Trauma Medicine: Through-and-Through Gunshot Wound to the Chest

This is an excellent educational article on traumatic gunshot wound care and treatment. Lots of good photos and vids, so please click on the Original link at Tac-Med Australia to see ALL of It!-SF

02 JUL 2016

The following case study is of an Afghan civilian woman who was medically evacuated to a Forward Surgical Team in regional Afghanistan having sustained a through-and-through gunshot wound to her right upper chest. The exact circumstance of the wounding was never made completely clear, but it was understood that the women was injured in crossfire during a firefight between two feuding Afghan tribes. The likely weapon that the bullet came from was an AK-47, and history from the woman suggested that the range she was shot from was likely between 300-400 metres, meaning that the bullet would have lost a significant amount of velocity before it struck her.
The casualty had been taken to a regional military base where her wounds were covered with occlusive dressings by the treating medic and an AME was organised to the FST that I was working at on the day. The following image shows the primary survey of the casualty in the resuscitation bay of the FST with myself assessing her wounds and one of the trauma surgeons listening to her chest to assess for breath sounds.

Read the Original Article with Photos and Vids at Tac-Med Australia

 

 

Field Review: The E3 Solutions “PTK 1.0”

My good friend Mark E., who has contributed some excellent narrative frequently to the blog, has started a new CO business venture:  E3 Solutions. His first product, the “PTK” or Personal Pocket Trauma Kit is what I will be reviewing today.

Having a viable trauma kit (not first aid/boo-boo kit..we are talking about shit to save your life not make your “owwie” feel better) around and readily available is an essential for every CO IMO. I tell all my students, if you are going to carry a firearm for self-defense, have a fully stocked trauma kit handy and know how to use it. Even if you don’t carry a weapon for self-defense, having the ability to stop serious bleeding if you are wounded, say in a car accident or maybe out hunting or hiking, could be a literal life saver for you or any unlucky soul you might come across. For this reason, I advise having a trauma kit handy in several locations, not just one..i.e your home, your vehicle, your gun range kit and of course, on your person, when you can.

For all the benefits a trauma kit offers, the one con is that for the most part, due to the quantity of materials and weight involved, they are often designed to be carried anywhere but on your person. Sure, you see them all the time on soldiers in the field in a MOLLE pack or on a belt, but for a civilian to strap on the same gear or pack would be a bit disconcerting to some I am sure, not to mention very conspicuous. But what if a civilian could have an “abbreviated” version of that trauma kit that could fit inconspicuously in a pants cargo pocket? That way, when it was needed, no more running to the backpack or vehicle, it’s right there to use! Enter the “Necessity is the Mother of Invention” PTK 1.0.

Now before I get into the specifics of the kit itself, I would be amiss to not tell you to first learn how to use one properly. Sure, the general directions sound easy enough on a pack of Quick-Clot, but I assure you, when blood is gushing out of a vein or artery and pain and adrenaline have combined into a nasty little cocktail of near hysteria and utter despair, those same directions might as well be Mandarin Chinese. I am not saying you need an EMT Certification to use a PTK, but you DO NEED to know the basics of Trauma Medicine with an emphasis on stopping Arterial Bleeding, both by Coagulant (Quick-clot or Celox) and Tourniquet, not to mention the ever so important skill of reducing and treating Shock, which has killed more people than bullets ever dreamed of. I highly suggest you seek Professional, Hands-On Training for this skill set, as a book can only go so far. Check out Texas’ own Lone Star Medics. These guys are the real deal and offer Real-World Applicable medical trauma training for the armed civilian.

OK, so on to the kit inventory. First off, is the Quick-clot 25gr 1st response Clotting Sponge. Pretty simple piece of kit: take the sponge and apply it to the wound with a lot of pressure to start stopping the bleeding. This is much simpler, easier to use and more streamlined for individual use than the Celox granules IMHO. Next up is what I would call your “Auxiliary” or “Backup” option if the bleeding cannot be stopped with the sponge alone; a SWAT-T Tourniquet/Pressure Dressing. There is an excellent You-Tube link on E3 Solutions for this piece of kit, I highly suggest watching it. Also in the kit is a 2 pack of 12 ply 4×4  Gauze Pads (to cover the wound), a pair of well made Red 5.5″ EMS Shears (to cut clothing, bandages, etc.) an XL Pair of Nitrile Gloves (to protect yourself against blood borne pathogens) and to keep everything in one place, a handy cardboard stabilizer, and all of this housed in a sturdy, re-closeable, poly storage bag.

Since I promised Mark an actual “field review” of his kit with critiques, I intend to fulfill my promise. I will tell you though, since I am always honest with my readers, on my last “outing” in the field, I or none of my associates experienced any life threatening, traumatic injuries that required the use of the PTK (Thank God!) I had to improvise as far as using the kit on an injury (Similar to pre-deployment work-up training, we designated a random operator as a casualty, “Single gun shot wound to upper thigh” would be yelled, for example. At that point, the team goes into action.  I also must apologize for not having any good photos, due to the nature (and location) of my last outing, no cameras or even  smartphones, were allowed in the AO.

I will approach this critique, to make things simpler for the reader,  in a Pro/Con type commentary. The reader needs to be reminded, (as I had to remind myself often) is this is a BARE BONES Trauma/Blowout Kit. It was designed to stop major, arterial bleeding from a traumatic injury such as knife or gunshot wound. It was not designed to address every traumatic injury you may come across (broken bones, neck injuries, etc.) Having said that, there are a few things the kit still needs to make it a viable kit IMHO.

Pro’s

• Kit fits and rides well in a cargo pocket, little shifting
• Due to stabilizer, Kit is easy to access, all packages can be torn open with one hand and teeth.
• Shears are sharp and very functional, cut through denim and canvas very easily.
• SWAT-T Tourniquet very easy to self-deploy for self-treatment, can be done with one hand (with some practice).

Con’s

• Since shock is ALWAYS an issue with any traumatic injury, an inexpensive, compact, foldable, mylar blanket needs to be added to the kit.
• A small roll of duct tape needs to be added, since in a pinch, the wound will need to be wrapped and the patient transported. This also gives the operator more options to self-treat and get mobile to an ER.
• Replace the gauze pads with an Israeli Dressing. This would be much more universal in application.

In Summary, the PTK 1.0 is an excellent Blow-Out/Trauma Kit to have on your person. Get yours today and check one more thing off your “Oh Shit, I wish I had that”!! inventory list.

Stay Prepared, Stay Armed and Stay Dangerous!

Where are you PTK??

(By Contributing Author Mark Edwards)

A few days before the tragic Batman Movie Massacre in Colorado, I found myself without my Pocket Trauma Kit (PTK).  In my daily travels, I find my brain dwelling on tasks at hand, and then at stop lights, sometimes wondering what I forgot to bring along.  On a recent Thursday, it was my PTK.

Some background might be in order.  A few years back, I took a course in Tactical Combat Casualty Care, or TCCC, as it is known for short.  Since that course, I immediately re-evaluated what I carry with me in my vehicle, my workbag, what I have at home, fighting bag and/or pockets.  I’ll focus on the pockets today.

So you might have had the revelation that “if you can make holes” with lead projectiles or sharp pointy things, perhaps it might be a good idea to have a way to plug some holes?  Put another way; to give yourself a chance to stop your own traumatic bleeding or that of a loved one.  Gun shot wounds (GSW’s) are bad and knife wounds can be even worse.  I have my normal trauma kit in a back pack in my vehicle trunk, and another at home.  But, hey, if you need to stop bleeding, RIGHT NOW, where you stand or sit, what are you going to do?

So back to the PTK.  Why have it at all?  It’s another thing to manage, right?  I’m a fan of the Keep It Simple Stupid or (KISS) approach. But when I checked my cargo pants pocket that day it hit me:  “If I get in a car wreck and puncture an artery, or catch a bullet through the wall of a movie theatre, I may not be able to get to my car trunk.”  The scenarios are, of course, endless, but imagine this one:  you catch a bullet while at a stop light because of some gang activity.  At that point, plugging a hole may be more important to your survival than firing back.  Let’s assume it is…so, time is of the essence.  Again, getting to the car trunk still might not be feasible, so carry on your person is the most viable option.

A few more assumptions…you establish and agree that a PTK is good for your world.  And you know enough about basic combat medicine to stop or reduce arterial bleeding to put a few common medical supplies to use.  And let’s assume that you practice accessing said items with either hand, and while seated, flat on your back, or standing.  Good, now what to put in your PTK?

Every possible version of contents could differ depending on what you do, your climate, work environment and type of clothing/dress.  You will find endless reference material on YouTube for both large and small trauma kits, some pocket-sizes and some not.  But I keep mine simple.  I have long since removed boo-boo type stuff (band-aids, anti-bacterial goop, alcohol prep pad) after the TCCC studies.  Keep in mind, the following two features that were important for me:  light weight and thin enough to carry at all times, and with just stuff to patch a GSW or stab wound or other puncture wound.

Here is a starting point:

• 1 ea Medical Shears
• 1 pair of Latex or Rubber Gloves
• 1 or 2 non-stick pads with adhesive tabs
• 1 clotting sponge (Celox, Quik-Clot, etc)

Where on your person to carry it?  My default is a front pocket of cargo pants or cargo shorts.  An alternate spot is a jacket/coat pocket, work bag or computer bag.  Between the arm rests or console of your vehicle is another.  These are locations I use every week, depending on what I’m wearing and what I’m doing for work tasks or personal pursuits.  See what works for you.

Next there is the consideration of what container to use so that your PTK is not constantly getting folded, bent, or otherwise wearing out the medical supply packaging, or poking through your pocket.  This is no small matter.  For simplicity, and availability, I use a common zip-top, one quart, food storage bag.  The upside is it’s water-tight and sweat-proof.  The downside is that you have to replace it once a month, if it is your every day carry PTK, because it will still wear down in the corners.

The key item to manage is the Medical Shears.  If you don’t craft a small, folded paperboard sheath, you’ll have a hole in the bag in a week or two.  Sure there are MOLLE solutions, and EMT pocket organizers you can buy (and don’t rule those out), but I’m talking about something you could put together and maintain with little expense and fit with the “thin and light approach.”  The bonus of the zip-top baggie, is that it will settle on a curvature to match your clothing and legs (assuming cargo pocket carry).  This helps it “print” less to avoid prying eyes, if you happen to care about such matters.

A ballpark cost estimate is $27.  Approximately $21 for the Quik-Clot, $3.30 for the shears, $.50 for each 3×4” pad, $1 for the gloves (individually wrapped) and $.20 for the baggie.  It’s time for this Texan to go make another one!