The pictures are from a smoke alarm call at 02:00 recently. Light smoke in a house no obvious fire found, no fire damage was found during the investigation. House was about 4,000 square feet, two story. Attic space on both ends of the house. One attic access had a one foot step down I sent one Firefighter to inspect it after I had to make sure I didn't miss anything. He stepped in before he realized there was step down and I didn't tell him about it. He stumbled and went through the drywall that was the ceiling below. Luckily the open garage door caught him. Tell your people about hazards no matter what. Light bulb moment.

Not everything is lights and sirens.


Captain Swen

      A 23 year old, 230 pound, muscular, African-American active duty (AD) Soldier in the U.S. Army sustained a high-velocity gunshot wound to his left shoulder in Paktika, Afghanistan.  The projectile penetrated anteriorly, immediately inferior to the distal 1/3d of the left clavicle and exited inferior to the left scapula.  He was treated by a first responder AD 68W Combat Medic with two packs of QuickClot Combat Gauze (Z-Medica, Wallingford, Connecticut, USA).  The gauze was packed into the wound under direct pressure and an 18g IV was placed in his contralateral upper extremity.  An infusion of 0.9% normal saline (NS) was initiated at a slow rate. He arrived at the 9 man surgical element, we bypassed EMT and just brought him straight into the OR.

                 After preoxygenation with 100% oxygen, a Sellick’s maneuver was applied to the patient’s cricoid cartilage and induction of general anesthesia was achieved with Etomidate (Amidate, Pfizer, Inc., New York, USA) followed immediately with succinylcholine (Anectine, Quelicin, suxamethonium, Pfizer Inc., New York, USA).  Direct larnygoscopy was performed, a Grade I view was obtained, and an 8.0mm endotracheal (ET) tube was inserted between the true vocal cords to a depth of 22cm at the teeth.  The ET cuff was inflated with 5mL of air and breath sounds were equal bilaterally with a positive end tidal CO2 waveform on the monitor (Propaq, ZOLL Medical, Chelmsford, Massachusetts, USA).
 
                After verification of ET tube placement, a massive amount of blood was noted on the floor.  Upon inspection, the patient had a rapid, active, arterial flow of pulsatile blood emanating from his wound.  An entire roll of gauze (Kerlix, Covidien,-Medtronic, Minnesota, USA) was placed into the wound and direct pressure was applied.  The patient was placed on the ventilator.

                The patient was found to have a partially severed left subclavian artery. 

                Succinylcholine is a widely used medication as part of the RSI technique in combat casualties.  Application of Combat Gauze to penetrating injuries has become routine for U.S. military forces.  The fasciculations caused by succinylcholine can be of sufficient intensity to dislodge the Combat Gauze and result in a rapid loss of hemostasis.   Alternatively, an actively moving patient can dislodge the clot formed by combat gauze.

                  I recommend a reinforcing combat gauze prior to patient movement, using a defasciculating dose of paralytic prior to using succinylcholine, or avoiding succinylcholine altogether if the patient has had a hemostatic dressing applied. The patient also received 4u PRBCs and 4 FFP, we didn't have TXA during surgery.

 


-George Johnson
CRNA

EXAMPLE PHOTO

My ATRIC class ended at 17:00 on Oct 01.  At 02:30 on Oct 02 I was on the ambulance when a we received a call for a shooting at an apartment complex.  Initially advised to stage for law enforcement, within minutes we were requested to "make scene."  Once onscene, I never thought twice about the perimeter officers and door guys with guns drawn. I wasn't concerned that the first time I heard the shooter had not been located was while I was caring for the victim.  I was not worried, because of the training I've received by the ALERRT staff during the course of Active Shooter II and ATRIC.  I trusted that my officers would watch over us as we provided indirect threat care. SWAT Officers Ellingston & Beller had placed an Israeli bandage over the abdominal entrance wound (intestine protruding), and no exit wound found, so we quickly moved him onto a backboard and into the ambulance.  The victim ultimately succumbed to his injuries At a local hospital, but because of the immediate care he received (made possible by the direct training provided ALERRT, and teamwork practiced in live scenarios), he was able to name his shooter(s). 

Katie Contreras
Lieutenant/Paramedic

Case Study 1 presented by Katie M Contreras
Lieutenant/Paramedic
Feel free to comment and share these as they are posted each week. Pictures of the SWAG will be posted after they have received it. We have already been told that the NAR 4 Aid Bag will be put to work saving lives immediately.

"Experience is not the best teacher; evaluated experience is." Howard G. Hendricks
To that end, WE NEED YOUR HELP!

Send us your patient case studies, your down-range stories, your 911 call, your memorable training, learning, "oh wow"-light bulb moments!
Send us an email @ [email protected] or FB message or carrier pigeon with a video of you telling about it or a small narrative explaining what happened (videos, pics, links, etc....).

We will sort through them and pick some of the best to showcase on the FB page and website.

BUT WAIT..... THERE'S MORE!

To thank you for your time and wisdom we will send you (no catch, totally free of charge, you don't even pay shipping) some pretty decent swag (see pics!).
You can't train too hard for a job that can kill you (and you never know, the life you save, may be your own!).

August 7, 2017 will be the first Post going up from your experiences you all share. The 1st GIVE AWAY is a NAR 4 AID BAG! We will post pictures of the each person with their free SWAG!

1TCCC Bag
1 Knights Armament Rail Cover Set For AR
5 100 OZ. Camelbak Reservoirs For Your Back Packs / Aid Bags / Hiking Pack or whatever you want to put them in
20 Glow In The Dark MED Patches
10 Patch Hats
1 Tactical Waist Pack
1 Individual First Aid Kit (IFAK) Drop Leg / Belt / Molle (for bags or body armor mounting)
3 Seat Belt Cutters
1 Willie X PT-1 Eye Wear / Sun Glasses / Ballistic Eye Protection
1 Retractable Leash
1NAR IPRO / Ballistic Eye Wear
1 Camelbak OD Green
2 Medium Multicam Combat Shirts (Sexy Shirt For All You Tacticool Folks)
1 Digital Soft Shell Jacket
1 Digital Combat Shirt (Sexy Shirt)
1 Gerber Multi Tool
2 Nomex Gloves

Afghanistan war map February 2017
red : government
white : taliban