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I just re-certified in first aid, CPR and AED last week. Our instructor was a retired Portland firefighter/paramedic with 30 years on the job. Regarding the use of tourniquets, he said they were a no no in almost every case. He also noted in 30 years he used them maybe 2-3 times tops, and those were limited to total amputations of a limb. For major arterial bleeding he said the best thing is to get gauze, cloth, etc. and get it covering the wound with direct pressure, then use the pressure points on the femoral artery for the leg (right next to the groin) or the radial artery for the arm (just below and to the inside of the bicep). He said you'll control the bleeding long enough to get help. He also said you'll protect them from losing a limb if you do it that way. He said if you use a tourniquet for anything but an amputation, be prepared for them to lose the limb immediately below the spot where it was applied.

I've heard different stories regarding tourniquets in various training classes over the years, even have been shown how to use them, but I'll tend to take the word/training of someone that has actually had to use them on the job. With that in mind, I'll take his advice and avoid tourniquet use unless absolutely necessary.
 
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Doesn't mean you can't be sued.
Just means they may not win.
How much money will you be out?

I had a co-worker that was a volunteer firefighter in LA, Cali his Supr told him to never do any first aid if not working for the dept. call 911 and that's it.

Of course that's commifornia and they may have different laws, different rules for volunteers who knows.

Yes, they could attempt a lawsuit, but you should be protected, should you meet the requirements of the law - which means training that is current and given by someone recognized by the state to provide that training. It's within 3 years for first aid, 1 year for CPR. Let that training lapse, and you could be liable.

Here is a link to the Oregon statute on the Good Samaritan law:

ORS 30.800 - Liability for emergency medical assistance - 2015 Oregon Revised Statutes

What's interesting is that I read another document about this that states you are potentially liable if you try to render assistance above and beyond your training (say try to perform some kind of surgical procedure) or if you begin to render assistance, then stop and leave before help arrives.

But as far as the potential for liability, many of us take that risk every day by carrying a gun. Should we use it in self defense, it is very likely we'll face at least a civil suit. So, either way, our actions could be costly. In this case those, I think it's far more likely that any of us will find ourselves needing to render some kind of first aid over ever pulling our guns in self defense.

So if you're planning on giving aid to someone, be sure your First Aid and CPR training are not only up to date, but keep those cards on you.
 
Farm truck . . . Did you have a gun on board? (Don't answer that)
SO . . . you gambled that you wouldn't be arrested and charged with kidnappinig!?!?!?!?

In the immortal words of Elmer Fudd, "Be vewwy vewwy careful!"

Sheldon
I use an ammo can for my first aid kit.
add betadine, neosporin, asprin. Kling roll bandage, 4X4 Sponges. 4" ace, 2 triangular bandages (slings) various band-aids. bandage scissors. Maybe a bee sting kit or benadryl.
small bottles of water. Rescue blanket. an irrigation syringe... 50cc. Your doctor may give you one.
 
Last night I had dropped my son's buddy off at his house and on my way back home when I came across I bicyclist who was getting up from a nasty spill. He had been riding on the paved trail near my house and when he went to cross the gravel road apparently he got into some of the deeper gravel and went down pretty hard. His left shoulder took the brunt of the hit along with some pretty good road rash on the back side of his arm. He was a little stunned and I asked where his car was. Turns out he was about 7 miles away so I insisted that I take him to his vehicle. I was in the farm truck and so I wasn't too worried about the blood which did end up on the seat but I felt a little unprepared as I didn't have anything to help clean up or patch the damage.

I may make one up as most of the ones I view online seem to be about how many pieces of cheap stuff they can claim are in the kit.

I'm looking for ideas from this smart group… and go!
Oh, add rubber gloves to your ammo can first aid kit
 
Yes, they could attempt a lawsuit, but you should be protected, should you meet the requirements of the law - which means training that is current and given by someone recognized by the state to provide that training. It's within 3 years for first aid, 1 year for CPR. Let that training lapse, and you could be liable.

Here is a link to the Oregon statute on the Good Samaritan law:

ORS 30.800 - Liability for emergency medical assistance - 2015 Oregon Revised Statutes

What's interesting is that I read another document about this that states you are potentially liable if you try to render assistance above and beyond your training (say try to perform some kind of surgical procedure) or if you begin to render assistance, then stop and leave before help arrives.

But as far as the potential for liability, many of us take that risk every day by carrying a gun. Should we use it in self defense, it is very likely we'll face at least a civil suit. So, either way, our actions could be costly. In this case those, I think it's far more likely that any of us will find ourselves needing to render some kind of first aid over ever pulling our guns in self defense.

So if you're planning on giving aid to someone, be sure your First Aid and CPR training are not only up to date, but keep those cards on you.

CPR, FORGET THE BREATHS, JUST KEEP UP WITH CHEST COMPRESSIONS.
 
I'm looking for ideas from this smart group… and go!

In my experience, there are very few "go to" kits. Kits generally come in two kinds: Too much and Too little.

In general, for "most" traumatic injuries, what I want is a package of occlusive dressings (petrolatinum gauze, aka gauze covered in vasoline) it's great for scrapes and burns as it will not stick to the wound and provides a good barrier to keep dirt and infection out.

If you're dealing with someone with serious deep cuts, you want a selection of kerlix rollers, simply stuff them into the wound, and cover that with occlusive dressings.

This is pretty much all the untrained can really use in a trauma situation, and in most cases, this is going to be what you're using when you're taking someone to the hospital. You could carry a CPR shield, however the current protocol for CPR is chest compression only. So why would you be giving rescue breaths? If you have a heartbeat but no airway, call EMS immediately, and if possible try to open the airway by lifting the chin. If you suspect a spinal cord injury (like a guy falling off a bike) you may really be taking your liability into your hands.

If you want to add some more stuff to your kit, a set of berman airways isn't too bad, and the whole kit is like $10 from amazon. Pick the one that's the same length as the corner of the mouth to the ear, shove it in sideways, and then twist it. These are obviously not to be used on conscious people. The other option is a NP airway, these are usually rubber and go up the nose.

I would add a few pairs of gloves, to this kit, and it's pretty much done. If you really want to go above and beyond, get a quart of sterile saline (bottle of eye-wash) this is the best way to clean out a large scrape or road rash if you're dealing with a conscious individual who can render self aid.

For my personal kit, it's a bit more involved, but it's made to treat more mundane stuff... heat prostration, headaches, alergic reactions, and all other kind of stuff that's strictly for family and friends.
 
In my experience, there are very few "go to" kits. Kits generally come in two kinds: Too much and Too little.

In general, for "most" traumatic injuries, what I want is a package of occlusive dressings (petrolatinum gauze, aka gauze covered in vasoline) it's great for scrapes and burns as it will not stick to the wound and provides a good barrier to keep dirt and infection out.

If you're dealing with someone with serious deep cuts, you want a selection of kerlix rollers, simply stuff them into the wound, and cover that with occlusive dressings.

This is pretty much all the untrained can really use in a trauma situation, and in most cases, this is going to be what you're using when you're taking someone to the hospital. You could carry a CPR shield, however the current protocol for CPR is chest compression only. So why would you be giving rescue breaths? If you have a heartbeat but no airway, call EMS immediately, and if possible try to open the airway by lifting the chin. If you suspect a spinal cord injury (like a guy falling off a bike) you may really be taking your liability into your hands.

If you want to add some more stuff to your kit, a set of berman airways isn't too bad, and the whole kit is like $10 from amazon. Pick the one that's the same length as the corner of the mouth to the ear, shove it in sideways, and then twist it. These are obviously not to be used on conscious people. The other option is a NP airway, these are usually rubber and go up the nose.

I would add a few pairs of gloves, to this kit, and it's pretty much done. If you really want to go above and beyond, get a quart of sterile saline (bottle of eye-wash) this is the best way to clean out a large scrape or road rash if you're dealing with a conscious individual who can render self aid.

For my personal kit, it's a bit more involved, but it's made to treat more mundane stuff... heat prostration, headaches, alergic reactions, and all other kind of stuff that's strictly for family and friends.
Ok, stop. I can't let dangerous, and incorrect medical advice be passed along like that. Not here.

Firstly, PETROLATUM should never be put onto a burn, ever. It's an insulator, and holds in the heat. For burns: stop the burning process by flushing the area with water, cover with a DRY breathable dressing, loosely. Seek medical care. You want to know what petrolatum soaked gauze is good for? Ticks.

Second: If you don't have the means to deliver oxygen to a patient, don't shove ANY kind of airway device into their mouth, or nose. Head tilt, chin lift is advised because it minimizes the risk of further C-spine injury. Moving the patient's head to open airway is advised in case they recover breaths on their own. If you are rendering care to someone, and aren't trying to perform surgery on them, the Good Samaritan law protects you from liability. Start shoving in an NPA to a PT with a fractured cribiform plate, then you're looking at a lawsuit.

I was a medic on active duty for eight years (2003-2011), medical rescue for Maricopa Sheriffs office (2006-2008), taught Self-Aid/Buddy Care to hundreds of active duty soldiers, contractors, and civilians, and was involved in the pilot program for developing continuous chest compressions through the American Heart Association. Bad first aid advice is a pet peeve.
 
I always carry a SWAT-T tourniquet with me. It can be used as a pressure dressing if stopping circulation is not required SWAT-T™ - Stretch Wrap And Tuck Tourniquet

Excellent video, thanks for sharing! A tourniquet doesn't mean the limb is for sure a goner, as long as you use one with a WIDE cross section. On a deep arterial bleed, the ruptured vessel has systolic, and diastolic pressure of zero. Meaning it can't resist a force applied to it. All the other vessels around it that are in tact can resist pressure from a pressure bandage, or tourniquet, and can continue feeding oxygenated blood past the injury to the limb keeping it alive for up to eight hours (as of now that's the window for surgeons to recover a limb after tourniquet application). That's why just enough pressure should be applied to make the bleeding stop, and no further. I've used dozens of CATs on deployment, and they work great. I carry the SWAT-T because it's versatile (splinting, pressure bandage, AND tourniquet), it's $10, and it fits in my pocket.
Side note: if I carry a gun, I carry an IFAK; for me or them victims, not them.
The rat tourniquet, 550 cord, zipties, etc... Anything that's thin will apply a greater force over a smaller area which makes it easy to apply too much force. i.e. The limb will likely have to be amputated.
 
Excellent video, thanks for sharing! A tourniquet doesn't mean the limb is for sure a goner, as long as you use one with a WIDE cross section. On a deep arterial bleed, the ruptured vessel has systolic, and diastolic pressure of zero. Meaning it can't resist a force applied to it. All the other vessels around it that are in tact can resist pressure from a pressure bandage, or tourniquet, and can continue feeding oxygenated blood past the injury to the limb keeping it alive for up to eight hours (as of now that's the window for surgeons to recover a limb after tourniquet application). That's why just enough pressure should be applied to make the bleeding stop, and no further. I've used dozens of CATs on deployment, and they work great. I carry the SWAT-T because it's versatile (splinting, pressure bandage, AND tourniquet), it's $10, and it fits in my pocket.
Side note: if I carry a gun, I carry an IFAK; for me or them victims, not them.
The rat tourniquet, 550 cord, zipties, etc... Anything that's thin will apply a greater force over a smaller area which makes it easy to apply too much force. i.e. The limb will likely have to be amputated.

You know, it's really frustrating to get different advice from different folks - even those that have extensive experience. I posted recently that I just renewed my First Aid, CPR/AED. Our instructor was a retired firefighter/paramedic with 20+ years experience. His direction on tourniquets was never, ever use them. Your advice sounds like a much better option - something that could allow their use if applied properly. Regarding CPR, he was against the 'compression only' method stating that his experience was that compression only is fine, up to about 4 minutes, then rescue breathing becomes necessary if help hasn't arrived.

I appreciate the advice of those with far more experience and training than many of us here. But it does get tough to manage differing views from equally qualified folks. In the last two weeks, I've read and been given sometimes contradictory advice/training. I wonder, how do those of us without the benefit of years of experience and training sort the advice out?

At this point, if I hear "don't ever do this..." I am tending to make a mental note to avoid doing that thing. With respect to CPR, seems compression only vs. compression + rescue breaths seems to have valid support on both sides, so I'll probably stick with compression only, so long as they have a good airway. As for the rest, I'll be limiting any potential care I provide to training I've received unless help is hours away and they will die otherwise - at that point, it may be worth trying something more, it's really all we can do.

Thanks for weighing in, it certainly is appreciated.
 
@etrain16

When someone stops breathing they have approximately eight minutes worth of oxygenated blood in their body. The key is to get that blood moving to keep the brain perfused. When you give 30 compressions you bring the systolic blood pressure up to about 60mmHg, but when you stop to give breaths the pressure drops to maybe 20mmHg. Start compressions again, and you may get up to 80, but then you fall back down to 40 to give another two breaths. You keep stair-stepping like that until rescuers arrive and start effective CPR with a bag-valve mask and supplemental oxygen.

Here's the issue with one person CPR of 30 compressions, two breaths: when you fill the patient's lungs with air you perfuse only the blood sitting in the capillary beds of the alveoli. It's much, much less efficient than when the blood is moving along with the airflow. That is why the standard changed. If you are ALONE, the best chance to keep someone alive is to do compressions. However, if you have another person available, and want to do what medics do, then give breaths DURING compressions. Good Samaritan law still protects you for doing CPR the old way, but with a slight twist, you can keep someone going long wnough for rescuers to arrive.

I have experience, yes, but I also care about the science, and research of today. Old medics stick to what they were taught. They're performing a task the way it was shown to them. You have to keep your training up to date so archaic medical techniques don't cost life and limb the way they used to.
 
@etrain16

When someone stops breathing they have approximately eight minutes worth of oxygenated blood in their body. The key is to get that blood moving to keep the brain perfused. When you give 30 compressions you bring the systolic blood pressure up to about 60mmHg, but when you stop to give breaths the pressure drops to maybe 20mmHg. Start compressions again, and you may get up to 80, but then you fall back down to 40 to give another two breaths. You keep stair-stepping like that until rescuers arrive and start effective CPR with a bag-valve mask and supplemental oxygen.

Here's the issue with one person CPR of 30 compressions, two breaths: when you fill the patient's lungs with air you perfuse only the blood sitting in the capillary beds of the alveoli. It's much, much less efficient than when the blood is moving along with the airflow. That is why the standard changed. If you are ALONE, the best chance to keep someone alive is to do compressions. However, if you have another person available, and want to do what medics do, then give breaths DURING compressions. Good Samaritan law still protects you for doing CPR the old way, but with a slight twist, you can keep someone going long wnough for rescuers to arrive.

I have experience, yes, but I also care about the science, and research of today. Old medics stick to what they were taught. They're performing a task the way it was shown to them. You have to keep your training up to date so archaic medical techniques don't cost life and limb the way they used to.

Thanks for the additional clarification :)
 
Ok, stop. I can't let dangerous, and incorrect medical advice be passed along like that. Not here.

Firstly, PETROLATUM should never be put onto a burn, ever. It's an insulator, and holds in the heat. For burns: stop the burning process by flushing the area with water, cover with a DRY breathable dressing, loosely. Seek medical care. You want to know what petrolatum soaked gauze is good for? Ticks.

Second: If you don't have the means to deliver oxygen to a patient, don't shove ANY kind of airway device into their mouth, or nose. Head tilt, chin lift is advised because it minimizes the risk of further C-spine injury. Moving the patient's head to open airway is advised in case they recover breaths on their own. If you are rendering care to someone, and aren't trying to perform surgery on them, the Good Samaritan law protects you from liability. Start shoving in an NPA to a PT with a fractured cribiform plate, then you're looking at a lawsuit.

I was a medic on active duty for eight years (2003-2011), medical rescue for Maricopa Sheriffs office (2006-2008), taught Self-Aid/Buddy Care to hundreds of active duty soldiers, contractors, and civilians, and was involved in the pilot program for developing continuous chest compressions through the American Heart Association. Bad first aid advice is a pet peeve.

I should probably add a few things, since maybe I didn't apply the rigor that some people will require.

PG dressings and burns: you don't actually use the PG in the wound, you use the foil package it comes in to keep stuff out of the injury. This is done in wilderness first aid, when you may have to hike someone a few miles to even get them to where they can be picked up by a chopper.

Head-tilt-chin-lift is something you need to be INSANELY careful about when there is any kind of suspected C-Spine injury. In most cases of airway problems, the tongue is the problem, this is why I prefer the berman airways (OP, not NP). In either case, you do not need supplementary O2, but a BVM may be required if they do not start breathing on their own.

In all cases, if someone has an airway compromise your first act should be to make sure help is on the way.
 
Improvised occlusive dressing for sucking chest wounds.
The foil wrapper it comes in may be a better choice. Either way, keeping something small over a profuse bleed like that is difficult. We always covered the entry/exit fully, and got a 14ga angiocatheter in them quickly. Regardless if it was tension-pneumo, tension-hemo, or a combination. Reinflating the compressed lung was priority en route to advanced care.

Petrolatum gauze doesn't excite me.
 
The foil wrapper it comes in may be a better choice. Either way, keeping something small over a profuse bleed like that is difficult. We always covered the entry/exit fully, and got a 14ga angiocatheter in them quickly. Regardless if it was tension-pneumo, tension-hemo, or a combination. Reinflating the compressed lung was priority en route to advanced care.

Petrolatum gauze doesn't excite me.

I totally get it, but it's cheap, easily available through channels of commerce (most want an Rx for needles) is shelf stable at least until it's expiration date (often longer, but the package often comes delaminated after it's expiration). While the needle has a great possibility to save a life, it's a more powerful tool that can just as easily take one if used improperly.
 
Great thread- lots of good information in here! When I was in Boy Scouts we were told to never apply a tourniquet except in a dire emergency where losing the limb was most likely going to happen anyway. I have heard conventional wisdom on tourniquets change now, though, and many friends coming back from the Middle East have told me how modern tourniquets applied properly have saved life AND limb.
Anyway, my suggested addition to a first aid kit is some unwaxed dental floss, thin sewing needles, and a tube of that topical novacaine you can buy in drugstores in either the first aid or tooth care aisle. I was camping on a completely isolated, remote island in the Mentawais when my surfing buddy cut himself up pretty bad on the reef. Unfortunately we had no butterfly bandages or superglue, and I think one of the cuts was too deep for them anyway. I had to use my wetsuit repair kit (unwaxed floss and a needle) to close that wound (after thoroughly cleaning it, sterilizing the "equipment", and dosing my buddy with a few percocets and some cheap vodka).
After that unpleasant experience I've added an emergency suture kit (and the knowledge of how to use it) to my first aid pouch. As someone mentioned earlier in this thread, practice on leather first! And learn how to tie a surgeons knot!
 
Doesn't mean you can't be sued.
Just means they may not win.
How much money will you be out?

I had a co-worker that was a volunteer firefighter in LA, Cali his Supr told him to never do any first aid if not working for the dept. call 911 and that's it.

Of course that's commifornia and they may have different laws, different rules for volunteers who knows.

Not really that different... because he was a volunteer firefighter he is considered a "Professional" which means he needs to precisely conform to the standards and practices of care required as such. Even if all he has is a juicebox and a hankerchief.

Despite taking and passing the EMT course, and several dozen other courses (wilderness first responder) I never went for the certification exams, first because this would limit me to the scope of practice of an EMT-B or a WFR, second because I never have any interest in working as either one, and third because of the possibility of liability.

If some dummie eats rock doing a cliff jump and I drag them out of the water so they don't drown, and get out my radio and call SAR who picks them up in a helo, they later find out they're paralyzed from the neck down, the chances of that coming back on me are sufficiently low. where if I was an "EMS professional" and I'm at the same swimming hole on my day off, I might be in a world of crap. I know this sounds like a strange distortion of how things should work, but it's more a sad commentary on how litigious we can be as a society.

I'm more than willing to do what I can to keep someone from dying near me, but the threat of lawsuits pushes many towards a "not my circus not my monkeys" approach to life. For the most part, staying friendly and familiar with the local SAR group, and others who are nice enough to share radio frequencies, gives me the best tool to help someone quickly: a way to get them the help they need.
 

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