Monday, February 20, 2023

Reminder: The Vehicle FAK


Somebody's patient, somewhere, may have blown out a varicose vein at work, managed to spurt out two units (a liter) of blood while driving to the hospital, had it immediately repaired by the ED MD on duty, and then, apparently stable, have then actually gone into mild shock, passing out, and requiring fluid resuscitation with half a gallon of normal saline, and required a hospital admission, for "just a little bleeding".

If that were my patient, I - of course - couldn't talk about it because of HIPPA laws. But there's always the possibility it happened somewhere.

Which is why keeping at a minimum some QuikClot, a roll of Coban, an ACE or Israeli bandage wrap for a pressure dressing, and a CAT-T tourniquet or equivalent, in a small and handy vehicle first aid kit isn't just a random option.

You may not be interested in trauma, combat medicine, or bleeding control, but that doesn't mean trauma isn't interested in you. Failure to plan is planning to fail.

This was "just a little ruptured vein". That wouldn't stop.
This patient didn't get to the hospital. But they made it to the morgue.
Leaks - ANY leaks - in your meatsuit can be terminal.

Unless you want to roll the dice on passing out in your car at freeway speeds, injuring yourself and possibly other people, and ending up in shock in Main Trauma all busted to hell, after the equivalent of a pinhole in a minor superficial vein turned into Demolition Derby. All because "you thought you could make it to the ER okay on your own", right up until things got hazy, and your car went all spinny and flippy and perhaps explodey.

Don't want to deal with the hassle of having that kind of stuff near to hand, anywhere, anytime?

No problem. Suture self.


Anonymous said...

John Murphy of FPF convinced me to wear a three-pocket ankle rig containing a 4" IBD, and a CAT. I put a cravat and gloves in the middle pocket. I actually wear two of these rigs, every day and everywhere.
As Murph says "this could prove to be the most important thing you carry". If you take his " Street Encounters " class you'll be drilled in self-administering each with no notice. Good stuff.
And yeah, I've got CATs and IBD's in all of the vehicles too.
Boat Guy

The Freeholder said...

They're in each vehicle, my range bag and my EDC bag. Plus one for upstairs. Downstairs has the big first-aid cabinet with all that and much more. Mrs. Freeholder says I'm paranoid. I doubt that I'm paranoid enough.

I'd never considered that you might need one for the situations you note. Learned me something today.

Behind Enemly Lines said...

Hello, Aesop

OK, note taken, time for action. I recall that you had a series of posts on first aid kits. Did you ever consolidate those into a single "just assemble this" or "just buy this brand and model kit" and-be-done-with-it post?

The better half's an RN (not ER, though, far from that), and I needed to refresh my training anyway. I think we can handle some reasonably advanced stuff between us. If possible, I'd prefer to find an off-the-shelf whole-hog civilian kit.

Thanks for your work and thoughts. I rarely post but have been reading a long time.


Behind Enemy Lines

The Old Guy said...

Aesop, could you make some recommendations on where these items could be purchased, brands recommended (both for and against), for those of us not in your field? Thanks.

Dan said...

Such issues can be thwarted by surgical intervention before the vein reaches that condition.
Sadly few insurers are willing to pay for 'vein stripping' because they consider it to always be a cosmetic issue. About a decade ago my wife was seeing a vascular surgeon due to significant vein issues....and the insurer refused to pay for the procedure to have the veins removed. That is until her vein started spurting blood across the doctor's exam room, the doctor grabbed a camera and recorded the bleeding, and my attorney contacted the insurer asking at what address they would like to be served. Then and ONLY then did they decide that it was a medical issue and not a cosmetic one.

Behind Enemy Lines said...

Thanks, Aesop. I remember now why I didn't just go buy "the thing" after reading your earlier posts. The information's here - much appreciated -- I'll get after it.


Behind Enemy Lines

Anonymous said...

Last year, I had a vein open up in my nose, giving me the nosebleed from hell. *After* I got my wife up off the floor (waking in the wee hours to a bloody bathroom was not good), I called 911 for a ride to the hospital. It's a 45 minute drive from home, and it takes another 30 for the 'bus to get home, but the bleedout wasn't immediately life threatening. Still, it was a pint or so that I'd rather have kept inside me.

No varicose veins in the household, but we're in BFE and trauma has its way. I'll see if I can find a Rhino Rocket in case my nose pulls that trick again. That inflatable tampon backstopping the cautery did the trick.

20+ years of CPAP and sinus irritation can get a little sporty. Now the CPAP machine is dialed up to New Orleans humidity and I use saline and Ayr gel before bedtime.


Anonymous said...

I work industrial maintenance (forklifts, sodeloaders, waterjets etc) and at a MINIMUM at any time i have compressed gauze and a TCCC approved CATT (from NAR).
Mostly because the numbskulls that work here WOULD put quicklot on your guts if available(no one listens when I say to get med training)
This is ankle carried and a setup on my truck visor looks like NAR puked all over it.
Any recommendations on a better way to have stuff like that handy in a warehouse environment?
(specifically metal welding cutting etc. couple times ive check and material poked a hole in my guaze wrap)

Suz said...

Check out Refuge Medical, at, a small American company who sell American made IFAK's and Trauma kits that do not contain band-aids, unless you buy their boo-boo kit. They have a sister company who go around teaching how to use said trauma kits using the MARCH algorithms.

I bought a couple of their products, have been VERY happy with the quality and the contents.
Not my company, no connection whatsoever other than I gave them some business, and like to support folks who live and work in America and believe in quality products and quality customer service.

As a visiting nurse who drives A LOT averaging 100-150 miles daily, I wanted to be prepared in case I was in an accident, or came across one. Like Aesop says, the blood belongs on the inside of the meatsuit, not squirting across the room.


Aesop said...

@Anon 2:22,

Maybe get a sheet of Kydex, and cut to fit the pockets on the ankle carry, as "armor" from the materials you work with.

Johnnyblately said...

Its more welding at the bottom of racks, and keeping the aluminum dust (that we literally make truckloads of) thats the issue.
Ill try some exhaust foil pockets sewn on a velcro ankle weight holder.

John Wilder said...

I used to have a really good kit back when I spent time in the field - need to dig it out, dust it off, and check expirations on everything.

Anonymous said...

I looked up the Rhino tampon and there's too much that I could screw up (not to mention needing a doc's prescription). Figuring out which size I need would be entertaining, too.

So, back to going with prevention and the almost-effective nose clips. Quick-clot on order for the rest.


Aesop said...


Who told you it was Rx only?
They've been sold by catalog as OTC for decades, by everyone.,Description,bleeds%20in%20adults%20and%20children.

Tucanae Services said...

Have used Coban in a pinch on projects other than medical. Useful restraint when nothing else is available.

Anonymous said...

North American Rescue. Amazon is full of knockoff/counterfeits. Imminent Threat Solutions has good blowout kit supplies from NAR also.

Anonymous said...


The other product (Rapid Rhino) wants a doc's approval, and I made a bad assumption. I have to figure out size, unless I can pry the detailed ER report out from the hospital. Assuming there is a detailed report. We have a quirky medical establishment in BFE.

Side issue: Sportsman's Warehouse (the not-Cabela's) sells kits with the SWAT-T tourniquet. Is that one worth a damn?


Anonymous said...

Aesop: another nicely done post. Shockingly, your medic posts are first rate. Ref correspondents' questions ref what to pack, well, here's my take on that. (ex paramedic, ex ED RN)., post number 316.

BigCountryExpat said...

Coban? Was ist der "Coban"?

Then I hit the link at the Zon
Got me 2x Boxes (24 rolls type one each) already in the Medstash.

TOTALLY threw me... No idea that's the name. I always called it 'that fucking sticky ass self-adhesive brown shit-pressure-tape'... you know, the shit they use after doing a blood draw that removes ALL the hair but leaves no residue (unlike reg med-tape)? Yeah, that shit LMAO

And dunno if you saw the poast I did with a minor accident when we first moved in Tennessee back in November when I accidentally dropped a knife on one of my toes, THAT was a "used quikclot but STILL needed stiches" as the shit kept bleeding like a motherfucker" cut. Yep... GREAT article, and valid AF

Aesop said...

Stands for "cohesive bandage", meaning "only sticks to itself".
Bargain version is Vetwrap. Which is great when you're wrapping a foreleg or paw on something hairy all over, like Mr. Fluffy or Clarabell the Cow.

Best part: If you're careful, you can unwrap a dressing, change the nasty bloody part next to the skin from last time, put in a clean new dressing, and then re-use the same strip of Coban to hold it down.

And now: comes in camo, and 87 colors of the rainbow!

Wonderful stuff.

Anonymous said...

There is a sort of inflatable tampon for nose bleeds with a non stick cover. I forgot the name of it but if you’re prone to these large bleeds it might be worth having one handy.
Otherwise, put direct pressure on the outside of your nose, and lean forward. Don’t swallow the blood, it irritates the stomach.