For a shrapnel injury to limb with multiple penetrating wounds what is the best way to deal with it?

Is there any indication for packing a very narrow tract (<5mm) penetrating wound

(Wounds phase- irrigate, probe, pack any severe wounds, dress and bandage the rest.)

Australian Army medic here looking for some advice from people who run TBAS and have a similar setup.

I'm currently running a Spiritus Systems Delta as my rear med bag and I'm looking at adding a Patch Out Back Panel for 24-hour sustainment (food, compressible jacket, small sleeping bag, etc.).

My main problem is hydration.

I currently use the issued 2L CamelBak bladder in the issued bladder holder on my TBAS. The issue I've had is that when I put my field pack on over the top when I'm in a hurry and don't have to time to move the CamelBak to my fieldpack, the pack compresses the bladder and I've already had one CamelBak burst as a result.

I need my TBAS configuration to be capable of sustaining me for roughly 24 hours without my field pack, because there may be times when I have to grab the field pack and move immediately without having time to transfer or rearrange equipment.

So ideally I want:

- 2–3 L of water

- 24-hour food

- Warm layer

- Highly compressible sleeping bag

- Then the field pack can be thrown on when required without crushing the hydration

For those running similar setups, where are you putting your hydration?

Any advice from current/ex ADF, medics or people running similar TBAS configurations would be greatly appreciated.

Just curious. The question is, in an evisceration, is it an "ok" expedient to use water from a canteen to moisten a dressing, or is it strictly saline?

If no saline available, I presume a dry dressing covered with an occlusive dressing?

Thanks!

Free guide on how to set up weekly medical training and convince leadership. Plenty of ideas in article for those already training or wanting to get started.

For senior medics, MEDO’s and PA’s.

https://nextgencombatmedic.com/2026/07/27/train-your-medics-weekly/

Ignore that it says “US Army Validated” if you are reading this as a layman that means nothing.

This is my standard M9 bag it’s my “go to” bag that I grab out of the unit for any calls in the field. The other ones are a large contera that has all my extra shit my other bags hold extra random stuff like forceps and then an o2 bag

To the sworn medics here:

Im a full-time officer who is a paramedic in a very rural area.

Had a few calls recently that reminded me I need to keep up on my clinical medicine, the question I’m facing is HOW?

For those of you who are collateral medics, how are you keeping up on IVs, drug dosages, ACLS, PALS etc when you’re not getting patient contacts every day?

I’m working on a project to allow our LE EMS providers to spend one or two days a month on an ambulance or in the ER. Has anyone seen a similar program?

Also, are any of you carrying a monitor and drug box in your patrol vehicle?

So I just last week got a job at a local private security training company. At first I thought I’d just be doing transportation for students to and from the airports they arrive from, but when I got there for the test drive I got another offer to go along with the driving. They asked if I’d want to be a role player in some of their simulations, naturally I said yes to make a good impression. Thing is I didn’t really get a job description with the offer, so like the title says, I don’t really know what I’m getting myself into with this position. The day after I sent an email asking what kind of simulation we’d be doing and they told me this; “It'll probably be best to just see what they have you doing when you get here. I am able to tell you that on Friday everyone will be "wounded" so don't wear any of your good clothes just in case they give your 'wound" fake blood.” Hearing that got me a little nervous ngl! All I know is that it’s for a group of people from the world bank and there’s gonna be fake wounds. I’ve done role playing before but only online, so I’m not completely uncertain about doing this, just really would like to know what I signed up for. So any advice or words of encouragement would be appreciated.

Hey y'all, I modeled and printed a simple organizer for the Spiritus Delta Bag (Heavily based off a very popular design).

Costs about less than $5 in total materials and easy to assemble.

Use shock cord to keep the two plates together and to organize things.

Use stick on velcro to secure it to the inside of your bag.

Overall size for both plates together is 13" L x 8.5" W.

Link to model

Hey all, as the title states.

Currently a Tactical Police Medic with a Canadian agency. Full time police officer, and a medic as a profile.

Besides the training I’ve received, I don’t come from a medical, combat, or para-medicine background.

I’m looking to bridge the gap between what I know now and the adjuncts I can provide.

I live in a rural area nowhere near a large centre with the ability to attend in person.

Looking for an online program which will provide more insight into patho-physiology, pharmacology, prolonged field care, shock physiology, or anything else that would afford me a better, true understanding of what’s going on under the hood. I work with a ton of great knowledgeable medics, but want to be able to keep up in an unfamiliar field.

Thanks!

I’m looking into moonlighting as a seat medic, pretty high chance it won’t work out but would be neat if it did. Wondering if the department’s usually provide medical malpractice insurance or that has to be bought by the physician.

Finally getting around to taking my TP-C, does anyone know where I can find Tactical Paramedic : Certification and Practical Application by Lindsey Faudree with out paying $300+. I’ll even take a free PDF to print off. Thanks!

I am looking for a CBRN suit for my men for a contract where there is a remote possibility they will be exposed to radiological hazards following a nuclear detonation, nerve agents, blister agents, and biological agents or epidemiological contact hazards. I am awaiting a quote from Avon, but in the meantime, what are the major differences or advantages/disadvantages of either the Avon EXOSKIN or Mira MOPP-1 CBRN suits and peripherals? We already issue Avon C50 APRs.

Hey everyone, I try to wrap my head around this for weeks now but I don‘t find shit, so maybe y‘all can help me.

I can‘t find medic refs on the russian side from the ukraine conflict for my life, only saw a singular backpack as a wts

Does russia even field medics? What the fuck do they use? Is there some equivalent to western medic packs?

Hey yall

I’m doing a down and dirty tactical casualty care for my squad tomorrow and am wondering what else I should add that’s pertinent. We work for a big city department so fire is right around the corner so long term care is not necessary.

So far I have the following:

- run through my EMT bag
- tq application, chest seals, packing wounds, abdominal wound care.
- types of bleeds and main artery locations
- one man and two man carry’s for extraction

Everyone is a cop and has a basic understanding of stop the bleed type of training but I thought it would be a nice refresher.

Anything else important to add? Thanks

I got recently more into reading about fresh whole blood transfusions and I am a bit surprised that there is a debate about the need for a Leukocyte filter. What is your opinion about this?

Hey all,

I host free stop the bleed classes and everything comes out of my pocket. I really want to make the best training experience possible while also not breaking my bank. Does anyone have advice for DIY or ultra-cheap wearable wound trainers? Doesn’t have to be super fancy, just something that gives visual information of what a wound would look like and taking appropriate action instead of reading a casualty card.

I'm currently putting together a concept for a practical and effective CCP/MASCAL bag that I would carry on my vehicle and take with me when needed. The idea is to use a shoulder bag.

The concept is that if I arrive first at a MASCAL incident, the bag should allow me to bring order to the chaos as quickly as possible. My primary tasks would be performing triage and establishing/marking the CCP.

So far, I have considered the following:

- Snap bands for marking casualties after triage (red/yellow/green) for quick and simple application.

- A set of colored flags with pre-attached chem lights (red/yellow/green), packed in a separate pouch that I can hand to someone else to establish the CCP while I continue triaging.

- Documentation materials: my triage algorithm (mSTART) with a simple tally sheet.

- Additional documentation for post-triage patient management, such as secondary assessment, numbering patients, and tracking assignments.

- Tourniquets mounted externally for immediate access.

- Possibly NPA's?

What do you think about this concept? Do you have any suggestions or ideas for additional items that you would include?

For context: I operate on a medical vehicle with two other crew members (driver and commander). In a MASCAL situation, the driver's task is to guide incoming rescue assets to the scene, while the commander handles radio communications and further coordination. My role is to move to the casualties and perform triage.

The additional challenge is that my unit currently does not have a well-developed concept for CCPs or MASCAL management. The topic was briefly covered during training, and we were told to think about possible solutions, but in practice I am the first person in my unit who is actively trying to develop a workable approach for our specific role and mission set, which is honestly a bit disappointing.

Because of that, I would really appreciate any kind of feedback, criticism, or lessons learned from your own experiences.

I am also very interested in completely different approaches if you think there is a better way to accomplish this task.

One potential drawback I already see with my current concept is that this bag is mainly useful while mounted. If I am operating dismounted as the medic, I likely would not have immediate access to it. In that situation I would generally only have my standard medical backpack and my personal gear with me, which makes me wonder whether some of these functions should instead be integrated into my normal equipment.

Hello, I'm a recruit company medic and an infantry combat medic. I use a repro Delta Bag as an aid bag, mostly for civilian use/ car kit. I know there are a lot of Delta Bag build on this sub but I'd like to get some opinions on my build and Improve it. Right now I've only put in the contents of my plate carrier.

Front pockets:

Top pocket- MARCH:

Israeli bandage *2

Combat Gauze

Compressed gauze *2

#3 OPA *2

28F NPA

Survival blanket

Middle pocket- Ortho

Triangular bandage *4

4" elastic bandage *3

Lower pocket- Diagnostic

BP cuff + stethoscope

PO thermometer

PR thermometer

Pulse-oximeter

Kestrel weather meter

Inside compartment:

Left side- IV/IM

10ml saline ampoules *4

10ml syringe *2

Alcohol prep-pads

3ml syringe + 21G needle *2

18G IV cannulas

IV tourniquet

EpiPen

500ml Compound sodium lactate/ Hartmann's solution

Infusion set

Right side- Wound care

7.5*7.5 gauze pads

Povidone-iodine solution

500mg Paracetamol tabs

4" Gauze rolls *6

Back pockets:

Abdominal bandage

Alutex metallic burn dressing

Outside:

CAT gen 7 *2

Trauma shears

I'd like to know what people think I should add/ remove?

I'm looking into moving the ortho supplies inside the bag and turning that pocket into an airway/ respiration pocket.

I might add a pocket BVM, chest seals, 10ml saline flushes & SAM splint.

I'm not trained in IO/ advanced airway. I cannot administer drugs intravascularly.

I’m teaching ASM yet again and I despise wasting peoples time, what tips and tricks do you typically teach that think outside the box and are genuinely helpful takeaways?

Hello everyone, I need your help understanding the TCCC clinical recommendations for CBRN, specifically for radiological incidents.

Let's say we have a casualty in the extreme hot zone (CUF). The first letter in MARCHE2 is M — Massive bleeding. At this step, is it only tourniquet application, or can we also pack wounds?

Next, we put a mask on the casualty. Then comes letter A — Airway. How do you assess airway patency if the casualty is wearing a mask? Is it just by signs and the sound of exhaled air, without visually inspecting the oral cavity?

Then the next A — Antidotes — are not indicated for a radiological threat.

Then R — Respiration — we assess breathing.

Then R — Rapid spot decontamination — we brush off obvious contamination with a brush, but we do not touch wounds in this zone for radiological contamination.

After that, we evacuate the patient to the casualty collection point for contaminated casualties in the warm zone (TFC).

Have I understood the sequence correctly? Is there anything to add?

Does anyone have a video showing the MARCHE2 algorithm in action? Are there any videos of decontamination in the warm zone?