Hemostatic agents, TQs and Pressure Bandages

[policemedic]

Suddenly I have funding to secure some equipment for the entire department, not just my team.

Among my preferences are z-folded Combat Gauze and the SOF-T Wide TQ. I'm also liking the DARK IFAK even though it comes with a CAT TQ and an Israeli bandage instead of the SOF-T Wide and the OLAES bandage.

With that said, I attended a class tonight where the instructor said hemostatics have fallen out of favor in SOF medicine. This is the first year I wasn't able to go to the SOMA conference, so I'm a bit out of the loop.

For the SOF medics on the board--and particularly those of you with recent schoolhouse experience--is the use of hemostatics falling by the wayside?

I'm also interested in whether anyone has had experience with the tension device on Israeli bandages breaking. I've never seen it personally, but it was brought up as a concern. My preference (ever since @amlove21 schooled me on them) is the OLAES bandage, but I want to know that if I end up fielding Israelis that they aren't going to shit the bed. My aid bag will always have OLAES, but that may not be true of the rest of the department.

Thoughts?

 

[TLDR20]

Combat gauze is still the flavor of the month in the SOF-Med setting. But that is used in conjunction with a classic pressure dx. As to the OLAES, and other expensive whiz bang products, I just ask what you are getting out if it that I can't get with Kerlix and ace wrap?

 

[policemedic]

Combat gauze is still the flavor of the month in the SOF-Med setting. But that is used in conjunction with a classic pressure dx. As to the OLAES, and other expensive whiz bang products, I just ask what you are getting out if it that I can't get with Kerlix and ace wrap?

Thanks.

I've always stressed that CG needs to have pressure maintained on it. That was one of the problems with the original Quick Clot powder formulation; troops thought all you had to do was pour it in the wound cavity and presto change-o, no more bleeding. My experience has been that when packed properly onto the bleeder and into the wound cavity, with a pressure bandage on top CG works quite well.

As to the OLAES specifically, I know what you mean. You can fashion a proper pressure bandage out of the items you mentioned, and those items have multiple uses.

However, I really like the multiple uses of the OLAES. I particularly like the Velcro along the bandage (cue the Velcro jokes).

Most importantly, I'm looking at the OLAES from two standpoints. One is mine. For my purposes it's a great bandage, and I don't have the space or weight constraints in SWAT that SOF medics do because I don't have to hump my aid bags further than the car and the target house. The other perspective is that of the patrol officer who gets trained once a year with a practical session of sorts during active shooter training every year. They want and need something that is effective, but faster and easier to use than opening three packages and using three different items. It's also easier for them to carry.

 

[TLDR20]

Makes sense.

 

[amlove21]

So I agree with both of you.

The z folded combat gauze is TCCC approved and the hotness- I really like it. @TLDR20 is completely correct, it should be coupled with a pressure dressing/over wrap.

I do think that the ace wrap/kerlex should be the default, I just happen to think that the Olaes is the heat, for all the reasons @policemedic wrote above. Great multi-use piece of kit.

You're on the right track- I am not a fan of any pre-packed IFAK, just because I always end up rat-effing it and taking what I want, putting my own stuff in, and in the end it looks almost nothing like what we bought.

Tourniquet, hemostatic, pressure dressing, a couple darts, chest seal. That's about as far down the rabbit hole I go on IFAKs, to be honest.

 

[TLDR20]

^an NPA with lube is always a good idea.

 

[policemedic]

So I agree with both of you.

The z folded combat gauze is TCCC approved and the hotness- I really like it. @TLDR20 is completely correct, it should be coupled with a pressure dressing/over wrap.

I do think that the ace wrap/kerlex should be the default, I just happen to think that the Olaes is the heat, for all the reasons @policemedic wrote above. Great multi-use piece of kit.

You're on the right track- I am not a fan of any pre-packed IFAK, just because I always end up rat-effing it and taking what I want, putting my own stuff in, and in the end it looks almost nothing like what we bought.

Tourniquet, hemostatic, pressure dressing, a couple darts, chest SEAL. That's about as far down the rabbit hole I go on IFAKs, to be honest.

Yeah, I'm right there with you. That's one of the reasons I like the DARK IFAK; it's packed with all the above minus the darts (which I carry plenty of and which my team guys aren't allowed to use anyway). Now, if I could get those guys to substitute the Israeli with an OLAES it would be an ideal COTS solution for my application. As it stands, I wouldn't quibble too much over the Israeli.

I'm glad we're all on the same track. I couldn't understand why anyone would say CG had fallen out of favor, especially since all the data that I get to see coming out of theater and from TEMS circles (plus my own experience) says its the tits (when used properly).

 

[Muppet]

Hey Policemedic. Bahner told me he said you sucked last night! Ok, I lied and I added that. He said he liked you. I told him our history and now he hates you. Oh, while me and Bahner were talking, Tom Dougherty was there (he is full time here also). Remember him from school. He was a adjunct with Lappe and Chet.

F.M.

 

[Muppet]

So I agree with both of you.

The z folded combat gauze is TCCC approved and the hotness- I really like it. @TLDR20 is completely correct, it should be coupled with a pressure dressing/over wrap.

I do think that the ace wrap/kerlex should be the default, I just happen to think that the Olaes is the heat, for all the reasons @policemedic wrote above. Great multi-use piece of kit.

You're on the right track- I am not a fan of any pre-packed IFAK, just because I always end up rat-effing it and taking what I want, putting my own stuff in, and in the end it looks almost nothing like what we bought.

Tourniquet, hemostatic, pressure dressing, a couple darts, chest SEAL. That's about as far down the rabbit hole I go on IFAKs, to be honest.

At the medic unit I work for full time, we recently added a active shooter bag we all put together our selves. The bag is from Tac Med. Solutions and we added 6 SOF-T's (2 are in the first in house bag) so that makes 8 on each medic unit (3) units, Israelies and kerlix, darts, nasal trumpets but no chest seals. Money I guess but they are easy to make and back in the day, there were no fancy ones made. We also have the fucked up quick clot tea bags but want to replace them but the z-fold combat guaze apparently are hard to come by these days. Since we (a few) of us belong to the Tac Med. team for the county / went to SWAT medic school and drilled with active shooter, we found a HUGE disconnect between standard EMS and tac. medicine. I honestly don't see some providers packing wounds though. The T.Q's have been used a few times already on bad accidents and such. TCCC is now being taught so the employees are all on the same page, even though some still think active shooter / mass cal will not happen (heads in sand theory).

F.M.

 

[policemedic]

At the medic unit I work for full time, we recently added a active shooter bag we all put together our selves. The bag is from Tac Med. Solutions and we added 6 SOF-T's (2 are in the first in house bag) so that makes 8 on each medic unit (3) units, Israelies and kerlix, darts, nasal trumpets but no chest seals. Money I guess but they are easy to make and back in the day, there were no fancy ones made. We also have the fucked up quick clot tea bags but want to replace them but the z-fold combat guaze apparently are hard to come by these days. Since we (a few) of us belong to the Tac Med. team for the county / went to SWAT medic school and drilled with active shooter, we found a HUGE disconnect between standard EMS and tac. medicine. I honestly don't see some providers packing wounds though. The T.Q's have been used a few times already on bad accidents and such. TCCC is now being taught so the employees are all on the same page, even though some still think active shooter / mass cal will not happen (heads in sand theory).

F.M.

I like the folks at TacMed.

Z-folded combat gauze is not hard to get. You won't get the MILSPEC package with the x-ray strip, but you don't need it in our setting. The LE package is the same stuff, but doesn't have the X-ray strip. If you have any problems finding it, let me know. The director of clinical affairs at Z-Medica is a good friend of mine.

And you're right, there is, has, and probably always will be a huge disconnect between TEMS/military medicine and EMS back on the block.

 

[Muppet]

I like the folks at TacMed.

Z-folded combat gauze is not hard to get. You won't get the MILSPEC package with the x-ray strip, but you don't need it in our setting. The LE package is the same stuff, but doesn't have the X-ray strip. If you have any problems finding it, let me know. The director of clinical affairs at Z-Medica is a good friend of mine.

And you're right, there is, has, and probably always will be a huge disconnect between TEMS/military medicine and EMS back on the block.

I'll talk to Bahner. I'll pass that on regarding the gauze. Thanks bro. I don't like the tea bags but again, I never used them but never heard good things about them. Some providers think this will never happen at a movie theater or school. We have 3 medic units so add the amount of T.Q.'s up. Other places around here have 1 T.Q. in the whole medic unit. Us and Bensalem EMS have active shooter bags (both places employ tac. medics). Next month we are teaching a TECC class at 143's, so is 185's also.

F.M.