TOUR_small.jpg
SOF Tourniquet, Gen II

My care would be done en route to the hospital which would be basically exposing the area and pouring in the Celox Hemostatic Granules then placing a roll of Celox Gauze over the wound and applying direct pressure with the Multi-Trauma Pad. If necessary I would use the SOF Tourniquet on a extremity if I could not control the bleeding with the above. I guess I should have a few chest seals but I don't know it they will adhear over the Celox Hemostatic Granules which turns to a gel on use. Please add suggestions on gear and options I'M sure I have missed.

That's a lot of hemostats.

Regular kerlix and Ace wrap would be useful. I like the Olaes bandages from Tac Med Solutions or even just the control wrap with the neat velcro brakes. The Israeli bandage too. Anything that can put pressure where it's needed.

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If necessary I would use the SOF Tourniquet on a extremity if I could not control the bleeding with the above.

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Go straight to the TQ nice and high on the extremity if the bleeding is that severe. If there's heavy blood flow don't waste time trying to stop it with pressure.

If you're sealing a sucking chest wound, just cover it with a seal. Don't put hemostats under it. Mop it off as best you can and seal it.

La-Bump

Danny Boy had some really good advice. Go straight to a TQ for a massive extremity bleed. They leave them on for hours in surgeries. Hemostatic agents like the celox are a good adjunct to basic wound packing techniques but a high pressure bleeder needs some kerlix or something similar to put pressure on it. If all the bleeding is stopped and if you won't get in trouble for doing a needle decompression you might consider a 3.5 inch 14 gauge catheter for that. You have to occlude the wound first. Your site is the second intercostal space midclavicular line. Be sure to clean with alchohol and ideally betadine, go superior to the rib, and stay lateral to the nipple. Leave the catheter in until air or blood stop coming out.

Thank you mkmckinley and Danny Boy for the advise, I would TQ a extremity heavy bleeder asap and apply direct pressure with the Celox Gauze packed into the wound and the Multi-Trauma Pad over that. If I had to address multi breeders I would use a ace bandage or tape to hold the dressing then move on. I'm more concerned with that torso hit and trying to control the bleeding while en route to the hospital which can be 15 minutes away at best.

there isn't a ton that you can do easily for a chest wound that's bleeding a lot. Anything centerline is probably going to be fatal anyway. You can try to reduce a pneumo/hemothorax with a needle decompression but you'll likely have an paramedic on scene pretty quickly that should be able to do that. Anyway if you're best bet would be to get some packing into the wound to try to clamp off any major bleeders. If it's the chest wall you'll just have to occlude the holes with something like an asherman chest seal or even just some hydrogel. You're not likely to be able to effectively tape something like that off using plastic like some of the old Army manuals dictate. There is a celox applicator thats pretty much like a tampon applicator. You push it into a wound and push the celox out into it. I have no first hand experience with it but it might work. In my experience the hem control agents don't work all by themselves and need pressure or packing to really work. Then they work really well.

You need the following -

1pr - Hands, Human
2pr - Gloves, Latex, Size Large
2ea - Tourniquet, Combat Application (or SOF-T, or anything that is PROVEN, RELIABLE, and which you can place ONE HANDED)
1ea - Combat Dressing, Izzy 6" with Slider (or an ace bandage and two rolls kerlix)




As a civilian patrol officer that is all you need. Ditch the hemostatic agents, if you simply must retain them to feel prepared, get one quickclot impregnated combat gauze roll and understand when and how to use it. If an officer has a minor penetrating injury to an extremity that you are fairly certain is not bleeding much ie. through and through gsw with no major vessel damage or minor stab wound with adipose tissue exposed bandage it with the izzy dressing. If the bleeding is any heavier, slap on the tourniquet and take him/her to the ER. If the officer has taken a hit in the thoracic area or abdominal area place a gloved hand over it and take them to the ER.

A tension pneumothorax is not going to develop before you can reach the hospital from blunt trauma after a vest strike. (If it does from a collision or something like that you probably wont be able to tell any way) If the pneumo is from an actual penetrating injury then you most likely will not need to needle decompress anyway as there is already a hole in the thoracic cavity to relieve pressure, the important thing is to prevent air from flowing into the pleural space thus the gloved hand over the wound.

mkmckinley - It is inappropriate for a civilian police officer with no medical training to insert a needle into another officers chest no matter how good their intentions, it makes no difference whether or not they will get in trouble for it.

PhilaPD - It is also very very ill advised for you to use hemostatic agents except in certain very specific instances. The most likely outcome of doing so is that you will significantly delay your buddies treatment at the hospital or significantly extend their surgical time prior to repairing the vasculature increasing their morbidity and mortality significantly. Dont do it.

Also thoracic injuries bleed but they typically dont bleed much if that makes sense, enough to be messy but not enough to matter physiologically unless something has been hit internally and there isnt anything you can do about that anyway.

Something else to consider is that you need to talk to your teammates and preplan. Not everyone wants to go by patrol car and if they want to wait for EMS you need to respect their wishes. Typically most of the thoracic injuries you will see are not a result of vest penetration but rather occur in the axillary region. These side penetration injuries have a huge risk of involving the spinal column made worse by the fact that most of these occur with a "bladed" stance rather than from a true 90 degree side angle and the projectile usually enters towards the front of the body and as it travels towards the center of the body it is angled rearward towards the spine. Many officers end up paralyzed as a result of this. The standard of care in the United States is to place a person with a likely spinal injury on a long backboard and do the best we can to immobilize that persons spinal column. If you drag that officer to the patrol car and pull him/her into the backseat with you, for better or worse their spinal column is not being protected. Most of us will agree that the damage is likely already done and no harm will come of this but there are officers who do not want to take that risk, you should talk about it and know ahead of time and respect their wishes.

Additionally you need to find a way to notify the hospital that you are coming in with a serious trauma patient so that they can activate the trauma team. Most hospitals will have people all over the place taking care of things and it take 3-5 minutes or longer to get everyone rounded up to adequately care for someone. Figure that part out before this happens, also if possible as part of your notification plan have the hospital staff meet you in the ambulance bay with a stretcher. Dragging a dying officer across the threshold of the ER trailing blood is not an effective way to calm the situation and ensure that officer is going to get effective initial care.

Place tourniquets, cover chest wounds, and drive fast. That is how you ensure your brothers and sisters have the best fighting chance possible to survive penetrating trauma in the line of duty and meet their responsibility to come home alive.

NinjaMedic,

Thank you for the advise, Here is the problem we face in Philadelphia, are medic units are thinly spaced and are usually tried up on bullshit runs (Non-Emergency) which cause Hugh delays in response times. I have personally seen 30 to 45 minute delays awaiting a medic. Now a EMS and a fire truck may respond but they are extremely limited in their scope of care they provide and can not transport. Thats why the scoop and run SOP has evolved trying to do what we can with no issued medical equipment on a trip to the closest Trauma center which at best is about 15 minutes away from were I patrol. Thats a lot of time to bleed out and since no other options are available to us its the best we can do. I would not do anything past trying to control bleeding while en-route to the hospital, thats why I'M asking for suggestions on how to do this effectively with items I can obtain from the INTERNET and local sources. I'M trained only as a American Red Cross Basic First Aid/CPR/AED First Responder and the training I received in the U.S.M.C. so I'll do the best I can, I'M just asking for suggestion on what basic gear to use to optimize the care level I can provide.

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Originally Posted by NinjaMedic

Also thoracic injuries bleed but they typically dont bleed much if that makes sense, enough to be messy but not enough to matter physiologically unless something has been hit internally and there isnt anything you can do about that anyway.

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Some might want to have a look at this video if they haven't seen it before. It's a sucking chest wound so it's a tad bit gross, but it demonstrates the lack of blood (and why it's called a sucking wound :P).

http://www.naemt.org/Education/V06%2...0Wound%201.mpg

PhilaPD - Unfortunatly those issues are not limited to the Philadelphia area, they are widspread and represent the status quo in the majority of our cities so I completely understand you predicament and what you are trying to do. I gave you my opinion as to how best to care for a downed brother while holding him in your lap in the back of a patrol car. I really do think that it is the best solution for most of our colleagues to be pulled into the back of a patrol car and taken to the closest trauma center and that is what I would expect of my team members as well. I am merely outlining some potential issues that you need to consider ahead of time. I stongly believe that you shouldnt use a hemostatic agent in your situation, but that is internet advice from someone you dont know from Adam and what you choose to do is up to you. I am not in any way trying to discourage you, in fact I encourage all peace officers to do what you are doing and in our community we actually volunteer and provide them with free condensed TCCC classes to assist with that. My point is that, in my opinion, the equipment I outlined above is the best way to accomplish what you need with the fewest complications.

Danny Boy - Great video! Thats what I was attempting to explain, and that is what the gloved hand should fix (although commercial devices work well too).

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Originally Posted by Danny Boy

Some might want to have a look at this video if they haven't seen it before. It's a sucking chest wound so it's a tad bit gross, but it demonstrates the lack of blood (and why it's called a sucking wound :P).

http://www.naemt.org/Education/V06%2...0Wound%201.mpg

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This is going to be a dumb question, but humor the neophyte. I have only had a few formal first aid classes. How is the guy in that video not dead? Isn't the wound directly over where the heart would be? What would make a hole that large? :confused:

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Originally Posted by mkmckinley

there isn't a ton that you can do easily for a chest wound that's bleeding a lot. Anything centerline is probably going to be fatal anyway. You can try to reduce a pneumo/hemothorax with a needle decompression but you'll likely have an paramedic on scene pretty quickly that should be able to do that.

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The furthest extent I would go and tell someone else to go for this would be to skip the needle thoracentesis and just stay with a Bolin chest seal for chest wound. There could be a chance you could damage the intercostal arteries. By the time all that needed to happen anyway the EMT's would be on scene. It takes some time to depress the respiratory system. I would definately do it in the (battle) field but not in CONUS. Just a Bolin and put them in the recovery position.

Also, while I would not hesitate to do a tracheotomy in the field and is the one thing I can't **** up if I tried to, I would not do this in CONUS unless the patient had a mandable missing or maxillofacial trauma and was unconscious. One thing to make sure is in your kit IS an NPA, nasopharyngeal airway tube, so the victim doesn't choke on their tongue if their lights go out.

Like the NInja said, skip the hemostatic agents and go with direct pressure and a tourniquet. You don't need to be putting shit in people, the ambu WILL be there shortly. Direct pressure and tourniquete. The SOF-T is what we use and it is better than previous issued ones. The Combat Application Tourniquet is a POS. The plastic windlas almost always snaps on me.

When you roll up on a ****ed up dude go through these steps MARCH.
Massive Hemmorage-direct pressure/tourniquete
Airway- fingersweep/NPA/recovery position
Respiratory- Rescue breaths
Circulation- Chest Compressions
Head To Toe- Go back over your work, sweep their back again for addition wounds and blood, take a smoke break.....

I would stick with stopping the massive hemmorage and make sure they are breathing and get the Pro's there ASAP.

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Originally Posted by Phila PD

I would not do anything past trying to control bleeding while en-route to the hospital, thats why I'M asking for suggestions on how to do this effectively with items I can obtain from the INTERNET and local sources.

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Good idea. As Ninjamedic said...get yourself some trauma dressings, a glove, and your hand. Direct pressure buys the most time.

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Originally Posted by Phila PD

I'M trained only as a American Red Cross Basic First Aid/CPR/AED First Responder

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There are places where even Paramedics cannot use hemostatic agents to stop bleeding. You're talking about a major headache if you try to use those on the streets. Using them on yourself is probably okay though. You can't easily sue yourself.

ADD: Unless you're a trained and currently certified EMT or Paramedic a) operating within your district AND b) on the clock or volunteering AND c) operating under the medical direction of a physician (MD), if you choose to implement one of the abovementioned devices on another person, you are practicing medicine without a license and doing so can get you in loads of legal trouble. IMHO, it's not worth it. As I said above...direct pressure and drive fast.

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Originally Posted by mkmckinley

There is a celox applicator thats pretty much like a tampon applicator. You push it into a wound and push the celox out into it.

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Celox applicator that I have in my kit.
http://stores.homestead.com/Laruetac...ail.bok?no=424

I also have Celox gauze roll that can be stuffed into wounds and Israeli pressure bandages. Here is a supply site"
http://www.redflarekits.com/mm5/merchant.mvc

I recommend that you get a SWAT-T tourniquet and practice with it as this is something you'll more likely be placing on yourself than on another officer. I'd also recommend getting a second SOF tourniquet to practice with. Also, get the red/orange version of the SOF for your use, in your environment tactical black serves no purpose.

Great thread and a lot of good info....I appreciate those with the knowledge sharing it with us. I'm trained as an EMT (not medic), training I went through for my agency (LE).

I have no formal training with quickclot, celox, etc (so I don't use it)...I learned pressure, tourniquet, chest seals, and the other methods discussed here and I try to stay within my limitations.

With the new quickclot/celox combat gauze, is that advisable to use in a manner consistent with other dressings along with pressure? I understand the issues with placing anything into a wound that will delay treatment at an ER, where a dr/nurse will have to clean it out prior to treating the person.....just looking for advise since everyone seems to carry these in medical kits now and there has been reference to only using this type of agent in specific circumstances.

Thank you in advance and I appreciate all the help.

JC

JC5611- We are starting to switch to just using QuikClot combat guaze. This stuff is awesome, it obsorbs super amounts of blood and stops bleeeding quickly. Yes along with the the hemostatic agent in the guaze, the quaze will not fill most cavities and apply the amount of pressure you need for a major bleed, packing kerlex or Zfold quaze over that and then applying an emergency bandage or ace wrap over that will work wonders.

To be honest, their aren't too many bleeds you can't stop with a good pressure dressing(packing the wound tight with guaze and wrapping a good ETB over that) Without the use of combat guaze or any other hemostatic agent as long as your pressure dressing is applied properly.

I forgot I wanted to touch on the tourniquet topic.
In my opinion the CAT is awesome! The problem I've seen over here is that people will try to use them more than once, they are only meant for single use. Using it more than once will put a lot of strain on the adhesive that is used and it will eventually fail.
The second reason I have seen that causes the windless to break is that people try to do too many rotations with it. If you cinch the strap down as tight as you can get it like you are supposed to, you should only need to turn the windless a few times in order to stop bleeding to the extremity, many people will barely tighten the strap and then crank down on the windless causing it to snap, or the adhesive holding the strap to break loose.
Personally, I feel the SOF-T has too many parts to operate which when your brain goes into caveman mode(which will happen in a trauma situation) their are too many steps you can miss or not do properly.
Just my personal opinion and experiance.

On the cave man mode topic, the Navy is using a tourniquet that I wasn't sure about at first, but after doing some trials with it, I really like.
It's called the TK4 and it is made by H&H
It's basically an 1 1/2" wide elastic band that has a hook on one end that looks like a fish and a regular looking hook on the other end. You wrap it around the extremety once and then bring it back through the fish looking hook then wrap it the rest of the way and secure it with the other hook.
My directions might sound confusing but it really is a very simple tourniquet to use and surprise it really does stop bleeding well!