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austeremedforum.com • Caveman Critical Care
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Caveman Critical Care

Posted: Sat Oct 07, 2017 1:26 am
by james huffaker
The goings on in Vegas, Lord have mercy on their souls, I walk around with a CAT in a hard case, a scissors pouch (EMT shears, window punch, straight/curved Kelly/mosquito forceps, and an N-SAR), an OLD Spidy folding dive knife (fully serrated/blunt point), a BOK and a glove pouch, and I contend, that security would not let me in so festooned. I don't care if you have a reasonable representation of an ambulance in your bag, you ain't getting in with it. I'm sure there are those with the proper creds (18-D, PJ, SARK, IDC/M) that could, but for the rest of us commoners, we got nothing to work with, or do we?

Go back a few years before BOKs, what were the recommendations for the gutter management of trauma?
-Pinning tongues to the lower lip, clothing as wound packing, dressings, straps to hold splinting material in place, tourniquets, cigarette package wrappers or plastic cards as chest seals...cricothyrotomy, chest tube, if you've got some fish tank tubing and some water bottles (water seal) or conversely, open finger thorocostomies to manage a tension pneumothorax or pneumo or hemo thorax. I think cloth works better then belts as tourniquets, can get them tighter, but what of a windlass? Junctional tourniquets are hard to find, but water bottles are ubiquituous where ever people gather, when properly applied, make reasonable junctional tourniquets. First though is finding or making something to cut with, be it broken glass, a sharp edge on a tin or aluminum can sheet metal or plastic (or if somebody managed to get a sharp in), sharp enough to cut clothes and skin.

To my knowledge, there are no classes that teach vetted, evidence based, best practices in this area, so it falls on us to spend the time with a willing co-conspirator(s), to run as many scenarios as we can imagine, and figure out what works and what won't there by vetting our own "best practices". In Vegas, 500 casualties, you ain't triaging. Start where you are, and move. Caveman Critical Care Thoughts?

Regards, Jim