Medical Kits – subverting the dominant paradigm

bitchslap
CAUTION: This post may turn some sacred cows into succulent tenderloin and juicy hamburger. pa4ortho is de-cloaking to unleash a volley of medical photon torpedoes in a broadside attack on gear-centric medical care in austere environs. Enjoy it. We sure did (after licking our wounds).–IvyMike & Grouch
Although it’s my name on the top of the post, this is all pa4ortho. Credit where credit is due.–Grouch
Oh yeah, on any gear mentioned in this post – for good or ill – the faculty of Hogwarts have no financial interest in manufacturers, vendors, or distributors. – IvyMike & Grouch & pa4ortho

Medical gear philosophy

A new private out of AIT wants to know: what’s the aid bag load plan? He gets great comfort in having a bag packed just like he was told to do. Much of the bag’s contents are high-tech gadgets that were placed in the bag not because they were needed, but to get funding. In order to hasten the procurement process an individual pushing for the new load plan only need add a few extra tidbits at the request of lobbyists for various manufacturers in order to get a few influential senators to back the bag. Hence we have the ubiquitous single purpose Benchmade hook knife in addition to scissors in every Combat ‘Lifetaker’ Bag (CLS), or the Asherman chest seal, never proven to have any benefit as a chest seal with a valve. How about the absolutely worthless Sawyer extractor? Millions sold, no value to the patient outcome.

gearwhore

Hold on guys, I just need to grab my med kit.

Later our private becomes a SGT.  Instead of tossing out gear, he gets more training and adds more high tech gadgets. His bag gets huge. He can’t do a push up with it, he can’t fire and maneuver, but by gosh he has separate solutions for IV, irrigation, and eyewash. Three pen lights, a flashlight with 2 colors of lightsaber attachments, and a headlamp. No one ever taught him about medicine, so he has lots of OTC meds like hydrocortisone, where the base petroleum jelly has more treatment value than the impotent steroid. He gets hot packs; comfortable, but will not change your core temp any more than it will change the temp of a 5 gal pail of water if you drop it in. He gets uncovered surgical tools ’cause they looked cool on Blackhawk Down, are as clean as the open sewer swamp he just set the bag down in, and sticks them in a nylon bag that he just contaminated with his first patients’ blood when he puts them back.

As he gets on in his training he learns to only carry items he needs. They must be multifunctional items. He learns to make an eye shield from stuff he already has, not a pre fab whiz bang one, etc. He learns how to make do with what he has as he discovers all the training on the CAT-T that every soldier carries (so he only needs 2) won’t help him when faced with 50 blast injured Iraqi policemen or Boston Marathon runners that don’t have them. He learns to improvise. He knows to cut the end off a SAM splint instead of carrying finger splints. A SAM splint becomes his extraction collar. You get the idea. Make the most with that you have.

The intellectually lazy want a set kit someone with great credentials “the Army” “SF” or “The Marines” put together for them.

Arguing about exact contents is a futile endeavor as it’s all based on a study of “what if?”

As environments and missions change so should your kit.  The kit you take to war won’t be ideal for a camp trip by the river with your family.

As with any kit it starts with a medical assessment. In no particular order:
1. How many are in the group and what level of training do they have?

2. Budget and weight (if you don’t have SOCOM’s Budget and supply chain, your priorities may be different)

3. What are the top medical threats? Weather, terrain, wildlife, 2 legged varmints? For travel to new areas do your research. Use local docs, trauma pattern studies based on your activity, missionaries, news reports, CDC, expats,  etc…

4. Which of those threats are time sensitive and fixable with what you can carry in an individual kit? If it does not fit that criteria it belongs in a main aid bag or somewhere else. Basically, how can you mitigate risk within your available resources?

5. What are the intrinsic medical problems within the group or individual the kit is for?  ie. allergic to bees, heart problems, diabetes, etc…

6. What are the distances/obstacles, time, and availability of the next layer of care? Main aid bag or hospital or aid station?

As an example, I will load my pockets with items when providing coverage for a large group, for example, narcotic pain meds and antibiotics when working a community in the developing world. When moving with a Battalion on planes I will pack motion sickness, and sleepers and anxiety meds to manage inflight issues when separated from the main pharmacy bag. As the doc it’s your job to anticipate issues and worst case scenarios and plan ahead.

The modular, layered medical kit

In blatant violation of the training and experience centered philosophy above, this is how I set up my medical equipment on deployment.  Again, don’t mistake gear for brains.  This is broken into trauma and medical modules.

Layer 1 – what you carry on you

Unless you are like a certain paramedic I knew a few years ago, you likely do not have an aid bag on your back 24/7.  Layer one is learning how to use the clothing and gear you already carry as an aid bag. I’m not talking about dependence on fancy EDC (Every day carry) micro pocket gadgets either. It’s t-shirts, pocket knives, keys, pens, and stuff in the environment you reside in. It includes an awareness of resources in your environment such as tap water, bottled water, etc.  You may even cache some supplies in work areas. It includes equipment you may have in your pack or BOB (bug out bag) like sleeping mats, sleeping bag, water purification items, a bush knife, cordage, tarp, and so on.

It also includes cross training those around you in these same skills. The medicine they know is more valuable to you personally than the medicine you know yourself.

This class takes about 6-10 hours to teach. I have taught it in the western US and in 4 countries. It is particularly suitable to the developing world/grid down/resource poor environments. We will try to cover a lot of the material in ongoing posts on this site.

 Layer 2 – blow out bag

This is a small bag that can manage a single patient due to a gunshot wound or other penetrating trauma. It does not contain sunburn cream. It is a single focus kit for combat.

There are various configurations of an Individual First aid kit IFAK or Blow out kit. They are basically a kit for an individual to carry based on a threat assessment of the environment you are in.

I have one on my armor, I also have a small one as a leg bag in the event I am not in an armored environment. BTW I hate leg bags hanging up so it’s usually riding somewhere else.

Contents:

 I prefer a drop open bag where the outer flap is inverted when closed and right side up when opened.  A blow out bag can be expanded to a flat ruck or one shoulder diagonal ruck that can be swung in front of you to access but never gets set down if you are the designated medic.
All this does is provide care until you get to the casualty collection point (CCP), or the main aid bag, hospital, or docs’ garage. You get the idea, the next level of care for definitive treatment.
Remember, when you don’t have this or you run out of stuff, revert to Layer One.

Layer 3 – main trauma aid bag and sub kits

You will find this with the medics, PAs, docs, and nurses at the CCP or extraction platform. It’s basically is the same as above, but more of it. This is the gear you use to do more advanced care and prep the patient for transport, surgery, or his imminent demise should the conditions be so austere that none of the above are available. Again it’s mission dependant with add on modules and add on pieces.
  • 0.9% Normal Saline solution
  • Hespan / Hextend
  • IV start kits, with 3-way stopcock and 30cc syringe
  • IO cath kit, (or the EZ IO drill)
  • Sam splints
  • Duct tape and plastic bags
  • Airway kit
  • Sedation kit
  • Gel hand wash
  • Gloves – Black nitrile gloves are Alpha-male tough, but their darkness makes it difficult to see things that may get on them. Get in the habit of rubbing fingers together to feel for blood or fluids.
  • Extraction kit may include Ropes, chain, pry bars, Hi-Lift jack, shovel, fire suppression, cut off saw, blocks for cribbing,
  • litter
  • Sked stretcher – always make sure to pack lots of blankets / clothing between your patient and the Sked. You don’t want to create a burn patient from pulling someone around in one. If you think I’m kidding, have someone drag you on the ground for a minute in one while wearing a t-shirt and pants.
  • Oregon spine splint – Fire and EMS guys, this is a KED, and it can be packed and used with the sked for extraction.
  • Mass casualty bag, this is basically a big bag with 1 gallon ziplocks filled with blow out bags, one per casualty. When medics move forward they can resupply by taking a whole bag instead of individual items. It’s faster.
  • Cold weather kit-
  • NBC kit

Layer 4- ICU bag.

This bag in my kit is bright orange. The color is a reminder that if it’s a tactical environment it’s not to be used. Also I can say to anyone, “Go get the orange bag!” and it’s easily found in the sea of green ones.

The contents include a full assortment of high end airway stuff, portable vent, meds for a code and trauma, IV pump, chest tube, The details are not important as if you get to this level you need to pack it yourself. The load plan shifts a lot here and overlaps with the surgical sets in other kits.

Layered medicine bag

Layer 1: Portable bag

It’s hard to improvise medicines, especially since the number one killer in the woods is the bee sting. We need to be able to manage stuff like that, so here are some suggestions. Keep in mind we are still talking austere care and not definitive care with air conditioning, 378 channels of TV, and a nurse call button every time you have to poop.

Please also remember the Medical Assesment above, and specifically focus on #5, the intrinsic and known medical problems of those in your group.

I use a series of small aluminum sealed keychain fobs of different colors that contain medicines focused on a particular body system or emergency.

fob

For example, my cardiac fob is red and contains a nitroglycerin patch, aspirin and/or Plavix, and metoprolol or other beta blockers . .

Anaphylaxis, (fits in a sharps shuttle) diphenhydramine, prednisone, albuterol MDI (on a seperate ring) EPI 1:1000 vial with a 1cc syringe (you can use the syringe multiple times on the same patient). Prednisone PO (by mouth) has rapid onset in under 10 minutes so I don’t carry IV or IM steroid anymore. It may need to be crushed and made liquid to swallow however. Zantac, Allegra.

Pain, tylenol, meloxicam, oxycodone, fent pop, fent patch,

GI, pepto bismol, immodium, Cipro, flagyl,

And etc.  As many systems as you need.  The keychain fobs force you to keep it small.

I have a knife that unscrews to open on a sealed kubotan handle that is filled with Hibiclense. The back side of the baton is a blunt trochar.

Small tweezers are also usually on the ring. You might add a magnifying glass if needed, or a small light.

That’s the small med kit. It can ride in small bag with other medical-related items or in a large pocket.

Large Med Bag

For bigger groups I use Ziplock pill bags in insulated soft boxes, think canvas with zippers with ensolite pad foam. You can make these yourself with your leftover pouches in your kit for cheap. Keep these out of the sun, and don’t let folks sit on them unless you want them to snort their medications. This bag is about the size of a suitcase with straps and treats very large groups.

Even though the following are not meds, the large med bag is where they lived: a stethoscope, ENT scope with tools and diagnostic bedside test cards.  It just seemed to work out that way.

Derm, diflucan, tegaderm, high potency topical steroid, silver sulfadiazine, etc.

EENT, otoscope, ear loop, olive oil, silver nitrate stick, tetracane, flourecin, cortisporin ear drops, ear forceps. Also a small meconium trap with a small suction cath, mouth operated for clearing ears.

And so forth.

Basically what I did when setting up sections was go through the Tarriscon Pharmacopoeia by system and select a few important drugs from each section that I was setting up. Each section became a pouch with some smaller ones combined.

I also carried a Tarriscon pharmacopoeia, Sanford antibiotic guide, and a small netbook running old windows XP. On the laptop, I had:

Illiad 4.5 is a diagnostic program that takes data and give a list of differential diagnosis.

MAXX contains 26 medical specialty references and is searchable

5 Minunte Medical Consult was also an old good one.

All of the above are references from the late 90’s when software was on disk and did not require internet to function.  This requires power but also can run digital ham programs and mapping software.  It never goes online to prevent malware.

That should get you started.

–pa4ortho

 

34 responses to “Medical Kits – subverting the dominant paradigm

  1. Pingback: Hogwarts: Medical Kits – Subverting The Dominant Paradigm | Western Rifle Shooters Association·

  2. Reblogged this on Starvin Larry and commented:
    Great job guys!
    I keep telling people that you do not try to suck the venom out of a snakebite-it simply does not work,and may spread the venom faster because as you’re using the pump-it causes more blood to flow to the area of the bite-and then away,carrying the venom.
    But I’m just an ex-professional chef turned carpenter/handyman-so I can’t possible be right can I?

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    • Venom spreads via the lymphatic system, not the cardiovascular system. And in every study I’ve seen suction did remove some amount of venom from the wound, so it might be worth rethinking that “it simply does not work” to something more technically accurate like “when used as directed, the Sawyer doesn’t remove clinically significant amounts of venom in the majority of cases”. In a situation where a dozen or more vials of antivenin and advanced medical care aren’t an option, mechanical removal of venom and envenomated tissue might be the best treatment. It’s the only “grid-down” curative treatment option available anyway. Just need to be prepared to deal with the resulting additional tissue damage the treatment will cause.

      Thanks for the read guys. Most of the items listed in layer III and IV aren’t in bags but in boxes on shelves here, might be time for me to rethink that strategy. Hmmm, no mention of local anesthesia either?

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      • Splitting hairs-there are multiple toxins in every venom,whether it’s from snakes,insects,gila monsters,or spiders,every one of them enters the body originally through the skin and blood vessels transport it from the site where the venom is injected-if a big rattlesnake hits you in a vein,and has injected a full dose of venom-you will most likely die,and anti-venin most likely won’t save you-because the vein transported the venom from the injection site.
        The chances of getting bitten by a poisonous snake in the U.S. is very low,just like you don’t sneak up on grizzly bears-you watch where you put you hands and feet in areas that have venomous snakes. Most people survive copperhead/cottonmouth and rattlesnake bites,except for Mojave rattlesnake bites-for whatever reason,that subspecies appears to be more venomous.Unless I,or someone in family gets bit by a mojave rattlesnake-which isn’t likely in Ohio-I’m not using any pump to “extract” venom.
        SOME of the toxins are in fact spread through the bloodstream.

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      • OK, it doesn’t remove a significant amount of venom, and no, extraction is not curative. That it works at all is because most bites are not envenomations and people survive despite the treatment.

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    • Having been bitten by a Mojave Green I can tell you if you have getting bit by a venomous reptile on your bucket list, don’t. 3.5 days in the hospital , 33 vials of antivenom and serious discussion on removing my leg, consider that ticket punched.

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  3. Good list – just don’t forget some dental tools…temporary filling kit, oil of cloves, maybe some tools (or a Gerber Multiplier) for extraction.

    I like to keep some benzos onboard with ketamine, and if the situation calls for it a pre-loaded B52 (50mg diphenhydramine, 5mg haloperidol (Haldol) and 2mg lorazepam (Ativan) )in case someone needs a time out.

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  4. I use and recommend garlic oil with cotton plug to heal severe ear ache. Also 50mg Tramadol and 500mg Naproxen once a day for severe back injury pain and Naproxen alone for teeth pain. Naproxen can be off the shelf. And I’ve heard that honey held in place with wrapping works well for open wound healing.

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  5. Thanks for the feedback

    I can toss up some snakebite stuff but basicly for vipers in the US its keep em calm, go to ER, call ahead to get antivenom enroute if needed. If in grid down keep em down and calm. provide supportive care for volume and ABC’s
    do not: cut, suck, constrict, raise, lower, apply spit and herb, or otherwise do anything to further damage the area.

    Dental is a seperate bag for me. I have typically kept it seperate back at an aid station but if going out to treat patients in the 3rd world its an indespensible part of the kit. I could see dental extraction being a very valuble skill in a grid down setting. Powdered lidocaine/marcaine is on my to purchase list. I have a small kits and a big kit. ebay “malik” for 150 and 151 dental pliers at the minimum. I carry some others as well.

    I do keep the kit light. I dont carry injectable valium due to heat stability issues most days but have in the past. Its helpful for seizure/head injured pts. For crazy, I use a B blocker like atenolol or metoprolol from the cardiac kit first to try to calm them down or at least make it easier to catch em after they run off naked into the woods…. If that does not work I go mutual of omaha on em and dart em with the ketamine.

    I do have PO valium in the big kit next to the ketamine as well as atropine for post emergant issues and keeping down secretions if needed.

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  6. I dont use J tubes at all unless the patient is fully under anesthesia due to risk of aspiration from a gag reflex.
    I dont use NPA very much although they are a fine tool. I find it gives more airway reassurance to the medic but the patient on his back is still at risk.
    the old WW1 expression was “those who face the heavens will soon be there”
    In my primary survey when possible, I cross the legs when checking there and place an arm under the head after checking there and do a log roll. then bend the top knee a bit. Adds a few seconds time, gets the patient in the rescue position with little spine movement. this way not only does the tounge stay forward but more aspirate (blood,vomit,secretions) goes out instead of back in towards the lungs. It also (admitedly imperfectly) identifies the patient as someone who has been checked.
    If you take a big hit and cant fight or function at all or are hiding hurt awaiting extraction, I reherse those around me to try move yourself into this position before you pass out if possible.

    I do have an NPA in the main aid bag and in the light airway kit, It is with a 60cc cath tip syringe as a light suction device.

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  7. Off memory, I would have to look up the exact numbers, of the about 10,000 snakebites in the US there have been about 27 deaths. I think its like 0.2% mortality. Its a whole different answer down under. Usualy there is some underlying issue on why they died. ETOH, small child, unusual bite location, and my personal favorite the snake worshiping cult that treated the bitten high priest with chanting and snake glands for 2 days before he died.

    Of note many “snake bites” you will see are really “stick bites” get a good history of the cause and did anyone reliable actually see a snake.
    the T’s of snake bite are usually well represented in the victim.
    Testosterone, Tequila, (black color or wife beater) Tshirt, Tattoos, Toothless, Teasing (the snake) , Trailer park (victims residence) , Truck with a gun rack…

    and of course……
    Parker’s Quotient in snake bites = IQ of the victim is proportional to the distance of the bite from the individual’ s nose divided by the number of bites ( per incident)

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  8. Honey, or even sugar, is good for healing otherwise intractable wounds – the sugar or honey extracts H2O from the cells va osmosis, killing bacteria. But, it’s messy, it should be flushed out bid and replaced – and is right out if insects are a problem.

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  9. Not to argue cause I’m out of my league here, mostly, but the Alberts, et al, “8 person” study (that didn’t use actual venom) is the most often cited study that the Sawyer isn’t very effective at removing venom – but anyone could probably find a study with that few number of participants to prove or disprove anything. One researcher did speculate that the suction applied to the wound would collapse the fang/wound channels and inhibite the venom extraction. If that were in fact true, a more aggressive/invasive approach might be more effective? Not saying that’s a fact, just that it might be reasonable. Some snake varieties, or younger/smaller ones, aren’t able to bite as deeply given their fang length either, and some bite victims might have been wearing clothing over the bitten area, further restricting the depth the fangs can reach. Suction/negative pressure might be more effective if the venom is closer to the surface. Each patient will present differently for certain, an obese individual with a bite on their cellulite filled ass might be treated differently than a slender kid with a bite on their boney ankle.

    I might have misused “curative” in my comment above as fighterdoc commented, but venom extracted is venom not able to cause further systemic reactions was my meaning. 100% venom extraction shortly after being bitten, while not possible of course, would be nearly 100% curative, no?

    Just not a fan of the “Let’s just wait and see, it’s probably nothing” approach to griddown snakebite medicine, especially when immediate intervention could be life saving and has little risk to the patient. If antivenin was never developed I’m fairly certain medical science would have found other effective methods to deal with venomous snake bites by now, but once you find a cure research into alternative treatments pretty much comes to a halt.

    Anyway, hope the pros here continue to instruct on other, more likely, situations where we need to understand how “griddown” changes things when it comes to practicing medicine.

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  10. In North American vipers the issue is local tissue destruction
    Suction causes more local tissue trauma
    Multiple studies demonstrate insignificant venom extraction
    Accept that sawer ripped you off and toss your extractor. Sorry.
    Turns out do no harm is the best treatment for this.
    As a guy I used to work with said “don’t just do something, stand there”

    Local wound care as flighterdoc says is the issue. Initial standard wound care followed by ulcer care where honey or sugar or root crop dressings may be indicated at that point. Scar management to limit contracture is the last step.

    Liked by 1 person

    • Interesting, treat for cosmetic appearance and ignore the removal what toxin is possible while it’s still localized at the area of the bite. Unless, I suppose, the reasoning is that most wouldn’t know enough to stop a necrotic ulcer from forming, or be able to treat it if it did, and that is a more likely cause of death. Death by complications from a hickey…

      But OK, so in a griddown case of an observed, intentional overdose in an adolescent with multiple oral medications, what would you recommend as the treatment? Careful, trick question….

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      • OK, you don’t believe the studies that show extraction is a myth. Fair enough – where are the studies that show extraction works?

        I have a Sawyer (hell, I have a Cutter, somewhere, in my museum of medical equipment called my basement), but absent clear and convincing evidence (not marketing hype) that extraction works, I wont bother with it.

        Liked by 1 person

      • How about you tell me the next time you fly in near me. I’ll buy you a frozen margarita at the airport bar, and give you a skinny, paper straw to drink it with. When the straw collapses and you can’t extract what you want from the glass, we’ll talk more about how the sucker might modify a proven technique to achieve the goal.

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      • I think a better choice would be to hand him a straw and a steak. If one of you can suck the juice out of the steak with a straw, the other one buys the steaks.

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  11. This thread drift is a great example of gear centric thinking and how it pervades the thought process in the austere med community.
    There is a tremendous amount of hype out there due to the big $ from getting a mil contract.
    It takes a lot of effort to reverse institutional momentum in thinking.

    Ralph i’m here to help:
    – step one hold your sawer extractor in front of your face.
    -step two watch the initial video segment of this post over and over again
    -step three ask yourself if you still want to use it. If yes go back to step one if no consider yourself a better off grid health care provider.

    The goal of what Im trying to share is “grid down” long term no resupply or just austere no equipment medicine. ACLS, CLS, TCCC, all are based on a large resuply train backing you.

    For example Bolin Hyfin asherman halo are all wonderfull fancy chest seal dressings for sucking chest wound….. ok except the asherman that one is not wonderfull……. However in the vast majority of the cases the first dressing placed is a hand. If you have no other gear then the plastic wrap from a kerlex roll works well tapes or wrapped in place. Heck stuff it in the hole (dont loose it) You just need to make the hole smaller than the airway so the air preferentially goes in and out of the trach not the hole in the chest. The patient needs to be monitored closely for tension pnumo regardless. Dont transport where you cant watch them. Assign a minimal injured patient to watch them in a mass call. By placing a needle or a small #11 blade slit in the sticky dressing over the hole in the event of tension , it will vent just like anything else will. Strongly consider your situation and place a chest tube if you can. (chest tube can be any sterile tube you have , et tube, foley, suction tube,) You still need a heimlich valve or intermitantly clamp it and monitor closely.
    Understand dressings just bought an unspecified amount of time. He still needs a chest tube.
    In a straight up tension without a chest tube or 14ga cath make a small hole and blunt disect over the rib into the chest. 4 IC space anterior axilary line. It will act as a flap and decompress tension but due to the angle of the hole it will seal on inhalation. Canadian study backed this up.
    Other improvised options include seran wrap around the chest, a mouse sticky pad, duct tape, It all works just the same.
    The advantage of the comercial dressings are they are fast, and stick well (except asherman) The goal is to buy a dressing that sticks to bloody greasy skin, We tested hyfin and halo with good results on wet oil coated privates, had them run 5 miles and then soak in a hot tub for 30 min. Both dressings stuck well.

    Some of the gear is great but you need to know how to function without it.

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    • I really do hate the Sawyer/snakebite example, and I don’t even own one actually. So I guess we agree on that, but maybe for different reasons. I’m not a gear whore, and what you’ve described for a sucking chest wound is essentially what we were taught in boot camp in the 80s (minus the chest tube of course).

      The point I was trying to make (or another dominant paradigm that needs to be subverted) still using this snakebite example is that, based on a few small studies intended to prove whether the Sawyer is effective as a first-aid measure when used as directed, they’ve been hailed as the definitive proof that suction isn’t effective at removing venom from wounds and surrounding tissue. Ankles or asses, viper or coral bites, in animals or people, using Sawyers or Shop-Vacs – none of it matters. I’m sure you saw where I was heading in the poisoning example, so don’t think we need to go there, but the premise is similar IMO. Perfect is not the enemy of good.

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      • Well, there are serious problems in injecting real venom into real people (or letting real people get bit by venomous serpents). The venom analog was designed to be the same molecular weight and charge, so it would act as a reliable replacement for real venom without the risk of hurting people.

        But, you make a valid point, that you don’t seem willing or able to apply to your position. Where is there ANY evidence that any venom can be sucked out of a wound, beyond conjecture? And conjecture is not evidence – it is what leads to a scientific hypothesis, which is then tested as best abled, and we’re back to the venom analog.

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      • The evidence is in the Alberts study flighterdoc:

        “The counts in the body (leg, lung, and pelvis) after extraction were less than the pre-extraction counts by a mean of –1,832 counts/min (95% CI –3,863 to 200 counts/min), which represents the maximum amount of mock venom that the Sawyer Extractor pump was able to remove from the body. When analyzing the data from this standpoint, we observed a mean 2.0% reduction in the total body “venom” load, with the
        maximum being 7.0% in 1 volunteer. ”

        http://coloradowm.org/pdf/suction.pdf

        Mock venom was removed in every one of the 8 subjects, and this was, again, when the Sawyer was
        used as directed – applied externally and no incisions made. We should also make a distinction between “first-aid”
        and “only aid”, removing 7% of the venom load could be clinically significant, if not life saving, in cases where no antivenin or hospitalization for supportive care is possible. Maybe that 1 in 8 chance is the best we might hope for, or maybe some longitudinal incisions between the fang wounds and suction applied subdermally might be even more effective with minimal risk?

        Like I said, research into alternative treatments pretty much stops when a safe and effective treatment/cure is found. I’m not suggesting suction be used for snake bite first-aid when calling 911 is still an option, just that it might be worth discussing updating and improving on some older, less effective, treatment methods when “the best” isn’t an option.

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      • From the conclusion in the study you quoted:

        “Conclusion: The Sawyer Extractor pump removed bloody fluid from our simulated snakebite wounds but removed virtually no mock venom, which suggests that suction
        is unlikely to be an effective treatment for reducing the total body venom burden after a venomous snakebite.”

        So, it removes serous fluid but no venom, or at least not any significant amount.

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      • I know, I read the study. If you had too you wouldn’t have asked for “ANY evidence that any venom can be sucked out of a wound”. Now that we both agree it can be, it’s just a question of how to remove more of it. If you have any thoughts on that I’d genuinely appreciate reading them.

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  12. So, drifting the thread further, food for thought: how do you take care of a patient without that supply train in back of you?

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  13. Hopefully we can relate that broad question into a series of posts on individual health issues. Look forward to your input.
    Sometimes we can make a big difference. Sometimes not so much.

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  14. Great article here. I know some folks that carry great big bags around with them with a lot of whiz bang gear, but in an emergency situation they are sometimes lost without the fancy stuff. This is just a reminder that when in an ideal situation the state of the art stuff is great, but the situation is not always ideal and we do not always have the equipment we want, so we need to be able to improvise.

    Now my next question, and this is purely hypothetical, not everyone would have access to some of those meds on a regular basis, so where does one, hypothetically, acquire those for kits? I know I have some PCN from the fish store, but I haven’t had my fish to the cardiologist to get some Plavix or Nitro.

    Thanks again for another great article here.

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  15. As a licenced health care provider in the USA I dont feel too comfortable directly telling folks how to circumvent the system due to possible repercussions to my licence based on the whims of the medical board in my state.
    You should develop a relationship with a doc you trust and get the required training and knowledge on remote use of medicine. Its not unheard of to have a RN treating patients under a remote doctors supervision on an oil rig for example. Similar to this you can justify getting medications for remote medical use….. planning to provide care to summer campers but it fell thru after buying meds etc…
    However indirectly I have heard about a few things that some people do, that for the record I dont recommend.

    fish ABO
    feed store
    Mexico
    alldaychemist.com

    Plavix is great but is it worth the hassle when ASA is also good?
    NTG can help MI pain and I do carry it but is there a big outcome difference? I think ASA and metoprolol are the primary interventions. Both are cheap and available online.

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    • As a licensed healthcare provider myself, I understand and would never recommend treating oneself over consulting with a PCP. My questions were purely academic for a last ditch scenario where the support of modern medicine may not be available. I appreciate your response based on the same academic exercise.

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  16. Well, while I too am leary about the DEA coming after me, if an established patient comes in and has half a decent story (going on a small boat cruise to the south seas, missionary work building chicken coops in Africa for a month, etc) I might be tempted to give them most anything not scheduled 1 or 2. Maybe.

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  17. When traveling check local regs on what meds you can bring in with you.

    Consider buying your scheduled meds on arrival.

    For local patients who do such work I offer training classes for free and Rx as appropriate.

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    • On a flag registered (i.e. Nationally registered, not state tagged) vessel, the master (owner/captain) can legally carry a medical kit that contains drugs up to and including sched-II. There are various pharmacies and companies that facilitate this, generally the package is sent overnight with tracking and to the ships master, only.

      some sources are oceanmedix and seaside marine.

      For personal use, as long as the drugs are in personal use quantities and pharmacy labeled for the individual carrying them, they’re not much of a problem. Or you can buy damned near anything OTC in most of the world, but in some countries you may not be getting what you’re paying for.

      Liked by 1 person

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