Forward links:
Arrr! -> The Enfield
The Enfield -> Today's Lesson(3)
Today's Lesson (3) -> Triage
Triage -> The Enfield

Backwards links:
The Enfield -> Arrr!
Today's Lesson (3) -> The Enfield
Triage -> Arrr!

Would you if I format that down to reference card size and post it as a PDF?

I thought it was something to do with dividing the living into three groups. (I first heard the word in an emergency-room context, where most people sitting there waiting are alive.)

Learn summat new every day...

Patrick C.: This isn't my system: it's a standard. This system is called "START" for "Simple Triage and Rapid Treatment" -- it's what's in all the books now. I'm sure it exists in the form of laminated wallet cards already.

The squeeze-the-fingernail trick is called checking for capillary refill. If the circulatory system is working well, the nailbeds will fill back up in under two seconds. If it isn't (and it isn't your job right at that time to figure out why, just that it isn't) -- it gives you a rough guestimate. If the patient is wearing nailpolish you can do the same trick on the back of the hand. If you can't get to the patient's hands, you can do it on the center of their forehead. That's tricker with patients who have lots of skin color, but doable.

"Triage" is a French word for the same reason "ambulance" is a French word. The French (specifically Napoleon's army) came up with both concepts in the course of developing battlefield medicine.

Note that start-triage.com, which will appear first in the list, is slow and possibly buggy Java.

What interesting to me is that this is the piece of the training that has MOST stayed with me: the ability to direct people to useful activity in an emergency. And that's good, because in my (thankfully limited) experience, ordering bystanders to call 911 and helping the injured person to stay calm have been the most critical things to do.

"You, go and call 999, stay on the line until they tell you that you can leave, and then come back and tell me that you've done it and if they have any instructions for me."

They were *very* hot on stop, think, and check the area for hazards before going in, lest you become a casualty yourself. They had lots of gruesome stories to demonstrate why, but there was one from my own workplace that could have resulted in several fatalities -- it was the third person who saw the unconscious people in the work pit who went and phoned for help. The first two went rushing into the pit to help, and joined the collection of people learning that argon is heavier than oxygen...

News from this morning, or Why You Fucking Do Not Fucking Put a Fucking X on a Fucking Door Unless You Personally Have Fucking Gone In and Fucking Looked:

Y'all remember the photo of the emaciated man being rescued in New Orleans the other day? Patrick sidelighted it, and here's the post he linked to again: Just One Photo

Okay. New Orleans. The hurricane had hit twenty-three days before. And yesterday afternoon...

When they [ATF agents Charles Smith and Sam Cohen] got to the house in the Mid-City section, they thought the couple might be safe. The door was marked with the bright orange "X" that indicates a patrol had already been through.

"I saw that 'X' and thought it would be OK," Smith said. "It had been checked."

A closer inspection showed this one was dated September 13, and that the house was not entered because it was locked. It also bore a zero and the letters A and D -- no one alive, no one dead. The same day, the SPCA had taken a dog from the other side of the duplex.

Okay. X on the door. Dated 13 September. Zero dead, 0 alive. That's seven days before.

Only guess what! There really were two people in there. One dead, one alive. And guess what else? The dead one only died five days before. That means that when that building was supposedly searched and cleared, there were two live people in it, and one of them had been able to hold out another two days.

Did anyone search? Nope. But how the fuck would someone know there was no one dead inside to write "0 D" if they didn't look?

The lesson: Do not go and say you've searched if you haven't. Maybe a subsequent team would have gone in if the building hadn't been marked as having been cleared. Lots of maybes. But know something? Someone who didn't have to be dead is sure-enough dead right now.

Because someone fucked up.

Double-checking this I find that on my (skinny) knuckles, it takes about twice as long to get evident color, and more for full refill.

My only question in this method is what does one do with obvious problems which can't wait, things like copious bleeding?

TK

... And Fucking Come Out Again, unless you think dying in a building that you were searching, and nobody comes to get you because you labled it as "searched" is a good idea.

As you noted -- one slash for "searching", two for "searched." And, of course, DATE THAT X. Sometimes, shit happens twice, and if I'm seeing 08-Nov tags in February, those buildings aren't searched.

Finally -- I really, really, REALLY, hate using I, II, III for triage codes. For one thing, a little smudge magically upgrades your patient. Since changing tags doesn't actually fix problems, this isn't helpful.

Arabic numerals are better -- the only likely confusion is a quickly scrawled 2->3 and visa versa. Even better is 1, 2, "NOW" and 0 -- none of which are likely to confuse, and when the cavalary arrives, it's not hard to figure out what to do with a guy who has "NOW" written on the forehead, but even 1,2,3,0 has far less failure modes than I,II,III,0.

The important things are:

Take charge. Make decisions.

Get more help rolling.

Do what you can while you're waiting for backup.

If you give a patient epinephrine, write E and the time (24 hour clock) on their forehead. If you give the patient morphine, write M and the time on their forehead. If for some reason that I can't imagine you lost your senses and put a tourniquet on a patient write the letter T and the time on their forehead.

Here's a slick trick if you're going to be with a patient longer-term. Feel their arm. Is there a place where the arm stops being warm and starts being cold? If so, put a line there with your Sharpie. Now do your interventions. Check for that warm/cold line again, and draw with your Sharpie on its new location. If the new line is higher up the arm, you're losing. If the new line is lower down the arm, you're gaining.

The E for Epi is new to me. The other thing I'd do for a tourniquet patient is make certain the tourniquet is visible.

Then again, the army has trained me to be very specific in how I apply various bandages so the medics can, at a glance, know how serious the bleeding underneath is.

TK

Also, isn't there a danger with only using color-coded tags? What if some of the later responders are colorblind?

Otherwise, I think what you said makes lots of sense.

I was in a train accident in 1968 - 1 killed, 8 injured, and a bunch of others with minor injuries including my brother. We were lucky - the landslide that derailed the train happened about 200 yards from a road. If the landslide had happened a further on in our journey, we would have been in the middle of nowhere in the Canadian Rockies. The RCMP (but on busses, not on horses) to the rescue! There was no formal triage as the major injuries were all in the car hit by the landslide, and everyone else was ambulatory.

If, on the other hand, the person does okay (and holding direct pressure isn't all that tough) the patient may live.

One way the patient has a chance. The other way ... he doesn't. Give him the chance.

And the color codes -- the color strips are also printed with numbers, and with little graphics for people who don't know their numbers. It's pretty well covered.

(Are you guys still using non-internationally-standardized names for such basic stuff? Isn't that, like, potentially dangerous? (I'm thinking specifically about multi-national efforts here -- not relevant to New Orleans, quite possibly very relevant to, say, military forces in Middle Eastern countries beginning with "I".))

Sometimes I feel a little egotistical assuming that, in an emergency situation, I should be the one to take charge.

Though if there were someone with actual medical/emergency training on hand, I wouldn't be, of course. But I've heard enough stories about how people tend to go into frozen-deer-in-headlights mode at such times that it only makes sense to prepare to deal with the possibility.

The basis for the name epinephrine in the United States was out of necessity—the name adrenalin (without a final "e") was registered as a trademark by Parke, Davis & Co. In other countries where this trademark was not registered, the name adrenaline was adopted at the insistence of the British pharmacologist Henry Hallett Dale. Resistance to the adoption of epinephrine has even resulted in some dispute as to the validity of the name (Aronson, 2000).

The monograph name in the European Pharmacopoeia remains adrenaline, despite the adoption of INN names for all other agents, and European Union (EU) countries continue to use either adrenaline or dual-labelling of both names on products. This is because of the confusion that the name epinephrine would cause to patients in EU countries, and resistance to the perceived Americanisation.

Uhh, epinephrine is the standard name, in particular, it is the INN. As is often the case (see "UTC") the Brits are the ones whinging about how the INN is chock full of American Names, which Aren't Right™), thus, they insist on using adrenaline -- never mind the great number of INN compounds that are, in fact, based off the British name -- see "paracetamol" as an even more common example.

Normally, I'm with you on "USA, suckitude thereof", but this is one case where you and the BMA need to Shut The Fuck Up™. Indeed, you passed legislation explicitly saying that everything would henceforth be INN -- except, of course, adrenaline.

For small children: if the bracelet tends to come off, it's probably too large. In an emergency, use safety pins to fasten it more securely (pin the chain to make it shorter, or pin it to clothing). Mine isn't that easy to remove single-handed, so I doubt that children could do it.

(If you're unconscious you betcha I'm going to start an IV on you. And I use iodine in the course of doing it. Unless you have a bracelet that says otherwise....)

We also look in your refrigerator for a Vial of Life.

(No, the EMTs are not looking for a beer. Even if it is a very hot day.)

I've (I'm sad to admit) never gotten CPR training, because the idea of mouth-to-mouth recussitation REALLY freaked me out.

But the idea of not knowing what to do in an emergency ALSO really bothers me.

Have you emergency medical types ever had this happen, where you tell someone to call 911 and that person says, "No." ???

At which point he took it, because "someone in authority" had asked for him.

TK

Leigh Butler wrote, Sometimes I feel a little egotistical assuming that, in an emergency situation, I should be the one to take charge.

Four years ago this Saturday, my sister was in a really bad car accident. During morning rush hour, driving on a highway, she suddenly lost control of her car; it skidded off the highway and rolled 360 degrees before coming to rest at the bottom of an embankment. We think it was caused by a tire blowout. When her car first went out of control, Abi thought she was going to die. When it came to rest, she was in severe pain from a broken arm, but was also convinced that she needed to find her cell phone or get out and flag down a car because she knew she needed an ambulance. Her own door was inoperable so she scrambled across the passenger seat and out into the wet grass before collapsing to her knees. At that point, the other drivers who'd stopped to help her came running down the embankment shouting to her that they had called 911 and that she shouldn't try to move, help was on its way.

One driver, a carpenter on his way to a construction site, had a blanket in his car. He brought it down and draped it gently around her, then talked to her to keep her calm until the paramedics arrived. That's all he did -- treated for shock, reassured her, and kept her company.

When the paramedics arrived, they put a collar on her, strapped her to a backboard, and took her to the hospital. Where they determined that she had two fractured cervical vertebrae -- C2 (the one Christopher Reeve broke) and C7. She spent three months in a halo vest so that her broken neck could heal. But thanks in part to the people who stopped, her spinal cord was never injured and she is not paralyzed. She made a full recovery.

I am so grateful to the strangers who stopped to help her. You don't need a great deal of knowledge in order to make a huge difference, if you're the first one on the scene.

Given the format of the training, you'd be putting your mouth on a dummy, rather than a human, if that's any help. It's worth it, because any training at all helps overcome the urge to panic or dither. You know what to look for, and what to do next, and when not to do anything at all. The Red Cross trainers have seen every level of squeamishness among their students--you won't be the first.
Many employers are willing to pay for their workers to take first aid/CPR training; check and see, because it'a always worth knowing the basics, no matter where you live or what you do. If nothing else, you'll know how to be useful if things are really bad.

It is better to be trained, and never need it, than to need it, and not know what to do.

For me, the added confidence of knowing what to do increased my comfort level far more than my usual squeamishness decreased it.

Sometimes I feel a little egotistical assuming that, in an emergency situation, I should be the one to take charge.

It's not egotistical, as long as you don't assume it's inevitably and always you.

If I, with my out-of-date lifeguard training, show up at the scene of an incident, and everyone else is standing around gawking, I take charge, substituting my teacher voice for the voice of brass (gotta get me one of those sometime). If James D. Macdonald shows up, I'm more than likely to fill him in, and defer to his vastly superior expertise.

You may not be the ideal triage manager, but you're almost certainly better than no triage manager.

Calm demeanor leads to people giving you authority in such circumstances (this may be why military types get credit in wrecks, and the like, we get lots of training putting off reaction; the now matters more than the thing, and the horrid gets put off until later). Knowing is better than not knowing, and since needs must when the Devil drives, you'll do what you know how to do and be squeamish later.

I've seen people who were so squicked at having given someone mouth to mouth that they went into a bush and puked, after the person came round.

And my last job actually offered certification, but I didn't do it because I chickened out.

I know. I should do it. Maybe I should go look it up right now.

http://excellenceinlearning.net/catalog/cpr-barriers.htm

I don't carry a kit, but I have the CPR mask and a couple of 4x4 gauze pads in my everyday bag; I figure the things I am most likely to run across on the street that equipment will help are CPR or a serious bleeder. (And when I'm downtown I'm usually within seven blocks of the Level 1 center anyway.)

So I guess I'm saying, is it better to have a bad first aider, or no first aider?

And if I suspect I might be a bad first aider, should I stay well clear of anything except following your excellent triage instructions and praying someone competent comes along before it becomes germane that I have no idea how to do the nail bed thing????

We had an elderly physician collapse from an episode of cardiac arrhythmia one day here--one of the other Old Doctors was an anesthesiologist, and immediately did CPR--and when the paramedics arrived, with the oxygen tank, and all the other tools of the trade, he stood aside, and was glad to do so, because they were set up to do some serious intervention, and he was just set up to do CPR, despite all his experience.

(It omits the "call 911" step, since the existence of an ambulance on scene implies that something like that happened already, but does include a "first, scream loudly for backup" part - same principle, writ large)

May be of interest as a comparison, though it's not specified how the triage method differs from that generally used at other incidents.

Laurie Mann
Whad'Ya Know?
http://www.dpsinfo.com/blog/2005/09/whadya-know.html

The accustomed say "thanks" and get on with whatever task requires the gloves. The rest come up with a variety of odd blathered questions, often starting with "Why do you have -those- in your bag?"

The last-but-one 911 call I made was because of a car wreck at midnight in front of my apartment's balcony. It was a noisy crash, and when I opened my blinds to see what the matter was, there was already a crowd gathering. I knew my running down to help would serve nothing; I let my previous phone conversation go with a "Car crash, gotta call 911" and called.

I wasn't asked my name. I was asked the location of the crash, and pertinent details like the number of injured, the number, color, and general type of vehicles involved, and then questions about the injured like:

Are they breathing?
Are they bleeding?

I got the impression that the 911 operator was glad to have a coherent person on the line, but that she was used to asking the right questions to get the right information, and saying the right things to calm down someone in a panic.

I have the lungs of iron and the voice of brass. I was on a balcony with a commanding view of the accident. I relayed information between the zeroth responders on the scene and the emergency operator, by dint of bellowing the questions I couldn't answer myself down to the people standing down by the accident. I think at some point I bellowed, "I'm on the phone with 911!" so everyone would know that 911 had been called, that help was on the way, and that the questions I was asking weren't just me being a nosy bystander, it was 911 asking through me. I must admit that I was trembling, terrified of telling others what to do, of speaking to complete strangers, but more terrified of what could happen if I didn't.

And it's amazing how people who don't know what to do in a crisis will listen to someone who does know what to do, or at least acts as if they do. They take their cue from the leadership they're given. If the Person Acting Like They're In Charge is calm, the people observing or involved in the emergency will be calmer than they otherwise might. If any perceived leaders are in hysterics or suchlike during the emergency, people who don't know what's going on are going to assume that it's worse than they think, and panic themselves...

Training oneself into a calm and helpful response to an emergency is possible. I see so many people in the comments here who treat responding calmly to life-threatening emergency situations as a matter of course, and it might be easy to think that either you're born with the ability to react coolly in an emergency or you're not. But that's not the case. The first crucial factor is knowledge of what to do in an emergency, and what to expect -- first-aid classes, instructions like this triage training here. The second one is practice. After a few rounds calling 911, after dealing with more than one co-worker having an asthma attack or shock set in, you know how to react. And it's not such a big deal.

And it means the world to the person you help, even if all you did was call for medical aid and sit there with them being calm or holding pressure on a wound.

What I really enjoyed was the CHALET report format:

If I'm first on scene at a Major incident, then if I am the attendant I need to run around the scene to do a quick bit of reconnaissance, I'm not there to treat anyone. I then get back in the ambulance and radio in a "CHALET" report. This is...

C - Casualties (number and severity). H - Hazards on the scene. A - Access, meeting points, vehicle parking area. L - Location, the map reference and best directions to get to the parking area. E - Emergency services required. T - Type of incident.

"Casualties (number and severity)" is what you've just learned from doing your START triage.

That strongly reminds me of the SALUTE report that we had when running around in various jungles, on making contact with enemy forces. The report you radioed back:

Strength
Armament
Location/Logistics
Uniform
Transport
Equipment

Both of those reports are designed so that if the transmission is cut or garbled, what you've already sent is the Most Important Stuff for the guys back at command and control to know what sort of response is most appropriate. (Uniform there is whether they're wearing uniforms, and if so, what kind.)

In a Wilderness rescue, one official position in the rescue team is "Patient's Buddy." This is one individual who has no other duty than to stay beside the patient and talk to him the whole way out. While you're going to be switching through a lot of folks doing the carrying (three miles into the backcountry and figure you're going to need twenty-one individuals switching in and out as bearers) the Patient's Buddy walks by his head, just chatting, telling him what's going on around him, determining the patient's wants and needs, explaining stuff, and incidentally keeping an eye on the patient's level of consciousness. While other folks hand off their assignments, the Patient's Buddy is with the patient the whole time, which could be hours or days. One face, one voice, right the way to definite treatment.

Jim, one question. If someone isn't breathing after you open their airway - and you got there really fast after the incident, suppose it was a bombing or something - why do you tag them black? Isn't it possible to get them started breathing again?

You wouldn't spend the time if there were other people who might start breathing on your own...but isn't there room for circumstance here? If you can tell by a visual that everyone else is yellow or red, for example?

Almost all of this information was new, but it all made sense to me except that bit. Can you clarify?

Well, four to six minutes without oxygen and they're probably going to be braindead anyway. Resuscitation is a labor-intensive activity.

Some people, in triage situation, might throw an oral airway into the non-breathing patient and give two breaths with a bag-valve mask (if you have the oral airways in your pocket and you have the BVM in your hand). But after that, time's up. You have other, more important, things to do right then.

When you're doing triage you aren't doing treatment. You are looking at an overwhelming task. Break it down into smaller parts that you can do. Get a system; use it.

(BTW, when I go out, I carry an 8cm oral airway in the lower left pocket of my jacket. Your 8cm airway is the most common adult size.)

If you have someone who is breathing 30+ times a mintute, and someone else not breathing at all ... the guy breathing at 30+ needs just as much help, but has a far better chance of living if you do something right now.

Wow, I really feel the need to get some training in this stuff...I should try to find out where I can get some.

Also, the Red Cross will send trainers to any place where you can assemble a group interested and willing to pay the fees. I'm not sure what the minimum number is.

Size
Activity
Uniform
Location
Time
Equipment

On the subject of attitude, and being calm:

There are a host of other drills, like the 9-line medevac (which tells how many, in what condition, where, how to approach, hazards to navigation, etc.).

The 8-step method of evaluatiing a casualty, the 9-signs of minor nerve-agent poisoning, and the 11 for major, acronyms for all sorts of things, instructions on the four lifesaving steps (open the airway, stop the bleeding, bandage the wound, treat for shock) are on the wrapper for the field dressing, and a host of others, are all meant to make it rote, or at least familiar.

That's to teach you to be calm: "To keep your head when all about are losing theirs."

And that, I have found, is often the only thing that matters, someone keeping calm.

TK

The only vaguely useful things I carry are a mobile phone and a selection of pens.

What kind of emergencies? That's a question that can be answered in many ways.

I'm not an EMT or vaguely like one. What's in my car's trunk:

Blanket(s). Tarp(s). Rain poncho. Bottle of cheap aspirin. Rope. Hatchet. A few cans of food (stew, fruit). Dog food. Flashlight. Flares.

I will probably add a waterproof box with some matches.

I've occasionally wondered, given that one of the area's failure modes is a volcano going off, if a spare air filter might be a good thing to keep around.

I'm sure there's a best-by date on the bottle.

General FYI:

Walgreen's regulary has $.39 or "2 / $1.00" sales of handy first aid items like hydrogen peroxide, isopropyl alchohol, 100 bottles of aspirin, etc.

When I had to empty out my "use it or lose it" medical savings account last month, I bought a ludicrous amount of first aid gear and over-the-counter remedies. My immediate family members are all getting first aid kits for Christmas.

This time of year, the only things I carry around that are for emergencies, in that sense, are the teeny first aid kit that lives in the belt pouch, the small first aid kid that lives in the bike rack pack, and the sorta medium first aid kit that gets tossed in if I'm going on a significant cycling trip.

Well, ok, possibly the umbrella counts as an emergency thing, too, because it's the umbrella for bringing when rain isn't expected.

The pens, LED lights, spirit level, whistle, thermometer, antiacid, lighter, utility knife, diamond hone, ceramic hone, flint and steel, glasses retaining strap, optics cleaning cloth, and glasses repair kit live in the belt pouch (along with my wallet, change purse, PDA, work ID badge, and a couple of 2 meter nylon web straps) because I feel like a complete moron if I want them and haven't got them.

Pockets get the Swiss Army knife, another LED light, the 3 foot measuring tape, the utility cord, the Space Pen, the transit pass, the business card holder, and my keys.

That's the sort of minimal 'might be useful' set of stuff; no compass, no water containers, no ability to filter or purify water, no fuel, no food, no spare clothing or rain gear or shelter materials, no ax, all of which I'd consider pretty much basic for actual survival in any emergency dire enough to make me worry about survival issues in the middle of Toronto.

In the winter, I've got IceWalkers (cleated sandals that go over your boots), a survival bag (like a blanket but a bag), a spare hat, a couple of survival blankets, and a lot more implements.

For inter-urban bus travel, mostly, yes. The Lady of the Ice has a very limited conception of mercy.

I'm told by friends who lived in Portland, OR during Mt. St. Helens' 1980 explosion that an old air filter is better than a new one during an ash fall - just pull it out of the car, whack it on the ground to knock the ash loose, and put it back. Ash particles are tiny enough to get through the mesh of a perfectly new filter, but an old half-clogged one will block them.

On my belt, all the time:
Buck knife.
Gerber Multi-tool.

In a bag, which gets dropped into whatever I'm carrying:
Airways (one adult, one child)
A couple of Army Field Dressings (6"x7" sterile, with long tails to keep the badange from shipping dirt, can be modified to pressure dressing or tourniquet, and with the wrapper can be used to treat a sucking chest wound).
Iodine

random things of similar nature in the camera bag, the knapsack and the camelback.

If I'm heading out with the horses, or hiking, etc. I have a bunch of bandaids, more dressings (including a couple of really large ones meant for open abdominal wounds), cravats (for splints, and (God forbid I should need to build one myself, a traction splint for broken leg) slings and making compresses, burn salve, neosporin, gauze, ace bandages, scalpel, tweezers.

The last time I had to use it was to treat a pair of mule-foals who had stepped in a cattle-guard.

There are somethings, meant to be used for horses and cows, which one might want to get for people bags, like vet-wrap, and the like.

TK

This is the list of things that fit into the tiny, girly wallet-onna-string that I always carry. Unlike some folks, if I had all sorts of useful stuff in a belt pouch, I wouldn't ever have the thing with me, 'cause it would look silly on me (looks perfectly reasonable on other folks, sure, but not on me), and I know myself. Also, I don't usually have pockets.

Since I don't have a car, I don't keep things in the trunk (though I did put together pretty decent emergency kits for my brothers' cars as a Christmas gift).

In the girly bag:

Swiss Army knife
Cell phone
Sharpie marker (soooo useful for so many things)
Alcohol prep pads
Hand sanitizer, when I remember to put it there
Cash
Lightdays sanitary napkins (they're small, they're individually wrapped, and they absorb all manner of things)
Whistle
Gauze pads in sterile wrappers

This, in addition to the stuff I use more frequently:
Lip gloss (it is a girly bag)
Wallet
Business cards

And the one non-useful thing:
Photo of cat

I should stuff some nitrile gloves in there, too.

There's more useful stuff in the bike bag, but the girly bag is the stuff I'm never without.

I think it was Gwydion who wrote:

Now the Leprous-White Lady
Leads her train of the Lost
Leads her spirits through glade and wood
And goodly fields of frost.

A. They're extremely cheap and readily obtainable;

B. You can use them at an accident site where there might be a danger from spilled fuel or other combustible chemicals, because they won't ignite anything;

C. You can tuck them in a pocket or elsewhere on your person without worrying about burning yourself;

D. You can secure them to physical objects (trees, signs, etc.) with duct tape for instant attention-getters. You can even secure them to yourself (chest, back, back of a hat) to increase your visibility at night; and

E. Even small children can handle them without getting burnt.

For those interested in this topic but freaking out a bit at the thought of it all-- just remember that you do not need to carry a Batman utility belt on your person at all times. Too much stuff on hand can be confusing and time-wasting if you don't drill with it regularly.

Last month, I asked a fellow firefighter for a spanner wrench (basic FF tool used to loosen and tighten hoses). He dug through three pockets on his gear, and accidentally tossed me six pairs of loose nitrile gloves and a packet of aspirin along with the wrench. Too much stuff.

A pair of nitrile gloves* and a CPR barrier mask will take up about as much space as a checkbook, if that. And if you're still averse to carrying stuff like this because you just don't think you could ever possibly use it (squeamishness, nerves, infirmity, whatever), kudos to you for your honesty, but who says you'd be the one to use it? Carry it around in a purse or glove compartment, and you might just be able to pass it on to someone who can.

----

*These suckers aren't just gloves, they're multi-tools. They can be tied around a limb (up to a certain size) as an emergency tourniquet. They can be used to tie hair back. Fill them with ice and they become little ice-packs. You can stick them on things as markers-- "We had to leave two people who couldn't move in the room on the second floor with the glove on the doorknob! Please hurry!"

It only sounds dorky until all hell breaks loose around you.

And for certain exotic transhumans, they're dandy condoms!

What I carry:

In a belt holster: radio, flashlight, shears, gloves.

In lower-left patch pocket: 8cm oral airway
In lower-right patch pocket: more exam gloves
In upper right zippered pocket: combo seatbelt-cutter/oxygen tank wrench
In upper left zippered pocket: nothing. It's where I put my radio when I'm working.
In slit/handwarmer pockets: heavy leather gloves
On belt: Buck folding hunter knife, Leatherman multitool.
In left cargo pocket of trousers: CPR mask + gloves (in the same case)
Right cargo pocket of trousers: Notebook and pen

During the part of the year when I'm not in a parka, I'm in a three-season jacket. Oral airway and seatbelt cutter in left pocket, extra gloves in right pocket.

----------

See my emergency kit page for the contents of my wilderness bag and my first aid kit.

(The Wildnerness bag is when it comes across the scanner, "Fish and Game is looking for a search party for a lost hunter. Gather in the school parking lot." Throw that into my normal backpack. The first aid kit is for when I don't have the ambulance with me.)

For the car I'd make sure to have both, and use the old Chem-lights as party decorations at Hallowe'en.

Holy colliding initials! My immediate mental unpacking of BVM was not 'bag-valve mask' but the Blessed Virgin Mary. Probably also good to have on-hand in an emergency.

Vassilissa, I have a similar problem whenever I see the World Taekwondo Federation's initials (I do taekwondo, but not at a WTF-affiliated school).

Back in the battlefield first-aid parts of my Army basic training (early 1970's), the instructor drilled us newbies, over and over, that the first step in treating an injury was "clear the airways".

So he gives an example of a typical battlefield injury. "What do you do?" "Clear the airway, Sergeant!" we respond.

He gives another example. "What do you do?" "Clear the airway!"

He tells us: "An artillery round lands near you. You see your buddy's legs have been blown off above both knees. What do you do?"

"CLEAR THE AIRWAY!!" we all shout in reply.

"WRONG, YOU IMBECILES!* By the time you clear his damned** airway, he'll have bled out and died! Jeezus, did your mamas drop you all on your heads?!***"

So, in a traumatic injury with massive bleeding, yep, a tourniquet is called for. (If I recall correctly, if the lower limb is still attached, you loosen the tourniquet for one minute out of ten, to try and keep some bloodflow t the lower limb, and possibly stave off the need for later amputation.)

*"imbeciles" was not the word he used

**that wasn't the word he used, either

***what he said our mamas must have done with us was much more colorful

If the man with both legs blown off also isn't breathing, he's dead anyway.

If the man with with both legs blown off is breathing, talking to you, screaming, he's got an airway.

If he doesn't have an airway what you do with his legs doesn't friggin' matter. And it takes approximately one second to open an airway.

Where'd this guy get spawned?

Anyway -- if you put on a tourniquet, and you loosen it -- all you're doing is putting cold, dead blood full of lactic acid and carbon dioxide back into central circulation. Good job, chief, you just killed your patient.

If you use a tourniquet you've just decided that the man is going to lose that limb. Period.

But, I can't really think of an injury to a limb that doesn't respond to direct pressure, elevation, and pressure points. It's possible, with a large crush injury, to not be able to figure out where to put the direct pressure. Here's a trick: Sluice it out with water. See where the bleeding starts. That's where to put the pressure.

And the sergeant did say that the airway should be cleared as soon as the gushing stumps were tied off.

No, but I do remember The Human Ton (and Handy) from The Tick.

"Now that was an Oedipal moment!"
[crickets chirp]
"Oedipus Rex?!"
[more crickets]
"Read a book!"

If you're looking to buy gloves, the Fisher nitrile with aloe are the best of any disposable gloves I've ever worn. Now everybody in my lab uses them. My brother-in-law who changes car batteries for Sears says they're the longest-lasting he's found... The small size seems to map to "tiny, child-sized or woman under 100 lbs", medium is "most women", large is "most men", XL is "men with big hands."

As for WTF, one of the guys in my kali class was talking about a taekwondo tournament he went to watch, and how it seemed stultified with rules... "They can't punch?" "No, WTF rules!" "They can't kick for the legs?" "WTF!" "They can't scoot around to the side?" "WTF!" :)

TK

The basic grade doesn't protect against the mould spores that can cause farmer's lung. Tou can get finer filters. Instead of being s sort of moulded fibrous paper they have some thickness, with extra filtering layers.

Anyway, that sort of rigid disposable mask maybe isn't so easy to pack, whatever filtering level they give.

It does depend what you're expecting to need protection against.

I don't actually know, but I'm guessing it may mean insulin.

ljjones[at]ix.netcom.com

I think it's a storage vial with medical history, kept in the fridge as a standard location. (I vaguely remember hearing about this sort of thing.)

Vial of Life:

This is a pill bottle, which you keep in your refrigerator, that contains a sheet with your medical information on it.

Here's AARP's description:

How the Vial of Life Program works:

* The Vial of Life puts important instructions in the hands of Emergency Responders and Physicians when it is needed most—during the first minutes of critical illness or accident in your home.

* Emergency Medical Personnel in the community have been notified to look for your special Vial of Life magnet.

* Simply complete the medical record forms with the assistance of your doctor or a family member.

* Ask your Pharmacist to add any new prescription to your medical record.

* Tightly roll up the completed forms, include your Living Will or Advanced Medical Directive, place them into the Vial of Life and put the cap on the Vial. Attach the Vial of Life under the top shelf of your refrigerator on the right hand side with a twist-tie or scotch tape.

* The second Medical Record is for your personal use and could be taken with you when you travel.

* Place your Vial of Life magnet on the front of your refrigerator.

Here are some links:

Santa Clara County FD

UNM Health Sciences Center

Alameda County FD

My Precious Kid (includes a form and labels)

The National Exchange Club

AARP

Get stickers and magnets here. (Among many other places.)

It's medical information for EMTs, stuck to the fridge where it's easy to find.

It sounds like a pretty good idea. Of course, a standard smartcard that could hold one's medical records and be read and updated by all hospitals, doctor's offices, pharmacies and first responders would be better. But this is America, and such a system would require government to set a standard, and government is (apparently) un-American.

Pardon my off-topic display of bile.

Except that using "a standard smartcard" is only useful if the responders have a machine handy to read the smartcard. With the hardcopy tucked inside a pill bottle (though with my wife's medical issues, she'd probably have to use a mayonnaise jar or something equivalent), the responders only have to be literate.

(Yeh, a card reader might eventually become standard equipment. In how many years?)

He didn't use the bystanders to apply pressure to the femoral arteries because none of the few people who were around were willing to approach the patient that closely. Some of them were too busy freaking out, but the it turns out the rest knew something my cousin didn't: the victim was the brother of a mob boss. Hence the car bomb.

(And when the mob boss sent a $5,000 thank-you check to my cousin, boy, wasn't THAT awkward for him, for the department, and come to think of it probably for the mob family.)

So yeah, as far as I know, the only remaining reason to use a tourniquet is if the limb is doomed anyway and you don't have enough hands available to apply pressure to all the spots on all the people who are bleeding.

(Caveat: I am SO not an expert. I am, however, as someone with a neurological disorder that usually prevents me from outwardly expressing recognizable emotional expression, always apparently calm during emergencies. So I've studied up a bit, since people keep PUTTING me in charge during emergencies.)

After all, you have to make sure all your college friends, and their friends, have jobs.

Or quelling disturbance?

TK

(I apologize if quoting this in its entirety is bad netiquette)

http://www.counterpunch.org/neumann09062005.html
But What About the Snipers?
By MICHAEL NEUMANN

All the vaguely sane world understands that the poor of New Orleans, whether because of their race or their class, got the worst of it. But, someone might say, what about the snipers? Looting food, ok, looting stores, well, that's a crime against property, not people, but shooting at rescue helicopters? Blocking public hospital evacuations? Could anything be lower?

Poverty isn't known to bring out the best in people, and the worst in people can, of course, weaken sympathy for them. Should we sympathize with some poor victims of New Orleans, but not others? Are there Good Victims and Bad Victims? Can you tell who's who?

Without damning or excusing people we know nothing about, it might be worth looking at possible reasons for their actions. Sniping is quite unlike like robbery or rape in that the sniper doesn't get anything from it. This isn't ordinary crime. The last thing a robber or rapist or junkie would want to do is shoot at hospital evacuation helicopters, something guaranteed to bring more police and troops into the area. In short, criminals ordinarily don't want to call attention to themselves.

What actually happened? The rescue professionals found themselves utterly incapable of saving everyone. As all their training requires, they decided to practice that favorite of hospital shows, triage. Normally, triage means saving the very worst off first, and hoping to save the others later.

In this case, it turned out to mean leaving the others die, and saving some of the very worst off: there were likely others, dying in attics, unknown and unheard, just as badly off. It meant saving, for instance, critically ill hospital patients, people whose condition and location were known, and who had to be among the worst off.

The rescuers workers could feel they were doing good, but their efforts were not solving the problem. That you can't make a serious attempt to help 80,000 victims with a few helicopters, winching up one person at a time, this was nothing the rescuers could affect; it was not worth thinking about.

But the other people, the ones the helicopters had to pass over, the abandoned, I'll bet they were thinking about it. Maybe - oh, very likely - they were wondering what to do.

So, again, what actually happened? Because there was shooting, the hospital patients could not be evacuated. Though the efforts of the rescuers were heroic, the scale of the rescue was pathetic, and on the way to becoming more pathetic still. One thing, I think, was certain and obvious. The people who really could help, the Federal Government and Bush's bureaucrats, at least some of those people with their formal requests and their triage procedures and their professionalism, and some of the rich, some of the powerful - these people wanted the helicopter evacuations to work. This half-ass effort was their only demonstration of compassionate competence. If the rescues failed, those responsible would have nothing, not one little bit of success, to show the world. There would be no containing the outrage, no damage control. The humanitarian disaster would produce a political disaster.

Now suppose you were a pissed-off thug living in filthy water, with the dead floating by, with crying, dying, frightened, hopeless victims all around you. You might fire on a helicopter just to make it clear that being left to rot was not acceptable. Or, if you were calm enough to think things through, you might ask yourself: what leverage do I have? What do those who have power over thousands of helicopters and rescue craft, over hundreds of thousands of rescuers - those smug assholes asleep at the wheel - what do they want that I can deny them?

Just one thing, to me anyway, comes to mind: the snipers could deny Bush and his minions their face-saving operation, their little bit of success, their triage. The federal authorities would do anything to save some people. They would even get off their asses and send in troops, massive military convoys, not fast, because it was too late for that, but finally. And with those convoys would come - this too was clear, wasn't it? - massive aid, massive rescues, a massive effort to save, not a few victims, not the cosmetic cases, but everyone. Or at least, from the standpoint of an ignored victim, blocking the helicopter evacuations was the only thing that might bring this result. If there was anything any lone thug up to his knees in filthy water could do, this would be it. Let the helicopter evacuations proceed, useful to a very few, and what could reasonably be expected? That real massive help would take much longer to come, because there would be less outrage, less desperation, from the comfortable people deciding who should live or die. The choice of the Bush administration was to save a few, to keep their own peculiar sense of proportion: moving heaven and earth to kill Arabs is one thing, moving heaven and earth to save a bunch of welfare cases is quite another. Triage was a part of business as usual, what Maureen Dowd described as "a chilling lack of empathy combined with a stunning lack of efficiency".

The choice of the snipers was to undo this triage, this business as usual: all would be saved, or none. Maybe the victims thought they too should have some say in who lived and who died. Maybe they thought that triage was only as legitimate as the need for it: was this really the best that America could do?

Would this make you take aim at a rescue helicopter? You don't know; you weren't standing in that water. Were any of the snipers thinking anything like what I've suggested? And if they were, would that be any kind of excuse? You don't know and neither do I.

I do know the shootings loomed large among the reasons that the troops finally got moving, bringing with them the first massive relief operations. If anyone adopted the strategy I imagined, it seems to have worked. I also know that much is permitted to people fighting for their lives, and the lives of others.

I can't help wondering if some of the gunshots reported might not have been intended as the equivalent of shooting off flares. Sending a message of "Hey, I'm over here!" rather than actually trying to harm rescue workers...