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  1. #26
    Join Date
    Jan 2014
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    Quote Originally Posted by Lindahl View Post
    Quickclot and the like is more for deep puncture wounds you find in the battlefield. You won't find much use for that stuff in the backcountry or sidecountry. WFA class heavily discouraged them because pressure and elevation should cover your needs. ...
    I felt the same way until I was on scene and help treat a brachial artery slice from ski edge last year. We had a review with the ER doc who treated and they agreed in a retrospective they gave that the Quickclot was a good addition to the packing of the wound. I carry a 4x4 of it now as cheap insurance. But yeah...when to use it matters.

  2. #27
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    Mar 2017
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    SLC, Utah
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    Quote Originally Posted by doebedoe View Post
    I felt the same way until I was on scene and help treat a brachial artery slice from ski edge last year. We had a review with the ER doc who treated and they agreed in a retrospective they gave that the Quickclot was a good addition to the packing of the wound. I carry a 4x4 of it now as cheap insurance. But yeah...when to use it matters.
    yep i carry it specifically for brachial artery bleeds - like, that's the specific use case. happens pretty commonly as a ski injury (skis are sharp and it's easy to cut your brachial). it won't stop all bleeding but it sure helps, and it's a nice middle ground between a tourniquet and a standard 4x4" at no extra weight.

    having seen an inbounds brachial bleed, i don't want to try to manage that in the backcountry - i want all the help i can get.

    also +1 on the WFR recommendation. seems irresponsible not to tbh. WFA is a bare minimum in my opinion. you owe it to your partners.

  3. #28
    Join Date
    Nov 2008
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    between campus and church
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    Here in VT I focus on bleeding wounds (tight trees have pokey things) and then shock management - extra layers, emergency blanket/bivy, hand/foot warmers, etc.

    My ziplock baggie also has gloves & sanitizer as PPE, additional Voile straps, and self adhesive compression wrap. A knife and/or scissors is also important.

  4. #29
    Join Date
    Dec 2006
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    Your Mom's House
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    Quote Originally Posted by SKIP IN7RO View Post
    The real question is, will all this stuff fit into your sidecountry vest?
    I can easily carry a basic first aid kit in my Dakine vest.

  5. #30
    Join Date
    Oct 2009
    Location
    Maine Coast
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    3,558
    Appreciate you folks updating my knowledge. I will add in some of those 4x4 quickclot bandages

  6. #31
    Join Date
    May 2009
    Location
    inpdx
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    more "side" country than "slack", ie not out of range
    just enough to wait for assistance, not necessarily fix an injury or move the injured party
    fits easily in any pack/vest that carries avy gear

    phone number stored in phone for local patrol/emerg response
    whistle
    SOL bivy
    food/bar
    ibuprofen

    it's not the "correct" answer for OP, just my n=1

  7. #32
    Join Date
    Sep 2010
    Location
    Zurich, Switzerland
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    5,742
    Quote Originally Posted by Peruvian View Post
    Here in VT I focus on bleeding wounds (tight trees have pokey things) and then shock management - extra layers, emergency blanket/bivy, hand/foot warmers, etc.

    My ziplock baggie also has gloves & sanitizer as PPE, additional Voile straps, and self adhesive compression wrap. A knife and/or scissors is also important.
    Oh yeah, good shout - I also carry coban/vet wrap and scissors. Gorillla tape also.

  8. #33
    Join Date
    Feb 2010
    Posts
    762
    If you are truly just waiting for rescue, then the most important thing after ABCs is the waiting.
    Watever gear you need to sit around for however long it takes.
    Including a snicker bar and phone battery. Not uncommon for a phone battery to die in the cold, just when it really mattets.
    A- personally, not carrying airways.
    B- Microshield type masks may not be worth using. My one experience with one resulted in chucking mine out. Not carrying an actual mask. And- super low chance that that is a life saver.
    C- Some stuff to stop bleeding makes sense.

  9. #34
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    Nov 2008
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    between campus and church
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    I should have included it above - but mild pain killers (Ibuprofen, acetaminophen, etc) should also be in your kit. It can relieve pain while waiting for rescue.

  10. #35
    Join Date
    Aug 2016
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    关你屁事
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    Deep puncture wound? Like a puncture wound from a tree branch?

    if you are injured immobile on snow, unless it’s spring sun, you are going to get cold quick and that may become the most pressing concern.

  11. #36
    Join Date
    May 2012
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    PNW
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    573
    Space blankets aren't going to stop the conductive heat loss of someone laying in the snow. Get them off the snow and onto a pack or something that will insulate them from the ground. Build a snow wall around them if they're stable and give them any extra clothing that's available. Sugary snacks and heat packs are also good.

    For bleeding, you're not going to get good visibility on a wound unless you get their shell/base layer cut off and expose it. It's a tough call but if you're really concerned about them bleeding out before actual medics arrive and you'll want some trauma shears to expose and assess the wound. Balance that against cutting up their expensive weather protection and increasing the potential for hypothermia. It gets pretty complex and having a WFR is really helpful in deciding how to act.

  12. #37
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    Jan 2014
    Location
    Gaperville, CO
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    If you're considering using quickclot bandage or tourniquet in the backcountry -- you're in a situation where stopping the bleed and hypovolemic shock is the priority concern over hypothermia. You can put more layers on someone from around your rescue party. You can't put blood back in.

  13. #38
    Join Date
    Dec 2010
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    Quote Originally Posted by tgapp View Post
    also +1 on the WFR recommendation. seems irresponsible not to tbh. WFA is a bare minimum in my opinion. you owe it to your partners.
    You really think its irresponsible to not have a WFR cert for inbounds skiing or sidecountry? Damn, you have high standards.

  14. #39
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    Mar 2017
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    SLC, Utah
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    Quote Originally Posted by californiagrown View Post
    You really think its irresponsible to not have a WFR cert for inbounds skiing or sidecountry? Damn, you have high standards.
    WFA is the minimum

    Skiing is dangerous

    Sidecountry is backcountry

    Sent from my Pixel 6 Pro using Tapatalk

  15. #40
    Join Date
    Oct 2006
    Location
    Bellevue
    Posts
    6,865
    I ski at the same place you do, I'm planning to make some adjustments for this year in what I carry but haven't done it yet. It's on my list in the next week or two. There are people in here with much more experience giving advice, so I'll try to explain my thoughts so you can decide if my reasoning is bad.

    What I have
    1. beater skins + voile straps. They aren't perfect but in some cases they will be better than wallowing uphill to try to get to someone. Summit had a post years ago about getting up to a mag in a treewell, it stuck with me.
    2. Space blanket or emergency bivy bag. Takes up less room than a beer, could be useful while waiting.
    3. Small first aid kit. I need to fill it back up with otc pain medications. I realized last year I had given all mine away when I didn't have any after a crash. Felt bad, but luckily it wasn't worse and someone else had some.
    4. 20 ft of cord. Credit to ACH for this one, alpental has creek holes. Haven't needed it but I'd rather have it than not. Planning to rethink this a bit, might decide longer is better. Plus a pulley? Someone on here almost got eaten by a creek hole last season.
    5. Backup gloves/mittens.

    Things I'm planning to add.
    6. Spare shell or a tarp. My spare jacket got stolen out of my car recently, I'm thinking a tarp might be a smarter call. Mostly concerned about days with heavy snow down low and 32 degree snow falling.
    7. Foam pad. The backpack is already useful to get under someone for insulation from the snow, but a foam sheet seems like it would be more valuable or a good addition. It can get cold waiting out there.

  16. #41
    Join Date
    Oct 2009
    Location
    Maine Coast
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    Add a chocolate bar to the list.

  17. #42
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    Oct 2003
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    Ogden
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    Quote Originally Posted by tgapp View Post

    Sidecountry is backcountry
    Quoted for truth. Despite being accessible by a lift, a traverse and a few side steps, it could take 30 plus minutes for help to get there. And 30 minutes is an eternity.

  18. #43
    Join Date
    May 2012
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    PNW
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    573
    Forgot to add a flask of cognac.

  19. #44
    Join Date
    Feb 2005
    Posts
    16,382
    A very well rounded pharmaceutical regime occupies a respectable chunk of my daily grab and go first aid kit.
    Is it radix panax notoginseng? - splat

  20. #45
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    Jan 2008
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    truckee
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    I would emphasize keeping the victim warm. My personal experience with an inbounds spine fracture is that I was shivering badly by the time they got me loaded up. My medical experience agrees. *

    I wouldn't recommend quick clot. You can stop brachial artery bleeding with direct pressure. ER docs like to cover a bleeding wound with a ton of gauze, wrap it up and put the person in a corner somewhere. Bleeding wounds are way down on the list of skiing injuries. Don't worry too much about sterility, just make the bleeding stop.

    Get trained on how to stop bleeding with pressure, how to deal with a potential spine injury without making it worse, how to stabilize a fracture or dislocation with severe deformity that might be compromising blood flow or nerve function (can be done with ski pole and clothing items.). Don't give the person anything to eat, they may need surgery, and for that they need an empty stomach. Water is ok.

    If you're inbounds you're almost always best off waiting for patrol to do anything except in the unlikely event of external bleeding.

    Protect the injured person from getting hit. Watched my kid and partner handling an injury at the top of North Bowl of Headwall at Olympic Valley and some guy fell and slid into them. Fortunately no further damage done, and a voly showed up shortly to warn people away.

    Your first aid kit is between your ears.

    (When I was hurt I was super impressed about how well ski patrol (the lead patroller was NSP) was trained in dealing with a spine injury. )

    *I'm a vascular surgeon but you're better off taking advice from a patroller, EMT, etc--someone who treats a lot of injuries in the field, not the hospital.

  21. #46
    Join Date
    Dec 2010
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    1,964
    Quote Originally Posted by old goat View Post
    I would emphasize keeping the victim warm. My personal experience with an inbounds spine fracture is that I was shivering badly by the time they got me loaded up. My medical experience agrees. *

    I wouldn't recommend quick clot. You can stop brachial artery bleeding with direct pressure. ER docs like to cover a bleeding wound with a ton of gauze, wrap it up and put the person in a corner somewhere. Bleeding wounds are way down on the list of skiing injuries. Don't worry too much about sterility, just make the bleeding stop.

    Get trained on how to stop bleeding with pressure, how to deal with a potential spine injury without making it worse, how to stabilize a fracture or dislocation with severe deformity that might be compromising blood flow or nerve function (can be done with ski pole and clothing items.). Don't give the person anything to eat, they may need surgery, and for that they need an empty stomach. Water is ok.

    If you're inbounds you're almost always best off waiting for patrol to do anything except in the unlikely event of external bleeding.

    Protect the injured person from getting hit. Watched my kid and partner handling an injury at the top of North Bowl of Headwall at Olympic Valley and some guy fell and slid into them. Fortunately no further damage done, and a voly showed up shortly to warn people away.

    Your first aid kit is between your ears.

    (When I was hurt I was super impressed about how well ski patrol (the lead patroller was NSP) was trained in dealing with a spine injury. )

    *I'm a vascular surgeon but you're better off taking advice from a patroller, EMT, etc--someone who treats a lot of injuries in the field, not the hospital.
    For the purposes of my original question (where patrol is 30-60 mins away), it seems like keeping victim warm is the primary concern. Would some hand warmers stuffed under the victims base layers be a better bang for buck than a space blanket, etc?

    To Abraham, the Paracord is a great idea for out the gates, and even in the gates (felsen).

  22. #47
    Join Date
    Jan 2014
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    Gaperville, CO
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    Quote Originally Posted by old goat View Post
    ...
    I wouldn't recommend quick clot. You can stop brachial artery bleeding with direct pressure. ER docs like to cover a bleeding wound with a ton of gauze, wrap it up and put the person in a corner somewhere. Bleeding wounds are way down on the list of skiing injuries. Don't worry too much about sterility, just make the bleeding stop.
    ...
    Respectfully disagree. I worked a scene where a teenager almost bled out due to a brachial artery slice in his armpit last spring on the hill. Without quickclot, a ton of gauze, consistent direct pressure, and a chopper, the ER surgeon that patched him up (and later gave us a retrospective) assured us the outcome would've been much different.

    Yes, don't worry about sterility. But bleeding wounds are up there on the injury list as they are one of the most common causes of shock for skiers. It's why even race coaches now commonly carry a stop the bleed kit.

  23. #48
    Join Date
    Sep 2010
    Location
    Shuswap Highlands
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    3,445
    If you don't mind carrying a few extra grams and are concerned with keeping a subject from getting colder, can't beat a 4-panel Ready-Heat torso blanket.
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    This combined with a tarp or extra shell should keep them warm for an hour or two. They only have a shelf life of a couple years though, so they are a bit spendy for the average 1st Aid kit.

  24. #49
    Join Date
    Apr 2021
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    1,034
    Quote Originally Posted by californiagrown View Post
    hand warmers stuffed under the victims base layers
    Yee-ouch! Don't do that.

  25. #50
    Join Date
    Jan 2008
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    truckee
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    Quote Originally Posted by doebedoe View Post
    Respectfully disagree. I worked a scene where a teenager almost bled out due to a brachial artery slice in his armpit last spring on the hill. Without quickclot, a ton of gauze, consistent direct pressure, and a chopper, the ER surgeon that patched him up (and later gave us a retrospective) assured us the outcome would've been much different.

    Yes, don't worry about sterility. But bleeding wounds are up there on the injury list as they are one of the most common causes of shock for skiers. It's why even race coaches now commonly carry a stop the bleed kit.
    Well yeah--of the causes of shock--hemorrhagic, cardiac, septic, and neurogenic--hemorrhagic would be at the top of the list. But by far the most common causes of major bleeding in ski injuries are ruptured solid organs--liver, spleen, kidney, the aorta, and big bones--femur and pelvis, and none of that is external and treatable with quick clot. (And of all those, only a femur fracture would be treatable with the tourniquet in a stop the bleed kit.)

    There might be a few unusual instances where Quick Clot would be useful, perhaps your brachial artery injury case truly wasn't controllable with pressure (although in my experience tons of gauze is the enemy of direct pressure) and it might be an appropriate item for a patroller's pack, but for a recreational skier in the resort or in the BC, who has to consider how much to carry, more water, extra clothes, etc, are much more likely to be useful.

    Humans are afraid of blood, for good reason. The usual response of most people (including most docs) when they see bleeding is to cover it up, when what is needed is to see the source of the bleeding as accurately as possible and to apply the pressure as directly as possible. You can't tell if your measures to stop bleeding are effective if you can't see the source.

    Preventing hypothermia is critical in controlling bleeding. Drop a few degrees below normal and blood doesn't clot.

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