Playing with your kid is the perfect time to teach TECC, right? How much space does a casualty collection point take?

How much bleeding is bad bleeding? 🩸 What do you do for each type?

Proper bandage application requires covering the entire gauze pad with the elastic wrap, and then clipping as much of the elastic wrap into the clip. Improper application involves the elastic bandage roping up in the middle, the gauze pad “taco-ing” around the edges, and provides very little direct pressure on the wound.

#1 rule in proper tourniquet application?
Take ALL the slack out FIRST.
Then tighten the windlass until all bleeding stops. Complete the application depending on the TQT you used. For a CAT, secure the windlass, ensure all the Velcro is secure & close the retaining band.

How do I stage my CAT tourniquet on my gear?
The most common mistake we see is officers who “tidy up” and clip the windlass in the retaining bar and close the velcro retaining strap. This is wrong. Leave the tourniquet the same way it came out of the package: winless free, and the velcro open for immediate use.

Resetting a tourniquet for use in training:
1. Feed 8” through the buckle
2. Lay the omnitape back on itself
3. Fold in half
4. Free windlass
5. Retaining band open

Training tourniquets should not be used operationally.

Step #1 in wound packing: identify the source of bleeding & begin packing there.

The second step in wound packing is to get gauze directly to the point of bleeding. Starting with a large wad of gauze is problematic in narrow wound tracks. Start with a small piece of gauze at the tip of your packing finger, put that at the point of bleeding, then continue to pack the wound until you just can’t get any more gauze in it. Then force in even more gauze. Wound packing is just direct pressure at the point of bleeding.

Proper dual tourniquet application involves 2 TQT placed side by side & touching. That essentially doubles the width of the tourniquet – wider tourniquets occlude better.

Long held SF tradition of always being prepared to provide a block of instruction during down time. Cold blood does not clot: keeping casualties warm must be part of your casualty management strategy.

For the pulse oximeter’s O2 saturation reading to be valid, the device must also be consistently identifying the patient’s pulse. If the pulse waveform or notation isn’t steady, the oxygen reading isn’t valid.

The most important thing to set yourself up for success with the EZ-IO needle is to ensure you are using the correct size needle. Once the needle is in the casualty and touching bone, before you activate the drill, you must be able to see one of the black measurement lines.

Size matters: Using an EZ-IO needle sized for kids is a better choice when treating pediatric patients.

Open surgical airways have a 66-91% success rate when done by paramedics and military prehospital providers. Using a bougie seems to make the technique easier.

Many question the utility of a nasal pharyngeal airway. A properly sized and placed NPA will put the tip close to the patient’s epiglottis. I have personally seen dual NPAs maintain an airway in a patient with progressive angio edema while prepping for intubation: it allowed for a controlled intubation, rather than a crash surgical airway.

Many question the utility of a nasal pharyngeal airway. A properly sized and placed NPA will put the tip close to the patient’s epiglottis. To properly place the NPA insert it IN the nose not UP the nose.

Under normal circumstances, the ambulance bay works well. But during a no-notice or mass casualty event, it will get blocked You need to re-route traffic and block off the turn around with stretchers, wheelchairs, and anything else you can find to prepare for arriving casualties. You may have to get creative.

In a No-notice event, the hospital must operate to maximize throughput, allocate resources, and manage the chaos.
One way to do this is to institute strict uni-directional flow.

In Las Vegas, 4-6 family & friends arrived for each patient, they stayed all night and wandered the halls looking for power outlets to charge phones and overwhelmed the bathrooms.

In a no-notice MCI, non-trauma centers will receive casualties as resources are overwhelmed. Most hospital morgues can only hold 1-2 bodies and you may have more dead than the morgue can hold. What is your hospital’s plan?