Shedding weight

U

ukparamedic

Longterm Registered User
No I'm not talking about my recent D&V (Although I did lose 2 stone) I'm talking about ET tubes.

In our kits we have everything from size 4 to size 11 ET tubes. Out of all these, only 6, 7 and 8 are required. Children aged 8-13 take a 6, most adults a 7 and large adults an 8. Most people will take a 6 nicely if you are stuck though.

So how much other kit do we have that is unnecessary and just adds weight?

In a hostile environment, you can save considerable weight by only carrying 6,7,8 tubes and binning the rest. Leave them uncut and sterile then you can cut them to size.

Cannulas - do you really need pinks and blues? In a hostile environment you are going to want to infuse large volumes so anything smaller than a green (18G) is unnecessary weight.

Dressings - an assortment of dressings, all different sizes and shapes. How many of these are actually required? Just go for the 6" size and ditch the rest.

Entonox - extremely heavy and bulky. There is an alternative called methoxyflurane branded Penthrox. Not licensed in the UK but if you are working in a hostile environment (where you can legally use it) it is a tiny lightweight alternative to entonox that fits in your pocket and will save masses of space and weight.
 
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ukparamedic said:
No I'm not talking about my recent D&V (Although I did lose 2 stone) I'm talking about ET tubes.

In our kits we have everything from size 4 to size 11 ET tubes. Out of all these, only 6, 7 and 8 are required. Children aged 8-13 take a 6, most adults a 7 and large adults an 8. Most people will take a 6 nicely if you are stuck though.

So how much other kit do we have that is unnecessary and just adds weight?

In a hostile environment, you can save considerable weight by only carrying 6,7,8 tubes and binning the rest. Leave them uncut and sterile then you can cut them to size.

All folks in HE will/should be carrying a #7 NPA in their personal med kit.

Cannulas - do you really need pinks and blues? In a hostile environment you are going to want to infuse large volumes so anything smaller than a green (18G) is unnecessary weight.

Two sizes of cannula should be carried - for fluids (18G) & treatment of TP (14G)

Dressings - an assortment of dressings, all different sizes and shapes. How many of these are actually required? Just go for the 6" size and ditch the rest.

1 x Israeli bandage, 1 x Haemostatic Dressing, 1 x CAT TQ, 1 x Bolin Chest Seal

Entonox - extremely heavy and bulky. There is an alternative called methoxyflurane branded Penthrox. Not licensed in the UK but if you are working in a hostile environment (where you can legally use it) it is a tiny lightweight alternative to entonox that fits in your pocket and will save masses of space and weight.
Click to expand...

Note:

Entonox shouldn't be administered to a TP casualty due to it's tissue solubility and interaction with air spaces.

Penthrox needs to be kept at a temperature below +30 Deg C and can only be used on a conscious casualty through the Penthrox inhaler. It shouldn't be used on casualties with any cardiovascular problems or conditions.

Administration of analgesia shouldn't be carried out until the Tactical Field Care phase of combat casualty care...

a. Able to fight: These medications should be carried by the combatant and self administered as soon as possible after the wound is sustained.

- Mobic, 15 mg PO once a day
- Tylenol, 650-mg bilayer caplet, 2 PO every 8 hours

b. Unable to fight: Note: Have naloxone readily available whenever administering opiates.

Does not otherwise require IV/IO access

- Oral transmucosal fentanyl citrate (OTFC), 800 ug transbuccally
- Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure
- Reassess in 15 minutes
- Add second lozenge, in other cheek, as necessary to control severe pain.
- Monitor for respiratory depression.

IV or IO access obtained:

- Morphine sulfate, 5 mg IV/IO
- Reassess in 10 minutes.
- Repeat dose every 10 minutes as necessary to control severe pain.
- Monitor for respiratory depression
- Promethazine, 25 mg IV/IM/IO every 6 hours as needed for nausea or for synergistic analgesic effect

The above is for information only, please consult a medical professional for further information.

Pb out
 
While we are discussing ET tubes, might aswell add that laryngoscopes are once use disposable items that can be quite bulky. Im not a big fan of SP services, but they do a plastic laryngoscope, that is very light weight. Not used one on the road so cant comment on their performance but have no problems intubating resus anne and her friend fat fred. Just another weight saving suggestion!
 
I'm going to put the cat amongst the pigeons and ask this. Are you carrying drugs to facilitate a rapid sequence induction intubation? If so then I would carry a 4,5,6,7,8 and 9. If not, I would ditch the tubes and carry what ever supra-glotic device that takes your fancy. I carry the i-gel and have had no problems with it, although, I have heard stories about it not providing a decent seal at low temperature.
If you can tube them without drugs then they have next to no chance of survival so if weight is an issue, why carry the kit?
As for pain relief, I would take Ketamine for trauma every time.

Regards

Matt
 
In Ireland, every patient with a GCS of 3 is now tubed as standard. There is a strong evidence base for tubing patients with GCS 3 and unfortunately, the so called professionals who are guiding UK paramedic practice are far more interested in protecting their own skill set and taking pay outs from companies than actually doing what is best for patients (nothing new, see the scandal of GPs taking payments from drug companies).

We do not practice drug assisted intubation yet because although the evidence suggests that this is what we should be doing, the powers that be are far more interested in removing the skill set from paramedics. Download or buy a copy of the latest EMJ and you will read very strong evidence based arguments which clearly state that this is a skill which paramedics have proven competence in and that we should be given the tools to do it properly.

It seems however that a certain doctor is far more interested in pursuing a crusade to have paid doctors on ambulances and as he is a gas man this is his way of doing it. See the various comments he has made over the last 11 years, none of which are complimentary towards paramedics and all of which serve to promote his crusade.

Combine this with his trip to Parliament arguing that as paramedics (in his opinion) shouldn't be intubating, this means doctors should be paid to work on ambulances. He once again incorrectly cites the USA and Australia where Paramedics have proven their competence in drug assisted intubation and completely twists the evidence to suit his agenda misinterpreting it as he sees fit.

Paramedic practice is slipping backwards in terms of progression as the CQC will require all paramedics to work under the direction of a doctor despite having fought so hard for legislation permitting us completely autonomous practice. It is worth noting that they do not apply the same restrictions to any other healthcare professional, only paramedics whom it seems are once again being victimised by those above. Why should we need to be regulated by yet another organisation and why should our level of autonomy slip backwards? We currently have autonomy to order, supply and administer drugs yet under the CQC we will not legally be able to practice without control from a doctor.

The CQC argued in an email to me that it is the Government who brought in the legislation but this is incorrect. The Government simply legislated that private paramedic practice should be regulated, they never stated how it should be regulated and having already admitted that they have no idea how to regulate this profession.
 
Please don't think I'm against paramedic intubation. To the contrary I'm all for it, but I fully recognise the limitations surround it's appropriateness in the unmedicated patient. For me paramedics should be able to RSI as a matter of routine. In days gone by the argument against surrounded the fact that a surgical airway would follow unsuccessful attempts. These days even London HEMS use supra-glotic devices for failed attempts thus diminishing the need for surgical interventions. All I was suggesting is that if weight is an issue then pick the kit that will do the job with the least weight penalty.

Regards

Matt
 
Just playing devils advocate here.

Apart from the Entonox, the kit you are mentioning removing for the purpose of weight saving amounts to nothing more than a few ounces. In the scheme of things, (Assuming we are discussing HM Forces medics) taking into account things like helmets, osprey, personal weapon, ammo, water etc, the abscence of a couple of cannulas and tubes amounts to feck all.

Surely it all comes down to the individuals personal fitness and quite frankly if they cant lug their med kit about it's a sad reflection on that particular individual and their task readiness.

P.
 
An ounce of kit saved is an extra ounce of water or an extra ounce of something else. Multiply this by 50 medics and your aircraft is suddenly a lot lighter or you have a lot more space on your vehicle for other equipment.
 
ukparamedic said:
An ounce of kit saved is an extra ounce of water or an extra ounce of something else. Multiply this by 50 medics and your aircraft is suddenly a lot lighter or you have a lot more space on your vehicle for other equipment.
Click to expand...

Not wishing to be pedantic but come on mate, you are obvioulsy a bright guy so surely you can see that a)the space saved by taking out a couple of tubes and cannulae is negligible and therefore of little use for either space saving or the carrying of alternative kit and b)You haven't saved any weight or space if you replace it with something else. As an aside, when have you seen 50 medics with personal/team med kits on one aircraft or vehicle?

I'm all for not carrying unnecessary weight and not a big fan of carrying anything that isn't going to earn it's keep, but seriously?

Cheers, P.
 
Great discussion. Load discipline is often overlooked until teams start tracking what actually gets used in the field. When it comes to ET tubes, carrying sizes 4–11 may feel thorough, but if operational data consistently shows 6, 7, and 8 cover the vast majority of cases, streamlining makes practical sense. The key is auditing real-world usage and aligning inventory with mission profiles rather than theoretical coverage.

The same principle applies to cannulas and dressings. In a hostile trauma environment where rapid volume resuscitation is the priority, focusing on 18G and larger reduces unnecessary bulk. Standardizing dressing sizes not only cuts weight but also reduces decision-making time under stress. Simplicity improves speed and efficiency.

What often surprises teams is how much weight small redundancies add up to. Conducting a structured kit weigh-in before and after rationalization can be eye-opening. Using calibrated industrial scales, similar to systems supplied by Scales4U in South Africa for precise load measurement, allows objective comparison instead of guesswork. When data shows a double-digit percentage reduction in pack weight without compromising capability, protocol adjustments become easier to justify.

Ultimately, weight reduction should be evidence-based. Audit usage, quantify load, and balance clinical necessity against mobility. In hostile settings, lighter and smarter almost always performs better than heavier and habitual.
 
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