Martial skills for EMS

Tonight as I sit here admittedly whining about the vaccinations I got today making my arms ache, I'm contemplating gentle submission techniques to present to EMT students tomorrow. Our lead instructor has police and SWAT experience with a lot of very "real world" stress testing. That noted, I'm coming up with a small number of value added items to augment the standards. I'll be digging deep on this one to come up with things both simple and effective that are less likely to cause harm.

It's been a while since I gave my Oni Kai Aikido blog any attention but this may provide material and an interesting direction for a few posts. While I maintain that Aikido is about the longest path to field applicable combat skills a person could choose, it is effective none the less. 

I miss my days of nearly living in dojos and being immersed in this stuff. Maybe a new evolution for Oni Kai is in order. I can certainly think of less noble applications for martial systems. 

SOF T tourniquet

I have a reasonable amount of experience with tourniquets and  a few weeks ago at Urban Shield I got to do some side by side comparison with a variety of them in classes and scenarios. One of the instructor favorites was the SOF T. It's one of three that seem to be among the most popular. I had mixed feelings about it. In spite of some initial difficulties and one very specific application issue, it seems to be a solid choice for regular carry and field use. 

There are a number of pros to this model, not the least of which is the solid construction and metal windlass. The ones I worked with held up well and worked even when wet, an obvious positive point. I was able to quickly crank down and stop femoral bleeds and the SOF T seemed very well suited for use on legs, possibly better than some other models. 

On the cons side, it was difficult to tighten with self application. The buckle wasn't prone to rapid deployment and it was tricky getting the windlass locked with one hand and it isn't the easiest to grip wet. That might not be a big deal as long as you are not attempting self rescue but for that reason alone, it's not my favorite. I had a hard time at first meeting the time limits for my tests when attempting to apply the SOF T to my upper arms. I did manage to deploy within desired times but had better times with other tourniquets. This could be unique to me but the same tendencies were observed with other students. It got much worse with fluids. 

Overall I would say you can trust it to work for sure and it's a good choice for patient transport because of the secure locking ring. Again, after a fair amount of practice I was able to use it quickly and effectively but I would prefer it not take much practice. At any rate, it's a solid piece of gear that will serve well should you need it. Effectively the differences are minor but did add up to low double digit percentile changes on speed of deployment. With exsanguination times as rapid as three minutes, thirty seconds can make difference. 

Either way, it's a solid choice and in this case arguing for or against probably isn't necessary. If you encounter a SOF T on a patient don't hesitate to use it and if you like them by all means add them to your load out. 

My jump bag load out

After a lot of years of BLS, ALS and pre-hospital trauma training through sources as varied as Scouting and Red Cross to the DOD, I have completed my EMR training and testing both filling in some gaps and bringing many disparate skills together in one functional body of knowledge. It's been a very positive experience that I am currently expanding to pursue EMT and PHTLS/TCCC certifications as well. After being an incidental first responder even before completing my EMR, I decided it was time to build a more serious jump bag for my volunteer activities with groups like NERT and the US Coast Guard and a trauma kit to pack in my messenger bag when I'm working as a bike messenger in San Francisco.

It seems that this is a challenge for a lot of newly certified EMR/EMT students that don't have the cash to buy pre-assembled kit from Galls or some other supplier who sell well thought out and complete kits starting at around $100 with nicer and more complete kits being upwards of $200-$300. Again, these are really nice and well thought out to include most things a first responder might need. Some consideration should be given to the idea that a jump bag should only contain things the person using it will be trained to use, but anyone who takes actual EMS courses will know what the items in a commercially assembled kit are for and know how to use them. In my case I was less trying to include every imaginable thing and more concerned with having enough of the basics while making room for critical items. There is no perfect or even "standard" kit. Mine is currently evolving both as I add things and increase my training level.

What I am not currently carrying in either bag is oxygen and cervical collars. A collar is too big for my smaller kit and the mini oxygen bottle is just too expensive right now. However both would be welcome additions and I'll likely be including both in the larger bag at some point. There are a couple other, "nice to have" items like a pulse oxymeter and a stop watch I added but other than O2 and a collar I'm pretty set. I don't anticipate needing those things on my own anyway but you just never know.My smaller kit was something I put together with things I needed for class(had to carry them around anyway), a few things I bought and several items that were kindly given to me from friends in the medical industry. The larger bag is a similar set up that started out as a very basic Galls kit someone gave me that was then expanded a lot with other items as they were introduced to my scope of practice. There is nothing in either kit that I have not been trained to use. 

I'm finding there is a minimum set of things I feel comfortable with like , gloves/compression bandage/tape and then the more complete load out with what you might expect any EMT to need. Even a kit as simple as the IPOK(individual officers patrol kit) that contains about four items in its simplest incarnation, saves lives. It also fits in a cargo or jacket pocket. It should be something every high school student knows how to use.

Bottom line, even if you only carry a pair of nitrile gloves, you should be carrying something with you at all times.