Custom Blow out kit

[Lowdown3]

Ok, within reason, let's make suggestions as to what to put in a blow out kit. Let's keep in mind SIZE of most pouches that blow out kits go in, the idea is not to have a portable trauma ward in a small pouch!

I'm thinking:

CAT tourniquet or SOF-TTW
Israeli bandage
Quickclot Combat gauze z fold type
H and H compressed gauze- 1 or 2
EMT shears
OPA
NPA
Needle decompression needle
Chest seal, preferably Hyfin or similar.

Thoughts?

[Dennis W]

That's about the same as what I have in mine, minus the OPA.

[Patriotic Sheepdog]

My overall thoughts on BOK...
This kit is for you. It is what you would use to apply self care or allow someone on your team to apply care to you for penetrating trauma/rapid severe hemorrhaging. I don't want to be digging into my personal BOK to get supplies for someone else. I will get into my IFAK for extra supplies for someone else, but my BOK is for me. If you just got shot, there is a chance that the shooter is still out there and I may need my BOK supplies. They don't need to be laid out on the ground treating someone else. Also, your BOK needs to be accessible from either hand...AND in various positions. Practice lying on your back, stomach, and each side. Stay low because if you sit up you may catch another round. I have my students practice this in the AC3 classes I teach. A couple members on here have taken this class and can attest to what I put them through.

Now, my thoughts on BOK contents. LD3 you mentioned small BOK, so I am assuming something like the HSGI Bleeder pouch. If you have something larger, then you may be able to fit more into it. Again, I use my BOK for one purpose (stated above) and it is not my IFAK or my AFAK I carry for my team. My team knows MY BOK is for me not them. They need to supply and make their own BOK. I won't steal from my BOK to treat them, however, I will take from my AFAK for them but that will take me a few more seconds to get to, so their BOK better be accessible and I better know where they carry it. Having a standard location that all team members carry their BOK may make it easier to locate in an emergency.

1. I don't like TQs IN a pouch. It needs to be rapidly accessible with either hand. Opening a pouch is just one more step that can take costly seconds.

2. Izzy and Combat gauze. I don't think having that extra H&H in a BOK is needed if you have the Izzy. Have the H&H in the FAK. If you have room in your kit then okay.

3. NPA will work for that semi conscious patient with a gag reflex. The BOK is for you, so do you want someone shoving a OPA down your throat if you have a gag reflex? Not to say that a NPA would feel better, but if I am conscious enough I will tell them not to drop an airway...yet. You do have some jelly with that NPA....(although your saliva can work in a pinch if your rescuer knows this trick, if not you may be getting a dry NPA shoved into your nare....remember this is for you)

4. Chest seal...your preference. In my BOK I have several vaseline gauze pads 3"x9" which are slim and can do the trick of stopping the air entering through the wound. If the wound is sealed quick enough you may...and thats a big may, not need a needle decompression. I keep my Bolen/Halo/Ascherman/Hyfin in my IFAK (which is pretty well accessible with either hand). I just don't like folding my commercial seals as I am not sure if that will cause loss of effectiveness is it sticking. I know if I get shot in the chest, and I am physically able, I can get the vaseline gauze on and apply pressure to stop the airleak and slow/stop the hemorrhage.

5. Needle is great to have, but does it need to go into the BOK? Having it in your BOK can make it possibly more accessible, however will the rescuer that comes to your aid know how to use it? If not, you may die of a poorly placed needle and could have lived with the GSW that he didn't treat because he THOUGHT you needed decompression. It most likely will not be needed immediately which is why I carry it in my IFAK/AFAK. Another thought, will you be using this on yourself? Maybe, but it is tricky enough doing this procedure on someone else, but on yourself it will be much harder.

Just a few of my thoughts...YMMV

[Rmplstlskn]

Sheepdog, you mention having both a BOK and IFAK handy. Do you carry BOTH of them on your battle/range gear? Maybe because you are a medical-trained guy you pull that additional burden? But like you said, if someone is untrained, using a needle can cause more harm than good...

I have gone through many versions of a BOK, and they all started big and have gotten smaller, as what I would LIKE to have in it is bulky and interferes with something, like going prone, or with my weapon sling, etc... So I now carry MINIMAL stuff, but I always think I am too minimal.

I do not carry a IFAK on my web gear, but I do have it in or on my 3-day backpack that goes with my web gear, able to be dropped if I need more mobility, dropping my IFAK along with it, leaving only a BOK on my chest rig..

Look forward to seeing others BOK supplies...

Rmpl

[Patriotic Sheepdog]

Sheepdog, you mention having both a BOK and IFAK handy. Do you carry BOTH of them on your battle/range gear? Yes, I carry a BOK with a TQ on the side of the BOK. BOK is attached to my CR. My second TQ is on my BB. My IFAK/AFAK is on my BB. My set up is like this in case i need to drop CR and hide rifle (like E&E and out of ammo). I will have at least one TQ available, with at least a IFAK. Maybe because you are a medical-trained guy you pull that additional burden? I guess so, my patrol pack has additional med gear plus my minimal personal gear. It also has my PPP (personal pill pack) for advil, allergies, antibiotics, etc. But like you said, if someone is untrained, using a needle can cause more harm than good...

I have gone through many versions of a BOK (me too), and they all started big and have gotten smaller, as what I would LIKE to have in it is bulky and interferes with something, like going prone, or with my weapon sling, etc... So I now carry MINIMAL stuff, but I always think I am too minimal.

I do not carry a IFAK on my web gear, but I do have it in or on my 3-day backpack that goes with my web gear, able to be dropped if I need more mobility, dropping my IFAK along with it, leaving only a BOK on my chest rig.. problem with this is if you just need a small bandage you will need to use something from your BOK which likely is a large bandage. then you have exhausted that large bandage until you can resupply from your pack. my IFAK/AFAK is on my BB. I carry (from my left to right) on my BB a TQ, double pistol mag carrier, a double rifle mag pouch, IFAK/AFAK, canteen, pistol and depending on mission a small E&E pouch.

Look forward to seeing others BOK supplies...

Rmpl

My comments above in red...

[protus]

What i carry.

On my rig.
Left and right sides oppsite my mags(left and right sides) Ride an CAT and izzy. Fast back to action self aid.
On my belt..
Thrid CAT on my strong side .see above for use.
Small of back is a tear away ifak. This is the grab and work on me kit. By me or team member.
Another CAT
Hh gauze
Izzy
Petro gauze pads
Halo/asherman
Opa/npa
Needle
Shears
Qc gauze
Hemostats
Pen light
Chem light
Majic marker

Pack will ride the ouchy boo boo kit and extra bleeder stuff (4+4s ..izzys...gauze...ace wrap etc ).

This is off the top of my head...i may have missed a item or two.

[protus]

I think also to calrify on my end.
Whats on my chest rig is what i grab for me. OHHH NOEZ I GOT CLIPPED....i grab one of two of the CATs and apply..stay in the fight..alive.
Whats on my belt. Is a continuation of that.
Well shucks protus...you got clipped thru both legs and your arm...
Out comes that thrid CAT or i tear off the bigger kit to self aid or for a team mate to apply.

My immediate grab stuff is just that. Tq..stuff and wrap...return fire.

I think if you had to have one small kit..say on yiur rig only and had limited real estate id go...
TQ -CAT or SOFT
Izzy
Qc combat quaze
Shears

Thats all youd need for that instant self aid.
Of course..none of us wiuld go that bare bones...(insert decomp...asherman...HH gauze...exrta tq...etc etc ) lol

[Lowdown3]

Well shucks protus...you got clipped thru both legs and your arm...

It's just a flesh wound!!!

[Rmplstlskn]

OHHH NOEZ I GOT CLIPPED....i grab one of two of the CATs and apply..stay in the fight..alive.
Whats on my belt. Is a continuation of that.
Well shucks protus...you got clipped thru both legs and your arm...
Out comes that thrid CAT or i tear off the bigger kit to self aid or for a team mate to apply.

This may be where my "I am NOT a medical person, just a dude who took some classes" comes to play, but my understanding of CAT (tourniquets) is that they are ONLY used for gushers, where an artery or other major blood vessel is pumping your life blood out, NOT for just a FLESH wound, as nasty as that may be and with some heavy bleeding (but not spurting). For a NON-SPURTER flesh wound, my understanding is that you would use something like an Israeli ABD pressure bandage or the QuickClot pressure wrap to put PRESSURE on the wound to stop the bleeding, not cut off the blood flow to your whole extremity (tourniquet).

Just want to make sure people reading all this properly understand things and don't think the CAT is their main thing to grab...

Rmpl

[Rmplstlskn]

problem with this is if you just need a small bandage you will need to use something from your BOK which likely is a large bandage. then you have exhausted that large bandage until you can resupply from your pack.

I didn't mention that I have small bandage boo-boo items in my admin pouch on my chest rig.

Rmpl

[Patriotic Sheepdog]

This may be where my "I am NOT a medical person, just a dude who took some classes" comes to play, but my understanding of CAT (tourniquets) is that they are ONLY used for gushers, where an artery or other major blood vessel is pumping your life blood out, NOT for just a FLESH wound, as nasty as that may be and with some heavy bleeding (but not spurting). For a NON-SPURTER flesh wound, my understanding is that you would use something like an Israeli ABD pressure bandage or the QuickClot pressure wrap to put PRESSURE on the wound to stop the bleeding, not cut off the blood flow to your whole extremity (tourniquet).

Just want to make sure people reading all this properly understand things and don't think the CAT is their main thing to grab...

Rmpl

I am glad you brought this point up. The TQ should be used for any wound that has any moderate amount of bleeding WHILE you are in a firefight. The time it takes for you to evaluate a moderate wound and apply a QuickClot gauze and or a pressure bandage while the bullets are going both ways may cost you and/or your teammates your lives. Applying the TQ should be quick and allow you to return to the firefight quickly, and having that extra weapon in the fight may make a huge difference. Once the firefight has subsided, full eval of the wound should commence and the appropriate treatment taken. Having a TQ in place for a short time will not cause harm. Another point, if you do feel it is NOT an arterial bleed, but a wound that has moderate bleeding, you may be able to put the TQ in place but may not have to tighten it all the way down. You only need to tighten down until the bleeding is stopped so you can return to the fight.

Remember, we always think about a bullet taking us out of a fight. Take a scenario like this...You are on patrol and take fire. You are moving to a ditch 3 feet away and jump in to go prone and your leg finds a sharp piece of metal that was covered by some leaves. It is sharp enough, and you hit it with enough force, that it fillets you open. You now have a 0.5"-1" deep and 4" long wound just above your left knee with moderate bleeding occurring. No arterial bleeding noted, but you are looking through blood and your BDU pants (plus the dirt, leaves and mud in the ditch). Bullets are flying as it is just the beginning of the fight. Maybe it is just a single shooter as you only hear one rifle shooting. One of your teammates is pinned down behind cover and cannot return fire. You are behind good cover, but wounded. You throw on your TQ and since you have been practicing it only takes you 30 seconds. The bleeding stops and you are able to lay down covering fire so your teammate can flank the OPFOR before he gets a better angle on either of you. Your teammate works his way around to get a clear shot from the flank while you are able to keep the shooter in his original position, and deliver the shot that is needed. The fight is over in less then 5 minutes. You then can eval your wound and treat as needed.

If you had taken the time to eval and see if TQ is needed or just a pressure bandage you would likely take at least a couple minutes...remember to fully eval you need to see the wound clearly which would require tearing/cutting your pants which takes time. Now this is for moderate to severe hemorrhage. A tiny little scrap or boo-boo can wait until the fight is over. Moderate bleeding can bleed a lot especially when you are moving and heart rate and blood pressure are elevated. Someone can lose quite a bit of blood with moderate bleeding in a 10 minute firefight.

Okay, a little dramatic, but you hopefully see what I am trying to get at.

Hope this helps

[Lowdown3]

Time yourself pulling a CAT tourniquet and putting it in your limb then time yourself pulling out an Izzy bandage and putting it on correctly (tight). That's the easy answer.

Gets you back into the fight quicker, can be done one handed, wherein it's tough to put on an Izzy one handed.

You can always do TQ reduction later.

[Rmplstlskn]

Thanks everyone for the further clarification... I understand the concept now.

I have never tested if I am able to run with a CAT on, and how cut off blood flow affects muscle actions minutes after the flow is stopped... As stated, I have always been "focused" on my own treatment and medical care (like I was out of the fight), never thought about getting up and running to another cover spot somewhere as a test...

Good info!

Rmpl

[Lowdown3]

It's important in training to get used to tightening it down. Too often you see this "I don't want to hurt myself" non sense.

A TQ properly applied in training for a few minutes is highly unlikely to cause any problems to the user.

A half arsed applied TQ is more of a problem actually.

It sucks cause the limb will throb like hades, but you can make short runs, crawl to cover, reload, use a weapon, etc. with one on.

On the CAT people put the windlass into the little plastic keeper and think they are GTG. But time permitting, always try to go over the windlass with any additional velcro and strapping if possible. It's very easy to bump the TQ while dragging someone through the woods, around cover, etc. and it's easy in doing so to release the windlass.

Last time we did this, everyone was kinda half arsing it, hurrying but not really hurrying. A few rounds let off now and then reminds people of the seriousness of the practice.

Ideally you are applying it WHILE moving to cover if possible. Therefore practicing shrimping via one side, with the "good" leg pushing, becomes important.

[protus]

This may be where my "I am NOT a medical person, just a dude who took some classes" comes to play, but my understanding of CAT (tourniquets) is that they are ONLY used for gushers, where an artery or other major blood vessel is pumping your life blood out, NOT for just a FLESH wound, as nasty as that may be and with some heavy bleeding (but not spurting). For a NON-SPURTER flesh wound, my understanding is that you would use something like an Israeli ABD pressure bandage or the QuickClot pressure wrap to put PRESSURE on the wound to stop the bleeding, not cut off the blood flow to your whole extremity (tourniquet).

Just want to make sure people reading all this properly understand things and don't think the CAT is their main thing to grab...

Rmpl

Me..you...ld and psd are on patrol.

CONTACT RIGHT PEW PEW PEWPEW...
RMPL...MOVE......
....
..RMPL
IM HIT..
PEW PEW PEW

PSD...NO GO NOT CLEAR...

LD GET SOME..PEW PEW PPPEEEWWWW

do youve taken a round toyour mid thigh..itz broken your femur...but not busted you femoral...but your leaking pretty good.

Psd cant get to you...ld and me are engaged...
Your still taking rounds around you....

Weve adjusted fire to your flank..psd is reloading and your trying to wrap an izzy around your leg..as rounds come in.


Im not a medical guy. Like you ive taken enough courses to be dangerous.
But....what is our scenerio. If we are in rattle..im going by the above.

Your hit...you strap up..return fire...

It will take you five times as long to apply an izzy as it would a CAT. That time is less rounds down round range...that means more at you and your buddy...that time means more blood loss....

Not being rude. But go duck behind your coffee table...have the wife toss socks at you while you try to apply a TQ..and izzy...if she scores a hit your doa

Think about it.....

Ymmv.