Tag Archives: SAR

More (well, some!) evidence to back up hemostatic dressings.

Unlike tourniquets and TXA, both of which have  a robust and growing body of literature to support their use, hemostatic dressings such as Quickclot, Combat Gauze, WoundStat etc have had limited published field experience to support their use.
EMS1 on Hemostatics

Blowout Kit

Blowout Kit

 

In US DoD studies, Combat Gauze was chosen as the agent of choice, but that decision was largely based on animal models, which are great, but provide limited value and don’t always translate well to clinical practice. Some suggest they are about 30% more effective than good wound packing with regular materials.

But here’s a study from Israel that supports their effectiveness in the field about 90% of the time!  Keep in mind that this is a small study, but it’s pretty reflective of this authors experience with hemostatics in the military setting, includes extremity and junctional injuries, and acknowledges where there are gaps in the data.

Hemostatic agents in their current form seem to be a potent addition to the hemorrhage control arsenal, and have lots of cheerleaders in the military health care community, but are not a silver bullet that will stop every source of bleeding.  Here’s hoping one of the many gels, foams, CO2 delivered TXA interventions is THE answer to the bleeding patient!

Tactical & Medical Decision Making

Not all tactical tools are tangible, some are cognitive.

This runs to 20 pages including bibliography, but it describes several essential skills that any emergency medical provider needs to have.

The OODA loop is something that we use in the classroom in order to give students a model of constant reevaluation of the patient condition, the conditions they’re operating under, the courses of action open to them, and the most efficient treatment, movement, or evac options.

To truly master Emergency Medicine, much less the tactical environment, you need to understand the OODA Loop. Yours should be tight and fast. But sometimes you need a far quicker response, and only training and simulation can build instant RPD through what this author calls tactical decision games (TDG) or decision making exercises (DME).

This is the core of current EMS education.

Simulation creates an experiential learning environment where the students can develop that mental database of Action : Response for everything from snoring respiration : jaw thrust or massive extremity bleed : tourniquet intuitively, not just academically. Where they can find themselves suddenly on the ground applying a tourniquet to their own leg intuitively knowing that placing the tourniquet chasis This way instead of that way will give them a better initial pull on the strap.  The same repetition that has someone doing a tap, rack, and engage on one stoppage but a reload just from the feel of the recoil.  That’s recognition primed decision making.

Klein says “…Their experience let them identify a reasonable reaction as the first one they
considered, so they did not bother thinking of others. They were not being perverse. They
were being skillful. We now call this strategy recognition-primed decision making.”2

Always with the paperwork, or get a textbook early if you’re taking ITLS!

We’ve wrapped our NSR ITLS Provider Course, and it’s all over even the paperwork.  ITLS is a great organization to work with, and they try hard to make the administration pretty seamless.

I sent it off yesterday morning, got a reply yesterday afternoon, and someone at Int’l is hard at work in the CMS getting our cards ready for printing a distribution to our friends at North Shore Rescue.

There’s the course roster, which we try hard to get done before hand.  The practical evaluation results, the student info forms, and the written “celebration of learning” answer forms all get scanned, and all the data goes into ITLS Course Management System.  We also keep copies of every course feedback form in our database; it’s nice to make sure we’re not making the same mistake three or four times!

The number one comment that we get is some variation on “I wish I’d gotten the textbook sooner!” and this has been consistent throughout the 15 years I’ve been teaching ITLS.  There’s a huge amount of info crammed into a 2-day provider course, and the more thoroughly you do a pre-read, the better your experience in the course will be!

Yesterday was a good day

Devon, Ian and I spent the day with 10 NSR members working our way through day one of ITLS.  We covered the ITLS Primary Survey and Ongoing Exam. Airway management, hemorrhage control, chest and abdominal injuries.

One of the best things we do in ITLS is almost insidious.  We get people talking the same language.  We take students with qualifications ranging from Wilderness First Aid through to EMR (in this case) who have been trained by the Red Cross, St John’s, JIBC, AET and other training providers, and we get them all using the same terminology.  This means that when teams are communicating and collaborating on scene, the transfer of information is fast, efficient, and leads to shorter scene times and better care.

North Shore Rescue 2 TK

We also try to introduce new equipment, procedures, and techniques to our classes. Comfortable with a CAT? Let’s look at a SOFT too.  Use the SAM Pelvic Sling? Have you looked at the TPOD for your agency?  Asherman Seals work, but how about Hyfin?

We don’t expect our clientele to stay on top of the latest science behind EMS.  That’s what we do.

Our second NSR course!

Tomorrow we start our second contract course, another ITLS for North Shore Rescue.  We’d originally planned this to be our ITLS Site Visit for sign-off as a ITLS Training Centre, but due to scheduling conflicts we won’t be getting our visit done this time around.

Ian’s packing up a his jumpbags, AV kit, and airway mannequins. I’ve got a briefcase full of admin and paperwork, and I’m answering questions from students already. Devon’s looking over his material.

Faculty at the CF SAR School in Comox, BC practice ITLS Rapid Trauma Surveys.

Faculty at the CF SAR School in Comox, BC practice ITLS Rapid Trauma Surveys.

Working with SAR groups is always a bit different than working with EMS or other health care providers.  Medicine is only a small part of the mission, whether you’re a CF SARTECH or a community volunteer, and amidst all of the other critical skills that they work hard to keep sharp, the more difficult it can be to keep the finer nuances of patient care.

Regular review of the material is great, but team based training helps to ensure that the collective knowledge of the team is maintained.  Not every team member needs to be an expert prehospital care provider; every team member does need to know what the goals and fundamentals of care are. That’s what makes a team efficient and effective, that they’re all working towards the same greater goal.

One of the great things about ITLS is it’s focus on a team based approach to caring for the HMMVW Amb on the flight line, KAFinjured.  Concurrent activity and clearly defined and communicated goals keeps scene times to a minimum and allows for superb care even under very austere conditions.

 

 

ITLS site visit

We’re at T-7 days until our second ITLS course for North Shore Rescue.  This course will also mark our site visit for our sign-off as an ITLS Training Centre.  Ian, Devon, and I are all divying up tasks and figuring out a teaching schedules.

We’ve done this before, there have been years where I’ve taught more than one course per week, but the added pressure of our certification as an ITLS Training Centre is putting a certain stress on us.  North Shore Rescue is always a great group to work with!