you have it and carry it, do you know how to use it?

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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you have it and carry it, do you know how to use it?

Post by sigma42 » Fri Jul 12, 2013 12:49 pm

Like the title says....

Just because you are carrying something in you bag, my question is are you trained in its proper use?

Are you "Practicing within your Scope of Practice"

What is "Scope of Practice"

Scope of practice
From Wikipedia, the free encyclopedia

Scope of Practice is a terminology used by national and state/provincial licensing boards for various professions that defines the procedures, actions, and processes that are permitted for the licensed individual. (Also covers "Certified" individuals in some states) The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency. Each jurisdiction has laws, licensing bodies, and regulations that describe requirements for education and training, and define scope of practice.

Definition

Scope of practice can be easily identified by three categories.[3] If requirements for practicing a skill or profession satisfy all three requirements then it is within that persons scope of practice:

Education and training — Has the person been educated academically or on-the-job and have documentation proving education to do the item in question?

Governing body — Does your state, district, province or federal government that oversees the skill or profession allow (or not explicitly disallow) the item in question?

Institution — Does the institution allow a person or their profession to do the item in question?

My reason for asking is not to judge, but for you to ask your self,

"If I am just a bystander and not ems nor am I trained to do something, and just because I have a C-collar in my bag do I really want to attempt to put it on a person and risk the chance of paralyzing that person because it was in my bag?"

So ask your self if carrying the "cool stuff" worth it, and just how much money you wasted in buying the stuff.

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Re: you have it and carry it, do you know how to use it?

Post by okiebill » Fri Jul 12, 2013 6:56 pm

sigma42 wrote:Like the title says....

Just because you are carrying something in you bag, my question is are you trained in its proper use?

Are you "Practicing within your Scope of Practice"

What is "Scope of Practice"

Scope of practice
From Wikipedia, the free encyclopedia

Scope of Practice is a terminology used by national and state/provincial licensing boards for various professions that defines the procedures, actions, and processes that are permitted for the licensed individual. (Also covers "Certified" individuals in some states) The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency. Each jurisdiction has laws, licensing bodies, and regulations that describe requirements for education and training, and define scope of practice.

Definition

Scope of practice can be easily identified by three categories.[3] If requirements for practicing a skill or profession satisfy all three requirements then it is within that persons scope of practice:

Education and training — Has the person been educated academically or on-the-job and have documentation proving education to do the item in question?

Governing body — Does your state, district, province or federal government that oversees the skill or profession allow (or not explicitly disallow) the item in question?

Institution — Does the institution allow a person or their profession to do the item in question?

My reason for asking is not to judge, but for you to ask your self,

"If I am just a bystander and not ems nor am I trained to do something, and just because I have a C-collar in my bag do I really want to attempt to put it on a person and risk the chance of paralyzing that person because it was in my bag?"

So ask your self if carrying the "cool stuff" worth it, and just how much money you wasted in buying the stuff.

I'll bite at the troll bait :) just a few thoughts...

Even if you are trained, If you are operating out of your own bag and not on shift you are running outside of every SOP / Set of Protocols that I know of... If you are going to question putting on a C-collar vs. Holding C-spine or just driving on by, you better just drive on by to continue looking for your own spine :wink:

If you are rolling a full kit and have no training and go to town on someone may god have mercy on your soul...

There is a situational grey area here and I hope that is where most sane folks balance training / equipment and application of skills.

Money on gear is rarely wasted because I may not have the skill to use it but that does not mean someone else does not....

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Re: you have it and carry it, do you know how to use it?

Post by CrossCut » Fri Jul 12, 2013 7:42 pm

^^^^^What okiebill said.^^^^^^^

When I was first certified by the ARC for first-aid and CPR/rescue breathing, they taught to lift under the victim's neck and tilt the head to open the airway, and to deliver a precordial thump before starting CPR. Just mention it as "the proper way" is constantly evolving, there's little doubt that current procedures will be considered archiac and dangerous in the decades to come. It's very likely we're all doing it "wrong" anyway.

Another example, semi-related and one that really irks me, is the recommendation not to store emetics or activated charcoal for poisoning. Their (poison control's) reasoning
being that emetics don't empty the stomach contents completely (as if getting only 3 of the 10 pills out of the kid's stomach is a bad thing), and that activated charcoal can negate the effects of antidotes given at the hospital. In any grid down, no help on the way scenario, there likely isn't going to be a hospital or antidotes. So I stock them, and have detailed refs on when and how to use them - but again, not certified.

And personally, I don't "carry" anything (except OPAs in one car FAK) that go beyond my limited training, but I do stock many items at home that are. Not to say I'm clueless in their use, just that I'm not trained or certified to use them - nor likely would I be able to use them to their greatest effectiveness. I hope someone with more knowledge and skill might be available, but if not then we're pretty much forced to use our own best judgement, no? I also don't have a C-collar, but if I had to move a patient with a suspected neck/spinal injury I'd use a jacket or a sweater and tape to help immobilize the neck if I had time.

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Re: you have it and carry it, do you know how to use it?

Post by McSquishin » Fri Jul 12, 2013 9:04 pm

99.99999999% of the time okiebill's got it covered. That said, scope of practice gets thrown out the window when SHTF (that 0.00000001% of the time I was alluding to). If I know how to do something, and there's no one else to answer to, then I'm doing it. With that said, my BOB doesn't have much in the way of high speed medical supplies. Just because I know how to do a chest tube/cric/whatever doesn't mean I'm going to carry those very unique and specific supplies. IMHO if SHTF and someone needs that level of intervention, and there's no higher level of care, then they're likely SOL. Not exactly what Op was referring to, I know, but still just throwing that out there.
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Re: you have it and carry it, do you know how to use it?

Post by medic photog » Sat Jul 13, 2013 1:40 am

Heh, I walk a fine line daily as it is. My scope of practice as a Paramedic is not what it is as an Urban Search and Rescue Medical Specialist. I have the equipment, the knowledge and the skill sets for use plus can tell which side of the fine line I'm on at a given time.

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Re: you have it and carry it, do you know how to use it?

Post by DrJack » Sat Jul 13, 2013 7:26 am

^That.

My scope on US Mil is quite broad, as well as on any Coalition force or DOD civilian.

My scope on other civilians is non-existent. Technically I'm not supposed to touch them unless I'm involved with the injuring party, but that gets really blurry a lot of time, and it's not like I'm going to not start CPR on a guy just because I'm not sure what agency he's contracted with.

Just like when I'm stateside, I have no duty to act if I witness a car accident and am in no way to exceed BLS interventions. But again, if I throw a tube in somebody and breath for them until the Ambulance arrives...
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Re: you have it and carry it, do you know how to use it?

Post by DannusMaximus » Mon Jul 15, 2013 10:17 am

It will be a sorry fucking day when I just stroll by some poor bastard who needs medical attention because I'm afraid I'll get sued for helping them.
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Re: you have it and carry it, do you know how to use it?

Post by IANMCDEVITT » Tue Jul 16, 2013 12:00 pm

Dan, it may be a sorry day indeed, now put the same scenario in another war/insurgency/militia country in the african continent. DO NOT STOP, i say again, DO NOT STOP......at the least you will be held accountable for any damage both to a patient and vehicle, (wether responsible or not) at the most, a rusty panga will claim your head (im taking about in an unstable country at the brink with social unrest)..... diffrent behavior for diffrent environments. If anyone here has truly taken a WhiPS class or serious PSD class, the first thing youll learn when dtiving is to z1) DRIVE THRU 2) PUSH THRU 3) REVERSE OUT) RAM,.............As far as carrying things above your scope, FUCK YEA, CARRY THEM that doesnt mean YOUR THE MOST EXPERIENCED MAN THATLL USE THEM. That just means that you HAVE THEM THERE TO USE.

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Re: you have it and carry it, do you know how to use it?

Post by DarkandShiny » Tue Jul 16, 2013 12:22 pm

It will be a sorry fucking day when I just stroll by some poor bastard who needs medical attention because I'm afraid I'll get sued for helping them.
Agreed. In fact in the US at least, those with medical training are obligated to give assistance in an emergency situation (such as the scene of an accident). Those without medical training who stop to help in an emergency situation are held harmless as it is assumed that their intentions are honorable. Yes there are obviously lots of cases that contradict this general principle but those are the exceptions. While I was an undergrad, I worked at the local fire department as an EMT-P. I saw lots of accidents and people hurt; I saw lots of people stop to help. The vast majority of the time their help was greatly appreciated. It was not uncommon for us to get on scene and find somebody doing chest compression on a heart attack victim. Their technique may have been off, but those efforts frequently saved the life of that poor bastard. I never once heard of a stranger getting sued for helping somebody in need.
.... just because I have a C-collar in my bag do I really want to attempt to put it on a person and risk the chance of paralyzing that person because it was in my bag?"
My medical certifications expired long ago. I would not hesitate to use a C-collar. I'm not going to try to perform emergency surgery; but I feel we all must do our best with what we have.

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Re: you have it and carry it, do you know how to use it?

Post by Veritas » Tue Jul 16, 2013 3:37 pm

Even if you know how to do something, perhaps it should not be performed...prehospital intubation comes to mind.

The more I learn the less I would do to someone out of the hospital. Compressions only CPR, basic airway maneuvers, hold pressure to stop bleeding....probably little else.
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Re: you have it and carry it, do you know how to use it?

Post by DrJack » Tue Jul 16, 2013 4:15 pm

IANMCDEVITT wrote:As far as carrying things above your scope, FUCK YEA, CARRY THEM that doesnt mean YOUR THE MOST EXPERIENCED MAN THATLL USE THEM. That just means that you HAVE THEM THERE TO USE.
For the record, I've never had a problem with someone else carrying my gear for me. 8-)
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Re: you have it and carry it, do you know how to use it?

Post by Jaeger » Tue Jul 16, 2013 4:27 pm

Yea, I agree.

Do you carry a snake bite kit (about the size of your thumb)? Have you ever been bitten, or used one?

You know, the darn things come with an instruction manual, and worse comes to worse you can open it, read it, and follow the directions. The poor snake bit fool will be far better off for it, and that poor fool might be yourself!

The first rule of an emergency situation is DO SOMETHING. I can't tell you how many times, in the military, something bad happened suddenly and the majority of trained people went tharn. Mentally preparing for an emergency means not freezing up because you see blood, or get scared, or whatever. If you cannot control and lead yourself what chance to you have being part of a group or leading others?

In terms of CPR (I'm instructor trainer in first aid, CPR, and DART), the civilian version has changed more than you think:
http://www.youtube.com/watch?v=E5huVSebZpM" onclick="window.open(this.href);return false;

But, that's an excellent example, because even if you cannot preform perfect CPR for 30 minutes if you push on their chest and breathe into their mouth you are helping them, and cannot re-kill them. Doing SOMETHING is better than doing nothing in MOST cases.
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Re: you have it and carry it, do you know how to use it?

Post by Metallitera » Tue Jul 16, 2013 9:19 pm

Jaeger wrote:In terms of CPR (I'm instructor trainer in first aid, CPR, and DART), the civilian version has changed more than you think...

Yuup. New AHA guidelines come out every 5 yrs.......

Jaeger wrote:Yea, I agree.

Do you carry a snake bite kit (about the size of your thumb)? Have you ever been bitten, or used one?

You know, the darn things come with an instruction manual, and worse comes to worse you can open it, read it, and follow the directions. The poor snake bit fool will be far better off for it, and that poor fool might be yourself!
According to current standards, that snake bit fool wouldn't be better off if you used that little kit and cut him with a scalpel blade and then attempted to "suction the venom out of the wounds" you just made, as the instructions would have you do.

Not staying current with the times seems to be a big pitfall of those who received training "years ago" or got training from somewhere that does not use national standard of care curriculum.

TQs and a good example.....when I went to EMT school almost 10yrs ago, they were not in the bleeding control alga-rhythm, now they're you're second step. Gotta stay current with the times people, not doing so is negligent, and that WILL get you in trouble.
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Re: you have it and carry it, do you know how to use it?

Post by Metallitera » Tue Jul 16, 2013 9:27 pm

Metallitera wrote:
Jaeger wrote:In terms of CPR (I'm instructor trainer in first aid, CPR, and DART), the civilian version has changed more than you think...

Yuup. New AHA guidelines come out every 5 yrs.......

Jaeger wrote:Yea, I agree.

Do you carry a snake bite kit (about the size of your thumb)? Have you ever been bitten, or used one?

You know, the darn things come with an instruction manual, and worse comes to worse you can open it, read it, and follow the directions. The poor snake bit fool will be far better off for it, and that poor fool might be yourself!
According to current standards, that snake bit fool wouldn't be better off if you used that little kit and cut him with a scalpel blade and then attempted to "suction the venom out of the wounds" you just made, as the instructions would have you do.

Not staying current with the times seems to be a big pitfall of those who received training "years ago" or got training from somewhere that does not use national standard of care curriculum.

TQs and a good example.....when I went to EMT school almost 10yrs ago, they were not in the bleeding control alga-rhythm except for an absolute last resort(and you had to make your own), now they're you're second step(and there's a plethora of commercial choices). Gotta stay current with the times people, not doing so is negligent, and that WILL get you in trouble.
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Re: you have it and carry it, do you know how to use it?

Post by DannusMaximus » Tue Jul 16, 2013 10:56 pm

Veritas wrote:The more I learn the less I would do to someone out of the hospital. Compressions only CPR, basic airway maneuvers, hold pressure to stop bleeding....probably little else.
Those three things you describe? Arguably the three most helpful things you could do for a person pre-hospital, and also the three things it would be most difficult to screw up. Doesn't take any fancy equipment and takes very little training. Interesting that as you personally gain knowledge / experience you're whittling down your out-of-hospital interventions to the most basic procedures. Care to share why?
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Re: you have it and carry it, do you know how to use it?

Post by Veritas » Wed Jul 17, 2013 1:52 am

DannusMaximus wrote:
Veritas wrote:The more I learn the less I would do to someone out of the hospital. Compressions only CPR, basic airway maneuvers, hold pressure to stop bleeding....probably little else.
Those three things you describe? Arguably the three most helpful things you could do for a person pre-hospital, and also the three things it would be most difficult to screw up. Doesn't take any fancy equipment and takes very little training. Interesting that as you personally gain knowledge / experience you're whittling down your out-of-hospital interventions to the most basic procedures. Care to share why?
Question asked, question answered. The easiest/simplest things do the best for people. All the fancy stuff can wait for the hospital, I don't think anyone is really going to get any benefit from me dropping a central line in them prehospital, lol. TQ argument aside, most bleeding can be stopped with pressure. Good compressions save lives, not ET tubes.

Since we are talking catastrophic stuff, mostly, the cause needs a hospital to reverse. Ex lap, cath lab, thrombectomy, tPA, etc etc is all hospital administered. Getting someone to the hospital faster is what saves lives. If it's not catastrophic, what do you need to do for them prehospital? Nothing. Just get them to someone who can evaluate them.


The c collar issue might be the only thing I'm not sure about. I don't carry one, and I don't think I would apply one to a stranger, but if I had concern for a c spine injury I would hold traction and wait for EMS, assuming they had pulses...

ETA: ....or I would just clear the c spine in the field, hahaha, blah blah blah scope of practice blah blah permanent death/injury blah blah
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Re: you have it and carry it, do you know how to use it?

Post by Jaeger » Wed Jul 17, 2013 2:12 am

Hospital may not always be an option.

May I ask what current standards suggest? Cutting too deeply can be a bad thing, but the little kit I have has a little metal flange on the scalpel to control depth and keep it very shallow. I probably wouldn't use it if I could get to a hospital, or call an ambulance, but I keep it in my BOB in case that isn't an option.

Lots of things I wouldn't try if everything was up and running, but many others I would if on my own and no way to call the cavalry.
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Re: you have it and carry it, do you know how to use it?

Post by DannusMaximus » Wed Jul 17, 2013 11:50 am

Jaeger wrote:Hospital may not always be an option.

May I ask what current standards suggest? Cutting too deeply can be a bad thing, but the little kit I have has a little metal flange on the scalpel to control depth and keep it very shallow. I probably wouldn't use it if I could get to a hospital, or call an ambulance, but I keep it in my BOB in case that isn't an option.

Lots of things I wouldn't try if everything was up and running, but many others I would if on my own and no way to call the cavalry.
We're talking about the snakebite thing, correct?

Here's why the cutting and sucking method doesn't work for most domestic poisonous snakes (or at least how it was explained to me many moons ago when I was working as a backpacking guide). A snake's fangs act like dual hypodermic needles. When the snake injects venom, it actually injects the venom, and a snake's fangs may be an inch or more long. Using common sense, do you think that you could suck out a substance that had been injected under pressure an inch or more into a person's muscle? Also, keep in mind that many snake bites will be 'dry bites' (no venom injected), and even an untreated venomous snake bite isn't very likely to kill a healthy adult. Using a razor blade to carve a 2" deep cut into a person's leg = far more harm than good.

Current standard is to immobilize the bitten extremity, treat for shock and get the person to a hospital. They used to treat putting a constriction band or TQ above the bite, but I don't think that's considered a useful thing to do any more.
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Re: you have it and carry it, do you know how to use it?

Post by Metallitera » Wed Jul 17, 2013 7:50 pm

DannusMaximus wrote:
Jaeger wrote:Hospital may not always be an option.

May I ask what current standards suggest? Cutting too deeply can be a bad thing, but the little kit I have has a little metal flange on the scalpel to control depth and keep it very shallow. I probably wouldn't use it if I could get to a hospital, or call an ambulance, but I keep it in my BOB in case that isn't an option.

Lots of things I wouldn't try if everything was up and running, but many others I would if on my own and no way to call the cavalry.
We're talking about the snakebite thing, correct?

Here's why the cutting and sucking method doesn't work for most domestic poisonous snakes (or at least how it was explained to me many moons ago when I was working as a backpacking guide). A snake's fangs act like dual hypodermic needles. When the snake injects venom, it actually injects the venom, and a snake's fangs may be an inch or more long. Using common sense, do you think that you could suck out a substance that had been injected under pressure an inch or more into a person's muscle? Also, keep in mind that many snake bites will be 'dry bites' (no venom injected), and even an untreated venomous snake bite isn't very likely to kill a healthy adult. Using a razor blade to carve a 2" deep cut into a person's leg = far more harm than good.

Current standard is to immobilize the bitten extremity, treat for shock and get the person to a hospital. They used to treat putting a constriction band or TQ above the bite, but I don't think that's considered a useful thing to do any more.
That's correct. IV, O2, monitor, transport, treat presenting symptoms.
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Re: you have it and carry it, do you know how to use it?

Post by Jaeger » Wed Jul 17, 2013 8:28 pm

Ok,I'll repeat myself. What if there's no hospital to go to, what do you then recommend?
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Re: you have it and carry it, do you know how to use it?

Post by DannusMaximus » Wed Jul 17, 2013 8:30 pm

Jaeger wrote:Ok,I'll repeat myself. What if there's no hospital to go to, what do you then recommend?
If there's no hospital then the person who is bitten is going to either:

A) Die
B) Be okay

Keep them comfortable, try to keep the bite from becoming infected, make sure they're drinking plenty of fluids. You'll know when A or B has occurred.
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Re: you have it and carry it, do you know how to use it?

Post by ineffableone » Wed Jul 17, 2013 9:16 pm

I think a lot of people when they first start out prepping get caught up in the acquisition of gear and all the cool neat things you can buy out there. As a prepper matures they start focusing on skills, and with those start realizing a lot of the gear is not needed. As a prepper continues, they often get into Bushcraftng, Homesteading, Primitive Skills, and other skill sets that tend to focus on self reliance and self sufficiency over the newest piece of gear. I think this is just a journey that preppers sort of need to take, and that not everyone even will make it all the way to Homesteading or Bushcrafting which is ok.

I have a pretty big med kit in my INCH pack, but most of it is not the specialty items it is just a lot of meds, and bandages, and alcohol wipes, and other very basic supplies. Just a lot more of them than a little PFK.

Now that said, way back when I first started seriously getting into prepping one of the first things I picked up was a giant med kit backpack that was filled with tons of crazy stuff. Including a blow up leg cast. LOL. While cool I would never bother to carry that heavy thing around. Over the years I cannibalized that med kit backpack removing all the useful stuff to fill different PFKs and to just use occasionally when I needed stuff.

I try to make sure every thing I carry is something I know how to use in at least the most basic of ways intended. But then with the amount of stuff in my INCH I don't have space or weight to spare for things I don't know how to use. There is still a bunch of stuff I want to put in my pack but don't have room to, so I am not going to waste space on stuff I don't know how to use.

Now if you have room and don't mind carrying it, carrying extra supplies for someone else who might know how to use the gear or carrying for the ability to barter with it when such supplies become rare could be understandable but honestly I would not. Maybe stocking such items in a closet sure but not in a pack where you have to hump around items that your not even going to use.
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Re: you have it and carry it, do you know how to use it?

Post by DrJack » Thu Jul 18, 2013 2:06 am

For snakebites in an austere environment.

Those rubber suction things you can put on the end of a 60ml syringe might do some good, or anything (other than your mouth) that can create a LOT of suction.

IV, immobilize, RICES, common-sense 1st aid kind of stuff.

In the us you're only going to find 2 kinds of venom, neurotoxin - treat as a drug OD. Maintaining airway and respirations until the venom wears off will be paramount. Anti-venoms are very effective but....yeah, good luck with that.

Pit vipers have a necrotic effect. Frequent dressing changes and debridement will be important. These are a nightmare in the field for a handful of reasons, but the main one is the drain on resources.
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Re: you have it and carry it, do you know how to use it?

Post by IANMCDEVITT » Thu Jul 18, 2013 11:04 am

Dans right. The patient will either die. Or be ok......there are a lot of dry bites out there so keep calm.

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